Building country capacity for sustainable HIV services: Learning from success

This blog was originally published on the Lancet Global Health Blog on May 21, 2014. 

To continue to make progress on tackling the AIDS epidemic, we must increasingly support and strengthen national partners’ ability to own, manage, sustain, and ultimately fund HIV services. Country ownership isn’t unique to HIV programmes, but getting the transition right is critical to providing more patients with care and treatment. Today marks the 3-year anniversary of three independent, national organisations in Cote d’Ivoire, Mozambique, and Tanzania, that have successfully transitioned select HIV programmes to national ownership. The affiliates provide evidence, and indeed a model, for how well planned transitions to national ownership can work.

The Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) in Tanzania, Fundação Ariel Contra o SIDA Pediátrico (Fundação Ariel) in Mozambique, and Fondation Ariel Glaser Pour la Lutte contre le SIDA Pédiatrique (Fondation Ariel) are autonomous organisations, owned and operated by highly capable national boards, leadership, and staff. Their establishment was assisted by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), with support from the US Centers for Disease Control and Prevention. Through its continued affiliation with the organisations, EGPAF provides capacity building, institutional systems and policies, and linkages to the global arena. Affiliates are periodically evaluated against clear metrics through both a self-assessment and EGPAF-facilitated accreditation review.

As an integral part of the national HIV response, the affiliates collectively support more than 650 public and private health facilities, have tested more than 895,000 pregnant women for HIV, and have started more than 180,000 patients on HIV treatment. The annual budgets, obtained from a range of donors and verified through financial audits from independent accounting firms, now total nearly US$30 million.

The affiliates also provide technical assistance to their countries’ governments at the national, regional, and local levels; advocate for patient-centred policies; and develop innovative solutions to address gaps in HIV services. Each affiliate is an important and respected implementing partner, with a significant and long-term role in their countries.

After 3 years of collaboration, we are taking stock of what worked, why it worked, and how our experience can further contribute to advancing country ownership in health and other development sectors. Here’s just a little of what we’ve learned:

Efforts to build national capacity and ownership must be driven by prioritising sustainability. We transitioned some EGPAF-supported regions, and thereby human and financial resources, to the affiliates, which, at times, made for tough decisions at EGPAF. These tough decisions were made easier knowing that, in the long term, building capable national organisations is the right path toward an AIDS-free generation.

Capacity building for national organisations needs to be comprehensive, focusing on more than just programmatic capacity. It must focus on developing well rounded, transparent, and sustainable organisations. Therefore, EGPAF’s capacity-building efforts focus on governance, financial management, compliance, human resources, advocacy, marketing, and resource mobilisation, in addition to programmatic areas.

Leadership and staff must be supported and led by an engaged, national board of directors. AGPAHI, Fundação Ariel, and Fondation Ariel are governed by highly qualified and committed groups of national leaders from diverse professional backgrounds. They hold the organisation, and themselves, accountable for programmatic excellence, sound financial management, and transparent operations.

Close collaboration with global organisations is a way to facilitate linkages for national organisations to join the global dialogue. National organisations may struggle to be connected to advances in the field and engage at a high level with donors, UN agencies, and researchers. Regular updates and participation of affiliates in EGPAF’s internal working groups and conferences ensures that the affiliates are equipped to provide technical assistance to regions, districts, and sites in their countries.

As AGPAHI, Fundação Ariel, and Fondation Ariel continue to grow and change, so too must EGPAF’s affiliation model and institutional relationships. As the affiliates have rapidly increased capacity during the past 3 years, EGPAF’s own capacity-building support is also evolving away from day-to-day operational and programmatic support to greater strategic and collaborative engagement in advocacy, communications, and programme innovations.

AGPAHI, Fundação Ariel, and Fondation Ariel demonstrate how capable, national organisations can shape the HIV response. Through these organisations, Cote d’Ivoire, Mozambique, and Tanzania have a new cadre of national leaders, working toward an AIDS-free generation in locally-relevant, innovative, and lasting ways.

Theresa Wolters is EGPAF’s associate director of capacity building and organization development, based in Washington, D.C.