Private and Public partnerships fighting HIV/AIDS in Asia-Pacific

1. Private and Public partnerships fighting HIV/AIDS in Asia-Pacific Private and Public Sector workshop ADB and UNICEF

2. Role of CSO in HIV/AIDS, Asia • Civil society remains at the forefront of HIV service provision, particularly among the most vulnerable and hard-to-reach populations such as sex workers, people who use drugs or men who have sex with men, and in places where behaviors that put people at high risk for HIV are criminalized. Civil society pioneered counseling and home-based care for the sick and have significantly augmented HIV services provided by the State. • REDEFINING AIDS IN ASIA: Crafting an Effective Response Report of the Commission on AIDS in Asia.2008

3. Major CSO roles in Asia-Pacific • Advocacy • Legislation, treatment, care; stigma and discrimination; and CSO/NGOs engagement in national decision making • Activism • Voices and rights of marginalised groups (Most-at-Risk populations and people living with HIV) • Service delivery • Home based care, treatment adherence, PMTCT, support to families and children affected by AIDS, community care and prevention/treatment services for the most-at-risk populations – Sex Workers, IDU and MSM

4. Level of success in meeting its objectives • Objectives vary: From rights-based, participatory to service delivery objectives • Thailand - NGOs are a key force in driving public actions toward making care and treatment affordable and accessible, and measures to mitigate impact of AIDS on families and children . • India - National AIDS Control Organization (NACO) has set up dedicated funding for engaging NGOs in National AIDS Control Plan and delegated responsibility to the State AIDS Cells (SAC) for the allocation, management and monitoring of funds to NGOs • Vietnam - An HIV/AIDS Law to protect rights of PLWHAs, including measures against stigma and discrimination progressively came into effective. The work of NGOs, local activists with UN and Central Commission for Ideology and Culture, for 2 years through seminars, joint consultations and publicity through media

5. % Asia-Pacific countries having laws, regulations or policies that present obstacles to effective HIV prevention, treatment, care and support for specific vulnerable sub-populations * Not including Marshall Islands, Palau, and Tuvalu Source: “Law, Policy and HIV in Asia-Pacific” – a Desk Review by www.aidsdatahub.org

6. Legal status of sex work in Asia-Pacific Source: “Law, Policy and AIDS” – a Desk Review by www.aidsdatahub.org

7. Effectiveness in monitoring the delivery of the program Assessment of Monitoring and Evaluation Systems Source: UNGASS Country progress reports 2008, www.aidsdatahub.org

8. Effectiveness in monitoring the delivery of the program Assessment of Monitoring and Evaluation Systems Source: UNGASS Country progress reports, 2008

9. Assessment of Monitoring and Evaluation Systems: Proportion of countries reporting selected key components (N=18) Source: UNGASS Country progress reports, 2008, www.aidsdatahub.org

10. Level of success in meeting its objectives • Buddhist Leadership Initiative - multi-country Mekong sub-regional initiative • Individual and community change • Increased knowledge of HIV & AIDS • Improved community understanding and acceptance of PLWHA • Increased support and involvement of PLWHA – formation of self help groups to expand livelihood options for PLWHAs • Organisational change • Increased engagement of Monks and Nuns and the broader Temple-based programmes to address HIV/AIDS needs of the community • Church initiatives – Church partnerships in PNG, Timor Leste; Myanmar – several faith-based leaders organized to provide care and support to over 15,000 OVCs. • World Vision and Caritas International among international faith-based NGOs engaged in large scale programmes across Cambodia, Laos, India, Myanmar, Thailand and China

11. Private sector • ILO Code of Practice, HIV/AIDS at the Workplace • Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) have become an essential part of the response. In 2008, a GBC led pledge was signed, committing 111 multinational businesses signatories to end HIV discrimination and stigma in the workplace Asia Pacific Business Coalition on AIDS (APBCA) and Asian Business Coalition on AIDS (ABCA) supports set-up and coordination of country-level business coalitions • Coca-Cola China - initiated an AIDS Orphan Care program in partnership with the Yunnan Provincial Women and Children Development Center, providing support and care to AIDS-impacted orphans from 75 villages across the region www.businessfightsaids.org • ADB building HIV Clause into Fidic Guidelines for procurement of services in infrastructure sector (Transport, energy, etc)

12. Scalability • CSO’s work is mostly small-scale. Scalability requires national leadership and coordination, as well as financial support • Thailand – Positive Partnership Program • China - A community-based care program supported by a network of women living with AIDS decreased loss to follow-up from more than 80% to less than 10% in pilot areas. Women’s groups providing referral services for testing and prevention of MTCT, drug adherence counseling and monitoring support raised the early antiretroviral (ARV) treatment rate from 30% to 60%, and drug adherence levels from 60% to 95% among women participating in the program

