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National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance


  • Wachira, Catherine
  • Ruger, Jennifer Prah


The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi's National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation? In 2007, we developed and conducted a survey of Malawian government ministries, United Nations agencies, members of the Country Coordination Mechanism, the Malawi National AIDS Commission (NAC), and NAC grantees (NÂ =Â 125, 90% response rate), seeking survey respondents' retrospective perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi's PRSP process (2000-2004). We also assessed principle health sector and economic indicators and budget allocations for HIV/AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: (i) consensus among global, national, and sub-national actors on goals and measurable outcomes; (ii) mutual collective accountability; and (iii) enhancement of individual and group health agency. Indicators to assess these elements included: (i) goal alignment; (ii) adequate resource levels; (iii) agreement on key outcomes and indicators for evaluating those outcomes; (iv) meaningful inclusion and participation of groups and institutions; (v) special efforts to ensure participation of vulnerable groups; and (vi) effectiveness and efficiency measures. Results suggest that the PRSP process supported accountability for NSF resources. However, the process may have marginalized key stakeholders, potentially undercutting the implementation of HIV/AIDS Action Plans.

Suggested Citation

  • Wachira, Catherine & Ruger, Jennifer Prah, 2011. "National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance," Social Science & Medicine, Elsevier, vol. 72(12), pages 1956-1964, June.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:12:p:1956-1964

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    References listed on IDEAS

    1. repec:aph:ajpbhl:10.2105/ajph.2007.121350_1 is not listed on IDEAS
    2. Ruger, Jennifer Prah, 2009. "Health and Social Justice," OUP Catalogue, Oxford University Press, number 9780199559978, June.
    3. Nancy Luke & Susan Cotts Watkins, 2002. "Reactions of Developing-Country Elites to International Population Policy," Population and Development Review, The Population Council, Inc., vol. 28(4), pages 707-733.
    4. Kaler, Amy, 2004. "AIDS-talk in everyday life: the presence of HIV/AIDS in men's informal conversation in Southern Malawi," Social Science & Medicine, Elsevier, vol. 59(2), pages 285-297, July.
    5. Peabody, John W., 1996. "Economic reform and health sector policy: Lessons from structural adjustment programs," Social Science & Medicine, Elsevier, vol. 43(5), pages 823-835, September.
    6. AfDB AfDB, . "Malawi - Country Profile," Country Brochure, African Development Bank, number 110.
    7. Bor, Jacob, 2007. "The political economy of AIDS leadership in developing countries: An exploratory analysis," Social Science & Medicine, Elsevier, vol. 64(8), pages 1585-1599, April.
    8. Angotti, Nicole & Bula, Agatha & Gaydosh, Lauren & Kimchi, Eitan Zeev & Thornton, Rebecca L. & Yeatman, Sara E., 2009. "Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility," Social Science & Medicine, Elsevier, vol. 68(12), pages 2263-2270, June.
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