Shared Health Governance (SHG), A Conceptual Framework on HIV/AIDS Governance

[Guest guest]

Shared Health Governance (SHG), A Conceptual Framework to understand HIV/AIDS

Governance.

National Poverty Reduction Strategies and HIV/AIDS Governance in Malawi: A

Preliminary Study of Shared Health Governance

Wangui Wachira

affiliation not provided to SSRN

Prah Ruger Yale University - School of Medicine

October 29, 2009

Abstract:

The public health and development communities understand clearly the need to

integrate anti-poverty efforts with HIV/AIDS programs. This article reports

findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process

on Malawi's National HIV/AIDS Strategic Framework (NSF). How does the PRSP

process support NSF accountability, participation, access to information,

funding, resource planning and allocation, monitoring, and evaluation?

In 2007, we developed and conducted an original survey of Malawian government

ministries, United Nations agencies, members of the Country Coordination

Mechanism, the Malawi National AIDS Commission (NAC), and NAC grantees (N=125,

90% response rate), seeking survey respondents' retrospective perceptions of NSF

resource levels, participation, inclusion, empowerment, and governance before,

during, and after Malawi's PRSP process. We also assessed principle health

sector and economic indicators and budget allocations for HIV/AIDS.

These indicators are key to a new conceptual framework called shared health

governance (SHG), which seeks congruence among the values and goals of different

groups and actors to reflect a common purpose.

Under this framework, global health policy must encompass

(i) consensus among global, national, and sub-national actors on goals and

measurable outcomes;

(ii) mutual collective accountability; and (iii) enhancement of individual and

group health agency.

The indicators we developed to assess these elements included:

(i) goal alignment;

(ii) adequate resource levels;

(iii) agreement on key outcomes and indicators for evaluating those outcomes;

(iv) meaningful inclusion and participation of groups and institutions;

(v) special efforts to ensure participation of vulnerable groups; and (vi)

effectiveness and efficiency measures.

Results suggest that the PRSP process supported accountability for NSF

resources.

However, the process may have marginalized key stakeholders, potentially

undercutting the implementation of HIV/AIDS Action Plans.

Accountability for achieving results also fell short.

Keywords: HIV/AIDS, Poverty Reduction Strategy Paper, Malawi, National HIV/AIDS

Strategic Framework

JEL Classifications: H75, I18, I30, H51

Working Paper Series

Date posted: November 09, 2009 ; Last revised: February 04, 2010

Suggested Citation

Wachira, Wangui and Ruger, Prah, National Poverty Reduction

Strategies and HIV/AIDS Governance in Malawi: A Preliminary Study of Shared

Health Governance (October 29, 2009).

Available at SSRN: http://ssrn.com/abstract=1502792