Urgent Action for an
Intensified and Unified Approach

28-29 October 2002
 

Professor Desmond Cohen 

HIVDEV Consultant 

October 2002 
 

Not to be circulated in altered form without permission of the author

High-Level Consultation on UN Country Responses to AIDS: 
Urgent Action for an Intensified and Unified Approach

This Discussion Brief arises from the recent evaluation of UNAIDS, but is 
not a summary of the Report. It is intended as a guide for the discussion in 
the light of the analysis and recommendations contained in the evaluation. 
The Brief has taken as its remit the broader question of how best to take 
forward the strengthening of the UN systemÕs response to HIV/AIDS at country 
level, within the reform processes presently underway. A summary of the main 
recommendations of the Evaluation Report relevant to operations at country 
level is provided in Section III of the Brief, and these recommendations are 
clearly important for the restructuring of UN operations. However, the 
discussion of options for going forward is not confined to the 
recommendations of the Report. 
 

I. Imperatives for Action for the UN System

The UN system has been actively involved in supporting the response to the 
HIV epidemic since the 1980s, initially through activities managed by WHO 
[Global Programme on AIDS] and subsequently since 1996 under the auspices of 
UNAIDS. The structures established in the mid 1990s had their origins in a 
developing concern about the epidemic which clearly threatened to undermine 
sustainable development, and at the same time demonstrated the willingness 
of the UN system to innovate in terms of new structures to address issues at 
global, regional and country levels. 

While UNAIDS appears at first sight to be a confusing arrangement its logic 
is in fact easy to understand. It was initially a joint programme of 6 UN 
agencies [now 8] who agreed to act as cosponsors, ie. to subsume policy and 
technical direction of their activities on HIV and AIDS to common processes 
of governance, with a Committee of Cosponsors consisting of the heads of 
agencies, and a broader based Programme Coordinating Board with 
representation of stakeholders. The Joint Programme is advised by a 
Secretariat located in Geneva which has a defined set of tasks, which 
include policy guidance, and technical and other support to the cosponsors. 

A number of considerations were dominant in the establishment of UNAIDS in 
its present form. These included the following: 
 

* The need for the response at country level to HIV/AIDS to be 
strengthened and to receive the priority in the UN systemÕs activities that 
it warranted ? the ECOSOC resolution [1994.24] was clear in the guidance it 
gave that country level operations had to be at the forefront of the 
activities of the new Joint Programme. 

* That the response had to be multi-sectoral and involve activities 
that crossed many traditional development boundaries, and thus required new 
and innovative approaches to the complex social, economic and political 
issues raised by the epidemic. 

* Fundamental to the shift to a multisectoral response was the 
perceived need for the Joint Programme to work within new frameworks and new 
partnerships, and to be a structure that was built on collaborative 
processes that arose from social mobilsation within countries. 

* To be able to work differently and more effectively, the cosponsors 
had to operate within common frameworks of policies and technical processes, 
and thus had to coordinate their operations at country level within new 
structures [UN Theme Group on AIDS]. The UNTGs would receive technical 
guidance and support from the Secretariat both to strengthen the UN country 
response, and to ensure technical and policy coherence in the activities 
pursued by the agencies at country level. 

* The cosponsors were expected to strengthen their capacity to deal 
with issues of HIV/AIDS, and to allocate more financial and human resources 
within organizational structures that integrated HIV and AIDS in their core 
activities. 

Do these considerations still apply? The evidence from many sources, 
including the Evaluation of UNAIDS, is that they are if anything even more 
relevant than they were at the establishment of the Joint Programme. The HIV 
epidemic has deepened over the past decade, and while there has been 
progress in many directions, it is still the case that there are huge 
challenges still to be met in putting in place effective multisectoral 
responses, that are genuinely reflective of broad social mobilization within 
countries. 

In increasing numbers of African countries the whole social, economic and 
political structure is threatened by the impact of the epidemic, such that 
sustaining national capacities will require enormous efforts by the 
multilateral and bilateral donors, NGOs and others. In the response at 
country level the UN system has if anything an even more crucial role to 
play, given its technical and other outreach, and its perceived neutrality 
and political independence. 

