National Poverty Reduction Strategies and HIV/AIDS Governance in Malawi: A Preliminary Study of Shared Health Governance

Social Science & Medicine, Vol. 72, pp. 1956-1964, 2011

10 Pages Posted: 9 Nov 2009 Last revised: 14 Oct 2014

See all articles by Catherine Wangui Wachira

Catherine Wangui Wachira

affiliation not provided to SSRN

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine

Date Written: 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). In this paper we ask, 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 a 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, and governance before, during, and after Malawi’s PRSP process (2000-2004). We also assessed principle health sector and economic indicators and budget allocations for HIV/AIDS.

These indicators are part of 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 should 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. Indicators 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 Classification: H75, I18, I30, H51

Suggested Citation

Wachira, Catherine Wangui and Prah Ruger, Jennifer, National Poverty Reduction Strategies and HIV/AIDS Governance in Malawi: A Preliminary Study of Shared Health Governance (October 29, 2009). Social Science & Medicine, Vol. 72, pp. 1956-1964, 2011, Available at SSRN: https://ssrn.com/abstract=1502792

Catherine Wangui Wachira

affiliation not provided to SSRN ( email )

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States