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Expanding community action - 5 (recommendations)
   Last updated: 29.06.02
5.1. Recommendations for NGOs/CBOs at a community level
Based upon the lessons learned from “Community Lessons, Global Learning” and other initiatives, this chapter promotes concrete recommendations developed by the Alliance for key stakeholders involved in scaling-up community action on HIV/AIDS:

NGOs/CBOs working at a local level should:

  • Strive to make their work more effective and more efficient, but not necessarily to scale-up. If groups do pursue scale-up, it should be for strategic purposes – to ensure that their unique strengths and talents make the greatest possible impact on the HIV/AIDS epidemic. NGOs/CBOs should say “yes” to scale-up that meets identified needs within the community, is relevant to their organisational vision, and is within their capacity. But they should say “no” to scale-up that is unrealistic, may unacceptably harm existing programmes, or will not significantly contribute to HIV/AIDS prevention or care.


  • Start scale-up based upon their existing strengths and strategies that they already know, while also actively learning about, and experimenting with, other approaches. Scale-up is a demanding process, even if it focuses on a NGO’s/CBO’s existing areas of expertise and experience. Therefore, organisations must be realistic about what they can and cannot achieve. They must also see scale-up as an active rather than mechanical.


  • Plan scale-up in advance, if at all possible. Whether or not advance planning is possible, groups should set aside time during the scale-up process for reflection, re-planning and adjustment of strategies. NGOs/CBOs should put systems (such as for programme monitoring and financial management) in place and address likely hindrances (such as weak leadership and staff burn out) early on as they start scaling-up. This will help to ensure that their efforts have the best chance of being not just effective, but also sustainable.


  • Keep rooted in and responsive to the needs of the community at all stages in the scale up process. But they must also be pragmatic about potential, necessary compromises that may need to be made on areas such as accountability and quality of programmes. NGOs/CBOs should aim for appropriate and locally owned initiatives, but must also be realistic that reaching more people may involve some degree of “letting go” in other areas.


  • Assess which aspects of scale-up need to be evaluated and which can just be monitored, and agree not only quantitative, but also qualitative, indicators with key stakeholders, particularly donors. This can help NGOs/CBOs to avoid unnecessarily complex and time-consuming evaluation processes, while also ensuring that they are actively learning from their experiences. The results of these efforts – especially the successes and failures that they highlight – can then be used to improve both the organisation’s own scale-up work and that of others, including government, donors and other NGOs/CBOs.


5.2. Recommendations for governments and policy-makers
Governments and policy leaders should:

  • Recognise that most NGOs/CBOs legitimately have a different viewpoint and scope of action from those working at a national and international level. Governments increasingly and importantly focus on reducing overall HIV incidence and providing universal coverage of care and support. While the NGO/CBO sector is a vital partner in achieving these national and international goals, individual NGOs/CBOs can, and should, pursue their own targets with their own strategies. For example, any given NGO home-care programme is likely to be too expensive to scale-up to reach the four million people living with HIV in India. However, scaling-up the NGO programme can make a crucial contribution to reaching thousands, rather than hundreds, of people, to training clinicians and social workers that may go on to support other efforts, and to develop good practice guidelines.


  • Foster a relationship of partnership and collaboration with NGOs/CBOs. This is vital to ensure that efforts are well co-ordinated and complementary. It can be achieved through practical steps, such as participating in the planning of each other’s activities and inviting NGOs/CBOs to present their experiences at government fora.


  • Complement the scale-up work of NGOs/CBOs by, where possible, increasing the State’s social and health services in parallel. This can help to ensure that comprehensive responses to HIV/AIDS are scaled up as a whole, rather than just selected components. In practice, this might involve increasing government facilities – such as blood screening and STI treatment – side by side with expanded NGO/CBO programmes in areas such as participatory prevention.


  • Take a lead role in creating a national supportive environment that enables scale-up work not just to function, but to flourish. This involves developing a context in which HIV/AIDS work is not merely accepted, but actively facilitated, which is crucial to ensuring that scaled up NGO/CBO efforts have a real chance of scaled up impact. In practice, this might involve measures such as legislating against discrimination of marginalised groups or supporting media campaigns to reduce stigma against PLHA.


  • Actively facilitate the exchange of information and resources about scale-up – in order to increase the quality of work carried out and co-ordination among those involved. This might involve co-ordinating research into models of good practice, bringing together different sectors in national fora to share lessons, and acting as a “match-maker” between NGO/CBO and opportunities for funding.


5.3. Recommendations for donors and NGO support programmes
Donors and NGO support programmes should:

  • Define their interpretation of scale-up at the start of their relationship with a NGO/CBO, and keep it consistent while the programme is being funded. This will help to foster a relationship of partnership, to keep the initiative “on track” throughout, and to ensure that expectations are understood and realistic on both sides.


  • Develop criteria to select NGOs/CBOs for scale-up that recognise both their absorptive capacity and the unique contribution each one can make. This must include attention to both internal factors (such as accounting procedures and governance structures) and external factors (such as credibility within the community and reputation among other organisations).


  • Invest time and money in building capacity, if the donor is serious about scale-up. It is cheaper and easier, especially in terms of technical support and administration, to fund a NGO to continue to do something it is already good at, reaching a steady number of beneficiaries. Scaling-up requires much more than expanded investment – from staff retreats to training to improved accounting to leadership development.


  • Specify - and be realistic about - the remit and timescale of their support to NGOs/CBOs for scale up. This should include being open about what funds can be used for, when disbursements will be made, and when results will be expected – so that NGOs/CBOs know what to expect and can plan accordingly. Donors should not expect partners to achieve unrealistic results with limited funding. And with the heavy technical support and capacity building costs involved in the start-up of scaling-up, there is little point in trying unless there is a commitment to sustained and expanded support over at least several years.


  • Allow and encourage NGOs to diversify their sources of support. Individual donors may need to be less controlling or influential with regard to NGOs’ activities. Donors need to let go of tight control, resist micromanagement and place trust in others, which NGOs need to ensure transparent accountability mechanisms and solid evaluation..


  • Acknowledge and transparently negotiate tensions amongst multilateral, governmental, NGO and donor goals, objectives and strategies for scale-up. Ideally, this involves finding common ground and willingness to provide some support outside the donor’s own strategic framework. If not, donors should acknowledge that they are essentially sub-contracting tasks rather than supporting NGO and community responses, and therefore responsibility for delivery rests with the donor rather than the NGO.


  • Actively promote scale-up as a vital aspect of the global response to HIV/AIDS, and facilitate the exchange of information about it among local, national and international stakeholders. In particular, donors should use their global perspective to proactively identify and introduce scale-up models from other subject areas and other countries – to enrich local responses and prevent the “reinvention of the wheel.”


Source: Expanding community action on HIV/AIDS
This is an extract from Expanding community action on HIV/AIDS: NGO/CBO strategies for scaling-up, published by the International HIV/AIDS Alliance in 2001.

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