Background and coordination structures

1. The missing link? Non-government organisations and district level HIV/AIDS programme coordination in Zambia • Aisling Walsh (Royal College of Surgeons in Ireland) • Joseph Simbaya (University of Zambia) • Phillimon Ndubani (University of Zambia) • Ruairi Brugha (Royal College of Surgeons in Ireland) • www.ghinet.org • Funders: Open Society Institute • Network Funders: Irish Aid and Danida

2. Background and coordination structures • Huge increase in funding for HIV – Global Fund, World Bank and PEPFAR • NGO numbers increased tenfold in Zambia since 1990s

3. Methods • 53 qualitative interviews (2 rounds – Jan 2007 & June 2008) • District Health Management Teams • Health facility managers • Mangers of NGOs and CBOs • District AIDS Coordination Advisors • Members of coordination bodies • 3 districts • 2 urban (Lusaka, Kabwe) • 1 rural (Mumbwa)

4. Results: NGOs have supported coordination + Registration of NGOs to district bodies increased +NGOs were active participants in coordination bodies (leading role) • Sharing of transport • Organising VCT days + Improved communication and information sharing • Referral networks • Mapping

5. Results: NGOs have undermined coordination −− Some NGOs sidestepped district coordination structures (PEPFAR primarily) −− Competition among NGOs for funds −− Multiple systems of reporting Consequences ? Service duplication Inability to identify service gaps Fragmentation of services Service imbalances

6. Key message and Recommendations Why is this happening? • Vertical donor funding, mainly PEPFAR • Government have not defined roles of sub-national bodies Recommendations • GHIs and other donors should make the granting of funds conditional on recipients registering with district coordination bodies. • Government should formalise the positions of different sub-national bodies

7. RCSI Irish Aid Danida LSHTM USAID SWEF Health 20/20