My guest this week is Nandini Oomman, director of the Center for Global Development’s HIV/AIDS Monitor. Her team has just released a new report, Zeroing In: AIDS Donors and Africa’s Health Workforce, which looks at how AIDS programs could be better designed to strengthen the capacity of nurses and doctors in developing countries. On the Wonkcast, Nandini and I discuss the report, and also explore the overall lessons learned from the HIV/AIDS Monitor, which is wrapping up its work this year after four years of operation.
The new report identifies six ways donors could minimize the negative spillover effects major donor HIV/AIDS programs can have on health systems in recipient countries. Until now, Nandini explains, donors have adopted an emergency response approach to AIDS, putting a priority on training a large number of health workers specifically to provide HIV/AIDS treatment (and, to a lesser extent, work on HIV prevention).
“So you then have a situation where it’s a weak health workforce and all the workers you would normally use to respond to a broader set of health priorities are focused and incentivized to perform on an AIDS treatment program,” says Nandini.
By focusing instead on the sustainable, long-term development of health workers with a broad range of skills, Nandini says, donor programs could treat AIDS while also fostering positive health outcomes across the board.
Under Nandini’s direction, the HIV/AIDS Monitor forged new ground at CGD. Much of our research seeks fresh policy solutions to specific problems. In contrast, the HIV/AIDS Monitor examined the practices of three very large donor programs—the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the World Bank—which together spend billions of dollars annually, and offered concrete suggestions for improvements.
To understand how the donors operate on the ground—in particular where and how the money was being spent and what effect it was having—Nandini’s team in Washington collaborated with local researchers in three aid recipient countries--Mozambique, Uganda, and Zambia.
One legacy of the Monitor, Nandini explains, is the wealth of information it has generated on donor programs—information that simply wasn’t available just a few years ago. “When we started, we had no data,” Nandini tells me. “When we went to the countries, our researchers had to seek out donors and their own governments to get data, and this was a very difficult thing.” In some cases, the work of the in-country Monitor teams inspired recipient governments to launch their own efforts to track donor spending and to press for more effective assistance.
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My thanks to Wren Elhai for his very able production assistance on the Wonkcast recording and for drafting this blog post.