National Aids Commissions and Country Coordinating Mechanisms : perceptions of functioning of the two national HIV governance structures in Lesotho
Thesis (MPhil)--Stellenbosch University, 2008.
ENGLISH ABSTRACT: A number of countries in sub-Saharan Africa are recipients of major international investments for HIV. Funding has required that different governance structures be established, with the creation of independent Country Coordinating Mechanisms (CCM) for the oversight of Global Fund grants in country, and National AIDS Commissions (NAC) have been established as part of the World Bank Multi-country AIDS Programme (MAP) for coordination of national HIV efforts. In addition UNAIDS and SADC have endorsed the concept of one national coordinating authority. The NAC in Lesotho reports to the Office of the Prime Minister and its structure and function is governed by statute. The CCM has broad stakeholder representation and functioning is determined by Global Fund guidelines. The Global Fund is by far the largest donor to HIV programmes in Lesotho, with current potential funding amounting to USD 100 million. This study seeks to determine perceptions of members of the two HIV governance structures in Lesotho on their respective roles, reporting lines, responsibilities, levels of tension and integration of HIV in developmental agendas, through the administration of a pre-tested questionnaire to CCM members and NAC management in Lesotho. Lack of clarity on the roles and functions exists for both CCM and NAC, with each group more likely to consider their own body as being more representative and having a clear and defined mandate. Strong disagreement exists on the extent of NAC functions beyond the classic coordination, advocacy and communication role, with NAC viewing their role as extending into direct programme implementation and management of funds. While the National Composite Policy Index for Lesotho indicates inclusion of HIV in broad developmental and health agendas, there is little tangible evidence of this being practically implemented. The structure and functioning of both NAC and CCM largely limits the inclusion of HIV into national developmental programmes. While the status quo of NAC reporting to the Office of the Prime Minister is supported, NAC members were significantly more likely than their CCM counterparts to want CCM to report to them. Not surprisingly, levels of tension between these two bodies is demonstrated in this study. In spite of one-third of respondents desiring the creation of a single oversight body for HIV, this study argues for the maintenance of two structures but that NAC should limit itself to its original intended mandate of coordination, that practical interpretation of the universal NAC role of ”coordination” be developed, and that internal NAC performance measures be adopted which are subject to periodic external review. Furthermore CCMs should be formally established by Ministerial decree or proclamation, and each body should have formal representation of the other in their membership. Membership of both NAC and CCM should include non-HIV developmental role players in the country. CCMs must also systematically report on Global Fund activities to NAC, so that NAC can fulfil its coordination function. Improved reporting to the public by both bodies on summarised indicators via the media is also recommended.
AFRIKAANSE OPSOMMING: Die doel van die studie is om die verskillende persepsies van die verskillende fondsadministreringsliggame in Lesotho the bepaal ten opsigte van onderskeidelike rolle, lyne van rapportering, verantwoordelikhede, moontlike spanningsvlakke en die integrasie van MIV agendas. ‘n Vraelys is gebruik om data in te samel; data is verwerk en aanbeveling ter verbetering van die situasie in Lesotho word gemaak.