13. Percentage of infants born to HIV infected women who received HIV test within 12 months, 2008 Source: Towards Universal Access_ Scaling Up Priority HIV Interventions in the Health Sector_ Progress Report, 2009, www.aidsdatahub.org

14. Percentage of HIV positive pregnant women receiving ART for their own health, 2008 Children risk losing their mothers – a new generation of AIDS orphans Source: Towards Universal Access_ Scaling Up Priority HIV Interventions in the Health Sector_ Progress Report, 2009, www.aidsdatahub.org

15. Percentage of MARPs reached with HIV prevention programme – Female Sex Workers Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

16. Percentage of MARPs reached with HIV prevention programme-IDU Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

17. Percentage of MARPs reached with HIV prevention programme-MSM Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

18. Local stakeholder buy in • Cambodia’s Continuum-of-Care (CoC) -Cambodia integrated the response into a decentralized public health care system with strong referral networks, and involving community-based organizations and people living with HIV (PLWH). Strong NGO/PLWH involvement provided psychosocial support, help reduce stigma and discrimination, and give valuable feedback to public health officials contributed to the effectiveness of this approach • Indonesia’s Spiritia – A national support network formed in 1995, assists 65 groups of people living with HIV throughout the country by providing treatment education, basic fact sheets and training in advocacy. Members of the Spiritia team regularly visit most of Indonesia’s 35 provinces, documenting treatment, care and support and encouraging local government to improve services

19. B. Efficiency • Engagement of CSO/NSP enhances efficiency overall, but fund channeling is process heavy • “The Five year Evaluation of the Global Fund (2007-2009) reported that the Country Coordinating Mechanism model ‘is perceived to be one of the most innovative and positive contributions of the Global Fund, which has provided an opening for participation that was previously non-existent in a number of countries. • The Global Fund's CCM model has already led to a substantial shift in the dynamics between civil society and the government in many countries by increasing the participation of civil society and of PLWAs governance and in HIV/AIDS prevention and care programs”

20. C. Equity – increased share to CSO Civil society organizations are at disadvantaged and get reduced funding under Direct Budget Support - when countries adopt SWaPs and/or pooled funding policies The Global Fund with its emphasis public-private partnership is the only financing mechanism which has made participation of civil society mandatory for awarding grants to countries Dual Financing policy,: some 40% of the representation in the CCM is of the non-government sector including the private sector (the minimum recommended by the Global Fund) Bangladesh - 3 PRs – Save the Children for prevention among MARPS, ICDDR,B for research and government for policy, advocacy and linkages across the MOH and other ministries. Majority of CCM leadership rests with the government

21. Increased private sector contributions, but participation in national planning minimal • The private sectors’ financial contribution has also been increasing during more recently. • 2003 - private sector contribution was 1% overall support • 2007 - the Global Fund raised $80 million from the private sector - 5% of overall support - which increased to 6.6 percent of all contributions in 2008. This includes annual $100 million contribution from Gates Foundation. • Six per cent of Global Fund financing is being channeled to private sector recipients.

22. D. Financial sustainability • NSPs in most other countries rely heavily on external sources such as the Global Fund, PEPFAR, and international NGOs. • Question of sustainability of important community-based service delivery particularly of treatment and care interventions and whether low-income countries can rely indefinitely on international aid to pay for treatment programs • Many donors pledge only for a limited time-span (i.e. 2-3 years), making it very difficult to anticipate donor support beyond this timeframe. Eg. in Cambodia, very few donors have pledged funding beyond 2012. • Source: Information taken from financial gap analysis in GF Rd 9 proposal

23. External resources and domestic spending on HIV/AIDS Source: “MARP – All Indicators”, Regional Overview, www.aidsdatahub.org

24. Private Sub Total International Sub Total Public Sub Total Thailand China Pakistan Philippines Indonesia Cambodia Viet Nam Mongolia Nepal Lao 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Source of AIDS funding in some countries in the region Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

25. Civil society involvement in the HIV response in Asia Pacific Source: “MARP – All Indicators”, Regional Overview, www.aidsdatahub.org

26. HIV and AIDS estimates in Asia, 1990-2008 * Without Pacific Region Source: UNAIDS_AIDS Epidemic Update, December 2009

27. Challenges to Effective NSP Participation • Restrictive policies and legal frameworks to promote and protect CSOs, NGOs, private sector in national policy making • Minimum standards for service provision – need to be developed, exist in few countries • Greater technical support needed for capacity development of NGOs, CSOs

28. Way forward • Support meaningful participation in national policy planning and development processes • Removal of restrictive measures and clarity on roles of NSPs in provision of HIV/AIDS services • Expand role of private sector in reaching most-at-risk groups (migrants, truckers, workers) • Strengthen collaboration with philanthropic foundations • Explore PPP for greater social protection measures to minimize impact of HIV/AIDS

29. For group work • Opportunities • Challenges – risks • Conditions