MAXIMIZING POSITIVE SYNERGIES - World Health Organization

of South Africa (GHI2, ND6). 26 Donors have also tended to concentrate on supporting existing
projects rather than financing new initiatives: as a result, few rural areas have health services other
than those publicly provided by the state.
Disparate government viewpoints on HIV/AIDS have historically affected the willingness of
donors to follow state guidance. Former high‐ranking officials gained international notoriety in
2000 for questioning the link between HIV infection and the development of AIDS‐related
conditions. Though national and provincial departments of health continued to treat AIDS‐related
conditions as outcomes of HIV infection, this official unwillingness has been cited as an important
reason for the relatively slow roll‐out and scale‐up of ARV treatment in South Africa and an
estimated 365,000 AIDS‐related deaths [15]. An additional complication was that the NDOH saw
attempts to focus on a single disease as contrary to efforts to improve equity (D1).
Programmatic and funding oversight of externally funded projects by the South African
government relies heavily on local conditions: overall, the state lacks capacity, skills and
experience (ND3, ND6). One GHI respondent noted that the offer of external assistance requires
the recipient to provide the administrative capacity to handle such funding, and this is not a focus
of the NDOH (GHI3). In addition, NGOs and provincial government are not required to apply to the
NDOH for approval before submitting funding proposals or accepting funds, limiting national level
oversight (ND2). These issues provided an incentive for some external donors to work directly with
NGOs where possible and bypass government structures (GHI1, D1), though this is reported to
have improved in the last few years (ND3, ND5).
At times, different reports on similar programmes or different statistics on the same issues are
presented at the same international fora by agencies implementing projects in South Africa. In
some instances, the NDOH itself only gets to know on such occasions about programmes
implemented in South Africa (ND5, ND6). Competition among donors has on occasion led to
attribution becoming an issue (ND2).
Participants in the study cited the desire to see tangible results or outputs that could be
definitively matched to funding and resource inputs. This would require direct linkages between
proposals, implementation plans, and monitoring and evaluation. Strategic planning at a national
level for NDOH funded projects has been ongoing for a number of years (ND6), but coordination
with non-state actors has varied. State institutions such as the South African AIDS Council (SANAC),
the NDOH’s Donor Coordination Forum, the National Treasury’s International Development
Cooperation Unit (IDCU), as well as donor bodies such as the EU+ Forum are some of the initiatives
mandated to coordinate functions amongst the different GHIs, donors and government
institutions. Donor coordinating units are also located within provincial and local levels of
government. The actual operation of these initiatives varies widely.
Historically, the Donor Coordination Forum has not succeeded in meeting on a frequent basis.
SANAC lacks the legal powers to enforce its decisions as it was not set up by an Act of Parliament.
Most participants agreed that it was the responsibility of government to ensure SANAC had the
authority to address donor‐related concerns. The importance of a government institution that
holds everybody accountable at every level was highlighted. For example, it was decided two
years ago that ARV treatment should be integrated into general clinical services and that
stand‐alone ARV clinics should no longer exist. However, stand‐alone ARV clinics are still found in
some parts of the country (ND6).
26 The anonymity of each interview was ensured using the following codes: National Department of Health personnel
are ‘ND’, donors are ‘D’ and GHIs are ‘GHI’.
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