Tag Archive for HIV/AIDS

GSO Commentary — An action plan for outreach to small and medium enterprises (SMEs) and the informal economy in the fight against HIV/AIDS in Africa

Summary of a Planning Group Discussion on HIV/AIDS and Social Responsibility.
Geneva, Switzerland

A meeting of the GSO Planning Group was convened at the ILO on 19 July to develop an action plan for outreach to small and medium enterprises (SMEs) and the informal economy in the fight against HIV/AIDS in Africa.  Participants represented international organizations, NGOs, trade associations, and individual companies.

As was recognized in the GSO roundtable event dedicated SMEs and the Informal Sector on 31 May, the overwhelming majority of people afflicted with and most vulnerable to HIV/AIDS are employed in the informal economy, i.e. outside formal or organized economic structures. In the African countries in question, this sector has been estimated to account for up to 75% of non-agricultural employment.  The Planning Group discussed major existing initiatives targeted at the workers in this sector and considered where there were “gaps” in these programs.  Although there was concern about outreach to SMEs as well, the group recognized that the two groups were distinct entities, having disparate requirements with respect to assistance.  A wide array of existing toolkits are directed to SMEs, but very little material or information is available on how to reach people in the informal economy.  The participants recommended that the action plan focus on outreach to the informal sector, with an emphasis on the informal economy in African countries.

The plan will address a number of particular issues, including funding, capacity-building, education and advocacy, prevention, treatment and access to health, stigma and other legal issues and the investment climate.  Opportunities will be explored for specific pilot projects in targeted African countries.  The group will present a draft of the action plan for debate and adoption at a GSO planning group meeting in Geneva September.  A follow-up roundtable will be convened in October to evaluate the effectiveness of the action plan and pilot projects.  A report with recommendations will then be made for presentation at the ICASA meeting in December.

Existing Initiatives

Amongst the existing initiatives discussed by the group were the ILO/AIDS’ work on a draft set of guidelines for SMEs currently under development and a separate and broader initiative by the ILO’s Social Protection Sector on a handbook for the informal sector.  Another ILO unit, the Small Enterprise Support and Development Unit (SEED), has also prepared a toolkit on business development services for SMEs which could be developed to include an HIV/AIDS component.  The IOE reported that they are working with SEED on this project, but they themselves have also prepared a toolkit specifically for their members (national employers’ associations) on HIV/AIDS.  Other products directed at SMEs mentioned by the group included toolkits put together by GTZ, as well as a series of country papers by Merck that have a section dedicated to SMEs.   The ILO conducted a review of existing kits prior to embarking on its own toolkit exercise, and it offered to share the results of this study with other members of the Planning Group.

The IOE described its members’ struggle to understand what drives or keeps businesses in the informal economy, along with their ultimate conclusion that assisting companies in this sector was consistent with their corporate interests.  Key elements in the latter respect are commitments to formalization of the informal sector along with the creation of an enabling business environment.  More generally, there was widespread concurrence that HIV/AIDS programs, irrespective of their target audience, should not have a deleterious effect on the investment climate.  A lot of concern was expressed about developing products that were in fact beneficial to investment in the targeted sector, whether it is SMEs or the informal sector.

The group went on to a discussion about how SMEs and the informal sectors were distinct groups, each having unique requirements with respect to assistance.  It was agreed that a wide array of existing toolkits are directed to SMEs but that very little material or information is available on how to reach people in the informal economy.  More efforts need to be devoted to understanding the “gaps” in these programs.  Following this discussion, the planning group agreed that the focus of the GSO action plan should be limited to filling the gaps specifically on outreach to the informal sector and not, for the time being, on outreach to SMEs.

Developing the Action Plan

The group then reviewed the possible components of an action plan, including the extent to which it should be an “umbrella plan” versus a plan oriented to concrete examples.  The consensus was reached to combine the two as much as possible.  The emphasis should be on mobilizing public/private partnerships for action against HIV/AIDS through bridging to the informal sector, whether by large MNEs or SMEs or other entities.