If the Joint Programme and the Secretariat are to be relevant and effective 
then they need to learn from their experience and must change the ways in 
whichÊ they operate. There remain many important areas where reform is 
essential if the Programme and the Secretariat are to meet their key 
challenge, which is to strengthen the support provided to countries in their 
response to the complex problems of the epidemic. In part the problems 
remain what they have always been ? too little capacity in cosponsors, 
inadequate levels of funding for HIV/AIDS, a failure in general to integrate 
AIDs in core activities, and weak commitment to effective coordination at 
country level, together with too few examples of joint programme development 
between cosponsors. 
 

II. The Joint Programme Structures at Country Level

These have evolved over time and in the light of experience. One of the most 
important elements, that of the UN Theme Group on AIDS, was foreseen by the 
original ECOSOC resolution, but in general there has been eclecticism with 
respect to organizational arrangements rather than working to an agreed 
blueprint. While a particular structure has evolved over time, with common 
elements, the actual working arrangements have reflected many variables, not 
least those of the personalities and experience etc. of those involved at 
country level. The most comprehensive accounts of some of the important 
issues that have arisen at country level are to be found in UN Support to 
Country Level Responses to HIV/AIDS: in- depth Assessment of the UN Theme 
Group on HIV/AIDS 

[UNAIDS, May 2002], and in the UNAIDS Evaluation Report]
 

UNAIDS Country Programme Advisors

There are now 56 CPAs and in recognition of their essential role the PCB has 
recently agreed to add a further 10 posts. Not all countries have benefitted 
from the presence of CPAs, and some CPAs are responsible for more than one 
country. The tasks and responsibilities of the CPA are complex, and require 
skills and competences of the highest order if they are to be undertaken 
effectively.Ê They not only have to support the UN Theme Group on AIDS in 
its functions [see below], but they are also expected to provide assistance 
in technical and other areas to countries [most obviously to the National 
AIDS Programme], and to act as a channel between the country and the UNAIDS 
Secretariat in Geneva. It is evident from some of the reports that CPAs have 
not always fully achieved the responsibilities placed on them. 

In part the difficulties that CPAs have often faced arose from weaknesses in 
the processes involved in their deployment. Initially there was little 
discussion with the cosponsors about appointment processes and task 
identification, with inevitable results in terms of misspecification of 
expectations. UNDP, for example, appointed its own National Professional 
Officers for AIDS in 20 countries some of which duplicated countries with a 
UNAIDS CPA, and with some functions that appeared to overlap. There have 
been ongoing problems in terms of location of responsibility for the 
activities of CPAs, where the Secretariat in Geneva existed at the end of a 
long and not always effective chain of control. While at the same time the 
Chair of the UNTG, and sometimes the RC, all placed demands on the CPA that 
were often impossible to meet. 

In part the perceived problems with CPAs had their origin in a changed 
perception of the tasks that needed to be met at country level. It was 
probably inevitable that the initial appointments of CPAs should be drawn 
from a pool of expertise that was heavily weighted towards public health, 
and that in part reflected a time-lag in adjusting to a multisectoral 
response to the epidemic. Skills and experience of CPAs were, therefore, not 
always well aligned with the new tasks facing the Joint Programme at country 
level, with inevitable problems. Over time these problems of task 
identification and CPA competence have been partially overcome with a much 
wider range of skills and experience sought in appointments, and with more 
attention paid by the Secretariat in training etc for new appointments. 

Over time Chairs of Theme Groups and RCs have become more aware of what can 
be expected of CPAs, and of the loci of responsibility for their activities. 
One major improvement has been in the establishment of the Country and 
Regional Support Department of the Secretariat, which has aligned objectives 
and structure with UNAIDS support at country level. Within the CRD there are 
not only Geographical Divisions but also a Support Unit with among its 
functions that of Theme Group Support. There is now also clear specification 
of the tasks of CPAs and a start has been made with monitoring and 
evaluation of country performance. 

It appears that many of the organizational issues have been resolved and 
CPAs can now count on much better organizational support from the 
Secretariat. It is also clearer what the relationships and responsibilities 
are between the CPA and Theme Group Chairs, although given the fact that 
Chairs are revolving positions, and the appointment of new CPAs, there 
continues to be a need for learning by all involved. 

