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What happens when the donors withdraw?

What happens when the donors withdraw? Community Based Organisations for HIV/AIDS and the World Bank in Zambia Aisling Walsh 1 , C Mulambia 2 , J Hanefeld 3 , G Walt 3 , R Brugha 1 1 Royal College of Surgeons in Ireland 2 Institute of Economic and Social Research, Zambia

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What happens when the donors withdraw?

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  1. What happens when the donors withdraw? Community Based Organisations for HIV/AIDS and the World Bank in Zambia Aisling Walsh1, C Mulambia2, J Hanefeld3, G Walt3, R Brugha1 1 Royal College of Surgeons in Ireland 2 Institute of Economic and Social Research, Zambia 3 London School of Hygiene and Tropical Medicine www.ghinet.org

  2. “The community sector is close to the action in responding to HIV and AIDS. All too often its people and groups are the ‘glue that holds responses to epidemics together, providing the day to day support that prevents HIV infections, cares for those living with AIDS and mobilises individual responses.’ (Intl. HIV/AIDS Alliance, 2004).

  3. Study aims and objectives Aim: to assess the impact of the cessation of the World Bank multi-country AIDS program (MAP) on the sustainability of CBOs for HIV in Zambia Objectives: to assess the impact on the CBOs A – ability to raise alternative funds B – ability to continue activities or provide services C – organisational capacity D – Coordination and planning of HIV/AIDS programmes and services

  4. Background 14.3% HIV prevalence (ZDHS, 2007) down from 16% (2002) HIV policies and structures Cabinet Committee on HIV/AIDS National AIDS Council National HIV/AIDS Strategic Framework Provincial/District/Community AIDS Task Forces Importance of CBOs in Zambia for provision of advocacy and support services World Bank MAP in Zambia $42m (2003-2008) Zambia National Response to HIV/AIDS project (ZANARA) Community Response to AIDS Other funders – PEPFAR (62%) and Global Fund (16%)

  5. Methods and sampling One district – rural Mumbwa Gatekeepers – District AIDS Coordination Advisor and National AIDS Council Mapping – national and district level 34 in-depth interviews – CBOs - District AIDS Task Force - Community Task Forces Analysis: thematic approach

  6. Results (1): Funding – from CRAIDS to the desert? Mixed views on funding conditions. + CRAIDS did not require audited accounts - Some CBOs got funding for services not applied for Confusion over project cessation – no formal communication given, some told there was the chance of another allocation. CBOs not aware of other funding sources: except CDF, ZNAN. ?PEPFAR? Funding for DATF has decreased

  7. Results (2): Continuation of service provision in the face of the funding desert? Advocacy and care/support services Home based care and outreach Sensitisation Nutritional support (OVCs, through HBC etc) Peer educators Counsellors Strong links with hospitals and other CBOs Reciprocal arrangements CBOs working within hospitals/clinics Capacity of volunteers (staff) Highly motivated Close to the community

  8. Results (3): Decrease in services – soft? Transport: ‘The only thing I can say is transport. If we have transport everything will be ok.’ Drop nutritional support (in particular for orphans) ‘For the OVCs there has been a change from when CRAIDS was funding us. There was a feeding programme. Right now we are failing to feed the children. We are also finding it very difficult to keep 100 children at school. Some of them have stopped coming to school.’ Drop in HBC ‘What is the point in visiting if we don’t have anything to offer.’

  9. Results (4): Decrease in services – soft? Volunteers: reduction in numbers, capacity, motivation Coordination and monitoring: DACA held in high regard but losing power? IGAs – are they really sustainable?

  10. Conclusions WBMAP was more flexible than other funders in enabling communities to access funds according to their own priorities Decrease in services is undermining package of HIV services – reduction is visibility at national level? Comparative advantage of CBOs Early recommendations Decentralised funding streams needed for HIV support services Funding for district coordination is essential Sustainability of IGAs needs to be addressed holistically

  11. “You know I would really like to see more leadership capacities built in these CBOs so that they can sustainably use the grants that these cooperating partners would actually give to them. Because now they realise that these things come once in a lifetime. So it is only when they use it sustainably that they can help the community”. (District stakeholder)

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