Accountability

Stakeholders at all levels of the global response to HIV and AIDS have long recognized the need for strong leadership in order to ensure universal access to prevention, treatment and care and support services. However, definitions of ‘leadership’ are as diverse as the groups of stakeholders who demand it and few have devised coherent strategies for how to motivate better leadership. AIDS Accountability International was formed with the express purpose to make a contribution in this regard: to identify and analyze leadership and to develop research-based advocacy tools that can be used to motivate political and other leaders to use their resources optimally for a more effective response to AIDS and related health challenges.

Political accountability is a governance principle based on the argument that those in positions of power must submit to scrutiny and possible sanctions for their use of power. AAI is convinced that we will see stronger leadership on AIDS if people in leadership positions know they will be held accountable for their performance in the AIDS response. For the purposes of our country scorecard analyses of government performance in the response to AIDS, AIDS Accountability International relies on a succinct definition of accountability. To paraphrase Amartya Sen, ‘accountability’ is the ability of stakeholders to sanction government for poor performance in an effort to improve the response to AIDS.[1]

However, in order for accountability to become a constructive governance principle in the response to AIDS it cannot be reduced to a simplistic ‘blame game’ between government and other stakeholders. Accountability should instead be understood as a governance ‘mechanism’ in three steps, as depicted in figure 1 below. 

 

 

 

 

Figure 1. Three-step process of accountability

 

 

 

 1. Access to data.

The dialogue on accountability cannot start unless stakeholders, including people living with, affected by and vulnerable to HIV, have sufficient and equal access to the relevant data on the national response collected through national M&E systems. Further, it is essential that this data is presented in a way that enables civil society stakeholders to engage with it and draw conclusions from it. It is important to note that the failure by governments to provide transparent access to the relevant data is sufficient grounds for legitimate demands for accountability.

2. Dialogue on performance.

Government must commit to and engage in annual reviews of country performance in the response in relation to the relevant national or global targets for service coverage and governance principles with all relevant stakeholders. The reviews will give government opportunities to explain instances of poor performance, and civil society stakeholders can assess whether those explanations are acceptable or whether to demand political accountability. Obviously, the failure of government to participate in such reviews, or a politically biased engagement only with some civil society stakeholders, is sufficient grounds for demands for accountability. 

3. Political action.

Access to data and dialogue between stakeholders are no ends in themselves but should determine which forms of political action are necessary. Where stakeholders can agree with government that unified action is required in relation to potential funders or global agencies such action will increase the leverage of country demands. Where government accepts responsibility for poor performance in some aspect of the response it should take action to improve that performance. Where civil society actors do not accept government explanations for poor performance, or disagree with government plans to remedy poor performance, civil society stakeholders should take political action to try increase the leverage of their demands for political accountability. 

 These three steps of the accountability mechanism will transfer the rhetorical reference to ‘accountability’ into actionable political interventions in order to ensure ‘accountable leadership’ in the response to AIDS. AAI scorecard analyses are developed with the ambition to strengthen civil society stakeholders’ grasp of the best available comparable data on how their respective governments have performed in the response. On the basis of the scorecard analysis, stakeholders are better equipped to enter into a constructive dialogue with governments on the strengths and weaknesses of the response to AIDS.  

 

Accountability in UNGASS Declarations

In the Millennium Declaration (2000) and the Declaration of Commitment on HIV/AIDS (2001) all United Nations (UN) Member States made far-reaching political commitments for an effective response to HIV and AIDS. The 2001 declaration set targets for the AIDS response against which governments should be held accountable. To measure progress, the Joint United Nations Programme on HIV/AIDS (UNAIDS) developed a monitoring and evaluation framework that, by 2010, had collected four rounds of data on 25 indicators of the response. 

The commitment to LGBT people without discrimination was unequivocal in both the 2001 and the 2006 Declarations (sections 58 and 29 respectively): 

“intensifying efforts to enact, strengthen or enforce, as appropriate, legislation, regulations and other measures to eliminate all forms of discrimination against and to ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups, in particular to ensure their access to, inter alia, education, inheritance, employment, health care, social and health services, prevention, support and treatment, information and legal protection, while respecting their privacy and confidentiality; and developing strategies to combat stigma and social exclusion connected with the epidemic.” 

Greater accountability, and the need to ensure that authorities explain publicly how they are carrying out the responsibilities they have been entrusted with, is essential to stimulating progress towards the Millennium Development Goals and the Declaration of Commitment on HIV/AIDS. Without this reporting and evaluation, there is no means   to   encourage  those  who   are 
succeeding, put pressure on those who are failing, or stimulate debate about how the factors driving the epidemic can be best addressed in different settings.

Country Submission of Data to UNAIDS

Countries submitted data online through three mechanisms:

1. The Country Response Information System (CRIS) Data Entry Software for Global reporting

2. The County Progress Reports

3. The National Composite Policy Index (NCPI)

Countries can submit data to UNAIDS through the CRIS (Country Response Information System), in Country Narrative Reports and in the NCPI (National Composite Policy Index).

Country Response Information System (CRIS)
The Country Response Information System is a data management system which is designed to improve the reporting of statistical country data to UNAIDS. Data submitted to the CRIS system has to fulfill certain criteria or guidelines on the construction of the indicators (For more information please see here ). Countries who have similar or applicable data but which does not fit these criteria usually report this additional data in their Country Progress or Country Narrative Report.

Country Narrative Report
The Country Report includes such information as an overview of the status of the epidemic in the country, information on the national response, best practices, major challenges and the monitoring and evaluation environment.

National Composite Policy Index (NCPI)
The process of completing the NCPI is as important as the final result. It aims to foster improved communication and capacity building between government and non-government agencies (Civil Society, bi-laterals and the UN agencies). It includes questions on human rights, strategic plans, political action, civil society inclusion, monitoring and evaluation as well as programmatic issues.

A Note on Reporting to UNAIDS
The information submitted to UNAIDS is both validated and verified by that agency. This includes UNAIDS checking for example illogical data, the degree of completeness of reporting, and perhaps methodological considerations.

Shadow reports
UNAIDS states in the 2009 Guidelines on Construction of Core Indicators that “shadow reports are intended to provide an alternative perspective where it is strongly felt that civil society was not adequately included in the national reporting process, where governments do not submit a Country Progress Report, or where data provided by government differs considerably from data collected by civil society monitoring government progress in service delivery. In accepting shadow reports, UNAIDS acknowledges the ‘watchdog’ function which many civil society organisations fulfil in their countries.”

Relevant Indicators to The AAI Scorecard on LGBT

It can be noted that of the 25 core indicators only 6 deal with most-at-risk populations (MARPs); these include men who have sex with men (MSM), sex workers, female and male (FSWs and MSWs) and injecting drug users (IDUs).

It can be noted that none of the indicators specified by UNAIDS request data on lesbian, women who have sex with women (WSW), gay, transgender, intersex or queer individuals. The only individuals that are included from the sexually diverse group are men who have sex with men (MSM) and male sex workers (MSWs).

The following indicators represent those that deal with these two groups:
Indicator 8:  HIV Testing in Most-at-risk Populations Percentage (SWs, MSM and IDUs)

Indicator 9:  Percentage of Most-at-risk Populations reached with HIV prevention programmes (SWs, MSM and IDUs)

Indicator 14: Percentage of Most-at-risk Populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission (SWs, MSM and IDUs)

Indicator 18: Percentage of female and male sex workers reporting the use of a condom with their most recent client

Indicator 19: Percentage of men reporting the use of a condom the last time they had anal sex with a male partner.

Indicator 23. Percentage of most-at-risk populations that are HIV infected.