Perhaps more substantively what remains is the issue of how to ensure that 
support for countries moves beyond the development of national strategy 
plans for AIDS to actual implementation. This is an issue that the 
Evaluation Report rightly identifies as one of the key challenges facing
UNAIDS at country level. The other, and related challenges, are social 
mobilization in many [perhaps most countries], plus the need for effective 
political leadership on issues of HIV/AIDS. These tasks will require skills 
and competences, plus Secretariat support, that still have to be recruited, 
developed and delivered. How are these tasks to be achieved? 
 

UN Theme Group on AIDS

As noted above the UNTG on AIDS was an organizational element of the country 
response identified by ECOSOC, and subsequently attempts have been made to 
ensure that UN system operations on AIDS at country level are consistent 
with UN reforms [such as UNDAF]. However, the performance of UNTGs has 
varied widely across countries, and it is increasingly clear that in general 
they cannot as presently constituted undertake the tasks that are expected 
of them. The UNAIDS Evaluation Report has set out the main issues, and these 
are broadly confirmed by other analyses of the problem. 

The UNTG on AIDS was seen as primily addressing one of the key criticisms 
of the UN system made by countries [and by bilateral donors]. This was that 
the UN contribution to the response at country level was indeed important, 
but that it was largely ineffective on account of the lack of coordination. 
It was argued that poor results arose from overlapping mandates of agencies; 
ineffective machinery at the country level for coordination of projects and 
programmes relating to HIV/AIDS, together with inconsistent technical and 
policy advice on HIV-related issues. The appointment of the CPA was intended 
to ensure that there was consistency with respect to technical matters, 
along with support for UNTG Chairs in taking forward issues of coordination 
between cosponsors, and in strengthening UN system relations with country 
counterparts and other stakeholders [including OECD donors].* 

Central to the improvement of UN system activities at country level were 
issues of coordination, and the UNTG on AIDS was expected to deal with this 
issue. This was not simply for the sake of coordination as such, but in 
order to ensure that UN programmes were mutually supportive of each other 
and focussed on issues that reflected country priorities. There was never 
any real expectation that the cosponsors would engage in joint programming 
given their different mandates and organizational structures, but it was 
hoped that at least there would emerge over time consistency in what was 
planned and implemented within countries. 

Thus through processes of coordination would emerge benefits in terms of 
country support, that arise from synergistic UN activities. Everyone was 
expected to gain from effective coordination: countries would know what to 
expect from the UN system by way of support, which would display greater 
transparency in its operations and consistency and coherence in what was 
delivered. Such benefits were also expected to accrue to other stakeholders, 
such as NGOs and OECD donors, who would also gain from the greater clarity 
and improved coordination deriving from the new UN structure. This seems not 
to have been achieved even in cases where the an expanded Theme Group has 
come into existence [with cosponsors and other stakeholders attending 
meetings ? in some countries chaired by a national representative]. 

Experiences in UNTGs have not exactly turned out as planned, although there 
is a wide variation in structure, in frequency of meetings, and of 
membership. There are a number of repeated criticisms, of which the main 
ones are the following: - 

   * That coordination of cosponsor activities remains deficient, and this 
     in spite of the development of Integrated Workplans [IWPs]. The latter 
     were initially seen as a mechanism for ensuring consistency between the 
     activities of cosponsors and potentially a means of bringing about 
     joint programming. The evidence seems to be that IWPs are not achieving 
     their objectives; are not even consistent with UNDAF requirements, and 
     are often little more than inventories of cosponsor activities 
     developed largely independently of each other. 

   * One of the main positive achievements of UNTGs and CPAs has been the 
     production, under conditions of reasonable conditions of consultation, 
     of strategic plans/frameworks. However, as noted above there is still a 
     major problem of translating plans into action. UNTGs have been largely 
     unsuccessful in moving forward on implementation and this remains one 
     of the major tasks confronting the Joint Programme. Furthermore, 
     because of the weakness of IWPs most of the activities undertaken by 
     the cosponsors in country are poorly correlated with what is in the 
     strategic plans, whereas the objective should be for the IWPs to be 
     based on plan objectives and be integrated with the overall country 
     response. 

