International NGO Perspective on Transformative Roles in HIV, Nutrition and Food Security

1. International NGO Perspective on Transformative Roles in HIV, Nutrition and Food Security World AIDS Day 2008, Irish Aid Seminar Connell Foley (Concern)

2. Content & Focus • Givens/Assumptions • Work of INGOs in these areas • Civil Society and INGOs • Role of International NGOs in HIV, Food Security and Nutrition. • Conclusions

3. Assumptions/Givens • The global HIV epidemic is still outpacing the global response (33 million living with HIV and AIDS; 300 m directly affected!). • Poorest disproportionally affected and most vulnerable • Vulnerability of those living with HIV and AIDS increased by lack of food and poor diet/nutrition (++ food & fuel price increases etc.) • Preventing new HIV infections is key to reversing the HIV and AIDS epidemic. • There is no cure but ARVs are effective where they can be accessed, afforded and taken properly. • There are still major historical, religious cultural and educational barriers to behaviour change and prevention. • HIV continues to decimate productive populations including those trying to fight poverty and HIV and AIDS (government services, NGOs, other institutions). • Many resources are being directed at the problem.

4. INGOs/Concern: Food Security and Nutrition • Food Security via: • Agricultural production and productivity • Livestock • Disaster Risk Reduction • Capacity building of services (Ag Ext; Vets etc.) • Microfinance (rural and urban) – some specific targeting • Livelihood diversification and options • Social Protection • Nutrition: • Diversification of food production and accessibility • Dietary diversification • Kitchen gardens • Behaviour change in preparation and use of foods (Positive Deviance/Hearth Model)

5. Models of Development Economic Growth Model • Inward investment; international markets and international trade; goods value chain Sustainability Model • Minimising vulnerability and risk; diversifying income sources and livelihoods options; environmental sustainability and positive management. • Is the dominance of the one model appropriate to all contexts?

6. INGOs/Concern: HIV and AIDS Interventions • Mainstreaming via: • Laying Foundations by highlighting the issue • Internal Mainstreaming – staff attitudes and behaviours • External Mainstreaming – ensuring that Food Security and Nutrition programmes include H&A susceptibility and vulnerability as part of contextual and problem analysis and that interventions reduce risk to programme participants and reduce likelihood of participants (and the programme) being negatively affected. • Programmes: • Building capacity of CSOs working on HIV issues • Linking the poorest to key services (VCT, ARVs etc.) • Trying to stop the spread of the pandemic through prevention-focused activities such as KAP and BCC strategies/activities.

7. Civil Society Perspective? • International NGO ≠ Civil Society • (Like NGO view of “government” – not analytical enough of the different elements) • Media is part of civil society – article in Irish Newspaper in 2008 saying that: “Africa gives nothing to the world except AIDS”… mixed reaction suggests civil society and public opinion does not have a singular perspective.

8. Types of Possible Partners for Concern

9. Are there special issues with HIV+ Organisations? • Historically, due to perceived ‘death-sentence’: • Strong activism (nothing to lose – ‘stand up for your rights’ • Personal volatility causing management and governance volatility?? • Higher loss of members and turnover of leadership? • Our experience alerts us to this possibility!

10. The Marginal Woman Farmer in Mozambique Her Needs: • Support from family, kin, community, extension agents, patrons (political)… • Inputs (seeds, tools, credit…) from private sector, CBOs, NGOs, extension agents and other government outreach workers. Her Risks, Susceptabilities and Vulnerabilities: • Who supports her to minimise these? • Women kin; close friends, church, voluntary groups • (Civil Society as voluntary group support and structured social capital but civil society also as a set of principles of ethical behaviours) Issue of how much time she has to give to care/work. Time poverty? Issue of personal agency and resilience

11. Key NGO Changes since 1993 • Programme Approach – larger, thematic, multi-level, multi-partner, micro-macro links… • Partnership Model – various sectors • Policy Advocacy • Linking with PRSPs, government policies and strategies • Analysis of target groups, contexts and issues becoming more systematic, professional… and complex

