Family in Djibouti. Credit: UNAIDS/P. Virot

National ownership is central to sustainable AIDS responses and is beyond doubt a path to improved aid effectiveness. To set the stage for engaged debates on national ownership and actions to realize this, UNAIDS organized a consultation in Geneva on 21 June 2010 that brought together government representatives, civil society, representatives from  regional political bodies, and development partners.

The dialogue resulted in a clear definition of national ownership which is:

“Inclusive multi-sectoral national leadership at all levels in managing the design of effective AIDS policy and strategy, its implementation, monitoring, reporting and sustainable resourcing as part of the national development agenda, and for assuring board result-based mutual accountability mechanisms and national capacities to strengthen the AIDS response”.

Participants also established indicators to measure progress. These indicators cover multi-sectoral AIDS coordination; non-discriminatory laws and regulations; inclusive process in the development of Strategy, work plan, operational plan and review; monitoring and evaluation and mutual accountability system; integration of HIV in national development plans and capacity development plans; sustainable HIV financing; mutual financial accountability mechanisms; alignment and harmonization; and capacity building.
Addressing the forum, Mr Michel Sidibé, executive director of UNAIDS, highlighted the need for countries and donors to move from short-term aid commitments to longer term financing that is both predictable and sustainable. According to Mr Sidibé key to achieving this is “understanding the interaction of ownership and external funding” which can happen by focusing on the ways that significant donors actually enable national ownership and empower country partners.

The US Global AIDS Coordinator Ambassador Eric Goosby stressed the importance of “mutual accountability.” He pointed out the imperative that donors “carry out their development work in such a way that engagements with country partners and priorities are mutually beneficial.”

The participants discussed strategic incentives to foster greater country partner ownership of national AIDS policies and programmes and to encourage production and use of evidence. In addition, how national ownership can be enhanced by mobilizing greater domestic resources and investments, and the roles and action that country partners and development partners can employ together to strengthen ownership.

Renewed approach to technical assistance and capacity building

Better and more sustainable articulation of countries’ needs, mentoring countries with counterparts from the North, coupled with the aggressive development of TA in the South and South-South cooperation would result in a renewed approach to technical assistance (TA). This could ensure that it is driven by demand rather than by supply. To strengthen national ownership, the inclusion of capacity building support as an integral part of joint operational planning would strengthen country’s responses. Zambia’s Minister of Health, H.E. Kapembwa Simbao, pointed out that “national ownership refers to the availability of in-country expertise to monitor their programmes.” 

UNAIDS Secretariat, in collaboration with all stakeholders, will continue to foster national ownership so that countries can make evidence-informed decisions and invest funds where they are most needed in order to achieve better outcomes for the AIDS response as well as the countries’ wider health and development goals. UNAIDS also plans to continue to support country and regional consultations that include all constituents.

Kenyan Finance Minister Uhuru Kenyatta presented the national budget for the 2010-2011 financial year to parliament on 10 June. The budget sees a near doubling of past allocations for HIV treatment, earmarking Ksh. 900 million (US$ 11.25 million) for antiretroviral treatment.

Earlier this year UNAIDS Executive Director, Michel Sidibé jointly launched the country’s National AIDS Strategic Plan (2010- 2013) with the Prime Minister, Right Honorable Raila Odinga. Mr Sidibé and the Kenyan Government then signed a Memorandum of Understanding committing the two parties to joint actions in several key areas including sustainable financing to support the national HIV response; and virtual elimination of vertical transmission of HIV from mother-to-child. During his visit Mr Sidibé also met with the President, His Excellency Mwai Kibaki as well as key ministers involved in the HIV response.

Mr Sidibé then called on the government of Kenya to earmark Ksh. 1 Billion per year to ensure the continuity of HIV treatment for people in need and to reduce instances of medicine stock-out threats. He also recommended the government counter donor dependency and develop a Cabinet paper on long-term sustainable financing of the national AIDS response including exploring options for increasing domestic resource mobilization such as airtime tax and airline taxes.

“UNAIDS welcomes the government’s increase in domestic funding towards the national AIDS response,” said Mr Sidibé, UNAIDS’ executive director.

In addition, a high-level steering committee has been established by the government to explore sustainable financing and a concept paper on alternative domestic financing scenarios has been developed detailing critical building blocks required to be put in place. The culmination of these efforts will be the development of a cabinet paper which will substantially reduce the country’s dependence on external financing for HIV programmes. 