   * It has perhaps been inevitable but there has been wide variation in 
     performance of UNTGs [whether in the expanded version or not]. In part 
     this reflects the varying commitment and time available to the Chairs 
     of the Theme Group, who typically have excessive work demands without 
     that of AIDS. Shifting to a pattern of rotating Chairs may have helped, 
     as also has been the inclusion of CPAs in the UN Country Team, but 
     these seems not to be the solution to the problem of varying 
     performance in key areas relating to country support. 

   * Much of the work of the UNTGs has actually been undertaken by Technical 
     Working Groups where the focal points of the cosponsors [and others in 
     some cases] come together regularly to discuss issues, review project 
     proposals, etc. This is potentially an important development and 
     something on which to build a more structured response. But it has its 
     own problems: many of the FPs are quite junior and inexperienced and 
     are over-burdened with other responsibilities in addition to AIDS. They 
     are in the nature of a temporary resource only, given staff turnover, 
     and they require training if they are to become more professional. 

   * Finally, the UNTG structure is lacking in accountability for what it 
     does and how well it does it. Apart from the fact that the Chair of the 
     TG is appointed by the RC there is little or no accountability for 
     performance. UN agency representatives in country are held to different 
     standards with respect to performance by their HQs, and none of the 
     cosponsors appear to have regular requirements in terms of reporting to 
     their HQs on HIV/AIDS. There appear also to be no formal mechanisms for 
     local accountability, even in the case of expanded TGs, which are 
     sometimes chaired by country nationals. 

It should be noted that the evaluation did not look at 
cosponsors activities at country level so an important element in forming a 
judgement about overall effectiveness of the Joint Programme is missing. It 
is also the case that some of the recommendations of the Report relate only 
indirectly to country level operations [eg. on the roles of the CCO and PCB] 
and while these are very important their effects are likely to be some time 
in changing the reality of what happens on the ground. 

The following is a brief resume of the main recommendations that directly 
relate to country level activities. No attempt is made in detail to comment 
on these, except to note that some of the recommendations, if they are 
accepted, would require adjustments to existing systems of a fairly radical 
nature. For example, more direct funding of cosponsors at country level 
requires financial capacity for control and disbursement that is often 
available at country level only in UNDP [hence the existing arrangements]. 
Furthermore, the World Bank does not actually determine budgetary frameworks 
nor allocations within countries, such that its authority in this area 
mainly extends to advisory functions. Other recommendations also have 
extensive implications for the cosponsors [such as those relating to agency 
functions, the appointment of RCs, accountability of UNTGs, joint 
programming etc]. The main recommendations are as follows: - 
 

   * There remains an ongoing need for advocacy, with a greater focus on 
     issues of women and other marginalized groups. 

   * Programme activities need to build on what has been achieved in terms 
     of strategic planning by a shift from planning to implementation. This 
     shift needs to be accompanied by a scaling up of activities that builds 
     on knowledge of what works. In the case of the latter there is an 
     urgent need to evaluate the activities that have been undertaken so as 
     to draw out the lessons of what makes for effective programmes, and to 
     then apply these in multiple settings. 

   * There is a need for much improved information flows about cosponsor 
     activities on HIV/AIDS at country level, and the integration of 
     HIV/AIDS as a cross cutting element in national budgeting [where the 
     World Bank is thought to have influence in determining public 
     expenditure frameworks and budget allocations]. 

   * Integrated Work Plans are 'a failure', and their deficiencies cannot be 
     remedied through bureaucratic reform processes. Instead the PCB should 
     look at how to use financial incentives as a mechanism to make IWPs 
     more effective. 

   * Programme Acceleration Funds have been a 'valuable facility' whose 
     effectiveness can be improved through changes in processes and in 
     objectives [with more emphasis on evaluation and monitoring 
     activities]. 

   * CPAs 'are key to the success of the programme at country level' and 
     their numbers and country allocation needs to be kept under constant 
     review by the PCB. 