12. NGO’s Engagement with Private Sector • Concern and Valid International • Concern and Valid Nutrition • Concern and DEPFA Bank • Concern and Kerry Group • No more the ideological knee-jerk reaction though suspicions over value sharing remain. • Why not partnership with pharmaceutical companies?? (but limits…)

13. Concern’s Engagement with Research • Valid International • IFPRI • IDS • Centre for Global Health, TCD • INTRAC • (ODI, ICRAF, ICRISAT, CIEd…) • Importance of evidence and stronger M&E; key component of operational and action research)

14. Dilemmas for INGOs I • HIV is not the only issue central to poverty and vulnerability!! • Many issues to be taken into consideration – risk, vulnerability, inequality, exclusion, poor governance, environmental threats, livelihoods, water, other diseases, poor education… • Focus on holistic analysis of all key issues in a context and design interventions based on the more critical of these. • Get around question of “Who designs….” (bias!)

15. Dilemmas for INGOs II • Aid architecture and processes: • Sector Wide Approaches (Swaps) - • Aid effectiveness (Paris Dec) processes and implications • Vertical funds and changing funding processes… • NGOs getting sucked closer to bilateral roles • NGOs pressurised to produce evidence – sucked closer to research roles and processes • Constant dilemma between humanitarian imperative (keeping people alive; meeting basic needs) and facilitating long-term and deeper transformation of communities and societies. • Constant dilemma between outcome and process • Move to partners – if intermediaries, huge issue of sub-contracting for service delivery v. transformative/facilitating institutions…. So many layers of weak capacity… effective???

16. Are INGOs losing their niche? • Community understanding and development. • Building social capital and supporting local institutions (especially of the poor) and their development. • How to empower extremely poor people and help them to influence the factors which affect their lives • Learning and innovation around this niche. Reality? • On HIV, do IEC but seem to achieve little behaviour change (weak BCC). • Mainstreaming can be evaporation if not careful. • Trying to do everything creates an issue of depth and effectiveness (yet narrow effectiveness often means lack of synergy and ‘virtuous and reinforcing circles’).

17. INGO Role • Linking the poorest to the policies, institutions and processes for long-term change (duty-bearers; rights) • Building capacity – confidence, continuity, empowering, taking responsibility as well as demanding rights • Supporting good local governance and making sure that the poorest have a say in decisions which affect them… • Creating CIVIL SOCIETY as a key component of open, transparent societies (assumption that this supports extreme poverty elimination as well as wider goal of human development – freedom etc.) • Learning and innovation in each context and to share between contexts – ‘proof of concept’ and ‘proof of application’.

18. Hub Model Government Commissioning Agency (Joint Forest Management Committees) Governance & Feedback Agreement NGO Service Delivery Agency Client Participation Searching for Alternative and Effective M&E Systems

19. Conclusion – Aid Effectiveness How are NGOs effective? • Debate often ends up in issue of client satisfaction or “accountability to beneficiaries” – how do they judge us? • Concern’s and MANGO’s “Listen First” action research suggests that revisiting quality of participation is the key element in making the organisation more accountable to beneficiaries. • What is our ‘added value’? Surely it is that of facilitating change at community level and empowering/building capacity of extremely poor people to be able to influence decisions which affect them and to have greater control over their lives.

20. Ends

21. Composition of Civil Society: General agreement on: - Religious organisations, churches, temples, mosques • - Social clubs • - Women's groups • - Private schools and colleges • - Free press and independent media • - Consumer associations • - Labour or trade unions • - Professional associations and cooperatives • - Community-based organisations (CBOs) • - Non-governmental organisations (NGOs) Argued over: - Tribe, clan (hereditary relations) • - Business/for-profit associations/organisations • - Political parties (esp. that in a ruling government) • - Extremist "un-civil" groups such as extremist political or religious groups.