The good, the bad and the uncomfortable in country ownership

2. COMMENTARY
21 Jan 2014

by Kate Macintyre

A mere $28billion later and the Global Fund’s dedication to country ownership as a guiding principle is still intact, bolstered, reinforced, reinvented or reemphasized at almost every opportunity. 

It’s a sound foundation, predicated on the notion that countries themselves know how to solve their own problems and can tailor their responses to AIDS, TB and malaria to their own political, cultural and epidemiological context.

And that’s right, and good, and as it should be, and the Global Fund is not alone in promoting this as the basis of its development investment: people living in the midst of the epidemics are considered most knowledgeable about what they need, when they need it and even how the interventions should be developed.

Ownership also, the argument goes, breeds responsibility for management, implementation and oversight. So by stating ownership by a country of the programmes that its cheque-book supports, the Global Fund is saying that the country should be accountable for the success or failure of those programmes.   

Underlying this commitment to country ownership is also a motivation from many donors: that if a country owns a programme, it is more likely to sustain it after donors’ funds have finished. So, in basic terms, “country ownership” from the donors’ perspective is an exit strategy. Moreover, it is seen as an exit strategy with a lower risk of failure in the long term.  

The cracks in this foundation of ‘good’ notions of country ownership only appear when what a national government wants jars with the vision of what a donor or other voices in the country desire.  

Many definitions of country ownership ascribe a degree of fairness to democratic processes that are simply not evident.   Nascent democracies in many parts of the world do not have systems set up to hear and deal with the multiple voices that the principle of “country ownership” assumes they do.  The systems also, importantly, don’t have protective policies in place to ensure there are safe spaces for vulnerable individuals or groups to speak their mind. 

Even in a mature democracy like America, where freedom of speech and civil society has a protected space, it took a seriously angry movement of gay men (ACT UP), with a sustained and brilliant campaign of about five years in the 1980’s, to draw serious government and societal attention to the problem of access to treatment for AIDS. 

This disconnect between the assumptions of the principle of country ownership and the realities of the political spaces in many countries heavily affected by the epidemics, is at the root of many of the tensions that can compromise the Global Fund model, and can seriously interfere in the process of grants applications and approvals.  An airing of the differences this disconnect produces is needed.

In its eagerness not to be too prescriptive, and to promote country participation, the Global Fund at its genesis allowed too much latitude in defining ownership. This meant problems from the word ‘Go’: who owned what? Does owned mean government-led, or does it allow for a diversity of voices to guide a country’s priority-setting? In the early days, gentle suggestions about the importance of  including civil society voices were met with silence.

The reality was, and in many cases continues to be, that the loudest voices are the well-established ones: government, its agencies, its technical partners. Representation on the country coordination mechanisms (CCMs) remains a challenge for women, for young people, for all people living with the diseases.  Too many groups ‘represented’ in CCMs are merely tokens, window-dressing to meet the quotas and criteria for eligibility demanded by the Fund.

One friend of mine put it simply: “No one listens to any voices outside the formal government channels. I only sit here in the hope that the funds that come in will trickle down to some groups that fight the epidemic that is mowing down my friends.” 

We, my friend and I, very much hope that the new country dialogue model envisioned under the new funding model will counteract that bias, and provide spaces to some of the CCM members who until now have sat in silence.

What we have also seen is the Global Fund itself increasing asserting its role as “technical corrector” via more recommendations from the TRP and the Grant Approvals Committee (see article). These recommendations range from concept notes being asked to incorporate more targeted programmes for human rights, a greater emphasis on harm reduction, wider attention to gender issues and key populations to demands that principal recipients be changed or entire programmes being excised from proposals.

There is a risk that some of these recommendations – most, if not all, of which have a very sound basis in public health – cross the fine line between technical support and the core principle of country ownership: and the risk is calibrated depending on where you sit.

As to be expected, with the roll-out of the NFM, as in so many donor-recipient models, there has been unease expressed as grumblings about more control coming from Geneva. And for some in implementing countries, those grumbles have translated into concerns about just how prescriptive the Fund has the potential to become in comparison to the Rounds system.

Today, the Fund asks that countries demonstrate their knowledge of their epidemics, their contexts, and the supporting data-based evidence for both their strategies and planned interventions in order to qualify for grants. Much of the quality of the exchange within the country dialogue should come from the quality of those national strategic plans. So better plans should equal more country ownership.  But how far will the national plans be willing to implement decent strategies that reach key populations? And how far will the Global Fund be prepared to go to ensure that those strategies, and those targets, are in place?

It comes down to the kind of working relationship countries are prepared to have – both with the Global Fund and with the civil society voices no longer prepared to stand in silence, but instead to stand with the full weight of Global Fund support behind them. This will be the critical challenge in making sure that country ownership is evenly distributed among all those who want to ensure the best possible impact of strategies to fight AIDS, TB and malaria.

Sadly, many governments remain nervous about power- and resource-sharing when it comes to civil society.   

Proof of that nervousness, that fear, has come this month from Nigeria, where President Goodluck Jonathan signed into a law the latest anti-gay legislation to terrorize the affected communities in sub-Saharan Africa (see article).  This is a classic, and not rare, clash between the Fund’s strategy for key populations and the national right to self-determination by a country’s elected officials.  What the Fund chooses to do next will have enormous repercussions both for Nigeria and all future discussions about its guiding principle of country ownership.

Kate Macintyre is the executive director of Aidspan. Opinions expressed in this commentary are her own.

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