•Tackling the AIDS
epidemic successfully depends on how well national responses are managed
and whether people and communities can be mobilized around the common
aim of controlling the epidemic. In short, HIV/AIDS poses a complex
• An effective
response to HIV/AIDS has to achieve three basic objectives: it must
reduce the number of new infections; it should expand access to care
and treatment for people living with HIV/AIDS; and it needs to soften
the impact of the epidemic on social and economic development. Usually,
this requires intensifying national poverty reduction efforts and providing
support for those worst affected.
• Strong social
and political mobilization is needed at family, community and national
levels in order to reach these objectives. That requires highly effective
forms of governance. There is no single blueprint for success, but lessons
learned over the past two decades show that well-governed national responses
share some basic principles.
• Political will,
vision and leadership are essential, especially at the highest level
of government. Such leadership should recognize that practical steps
must be taken to allocate national resources to HIV/AIDS-related priorities
and to marshal institutions and actors beyond the health sector. The
response in countries such as Uganda and Thailand benefited greatly
from strong leadership in the early stages of the epidemic, making it
possible to mobilize communities, governments and civil society groups.
• Strategic national
AIDS plans are another key ingredient of effective governance. The best
of these plans cover a variety of sectors, and include prevention, care
and treatment, as well as measures that soften the impact of the epidemic.
They are designed to achieve clear targets and are marked by firm lines
of accountability. They are coordinated and funded at the highest level
of government, but also promote strong community participation. Such
large-scale multisectoral planning provides the framework for harmonizing
the activities of diverse partners.
• In countries
with effective responses, all departments of government and civil society
have been spurred into action. Successful governance of an HIV/AIDS
response demands that the widest range of government departments, civil
society groups and the private sector collaborate across different sectors
and at various levels. Senegal, for example, has managed to contain
the epidemic because it nurtured partnerships between women’s groups,
faith-based organizations, district authorities, government agencies
and private sector entities.
• All sectors
of government (and not just those explicitly tasked with health issues)
have a key role to play. Labour departments can promote workplace prevention
and care programmes in the private sector, for instance. Education ministries
can introduce AIDS education for schoolchildren and their parents. Agriculture
departments can deploy their networks of extension workers to help communities
cope with the impact of the epidemic.
• Responses work
best when they are decentralized and scaled up. In the context of the
epidemic, effective governance therefore depends on governments’ abilities
to mobilize and support local-level action. District and municipal authorities
are most effective when they receive the means to scale up their activities
and work hand in hand with communities that are at the front line of
prevention and care. Botswana, Ghana and Laos are good examples of special
efforts being made to boost provincial- and district-level strategic
planning and implementation capacity.
with a strong enough capacity to plan, implement and manage their strategies
have been shown to achieve the strongest successes against the epidemic.
This goes beyond the question of sufficient finances. Sharp increases
in funding for HIV/AIDS work demands that governments and communities
are able to absorb that assistance. Special efforts are therefore needed
to strengthen accountability frameworks, managerial capacities and monitoring,
evaluation and budgeting systems. Without such measures, funds cannot
be rapidly disbursed, nor can programmes be kept in effective operation.
• One of the
primary lessons learned over the past 20 years is that HIV/AIDS must
be at the top of national development agendas. The epidemic
is not a separate, discreet matter. National development plans and poverty
reduction strategies that take full account of the need to slow the
spread of the epidemic and cope with its impact achieve the most success.
Failing that, the resources allocated from national budgets to prevention
and care will remain inadequate.
• In countries
with effective responses, HIV/AIDS priorities are earnestly debated
in the national parliament, and carry the full support of the cabinet
and ministry of finance. This is particularly important when a country
chooses to allocate debt relief savings—a valuable chance to increase
the funds going towards an AIDS response. Among others, Burkina Faso
and Cameroon are examples of countries that have effectively done this.
• HIV/AIDS poses
a unique challenge. While it requires a serious public health response,
it also demands much broader action. All sectors and levels of government
and civil society must be mobilized if prevention efforts are to succeed
and the epidemic’s effects are to be reduced.
• But countries
cannot carry the burden alone. Rather than back fragmented projects,
global funding must support large-scale and comprehensive national strategic
plans that cover the gamut of interventions needed to control the epidemic.
Success then hinges on how well countries manage to govern their own
responses, and on the support of donors, the United Nations, multilateral
lending institutions and international civil society organizations.