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CITY
AIDS AMERICAS Americas Leadership Initiative for AIDS Competence in Cities |
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First Annual Workshop and Conference A Program of CIFAL Atlanta Session 3: Best Practices Sharing: Peer assist reviews Topic: Mobilizing Resources Mediator: Main points with potential for collaboration:
San Juan: we wrote letters to the mayor, and he responded, and now the HIV/AIDS program has changed drastically, it’s much more coordinated. Everything is now in one building- pharmacy, psychologists, gynecologists, outreach workers, and all focused on HIV/AIDS- because of the letters that we wrote. In a lot of the Latin countries, programs are working, and they’re getting the help they need, and you don’t see that in the United States. There was a big scandal with the AIDS funds in Puerto Rico. There was a big fraud. The director of the AIDS program stole more than 100 million dollars from patients with AIDS. He is now in jail. This led to our letter-writing campaign, demanding justice, and now we’re going in the right direction. AIDS has gone down very much in Puerto Rico. We now have condom programs, which many of the quasi-moralist programs don’t like, but what do we prefer…? It’s important to make contact with those individuals, like our mayor, who have control over the resources. Durban: I work for the municipality, and the letters people write to the mayor come to me, and I am frustrated that I can’t do anything. The government system is not yet in a position to access funds, and all the organizations on the ground don’t have enough funds. It discourages people who have come forward to call attention to the epidemic. South Africa is a big country, and this has become a very big problem. The literacy rate is very low. We depend on a large effort by outreach volunteers going door to door, and these people are scarce, and many of them end up infected as well. We need to give them the support they need to sustain their enthusiasm for the cause. Curitiba: We went in a different direction, we decentralized services. We have many different centers serving patients. We don’t work only with HIV; we are responsible for care in all matters of health. Sometimes you have to make decisions about what problems or patients must be prioritized. It does not matter whether you decentralize or centralize, but you have to use resources in the best way possible, you cannot have corruption, but not only that, we have to be very careful using the money efficiently. We need to work very hard to prevent the epidemic. The money is always insufficient for what we need. We evaluate ourselves in level 3. We want to identify possible sources. In Brazil, we have funds from the Ministry of Health, but we know this kind of source will stop one day, then what? How do we sustain the project and keep it going? I think sharing our experiences we can find a solution. World Bank: I work mainly on AIDS in sub-Saharan Africa. We look at how local governments address the problem. San Juan: We use our own resources and we have access to a municipal system that supports us to get positive results that will achieve a promising future. The center has collaborative agreements with other agencies, both nongovernmental and private. The center participates like a group planning for the prevention of HIV/AIDS. We look for different sources of federal and state funding, and we are supported by a supported by a complete municipal system. We count on municipal services that provide services to the HIV/AIDS community. There is not only state but federal funds, which a lot of people don’t know about it. We’re going to set up a resource list on the internet to direct us to such funding. I think this is a wonderful thing. Haiti: I would like to share 2 experiences. I co-founded an organization, volunteering for the Development of Haiti; we have existed for 18 years, fighting AIDS since 1987. We were only 22 years old when we founded it, so it was very difficult to get access to funds. People in Haiti prefer to give funds to older people, or people who will share the money with them. We have to talk about corruption as well. We developed a peer training method. We started training other young people, and they went out to train others. And now we are a national organization in all the provinces of Haiti. We have a seat in the country and we have access to global funds. The method we developed is working, even the government of Haiti uses this method, and they invite our organization to public television to promote our program. We have another organization that is following our same method. We believe the best way is to teach young people to teach other young people. That way they will be more confident and feel more comfortable talking to other young people about the issue. At first the schools did not want us to come and talk, but now we are gaining access. In some schools, they are now teaching AIDS prevention in class. Because we have worked with the schools, and now 5 schools have classes where young people come to talk about AIDS. The biggest problem has been with churches, especially the Catholic Church. But we have gotten the evangelical churches involved, which is surprising, because they were supposed to be against condoms and sex education. But since we are using young kids to teach other youth, we have made a big victory. At some schools, they will not allow youth to come in and teach about AIDS, but now they are sending children for AIDS education at centers outside of the school. We have rooms for students to stay at our center. The students have been very willing to learn. If we were looking for money to reach all those kids, it would be difficult, but we can maximize our limited resources by teaching kids to teach other kids. Mexico: The work of the civil society with people living with AIDS, and the help of the government, we have increased the resources available for AIDS treatment. This has been a process of lobbying with legislators. In 5 years, we are able to augment our budget 7 times. Now we would like to legislate it and turn this process into law, because it’s very difficult to negotiate the budget every year. We want to achieve economies of scale in buying medicines. We have been able to create a national guide for AIDS treatment. These advances have allowed nearly complete treatment coverage, but we have now dedicated too many resources at care, and too little to prevention. We need to work to obtain more resources for prevention. We need to look for ways to achieve the goals of the Global Fund. We are preparing to be able to access Global fund money, but we need to be able to find other funding sources, as well. We’re working on the preparation of new leadership at the level of civil organizations, through