Elusive accountabilities in the HIV scale-up: ‘Ownership’ as a functional tautology

Abstract

Mounting concerns over aid effectiveness have rendered ‘ownership’ a central concept in the vocabulary of development assistance for health (DAH). The article investigates the application of both ‘national ownership’ and ‘country ownership’ in the broader development discourse as well as more specifically in the context of internationally funded HIV/AIDS interventions. Based on comprehensive literature reviews, the research uncovers a multiplicity of definitions, most of which either divert from or plainly contradict the concept's original meaning and intent. During the last 10 years in particular, it appears that both public and private donors have advocated for greater ‘ownership’ by recipient governments and countries to hedge their own political risk rather than to work towards greater inclusion of the latter in agenda-setting and programming. Such politically driven semantic dynamics suggest that the concept's salience is not merely a discursive reflection of globally skewed power relations in DAH but a deliberate exercise in limiting donors' accountabilities. At the same time, the research also finds evidence that this conceptual contortion frames current global public health scholarship, thus adding further urgency to the need to critically re-evaluate the international political economy of global public health from a discursive perspective.