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake.
Credit: UNAIDS

As Haiti begins to rebuild after the destruction left by the 7.0 magnitude earthquake that struck 10 miles outside Port-au-Prince on 12 January, first reports are coming in on the impact the tremble has had on Haiti’s AIDS response.

Haiti is the country with the most severe HIV epidemic among the Caribbean states–home to half of all people living with HIV in the region. Before the quake, there were an estimated 120 000 people living with HIV in the country with an estimated 6 800 children under the age of 15 also carrying the virus.

Data is starting to emerge on people living with HIV who have been affected by the quake and on critical infrastructure needed to provide essential services. An initial report estimates that out of 120 000 people living with HIV just under 70 000 live in affected areas. Prior to the quake, around 19 000 people were estimated to be on Anti-Retroviral Treatment (ART).

“The world has a real opportunity to rebuild Haiti better, we must sustain the outpour of support now and tomorrow,” Mr Michel Sidibé UNAIDS Executive Director said when speaking of the pledges made by the international community.

The UNAIDS country team and cosponsors are working with the government of Haiti and partners such as PEPFAR and Global Fund to Fight HIV, TB and Malaria as well as non-governmental organisations to gather information to asses the impact of the quake on clinics, lab equipment and as well as human resources. It is now critical that HIV prevention, treatment care and support services are resumed in affected areas.

The UNAIDS country team met staff working in Haiti’s oldest ART centre GHESKIO. The organization provides treatment for 6000 people of whom 80% have now been accounted for.

UN Health Cluster coordination meeting in Port-au-Prince
Credit: UNAIDS

While the clinic has suffered some damage to its structure, essential equipment and tragically also suffered human losses, staff at GHESKIO reported that they have enough stock of anti-retrovirals to cover the immediate need.

Other centres were not as fortunate. The UNAIDS country team visited the Hospital de la Paix which provides prevention of mother-to-child transmission services in Port-au-Prince. Here staff reported destruction of stock as well as lack of financial abilities to buy breast milk substitute necessary to prevent transmission from mother to child through the breast milk. Services at the clinic were only resumed 12 days after the quake.

Members of the UN country team on AIDS will visit five major PMTCT centres in the coming days to establish if similar damages are found.

An initial situational analysis indicate immediate short term needs include limiting treatment interruption, provide nutritional support of people on treatment, and make sure PMTCT services are resumed. Networks of people living with HIV report that they urgently need food and water, tents, and hygiene kit in meeting with the UNAIDS country team.

In Haiti heterosexual transmission, often tied to sex work, is the primary source of HIV transmission although emerging evidence indicated that substantial transmission is also occurring among men who have sex with men. A challenge will be to ensure that key prevention commodities are made available to the displaced populations in and around Port-au-Prince.

“We are seeing real suffering. It is in moments like this where those most at risk are forgotten. We must ensure that the marginalized members of our communities have access to HIV prevention, treatment, care and support services,” Mr Sidibé said, promising that UNAIDS would be part of the global effort to support Haiti to build a better tomorrow.

UNAIDS is committed to working with the Haitian government and other development partners such as Global Fund and PEPFAR to look at how Haiti’s AIDS response can be strengthened over the long-term.

Support is needed to re-establish the AIDS-infrastructure as well as strengthening civil society, ensuring special attention towards HIV prevention, treatment, care and support services to populations at higher risk and put in place on coordinating authority to ensure no gaps or overlaps in the national response.

Executive Director of UNAIDS Mr Michel Sidibé participated in a panel on global health challenges, 22 October 2009, Stockholm.
Credit: UNAIDS

The European Development Days opened yesterday in Stockholm by Her Royal Highness Crown Princess of Sweden Victoria, the President of the EU Commission José Manuel Barroso and the Swedish Prime Minister Fredrik Reinfeldt.

The three day event brings together more than 1500 organizations and 400 individuals from the development community to discuss how to make development aid more effective, and it aspires to build a global coalition to achieve the Millennium Development Goals (MDGs) for 2015.

The European Development Days are hosted jointly every year by the European Commission and the EU presidency, with this year’s event being the fourth edition.

The Executive Director of UNAIDS Mr Michel Sidibé participated in a panel on global health challenges, which explored ways of making the world a healthier place, despite the ailing state of the global economy.

