Regional HIV-related policy processes in Peru in the context of the Peruvian National Decentralization Plan and Global Fund support. Peru GHIN study phase II
R. Iguiniz1,2,3, R. Lopez4, C. Sandoval5, A. Chirinos6, J. Pajuelo7, C. Caceres1,5
1Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano, Lima, Peru, 2Universidad Peruana Cayetano Heredia Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru, 3Milano The New School for Management and Urban Policy, New York, United States, 4Acción Internacional para la Salud, América Latina y el Caribe, Lima, Peru, 5Universidad Peruana Cayetano Heredia, Lima, Peru, 6CooperAcción, Lima, Peru, 7Instituto Peruano de Paternidad Responsable - INPPARES, Lima, Peru
Background: The implementation of large projects such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) represents a very significant investment in HIV/AIDS in Peru and a challenge to the administrative capacity of the country. It is agreed that developing and implementing the GFATM projects successfully requires new relationships between the public sector and civil society organizations and vulnerable groups; however the analysis of these relationships and their impact on HIV-related sustainable policies and policy changes is still pending. The objective of this paper is to examine what challenges the national decentralization process in Peru presents to the constitution of regional multi-sectoral HIV-related coordination mechanisms promoted by the GFATM and vice versa.
Methods: Data collection was conducted in five different geopolitical regions representing contexts of diverse geography, culture, HIV prevalence, progress of decentralization in their regional governments, and cultural and political significance of HIV/AIDS within the region. In each region at least one HIV-focused project funded by GFATM was locally active. Concerted Regional Development Plans and other policy documents of the five regions were analyzed considering the stages of, and actors involved in the policy formulation process were interviewed.
Results: Depending on the stage and strength of the decentralization process in each region, the GFATM projects have contributed to the regional governments' assumption of new responsibilities in response to the epidemic. Concerning HIV-related policy, decentralization processes need to be strengthened and the responsibilities of the government at the national and regional level must be clearly defined. Channels of participation of civil society institutions and community actors are not clear.
Conclusions: Where the regional governments and civil society organizations are already active and organized, GFATM initiatives have generally helped to consolidate the descentralization process. But when regional institutions were weak, GFATM projects did not trigger their activation.
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