Kibret Shiferaw1
The Challenge of Multi-sectoral responses to HIV/AIDS in Ethiopia. A case study of
Achefer Wereda (District)
1. Introduction
The HIV/AIDS situation in Ethiopia has evolved from two reported AIDS cases in 1986
to a cumulative total of 147,000 by mid 2003, but the vast majority of cases are
unreported and many more people have died unnoticed and unaided. It is currently
estimated that 1.5 million people are living with HIV/AIDS and this is a staggering
number to cope with given the shortages of resources for such a poor country (FMOH
2004).
As a result of increased number of infected people, the government developed
comprehensive HIV/AIDS policy in 1998. The launch of this policy created a ground for
multi-sectoral and the integration of sectors efforts through establishing a coordinating
body. The National AIDS Prevention and Control Council was established in 2000 this
office is works at the grassroots level with the name of HAPCO (HIV/AIDS prevention
and Control Office) and is charged with implementing the strategic framework for the
national response to HIV/AIDS and coordination of the multi-sectoral response. The
council consists of members drawn from sector ministries, regional states, NGOs,
religious bodies and representatives from civil society and people living with HIV/AIDS.
It is led by the president of the country at country level, at region by the regional
president or his delegate and at Wereda and Kebele level by the Wereda and Kebele
administrators. The same structure is expected to reach to the lower government
administration structure (Wereda and Kebele).
The implementation of a multi-sectoral response to HIV/AIDS commenced in the
Amehara region, West Gojam Zone, Achefer Wereda, it has since been rolled out
nationally. Now, a multi-sectoral response to HIV/AIDS is generally used in some form
in all HIV/AIDS prevention and control programmes in the country.
1
Kimmage Development Studies Centre
This paper is part of a thesis submitted for the fulfilment of the requirement for an M.A in
development studies, and begins with the background of the theoretical summary of a
multi-sectoral response, followed by major finding of the field study, interpretation and
analysis, recommendation, and finally gives a conclusion.
2. Background
The cross-sectoral nature of the pandemic is today widely acknowledged by all key
agents involved in HIV/AIDS control and multi-sectoral responses are widely advocated
by national AIDS control programmes and donors alike (Tpouzis and Hemrich 2000).
According to the Commonwealth Secretariat (2003), multi-sectoral, refers to the
involvement of all sectors of society, governments, business, civil society organisations,
communities and people living with HIV/AIDS at all levels in addressing the cause of
and impact of HIV/AIDS epidemic. The HIV/AIDS pandemic serves as a reminder to
humankind that social, economic and health problems cannot be “cured” with vertical,
isolated, uncoordinated, and unintegrated approaches or responses. Instead, a truly
integrated and long-term multi-sectoral response that incorporates broad-based
socioeconomic development is necessary (Calderon 1997).
Multidimensional problems and corresponding responses can be very difficult to
implement in reality, especially in cases where different development actors –
government ministries, multi and bilateral agencies and NGOs, are required to respond in
a coordinated and cooperative way. In the case of Ethiopia and its experience with multisectoral HIV/AIDS responses, not much research has been carried out. This falls in line
with general reviews of multi-sectoral responses to HIV/AIDS.
Tpouzis and Hemrich argue that “the nature and quality of the response of non-health
ministries is not clear and has not been assessed in depth to date” (2000, p.87) and that
research has not been done on the strategic implementation of the multi-sectoral response
to HIV/AIDS.
2
Given the lack of data on multi-sectoral responses in Ethiopia, and that West Gojam Zone
in Amahara Region has a track record in this approach, the author felt that since he had
worked in the region and on HIV/AIDS, this subject would make a suitable topic for
investigation for the purposes of his own academic development, and to make a
worthwhile contribution to the state of knowledge in the area of responses to HIV/AIDS.
