National poverty reduction strategies and HIV/AIDS governance in MalawiA

National responses

National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance.

Wachira C, Ruger JP. Soc Sci Med. 2010 Jun 9. [Epub ahead of print]

The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi's National HIV/AIDS Strategic Framework. Wachira and Ruger ask, how does the Poverty Reduction Strategy Paper process support National HIV/AIDS Strategic Framework accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation? In 2007, they developed and conducted a survey of Malawian government ministries, United Nations agencies, members of the Country Coordination Mechanism, the Malawi National AIDS Commission (NAC), and National AIDS Commission grantees (N = 125, 90% response rate), seeking survey respondents' retrospective perceptions of National HIV/AIDS Strategic Framework resource levels, participation, inclusion, and governance before, during, and after Malawi's Poverty Reduction Strategy Paper process (2000-2004). The authors also assessed health sector and economic indicators and budget allocations for HIV. These indicators are part of a new conceptual framework called shared health governance, which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: (i) consensus among global, national, and sub-national actors on goals and measurable outcomes; (ii) mutual collective accountability; and (iii) enhancement of individual and group health agency. Indicators to assess these elements included: (i) goal alignment; (ii) adequate resource levels; (iii) agreement on key outcomes and indicators for evaluating those outcomes; (iv) meaningful inclusion and participation of groups and institutions; (v) special efforts to ensure participation of vulnerable groups; and (vi) effectiveness and efficiency measures. Results suggest that the Poverty Reduction Strategy Paper process supported accountability for National HIV/AIDS Strategic Framework resources. However, the process may have marginalized key stakeholders, potentially undercutting the implementation of HIV Action Plans.

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Editors’ note: In addressing the heavy burden that debt servicing imposes on government budgets, the Poverty Reduction Strategy Paper (PRSP) process, unlike the previous Structural Adjustment Programmes, engages domestic stakeholders, government-related institutions, and external development partners. In determining the macroeconomic, structural, and social policies and programmes that a country will use to promote growth and reduce poverty, five core principles are paramount: the process must be country-driven, results-oriented, comprehensive, partnership-oriented, and long term. With support from UNDP, Malawi allocated 30% of its debt relief savings to HIV when it became clear that HIV affected all four strategic pillars of the PRSP: sustainable pro-poor economic growth, human capital development, improvement in the quality of life of the most vulnerable, and good governance. This retrospective study uses the concept of shared health governance as a conceptual framework to assess whether good governance and participation were developed and strengthened through PRSP support to the National AIDS Strategy. With several countries facing development challenges exacerbated by HIV and in the process of developing next-generation PRSPs which could influence future HIV budgeting, this article on lessons learned makes for essential reading for policy makers, programme planners, economists, and advocates.