In the past decade global health resources for AIDS have increased dramatically. What have these investments meant to responses of communities affected by HIV and AIDS? To explore this issue, research was conducted in Kenya, Malawi and Zambia and this report describes the findings, analysis and questions arising for policy.
The qualitative methodology used provides a rich and triangulated analysis. Based on a review of the literature, four sets of critical debates were identified, focusing on:
- the effects of disease-specific funding
- its effects on national sovereignty
- issues of flow-through and ‘aid effectiveness’ as well as
- whether this aid facilitates civil society engagement and holding governments to account.
The conceptual framework ensured that issues raised at national level were tracked down to local sites to consider how local groups negotiate the aid architecture.
In total 109 structured in-depth interviews were carried out, at all levels, and 21 focus group discussions were conducted in local sites. The analysis triangulates perspectives from: local community members and community groups; local government staff; national civil society organisations; government officials; and staff of international NGOs and donor agencies.
Findings show that the influence of donors is seen as determining, whilst their own agendas are set ‘at home’ and their interactions are seen as poorly coordinated. National governments appear challenged in leading national responses, but results speak against further centralising funding and power.
The complex (and often complicated) aid systems continue to be beset with a range of problems in terms of effectiveness, coordination and local access, but a plurality of channels appears important to the survival of local groups’ and civil society’s capacity to respond. Key recommendations centre on the need for donors and governments to both harmonise and simplify multiple systems of support down to community level, as well as strengthening indigenous support structures.
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