NACP III. Why a private-public partnership is essential (3)

[Guest guest]

A public-private partnership is essential A Basis for NACP III

Clarifications

In a previous posting I had suggested that a private-public

partnership is essential to fight the spread of HIV/AIDS. A number of people

have responded and I would like to address the issues they raised.

I start by reiterating that HIV/AIDS is going to be very hard to

eradicate in the absence of a very effective vaccine or an easy to

administer cure. The spread of HIV/AIDS has social, economic,

educational, political, and medical dimensions, and so must successful programs

to stop the spread. Understanding the full context and implication of these two

simple sentences convinces me that a public-private partnership is a must.

HIV/AIDS spreads because of what we do as private individuals.

The government cannot and should not come into our bedrooms nor regulate

consensual sexual relationships nor can it stop us from indulging in risky

behavior. Together with the government we as a community will have to create the

right understanding and environment, mobilize society and empower all

individuals to reduce risk.

An example of how this can happen at every level is best said by Ashok Row Kavi

who recently wrote " Our dietary consultant, Usha Kamdar, goes to corporates and

gets them to sponsor diets for people who cannot afford everything. We need

better public-private partnerships for that to happen across the board. "

A number of people have advocated for community organizations over

NGOs. There is no doubt that community based organizations have shown excellent

results, especially within the marginalized communities.

Similarly, employers have vested interest in the welfare of their

workers, have access to them, and can therefore influence behavior

change. Each organization has a role to play and a partnership between them and

the government is what I believe is essential.

I have, therefore, consistently defined " private " as consisting of CBOs

(community based organizations), NGOs (non-government organizations) and

employers (small and big). The uncontrolled spread of HIV/AIDS exposes the many

ills in a society, and without recognizing these and the interactions and the

synergy between them our efforts will fall short. Without cooperation between

different organizations working on overcoming the social, economic, political,

and medical ills faced by the common person we will not be succeed.

A number of people have questioned my advocacy for NGOs and, to first

approximation, characterized all NGOs as ineffective and, worse, as

opportunists. Yes, I do advocate for NGOs and believe they (and CBOs

and employers) have a very important and essential role to play in

HIV/AIDS containment and in the development of the poor and

marginalized in general.

My belief in them is based on my interactions with, and knowledge of, many

amazing NGOs in different parts of the India. I will mention a few – Sewa in

Gujrat, Seva Mandir in Udaipur, Arpana in Madhuban, Delhi and HP, Mahatma Gandhi

Memorial Trust in Bhimawaram, Newlight in Kolkata, Tilonia's Barefoot College,

SANGRAM, YRG Care, SAATHII, Humsafar Trust, Naz Foundation, Freedom Foundation

and Narmada Bachao Andolan. The list is endless. The more I travel

around India the more I become aware of how blessed India is to have a long

history of extraordinary, committed, and pioneering NGOs. (It is very important

to keep in mind that most developing countries do not have this tradition nor

the broad base of expertise and experience.)

Yes there are many NGOs, especially in the field of HIV/AIDS, that

have sprung up to exploit the situation and for personal profit. The

challenge before us all is to identify the good ones (whether they are NGOs or

CBOs) and support and strengthen them rather than wasting time and energy

worrying about the bad ones.

Many responses have highlighted the corruption involving NGOs and the

corrupt nexus between the government and these NGOs. Yes, these

statements are true and the reality is infuriating for it is precisely such a

corrupt environment that creates a breeding ground in which HIV/AIDS thrives.

So we have to face this social ill as it is a root cause of many of India's

problems and confront it. This also requires a private-public partnership. What

these statements of corruption highlight is that in practice there may only be

500 good NGOs and not 20,000.

Our goal has to be to identify and empower these 500 and create many more such.

Corruption cannot be weeded out by the government alone – majority of the people

have to be willing to make very significant sacrifices and work hard for decades

to rid India of it.