2.1.Multi-sectoral response to HIV/AIDS
HIV/AIDS affect all sectors. The magnitude of devastation of the pandemic varies from
sector to sector depending on the vulnerability. It requires the national coordinated
response of all sectors. The past experience shows that leaving HIV/AIDS activities to
the ministries of health did not alter HIV prevention. From the early days of the
epidemic, the progression has been, from a largely central level, health sector-led
response, to a more multi-sectoral effort coordinated by national HIV/AIDS councils
(HAPCO), with greater responsibility for implementation being devolved to the
individual sectors and the decentralised levels. The World Bank argues that “The role of
multi-sectoral national HIV/AIDS councils in providing strategic guidance, leading
institutional and policy reforms, ensuring coordination and adequate implementation, and
monitoring and evaluation has been pivotal”( 2000b,p.5). The multi-sectoral response has
to be decentralised to regional and local levels for its effective management and
expansion to curve the problem of HIV on time (World Bank 2000b).
According to Poku (2001) the role of the government is crucial to put AIDS at the centre
of national agendas rather than putting it on the health agenda. Thus, the Ethiopian
strategic plan calls for a multi-sectoral response implementation with the leading role of
government and community ownership for an integrated and comprehensive intervention
strategy among all sectors including NGOs, FBOs and the private sector. HAPCO (2004)
notes that this could be best achieved if all sectors mainstream prevention, care, and
support activities in their organisations mandates and plans. According to HAPCO (2004)
this strategy of multi-sectoralism remains to be the major guiding principle of HIV/ AIDS
prevention and care and support, capacity building, youth and monitoring and evaluation.
3
Sectors have different approaches of multi-sectoral responses. These are Integration and
Mainstreaming.
Integration
Integration and mainstreaming are often used synonymously in the area of HIV/AIDS.
However, I would like to propose the conventional distinction between the two in order to
come to a clearer operational approach for actually addressing HIV/AIDS with
institutions. Integration occurs when HIV/AIDS interventions introduced into a project,
programmes, and permanent activities of sectors or policy context as a component,
separate activity or content area, without much interference with the specific core
business of the institution or the main purpose of the policy instrument. In other words,
consistent HIV/AIDS activities may be executed, but they are being wielded as a separate
area rather than to incorporated in, and interfere with, the already existing ones
(UNAIDS/GTZ 2002).
Mainstreaming
UNAIDS propose a working definition of Mainstreaming AIDS to be a process that
enables all the people and institutions involved in Development, including all sectors and
levels of government, the business sector, civil society, and international agencies to
address the causes and effects of AIDS in an effective and sustained manner, both through
their core business (usual work) for the benefit of their development partners and within
their workplace for the benefit of their workers (2004).
Mainstreaming offers an alternative approach to the challenge of planning for HIV/AIDS
within sectors in a multi-sectoral response. In mainstreaming issues of comparative
advantage, possible specific context interventions and their cost effectiveness, and
appropriate resource distributions are taken into consideration to prevent duplication of
efforts among sectors (inter-sectors), sectors and individuals. A productive mainstreaming
process leads to the identification and division of clearer areas of responsibility between
partners involved in multi-sectoral responses at each level (UNAIDS/GTZ 2002).
2.2. Challenges of multi-sectoral responses to HIV/AIDS in Ethiopia
4
Ethiopia began the HIV/AIDS policy process in 1989, far earlier than most other
countries. It took nine years to complete. Moreover, the process involved limited human,
financial, technical, material, and management capacities. The health care institutions are
massively under equipped to address HIV/AIDS, particularly in rural areas. The country's
size and poor transport infrastructure are also key factors.
Thus, according to the Ethiopian strategic plan (HAPCO 2004) the probable challenges
of Multi-sectoral responses to HIV/AIDS are:
 Perception of and consensus around the new implementation arrangement
(Multi-sectoral response).
 Resource availability and absorption/utilisation capacity
 Addressing the growing service demand and sustainability
 Rapid expansion of the epidemic to the rural areas
 Human Resources.
