1. COORDINATION − FIT FOR PURPOSE:
STRIVING FOR MORE EFFECTIVE AIDS
COORDINATION AT COUNTRY LEVEL
AIDS Architecture - Emerging Issues for Discussion
Cindy Carlson

2. AIDS governance and coordination is a key element
of the AU Roadmap
1
More diversified, balanced
and sustainable financing
models
2
Access to medicines –
local production and
regulatory harmonisation
3
Leadership, governance
and oversight for
sustainability
Priority actions
 Develop financial sustainability plans
with clear targets
 Ensure development partners meet
commitments and align with Africa’s
priorities
 Maximise opportunities to diversify
funding sources and increase
domestic resource allocation
 Invest in leading medicines
manufacturers – focusing on AIDS,
TB and malaria
 Use strategic investment
approaches for scale-up of basic
programmes
 Lay foundations for a single African
regulatory agency
 Support communities to claim their
rights and participate in
governance of the responses
 Acquire essential skills through
technology transfers and south-south
cooperation
 Incorporate TRIPS flexibilities and
avoid "TRIPS-plus" measures in trade
agreements
 Ensure investments contribute to
health system strengthening
 Mobilise leadership at all levels to
implement the Roadmap
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3. The beginnings of a new national AIDS
architecture
• Time for a rethink on AIDS
governance and
coordination
• Some countries are
already making changes
• These efforts need to be
supported and shared
• The purpose of this
meeting is to consider the
role of regional bodies in
supporting national
efforts.

4. AIDS Architecture – what do we mean?
‘AIDS Architecture’ refers to the structures and
mechanisms developed to coordinate and
manage the national HIV response.
• In most developing countries governance,
coordination and management has been through
some form of ‘national AIDS coordinating authority’ –
NACA, and its secretariat,
• The AIDS strategy is operationalised through multiple
implementingi partners
• Countries receiving Global Fund financing also have
country coordinating mechanisms (CCMs)

5. What have been the primary coordination
and management functions?
• Responsibility for developing and coordinating
national policy and the NSP
• Monitoring and evaluation of the HIV response
• Mainstreaming and Partnership relations
• Resource mobilisation
• Grant management

6. How have main functions been situated to date?
Council/Commission
Secretariat
Implementers
1. Deliberate on, and advocate for,
national AIDS policy and strategy to
forward to legislature and executive
for approval
1. Provide technical input into, and
formulation of, AIDS policy and
strategy.
1. Implement AIDS
interventions aligned with
national policy and strategy
2. Report to executive and legislature
on national strategy progress
towards achieving results
2. Aggregate programme data into
monitoring reports for the NACA
and other stakeholders
2. Provide monitoring data
to Secretariat for national
reporting
3. Establish high level platform for
holding government, private sector
and civil society to account for
contributing to and reporting on AIDS
results.
3. Facilitate annual or semi-annual
multi-stakeholder meetings on
national response progress
3. Actively participate in
national multi-stakeholder
meetings
4. Advocate for and mobilise
increased domestic resources (public
and private) for AIDS response
4. Monitor and provide financial
information on aggregate resource
need for the national response
4. Provide financial reports
on expenditure and need.
5. Advocate for the removal of
legislative barriers that prevent
providing services and interventions
for key vulnerable groups.
5. Inform AIDS Council of barriers
and challenges that exist
5. Report on obstacles and
challenges to
implementation (social,
financial, political, etc)
Essential Functions
Supplementary Functions
a. Donor grant management
b. Donor relations and
coordination
c. Coordinate annual work plans
for entirety of national response

7. Examples of different coordination
Country
Description of Coordination
Brazil
National AIDS/STD Control Programme within MOH supported
by a multi-partner Commission
India
National AIDS Control Organization headed by Director General
within Ministry of Health, supported by State AIDS Control
Societies, led by Indian Administrative Service Officers.
Moldova
Independent multi-stakeholder National HIV/AIDS, STI and TB
Coordination Council under the Ministry of Health with
Secretariat based in the National Centre for Health
Management, Ministry of Health
Rwanda
Institute within the Ministry of Health reporting to a nonMinistry Board of Directors that in turn reports to the Minister
of Health
South Africa
Independent council under the Office of the President; with
autonomous Secretariat housed within the Department of
Health, and national strategy covering HIV and TB ;

