IFGH 2012: National Level Human Resource Constraints in Implementing Donor-Funded HIV/AIDS Programme in Lesotho

Authors:Biesma R.² Makoa E.¹, Odonkor P.¹, Tsekoa L^.1, Mmpemi R.¹, Brugha R.²

Author Affiliations:1Faculty of Health Sciences, National University of Lesotho, 2Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland

Option 1– Scientific / Empirical Research Findings Presented as – Poster

Background:

Resource-poor countries in Sub-Saharan Africa with high HIV/AIDS prevalence have multiple donors to assist them in their national responses. Over the last years, development aid for HIV/AIDS had increased dramatically. There is limited evidence on how health authorities in developing countries cope with rapid changes in administrative, policy and socioeconomic contexts in which they work.

Aims:

To assess the performance of the main government stakeholders responsible for managing and implementing a donor-funded HIV/AIDS programme in Lesotho using a framework on knowledge absorptive capacity.

Methods:

In-depth key informant interviews with 22 representatives of the government, bilateral and multilateral development agencies and a review of key documents. Data were analysed using Atlas Ti software.

Results:

Capacities for implementing innovative and parallel financial management and reporting mechanisms in ministries were often weak. Even if staff capacity was strengthened to fulfill Global Fund requirements, they were easily lost because of migration of staff to non-governmental organisations and out of the country, where they would receive more attractive salaries and incentives. Decentralisation processes, which aimed to shift the locus of much decision-making to lower levels of government and to facilities, were not being fully implemented, despite this being a component of the Round 5 Global Fund grant. The Ministry of Health was not ready to delegate power, there was poor capacity of district health management teams; and centrally made Global Fund supported programmatic plans were not easily integrated into local administrative structures.

Discussion/conclusions/ implications:

Poor program management skills and an over-reliance on administrative norms and bureaucratic regulations at central level are dysfunctional to implementing multiple large-scale donor-funded health programmes. Application of the framework revealed how vulnerable African governments are to loss of staff capacity.