3. Major Findings from the field study
3.1. HIV/AIDS in the Wereda
This information was collected in order to understand the depth of the problem faced by
the Wereda because of the pandemic. The information was collected mainly through
personal interviews with eight people. Another source of data was from the FGD, of
which twenty people participated in two groups and secondary data.
Personal interviews and group discussion on the problems stemming from HIV/AIDS in
Wereda highlighted the increases in the numbers of street children and orphans. This is
backed up the secondary data reports.
Achefer Wereda is 560 Km far from Capital city, Addis Ababa. The population of the
Wereda is 338,364 (male 172,709 and Female 165,655). The Wereda is divided in 43
Kebeles (urban 4 Kebeles and rural 39 Kebeles.). The population of urban dwellers is
25,791 (Male 11,387 and Female 14,404) and rural dwellers is 312,573 (Male 161,322
5
and female 151,573). Out of 43 Kebeles in the Wereda, 28 Kebeles had orphans, 369
male and 292 female children. In addition to this, 109 female and 120 male children are
living on the street. In 29 schools out of 41 schools there are 148 male and 105 female
parentless students are attending the school. The plan of the 1999 Ethiopian fiscal year
prepared by Wereda HAPCO also reveals that as a result of becoming orphans, some
children are migrating from local Kebeles to village towns, looking for work, for
instance, some children are employed as shepherds, also many grandfathers and
grandmothers having to take care of their grand children.
In terms of the numbers of new infections, the former zonal HAPCO head said that while
the infection rate in the cities had become stagnant, in the rural areas that are in the
Wereda the infection rate is increasing. The data collected from Achefer Wereda Health
centre backs up this point. In the Ethiopian calendar year 1997/2004-05 the number of
people tested for HIV were 146, out of this 6 were positive, that is a 4.1% infection rate.
In 1998, 848 people were tested for HIV and 79 people were positive, an infection rate of
9.31%.
During the focus group discussion, the participants remarked at how HIV/AIDS infection
was speeded up by new developments. One example that was given was the two projects
related to electricity development and road construction. In both group discussions, the
participant showed their concern in articulating their past experiences, and using those to
predict what could come about from the new projects.
Previously Kunzila kebele was an army camp, and this camp was associated with
prostitution and HIV/AIDS. According to one person from the teachers association, the
kebele lost one generation with the infection of the pandemic. Yet, in the same place, the
two projects are establishing their camps. These activities were attracting many job
seekers, as well as prostitution, making a fertile ground for the spread of HIV. One of the
participants of the group discussion expressed that “development is coming with death”.
If the spread of HIV was not halted, the beneficiaries may not exist to taste the fruit of
development.
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3.2.Sectors’ understanding of multi-sectoral
The interviews held with representatives of the Agriculture, Education and Capacity
Building sectors showed that theoretically they believed that the task of HIV/AIDS
prevention and control was the responsibility of all sectors. But in practice, it is left to
the main sectors such as HAPCO and the Health offices to deal with.
3.3. Sectoral Response
The Wereda HAPCO requested for the assignment of a HIV/AIDS focal person in each
sector office. All sector offices assigned the HIV/AIDS focal person to do their
mainstreaming assignment as well as their core function. All interviewees agreed that the
focal persons assignment is based on the criteria the person or section heads relation to
HIV/AIDS activities.
It was expressed by respondents, that the additional tasks around HIV/AIDS, though very
important, were often causing problems in terms of increasing the workloads of focal
persons. Of those interviewed, all focal persons confirmed that they did not receive any
guide lines or job descriptions. In addition to this, they did not receive any training in
how to work as focal persons.
According to the HAPCO head and peer group discussion, the EMSAP and Global fund
channelled to Wereda HAPCO for the support of orphan children that has to be disbursed
through CBOs did not reach the traditional associations (CBOs; due to the financial
procedure of HAPCO that demands the legal registration).
On the matter of the role of NGOs and their response to HIV/AIDS, it was felt that while
NGOs are coming to the Wereda with novel projects, which seemed good for the
community, they often designed their responses in line with their own strategy and with
activities which suited them. As a result, the NGO responses were not in line with
national policy, were of dubious quality often lacking base line surveys, of questionable
sustainability, and lacking in community participation from their inception.
