Development planning and HIV/AIDS in sub-Saharan AfricaDevelopment planning and HIV/AIDS in sub-Saharan Africa By Mirjam van Donk Final Report Prepared for the UNDP Regional Project on
Trang 1Development planning and HIV/AIDS in sub-Saharan Africa
Development planning and HIV/AIDS in sub-Saharan Africa
By Mirjam van Donk
Final Report
Prepared for the UNDP Regional Project on HIV and Development in sub-Saharan Africa
July 2004
UNDP Regional Service Center
7 Naivasha Road, Sunninghill 2157, Johannesburg
South Africa Tel: 27 11 603 5000
Fax: 27 11 603 5071
Trang 2Prepared for the UNDP Regional
Project on HIV and Development
in sub-Saharan Africa
July 2004
Trang 4FOREWORD 1
ACKNOWLEDGEMENTS 2
ACRONYMS 3
1 INTRODUCTION 5
1.1 Introduction 5
1.2 Background to the study 5
1.3 Study aim and activities 5
1.4 Project management and execution 6
1.5 Overview of the report 6
2 DEVELOPMENT PLANNING IN SUB-SAHARAN AFRICA: A BRIEF OVERVIEW 9
2.1 Introduction 9
2.2 Four fundamental challenges 9
2.3 Responses to development challenges and progress achieved, 1950s-1999 10
The 1950s and 1960s: the development era 10
The 1970s: crisis in development planning 11
The 1980s: structural adjustment 13
The 1990s: ‘structural adjustment with a human face’ 15
2.4 Concluding comments 17
3 A TYPOLOGY OF DEVELOPMENT PLANNING IN SUB-SAHARAN AFRICA 21
3.1 Introduction 21
3.2 When planning fails: contested perspectives 21
3.3 (Re)Defining development planning 22
3.4 Typology of development planning and associated frameworks 23
Key types of development planning in sub-Saharan Africa 24
Principal development planning frameworks 25
3.5 Issues of integration and alignment 29
4 DEVELOPMENT PLANNING AND HIV/AIDS: AN ASSESSMENT OF PRINCIPAL DEVELOPMENT PLANNING FRAMEWORKS 31
4.1 Introduction 31
4.2 Conceptual shifts for an expanded response to HIV/AIDS 31
4.3 HIV/AIDS: a three-pronged response 32
Prevention 32
Treatment and care 33
Impact mitigation 33
4.4 Development planning and HIV/AIDS: a tentative framework for assessment 34
4.5 Exploring possible links between development planning and HIV/AIDS 38
National Strategic Framework for HIV/AIDS 38
PRSP 39
MTEF 40
Trang 5Sector Plans 41
Rural / Urban Development Frameworks 43
4.6 Concluding observations 44
5 INTRODUCTION TO THE COUNTRY ASSESSMENTS 47
5.1 Introduction 47
5.2 The selection process 47
Development planning frameworks 48
HIV prevalence 48
Status of development and other criteria 48
5.3 Comparison of development profile of selected countries 51
Adult HIV prevalence rate 51
Life expectancy 51
Trends in GDP growth 52
GNI per capita 53
Concluding comments 53
5.4 Research methodology for country assessments 54
Research questions 54
Research methodology 54
Research process 55
Challenges and difficulties encountered 56
5.5 Structure of the country assessments 56
6 CAMEROON 57
6.1 Introduction 57
6.2 Overview of development trends since 1980 57
Demographic trends 57
Economic performance and structure of the economy 58
Poverty and inequality 58
Human development .59
HIV/AIDS 60
Conclusion 61
6.3 The core determinants and key consequences of HIV infection in Cameroon 61
Core determinants 61
Key consequences 62
6.4 Development planning and HIV/AIDS in Cameroon 63
Development planning in Cameroon in historical context 63
The PRSP, 2003-2015 64
The MTEF, 2003-2015 67
The Strategic Framework for the Fight Against AIDS, 2000-2010 69
The Health Strategy, 2001-2010 73
The Education Strategy, 2001-2011 75
The Rural Development Strategy (DSDSR), 2002-2004 77
The planning process 79
Alignment and implementation of development planning frameworks 80
Concluding comments 81
6.5 Conclusion 82
7 SENEGAL 83
7.1 Introduction 83
7.2 Overview of development trends since 1980 83
Demographic trends 84
Economic performance and structure of the economy 84
Poverty and inequality 84
Human development .85
Trang 6HIV/AIDS 86
Conclusion 87
7.3 The core determinants and key consequences of HIV infection in Senegal 88
Core determinants 88
Key consequences 89
7.4 Development planning and HIV/AIDS in Senegal 89
Development planning in Senegal in historical context 89
The 10th Economic and Social Development Plan, 2002-2007 91
The PRSP, 2002-2015 92
The Strategic Framework for the Fight Against AIDS, 2002-2006 93
The National Plan for Health Development (PNDS), 1998-2007 95
The Development Framework for Education and Training (PDEF), 2000-2010 97
The Kaolack Regional Integrated Development Plan (PRDI), 2001-2005 98
The planning process 101
Alignment and implementation of development planning frameworks 102
Concluding comments 102
7.5 Conclusion 103
8 UGANDA 105
8.1 Introduction 105
8.2 Overview of development trends since 1980 105
Demographic trends 105
Economic performance and structure of the economy 106
Poverty and inequality 106
Human development .107
HIV/AIDS 108
Conclusion 109