Mr Sidibé emphasized that the world is lagging behind when it comes to HIV prevention, outlining key barriers to halting the spread of HIV including investing resources with populations who are criminalized and marginalized.

“We have effective prevention interventions – however we are not convincing enough decision-makers to invest sufficiently in them”, Sidibé continued, stressing that success will require building an HIV prevention movement with the grassroots to over come political inertia.

He also expressed the need for programmes to “address sexuality and gender inequality in frank, open ways, keeping up with a changing epidemic.”

Executive Director of UNAIDS Mr Michel Sidibé meet with the former President of Mali, Mr Alpha Oumar Konaré during the European Development Days, 22 October 2009, Stockholm.
Credit: UNAIDS

The session also focused how to meet the health related MDGs, and Mr Sidibé spoke of the need to take the AIDS response out of isolation saying that policy-makers should leverage the energy and creativity of the AIDS movement to deliver on the AIDS+MDG agenda.

Lluis Riera, Director for Development Policy at the European Commission's Directorate General for Development, Michel Kazatchkine Executive Director of the global fund to Fight AIDS, TB and Malaria and Anders Nordström, Director General of the Swedish International Development Cooperation Agency (Sida) also addressed the session.

The Global Health Challenges session was a joint initiative of UNAIDS, The Global Fund to Fight AIDS, TB and Malaria, the GAVI Alliance, the Stop AIDS Alliance, and AIDS Accountability International.

Executive Director of UNAIDS Mr Michel Sidibé with Mr. George Soros during the European Development Days, 22 October 2009, Stockholm.
Credit: UNAIDS

While in Sweden, Mr Sidibé also took the opportunity to meet with Swedish non-governmental organizations (NGO) engaged in the AIDS response. Among them Noah's Ark, an NGO that has been involved in the fight against HIV since 1986, as well as representatives of the Swedish Network of People Living with HIV.

The European Development Days is hosted by the current EU President, Sweden and will conclude on 24 October.

(from left) Ambassador Louis Charles Viossat; Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.
Credit: UNAIDS/Mamadou Gomis

Assessing what really works in the AIDS response, and understanding how it works, is all the more pressing in the current context of global financial slowdown said experts at an ICASA session on Friday.

"The current economic downturn leads us to redouble our efforts and look carefully at the effectiveness of programmes and whether or not they are delivering the results we want," stressed Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.

The event, “Public private partnerships against HIV: how can we together turn the tide?” was organized by UNAIDS as part of the conference’s Leadership Programme. Ambassador Louis Charles Viossat chaired a discussion with panelists who included representatives from the Nigerian Business Coalition Against AIDS, Versteergard Frandsen, the Cameroon Business Coalition against AIDS and the United Nations Economic Commission for Africa.

The event explored the benefits and challenges of public-private partnerships in the global response to AIDS.

A public-private partnership (PPP) is defined as an “institutional relationship between the state and the private profit and/or the private non-profit sector, where the different public and private actors jointly participate in defining the objectives, methods and implementation of an agreement of cooperation”. They are characterized by the sharing of common objectives, as well as risks and rewards.

For governments, PPPs can be an opportunity to harness experience in areas where they lack expertise, as well logistical efficiencies that enable better delivery of prevention and treatment services, reducing costs.

For the private sector (profit and non-profit), PPPs may mean a gain in business opportunities, and an enhanced social and economic environment to operate in.

Participants were agreed that attention should be paid to ensure wide participation and representation across the private sector including from the labour unions, employers’ federations, small and medium enterprises and the informal sector. While progress has been seen, there is still a lot to do to improve participation by small and medium enterprises and the informal sector which employ most of the labour force in Africa.

The group identified four factors as critical in creating and sustaining successful PPPs:

• Clear definition of partners’ roles and responsibilities
• Transparency and respect for ethical standards
• Coordination between partners
• Periodic assessments of the partnership

For Ambassador Louis Charles Viossat, "public-private partnerships have proved to be effective and a way forward to better respond to AIDS. However, we need to acknowledge that they are not a silver bullet.”

“Training, information, periodic assessment of the partnership and application of ethical standards are all important," he continued.