7
Other difficulties associated with NGO activity were given in the peer discussions, in
particular, the problem of the duplication of committees.
Finally, there were criticisms of what is actually done. It was a common belief, that
current activities are too focused on awareness rising, a valuable part of the prevention,
but the rest of the activities, such as care and support are totally ignored in all
government sectors. This imbalance needs to be redressed so that a comprehensive and
relevant response is given. .
3.4. Inter-sectoral response
The inter-sectoral relation is not there. Even if the focal persons assigned in each office,
they did not practice working together with other sectors. The weakness observed on
working together is not a stop at Wereda office level also it is reflected at grass root level.
The participants of peer conversation states that “In doing awareness raising, the sectors
that have structure at Kebele level do not integrate with each other or with civil societies
at Kebele level.”
In the guideline which is prepared for multi-sectoral responses of all sectors state that all
sectors have to work together in a coordinated way with the organisations, institutions or
offices and share experiences with each other. The respondent and the participant of peer
and group discussions underline that there is lack of inter-sectoral communication and its
consequence of resource wastage.
3.5.Coordination
All interviewed participants of the group discussion acknowledged that the coordinating
body is not functioning well; it is difficult to create understanding among sectors on what
each of them are doing.
Networking is the system used to coordinate activities and share experiences between
sectors. In the discussion with the groups, the respondents indicated that there is lack of
networking among sectors in Wereda of Achefer. All respondents expect Wereda HAPCO
8
to call a meeting and discuss the issue of HIV/AIDS. The Wereda HAPCO response is
that they do not have sufficient authority and power with the responsibility given to them.
3.6. Resource Mobilization/Funding
The interviewed sectors head explained that the HIV/AIDS activities were dependent on
budget support of external donors. Historically, this is what has happened. The
government sector offices budget plan shows a heavy reliance on external donors. The
main budget sources of Wereda HAPCO are EMSAP and The Global Fund, but these
funds also need to be complemented by recurrent budget such as administration and
running costs. But most external budgets are earmarked and not flexible in terms of
implementing different activities.
In terms of distribution of resources, funds coming from international donors focus on big
cities and towns. The sectoral focal persons have problems in executing activities,
according to the HAPCO Head, since sectors do not have a permanent budget line for
HIV/AIDS, the budget allocated from the Wereda is not sufficient to implement their core
business. The management bodies of the sector offices are forced to allocate the limited
budget on core business rather than HIV/AIDS.
3.7. Vulnerable groups
There seems to be a problem in deciding who should be the target of activities, as there is
some confusion over who are the vulnerable groups. Some of the respondents perceived
that vulnerable groups are only women who are working in the bar. The focal person of
the Education office and HAPCO head view that vulnerable groups are women, children
and youth. Most of the respondents heard the word vulnerable group from mass media.
They do not understand why they are vulnerable.
The lack of care and support, and special programmes for vulnerable groups exacerbates
the spread of HIV.
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4.
INTERPRETATIONS AND ANALYSIS
4.1. Perception of multi-sectoral response
The understanding by sectoral officers interviewed fell into two categories. One category
understands the multi-sectoral response as the responsibility of all local sectors to plan
and implement activities in response to HIV/AIDS. The other category which saw it as
meaning as one respondent said that “more work is expected from HAPCO and PLWA
associations”. The view of this respondent shows that it was felt that the sectors have
limited responses and much responsibility is expected from the named two organisations.
These understandings or misunderstandings have come from the regional offices, which
have the mandate to guide the understanding of multi-sectoral response to the Wereda
offices.
In addition to this, they have to show the clear and equal responsibilities of sectors.
