Accelerating progress in preventing violence against children and adolescents through multisectoral intervention packages in low- and middle-income co

Left behind in the AIDS response, adolescents are the only global population in which AIDS related deaths are increasing (UNICEF, 2016). In fact, AIDS is the leading cause of death among 10-19 year olds in Africa and, in 15 countries in Sub-Saharan Africa, children account for at least 50% of the population (UNICEF, 2016; UNFPA, 2014). Reducing adolescent AIDS is therefore necessary for a productive labour market. However, despite international efforts, AIDS remains a major global health challenge, notably in access to antiretroviral therapy (ART). Globally, over half of eligible HIV-positive patients lack access to ART (UNAIDS, 2016). Treatment coverage estimates for Africa remain quite varied, ranging from as low as 0% (Comoros) to 68% (Rwanda) (WHO, 2016). Remarkably, the international community is shifting priorities away from AIDS and, consequently, all but one of the 14 largest AIDS donors reduced funding in 2015 (Kates, Wexler, & Lief, 2016). Governments invest funds in several ways. One mechanism is official development assistance (ODA), which is intended to "promote the economic development and welfare of developing countries" (OECD, 2016). These funds can either be disbursed via multilateral organisations (e.g. Global Health Initiatives, GHIs) or bilaterally via grants or loans (MOFA Japan, 2011). GHIs refer to organisations receiving funds from governments to address epidemics like AIDS, including the Global Fund to Fight AIDS, Tuberculosis & Malaria, the US President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's Multi-Country AIDS Programme (Warren, Wyss, Shakarishvili, Atun, & de Savigny, 2013). Prominent bilateral ODA organisations in the AIDS response include SIDA (Sweden), NORAD (Norway), and USAID (USA).
The dissertation will address the question of: What financing structures are most effective in facilitating antiretroviral therapy coverage for HIV-positive adolescents aged 10-19 in Sub-Saharan Africa? To study this question, three components will be undertaken to examine:
1. Has domestic financing for HIV led to better treatment coverage for HIV-positive adolescents in
Sub-Saharan Africa as compared to foreign aid (i.e. official development assistance)?
2. Have countries continued provision and scale-up of ART to HIV-positive adolescents when donor
funding flat-lines?
3. Do corruption, democracy levels, armed conflict and state fragility moderate the impact of aid in
provision of ART to HIV-positive adolescents? A meta-process evaluation is currently underway to theorise aid implementation in the context of the global HIV response and, subsequently, its potential variations. This DPhil project has been discussed with Professor David Humphreys, who has agreed to supervise the project in consultation, as needed, with Lucie Cluver for topical support.
Added value: This project will address a significant gap in the literature. This study is the first to examine the impact of foreign aid on HIV treatment coverage, particularly on the oft-neglected adolescent subpopulation. The project will contribute to emerging literature on the political economy of health through its examination of how political structures shape adolescent health outcomes (Ruger, 2009). Notably, donor funding is beginning to flat-line and donor fatigue is an increasing problem for programmes (Grépin, 2012). The project will contribute new information on aid effectiveness and the best financing mechanisms for improving health. The project builds on Moyo's work by empirically (a) testing the long-term impacts of aid, (b) analysing whether national financing is better, and (c) examining HIV in the context of the "four horses". The findings will contribute to the initiatives of African governments toward an evidence-based approach to financing national HIV response and will inform international partners and donor-countries with an evidence-based policy evaluation of their work.