   * There is effectively no accountability in respect of operations at 
     country level by UNAIDS, such that the PCB needs to 'make specific 
     arrangements to define operational accountability of the joint 
     programme to national stakeholders'. Efforts need to be made to support 
     Òpartnership forums that are managed and led by national authorities' 
     where conditions make these feasible. 

   * Regional activities of UNAIDS [of both the Secretariat and the 
     cosponsors?] have been productive in addressing cross-border and 
     regional issues, and the Inter Country Teams of the Secretariat 'should 
     not be used for internal coordination among regional offices of the 
     cosponsors''. Activities at regional level should be 'demand driven by 
     countries in the regions and linked to sustainable political entities'. 

The previous sections are all reflective of the past ? although 
they are also to a degree descriptive of the present. There are clearly 
problems with the UN system's present performance, and everyone accepts that 
if the Millennium Goals and UNGASS targets are to be realized then there 
will have to be significant reform. The broad outline of the major changes 
that are needed are implicit in the above discussion, and are set out more 
as options for discussion in this and the following section. Initially, 
however, it is useful to briefly set out certain important considerations 
that act as constraints on what the UN system can be expected to achieve in 
terms of strengthening its support for country level activities. 

   * Most countries' AIDS activities are heavily dependent on development 
     assistance, such that continuing present levels of activities will 
     depend on maintaining existing flows of funding [and other resources]. 
     To implement multisectoral programmes will require significant 
     additional funding, and this will be especially true if there are major 
     changes in access to care and treatment [including ARV therapies]. 
     UNAIDS has estimated that overall requirements for funds will rise from 
     about $2 billion in 2002 to $9 billion in 2005. The gap is huge, and 
     seems unlikely to be filled. In addition countries in SSA with 
     deepening social and economic problems due to HIV/AIDS will require 
     major additional external assistance. 

   * UN agencies, whether cosponsors or not, are not going to be sources of 
     significant funding for country level programmes. The only cosponsor 
     which does not fit this statement is the World Bank, but significantly 
     the Bank has largely distanced itself from involvement in UNTGs, IWPs 
     etc and has more or less largely gone its own way. How to more actively 
     coordinate the activities of the World Bank with the other cosponsors 
     is therefore one of the key issues for discussion. A similar discussion 
     is required of the Global Fund which is an additional source of funding 
     for country level activities, but is similarly weakly integrated with 
     the more general UN response. It should be noted that the funding of 
     the Global Fund is itself very limited, and in no way matches the 
     estimates of the sums needed. 

What kind of role does this leave for the UN system, and more specifically 
for the cosponsors other than the World Bank? Within the constraints of 
financial resources the objective is to do well the kinds of things that 
that the UN is good at. Tthis sounds like a tautology but it means building 
on system strengths and engaging in reform where this will improve 
performance. A typology of possibilities is set out in Table 1 [Annex], 
based on the assumption that the role of the UN would vary across countries. 
In other words the UN would engage in further prioritization of its 
functions and activities in relation to the stage of a country's 
development. In practice this would mean that resources would be focused on 
the least developed countries in sub-Saharan Africa where the epidemic is 
most severe, and in the poorest countries of Asia. 
 

The functional areas that would seem to make sense are as follows:- 

* Advocacy and policy guidance; goal setting and monitoring of 
performance [eg. in relation to UNGASS and goals for sustainable development 
as reflected in the Millennium Declaration]; technical cooperation in 
respect of capacity development in areas crucial for the national response 
to AIDS: budgetary support for the most resource poor countries.
 

*  Integration of HIV/AIDS in core activities of all UN agencies, both 
those that are cosponsors and those that are not [such as FAO, WFP, UNHCR, 
and so on]. It is evident that while the UN system may face budgetary 
constraints on what it can achieve in terms of HIV-specific programmes, it 
can nevertheless through policy and programme integration in core activities 
significantly increase the resources that are brought to bear on the HIV 
epidemic. 
 