HIV/AIDS is the problem of development and needs the participation of all sectors in the
response. On the other hand according to Garbus bureaucratic constraints are obstructing
the response. The Ministry of Health has traditionally been one of the weakest ministries
in Ethiopia, and its ability to absorb and manage new funding has been problematic
(2003). The Ministry of Health is stretched, but it is crucial to get across a deep and
proper understanding of multi-sectoral responses in a situation of limited resources like
Ethiopia.
Currently, the knowledge of the multi-sectoral response is superficial. The various sector
focal persons hear about multi-sectoral response from the media and other sources but
there are not enough efforts to give a full understanding of the approach and its benefits.
The multi-sectoral response will not be practical unless the people understand it through
training and sharing the responsibility among the sectors.
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4.2. Sectoral Response
The sectoral response has to arise from the impact study of the sector office or
organisation this will help to remould their work to respond to the effect of HIV/AIDS
(Elsey and Kutengul (2003). In reality, the sectors examined in this research did not give
enough emphasis to collecting impact data of the sector. In fact, all assigned a focal
person to respond to external demands. This shows they lack some amount of real
ownership of this approach.
The responsibility of the focal person is beyond implementing the sections – or sector’s
HIV/AIDS activities, according to Elsey and Kutengul (2003), it is to be catalyst to
mainstream HIV/AIDS activity within the sector and to influence a wide range of
individuals at all levels both within the sector and other key stakeholders.
Furthermore, UNAIDS (2004) asserts that the multi-sectoral response and mainstreaming
are indivisible. If the multi-sectoral response to achieve its goal of decreasing the
pandemic, it needs to address the development related causes and effects which fuel it
through effective mainstreaming processes. This is illustrated by the finding from the
group discussions and interviews concerning the two projects of Belessa Electric City
Power development and Belessa Road Development in the Wereda which are linked with
high mobility of workers in Wereda, and which respondents indicated had assisted in the
spread of HIV/AIDS.
Common Wealth (2003) acknowledges that the private sector and hierarchical
organisation of government may pose some constraint, since National AIDS Programmes,
located in Ministries of Health, may not have the authority to involve other sectors. This
fear has been found to be true in this research, with very little response from the private
sectors.
4.3. Coordinating body
The proper and effective coordination of activities is very important for promotion of a
multi-sectoral response.
But, this function is contingent upon the human resources
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available at Wereda HAPCO office. At present, according to the ex zonal HAPCO and
Wereda head, there is a lack of HAPCO structure at Kebeles level and human resources at
Wereda HAPCO. Garbus indicates that responsibility for coordinating HIV/AIDS
interventions rests with the regional HIV/AIDS councils (HAPCO). These, in turn, work
through the Zones, Weredas, and Kebeles. It requires large numbers of skilled staff to
carry out programs at the different levels of government administration structure (2003).
The little coordinating role played by HAPCO, leads sectors to duplicate activities and
waste resources.
In addition to this, the private sector is left out from the multi-sectoral response due to the
absence of coordination. The perception of the participants was that HAPCO is
responsible for the implementation of activities in the Wereda or as an implementer. This
perception confused sectors to understand the Wereda or HAPCO as a coordinating body
with the real mandate given by the government.
This study also proved that the technical competence of the HAPCO office to provide
effective leadership in all matters concerning the multi-sectoral response was limited
especially at Wereda levels (HAPCO 2005). The head of HAPCO may have the mandate,
but rarely have the understanding, capacity and access to resources to take up their
coordinating role with sectors and other players.
4.3.1. Inter-sectoral response
The non-existence of the networking system in the Wereda makes the horizontal
communication difficult among sector offices and private sector including religious
institutions. The level of the response is not well known among sectors due to lack of
sharing of experiences. The lack of skilled experts to guide this kind of collaboration has
been observed as a major obstacle in inter-sectoral collaboration.
However,
the
multi-sectoral
response
to
HIV/AIDS
considered
inter-sectoral
collaboration and coordination as one of the essential elements. Inter-sectoral
collaboration promotes efficiency and avoids duplication of activities and wastage of
12
resources. According to HAPCO, the challenge of inter-sectoral collaboration is the
limited cooperation and coordination mechanisms among sector offices. Weak
networking structures results in weak information exchange among sectors. Sectors
focus on a few common interventions that result in duplication of effort and wastage of
resource rather than building on local expertise available and addressing specific issues
(2005).
