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The Global Fund from an African perspective National coordination mechanisms, between transnational networks and power relationships (Senegal, Côte d'Ivoire, Burkina Faso, Cameroon) (eng)

Fred EBOKO et And the "Governance and AIDS in Africa group"

Résumé

This publication takes the opportunity of the Global Fund to Fight AIDS, Tuberculosis and Malaria's Replenishment Conference to issue the first qualitative results of research conducted under the aegis of ANRS. This research focused on the Country Coordinating Mechanism (CCM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund from an African perspective

The purpose of this dossier is to analyse the contexts in which Global Fund financing is provided in the region of the world most affected by the diseases to which this mechanism owes its birth: sub-Saharan Africa. Based on the Country Coordinating Mechanism (CCM), which form the multi-stakeholder collegial structures within which the distribution of funds is organised, together with multisectoral action plans, this dossier proposes downstream studies, on the "ground" from four countries: Senegal, Côte d'Ivoire, Burkina Faso and Cameroon. The latter have the particularity of having experienced significant progress due to international funding, but they are also the grey area in which this progress is slowest: West and Central Africa.

This dossier is the result of a research project conducted since 2015 with funding from the National Research Agency on AIDS and viral hepatitis. Initially devoted to three countries: Senegal, Côte d'Ivoire and Cameroon, this collective work was extended to Burkina Faso through a doctoral research that joined the research activities of this project.

This work is presented in four parts. It opens with a socio-historical presentation of the Global Fund which articulates the problem of the "unprecedented political alliance" that the Fund is with the question of private actors in this mechanism of international solidarity. The second part focuses on the tension between the Fund's multilateral purpose and the bilateral issues that unite African partners and donor country cooperation agencies. The third part concerns the relationship between public authorities and civil society organizations, between tensions and reconciliations, particularly around the issue of "key populations", and especially that of men who have sex with men (MSM). The comparative approach in this case sheds light on the ideological dynamics facing epidemiological issues. The dossier concludes with a short Policy Brief with recommendations to the CCMs and the Global Fund to improve the relationship between the various actors.

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Texte intégral

1The creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria reflects the birth of a desired, expected, postponed, fought and ultimately dedicated being. The conditions for the arrival of this unique financing mechanism in the world represent the vicissitudes of international relations and the hopes of the contemporary globalised world. This dossier presents the results of a study conducted under the aegis of the National Agency for Research on AIDS and Viral Hepatitis (ANRS). It concerns four countries in West and Central Africa: Senegal, Côte d'Ivoire, Burkina Faso and Cameroon. It focuses on the power relations between the different actors that make up the Global Fund's Country Coordinating Mechanism (CCM). The main objective of CCMs in all countries where the Global Fund operates is to bring together all stakeholders in the fight against the three diseases to which the Fund devotes its action and funding in order to increase their effectiveness.

2These CCMs therefore represent a multi-sectoral deliberative forum (Spicer et al. 2010). The purpose of this study is to analyse the relationships between these different actors, international and national, public and non-governmental, in the context of activities that lead to the Fund's grant allocation to individual beneficiaries in the countries hosting these CCMs.

3The central assumption of this work is that power relations between actors guide the coordination and action of CCMs. This hypothesis leads to a sub-hypothesis: these power relations vary according to the political trajectory of each State, beyond the level of dependence of the countries on the resources provided by the Fund. The role of public authorities is central to the implementation of public policies. Nevertheless, the way in which state actors are framed in public action in Africa produces governance at several scales (multiscalar) within which power relations depend on the historicity of partnerships in each country. This situation shapes the real adherence or passive resistance of national actors to the bureaucratic and ideological norms that underpin the architecture and dynamics of CCMs.

4It is useful to present in a synoptic way the historical context in which the Fund was created (Eboko et al., 2015). This introduction then provides a better understanding of the epidemiological and political situation in which the Fund operates in each country. In this context, the question of procedures (Tchiombiano, Nay, Eboko, 2018) and technical assistance to countries receiving grants is important. It highlights partnership relations and transnational networks between North and South, as much as it makes it possible to analyse the diplomatic ambitions of the countries of the North in an intrinsic way. Thus, their declension in different countries constitutes a prism of the tension embodied by the Global Fund in international relations and so-called "development" policies, between the multilateral option and bilateral dynamics. Thus, Côte d'Ivoire is an atypical case in West and Central Africa. Indeed, of the four countries on our panel, Côte d'Ivoire is the country whose majority of resources for the fight against AIDS, tuberculosis and malaria come from American bilateral aid (PEPFAR): 78%. The Global Fund contributes 15% of this investment. This differentiates this country from the other three countries, which depend mainly on the contribution of the Fund. This balance between bi and multilateral action influences the power play within the CCMs and provides relevant analytical elements for each of the countries in our study.

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Fred EBOKO et And the "Governance and AIDS in Africa group", « The Global Fund from an African perspective National coordination mechanisms, between transnational networks and power relationships (Senegal, Côte d'Ivoire, Burkina Faso, Cameroon) (eng) », Face à face [En ligne], 15 | 2019, mis en ligne le 10 octobre 2019, consulté le 09 décembre 2019. URL : http://journals.openedition.org/faceaface/1474

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