* Within the cosponsors a series of reforms are needed to increase 
their effectiveness at country level. These include many issues that are 
currently the subject of UN reform processes, which have as their aim a 
better coordination ofÊ programmes across agencies. It is clear from country 
experience that IWPs are inadequate for the task, and that UNDAF needs to 
establish better systems for achieving this overall objective. UNDAF and 
cosponsors need also to look at constraints in the way of joint programming, 
and to seek to establish mechanisms for shared activities between 
cosponsors. This means looking again at cosponsor mandates so that they 
reflect a willingness of agencies to work collaboratively on HIV/AIDS, 
together with a review of financial and other arrangements so as to 
encourage joint programming. 

The balance and range of specific tasks for the cosponsors and for the 
Secretariat will vary within regions and across countries [see table]. But 
as always effective outcomes will depend on ensuring that activities are 
focused on problem solving, and are supported by appropriate organizational 
structures. From the Evaluation Report and other empirical evidence it is 
clear that the substantive focus needs to be on a limited number of areas. 
These are identified below, without any detailed explanation as to their 
inclusion. 

 
* Informed advocacy about the epidemic with a continuing focus on the 
threat to sustainable development; including political dialogue that aims to 
ensure ongoing commitment to effective, multisectoral responses to the 
epidemic by political leaders. Central to this process of political 
dialogue, and programme development and implementation, are processes of 
capacity development ? both of organizations and of human resources ? at all 
levels. 
 

* The collection, analysis and production of strategic information as 
the foundation for ensuring that the response to the epidemic is located in 
the reality of the situation facing countries. It is essential that data 
needs be seen as extending beyond HIV surveillance and include also a range 
of social, cultural and economic information upon which to base 
interventions aimed at generating outcomes that change key behavioural 
parameters. 
 

* In most countries there is a need to scale up activities, and 
efforts need to be concentrated on bringing services and support to a much 
greater range of people. How this is to be achieved within capacity and 
resource constraints remains one of the key problems facing UNAIDS and other 
stakeholders. It cannot mean 'business as usual' in that existing programmes 
are often confined to a few urban areas in many countries, limited in range 
and quality, and often highly bureaucratic in their delivery. One of the 
challenges, therefore, is to localize the response as well as scale up. 
 

* All of the above tasks will require ongoing provision of technical 
support if capacity is to be developed, policies sustained and support 
provided for affected populations. To achieve these outcomes will mean much 
more attention to the conditions in which technical cooperation takes place: 
in the past there have been no coherent plans or processes to ensure that TC 
is effective. This is in part a reflection of weak coordination of 
activities within the Joint Programme[including the Secretariat of UNAIDS], 
and the weakness of overall coordination by Governments. 
 

* It is clear that there is a need for better focussed TC, in part to 
ensure that key objectives are met. It is still the case that developmental 
aspects of the epidemic are addressed hardly at all, and yet sustaining key 
productive sectors [such as agriculture, education, health and transport] 
has to be seen as the highest priority in resource allocation. Similarly 
with social mobilization - in most countries the extent of general 
involvement and commitment falls well below what is needed for an effective 
national response. Finally, in all countries there is an ongoing need for 
resource mobilization, and efforts need to be targeted on achieving much 
higher levels of both financial and other resource inputs 

As noted above the organizational arrangements of UNAIDS have to 
be aligned with the substantive activities outlined in the previous section. 
This is the challenge; to ensure relevance and effectiveness, and to build 
on what has undoubtedly been achieved by UNAIDS since its inception. It must 
be recognized, of course, that supposedly perfect structures may produce 
outputs of low effectiveness, given their inter-action with the reality of 
many countries, where there remains a good deal of resistance to facing up 
to the social and economic consequences of AIDS and how best to respond. 

Many of the possible areas for improvement have been identified, 
some by the Evaluation Report and other surveys, and others from experience 
in the field. The following are simply suggestions for assisting the 
discussion at the meeting, and it is anticipated that participants will have 
many other recommendations to make for improving overall performance. It 
should be noted, however, that organizational reform has costs as well as 
potential benefits, and that it is often preferable to build on what exists 
rather than to start afresh with untried structures. 

The less contentious areas for organizational review are as 
follows: - 

* Given that the epidemic has different intensities and takes 
different forms in different regions does it make any sense to have a single 
organizational structure everywhere [one CPA typically standing alone, and 
with a UNTG with a Chair chosen by the RC from amongst the agencies present 
in the country]? Commonsense would suggest that this 'one size fits all' is 
probably not entirely satisfactory, and that the 'model' needs to be looked 
at again. 

