Abstract
BackgroundWhile sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn.MethodsIn-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011.ResultsFunding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce.Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics.Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced.ConclusionsWhilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground and accurate costings for sustainable service delivery, building on existing community strengths, are needed before projects commence. This study highlights the importance of enabling and building the capacity of existing CBOs and community structures, rather than creating new mechanisms.
Highlights
While sustainability of health programmes has been the subject of empirical studies, there is little evidence on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS
The reality on the ground contrasted with the perception of some national level respondents, which was that CBOs emerged in order to access Community Response to AIDS (CRAIDS) funds, without proper plans in place to serve the community of people and families living with HIV and AIDS
CBO respondents reported that these organisations, which were all in place before CRAIDS funding was established, had been formed due to an increase of HIV and AIDS in their communities and in particular due to the rise of orphans and vulnerable children (OVCs)
Summary
While sustainability of health programmes has been the subject of empirical studies, there is little evidence on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Community Based Organisations (CBOs)a develop services and interventions that are culturally appropriate and more responsive to the preferences and needs of communities than those provided by state sectors [3]. Zambia The World Bank Multi-County AIDS Program in Africa (MAP), which was launched in 2000, was the first Global Health Initiative that was established to fight HIV and AIDS, and was followed by the Global Fund in 2002 and PEPFAR in 2004. In 2002, the World Bank provided the Zambian Government with a grant of US $ 42 million to support the National HIV/AIDS Strategic Plan 2001–2005 through the MAP-funded Zambia National Response to HIV/AIDS (ZANARA) project, which was to run between 2003 and 2008. One component of ZANARA was the Community Response to AIDS (CRAIDS), a funding mechanism that provided resources for community based HIV and AIDS programmes and accounted for 35% of total MAP commitments in Zambia
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