In the new HIV and Aids strategy, government places responsibility on CBOs, among others, if the objectives set out in the plan are to be met. But there is one big frustration that the strategy and those who are pushing for it need to address. CHARLES MPAKA reports in this second of our two-part series
BY the end of 2020, Malawi should have diagnosed 90 percent of all people living with HIV.
By the end of that year, Malawi should have started and retained 90 percent of all those diagnosed with HIV on anti-retroviral treatment (ART).
By then, Malawi should have achieved viral suppression for 90 percent of patients on ART.
This is the agenda Malawi has set for itself in keeping with the goal by the UNAIDS for the world to control the HIV epidemic altogether by the year 2030.
The work towards those goals will be guided by the new Malawi National HIV and Aids Strategic Plan for 2015 – 2020.
In the plan, alongside other measures, the government banks on the active participation of community-based organisations (CBOs), among other players, in complementing public sector efforts if the 2020 objectives are to be achieved.
According to the strategy, primary prevention activities will target adolescent girls and young women, young men who want to protect themselves through VMMC [Voluntary Medical Male Circumcision] and those who are tested negative through prioritised testing efforts.
The targeted community activities include: demand creation for services, knowledge sharing on services, mobilising communities to access prevention services, conducting referrals of HIV positive individuals to health facilities and follow ups for ART clients to ensure treatment adherence, and providing psychosocial support.
“Those are activities that CBOs are best placed to handle,” says Maziko Matemba, chairperson for Malawi Network of Aids Service Organisations (Manaso) in the Southern region.
“But it is up to the government and national and international NGOs to give these CBOs the space and the muscle to function to their fullest potential,” he says.
The CBOs engaged in this story indicated they do not have all the means they need.
“We try our best but we can only go to some extent. When we apply for funding, we don’t get it. In the cases when we are lucky, our budgets are trimmed and we often get the money months or years later by which time prices of commodities have gone up such that the money hardly caters for our needs,” says Leonnard Zuze from Mapanga CBO in Thyolo.
In their applications, he says, they are commonly told they do not have the capacity to handle the amounts of money they ask for.
Cecilia Chivunga, Executive Director for Youth Impact, a local organisation based in Liwonde which also started as a youth CBO, says it is a lame explanation to deny the CBOs adequate support on the basis that they do not have capacity.
“We conduct voluntary counselling and testing. We walk to schools and youth gatherings to conduct mass awareness campaigns.
“In the case of our organisation, I have a university degree and we have a well-qualified accountant. So what does capacity mean?” she says.
Emily Banda, chairperson for the NGO Board, is equally dismissive of the argument of capacity.
She wonders: How do you rate some organisation’s capacity as low when you deny them the opportunity to employ the best personnel since you are limiting their salaries, if any?
“It’s something that is being created so that the gap is widened and they [the bigger organisations] find space.
“Smaller organisations are denied overheads, capital costs where they can buy institutional property like vehicles, computers and others. They are not allowed to have better salaries. So, how do you expect a local organisation to employ a chartered accountant and use the best accounting system when there are no good resources being offered?
“How do you expect a local organisation to ably monitor its activities when they have no transportation? How do you expect a local organisation to produce good reports when they have no computer and skilled personnel to do that?” she questions. [See side bar for more of Banda’s views].
On his part, Matemba argues that the issue of capacity is now an over-darned excuse meant to deny CBOs the opportunity to exert greater impact.
“Perhaps, it is time we defined what capacity means,” he says.
The CBOs complained that they do not have resources but district councils make demands that do not consider their situation.
“We operate from very remote locations and we don’t have the means to be travelling to district council offices every month to submit reports as is required. But district council officials demand that we travel to them to submit the reports.
“It is them that are supposed to come to us. They have at their disposal resources from the government and other donors,” said a member of one CBO from Chileka in Blantyre.
One district council official in Mulanje who spoke on condition of anonymity admitted the “unfairness of our demands” on the CBOs.
“But it is not true that we have resources. Not all councils have the means to travel to these rural areas to collect reports and conduct activities,” she said.
The debate can rage on but as Malawi gears for the new strategy, the role of CBOs is increasingly crucial.
And to enable them to brace up for the challenge, Manaso has been going around the country appraising its member CBOs on the new plan.
Formed in 1996, Manaso has a membership of over 900 organisations, 80 percent of which are CBOs.
“We have worked with CBOs and we know what they are capable of achieving,” Matemba says.
“But we are talking about a new plan now. We need to reorient the CBOs on compilation of reports. They need to revitalise their structures and improve their coordination with district council offices.”
But that is as much as Manaso can do because it does not disburse funding.
That is, even as the new strategy gets underway, banking on CBOs for its successful implementation, community organisations still have to battle with the ambiguous question of capacity – especially when it is defined in terms of money and equipment.
And whoever addresses that will have helped the country achieve the 2020 targets.