The group then agreed that there was some urgency in conducting a mapping exercise of existing initiatives.  Several participants agreed to share their existing materials, and the ILO agreed to conduct a survey of its African members to gather additional materials.   The action plan would then incorporate this existing knowledge and identify issues for further research and analysis.  A better understanding was needed of the nature of the informal economy encompassing such issues as funding, capacity-building, education and advocacy, prevention, treatment and access to health, gender, stigma and other legal issues, and the changing nature of the investment climate.  Questions to be answered include:  Who is a recipient?  Who is a service provider?  What services exist in the informal economy?  What is the incidence of HIV and AIDS?  Should specific sectors be targeted?   The action plan will also identify a number of African countries for targeted pilot project development and will consult with local representatives of organizations that are oriented to working with the informal sector in these countries.

Available Resources

As regards the implementation of any plan that might be agreed, Katherine Hagen referred to her discussions with the Geneva International Academic Network, a local research program funded by the Federal Government of Switzerland, along with the Canton of Geneva.  The purpose of this initiative is to promote research oriented cooperation between local academic institutions and the international organizations.  The ILO and the Graduate Institute of International Studies have expressed an interest in cooperating with the GSO to organize a GIAN-funded project relating to the action plan under discussion.  GIAN would provide funding to cover the costs of two or three interns assigned to conduct academic research on specific topics in support of the action plan, as well as the travel costs of developing country participants in any multi-stakeholder events that might be scheduled.  Unfortunately, however, they cannot meet the costs of the time that regular GSO staff might put into the initiative.
A representative from the World YWCA said that her organization currently had 3 interns whose time could be devoted to the implementation of the action plan under discussion.  Similarly, an intern from Merck reported that her employer was in agreement with her being seconded to the project.

A website to enable communication between project participants would be set up and maintained by the World Bank.  The Bank was also willing to introduce links from private sector pages on its HIV/AIDS country pages to any toolkits that might be appropriate for use in a given national setting.

Conclusion and Next Steps

GSO will prepare a TOR for the development of an action plan and supporting research products.  The planning group agreed on the timeline as noted below.  The project will get underway as quickly as possible, with recruitment of interns and collection of available information to occur in August.   Research projects will be developed on specific related issues, and a draft action plan will be prepared by early September.  An agenda for the October roundtable will also be worked up and a preliminary list of participants will be identified.

The planning group will get back together in mid-September to review the draft action plan and progress on the supporting research products.  The revised materials will then be presented to a broad multi-stakeholder group of interested parties in a roundtable event in Geneva in October.  The roundtable agenda will include opportunities to discuss the specific research projects, as well as for debate and approval of a revised action plan.   Participants at the October roundtable will include the representatives of local organizations in the selected African countries.  These participants will be invited to identify how they and their respective organizations might support the action plan and proposed pilot projects.  A report will then be prepared of the roundtable discussion and revised action plan for presentation at the ICASA meeting in Abuja, Nigeria in December.

GSO Commentary — Reaching across the Public/Private Divide

Summary of a Roundtable Discussion on HIV/AIDS and Social Responsibility.
Geneva, Switzerland

A dialogue on “Social Responsibility and HIV/AIDS:  Reaching across the Public/Private Divide” was convened by the Geneva Social Observatory on 19 April 2005, at facilities made available by the World Health Organization.  This was the second roundtable in the GSO series on “Social Responsibility and HIV/AIDS.”  Katherine Hagen, Managing Director of the GSO, introduced the meeting by describing the continuing challenges associated with connecting private sector HIV/AIDS initiatives with public programs.  Following the initial GSO roundtable on 24 February 2005, which focused on “The Current State and Prospects for Public/Private Partnerships”, the participants had identified a number of the main issues for further discussion in the GSO series (see below).  The following issues from that list were intended to form the basis of the second roundtable:

•    How to overcome the barriers to involvement of the private sector in funding from the Global Fund (and other sources)
•    Dealing with the tensions and mistrust between public and private sectors,
•    Dealing with the tensions and mistrust between business and NGOs

This second session focused on the role of co-investment as well as a number of other constructive efforts at building partnerships.  As explained by representatives of the Global Fund, co-investment is a process through which the public sector, NGOs and corporations can leverage their HIV/AIDS interventions through efficient cooperation.  The roundtable participants were encouraged to share their views on what these initiatives tell us about reaching across the public/private divide and how this might contribute to the development of improved policies on public/private partnerships.  The group heard from the Global Fund, the World Bank, a bilateral donor, and individual companies, as well as UNAIDS, WHO, ILO, various NGOs, labour unions and trade associations.