8. What has worked well with AIDS
coordination?
• Raised the profile of HIV and AIDS in most countries;
• Promoted inclusive multi-stakeholder and multisectorial approaches including for planning and
implementing strategies;
• Promoted one M&E framework and one
coordinating authority;
• Supported the mobilization of financial resources
• Promoted rights based approaches to AIDS
• Created some momentum for government and
donors to harmonize with one AIDS strategy
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9. What have been the key challenges?
NACAs:
• problems with public accountability mechanisms and getting high
level representation
Secretariats
• Too often dependent on donor funds and operating more as ‘PMU’
than national coordination body
• Weak coordination of implementation, monitoring and poor
accountability for national AIDS response results across all partners
• Effectiveness more to do with inter-personal relationships rather
than high level placement (weak political support)
• Challenges with maintaining smooth working relationships across
government, especially between NAC Secretariats and MOHs
• Slow and costly decision making processes
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10. What lessons have we learned?
• Structures are not a substitute for political
commitment
• Location of NAC is not as critical as function of NAC
• Creation of new structures with weak or no legal
mandate limits institutional effectiveness, leading
to
• Duplication and unhealthy competition with other
government structures.
• Lack of sustainability
• Stand alone NACs have been very expensive (e.g.
up to 20% of HIV programme costs in some Asian
countries) and have been highly dependent on
external support
• One size does not fit all!!

11. Why are we talking about needing
change now (1)?
Changes in AIDS science and epidemiology:
• Growing evidence indicates that the majority of effective
investment is bio-medical in nature, including treatment as
prevention, PMTCT and circumcision, implying need to;
• Strengthen national health sector response and underpinning health
systems
• Increase integration of HIV and AIDS services with other health
services
• Other, non-medical, prevention interventions, e.g. BCC, should be
contributing to, and learning from, experiences of both infectious
and chronic disease prevention
• Progress in national responses means AIDS is no longer an
emergency -> now needs long term, sustainable interventions and
related governance
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12. Why are we talking about needing
change now (2)?
• Changes in funding ->Declining funding for development
assistance generally and HIV sepcifically
• But still need to achieve results (getting to zero), using funding more
effectively and efficiently
• Bring AIDS ‘out of isolation’ and build synergies between HIV and
other national development priorities.
• Attention to who, what and how for:
• Leadership and accountability for achieving results
• Sustainable structures for medium and long term with legal
mandates
• Greater integration of programme interventions and management for
greater effectiveness and efficiency of HIV investments.
12

13. HIV responses – alternatives post 2015
Type of strategy
Stand
alone HIV
strategy
Multi-sectoral
aspects
determined in
NSP and
coordinated via
NAC
HIV fully
integrated
into health or
development
strategies
Strengthening of HIV
approaches in sector
strategies with
accountability
integrated into
national health or
development
coordination
HIV a chapter
in national
development
plan with
sectoral
action plans
Multi-sectoral aspects
defined as part of
‘health is everybody’s
business and
managed through
MOUs with a
government body
charged with
coordination
13

14. AIDS Architecture– Main principles
1. Government should be central to governance of the HIV response
within the context of shared responsibility and global solidarity
2. Coordination that includes HIV and AIDS needs to remain inclusive
of multiple stakeholders (across government sectors, civil society,
people living with HIV and AIDS and the private sector).
3. Coordination that includes HIV and AIDS structures should adapt
and embed innovations from HIV programming in other areas of
health and development sectors (and vice versa).
4. Any new configuration of coordination that includes HIV and AIDS
should not conform to a prescribed model.
5. The core role of any coordination that includes HIV and AIDS should
be to continue to lead and coordinate the planning and monitoring
of the HIV/AIDS response.
6. A further important role is also to ensure alignment of partner
resources to national priorities, accountability for achieving results
and investments represent better value for money.
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15. How can we move things forward?
• Critical analysis of the national AIDS responses and their
strategies
• Analysis of who needs to be involved to directly implement the
strategies and who needs to be involved to enable its
implementation.
• Critical analysis of the current coordination arrangements
• Analysis of what resources are available from domestic and from
external sources
• Prioritisation of the whole sphere of AIDS response action
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16. Anything is possible!