Poverty Reduction Strategies Paper Process and HIV/AIDS Governance in Malawi
As of 2011, Malawi still had one of the lowest life expectancies in the world due primarily to HIV/ AIDS. Its HIV prevalence rate (2007) was 25% and 11%, in urban and rural areas respectively. In 2007, our research team assessed the Poverty Reduction Strategy Paper (PRSP) process's impact on the implementation of the Malawi National HIV/AIDS Strategic Framework (NSF) through a Shared Health Governance lens.
The research employed Shared Health Governance (SHG) as its global health governance framework. Understanding global health as a joint enterprise of different communities, SHG values the consensus among global, national, and sub-national actors on common goals and measurable outcomes. It emphasizes the importance of agreements among various actors' values and goals. In the SHG framework, global health policies are based on mutual collective accountability and enhance health agency.
SHG was operationalized through six indicators to evaluate the impact of the PRSP process: 1. goal alignment, 2. adequate resource levels, 3. agreement on key outcomes and indicators for evaluating those outcomes, 4. meaningful inclusion and participation of groups and institutions, 5. special efforts to ensure participation of vulnerable groups, and 6. effectiveness and efficiency.
Results were mixed, indicating that the process generally met the desired accountability standard, though it fell short of necessary resources and may have marginalized key stakeholders. This research was an initial attempt to holistically evaluate a specific policy with overarching SHG principles. It identified achievements and shortcomings of the program and showed the need to evaluate each policy from the perspective of the overall contribution to the SHG, aiming at the common good in public health.