By Kate Hawkins, STEPS Centre member

The past decade has witnessed a change in the public health funding landscape – with the rise of global health initiatives as well as increases in bilateral funding for health sector development. Action on HIV/AIDS has been associated with high profile programmes such as the Global Fund to Fight AIDS, TB and Malaria and the US President’s Emergency Plan for AIDS Relief as well as large philanthropic initiatives such as the Bill and Melinda Gates Foundation.

How to improve the aid architecture for health is a hot topic. Recent weeks have seen publication of a report from the World Health Organization’s Maximizing Positive Synergies Collaborative Group and a widely read editorial in the Lancet about the effect of global health initiatives on efforts to strengthen health systems.

Critics of global health initiatives have claimed they lead to inefficiency, duplication, lack of country ownership and the co-option of national agendas by international agencies and the private sector. Many health actors have called for greater simplification of the way that aid for health delivered often favouring sector wide and general budgetary support. However, others have cautioned that budget support needs good governance, transparency and real ownership by the citizens of countries if it is to deliver the health outcomes that are needed.

In some respects explorations of the aid architecture have tended to represent the view ‘from above’ or to concentrate on tracking the flow of funds. Very little research has been conducted into how community groups experience the new aid for AIDS – how sovereignty and the politics of knowledge at local level are influenced by these global health relationships. Whilst funding directives might provide constraints they may also open up new possibilities in the negotiation of appropriate local responses to the epidemic. These may influence the relationship between citizens and the state.

To address this gap in the knowledge base IDS is working with the Research for Equity and Community Health (REACH) Trust (Malawi), Institute of Economic and Social Research of the University of Zambia and the African Population and Health Center (Kenya) on a three-country research project, ‘Aid for AIDS’, which will highlight community level stories, as well as perspectives of government and international representatives, and will provide lessons for future donor policy.

The long-term vision underpinning this study is of a World where local people have appropriate resources, knowledge and informed access to options for transcending significant health and social challenges.

To find out more about the project contact Hayley MacGregor.