The views expressed in this presentation are the views of the author(s) and do not necessarily reflect the

views or policies of the Asian

Development Bank (ADB), or its Board of Directors or the governments they represent. ADB does not guarantee the source, originality,
accuracy, completeness or reliability of any statement, information, data, finding, interpretation, advice, opinion, or view presented, nor
does it make any representation concerning the same.

Private and Public partnerships

fighting HIV/AIDS in Asia-
Asia-Pacific

Private and Public

Sector workshop
ADB and UNICEF
 Role of CSO in HIV/AIDS, Asia
Civil society remains at the forefront of HIV service
provision, particularly among the most vulnerable and
hard--to
hard to--reach populations such as sex workers, people
who use drugs or men who have sex with men, and in
places where behaviors that put people at high risk for
HIV are criminalized. Civil society pioneered counseling
and home-
home-based care for the sick and have significantly
augmented HIV services provided by the State.

REDEFINING AIDS IN ASIA: Crafting an Effective Response Report of the Commission on AIDS in Asia.2008
 Major CSO roles in Asia-
Asia-Pacific

Advocacy
Legislation, treatment, care; stigma and discrimination; and
CSO/NGOs engagement in national decision making

Activism
Voices and rights of marginalised groups (Most-
(Most-at
at--Risk populations
and people living with HIV)

Service delivery
Home based care, treatment adherence, PMTCT, support to
families and children affected by AIDS, community care and
prevention/treatment services for the most-
most-at
at--risk populations –
Sex Workers, IDU and MSM
 Level of success in meeting its objectives

Objectives vary: From rights-

rights-based, participatory to
service delivery objectives

Thailand - NGOs are a key force in driving public actions toward making care
and treatment affordable and accessible, and measures to mitigate impact of AIDS
on families and children .

India - National AIDS Control Organization (NACO) has set up dedicated funding
for engaging NGOs in National AIDS Control Plan and delegated responsibility to
the State AIDS Ce
Cells
lls (SAC) for the allocation, management and monitoring of funds
to NGOs

Vietnam - An HIV/AIDS Law to protect rights of PLWHAs, including measures

against stigma and discrimination progressively came into effective. The work of
NGOs, local activists with UN and Central Commission for Ideology and Culture, for
2 years through seminars, joint consultations and publicity through media
 % Asia-Pacific countries having laws, regulations or policies that
present obstacles to effective HIV prevention, treatment, care and
support for specific vulnerable sub-populations

* Not including Marshall Islands, Palau, and Tuvalu

Source: “Law, Policy and HIV in Asia-Pacific” – a Desk Review by www.aidsdatahub.org

 Legal status of sex work in Asia-
Asia-Pacific
Illegal Legal Limitations to Legality
Afghanistan Indonesia Crimes against decency/morality sometimes applied
Bhutan Legal for females over the age of 18; illegal for males. Metropolitan
Brunei Darussalam Bangladesh Police Acts of Dhaka, Rajshahi, Sylhet, Chittagong, Khulna, and
China Barisal prohibit the sale or purchase of sex in public places
DPR Korea Cambodia Prohibited by the constitution; Law on the Suppression of Human
Fiji Trafficking and Sexual Exploitation sometimes applied for related
Japan+ activities
Lao PDR Hong Kong Most related activities are illegal, such as public solicitation, causing
Maldives or procuring another to be a prostitute, living on the prostitution of
Mongolia others, or keeping a vice establishment
Myanmar India Most related activities are illegal, such as the selling, procuring, and
Pakistan exploiting of any person for commercial sex as well as profiting from
Papua New Guinea the prostitution of another
Philippines Malaysia Soliciting is illegal
Republic of Korea Forced prostitution is illegal; public order and obscenity laws
Nepal
Thailand sometimes enforced
Vietnam Singapore Most related activities are illegal, such as public solicitation, living on
the earnings of a prostitute, and maintaining a brothel are illegal
Soliciting is illegal; Vagrancy Act 1978 used for arresting sex workers
Sri Lanka
for loitering
Government regulations prohibit persons from organizing
Timor-Leste
prostitution
Source: “Law, Policy and AIDS” – a Desk Review by www.aidsdatahub.org
 Effectiveness in monitoring the delivery of the program
Assessment of Monitoring and Evaluation Systems
N Bangla- Cambo- Indone- Malay- Mongo-
Content area China Fiji India Lao
o. desh dia sia sia lia
A M&E plan of the NSP has been
1 Yes Yes Yes Yes Yes Yes Yes Yes Yes
developed
1.1 Endorsed by key partners in M&E Yes Yes Yes Yes Yes Yes Yes Yes Yes

