ERROR MSG
Connecting the Grassroots:
Designing a Mechanism to Enhance South-U.S. ASO
Communication and Collaboration
Global AIDS Action Network (GAAN)-A Tides Center Project
November 30, 2002
Contents:
Abstract Summary
- discount hotels in BathObjectives of the Connecting the Grassroots Project
- Historic Context and Recent Developments on Twinning
- The Complex Nature of International ASO Communication, Collaboration and Twinning
- Needs to Be Addressed by Twinning Enhancing Mechanisms
- Scale and Scope of Needed Mechanisms
- Southern ASO Leadership-An Essential Component
- Proposed Mechanisms to Enhance ASO Twinning: Southern Based Regional Hubs
- Activities of Regional Hubs
- Cost of Regional Hubs
- Remaining Questions
Attachment A. Summary Key Findings and Recommendations
Attachment B. Design of a Southern-based Regional Hub to Enhance ASO Collaboration
Attachment C. An Example of a Regional Hub at Work
Abstract Summary
GAAN concludes that mechanisms to enhance international ASO collaboration are needed as twinning activities multiple. Key to the successful implementation of ASO twinnings is sustained leadership by southern groups and deliberate coordination of goals and standards by northern institutions. We recommend that USAID do the following:
ERROR MSG 1.1 Support the creation of southern-based regional hubs tasked specifically to enhance international ASO communication and collaboration. This effort should be undertaken with other funding agencies if at all possible.
1.2 Support efforts to create a global Internet mechanism on twinning such as is now being considered by the Canadian government assuming that this mechanism is complementary to southern-led mechanisms and that U.S. support is welcome.
1. Objectives of the Connecting the Grassroots Project
Over the last twelve months the Global AIDS Action Network (GAAN) has undertaken substantial consultation to understand how international ASO communication and collaboration could be enhanced. The hoped for outcome of this effort is to design mechanisms that could strengthen such collaborations.
During this process GAAN consulted with dozens of groups and institutions involved in international twinning as well as forming a 14-member advisory group (comprised of U.S. and southern ASOs) to consider in-depth the key questions of the project. We formally collaborated with a parallel effort undertaken by the Canadian government organizing a joint two-day meeting on ASO collaboration with our Canadian counterpart, the Interagency Coalition on AIDS and Development (ICAD). ICAD and GAAN also served on each other’s advisory boards, sharing our findings throughout the year.
Given the accelerating enthusiasm for twinning of ASOs and other institutions, it is important to note that this consultation seeks to address only a piece of this complex challenge. It is not our purpose to address all aspects of twinning or even all aspects of ASO twinning. Many of the broad issues around twinning and the overall involvement of U.S. AIDS groups in global AIDS activities were addressed in our earlier key stakeholder consultation and we refer the interested reader to that document
Our purpose here is to respond to the reality of expanding U.S.-developing nation ASO twinning and to consider how mechanisms might be created to strengthen these efforts. The principal objective of this project is "to develop a blueprint for the creation of a mechanism to enhance and sustain communication and collaboration between ASOs in developing nations and in the U.S."
2. Historic Context and Recent Developments on Twinning
U.S. AIDS groups and their counterparts in other nations have sought to establish and maintain relationships since the beginning of the AIDS pandemic. U.S. groups were involved in the creation of all three global AIDS networks, for example, and a myriad of short term connections to groups in other nations have occurred over the last two decades. Nearly all of these efforts were based on the immediate needs of the groups involved and were self funded. These global AIDS activities waxed and waned as needs and resources dictated, with virtually no U.S. group having a long term relationship with southern groups as of 1995, but many having substantial international experience and motivation.