This leads to the need for constructive monitoring. Both the

government and independent bodies, including CBOs and NGOs, have to be willing

to scrutinize the programs and themselves. Together they have to create good

programs and a transparent and upright system. Again this can be happen only if

there is a private-public partnership.

The problem I have encountered in the NGO community and would like to

challenge is the self-centeredness, isolation, one up man ship, and

the overwhelming preoccupation with finding faults with others.

One telling illustration of how myopic we all can be occurred during a

discussion on HIV/AIDS in which I brought up the example of Medha

Patkar and how she combines social activism with careful analysis

exemplified by her contributions to World Commission on Dams.

A leading HIV/AIDS researcher immediately took issue, characterized her as an

obstructionist and against national " progress " . Little did this person realize

that she and her organization NBA was also helping fight the spread of HIV/AIDS.

In our haste to criticize we seem to forget something we all understand – that

forced displacements, relocations, inadequate compensations all disrupt people's

lives and the associated stresses lead to risky behavior. Just because NBA is

not an HIV/AIDS centric movement is no reason to fail to see how its actions and

advocacy also help fight the spread of HIV/AIDS.

This lack of cohesion and cooperation between people and leaders of

organizations, each motivated in different ways and with different

priorities, but all working towards helping the poor and the marginalized, is

the crux of my argument for a private-public

partnership.

Only when we see and recognize the underlying differences in priorities (which

also define individual passions and skills), and

respect the need and power of co-opting these differences into a

larger synergistic whole will we create a movement large enough to

confront the spread of HIV/AIDS.

Let us not kid ourselves and resort to wishful thinking – that government can

stop the spread of HIV/AIDS overnight and begins to deliver on its

responsibilities. If such governance existed in India, then HIV/AIDS and the

many other problems would have already been addressed.

Once again I will illustrate the need for this broader understanding

and the belief in shared fate through an eye-opening experience during the

workshop " Land, Community, and Governance " organized by

Seva-Mandir in Udaipur during 12-13 September, 2003. (For my notes on

this workshop please see

http://t8web.lanl.gov/people/rajan/AIDS-india/MYWORK/SM03conf.html.)

Each participant, in their slightly different words, reached the same

conclusion – " change and progress can come only through unity and

collective action. " Yet different NGOs or CBOs, operating within even

the same city and doing similar work, were reluctant to work

cooperatively and in private spent all their time trashing the other

NGOs.

The justifications for non-cooperation – the very strong egos of the leaders,

their intense and passionate drives, and competition for

limited resources – seem to be worn, with pride, as medals. To me it

is ironic that the advice we give to the poor, the sex-workers, MSM,

and IV drug users is too bitter to apply to ourselves. So if we want

to succeed and stop the spread of HIV/AIDS we have to rise above this

bickering and once again seek out the good organizations, learn from

them, and create a bigger movement through cooperation. Today the

Worldwide Web and the internet provide a very low cost and overhead

tool for developing these collaborations, disseminating information

and sharing experiences.

The last issue concerns my suggestion for monitoring progress on

containing the spread of HIV/AIDS by private organizations. The

objections raised were that the reports would be of highly varying

quality, rigor, and fidelity. Yes, initially they will be and that, in itself,

should inform us how uneven our response to fighting the

spread is and where there are holes in the program. This exercise will teach all

of us that we need to hold ourselves to the same standards that we expect of the

government and other organizations.

How fast NGOs and CBOs learn to monitor the various factors will be a clear

indication of how effective their programs are and how well the private-public

partnership is working. It is for this reason that I believe that NACO and the

government should encourage and facilitate such an independent monitoring system

even though at first sight it may seem threatening and/or imply the possibility

of creating addition angst through poor, false or biased reports.

To summarize, I believe a private-public partnership is a must. In

fact I will go so far as to say that its absence is an indicator that

we are failing in our fight against the spread of HIV/AIDS.

Rajan Gupta

E-mail: <rajan_gupta87544@...>