Numerous models for partnership were presented – direct partnerships of a company with a government to develop a national health infrastructure for HIV/AIDS or to combine public and private services for a more coherent community-wide effort; working with NGOs to implement specific programs together; developing sectorally based programs; involving trade unions and employers’ associations; and linking up with new for-profit HMOs or other health delivery mechanisms.  As for the barriers to integrated programs, some participants expressed the view that the private sector has not done enough soon enough, but others suggested that the private sector has not been welcome to be recipients or even conduits of funding through the CCMs and the Global Fund.   Some suggested that the private sector needed to mobilize more of its own resources to fight the epidemic, while others suggested that more efforts should be made through the private sector and private initiatives.

Experimentation at the local community level is showing how the private sector might at least work with other Global Fund recipients.  There is considerable business momentum to participate in community-based cooperative programs, as well as to explore newer strategies linking up the larger companies with their contractors and suppliers.  Aspects of this involve the capacity and expertise acquired by individual companies on prevention programs, voluntary testing strategies, and implementation of care and treatment programs that can be shared with local communities provided there is a mutual benefit, as, for example, through access to reduced drug prices.  Some of this is also driven by a search for alternatives to an inadequate public health infrastructure, either through the encouragement of alternative (and sometimes subsidized) health insurance schemes – or, in the case of one major experiment, a public/private partnership that is exclusively oriented to building up a better public health infrastructure for HIV/AIDS.  The question of trust remains an important hurdle to make these kinds of partnerships work.

The examples discussed by the group were almost exclusively ones in which large multinational companies had a leading role, although there were a few accounts of employers associations and trade unions reaching out to their networks, albeit with very limited funds.  The issues discussed in today’s session clearly merit further consideration to promote a better mapping of initiatives as well as further consideration of a set of possible solutions for overcoming the barriers to improved public/private partnerships.  In the course of this series of roundtables, the GSO will seek to develop these aspects of a better information exchange.

Meanwhile, there are as yet unanswered question on how to get a wider variety of parties involved, and especially the SMEs and the workers in the informal economy. The third GSO roundtable will focus on this question – “Connecting with SMEs and the informal economy”- to be held on Tuesday, 31 May.

The list of issues identified at the first roundtable event included:

•    How to overcome the barriers to involvement of the private sector in funding from the Global Fund (and other sources)
•    Dealing with the tensions and mistrust between public and private sectors
•    Dealing with the tensions and mistrust between business and NGOs
•    The challenge of networking with SMEs and the informal sector
•    The changing dynamics of drug pricing
•    The changing dynamics of public/private cooperation in developing a health infrastructure and capacity-building in general
•    Applications of best practice in country-specific circumstances
•    Engaging the diverse perspectives from international organizations, donors, the private sector, NGOs, trade unions, and host governments for which the Geneva setting is well situated.

GSO Commentary — Summary of a Roundtable Discussion on HIV/AIDS and Social Responsibility. Geneva, Switzerland

Summary of a Roundtable Discussion on HIV/AIDS and Social Responsibility.
Geneva, Switzerland

The third GSO roundtable on “HIV/AIDS and Social Responsibility” was convened at the ILO on 31 May and addressed the theme of “connecting with SMEs and the informal economy”.  Participants from international organizations, governments, NGOs, trade associations, and individual companies shared their views and experiences and agreed to develop an action plan for outreach to people working in SMEs and the informal economy.  This event benefited from the experiences of representatives from the employers’ associations of Lesotho, Namibia and Uganda. Various field studies and surveys were also brought into the discussion, along with information about recent initiatives organized or funded by the ILO, World Bank, UNDP, the Global Fund, bilateral donors and private donors.

In the countries that are suffering the most from the HIV/AIDS pandemic, the overwhelming majority of people afflicted with and most vulnerable to the disease are in the informal economy.  At this roundtable, the focus was on SMEs and the informal economy in sub-Saharan Africa.  The discussion covered the way that the outreach needs to be targeted to these groups, the challenges that are particularly applicable, approaches to capacity building, the role of multinational enterprises, and the issues of health insurance and legal reform.

Targeted Outreach

Key findings show that there is a need to establish policies that are targeted to the circumstances of SMEs and the informal economy but that the policies also need to cover the full range of needs, including useful education and prevention strategies, practical and relevant non-discrimination strategies, information on how to access voluntary counseling and testing, realistic access to reliable and confidential treatment programmes, and viable options for care and support.  All participants also emphasized the disproportionate presence of women working in SMEs and the informal economy and the urgency of developing strategies for women and their particular needs, especially for prevention and control of their own lives.

