Geographic prioritisation in Kenya and Uganda

A power analysis of donor transition

Bibliographic Data

ID21881315
AuthorsLigia Paina (0000-0002-8403-7825, Johns Hopkins University, corresponding author), Daniela C Rodríguez (0000-0003-2523-1123, Johns Hopkins University), Henry Zakumumpa (0000-0002-8169-1151, Makerere University), Caroline Mackenzie (IPSOS-Kenya, Nairobi, Kenya), Freddie Ssengooba (0000-0003-3489-0745, Makerere University), Sara Bennett (0000-0001-8094-8798, Johns Hopkins University)
Year2023
Volume8
Issue5
Pagese010499
Publication date2023-05-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010499
PMID37236658
OpenAlexW4378470501
LanguageEN
Citations received5
References cited27

Introduction Donor transition for HIV/AIDS programmes remains sensitive, marking a significant shift away from the traditional investment model of large-scale, vertical investments to control the epidemic and achieve rapid scaling-up of services. In late 2015, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) headquarters instructed their country missions to implement ‘geographic prioritisation’ (GP), whereby PEPFAR investments would target geographic areas with high HIV burden and reduce or cease support in areas with low burden. Methods Using Gaventa’s power cube framework, we compare how power is distributed and manifested using qualitative data collected in an evaluation of the GP’s impact in Kenya and Uganda. Results We found that the GP was designed with little space for national and local actors to shape either the policy or its implementation. While decision-making processes limited the scope for national-level government actors to shape the GP, the national government in Kenya claimed such a space, proactively pressuring PEPFAR to change particular aspects of its GP plan. Subnational level actors were typically recipients of top-down decision-making with apparently limited scope to resist or change GP. While civil society had the potential to hold both PEPFAR and government actors accountable, the closed-door nature of policy-making and the lack of transparency about decisions made this difficult. Conclusion Donor agencies should exercise power responsibly, especially to ensure that transition processes meaningfully engage governments and others with a mandate for service delivery. Furthermore, subnational actors and civil society are often better positioned to understand the implications and changes arising from transition. Greater transparency and accountability would increase the success of global health programme transitions, especially in the context of greater decentralisation, requiring donors and country counterparts to be more aware and flexible of working within political systems that have implications for programmatic success

Business · Civil society · Economic growth · Economics · Mandate · Political science · Politics · Service delivery framework · Global Maternal and Child Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Public Administration · Marketing

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