As GAAN noted in our "Key Stakeholder Report", this ongoing concern exploded in the late 1990s with the advent of the Internet and successful treatment protocols for HIV. With these two events many U.S. groups not only felt a moral imperative to undertake global work, but also were able to establish ongoing communication with their southern colleagues. Ultimately, only a small subset of the vast American AIDS community has been able to meaningfully become involved and some of this involvement was focused on U.S. global AIDS policy. A number of groups, however, sought to establish direct program relationships with their counterparts in developing nations, a process commonly referred to as "twinning," although it is also called "international ASO collaboration."
Seeking to explore the potential value of these efforts in 1999, USAID and CDC launched a pilot project to support four international ASO partnerships between groups in the U.S. and Central America, the Caribbean and Africa. These partnerships were supported for the next four years.
Simultaneously the Canadian government was exploring international ASO partnerships, which they described as twinning. This effort resulted first in guidebook on international twinning created by ICAD and rapidly thereafter exploratory funding of actual twinnings between Canadian ASOs and groups in developing nations. These efforts differed from the CDC/USAID partnerships, having different purposes, shorter duration and less funding per project. The first round of these twinning were judged a success and expanded support was therefore made available by the Canadian International Development Agency (CIDA). The Canadian government has also supported a parallel effort to the Connecting the Grassroots project to consider how mechanisms could be created to enhance twinning efforts. This effort was also undertaken by ICAD and is reported on later in this document.
Another agency interested in ASO twinning is the Health Resources Services Administration (HRSA), which has vast expertise in domestic AIDS programs and in recent years has become involved for the first time in international activities. Because of its depth of expertise and long experience in working with frontline U.S. AIDS groups, HRSA believes that it should undertake international AIDS twinning activities not only of ASOs, but of also of hospitals and other health institutions. The agency is now beginning a three-year ASO twinning program in the Caribbean, but sees this as only the start of larger effort.
Consideration of twinning institutions in response to the HIV/AIDS pandemic is has not been limited to ASOs, but also includes the twinning hospitals and research institutions. Hospital twinning has specifically been advanced as a means of rapidly expanding the treatment capacity of southern institutions given the advent of retroviral therapy. GAAN understands that the idea of twinning hospitals has been advanced by the French and Canadian governments, as well as by the U.S. Department of State, and that it is supported in various pieces of legislation now pending before the U.S. Congress. The concept also received support from G8 leaders in their 2002 statement, which identified a method of improved health programs in Africa to be "supporting and encouraging the twinning of hospitals and other health organizations between G8 and African countries."
Simultaneous to these actions by governments many U.S. groups themselves proceeded to undertake relationships with their colleagues in developing nations. In the last four years the number of U.S. ASOs engaged in international work has expanded many fold and now incorporates a range of diverse activities that is discussed in more detail below.
GAAN has drawn three conclusions from the twinning activities described above—both of which are fundamental to the recommendations of this project:
2.1. Significant international ASO twinning is underway and will substantially expand in the nearfuture. These activities are real now, not theoretical.
2.2. Many agencies are committed to supporting twinnings, but these efforts are not coordinated and therefore do not share unified goals or standards.
2.3. Therefore mechanisms that could enhance the effectiveness and coordination of twinning efforts would be useful.
Thus the core premise of this consultation is affirmed. The key question of how mechanisms to enhance ASO collaboration should be structured remains before us.
3. The Complex Nature of International ASO Communication, Collaboration and Twinning
International ASO twinning occurs around a wide range of activities though programs that differ greatly in size. Formal twinnings, defined as substantial projects undertaken under a written agreement, are only a small part of a much broader universe of international ASO communication and collaboration.
The graphic above is one way to conceptualize the universe of potential ASO communication and collaboration. It considers both the purpose of the collaboration and the scale. The largest number of ASOs falls into the scale of informal activities either because they are new to international work or because they have decided not expand their efforts.
It is important to note that the vast majority of groups who create informal communication and collaborations will not try to establish formal twinnings. However the few that do so will have received substantial benefit from their informal work, which is an essential proving ground for more formal activities. AIDS groups need time to establish international communication with their counterparts and identify areas of common interest. Many groups, northern and southern, never go beyond this stage, as informal communication alone is sufficient to meet their needs.