Innovation was stressed as a key factor for any public-private partnership to be successful. Navneet Garg, Global Business Manager from Danish company Versteergard Frandsen, "The Millennium Development Goals (MDGs) of stopping the transmission of HIV by 2015 can only be met by using innovative approaches which facilitate rapid scale-up targeting one and all.  Public and private partners should utilize their respective strengths and enhance their partnership accordingly. The enormous challenge needs both partners to step up to achieve what is needed to meet the MDGs".

The Joint Annual Programme Review process is a vital tool in the global effort by governments and development organizations to ‘make the money work’ Credit: UNAIDS/P.Virot

HIV prevalence in Kenya has halved in a decade – a dramatic and sustained decline rarely seen elsewhere in Africa. The Government aims to continue this level of progress by ensuring that the national response to the epidemic is as coordinated and collaborative as possible, and that funding is spent effectively.

In recent years, as national responses to and funding for AIDS in many countries have become more complex – with more activities, stakeholders and donors than a few years ago – coordination has become an even bigger challenge.

Kenya decided to support coordination by conducting Joint Annual Programme Reviews, which bring together a wide range of people working on AIDS to take a comprehensive look at the overall national response. The Joint Review process is led by the national Government and involves participation at all government levels, as well as by civil society organizations, networks of people living with HIV, local and district authorities, and international donors and organizations.

“Joint Reviews of National AIDS Responses: A Guidance Paper”.

With the lessons learned from the Joint Review processes in Kenya and other countries, UNAIDS has developed a new publication entitled “Joint Reviews of National AIDS Responses: A Guidance Paper”. It aims to help countries conduct Joint Reviews and improve coordination, implementation and funding effectiveness among the many stakeholders involved in national responses.

Well carried out Joint Reviews provide a truly nationally-led forum for sharing information, achievements, shortfalls, challenges and emerging issues, and assessing how well efforts and spending are aligned in meeting the goals of the national AIDS strategy.

Kenya has undertaken in 2007 the 6th consecutive Joint Review of its national response and the process has become a valued method for building bridges and coalitions among the many groups involved in the AIDS response.

With the lessons learned from the Joint Review processes in Kenya and other countries, UNAIDS has developed a new publication entitled “Joint Reviews of National AIDS Responses: A Guidance Paper”.

Kenya’s 2007 Joint Review lasted two and a half months and involved hundreds of participants – not a quick or easy process, but well worth the effort. The Review is widely recognized by those working on AIDS as a platform for bringing together data from a range of sectors and levels, including surveillance and service delivery data, as well as qualitative data collected at the community level. The 2007 Review was more inclusive than ever, with participants from all 71 districts and nine regions of the country. The findings and recommendations were used to revise the way the country measures the results of AIDS programmes, and also to inform planning at district and regional levels. The effort of doing regular participatory joint reviews has resulted in more alignment, collaboration and commitment among the many organizations involved in the Kenyan AIDS response.

Anatomy of a Joint Review

The new Guidance Paper gives specific advice for conducting a successful Joint Review. However, just as every country’s AIDS epidemic and response is different, the Joint Review process in each country will differ according to the national political environment, health and social policies, infrastructure, economic development and other factors. Nonetheless, the Guidance Paper lays out several principles which should help build a strong Joint Review process in any country, including:

1. national ownership
2. inclusion and participation
3. commitment to results – participants must agree from the outset to subscribe to the recommendations of the Review
4. impartiality
5. evidence informed
6. enhancing national planning
7. sensitivity to gender and human rights.

The Joint Annual Programme Review process is a vital tool in the global effort by governments and development organizations to ‘make the money work’ – ensuring that all AIDS funds are linked to national objectives and simplifying aid structures. In Kenya, for example, the Joint Review process has helped to strengthen donors’ confidence in the quality and effectiveness of national programmes.

The new Guidance Paper on Joint Reviews, along with other related tools, is designed to help countries unite the many stakeholders involved in the AIDS response, in order to increase understanding of the epidemic and work collectively to achieve results.

The Third High-Level Forum on Aid
Effectiveness takes place this week in
Ghana.

The Third High-Level Forum on Aid Effectiveness takes place this week in Ghana. To mark this event, we begin a new web series “Making the money work”. In coming months we will explore different aspects of aid effectiveness; how financial aid to countries can be made more effective, accountable and results-oriented.