4.4. Monitoring and Evaluation
Vertical reporting in sector offices to their head does not include HIV/AIDS activities.
The evaluation and monitoring of the Wereda multi-sectoral response is not incorporated
with HAPCO or with an independent body which is comprised of all stakeholders. In
addition to this the sectors do not have specific tools for monitoring and evaluation.
The national monitoring evaluation guide has to be well known by the Wereda sectors
and the guideline should be adapted to the Wereda level in accordance with the local
situation, to promote the monitoring of HIV/AIDS activities.
4.5. Addressing the Vulnerable group
The finding of this research in the Wereda confirms that the epidemic is generalised. In
most African countries, HIV/AIDS is reaching well beyond those groups with high-risk
behaviours and, most current programmes are not reaching nearly enough people in rural
areas, especially youths and women (World Bank 2000a). This World Bank finding is
applicable in the study area, according to the ex Zonal HAPCO, the HIV infection rate is
declining in cities and increasing in rural areas.
Indeed, while HIV prevention work is necessary to inform and motivate people to protect
themselves, it cannot solve deeply-rooted societal causes of susceptibility; likewise,
treatment, care and support programmes can reduce the impact of AIDS on affected
households, but cannot address the basic reasons for their vulnerability (UNAIDS 2004).
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5. Recommendations
The multi-sectoral response implementation from federal ministries offices down to
kebele level has to be as a core business to all sectors. These will strengthen the
monitoring and evaluation through reports and other tools.
The commitment of the government does not have to stop at establishing HAPCO office
and doing a few activities. The commitment has to be shown in terms of allocating
budgetary funds and prioritising HIV/AIDS, starting from Prime Minster offices.
Performance of HIV/AIDS activities has to be taken as a criterion for the promotion of
office heads.
To have effective responses in each sector, the sectors have to mainstream HIV/AIDS
into their core business.
This type of approach will reduce costs and improve
effectiveness. Since the understanding of mainstreaming is poor in each sector, effective
training has to be given for all personnel in Wereda. The role of the focal persons will be
a coordinator of HIV/AIDS activities in each sector.
The establishment of proper communication structures will build inter-sectoral relations,
and in turn, stop the duplication of activities and create a forum to share experiences. To
develop this inter-sectoral relation among sectors in the Wereda, the formation of a
networking forum is recommended. The networking does not have to be bounded only in
the Wereda; it should widen its connection to the neighbouring Weredas and Zone. This
will help to develop the capacity and continuity of the sectors response.
As it is observed in findings, HAPCO’s coordinating role is not clear. HAPCO’s mandate
has to be clarified to sector actors. The authority of HAPCO has to be demarcated. To get
the best out of it, an independent Wereda HAPCO has to be authorised to coordinate the
multi-sectoral response in the Wereda. The structure of HAPCO has to reach to the kebele
level.
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Traditional resources have to be mobilised beyond the mandate they established. The
resources such as Edir are restricted currently only for funeral ceremonies, this has to be
changed to be multipurpose. The resources can be utilised in care and support, and
income generating activities for the PLWAS. The same approach has to be used for the
rest of traditional association like Mehabir and Ekub, all their capital can be utilised for
income generating activities. The deposit of the professional associations (teacher
association and others) can be used for the same purpose. Instead of looking to outside
support, it is better to look to the inside, and to develop self confidence. In addition to this
every sector has to allocate budget for the activities.
The private sector such as business institutions, traditional associations and professional
associations are not involved in the multi sectoral response. There is a need to develop a
mechanism which organises this sector for the response.
