VIII. Strengthening Multilateral Actions

“The United States is committed to working with other nations to reduce suffering and to spare lives. And working together is the key. Only through sustained and focused international cooperation can we address problems so grave and suffering so great.” President George W . Bush, May 11, 2001

The crisis of global AIDS is too great for any one entity to solve. Turning the tide will require a sustained collaborative effort from a multitude of international, national, and local organizations leveraging their comparative strengths. Not only are there extraordinary resource needs, but the diverse drivers and consequences of the disease, and its many complicated interactions with a variety of other social, political, and economic circumstances, demand an equal number of diverse actors with varied expertise.

President Bush’s Emergency Plan makes an unprecedented commitment of resources and focuses funds on the U.S. Government’s strengths in providing technical assistance, training, research, and material resources to dramatically increase health care infrastructure and capacity to address HIV/AIDS effectively, including providing treatment. The Emergency Plan recognizes, however, that strengthened health care systems are but one powerful tool in combating HIV/AIDS. Many other essential requirements, including such basic needs as clean water and adequate nutrition, present barriers to a successful HIV/AIDS response. Conflict, famine, and gender inequality all make contributions to the spread of HIV and the devastation of AIDS, and must be addressed.

The President’s Emergency Plan commits a significant proportion of its resources to the Global Fund to Fight AIDS, Tuberculosis, and Malaria in recognition of the fact that the Fund is a promising global force in the fight against AIDS and offers important opportunities to address needs complementary to other elements of this strategy. Other multilateral institutions and international organizations, such as UNAIDS and its “Three Ones” principles, WHO and its “3 by 5” initiative, the World Bank, and the World Bank’s International Bank for Reconstruction and Development, have also provided essential global leadership, expertise, and resources, particularly in the areas of advocacy, government and civil society collaboration, HIV/AIDS and economic development, and health sector response (including HIV/AIDS surveillance, prevention, treatment, and care). Organizations such as the World Food Program (WFP), the United Nations Children’s Fund (UNICEF), the United Nations Development Program (UNDP), the International Labor Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations High Commissioner for Refugees (UNHCR), and the International Committee of the Red Cross (ICRC) have HIV/AIDS programs focused on specific needs or populations, such as food security, mothers and children, workplace issues, refugees, migrant workers, and youth.

The contributions of these multilateral institutions and international organizations working with great dedication to combat HIV/AIDS provide a vital opportunity for a comprehensive response. The U.S. Government will strengthen its relationships with multilateral institutions and international organizations to amplify global action against HIV/AIDS by encouraging coordination to fill gaps in current activities and ensure efficient use of funds. Effective collaboration, however, requires addressing several of the challenges currently facing the international community in its fight against HIV/AIDS.

Duplication of program efforts and an uncoordinated response, especially in the most afflicted nations where so many have initiated programs, must be avoided. Harmonized proposal, surveillance, reporting, and accountability requirements will avoid placing additional burdens on governments already weighed down by the disease burdens of HIV/AIDS, malaria, and tuberculosis. As an international community, donors should commit to promoting best practices and evidence-based interventions and adhere to high standards for resource allocation and management. At the same time, recognizing that HIV/AIDS is a global emergency, donors should ensure that funds are quickly dispersed to organizations effectively serving those in need, with an eye to building local capacity for a sustainable long-term response.

The U.S. Government will use the full range of diplomatic tools to engage international organizations as partners in the fight against HIV/AIDS. Under President Bush’s Emergency Plan, efforts will be made to strengthen U.S. participation on governing boards and to consult closely and often with both the leadership and working levels of the multilateral and other international organizations working on HIV/AIDS. Across the world, the United States will coordinate programmatic and diplomatic efforts at the local level in order to enhance the effect of global contributions. Together with the strength of USG bilateral programs, effective multilateral engagement and action will win the war on AIDS.

Multilateral Objective:
Ensure a comprehensive and amplified response to global HIV/AIDS through leadership, engagement, and coordination with multilateral institutions and international organizations

Multilateral Strategies:

1. Coordinating programs to capitalize on the comparative advantage offered by each multilateral organization, including targeting multilateral strengths to unique challenges

2. Working to harmonize proposal, reporting, and strategic information systems across all multilateral and international organizations

3. Promoting evidence-based policies and sound management strategies

4. Encouraging expanded partnerships that build local capacity

1. Coordinating programs to capitalize on the comparative advantage offered by each multilateral organization, including targeting multilateral strengths to unique challenges

True progress against HIV/AIDS will require a comprehensive response that addresses the diverse drivers and consequences of disease. The United States will focus its interventions on health care and human services approaches to HIV/AIDS prevention, treatment, and care that capitalize on its expertise in technical assistance, training, and research. Many multilateral organizations have vital expertise in specific areas. For instance, WHO addresses the health sector to HIV/AIDS and works closely with health ministries. The ILO focuses on HIV/AIDS in the workplace and the rights of workers living with HIV/AIDS, while the WFP focuses on food security and nutritional needs. ICRC and UNHCR are able to reach refugees and displaced persons, while many other organizations focus on improving the status of women. Each of these interventions, and those from other agencies both in and out of the U.N. system, is important to a comprehensive and effective response to global HIV/AIDS, and contributions are amplified when they are coordinated.