leadership conferences and meetings such as this one. Honduras: I am the national coordinator of a youth prevention project. Our main focus is not only prevention among youth, but also obtaining funds for rural communities that have traditionally had little access to funds. We have had difficulties with the Global Fund. The executive director of the program is looking for creative ways to distributive resources. Many NGO’s are not reaching the smaller communities. Or they take part of the money for overhead costs, making it difficult for resources to reach them. And despite requests for help and growing attention to the problem, we are not able to meet the growing needs. Honduras suffers from a lot of corruption as well. Not only do we work on the educational component, but we look for ways to teach skills to manage money to members of the smaller communities, so that they can bypass the NGO’s and the municipality. We want them to have the skills to manage funds for a municipality of about 10,000 people. There is a lot of transparency and responsibility and motivation, but we are worried that people may not have the skills to manage the funds. This is the same strategy the Global Fund has used in malaria. We create commissions of 4 people within the local communities and train them to manage the funds. San Juan: the Global Fund, federal government, etc give funds for AIDS, but local governments are taking money for overhead rather than spending them on AIDS. Local communities should be put in place a controller to make sure the funds are used properly. Argentina: There is an AIDS law that pays for medication (ARV’s) for those that are infected. The distribution is not centralized, each province distribute HIV medicine to infected persons. Another source of resources is from civil society, business, international organizations, and people living with AIDS. Each are interested in different themes, some may be more interested in vulnerable populations. Argentina receives resources from the Global Fund, which go to a coordinating mechanism, which includes representatives from all the principal actors listed above. Different NGO’s focus on different themes- sex workers, poverty, harm reduction, men who have sex with men, etc.- using money from the Global Fund. There are now generic drugs which have dropped the costs of drugs a great deal. We are concerned about how we can continue obtaining resources and making our programs sustainable. How can we sustain these programs which have been evaluated to be successful? To what extent are federal resources being mobilized? There is a small amount of money in the budget for prevention, but little for treatment programs. Things are much better in Buenos Aires than in the rest of the country. Ecuador: I believe that there are different paths of evolution in our different countries. The first step is to have money dedicated in the budget to the HIV/AIDS issue. The next step is to have a law that mandates how funds will be spent on HIV/AIDS, that guarantees a permanent figure for the AIDS program. The most important thing we’re doing is having a body to coordinate the use of funds targeted for HIV/AIDS. We have a national counsel of health, at each level of government, there is a counsel made up of members of civil society, and all institutions are represented. This puts a social supervision over the use of resources that are coming in from outside. He suggests that there not only be a national but an international committee directed towards creating sustainability of funding for AIDS programs. Durban: The local government is not competent to manage health in my country. The HIV/AIDS problem is so great now that everyone has to get involved. The government has said that it cannot do everything; people need to come in with their own initiatives. At this point, local government is not able to respond positively to the efforts of organizations on the ground. People are doing important work, especially women’s groups, but no one is supporting them, unless they have someone who knows how to write grants. There is a great deal of poverty, and adolescents living on their own because their parents are dead. We need a committee to make sure funds are used wisely, and to make a connection between funding sources and local organizations working on the problem that need support. I’m suggesting a process that takes place outside of the bureaucracy of govt. Is there a way for your connections and coworkers to speak out and act to make the changes needed to mobilize resources effectively? Are there people you can enlist or pressure to make such changes? There are rules that constrain us, and have to be followed. If you gather support and get signatures, and show government that a lot of citizens care about the issue, you can help effect change within the govt. You can’t be scared of speaking, because silence is our worst enemy. When there is silence, there are no funds. The funds are there, but you’re scared about what the government is going to do once you ask for those funds. I’m calling for a response which can assist people to go on with their lives while government organizes a larger response. We need to monitor and account for funds at every step of the way so that resources go to the right places. World Bank: One way to respond is for a local government to set up a “big-bang” response by enlisting multiple NGO’s. Charlotte: What about private sources of funds? Puerto Rico: There are large companies and wealthy individuals in Puerto Rico, to whom people have written and requested funds, and they have given funds, and monitored there use carefully. San Pedro Sula: We have been tackling the problem of prevention. There is always going to be a lack of resources in the conditions of our city. We could have given responsibility for the AIDS issue to the secretary of health, but it would not have been humane. We have a bank of information that lists all the NGO’s in our city, what funds have been invested, and what target populations they have been working with. We have seen corruption, and it is difficult to control when NGO’s don’t make exact reports of their finances. There’s an NGO that works with children and adults 10-25 years old. San Pedro has recently become a leader in textiles, and in any given factory there may be thousands of people working. The textile companies give funding for this social service NGO’s. The workers that test positive for HIV are discriminated against by the NGO, and lose services from the NGO. Now, there are legal resources for people to fight against the discrimination. We’re working with certain NGO’s to ensure that people receive their medicines Puerto Rico: I am very interested in the discrimination that has occurred against PWLA’s in Honduras, because I work for a human rights foundation in Puerto Rico, and