While we all can agree that global funding for HIV and health is in
trouble, what exactly is the reason for this trouble. Sure we all know
about the global economic crisis and its consequences. But really, wasnt this going to happen anyway. The world economy will have its ups and downs and its best that we recognize this early than late.
But really, did any of us look at what we did with the money we got during the gravy period. After *all this wasnt just money, it was life saving resources. Lifelines for people in desperate trouble*. We moved billions and spent them. I still can find good estimates of what actually made it to the people that needed them. Funding for HIV moved with huge transaction costs for governments, NGOs and any other civil society organizations.
Wonder how much actually got to the people who needed them. Just to give you a flavor, we did cost utility analysis of some of programs in Pakistan and found that costs of HIV prevention programs for MARPs ran 250-2500% higher than unit cost estimates. Is this true elsewhere - actually, I dont know because I havent seen much of this kind of analysis.
So now that the gravy train has slowed down, maybe its time to take stock.
Lets review how the money is spent. Money is there and can still save a lot of lives, probably just as many (or more) than during the gravy days. Can we reduce the costs we impose and allow resources to reach those actually need them, the people in whose name we are asking for the money.
My question to the activists out there is: does activism just stop with generating funds or is there a responsibility to the people in whose name we ask for money. If the answer is yes, then should we not ask for more accountability and not less.
As for poor tools for accountability, isnt this a chicken and egg problem.
We havent really asked for accountability and perhaps even thwarted any attempts at it, is it a surprise then that there are coarse and blunt tools to account for fund flows and to measure progress. These things are organic (like good civil society responses that they monitor) and must learn from experience. Absent good programmatic monitoring and evaluation mechanisms, accountants step in and the results are predictable. Perhaps the short funding will give impetus for developing good monitoring practices.
Perhaps the activists can advocate for these to the civil society and NGOs that they have kept on the gravy trains for so long.