Of the groups that do identify areas where they would like to work together, some will chose to work on global AIDS policy issues or for purposes of solidarity, projects that are unlikely to be supported by many international funders. Formal collaborations will vary in purpose—with projects working on treatment access having little contact with groups working on youth prevention activities despite the fact that both may be twinning projects underway in the same southern nation. GAAN found multiple examples of U.S. ASOs undertaking twinnings in specific southern nations, but having no idea that other U.S. groups also were twinning with other groups in the same nation.
In designing mechanisms to enhance twinning, GAAN concludes that each formal twinning exists within a much broader universe of international ASO communication and collaboration. Further formal twinnings are begun by groups that have first become educated, experienced and connected though informal activities and the success of these efforts are dependent on that experience. One of the real, but hidden, benefits of this informal work is that groups will learn not just what can be done, but what cannot be done though twinning.
In addition much good work is accomplished through collaborations that do not seek to become formal twinning or cannot receive funding to do so. For all these reasons GAAN recommends that
3.1. Mechanisms to enhance international ASO twinning should not be limited to groups in formal relationships, but seek to support a wide range of collaborations. They should seek to strengthen not only the formal projects, but also a much broader set of activities.
4. Needs to Be Addressed by Twinning Enhancing Mechanisms
Assuming that the mechanisms to enhance twinning will serve a wide range of groups, core needs common to all organizations need to be identified. During the consultation two needs common to all collaborations were identified:
4.1. Means to find each other or formal entry portals
Most groups now in international collaborations found their partners though informal staff contact, often at international meetings. Many groups described haphazard processes and some experienced failed collaborations because of their inability to identify appropriate partners. All participants agreed that mechanisms that would facilitate the ability of groups interested in international collaboration to find each other are needed.
4.2. Twinning specific spaces to communicate and collaborate
Many groups now engaged in twinnings feel isolated and have no way of knowing what other groups may be collaborating on the same issue or in the same nations. The advisory group felt that mechanisms such as websites and meetings devoted specifically to twinning were needed for groups engaging in international collaboration to communicate and support each other
GAAN concludes that mechanisms to enhance international ASO collaboration should have two core objectives:
4.3. To serve as an entry portal for a wide range of groups exploring international collaboration to foster international communication and solidarity
4.4. To provide support to a wide range of ASOs already engaged in ongoing international communication and collaboration including informal relationships, assisting these groups in collaborating with each other and strengthening their projects
5. Scale and Scope of Needed Mechanisms
In considering mechanisms, one challenge involves the diverse nature of twinning activities. Another is cultural diversity, particularly language. GAAN found simply in organizing dialog around this project that all mechanisms (e.g., Internet communication, conference calls and face-to-face meetings) were complicated by differing experiences, capacities and most of all language. This project was forced to utilize very focused agendas, select participants who were highly experienced in international collaboration and provide substantial translation services to achieve a meaningful global dialog. Such a narrow focus and select participants is viable for this project, but it is contrary to the need for twinning enhancing mechanisms to support a wide range of groups in diverse activities.
Furthermore we observe that already existing mechanisms to advance international communication and collaboration are focused often by geographic region. The most compelling example was SAATHII (Solidarity and Action Against the HIV Infection in India) that began as a web based discussion on AIDS in India and has grown in a multifunction group bringing both individuals and groups together on AIDS activities relative to that nation. By focusing the discussion geographically, SAATHII appears to have included a wide range of groups and achieved substantial depth in its discussions.
Regional meetings were cited by many project participants as the ideal meeting venues for groups seeking to work internationally as were geographically focused web discussions. However no region appears to have created a mechanism that tightly coordinated Internet discussions with face-to-face meetings except for SAATHII. Within the project advisory group, the SAATHII experience was well received as a potential model for international collaboration. GAAN itself is very impressed with this already existing example of an apparently successful mechanism to promote international communication and collaboration on AIDS in India.
