Funding and Implementing HIV/AIDS Activities in the Context of Decentralization: Ethiopia and Senegal

Both Senegal and Ethiopia have recently undertaken changes in the political and financial administration of government services, decentralizing decisionmaking power to local levels. In Senegal, decentralization of health service planning and implementation to the district level poses both challenges and opportunities to the financing, treatment, and prevention of HIV. The positive consequences of decentralization are that local decision-making and implementation of HIV/AIDS activities are integrated into the health system, more resources can be made available for HIV/AIDS activities, and the public and private sectors plan jointly for HIV/AIDS services. However, some constraints posed by these reforms still need to be addressed. National coordinating bodies do not organize well with key health committees, and the roles of the various HIV/AIDS committees are not clearly understood. Non-governmental organizations (NGO) and community groups play a crucial role in the delivery of HIV/AIDS services, and in some cases are the exclusive service provider for the treatment of HIV/AIDS related illnesses. Decentralization in Ethiopia created a federal unit to coordinate health service provision and regional autonomous states in their planning and implementation services. In practice, however, these bodies do not function, and due to the lack of public service provision, treatment of HIV/AIDS is exclusively provided by NGOs. Prevention activities are not standardized, and there are imbalances between needs and resources at the regional level.