Developed in consultation with civil

1.2 Yes Yes No Yes Yes Yes Yes Yes Yes
society
Yes, but
Yes, Yes, Yes, Yes,
only Yes, most Yes, all
1.3 Partners have aligned with M&E - No most most most most
some partners partner
partners partners partners partners
partners
2 The M&E budget is secured No No No No Yes Yes Yes Yes No
In In In In
3 Functional M&E unit Yes No Yes Yes No
progress progress progress progress
4 Strategy for data collection and analysis Yes Yes yes Yes Yes Yes Yes Yes Yes

Well-defined standardized set of

5 Yes Yes yes Yes Yes Yes Yes Yes Yes
indicators
6 HIV sero-surveillance Yes Yes yes Yes Yes Yes Yes Yes Yes
7 Behavioural surveillance Yes Yes yes Yes Yes Yes Yes No Yes
8 Guidelines on data collection tools Yes Yes yes Yes Yes Yes Yes No Yes
9 Strategy for assessing data quality Yes Yes yes Yes Yes No Yes No Yes

Strategy for data dissemination and use,

10 Yes Yes yes Yes Yes Yes Yes Yes Yes
including yearly publication

11 National and sub-national database No Yes yes No Yes Yes No N/A No

Source: UNGASS Country progress reports 2008, www.aidsdatahub.org

 Effectiveness in monitoring the delivery of the program
Assessment of Monitoring and Evaluation Systems
N Myan- Pakis- Phili- Singa- Sri Thai- Viet-
Content area Nepal PNG
o. mar tan ppine pore Lanka land nam
In In In In
1 A M&E plan of the NSP has been developed Yes Yes Yes Yes Yes
progress progress progress progress
1.1 Endorsed by key partners in M&E Yes Yes Yes - Yes - NA - Yes

1.2 Developed in consultation with civil society Yes Yes Yes - Yes - Yes - Yes

Yes, but
Yes, Yes, Yes,
Yes, all only yes, most
1.3 Partners have aligned with M&E most - most - - most
partners some partners
partner partners partners
partners
Yes
2 The M&E budget is secured No No Yes Yes - No Yes Yes
(mostly)
In
In In In
3 Functional M&E unit Yes progres Yes Yes Yes Yes
progress progress progress
s
4 Strategy for data collection and analysis Yes Yes Yes Yes Yes Yes Yes Yes Yes
5 Well-defined standardized set of indicators Yes Yes Yes Yes Yes Yes Yes Yes Yes
6 HIV sero-surveillance Yes Yes Yes Yes Yes Yes Yes Yes Yes
7 Behavioural surveillance Yes Yes Yes Yes Yes Yes Yes Yes Yes
8 Guidelines on data collection tools Yes Yes Yes Yes Yes Yes Yes Yes Yes
9 Strategy for assessing data quality Yes Yes Yes Yes Yes Yes Yes Yes Yes
Yes
Strategy for data dissemination and use,
10 Yes (partially Yes Yes Yes No Yes Yes Yes
including yearly publication )
Yes
11 National and sub-national database Yes (partially N/A No No Yes Yes Yes Yes
)
Source: UNGASS Country progress reports, 2008
 Assessment of Monitoring and Evaluation Systems: Proportion of
countries reporting selected key components (N=18)

National and sub-national database 50

Strategy for data dissemination and use, including yearly publication 89
Strategy for assessing data quality 89
Guidelines on data collection tools 94
Behavioural surveillance 94
HIV sero-surveillance 100
Well-defined standardized set of indicators 100
Strategy for data collection and analysis 100
Functional M&E unit 44
T he M&E budget is secured 50
Partners have aligned with M&E 61
Developed in consultation with civil society 78
Endorsed by key partners in M&E 78
A M&E plan of the NSP has been developed 78

0 10 20 30 40 50 60 70 80 90 100
Percent

Source: UNGASS Country progress reports, 2008, www.aidsdatahub.org

Level of success in meeting its objectives
Buddhist Leadership Initiative - multi-country Mekong sub-regional
initiative

Individual and community change

• Increased knowledge of HIV & AIDS
• Improved community understanding and acceptance of PLWHA
• Increased support and involvement of PLWHA – formation of self help groups to
expand livelihood options for PLWHAs

Organisational change
• Increased engagement of Monks and Nuns and the broader Temple-based
programmes to address HIV/AIDS needs of the community

Church initiatives – Church partnerships in PNG, Timor Leste; Myanmar –

several faith-based leaders organized to provide care and support to over 15,000
OVCs.

