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HIV/AIDS and the Private Sector: What Role, What Next?

Written by Fiona Samuels

On the 5th and 6th of October 2006 Chatham House organised an event entitled HIV/AIDS: Scaling-up Effective Interventions and the Contribution of the Private Sector. This was a high level meeting with a range of government representatives from the developed and developing world, from international organisations and from the private sector, including NGOs and private companies. What made it different from the usual AIDS conferences was the high level of participation of the private – company – sector. For programme details see  http://www.chathamhouse.org.uk/index.php?id=5&cid=96

This event comes as part of a recent series of events on the role of the private sector in the HIV/AIDS response, including the ODI seminar on the 10th of October http://www.odi.org.uk/speeches/aids_06/index.html  and an earlier event organised by the University of Westminster Business School in September 2006  http://www.wmin.ac.uk/page-11594 . The private sector was also given considerable voice at this year’s International AIDS Conference in Toronto.

The questions that the Chatham House event were essentially trying to grapple with included what is the role of the private sector in the HIV/AIDS response?, how can private companies get involved more in the response?, what is the comparative advantage of the private sector in the response?, how can the comparative advantages of the private sector be capitalised and drawn on in the response to HIV/AIDS and how can boutique-type responses of the private sector be scaled-up?  

The event took place over 2 days and consisted mostly of presentations with some time for more focused group discussions and presentations back to the plenary with wider group discussion and debate. Presentations were made by international, government (both developing and developed country) and donor organisations as well as by representatives from the private sector. 

Presenters included Richard Feachem (Executive Director of the Global Fund) who spoke about the role of companies and individual citizens in the areas of financing and implementation of projects financed by the Global Fund. He extolled the virtues of the Product Red Campaign, which involves companies such as Armani, Motorola, Gap and American Express, referring to the trebling since March 2006 in contributions of the private sector to the Fund since the start of the campaign (before the campaign the total amount of this contribution was 0.1%; it went up threefold by June 2006).

Professor Michel Kazatchkine (French Ambassador on HIV/AIDS and Communicable Disease, Ministry of Foreign Affairs, France) gave a succinct presentation showing that the evidence is now there for a) the positive impact of ART on decreasing mortality, decreasing incidence and increasing productivity, b) the cost effectiveness and cost saving of ART interventions and c) the role of public-private partnerships in the HIV/AIDS response. He concluded by stressing the importance of looking at how effects of HIV/AIDS differ across the public and private sectors and by looking further at different kinds of public-private partnerships, giving as examples the need to develop innovative financial and insurance mechanisms, in which the latter anticipate risk rather than it coming as an aftermath. 

Another setting of the scene was done by Angela Wilkinson, in which she described the “AIDS in Africa: Three scenarios to 2025” work that was carried out by UNAIDS during 2003 and 2004, in which 3 possible case studies for how the AIDS epidemic in Africa could evolve over the next 20 years based on policy decisions taken today by African leaders and the rest of the world were developed. The three scenarios were entitled: Traps and Legacies, Tough Choices and Times of Transition. For more see http://aidsscenarios.unaids.org/scenarios/    

Others (e.g. representatives from Zambia, China, Rwanda, USA) also did scene setting both in terms of the state of play in their countries and what they were supporting or what was being done programmatically in the response to HIV and in involving the private sector. 

A number of presentations were made by representatives from private companies – Anglo American, Heineken, Lafarge, Unilever, Merck - describing their work-place policies and/or programmes they had put in place to deal with issues around HIV/AID prevention, treatment and care. Many of these programmes involved public-private partnerships, e.g. Unilever and CARE International. The executive director of the Global Business Coalition on HIV/AIDS also spoke about the support this coalition has been giving to private companies and to fostering private-public partnerships. 

Numbers were very much on the scene again with Debrework Zewedie (Director, HIV/AIDS Global Program, World Bank) referring to the “Three Ones” (One country authority, one strategic plan, one M&E system), Brian Brink (Senior Vice President Health, Anglo American, South Africa) referring to the ultimate aim of Anglo as being the Three Zeros (0 new infections, 0 people who get sick or die from AIDS, and 0 babies born to an HIV- positive woman) and Jeffrey Sturchio (Vice President, External Affairs, Merck), in summing up Day 1 referring to the Three Twos: Diversity, dynamics, demonstration and learning, leverage and leadership. WHO and UNAIDS are now no longer talking about numbers, i.e. ‘3 by 5’, 3 million people on treatment by 2005 has now been superseded by the ambitious Universal Access to prevention, care and treatment in 5 years.

What was apparent and what was also discussed as being missing at the conference and more generally in the HIV/AIDS response were small and medium size enterprises (SMEs). Emphasis is usually on large companies and their success stories in the HIV response. Nevertheless, as many speakers and members of the audience pointed out, the majority of workers in Africa are employed in SMEs and it is through supporting them that developing countries will grow. Questions remain concerning how SMEs can be brought into the discussions, what roles they could play, how these workers could benefit, etc. There was an awareness on the part of the private companies that they are often too fragmented and uncoordinated and they fail to explain clearly what they are doing and why. Thus there is need for increased coordination and/or the creation of a focal point. 

An interesting discussion was held around what governments could do to involve the private sector more  as well as how the private sector can do better in dealing with governments. It was pointed out that governments are reluctant to involve the private sector as they are seen as competing for scarce resources. There is also as sense that private companies have the money to support their workers so do not need support from government or from donors. Private companies who have started giving treatment to their workers are also viewed by the public sector as neglecting the wider community in which they work and finally there is a certain amount of suspicion towards the private sector with respect to what their real interests are. There was a sense that the National AIDS councils or commissions (NACs) in developing countries are not adequately doing their job of coordinating all the different stakeholders and they need to be held to account. At the same time, however, companies come into the countries and develop their own strategies with regards to AIDS prevention, treatment and care, unaware of the country’s strategy, targets and systems.

The issue of availability of health staff and capacity was raised. There was a sense that the private sector ‘steals the best staff’, thus undermining rather than building the country’s capacity. There was a discussion on the role the private sector could and should play in increasing the cadre of workers as it is clear that the government processes are slow. 

To sum up, there was a sense that government should demand more from the private sector than they currently do. There are examples (as well as toolkits and other documentation) of successful prevention, treatment and care programmes being run by the private sector which other companies can draw on. At the same time, there was feeling that the private sector is being left out and is unable to access programmes and funds, this is especially the case for SMEs. Private companies need to be transparent in their aims and need to present a united front. Learning from private companies where things were unsuccessful was also pointed out as being key to this process. The comparative advantage of private companies, which includes their characteristic of being ‘doers’ and of getting things going needs to be built on and turned to the advantage of the HIV/AIDS response.

As the World Bank Representative stressed: Coordination, Coordination, Coordination – stakeholders should not be working in isolation but all need to be involved in the development of strategies and plans: the private sector needs to be aware of what the national strategies are, they need to dialogue with the government regarding their plans and programmes and report back to the government; the NACs need to be there to answer questions and to ensure that all programmes fit with national agendas.