The U.S. Government will strongly encourage coordination to fill gaps by:

• Engaging, through the U.S. Global AIDS Coordinator, the leadership of multilateral and international organizations to identify and then complement comparative strengths;

• Encouraging the development of one in-country structure that can failitate coordination between donors, host governments, people living with HIV/AIDS, and NGOs; and

• Ensuring that U.S. missions, through their networks of public affairs, refugee, economic, health, and development assistance officers and other specialists, are working with their in-country counterparts in the field.

2. Working to harmonize proposal, reporting, and strategic information systems across all multilateral and international organizations

Harmonization of proposal, reporting, surveillance, management, and evaluation procedures across all multilateral and international organizations is a key to the success of global HIV/AIDS efforts. Harmonized procedures both ensure comparability of different programs across countries and decrease the burden on host organizations and governments. The U.S. Government will actively participate in harmonization efforts with WHO, UNAIDS, the Global Fund, and other multilateral organizations, through the participation of U.S. Government representatives to each of these bodies. Harmonizing multilateral efforts includes engaging all the partners within a given organization to follow through on agreed commitments. The United States will use its bilateral relationships to further and strengthen the U.S.-supported goals of multilateral organizations. Activities include:

• Actively working to ensure that all resolutions and commitments agreed to in the multilateral area are compatible with our bilateral policies;

• Using our bilateral relationships to come up with creative ways to work together to further those goals agreed upon within our common organizations; and

• Working to adopt the same monitoring and evaluation, procurement, and reporting standards to ease the work of recipients.

3. Promoting evidence-based policies and sound management strategies

President Bush’s Emergency Plan recognizes that the nature of the HIV/AIDS crisis urges immediate action, yet interventions must reflect sound science and management. The large influx of resources for combating global HIV/AIDS from both bilateral and multilateral donors makes best practices and accountability for use of those funds even more important, particularly to sustain public support for the AIDS effort. The U.S. Government will strive to ensure accountability for its contributions, both through multilateral and bilateral efforts, and will encourage partners to do the same.

To achieve maximum impact against the disease, funds must be targeted to effective interventions. Two decades of HIV/AIDS work have revealed an evidence base on which to begin building effective programs. The United States will work closely with technical organizations such as WHO to determine the best range of options for treatment, prevention, and care, and will promote the adoption of such established best practices across all areas of multilateral action. Specifically, the U.S. Global AIDS Coordinator will:

• Actively work with the Global Fund Secretariat, through the U.S. Executive Director’s Office at the World Bank and elsewhere, to ensure a focus on results-based management of HIV/AIDS projects;

• Use the “parallel project review” process mandated by Congress to lead an internal USG review to ensure that all proposals recommended to the Global Fund Board for approval are technically and developmentally sound, demonstrate that added resources will bring results, and meet high programmatic and financial accountability standards;

• Use the programmatic expertise of the Department of Health and Human Services and policy experts at the Department of State, both in the United States and in countries in which the U.S. Government has HIV/AIDS program presence and expertise, to evaluate proposals and their impact potential on the ground;

• Provide guidance to U.S. Government representatives to multilateral organizations on the technical efficacy, need, and management strategies of proposed programming; and

• Collaborate with other donors, including the Global Fund Secretariat, to encourage other nations to undertake a similarly detailed review in countries where they have expertise to ensure the best possible outcome for recommended projects.

4. Encouraging expanded partnerships that build local capacity

The U.S. Government will encourage multilateral organizations to work through local partners and existing mechanisms within the host country’s national strategy wherever possible, and, where this is not possible, to make building local capacity a strong priority. Multilateral organizations that serve as in-country implementing partners will also be encouraged to have phase-out goals for a country’s “graduation” from the need to rely on outside sources for management or implementation of programs.

Governments, NGOs, and the private sector all have a role to play in this effort. The U.S. Government will work both within multilateral organizations and through embassies to identify and support NGO and private sector providers to participate in partnerships and build their capacity to manage programs at the local level. The U.S. Government will:

• Set an example in capacity building by including “graduation” language in our contracts for bilateral grants with all non-local organizations;

• Continue to support the Global Fund’s commitment to including similar “exit strategies” in their grant agreements with UNDP and other major multilaterals serving as temporary principal recipients and will work to ensure this goal is achieved; and

• Facilitate the creation of co-investment strategies with private sector partners and/or local government partners to deliver services that will serve as models for the rest of the world.

Back to Table of Contents