World Vision and Caritas International among international faith-based NGOs

engaged in large scale programmes across Cambodia, Laos, India, Myanmar,
Thailand and China
 Private sector
ILO Code of Practice, HIV/AIDS at the Workplace

Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC)

have become an essential part of the response. In 2008, a GBC led
pledge was signed, committing 111 multinational businesses signatories
to end HIV discrimination and stigma in the workplace Asia Pacific
Business Coalition on AIDS (APBCA) and Asian Business Coalition on
AIDS (ABCA) supports set-
set-up and coordination of country-
country-level business
coalitions

Coca-Cola China - initiated an AIDS Orphan Care program in partnership

Coca-
with the Yunnan Provincial Women and Children Development Center,
providing support and care to AIDS-
AIDS-impacted orphans from 75 villages
across the region www.businessfightsaids.org

ADB building HIV Clause into Fidic Guidelines for procurement of services
in infrastructure sector (Transport, energy, etc)
 Scalability
CSO’s work is mostly small-
small-scale. Scalability
requires national leadership and coordination, as
well as financial support

Thailand – Positive Partnership Program

China - A community-
community-based care program supported by a network of
women living with AIDS decreased loss to follow-
follow-up from more than 80%
to less than 10% in pilot areas. Women’s groups providing referral services
for testing and prevention of MTCT, drug adherence counseling and
monitoring support raised the early antiretroviral (ARV) treatment rate from
30% to 60%, and drug adherence levels from 60% to 95% among women
participating in the program
 Percentage of infants born to HIV infected women who
received HIV test within 12 months, 2008

7% 6
6
6%

5%

4%

3% 3
2
2%

1
1%
0
0%
Nepal Pakistan Lao PDR Philippines Papua New Myanmar
Guinea

Source: Towards Universal Access_ Scaling Up Priority HIV Interventions in the Health Sector_ Progress Report, 2009,
www.aidsdatahub.org

13
Percentage of HIV positive pregnant women
receiving ART for their own health, 2008
Children risk losing their mothers – a new generation of AIDS orphans
25%

20%

14%
15%
12%

10%
6%

5%
2%
1%
0% 0%
0%
Pakistan Lao PDR Papua New Nepal Philippines Cambodia China
Guinea

Source: Towards Universal Access_ Scaling Up Priority HIV Interventions in the Health Sector_ Progress Report, 2009,
www.aidsdatahub.org
14
 Percentage of MARPs reached with HIV
prevention programme – Female Sex Workers

2005/2006 2007
100

80

60

40

20

Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

 Percentage of MARPs reached with HIV
prevention programme
programme--IDU
2005/2006 2007
100

80

60

40

20

0
Bangladesh China India Indonesia Nepal Pakistan Philippines Viet Nam

Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

 Percentage of MARPs reached with HIV
prevention programme
programme--MSM
2005/2006 2007
100

80

60

40

20

Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

 Local stakeholder buy in

Cambodia’s Continuum
Continuum--of-
of-Care ((CoC
CoC)) -Cambodia integrated the
response into a decentralized public health care system with strong referral
networks, and involving community-
community-based organizations and people living
with HIV (PLWH). Strong NGO/PLWH involvement provided psychosocial
support, help reduce stigma and discrimination, and give valuable
feedback to public health officials contributed to the effectiveness of this
approach

Indonesia’s Spiritia – A national support network formed in 1995,

assists 65 groups of people living with HIV throughout the country by
providing treatment education, basic fact sheets and training in advocacy.
Members of the Spiritia team regularly visit most of Indonesia’s 35
provinces, documenting treatment, care and support and encouraging local
government to improve services
 B. Efficiency
Engagement of CSO/NSP enhances efficiency overall, but fund
channeling is process heavy

“The Five year Evaluation of the Global Fund (2007-

(2007-2009) reported
that the Country Coordinating Mechanism model ‘is ‘is perceived to be
one of the most innovative and positive contributions of the Global
Fund, which has provided an opening for participation that was
previously non-
non-existent in a number of countries
countries..