The Challenges

One major obstacle to reaching out to the SMEs and informal economy is the state of denial about the pandemic. The perception among the SMEs is that AIDS is a society problem, not a business problem.  Even though these employers are experiencing high turnover, they do not incur a high cost in hiring new workers to replace the ones they lose.  Also, the stigma of publicly acknowledging HIV/AIDS is severe, and there is even reluctance among some SMEs to promote condom use.  Even where there is recognition that the losses do affect the business, the apparent costs of treatment and the difficulty of ensuring confidentiality are additional obstacles to action.

In spite of these obstacles, the urgency of promoting prevention strategies and encouraging people to seek testing and treatment calls for making the effort.  The first challenge is to convince them to create the time to listen.  One way of reaching the SMES is through integrating an HIV/AIDS component into other developmental tools, such as the “Improve Your Business” model or other general training programmes.   Also, NGOs can play an important role in reaching the informal sector.  Groups like the YWCA are especially well situated to use their existing programmes of education and empowerment to mobilize women, who are not likely to take time away from their stalls or other places of work, just to discuss HIV/AIDS.

In addition to information on prevention, voluntary counseling and testing is being promoted in many countries.  Participants reported that there is a general willingness to test, but the question is asked what next?  Drugs can’t be accessed so why test?  Even if there is an external donor who is willing to fund the effort, whether this is a public or private donor, there is the concern about sustainability once that external funding comes to an end.

The message needs to include the certainty of treatment.  One helpful development for effective outreach, therefore, has been bringing the prices of drugs lower.  Some lower-priced drugs are being channeled through governments, while others are being made available through faith-based organizations – it doesn’t matter which vehicle is used.  The question is how to include SMEs and informal sector organizations, as well as employer associations in these projects.

Capacity Building

The participants noted that considerable resources have been mobilized through the Global Fund, the World Bank and bilateral donors to help cover the costs of treatment, but they agreed that it has been especially difficult to direct those resources to SMEs and the informal economy.  For one thing, the private sector, no matter the size of the enterprise, is expected to be providing resources for the effort, not receiving them.  Revised policies for co-investment and other participatory frameworks need to accommodate the limited resources of SMEs and the informal economy.  For another, participants noted that both the labour and employer representatives and other workplace-oriented organizations have often been marginalized by the Country Coordinating Mechanisms (CCMs) because of their location and domination by Ministries of Health.  The group noted that one could help SMEs and informal sector operators to organize themselves as NGOs in order to participate in the CCM process.

Delivering skills training for preparing credible project proposals is another important priority.  Capacity building is in fact being done through programmes assisted by the ILO, the World Bank and UNAIDS.  The MAP programme, for example, is working with groups on how to mobilize the private sector through national business coalitions.  Private sector initiatives are receiving assistance in 17 Anglophone and 8 Francophone countries.  There is an increased focus on involving SMEs and the informal sector.

The Role of MNEs

The group noted that most of the private sector programmes to fight HIV/AIDS in the workplace are in the big multinational companies, whose programmes tend to be company-specific.  One approach for reaching smaller enterprises has been to promote MNE collaboration with SMEs.  Companies like Coca Cola, Nestlé and Ford were among those mentioned by the group.  The lesson they have learned is that the big companies have the expertise and the capacity to help others, but they can’t take the message to the SMEs or the communities at large on their own.  In many instances, this is done through SME and informal sector organizations, often sector-specific such as truckdrivers or contractors or small retail shopowners.  Some companies are also working with NGOs like the Red Cross or the YWCA to be effective.

Health Insurance

Actual delivery of treatment for HIV/AIDS continues to be a problem in Africa because there is no good health structure.  One proposal discussed by the group is to encourage private health care companies to fill the void.  Private HMOs, for example, are creating a package of services that includes HIV/AIDS.  It was argued that the extra amount that it costs to include HIV/AIDS treatment in an HMO is so token that it can be appealing.  Another option involves joining together through associations of small employers to promote cost-effective measures, such as health care delivery by medical staff assistants.  One avenue worth pursuing is to trace the ways the poor spend their money and analyse how it might be possible to connect their spending patterns to the purchase of premiums for health insurance.