* Both the organizational structure and the resources, as well as the 
activities that are undertaken, need to be aligned with need. The Table 
[Annex] suggests one possible typology that might make sense, and suggests 
the alignment of the UN roles and activities with regional levels of 
development [and implicit resource availabilities]. An extension of this 
would be to recognize that the epidemic is having its greatest impact in 
sub-Saharan Africa, where the flows of resources and capacity are most 
constraining of effective responses, and where needs are greatest. It would 
follow that UNAIDS [possibly the UN system?] will need a much greater volume 
of resources and with strengthened organizational structures in country. 

* One suggestion is for the UN to appoint a high level representative 
for HIV/AIDS on the analogy with similar appointments in the case of 
humanitarian disasters. While this might look like a productive change in 
signaling a greater level of concern by the UN, it is by no means obvious 
that it would actually deal with the structural problems that have been 
identified. There is a great potential for actually making matters worse 
than they are at present in terms of overlapping responsibilities with the 
RC, and the appointment would not actually in itself address the real issues 
that have been identified of better programme coordination and delivery, 
scaling-up of activities, etc. In any case there may be a problem 
mis-specification in that the problems facing the most severely affected 
countries are not temporary as with humanitarian and other crises. 

While a new high level of representation might not be the way 
forward it is still the case that HIV/AIDS needs much higher levels of 
prioritization in the work of the cosponsors [and other UN agencies]. 
Shifting priorities in this way will follow, perhaps, from changes in agency 
mandates and from proposals contained in the Evaluation Report relating to 
the machinery of governance [reporting and other relationships between the 
CCO and PCB, and between these and the governing bodies of agencies]. 
Changes from this direction are unlikely to yield instant improvements and 
will at best generate reform over an extended period. 

Under more direct control of UNAIDS is the flow of resources at the 
disposal of CPAs, who are potentially in a much better position to influence 
country programme development.Ê They require not only more financial and 
human resources to be effective, but also to have a much higher status 
within the UN Country Team. There is a complex set of organizational and 
other reforms here that need to be identified and implemented: these include 
the following:

1. The human resource profile of CPAs, including their expertise and 
experience/seniority, which needs to be better aligned with the tasks that 
need to be undertaken. 

2. The financial resources at the disposal of CPAs and the degree to 
which these can be allocated independently of the UNTG [Chair] and of the 
Secretariat in Geneva. While the Evaluation Report is not exactly positive 
about the use of Programme Development Funds they do potentially hold out 
possibilities for strategic use that are presently not being exploited. 

3.  CPAs need to know what is happening in country in terms of what the 
cosponsors are planning/doing and of other stakeholders. There has to be a 
counterpart to whom Government can turn for information about what UNAIDS is 
doing, and a resource that can be drawn upon when information and guidance 
is required about technical and other matters. For the CPA to undertake 
effectively these complex and demanding functions then they require 
additional staff [nationals for preference] with appropriate experience and 
skills. But this may not be the case in all countries and not to the same 
extent everywhere [so decisions are needed on where to expand staffing and 
with what expertise, and with what task prioritization]. 

How is the UNTG to be assisted in meeting its functions as a 
mechanism for effective coordination [given that this is the key criticism 
of the Evaluation Report]? The IWP as an instrument of coordination is on 
the evidence not effective, but is this inevitable and what changes are 
feasible that could make IWPs work? In what ways would the cosponsors need 
to change, and how can the UNAIDS Secretariat assist them in putting 
together IWPs that meet everyoneÕs needs? Now if some of the suggested 
reforms made in the Brief are carried out then there could be both more 
resources for IWPs [through higher financial and other resource allocations 
to CPAs, and perhaps through other channels]. What seems required at this 
stage is detailed analysis of the functions of IWPs; of the resources needed 
to make them effective, and then technical support to Theme Groups by the 
UNAIDS Secretariat to ensure that IWPs become the effective base for 
cosponsor support to the national response. 