The Global Fund's CCM model has already led to a substantial shift
in the dynamics between civil society and the government in many
countries by increasing the participation of civil society and of
PLWAs governance and in HIV/AIDS prevention and care
programs”
 C. Equity – increased share to CSO

Civil society organizations are at disadvantaged and get reduced funding

under Direct Budget Support - when countries adopt SWaPs and/or pooled
funding policies

The Global Fund with its emphasis public-private partnership is the only
financing mechanism which has made participation of civil society
mandatory for awarding grants to countries

Dual Financing policy,: some 40% of the representation in the CCM is of the
non-government sector including the private sector (the minimum
recommended by the Global Fund)

Bangladesh - 3 PRs – Save the Children for prevention among MARPS,

ICDDR,B for research and government for policy, advocacy and linkages
across the MOH and other ministries.

Majority of CCM leadership rests with the government

 Increased private sector contributions, but
participation in national planning minimal

The private sectors’ financial contribution has also been increasing

during more recently.

2003 - private sector contribution was 1% overall support

2007 - the Global Fund raised $80 million from the private sector -
5% of overall support - which increased to 6.6 percent of all
contributions in 2008. This includes annual $100 million
contribution from Gates Foundation.

Six per cent of Global Fund financing is being channeled to private

sector recipients.
 D. Financial sustainability

NSPs in most other countries rely heavily on external sources such

as the Global Fund, PEPFAR, and international NGOs.

Question of sustainability of important community-

community-based service
delivery particularly of treatment and care interventions and
whether low-
low-income countries can rely indefinitely on international
aid to pay for treatment programs

Many donors pledge only for a limited time-

time-span (i.e. 2
2--3 years),
making it very difficult to anticipate donor support beyond this
timeframe. Eg
Eg.. in Cambodia, very few donors have pledged funding
beyond 2012.

Source: Information taken from financial gap analysis in GF Rd 9 proposal

 External resources and domestic spending on
HIV/AIDS
domestic funding external funding
100%

80%

60%

40%

20%

0%
2004

2007

2004

2007

2004

2007

2004

2007

2004

2007

2004

2007

2004

2007

2004

2007

2004

2007

2004

2007
Cambodia China India Indonesia Lao PDR Nepal Pakistan Phillipines Thailand Viet Nam

Source: “MARP – All Indicators”, Regional Overview, www.aidsdatahub.org

 Source of AIDS funding in some countries in
the region
Public Sub Total International Sub Total Private Sub Total

Thailand

China

Pakistan

Philippines

Indonesia

Cambodia

Viet Nam

Mongolia

Nepal

Lao

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

Source: UNGASS country progress reports, 2005 & 2008, www.aidsdatahub.org

 Civil society involvement in the HIV response
in Asia Pacific

100%

80% Asia Pacific Other countries

60%

40%

20%

0%

% countries where CSOs are % countries where CSO % countries where CSO
involved in development of services are included in implementation supported
national HIV plan national response

Source: “MARP – All Indicators”, Regional Overview, www.aidsdatahub.org

 HIV and AIDS estimates in Asia, 1990-
1990-2008

Source: UNAIDS_AIDS Epidemic Update, December 2009 * Without Pacific Region

Challenges to Effective NSP Participation

• Restrictive policies and legal frameworks to promote

and protect CSOs, NGOs, private sector in national
policy making

• Minimum standards for service provision – need to be

developed, exist in few countries

• Greater technical support needed for capacity

development of NGOs, CSOs
 Way forward
• Support meaningful participation in national policy
planning and development processes

• Removal of restrictive measures and clarity on roles of

NSPs in provision of HIV/AIDS services

• Expand role of private sector in reaching most-

most-at-
at-risk
groups (migrants, truckers, workers)

• Strengthen collaboration with philanthropic foundations

• Explore PPP for greater social protection measures to

minimize impact of HIV/AIDS
 For group work

• Opportunities
• Challenges – risks
• Conditions