Donors and development agencies are devoting more resources than ever to, among other development goals, the AIDS response in developing countries–welcome news for the millions of people infected and affected by the epidemic. However, many governments and organizations face significant challenges to use this aid effectively and to meet the multiple and often complex requirements of different donors. To address this, the Joint UN Programme on HIV/AIDS (UNAIDS) has taken a leading role in helping countries to "make the money work".

Antonio A. Tujan Jr., Chair of the
International Steering Group of the
"CSO Parallel Forum on Aid
Effectiveness", addressed the Parallel
Forum in Accra ahead of the Third
High-Level Forum, 1 September 2008.
Credit: UNAIDS

The Third High-Level Forum on Aid Effectiveness (HLF) takes place 2-4 September 2008 in Accra and will bring together ministers from over 100 countries along with donors, civil society, UNAIDS, its Cosponsors and other development agencies.

UNAIDS Executive Director Dr Peter Piot will participate as a member of the United Nations Development Group delegation.

Participants will take stock of how aid is being delivered and used, and plan and intensify efforts for improvement in aid effectiveness in the strengthening of health systems among other development goals.

“We are seeing improvements in how development aid is being planned and delivered, but results do not yet match commitments made in Paris in 2005. The AIDS response has championed more inclusive partnerships as being key and we have pioneered the principle of ownership through the 'three ones',” said UNAIDS Executive Director Dr Peter Piot.

“It has been our collective focus on AIDS results and accountability where the response has made most progress. Those results now need to be sustained. The Paris agenda sets the framework, but we must be ambitious in what we demand from the international community as we look to the future.”

Addressing flaws in aid delivery practices

Ghana Minister of Finance and
Economic Planning, Kwadwo Baah-
Wiredu addressed the CSO Parallel
Forum on Aid Effectiveness,
1 September 2008. Credit: UNAIDS

The meeting, organized by the Organisation for Economic Co-operation and Development (OECD), the World Bank and the Government of Ghana, builds on the 2005 High-Level Forum when over 100 countries and organisations endorsed the Paris Declaration on Aid Effectiveness.

This is part of a larger movement spearheaded by organizations such as UNAIDS that started in the late 1990s when recipient countries brought forward that donors needed to support country priority setting and harmonize their approaches in order for the countries to be able to coordinate their AIDS efforts and make more efficient use of donor funding. Donors and aid agencies also progressively realized that the multiple requirements they imposed on countries drained precious resources and led to duplication of efforts.

Progress

Progress has been made in improving the alignment of global support for AIDS and in reducing the burden placed on countries and in the development and strengthening the quality of policies, institutions and processes that take the “Three Ones” principles forward.

This has resulted in improved quality and greater technical support for the development of national AIDS strategies, the mainstreaming of AIDS into development plans, development of joint UN teams on AIDS and joint programmes, and development of accountability tools. The report “Progress update and Lessons Learned from Aid Effectiveness in AIDS Responses” relates the lessons that UNAIDS has learned through its involvement in these processes.

Ghana’s experience with harmonization and coordination

Ghana is a fitting host for the Third HLF because it is a good example of harmonization in action, implementing the “Three Ones” and the recommendations of the GTT, and working towards greater alignment in its AIDS response for several years.

In 2006 Ghana established a joint UN team on AIDS, and has used participatory processes for decision-making among multiple stakeholders. This has strengthened the recognition of the Ghana AIDS Commission (GAC) as the one national authority on AIDS. It has also fostered a strong sense of national ownership of the AIDS response which led to the development of a National Strategic Framework (2006-2010) with a single National Monitoring and Evaluation Plan, developed along the lines of the key principles of the “Three Ones”.

The GAC plans to further implement these principles, in part by strengthening its partnerships with donors and by reinforcing the abilities of national actors – including community-based organizations and the private sector – to contribute in a cohesive way to the national response. It also aims to improve systems for collecting, analyzing, sharing and using AIDS data, which will lead to more evidence-informed programming which will systematically address the needs of groups at higher risk of HIV.

More work to be done

Ghana however, like many countries, still faces challenges in coordinating multiple donors, projects and processes. More coherence is needed so that the UN can “deliver as one” and help countries to scale-up their response to AIDS. The Third HLF is seen as an important opportunity to assess progress, determine next steps and step up efforts among donors, countries and UN agencies.

Dr. César Antonio Núñez, UNAIDS
Regional Director for Latin
America, underlined the
importance of the spending
assessment tool for generating
strategic information for decision
making.

