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Executive Summary of Expanding community action on HIV/AIDS
   Last updated: 29.06.02
 
HIV/AIDS remains one of the most significant development challenges today, and clearly there is still a great deal to learn about how to slow the spread of HIV and deal with the consequences of AIDS. Fortunately, the experience of responding to the pandemic over the past twenty years has shown that there are many approaches that either work or probably work. The challenge now is to move from successful small-scale projects that reach relatively few individuals to effective strategies that really make an impact on the pandemic. How can individual NGOs/CBOs, scale-up their own contribution to effective responses?

For NGOs/CBOs working on HIV at a community level, scaling-up effective action on AIDS involves five key considerations:
  • Focus – ensuring that their programmes work most closely with individuals and groups that have the most significant effect on epidemic dynamics.

  • Coverage – ensuring that as many key people and groups as possible are reached.

  • Quality – ensuring that programmes and interventions are appropriate to the local context and target group and are of a consistently high standard.

  • Sustainability – ensuring that the organisation, its programme and its effects last over time.

  • Impact – ensuring that adequate attention is paid to each of the issues of focus, coverage, quality and sustainability, so maximising the potential impact.


As any NGO/CBO sets out to scale-up its work, it may pay more attention to any one of the first four elements noted above. This is entirely appropriate, as different scale-up strategies are appropriate for different NGOs/CBOs in different circumstances. Nevertheless, it is crucial that any scale-up strategy pays particular attention to how the above factors interact and complement each other, ultimately contributing to increased impact.

Based upon its practical experiences, the Alliance has already learned much about supporting NGOs/CBOs to scale-up at a community-level. Drawing on different approaches to scale-up that have been used in different circumstances, it is possible to provide a “menu” of options from which each NGO/CBO can select a “strategy package” to suit its own specific vision, capacity and resources.

In addition, the Alliance has learned a considerable amount about the process of scaling-up for NGOs/CBOs. It is clear that scale-up ideally proceeds in a planned and strategic manner, based on rigorous programme evaluation, epidemiological analysis and participatory assessment with affected communities. However, in practice, scale-up rarely proceeds in such ideal circumstances and NGOs/CBOs must manage predictable tensions in the scale-up process: between “top down” and “bottom up” approaches; reaching more people and maintaining quality, and being accountable to the community and reporting to donors.

While flexibility and creativity are undoubtedly important, there do appear to be certain key pre-requisites for effective scale-up. For example, there are minimum organisational requirements that must be in place prior to effective scale-up, such as solid administrative systems and confident and capable leadership. The scale-up process should be both community led and evidence based, and should complement, rather than exclude, support to marginalised groups. Also, sustaining scale-up requires attention not only to programmes and organisations but also to the quality and impact of the work at individual, community and societal levels.

However, despite these lessons and the increasing number of groups scaling up their HIV/AIDS efforts, many significant questions still require more attention:

  • Which strategies best suit which types of NGOs/CBOs and communities, and which are most cost and time effective?

  • Which strategies most effectively balance all of focus, coverage, quality, sustainability and impact – rather than heavily focusing on just coverage?

  • What short and long-term compromises – in areas such as accountability to communities and quality of work - are acceptable for the sake of scale up?

  • Is it realistic to talk of sustaining scale-up efforts locally, or is external funding always necessary?


Even with these areas of doubt, the Alliance proposes a series of concrete recommendations.

For NGOs/CBOs, perhaps the most important recommendation is that while every group working on AIDS should be striving to make their work more effective and more efficient, not all groups should necessarily be trying to scale-up. For those NGOs/CBOs that do pursue scale-up, evaluation, assessment and planning should ideally take place beforehand. At the very least, time and money should be allocated for reflection and planning as part of the scale-up process.

For governments and policy makers, the Alliance’s key recommendation is to recognise that most NGOs/CBOs legitimately have a different viewpoint and scope of action than 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, will 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 living 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, or to develop good practice guidelines.

Finally, for donors and NGO support providers, the Alliance recommends paying particular attention to jointly defining scale-up at the start of relationships with NGOs/CBOs, developing explicit strategies and criteria to select groups which will receive additional funding to support scale-up, and specifying realistic objectives and timescales.

The full report is available in PDF format by following this link (40 pages, 998 Kbytes).

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.

To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 998 Kbytes).