Exploring the meaning and limits of ‘country

ownership’ with externally-funded

projects Annie Neo Parsons, Christina Zarowsky

Centre for Research in HIV and AIDS School of Public Health

University of the Western Cape

Objectives

• Description of the 11 projects under the UWC administered CDC-PEPFAR grant

• Overview of ‘Country Ownership’

• A synthesis of project experiences

• Three key areas going forward

Background

• CDC-PEPFAR grant administered by the UWC Centre for Research in HIV and AIDS since 2008

• Funds 11 diverse UWC-designed projects on developing human capacity to address HIV and AIDS in South Africa, namely:

Context

• All projects sought national, provincial, and/or district level government involvement – with varying levels of interest/approval/involvement

• No initial funder expectation of South African government involvement in each project

• Shift to promotion of country ownership and integration from 2010

Accra Agenda

• “Country ownership is key. Developing country governments will take stronger leadership of their own development policies, and will engage with their parliaments and citizens in shaping those policies. Donors will support them by respecting countries’ priorities, investing in their human resources and institutions, making greater use of their systems to deliver aid, and increasing the predictability of aid flows.”

• Accra Agenda for Action 2008, page 1

PEPFAR

• “PEPFAR's emphasis on country ownership will include:– Continuing bilateral engagement through its Partnership Frameworks

and other efforts to promote and develop a more sustainable response to the local epidemic, whether concentrated or generalized;

– Ensuring that the services PEPFAR supports are aligned with the national plans of partner governments and integrated with existing health care delivery systems;

– Strengthening engagement with diplomatic efforts at all levels of government to raise the profile and dialogue around the AIDS epidemic and its linkages with broader health and development issues;

– Expanding technical assistance and mentoring to country governments, in order to support a capable cadre of professionals to carry out the tasks necessary for a functioning health system; and

– Partnering with governments through bilateral, regional and multilateral mechanisms to support and facilitate South-to-South technical assistance.”

• http://www.pepfar.gov/about/138339.htm

Impact on projects

• Focus on strengthening country capacity

• Integration interpreted as incorporation

• Withdrawal of funding but projects expected to continue

• Projects increased attempts to engage government on future incorporation

A synthesis of experiences

• Questions arose as projects attempted to incorporate with government:– Were project aims in line with specific

government departmental priorities?– What levels of government should

projects approach – what is a ‘locally-driven solution’?

– Were resources available? (Would projects exist without external funding?)

Project aims/government priorities

• Health Promoting Schools: varying interest and resistance from health and education at different levels… pre 2012. Then seen as in line with education priorities

• HIV Prevention through Sports: no interest from (local level) sports and recreation

• Traditional Healers: upcoming regulations from health, but by very nature not part of any government department

What level of government matters

• Health Promoting Schools: agreements with district level education superseded by provincial decisions. Who holds operational power?

• HIV Ed for Local Government: individual municipalities, SALGA?... how to ensure effective entry and ongoing participation

• Human Resources Information Systems: work in districts; provincial authoritive body; national overall responsibility

Are there resources?

• CHWs: alignment of existing policies sought but no resources within government sector. Latterly incorporated into SANAC.

• M&E Officers for KZN DoH: need (still) there but posts unfilled. Department promised to hire, but only 1 of 3 absorbed as of end 2012

Going forward: 3 key areas

• What relation does funding have to decision-making power – Projects have restricted scope in

negotiating how existing funded programmes can fit into government need hierarchies

• What level of government holds 'ownership’– And impacts on a project’s operations

• How can local government sustain externally funded projects in resource-poor (or strained) settings?