This could be helped by
organising them in one association or establishing one committee which mobilise the
business sector and associations also it will coordinate individual efforts. For instance,
bar workers (women) who are working in bars and hotels are paid low wages. Due to this,
they are forced to render sexual services to subsist their life. But, if the business sector
such as hotel and bar owners were aware of such issues they can improve the wage of the
workers. In addition to this the bar workers if they establish associations, they can voice
the problem. In turn if the private sector organised they could be active participants in
established networks.
The NGOs who are working in the community have to understand the multi-sectoral
response. Project design has to be turned to multi-sectoral response which calls for the
participation of all government and private sectors. The NGOs have to move beyond
having limited number of stakeholders to broad participation of stakeholders. Instead of
implementing activities, NGOs should start working through private and government
sectors. They have to play the role of facilitator for the sake of sustainability.
The current emphasis given to the vulnerable groups is minimal, and fails to address the
vulnerability of affected individuals and communities. It is therefore essential that
15
responses are expanded beyond risk reduction strategies. Some progress has to be made
in understanding the multiple causes and manifestation of gender inequality, with greater
appreciation of specific actions that can be undertaken. In the absence of policies and
programmes that work towards bridging the gender gap. Many HIV/AIDS-related efforts
may prove to be ineffectual and short-lived.
The employee of projects related to road building, electricity, communication and others
are very mobile. All such projects should include a risk assessment related to the possible
spread of HIV/AIDS.
Infrastructure development projects, such as these, should
incorporate programmes of HIV/AIDS prevention and controls. In addition, people who
are living in the project areas should be given information relating to HIV/AIDS to
encourage behavioural change as a precaution. This needs the participation of all sectors.
The national monitoring and evaluation programme has to be adapted to fit the local
environment. The monitoring and evaluation system of various sectors have to be
broadened to incorporate HIV/AIDS activities. To strengthen the inter-sectoral response,
an ad hoc committee for monitoring and evaluation should be established under the
HAPCO office. The membership of the ad hoc committee would be from the sectors that
have structures at kebele level. The monitoring and evolution system should be agreed by
all sectors.
6. Conclusion
This study was carried out to identify the factors which influence the implementation of
the multi-sectoral response strategy in Achefer Wereda. It explored the capacity and effort
of the Wereda sector offices to implement the multi-sectoral response. A comparison was
made between the theory and pragmatic evidence of the approach. These are the bases for
the recommendations given above. The findings and analysis of the multi-sectoral
response in the Wereda leads to an overall conclusion that many challenges remain in
putting it into practice in the country.
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The proposed paradigm is totally new and untested to the country both from the
perspective of the development and HIV/AIDS in particular. Several countries have
already moved along the proposed dimension to some degree. HIV/AIDS has multiple
facets such as biomedical, socio-economic, political, and cultural, and these provide
strong arguments for the need of a multi-sectoral approach.
The understanding of the problem of HIV/AIDS as a problem of development has to be
taken among the implementers. HIV/AIDS should not be seen as a problem of poor and
marginalised people. The approach has to be discussed and understood among the
stakeholders. Different approaches have to be evaluated before they are implemented in
terms of their coherence and repercussions with the attitudes and cultures of the country.
The findings revealed that the current coordination structure (HAPCO) lacks the power to
coordinate a response. This coordination problem is a stumbling block to getting a better
multi-sectoral response.
The study also found minimal commitment by sectors heads in the Wereda. To address
this, the political will of the federal government must be used. The will should be used to
strengthen the coordinating body, and reinforce the priority given to HIV/AIDS as a cross
cutting issue.
17
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Implementing Principle, ISA Consultants Ltd. & GTZ Regional AIDS programme, Accra.
World Bank (2000a) Intensifying Action Against HIV/AIDS in Africa: Responding to
Development Crisis, World Bank, Washington.
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World Bank (2000b) Multi-Country HIV/AIDS Programme (MAP) for Africa, World
Bank
Author Information
Kibret Shiferaw Belachew has an MA in Development Studies from Kimmage
Development Studies Centre, Ireland, and has a number of years experience in working
with NGOs focusing on HIV/AIDS.
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