Managing AIDS: The Rise of 'Good Governance' and New Governance Strategies

The early response by civil society, and the structural conditions in which it operated, predated a significant shift in the field of development over the past two decades. This shift is broadly characterized by a move away from the conditionality and structural adjustment programs of the 1980s and early 1990s toward a more ‘inclusive’ neoliberal development regime, also referred to as the post-Washington Consensus (see Craig and Porter 2006). By the late 1990s, key principles of ‘good governance’— such as institutional strengthening, ownership and alignment, development partnerships, civil society participation, and results-oriented development—were becoming the dominant language within development policy circles and are shaping the practices of most (if not all) development organizations operating today. While the specific policies and practices adopted by international development organizations are often quite diverse, there has been ‘significant convergence towards a relatively coherent set of governance strategies’ over the last two decades that entail core elements of NPM and aid effectiveness. These strategies are described by Best as ‘ownership, standardization, risk and vulnerability management, and results measurement’ (2014, 87) and by Foller et al. as ‘marketization, managerialisation, scientisation, and standardization’ (2013, 11). As we will illustrate below, these governing strategies have significantly shaped efforts at all levels to respond to HIV/AIDS over the last 15 years, with AIDS donors utilizing new and more subtle ‘strategies of control’ with more proximate civil society ‘partners’ (Thorn 2011), such as competitive tendering, auditing and evaluation requirements, results and performance-based financing, capacity-building, and harmonization with national and donor priorities.

Alongside this broad shift in development practice, we also have witnessed the emergence of new actors with a global reach and capacity dedicated solely to addressing the global AIDS pandemic. Of particular interest here is the fact that, in 2003, then-US President George W. Bush launched the PEPFAR—the largest commitment made by any single nation for an international health project.2 By the end of 2008, PEPFAR had distributed roughly $18 billion for AIDS activities around the world (OGAC 2009) and significantly shaped the AIDS responses of national governments and civil society actors in the global South. While PEPFAR has undoubtedly contributed to better access to treatment for people living with AIDS in the global South and has reflexively incorporated more ‘inclusive’ development ideas of civil society partnership and participation into its governance structures and aid policies, PEPFAR has also been widely criticized for its lack of reflexivity, including exporting a set of morally conservative policies, firmly grounded in an Evangelical Christian worldview, to the global South. While scholars, human rights activists, and civil society groups were quick to condemn the cultural and moral imperialism of PEPFAR’s policies and their consequences for local HIV/AIDS programming (see Siegal 2006; Health GAP 2006; Sonke Gender Justice Network 2007; Evertz 2010), less attention has focused on PEPFAR’s alignment with broader shifts in development practice toward ‘good governance’ and the institutionalization of ‘new managerialism’ to dispense and manage aid to development ‘partners’ (cf. see Oliver 2012; Thorn 2011; Sonke Gender Justice Network 2007). As we illustrate in more detail below, interviews with government officials and civil society actors in Uganda reveal strong concerns about the more practical aspects of PEPFAR’s funding practices, such as the use of short-term project-based funding, the emphasis on measurable results, and onerous reporting and auditing requirements for grant recipients.

These new strategies and financing modalities not only govern aid relations with PEPFAR grant recipients (thereby ensuring compliance with US determined priorities and policies) but also underpin Uganda’s CSF—a national financing mechanism for HIV/AIDS that ‘pools’ and disburses multiple donor funds to local projects that can demonstrate an alignment with national HIV/AIDS plans and policies (CSF Manual 2008, 2). Donors’ role in establishing and designing the Fund has meant that the dominant practices of ‘good governance’ are embedded within a nationally centralized granting mechanism for HIV/AIDS and, consequently, the organizational structures and on-the-ground projects of Ugandan civil society.

Both PEPFAR and the CSF employ similar governing strategies in disbursing and managing their HIV/AIDS funds to civil society ‘partners’. These strategies reflect the aforementioned spread of NPM and principles of aid effectiveness as expressed by the 2005 Paris Declaration on Aid Effectiveness and 2008 Accra Agenda on Action. For our purposes, we understand ‘market-based managerialism’ as emerging from the institutionalization of NPM in global governance structures (characterized by the use of market-like mechanisms and management practices characteristic of private business) (Vabo 2009), whereas ‘ownership strategies’ stress the value of participation (especially of civil society actors), building strong domestic institutions and political support for development programs, and donor harmonization with recipient country priorities and policies (Best 2014). It is evident from our empirical findings that these strategies intersect, negotiate, and overlap in the on-the-ground practices of AIDS governance and project implementation. The question then becomes how these governing strategies consolidate the power of donor and state actors, give rise to new ways of managing and regulating civil society, and produce new challenges for many grassroots civil society groups.

 
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