Executive Summary
communities. In India, for instance, CBOs often work in communities that are most at risk for HIV, while NGOs are larger organizations which often struggle in trying to reach hidden, marginalized, and stigmatized communities and do not necessarily represent the communities they work for rather than with. The country studies presented sharp differences in terms of the involvement of CSOs and their role. At the national level, large international and national CSOs have been the main recipients of international aid due to their ability to implement projects and meet donors’ reporting requirements (financial reporting, monitoring results, and providing fiduciary control) as well as their capacity to disburse funds quickly. In these cases CSOs represent a substitute for rather than a complement to government funding channels. Small NGOs and CBOs tend to provide a complementary role to government functions, especially when it is the result of deliberate government policy decision based on the acknowledgment that small NGOs and CBOs are best placed to deliver specific HIV and AIDS services. However, their ability to play this role is limited by their weak capacity to implement projects and meet requirements of funding channels. In all four countries (India, Kenya, Nigeria, and Peru) the NGOs’ and CBOs’ allocation of funding for HIV and AIDS activities was markedly different from the national response. • India has a long tradition of CSOs operating at various levels (nation, state, and local communities). Due to the importance of reaching high-risk groups for controlling the HIV epidemic, small NGOs and CBOs are at the core of the country HIV and AIDS response. They have become implementers of interventions targeting high-risk communities as a result of a deliberate government decision to channel funding to these organizations and to provide them with training. Two-thirds of the investment provided by the pooling partners—DFID, World Bank, and government—finance targeted interventions for the prevention of HIV among most at-risk populations by contracting with NGOs and CBOs to implement the program. • Kenya has a long history of CSOs being involved in the HIV and AIDS response at the community level. Their role was confirmed by the evaluation of the community response to HIV and AIDS in Kenya (World Bank 2011a), which showed that CBOs provided services that were complementary to the government. Government HIV and AIDS spending was dominated by treatment and care (55 percent of national spending) with few resources for impact mitigation (8 percent) (Nigeria 2010). In contrast, the surveyed CBOs had a different structure of spending: 29 percent was spent for impact mitigation and only 15 percent for treatment and care (World Bank 2011a).5 • Nigeria’s CBOs have emerged as a vital part of the response to HIV and AIDS, especially after the democratization process that started in 1999. Expansion of their role was facilitated by increased donor funding reaching them. According to the evaluation of the community response to HIV and AIDS in Nigeria, surveyed CBOs spent their resources nearly equally on prevention (25 percent),
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