One of the main criticisms of the UNTG is its lack of 
accountability, and it is unclear under present arrangements how this can be 
increased. In practice there is little or no accountability for performance, 
or the lack of it, and this is clearly something that must be changed. The 
heads of agencies in country are busy people with multiple demands, so the 
work on HIV/AIDS is just another work requirement fitted in as best as 
possible. It is hard to see how this can be changed, although suggestions 
have been made for some time about agencies setting reporting demands on 
their representatives and building performance on AIDS into career 
appraisal. These are worth pursuing, and may or may not generate positive 
effects. More is obviously needed, although it is not clear what will make a 
difference. Possible changes are as follows:

1. To establish much more explicit guidelines for UNTGs, including 
reporting processes both to national governments and to the UNAIDS 
Secretariat. These reports need to be in an ex-ante and ex-post form, so 
that there is publicly available evidence about what the Joint Programme 
proposes to do, as well as reports of programme performance. Part of the 
process of accountability should be regular reviews of cosponsor activities 
in country that are available to stakeholders, and publication of programme 
and project evaluations. None of these changes would affect existing 
responsibilities, or agency autonomy, except for a requirement for 
transparency about activities. 

2. One of the missing elements in the present structure is the absence 
of any formal accounting by UNAIDS to any national forums for what it is 
achieving or failing to achieve. It could be argued that this is implicit in 
country representation on the governing bodies of agencies, and elsewhere. 
But these mechanisms are all rather remote, and too restricted in terms of 
knowledge and accessability. There is a need to look at other country-based 
processes, such as use of the extended Theme Group for some purposes and 
regular reporting to NACs [where these exist and are functioning 
effectively]. 

3. There is a need for much greater reporting requirements on agency 
performance at country level on issues of HIV-specific and HIV-related 
activities. These are at present weak to non-existent and need to become 
much more effective. Of course strengthening reporting etc would make little 
difference to cosponsor effectiveness and accountability unless HQs had the 
capacity to monitor and support country level operation. For this to change 
then cosponsors need to expand their technical support for country 
operations- and this means capacity development in the cosponsors. This is 
potentially a role for the UNAIDS Secretariat who may find it necessary to 
assist cosponsors in developing and retaining the needed capacity. 

4. Work practice and performance within UNTGs clearly varies a great 
deal. It is evident that issues of HIV/AIDS are usually in most countries 
taken as an agenda item at regular meetings of heads of agencies. This does 
not appear from the evaluations of UNTGs an effective way to operate. Again 
it is hard to see how management of UNTGs can be improved, unless specific 
instructions are given to RCs about their responsibility overall for UNTG 
performance. This might strengthen both the accountability of Chairs of 
UNTGs and of RCs [who have ultimate accountability]. Implicit in this 
suggestion is a move towards more formal guidelines setting out procedures 
relating to UNTGs that replace the present set of ad hoc arrangements. 

5. Very important for the overall performance of UNTGs would be a 
strengthening of the Technical Working Groups where these exist. This is the 
level at which much of the actual work of the cosponsors takes place, and it 
is more likely that effective coordination will be achieved through 
strengthening the skills and capacities of the cosponsorsÕ focal points than 
in other ways. Again there is a question mark as to how best to do this, and 
who would do it [including the role of the CPA in such capacity 
development]. 

Regional and Cross-Border Issues

One of the areas where changes are clearly needed relates to the regional 
activities of the cosponsors and the Secretariat [Inter Country Teams]. This 
matter is addressed by the evaluation team in a rather summary way, and yet 
it is important for ensuring coherence in terms of the support forthcoming 
to countries with respect to regional issues. This is not simply, as they 
suggest,Ê one of cross-border problems [such as labour mobility], but 
extends to other critical areas. Such as strengthening regional capacity and 
in drawing the lessons of what is effective in terms of programmes and 
applying these to other countries and sub-regions. Inter-country learning 
and the strengthening of capacity in regional institutions are important for 
improving the relevance and effectiveness of both regional and country 
activities. 

* What mechanisms need to be developed to ensure effective 
coordination of regional activities of UNAIDS? These would include 
strengthening structures for regional collaboration and improvements in 
horizontal learning so as to accelerate the application of regional 
expertise to country level and cross-border activities. 

Annex
 

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