Understanding the magnitude of spending on AIDS programmes, the sources of such funding, and the activities supported by such expenditures is critically important to policymakers, programme planners, and international donors. Effective resource monitoring helps identify gaps in the response, improves the strategic ability of countries and donors to target resources most effectively, and helps measure the degree to which words of commitment on AIDS are matched by financial resources.

Working towards better tracking of AIDS spending in countries in Latin America, more than 50 representatives from the region joined in Panama for a specialist workshop designed to underline changes in the technical classification process for tracking AIDS spending and help countries make better use of the UNAIDS-designed National AIDS Spending Assessment (NASA) tool for their analysis.

Organized by UNAIDS, through its Regional Support Team for Latin America and the International Center for Technical Cooperation on AIDS (ICTC), the workshop also served as a platform for discussing challenges and problems faced by countries when implementing the spending assessments.

NASA is a methodology that identifies financing flows directed to HIV prevention and health care for AIDS. It also identifies funds directed to activities on education, social development and social security that are related to AIDS. The information provided through NASA helps identify how funds are being channeled to different groups of people and geographically which assists with the development of National Strategic Plans and advocacy actions.

Dr. César Antonio Núñez, UNAIDS Regional Director for Latin America, underlined the importance of the spending assessment tool for generating strategic information for decision making. “This is critical for countries to identify if the spending of their resources, both national and external, is undertaken in populations and areas recognized as priorities,” he said.

Carlos Passarelli, ICTC Director, emphasized that “the Centre supports this joint effort of countries in improving their capacities on planning and administration of resources because this is key for the sustainability of AIDS responses in the region”.

CHAT helps map stakeholders in
countries and assess the strengths
and weaknesses of their engagement
with the national AIDS response.

With increased funding and technical support resources available for AIDS, the need for coordinated, harmonized and aligned national AIDS responses has never been greater. To help countries ensure inclusive, participatory national responses to AIDS, UNAIDS with the World Bank has developed the ‘Country Harmonization and Alignment Tool' (CHAT) to help map stakeholders in countries and assess the strengths and weaknesses of their engagement with the national AIDS response. Team Leader in the Aid Effectiveness Division, Desmond Whyms, explains how the tool can help move AIDS responses forward and lead to positive action for change.

What is CHAT?

Many countries now face the challenge of having considerable amounts of money and technical support for AIDS available, but often lack strong coordination for those resources to ensure a common focus among the wide variety of national partners and international partners. CHAT aims to inspire a more inclusive national response through a survey process which first maps the various stakeholders involved in the national response and then through structured interviews with national and international partners establishes how well the national partners are engaged and how harmonized the international players are. This systematic information gathering and analysis helps to put together a picture at country level of the quality of the partnerships in the AIDS response, which then catalyses a dialogue on the strengths and weaknesses, and can help countries move forward in a more harmonized way.

How should countries use CHAT?

Every country’s AIDS coordinating authority should be doing a regular review of progress and performance, and the CHAT is designed to be a part of that process. It is also possible to use CHAT as a free standing tool if a country wants to have a more immediate overview of the quality of the national and international engagement in the national AIDS plan.

What are the necessary steps to put the tool into practice?

CHAT has been piloted in several countries in 2006. In many of the pilot countries, the administration and analysis has been done by a consultant, on behalf of the national AIDS authority. It is designed as a light process that is not burdensome for staff in the national AIDS authority. The consultant administers the appropriate questionnaires—one for national and one for international partners, and then collates and analyses the data to produce a draft report. The CHAT contains guidance on how to do this.

CHAT covers the range of areas in which the
national and international partners should be
engaged with the AIDS response at the country
level.

Can you give an example of some of the areas covered in the questionnaire?

CHAT covers the range of areas in which the national and international partners should be engaged with the AIDS response at the country level like strategy development, resource allocation, administration and monitoring procedures. The questions are based on what is best practice and what’s been promised by international institutions’ headquarters, following their commitments to the Paris Declaration, the Three Ones and the Global Task Team for example. By the very fact of starting to ask these questions at the country level we are starting to put pressure to move in this direction, and that we need to improve the way we work and the way we are engaging to achieve results.

The questionnaires are in the format of self reporting, for example: does your organization participate in decision making about the allocation of resources within the national AIDS budget? For many of the national partners we’ve contacted in the pilot countries, this is the first time anyone had ever really asked them these questions. The feedback has been that this exercise is empowering as all voices are being listened to.