5.1. GAAN concludes that mechanisms to enhance ASO twinning should be focused on specific geographic regions as the only means by which they can achieve the flexibility and depth required to be effective.
6. Southern ASO Leadership—An Essential Component
Throughout this project GAAN has been concerned about how mechanisms to promote international collaboration could be established when all funding would come from northern institutions. One of the great concerns of U.S. groups and agencies in undertaking international twinnings is that this work be culturally informed and that "southern need, not northern good intentions" drive project design. One of the principal conclusions of the GAAN’s key stakeholder consultation is that southern groups felt that true partnerships were useful and viable, so long as the fundamental relationship was structured in a way that promoted equality between the two groups.
In constructing mechanisms to promote twinnings the same need for equal leadership from southern ASOs is essential. These structures must serve and be trusted by southern ASOs or they are of little value. As in twinnings themselves, this question is complicated by the fact that all funding will come from northern institutions.
7. Proposed Mechanisms to Enhance ASO Twinning: Southern-based Regional Hubs
Given the findings cited above GAAN concludes that the needed mechanisms to enhance ASO twinnings are southern-based hubs geographically focused and specifically designed to promote a wide range of ASO communication and collaboration.
Each regional twinning hub would have three elements:
7.1. Each hub would be under the control of existing southern ASOs based in the region being served. Ideally this would be a single group working in collaboration with others in the region. Preferably this group would have some formal relationship, perhaps only advisory, with northern groups and perhaps even subcontract elements of program activity, but decision-making should be among southern groups. This allows the discussions and project activities to be led from the south.
7.2. Each hub is geographicly focused, not global in scope. How focused is a difficult question, which we were unable to answer in this consultation. We found that the regional definitions used by WHO (i.e., Asia, Africa, LAC) for example are clearly problematic for most ASOs, bring little cultural focus and fail to solve the problem of language. On the other hand national focus works in a nation such as India, but is not viable for every nation.
The advisory group discussion on the geographic definitions of hubs broke down and GAAN concluded that it is premature. We believe that the geographic definitions of the hubs will emerge as they are evolve. Our best guess is that 10 or 12 regional hubs might ultimately be useful, a few serving very large countries and others working in several nations. It is probable that some nations will not participate at all. This lack of clarity on geographic scope is one of the principal reasons that GAAN recommends that hub creation begin with a few regions and expand gradually from there.
7.3. Each hub would specifically seek to promote and enhance international ASO communication and collaboration including, for USAID’s purposes, with U.S. groups. This includes using the Internet, face-to-face meetings and other activities to achieve specific goals to as is discussed below.
GAAN assumes that each hub would promote international collaboration beyond simply that between U.S. and regional ASOs. We further assume that the hub would use existing relationships, tools and opportunities to promote collaboration (i.e., existing websites or annual meetings). The intent is to add value to existing mechanisms, not create entirely new structures.
8. Activities of Each Hub
The activities of each twinning hub will vary substantially depending on the needs and capacities of each region. One of the great strengths of the regional hub structure is that it allows the mechanism to adopt to meet the need of groups working in international collaboration within each region. However some core activities were identified during the consultation as essential to all twinning hubs:
8.1. Internet mechanisms that provide both points of entry and support for ongoing collaboration between ASOs. Minimally this would include a website and discussion group on region specific issues.
8.2. Face-to-face mechanisms that also provide points of entry and support for ongoing collaborations between ASOs. Probably this is an annual meeting (or satellite to an existing meeting), but it might include study tours, visits, etc.
These two core activities should be tightly coordinated so that groups attending meetings use the Internet to prepare and also follow-up their face-to-face discussions. These are actually two elements of single mechanism that is much stronger then either would be on its own.
Beyond these two core activities the goals of each hub will vary. However in our discussions some strategies resonated with many participants and are likely to emerge in many regions:
