On May 18th, 2009, The U.S. Government and Malawi signed the first ever Partnership Framework (PF) “as a means of promoting national ownership of sustainable HIV programs.” For those who crave details about agreements and partnerships, read the original, signed Malawian PDF version of the PF here and for those who just want the gist of what’s happening, PEPFAR’s OGAC offers a summary of it here.There is a lot of good stuff in both documents that would make all of us aid effectiveness junkies squeal with delight:
- country led (essentially the Government of Malawi, although in other countries other local partners may also participate) process to re-write the HIV/AIDS national plan for 2009-2012 with specific donor partner buy in (such as the GFATM, DfID, UN agencies etc) with the Government of Malawi (GOM),
- guiding principles for the implementation of the PF,
- specific PF goals with descriptions of the following:o national indicators and targets PEPFAR will contribute too program areas that PEPFAR will support through the PFo listed policy reforms that the GOM has agreed to initiate in support of PEPFAR’s programso five-year benchmarks/measurements of success of PEPFAR’s contributions
- A table that summarizes the goals, objectives and relative roles/commitments of each partner in the framework including the GOM.
So far so good, but for the brain that is still muddled about different global health partnerships and frameworks and how these all relate to each other, there isn’t much clarity in either document. I found myself wanting to draw a Venn diagram to understand how the different partnership agreements—PEPFAR’s PF, The Global Fund’s National Strategy Application (NSA), the International Health Partnership (IHP) and many more—relate to each other and to Malawi’s National AIDS Plan, let alone its health and development plans.What’s good about the PF:
- It responds (at least on paper) directly to several evidence based recommendations we have presented to PEPFAR, captured in this latest HIV/AIDS Monitor policy tracking tool. These include: supporting a national AIDS plan, investing in pre-service training to produce additional health workers, and graduating ARVs and other HIV commodities in to national supply chains for other goods through the Central Medical Stores (CMS).
- It is a first baby step towards making the governments of recipient countries true partners in the PEPFAR supported AIDS response and it has most of the ingredients to make aid more effective (a la Paris Declaration).
- Finally, PEPFAR’s architects are thinking about the long term financial and program sustainability of a given national AIDS response—who is going to pay for it and who is going to do the work in preparation for the long haul when donor interest/commitment wanes.
What to watch out for: - This is still only an agreement; the implementation plan and how and to whom each partner will be held accountable for their commitments has not been worked out.
- The overall objective suggests that while the PF is developed in the interest of all parties who sign on to it, PEPFAR global goals may still be prioritized over others’. After all PEPFAR is ultimately accountable to the U.S. Congress for its 3-12-12 goals and not necessarily for its contribution to country specific goals, so a partnership framework (that is not legally binding) may not make a difference. As the framework itself states, “The overall goal of this Partnership Framework is to partner with the GOM to contribute to the implementation of the goals, objectives, strategies and action points of the NAF in the fight against HIV and AIDS. In doing so, this Partnership Framework will also significantly contribute to the global PEPFAR goals”.
- Will a partnership framework and an implementation plan force countries to prioritize AIDS even more than other health priorities? On the financing, nobody is coming clean with ideas or a strategy for mobilizing future resources for the HIV/AIDS response. While PEPFAR will contribute funding for the next five years and the GOM will also contribute a portion of this funding, it isn’t clear how any one partner will be able to pick up the tab, especially countries themselves. Domestic sources for health should not be forced to focus on AIDS with such frameworks, at the cost of other health priorities. And on health systems, will PEPFAR’s strengthening efforts create lasting capacity—human resources and infrastructure/systems—for AIDS and other health priorities or will AIDS programs continue to get priority, especially because the government is now tasked with leading the charge in this partnership framework.
- Malawi is not a PEPFAR focus country, and there are other non-focus countries that have been invited to develop a PF. Though all focus countries are on the list, it is not yet clear when these are expected to be completed (though draft guidance states no funding increases will be granted above FY08 levels unless the PF is in place), and how the PFs may differ between focus and non-focus countries. Given that PEPFAR funding has been effectively flat-lined, this may result in a shift of PEPFAR funding among focus and non-focus countries.