What happens at the end of the questionnaire and analysis?

The output is an analytical report which is intended to feed into the discussions in the context of the joint AIDS review. Most of the international community has already signed up to the principles of good practice and the challenge of the CHAT is to see if those principles are being applied in a particular country to the AIDS response. This is the only tool that exists that allows us to explore this, the intention being that it will flag areas for improvement that can then be addressed through the AIDS review at national level. We can also bring the findings back to headquarters for a comparative analysis, and look at the patterns across the regions.

What are the benefits for the countries?

Most people know the quantity of the response within countries and they should know how much money is being brought by the different partners but what is less known is how well it is all adding up together and pulling in the same direction. This is a low-maintenance tool that really allows countries to start taking stock of the quality of the AIDS response in their countries in terms of harmonization and alignment between national and international partners. It will help us start making sure that we really are “making the money work” and moving towards Universal Access.

This week, leaders from Luxemburg, United Kingdom Department for International Development (DFID), UNICEF and the Joint United Nations Programme on HIV/AIDS (UNAIDS) are visiting Rwanda for a two-day, high-level mission to gain a joint perspective on the progress of the national AIDS response and the ongoing challenges it faces.

Joseline Nyiraguhimwa, age 11, at the site of the IMPORE Association, Prevention of Mother to Child Transmission Centre in Kacyiru, Rwanda. She has lost her father and lives with her mother.
Photo credit: UNAIDS/Riccardo Gangale

Over a quarter of a million people are estimated to be living with HIV in Rwanda, according to UNAIDS 2003 figures.

Over the last years – and against a backdrop of extremely difficult circumstances - the country’s AIDS response is showing encouraging signs of progress.

Political commitment to tackling AIDS is high, with the personal involvement of the President and the First Lady.  The expansion of the country’s AIDS programme points to a welcome trend. Services to prevent mother-to-child transmission are available at 50% of all health centres in the country, sites offering voluntary counselling and testing have increased, and according to national estimates the number of people receiving antiretroviral therapy rose from 8700 in 2004 to more than 19000 by end 2005, a more than 50% increase. Over the past years, trends among pregnant women indicate signs of a decline in HIV prevalence in some areas.

But the country faces ongoing challenges to more rapid progress. Women are particularly hard hit by HIV in Rwanda - recent national data suggests that women aged 15 - 24 years old have five times the HIV prevalence rate than men of the same age group.

Children also need greater attention. Rwanda has one of the highest proportions of orphans in the world – 1.25 million, and in 2003 it was estimated that Rwanda had 22,000 children under 15 living with HIV.

This week, leaders from Luxemburg, United Kingdom Department for International Development (DFID), UNICEF and the Joint United Nations Programme on HIV/AIDS (UNAIDS) are visiting Rwanda for a high-level mission to gain a joint perspective on the progress of the national AIDS response and the ongoing challenges it faces.

Mr Jean-Louis Schiltz, Luxemburg Minister for Development Cooperation and Humanitarian Action; Sir Suma Chakrabarti, Permanent Secretary, United Kingdom Department for International Development (DFID); Ms. Ann M. Veneman, Executive Director of UNICEF and Dr Peter Piot, Executive Director of UNAIDS are meeting with representatives of the government including President of Rwanda, H.E. Paul Kagame and First Lady Mrs. Jeannette Kagame, civil society, UN and donor agencies to gain a collective understanding of the current challenges and opportunities for the AIDS response in Rwanda. Central to the mission is the exploration of ways to improve partner harmonization at all levels.

As part of the visit, the delegation is also visiting some key community-based programmes that provide care and support to people living with HIV, child headed households as well as prevention services, including HIV testing and counselling. 

“Rwanda’s AIDS response is showing some significant positive trends which underline the commitment in the country to seriously tackle AIDS. This joint mission is a key opportunity for AIDS leaders and key players in the Rwandan response to revise the current situation and make concrete recommendations for future action,” said UNAIDS Country Coordinator, Dirk Van Hove.

View more photos of Mission to Rwanda

Kigali, 12 February 2006
Executive Director of UNAIDS Dr Peter Piot, (right), sits next to Dr. Innocent Nyaruhirira, Rwandan Minister of State in charge of HIV/AIDS.
Photo: UNAIDS/Riccardo Gangale