we have lawyers who can help. Those practices are illegal everywhere, and we have to sue those who engage in them. It is possible to use current law to close such companies down. San Pedro Sula: We have had a lot of discrimination by private companies against persons living with AIDS. Some require that you get an AIDS test before they hire you. We have to seek more resources from every possible source. Honduras: How do we coordinate funds from diverse sources to ensure there is not duplication, etc.? San Pedro Sula: There was 86 NGO’s in our city in 2002 working solely with women and children in HIV/AIDS prevention. When they apply for funds, they say, we help children with AIDS, but when we ask for their financial statements, there is no proof that the funds that have been used for those purposes. When we asked for information, only 25 of these NGO’s responded. so we canceled their funding. San Juan- In Puerto Rico, you must prove that you are using the money for AIDS or you will lose funding. Session 3 Continued Curitiba: The issue of mobilizing resources is very important. Even though we provide universal access to treatment, and interdisciplinary work with different municipal secretaries, among many other services, there is always this bottleneck, which is funding. We’re working with the national AIDS program to get a new bus to do outreach work with adolescents. In Brazil, there is a great need to reach out to young adults. The bus will have multimedia presentations that really speak the language of youth. It will provide AIDS education to the youth. It costs $70,000. It’s an example of funding we receive from the federal government, which we can use as an investment. Of course, we are receiving funding from the federal government, but the municipal government is investing as well to add further support. Seattle: All of the funding that comes into our county, from the states, federal government, county, city, is all funneled through one body that makes decision about where the money goes. That body consists of 1/3 people living with HIV, that don’t have any conflicts of interest, health care providers that do have a conflict of interest, then other professionals, people from the faith community, etc. We have principles of how we work, and one of the keys is that you don’t duplicate work. The health dept got a van for a particular project. Now that van belongs to everyone and it gets moved around and used as needed. Have you always had this coordinating committee? When and how did you make the switch to having such a committee? It’s incredible that you can use the bus for other than its original purpose, and that it’s shared by different agencies without anybody getting irate or upset. I think the reason is that there is a belief that all resources belong to people living with HIV, not to an agency, or a government. We are very lucky. I don’t know how to make this happen. But the people who do HIV/AIDS work in Seattle aren’t doing it for personal gain. They’re doing it because they believe in it. The fundamental concept is that that bus belongs to the people who have AIDS, it is a tool to help them, and doesn’t belong to a particular agency. The resources belong to the people, and not to the government. Curitiba: Even if people living with AIDS can receive resources (AIDS is a key competency of our government). I am against giving the resources to the people. Seattle- The money doesn’t go directly to the people, it goes to a coordinating body that distributes it to agencies that help people living with HIV. The public health dept coordinates the sharing of the resources (e.g. the van), which they have lawful authority to do. If the different groups don’t coordinate services well, they can lose funding and resources. The organizations borrow resources from the govt. How did you all get to this level of organization? How did the different committees come together? Luck and timing. Seattle is a second wave city. When San Fran and other cities were getting buried by HIV, Seattle was just getting started. We had a strong activist community, very committed local and state officials. There were various committees at first, but they decided it would be more effective to come together since they were working towards common goals. People living with AIDS got really pushy, and through activism, they were able to promote a system that would look out for their needs. One person can make a huge difference anywhere. For us it was Dr. Bob Wood who was a physician, a gay man (most of the infected people in my area are gay), and a person living with HIV. He now works in the public health dept. He was one of the first people to say enough is enough and demand an adequate response to HIV in Seattle. Can this kind of funding and coordination come from the government side? Or does it have to come from the activists? The government laid out the rules by which the game should be played, although that was informed by the demands of activists. The government laid out who needed to be at the table for decisions to be made. The key was activists, providers, and government officials getting together and writing the legislation at both the state and federal level. It was key was that you had activists who were people living with HIV, who had no conflict of interest, rather than people living with HIV that had been recruited by different agencies to represent their interests. The CDC and the Ryan White Care Act were initially uncoordinated, and we had to give feedback to get them talking to each other. I encourage every country here to apply for funds from the Bill and Melinda Gates Foundation. They have huge amounts of money, and they love to fund organizing efforts. Rather than simply funding a project to fight AIDS, they would be more willing to fund an organizing effort that would help you use funds more efficiently. San Juan: You need the activists to be there to initiate the process. World Bank: In many countries, a lot of international aid goes into the federal government. And local governments can access these international funds by applying for federal funds, rather than going directly to international funding sources. PROCEDURE: The group has written post-it notes with important themes during the course of the meeting. They have decided to place a check mark on the two themes they find most important, in order to decide which points to emphasize from their group discussion. Curitiba: The most important thing is to know where the sources of funding are, whether they are from the government, or from foundations, or other private sources. It is important to find out the purposes for which those organizations give money. Each country has to decide what kinds of resources it needs, and establish projects to obtain the money. |
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