Legal Issues

The protection of rights is another concern, which depends on having an appropriate legal and political framework.  The ILO has various conventions covering discrimination and occupational safety and health, but there are no ILO conventions on HIV/AIDS specifically.  Another concern is that HIV/AIDS is not recognized as a workplace sickness.  This is important for both prevention and treatment.  Although such protections are by definition only relevant to the formal economy, they are nonetheless important for the spillover effect of interactions between the formal and informal sectors.

Conclusion and Next Steps

The group concluded that many innovative ideas and valuable experiences had been shared in the course of the exchange.  In addition, there were other ideas and experiences in the previous two roundtables that had a direct bearing on the linkages to SMEs and the informal economy.  The participants agreed that the next steps should include pulling these various ideas together into an action plan, with visible options for the group to consider.  A small planning group should be convened in July from volunteers among the participants to develop a proposal for action.  Then, in September the GSO could convene a programme to debate and adopt this action plan.  There was broad consensus among the participants to proceed in this modified direction over the course of the next two scheduled dates in the GSO series.

Future dates include a planning group meeting on Tuesday, 19 July and a debate for an action plan directed to SMEs and the informal economy on Thursday, 15 September.  Participants are also encouraged to hold the date of Thursday, 17 November for a follow-up roundtable.

GSO Commentary — The Current State and Prospects for Public/Private Partnerships

Summary of a Roundtable Discussion on HIV/AIDS and Social Responsibility.
Geneva, Switzerland

The Geneva Social Observatory convened the first of a series of dialogues to look at how the private sector and the world of work can be better integrated into comprehensive national and global campaigns against HIV/AIDS.  Participants were invited from a wide variety groups with an interest in the campaign against HIV/AIDS – from intergovernmental organizations, donor governments, NGOs, trade unions, private sector associations, and individual companies. The preliminary exchange of views in this first event identified the following areas for further consideration in the roundtable series:

•    How to overcome the barriers to involvement of the private sector in funding from the Global Fund (and other sources)
•    Dealing with the tensions and mistrust between public and private sectors,
•    Dealing with the tensions and mistrust between business and NGOs
•    The challenge of networking with SMEs and the informal sector
•    The changing dynamics of drug pricing
•    The changing dynamics of public/private cooperation in developing a health infrastructure and capacity-building in general
•    Applications of best practice in country-specific circumstances
•    Engaging the diverse perspectives from international organizations, donors, the private sector, NGOs, trade unions, and host governments for which the Geneva setting is well situated.

This first discussion featured interventions from the intergovernmental organizations, large multinational companies, organizations representing small and medium enterprises, and non-governmental organizations.  The IGOs emphasized their interest in a rights-based approach and their normative expertise, with a focus on developing a co-investment strategy with the private sector.  It was noted that multilateral institutions like the WHO and the ILO and even the Global Fund tend to have good relationships with governments, but that entities from the private sector are often excluded from such relationships.

Representatives of SMEs pointed out that the campaign against HIV/AIDS is often perceived to be beyond their means, while other participants suggested that there are programmes for SMEs that are cost-effective.   Large MNEs are experimenting with a decentralized approach to awareness building and partnerships with strong NGO networks as well as their supply chains. The participants agreed that training programmes are always important, but they should also facilitate a broadened transfer of knowledge and other resources to others.

Thus, another role for multinational companies is to apply their core competencies to the campaign against HIV/AIDS.  MNEs, especially those in the health field, can and should leverage their knowledge about health care delivery.  There is also a need for better information about public/private cooperation in delivering health care and a need for greater experimentation in this area.

The discussion reaffirmed the need for public and private efforts to focus on building up the health infrastructure.   However, pharmaceutical firms and others involved in various aspects of health or health care delivery can only contribute to infrastructure development to the extent that there are markets for their products or services.  Other kinds of innovative tools are also being looked at through public policy in the regulatory arena or taxation or other kinds of policy initiatives that are seemingly unconnected to the HIV/AIDS campaign and yet have the potential to break open the logjam.  Something drastic has to happen to release the capacity bottlenecks in the system.  Other factors besides drug prices are currently more important, although there continue to be differential pricing issues and issues relating to research and development and the intellectual property rights of private pharmaceutical companies.

Finally, there was a general consensus that the potential for partnerships with the private sector should be encouraged in a wide variety of combinations.  Although the dilemma of how to improve direct public/private cooperation continues to be a serious issue, especially in Africa, there is also an accelerating array of other kinds of partnering opportunities that could contribute to a better involvement of the private sector in the campaign against HIV/AIDS.