In the late 1980s cases of a condition that subsequently came to be called AIDS (Acquired Immune Deficiency Syndrome) were detected in many countries, including Indonesia. Thecausal agent is a slowly replicating virus known as Human Immunodeficiency Virus (HIV). In response to the epidemic, more than 60 National AIDS Commissions (NACs) were established by 2005.
At the latest LSTM seminar, Professor Peter Heywood, of theMenzies Centre for Health Policy, at the University of Sydney, outlined his assessment of NACs, conducted using the Institutional Analysis and Development (IAD) framework. With training in epidemiology, policy analysis, economics, and nutrition, Professor Heywood has a strong background and experience in health policy and health sector reform in low-income countries with particular emphasis on South and Southeast Asia and the Pacific. Before retiring in 2006, he was a Lead Health Sector Specialist with the World Bank, leading that institution’s dialogue in the health sector and developing and supervising large portfolios of health sector investments in the public and private sectors in India (1998–2004) and Indonesia (2004–2006).
The IAD framework, was developed by Elinor Ostrom, who won the 2009 Nobel Prize for Economic Science, for her analysis of economic governance.
NACs have been established in more than 60 countries, usually with support of the World Bank and UNAIDS. The NACs are usually charged with overall coordination of a multi-sectoral response to the HIV epidemic. The response included a bundle of activities such as strategic planning, program evaluation, surveillance, preventIon of transmission and counselling and testing. In 2005 the World Bank evaluated the effectiveness of NACs and concluded that they were often set up too quickly, were not able to set priorities between activities and that the multisectoral approach often resulted in disengagement of the health sector. As efforts to improve HIV control outcomes have met with only limited success there is a need for new approaches to strengthening program performance.
Professor Heywood proposed that one such new approach is the Institutional Analysis and Development (IAD) framework developed by Elinor Ostrom. The IAD framework directs attention to the incentive structure for those working in the program as well as external factors (biophysical conditions, community attitudes and rules-in-use) that affect decisions. The framework also emphasizes the importance of the economic nature of the control activities, sub-national levels, the structure of funding and ability to set priorities and resolve disputes between the various arms of government in involved. The presentation included examples of the most important of these factors.