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ABOUT the HIV/AIDS MONITOR

The HIV/AIDS Monitor program aims to improve the ability of donor countries to respond effectively to one of the world’s most significant public health and development challenges: the HIV/AIDS pandemic. Through systematic research and analysis of major aid delivery mechanisms in three countries in Africa, coupled with complementary research and assessment at the global level, the HIV/AIDS Monitor undertakes targeted analyses and policy outreach to support strengthening the organization, management, and delivery of external assistance to HIV/AIDS programs. Rather than focusing directly on the efficacy of specific health interventions, we are concerned with the effectiveness of different donor strategies to support projects and programs on the ground.

According to UNAIDS, global funding to combat HIV/AIDS has increased almost five-fold since 2001, from $2.1 billion to $10 billion in 2007.¹ The three most prominent initiatives for this funding are the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) and the World Bank programs, including primarily the Multi-country HIV/AIDS Program (MAP) (click here for an overview of each funding mechanism). These global efforts to fight HIV/AIDS have brought substantially larger-scale funding to countries and governments for aggressive responses to the pandemic. However, debate rages about the most effective ways for donors to deliver and manage these increased aid flows. With their distinct approaches to design and implement programs to fight HIV/AIDS, these three initiatives are in effect a large-scale experiment. It is far from clear which of these approaches (or more likely, combinations of these approaches) will prove to be most effective in which circumstances. Finding out what is working, fixing what is not, and making these three funding mechanisms work more effectively should be a high priority – as high as mobilizing more resources. Lessons learned from these initiatives are likely to have substantial impact for years to come on donor practices and aid modalities for HIV/AIDS programs and foreign aid programs more generally.

GOAL and OBJECTIVES

The overall goal of the HIV/AIDS Monitor is to improve the performance of all three initiatives by examining key issues in their design and approach, and providing timely analyses to improve the efficiency and effectiveness of each initiative.

Objectives:

1. To conduct high quality research and analysis on topics that affect aid design, delivery and management for donor-funded HIV/AIDS programs.
2. To conduct effective outreach and dissemination of results to inspire and influence change in donor programs for HIV/AIDS
3. To stimulate informed conversation among donors, implementers and advocates around these and other related issues.

PROGRAM DESIGN

The program is designed to gain a clear understanding of the policies, procedures, methods of implementation and implications of the three funding mechanisms by capturing both global and country-level perspectives. This is accomplished by two interconnected branches of analysis: analysis of principal themes at the global and headquarters level and in-depth studies conducted in three African countries that receive funding from all three sources: Mozambique, Uganda and Zambia.

A) Global Analysis:

The global analysis piece of the project explores how the three funding initiatives address major challenges in HIV/AIDS program design, implementation and evaluation, and where and when these approaches are successful or less so. Lessons that can be drawn from these analyses provide key evidence to stakeholders and other audiences. By framing the questions as challenges that all three donors confront, we hope to avoid simplistic or overly-politicized interpretations. Data for analyses will be drawn from the initiatives’ policies, procedures and guidelines; consultations with stakeholders; published budget data; existing research; and other relevant sources.

The global-level research focuses on five major areas of research:

1. Disbursement: What are the implications of disbursement policies and practices on the transfer of resources from donor to recipient countries? (See A Trickle or a Flood)
2. Supply Chain for ARVs: How can donors and other stakeholders ensure the most efficient, and cost-effective flow of ARVs through the supply chain? (Forthcoming)
3. Role of Performance in Funding Decisions: How does performance affect donor decisions on how to allocate funding? (forthcoming)
4. Donor Policies on Addressing Gender Inequality: How do donor policies address gender inequality? (forthcoming)
5. Monitoring and Evaluation: How do donors monitor and evaluate their programs? (forthcoming)

B) Country Level Analysis:

In preparing the country-level research questions, CGD conducted a series of assessments in six African countries (Ethiopia, Malawi, Mozambique, Rwanda, Uganda and Zambia) to determine the key challenges facing governments and in-country stakeholders as a result of the aid flowing from these three donors. With lessons learned from this process, we developed an initial framework of six questions which we will address through in-depth analyses by the local research partners (with assistance from a field director and CGD as necessary) in three specific countries – Mozambique, Uganda and Zambia.

Specific areas of research include:

1. Tracking the funding: How much money is being committed/disbursed and who are the recipients? Do recipients have the capacity to use the funding they are given? (See Following the Funding)
2. Analysis of donor efforts to address gender inequality: How is gender inequality addressed in donor programs? (See Moving Beyond Gender as Usual)
3. Relationship between funding and performance: How is each funding mechanism operationalizing the concept of performance-based funding? How are results measured? (See Are Funding Decisions Based on Performance?)
4. Relationship of HIV/AIDS and reproductive health programs: How does the large volume of funds for HIV/AIDS programs affect other essential health interventions such as reproductive health? (forthcoming)
5. Donor interactions with national health systems: How are HIV/AIDS donor programs interacting with health systems and their various parts, including health information systems, supply chains, and the health workforce? (See Seizing the Opportunity on AIDS and Health Systems)
6. Effects on human resources for health: How have the donor programs affected the human resources for health situation? (forthcoming)

OUTPUTS

• Periodic Analytic Reports and Papers: These papers on global and country-level analyses are released periodically.
• E-newsletters [link to newsletter archive]: We issue a weekly e-newsletter to a broad distribution list. The newsletter, along with the public website, serves as the primary tool for dissemination of up-to-date information about donor activities and other issues related to international HIV/AIDS policy.
• Website: The CGD HIV/AIDS Monitor program has developed an interactive website to showcase our analysis and impact, to make sure key stakeholders are informed and engaged, and to facilitate dissemination of a variety of products to key audiences on an on-going basis.
• Major Conference: At the conclusion of the project, CGD will host a major conference to discuss and debate key issues and findings among important policymakers, technical experts, host country officials, and other stakeholders. This conference is tentatively scheduled for the end of 2009.

PERSONNEL

The HIV/AIDS Monitor is directed by Nandini Oomman. Other members of the team include Steve Radelet, Steve Rosenzweig, Ruth Levine, Mead Over, Michael Bernstein, David Wendt, and Christina Droggitis.

This initiative is funded in part by the Bill & Melinda Gates Foundation, the International Development Research Centre of Canada, the William and Flora Hewlett Foundation, the David and Lucile Packard Foundation, the Swedish International Development Cooperation Agency, and the Rockefeller Foundation.

1. Kates et al. Financing the response to AIDS in low- and middle-income countries: International assistance from the G8, European Commission and other donor Governments, 2007. UNAIDS and the Kaiser Family Foundation. 2008.

HIV/AIDS Monitor