Response management: A conceptual analysis and overview

The management of the HIV and AIDS response worldwide has evolved as the epidemic unfolded and new knowledge and understanding of the complexity of the epidemic emerged. Response management focuses on narrowing the gap between supply and demand of HIV and AIDS services, harmonising services to avoid duplication, rationalising resource use, and ensuring equitable distribution of services.   

HIV and AIDS response management systems differ from one country to another depending on the level of political commitment, institutional arrangements and availability of adequate financial resources, and skilled and competent human resources. Systems that are effective and efficient are characterised by clearly defined mandates, roles and responsibilities, a functional participatory planning and programme development process and an effective and functional monitoring and evaluation system. Equally such systems are decentralized and take cognizance of the strategic role of communities in coordinating community-based interventions.

Swaziland’s Coordination and Management Arrangements

Swaziland has demonstrated strong political commitment and has laid the foundations for effective management of the multi-sectoral response. Swaziland established a National Emergency Response Council on HIV and AIDS (NERCHA) in 2003. Subsequently, Swaziland established regional coordinating structures and sectors that have enhanced and expanded multi-sectoral partnerships and community involvement in the response management.

NERCHA has the overall legal mandate to coordinate the national multi-sectoral response. At regional level coordination is a partnership between NERCHA and the Ministry of Local Government and Housing (MLRD) through the regional coordinating mechanisms. These structures include the Regional Multi-Sectoral HIV and AIDS Coordinating Committee (REMSHACC), Tinkhundla Multi-sectoral HIV and AIDS Coordinating Committee (TMSHACC), and Chiefdom Multi-sectoral HIV and AIDS Coordinating Committee (CHIMSHACC). From an institutional arrangement these structures are HIV and AIDS sub-committees of the Regional Development Committees. Other coordinating structures include the Regional Health Management Teams (RHMT) under the Ministry of Health, and the Municipality HIV and AIDS Teams that coordinate the urban response. The regional coordination structures are in line with the National Decentralisation Policy of 2005. At community level, KaGogo Centres also play an important role in coordinating community services.

In addition to regional coordination, Swaziland has identified government (government ministries and departments) and non-governmental sectors that support sectoral coordination of the response. The roles and responsibilities for these sectors have been further articulated during the process leading to the development of the NSF. The key shift from the NSP II to NSF in the context of sectors is the re-categorization of sectors and clearer articulation of links between non-governmental and government sectors. The non-governmental sectors previously classified as sub-sectors have been elevated to sector level. 

The role and coordination of development partners has been crucial in the national response. Current development partners are the bilateral, multi-lateral and private donor agencies supporting the planning, development and implementation of the national response, and providing financial support. The UN agencies are coordinated through the Joint UN Team on AIDS. Mechanisms for coordinating other development partners have not been effectively institutionalized. The Swaziland Partnership Forum has served as networking and information sharing platform as opposed to playing a significant role in coordination and partnership strengthening.      

The expansion of the response has had its own management challenges ranging from increased number of partnerships and service providers, to lack of clarity of roles and responsibilities. A key concern of the multisectoral approach has been the coordination, harmonization and alignment of development partners’ programmes with national action plans, and monitoring of donor support and civil society and private sector interventions. These concerns have resonated globally, leading to the re-thinking of the multi-sectoral response approach. In response to these concerns, UNAIDS took the lead in 2003, and introduced the Three Ones principles. The principles emphasise the need for one national coordinating authority, one national HIV and AIDS strategic framework, and one monitoring and evaluation framework. The Three Ones principles presuppose that key stakeholders will align and harmonize their response to the national frameworks. While this has had some success, not all stakeholders have mainstreamed the principles in their operations.

Swaziland has adopted and operationlized the Three Ones principles at national level and through the decentralized coordination mechanism at regional and sector levels. To a large extent the regional approach has expanded the “space” for meaningful involvement by stakeholders and created the opportunity for strengthening national and community ownership, good governance and accountability. The regional coordination approach has been used in Botswana, Malawi, Rwanda and Uganda among other countries and is considered to be best practice. The regional coordination structures in Swaziland are in line with the National Policy on Decentralization of 2005.

The NSF puts emphasis on strengthening regional coordination of the response for two reasons. First, the regional response approach is considered to be best practice; and second, the approach creates a unique opportunity for decentralizing HIV and AIDS planning. The NSF supports and promotes Regional Action Plans (RAP) that feed into the National Action Plan (NAP) and serve as the vehicle for operationalising the NSF. This approach strengthens the implementation of the three ones principles and the National Decentralization Policy of 2005. The approach also creates a great opportunity for public and non-governmental sectors to plan and focus on areas of their comparative and competitive advantage, shifting the HIV and AIDS response from “business as usual” to a more strategic approach. 

For objectives and targets under Response Management  

Refer to National Strategic Framework (NSF).