8.3 The core determinants and key consequences of HIV infection in Uganda 109
Core determinants 110
Key consequences 111
8.4 Development planning and HIV/AIDS in Uganda 112
Development planning in Uganda in historical context 112
The Poverty Eradication Action Plan (PEAP) 2001 113
The MTEF, 2003/04-2005/06 115
The National Strategic Framework for HIV/AIDS Activities (NSFA), 2000/01-2005/06 118
The Plan for Modernisation of Agriculture (PMA) 2000 119
The Health Sector Strategic Plan (HSSP), 2000/01-2004/05 121
The Education Strategic Investment Plan (ESIP), 1998-2003 123
The planning process 125
Alignment and implementation of development planning frameworks 128
Concluding comments 128
8.5 Conclusion 129
9 ZIMBABWE 131
9.1 Introduction 131
9.2 Overview of development trends since 1980 131
Demographic trends 131
Economic performance and structure of the economy 132
Poverty and inequality 133
Human development .133
HIV/AIDS 133
Conclusion 134
9.3 The core determinants and key consequences of HIV infection in Zimbabwe 135
Core determinants 135
Key consequences 136
Trang 79.4 Development planning and HIV/AIDS in Zimbabwe 137
Development planning in Zimbabwe in historical context 138
The National Economic Revival Programme (NERP) 139
The National HIV/AIDS Strategic Framework 141
The 2003 Revival Action Plan, Ministry of Health and Child Welfare 144
The Plan of Action for the Ministry of Education, Sports and Culture 145
The planning process 147
Alignment and implementation of development planning frameworks 148
9.5 Conclusion 149
10 SYNTHESIS OF COUNTRY ASSESSMENTS 151
10.1 Introduction 151
10.2 Development planning and HIV prevention: reducing vulnerability? 151
Factors facilitating HIV spread according to interview respondents 154
10.3 Development planning and the key consequences of HIV infection 155
Key consequences of HIV/AIDS identified by interview respondents 157
10.4 Development planning: an implicit contribution to HIV vulnerability reduction? 158
10.5 Concluding remarks 160
11 CONCLUSION AND RECOMMENDATIONS 163
11.1 Introduction 163
11.2 Key lessons and conclusions 164
11.3 Recommendations 168
BIBLIOGRAPHY 173
Appendices Appendix 1 Assessing the link between rural development planning and HIV/AIDS 181
Appendix 2 Country Profiles 183
Country Profile of Cameroon 184
Country Profile of Senegal 186
Country Profile of Uganda 188
Country Profile of Zimbabwe 190
Appendix 3 List of respondents 192
LIST OF TABLES, GRAPHS AND BOXES Tables Table 2.1 Enrolment ratios in sub-Saharan Africa, 1960-1997 11
Table 2.2 Poverty trends in African LDCs, 1965-1999 14
Table 2.3 Overview of dominant theories of development 19
Table 3.1 Overview of key types of development planning in sub-Saharan Africa, 1960s-1990s 30
Table 4.1 Template to assess possible links between development planning and HIV/AIDS 37
Table 4.2 Assessing the link between economic development planning and HIV/AIDS: The stabilisation approach of the 1980s 38
Table 5.1 Selected development planning frameworks in eligible countries (end of March 2003) 48
Table 5.2 Selection process and results of the UNDP study 50
Table 6.1 Explicit objectives in Cameroon’s development planning frameworks 78
Table 7.1 Explicit objectives in Senegal’s development planning frameworks 100
Table 8.1 Explicit objectives in Uganda’s development planning frameworks 124
Table 9.1 Possible links between HIV/AIDS and the NERP 142
Table 9.2 Explicit objectives in Zimbabwe’s development planning frameworks 146
Table 10.1 Consideration given to HIV/AIDS in the development planning frameworks of Cameroon, Senegal, Uganda and Zimbabwe 153
Trang 8Graph 2.1 Poverty trends in African LDCs, 1965-1999 14
Graph 2.2 Trends in GDP growth (%), 1990s 16
Graph 2.3 Trends in GNI per capita (US$) in the 1990s 16
Graph 3.1 Ideal type linkages between development planning frameworks 29
Graph 5.1 Adult HIV prevalence rate in eligible countries, 2001 (%) 49
Graph 5.2 Spread of HIV over time in selected countries .51
Graph 5.3 Life expectancy in selected countries, 1990-2001 52
Graph 5.4 Trends in GDP growth in selected countries, 1980-1999 52
Graph 5.5 Trends in GNI per capita in selected countries, 1980-1999 53
Graph 5.6 From a narrow approach to a developmental approach to HIV/AIDS 55
Graph 6.1 Life expectancy and HIV prevalence rate in Cameroon .60
Graph 7.1 School enrolment in Senegal, 1991-1999 85
Graph 7.2 Senegal’s planning system 90
Graph 8.1 GDP per capita in Uganda, 1980-2000 107
Graph 9.1 GDP growth (%) in Zimbabwe, 1980-2000 132
Graph 9.2 GNI per capita in Zimbabwe, 1985-2000 132
Graph 9.3 HIV prevalence rates in Zimbabwe, 1990-2001 134
Boxes Box 2.1 Key characteristics of economic planning in sub-Saharan Africa 13
Box 5.1 Principal planning frameworks and related documents 54
Box 10.1 Most commonly identified factors of vulnerability to HIV infection by respondents 154
Box 10.2 Most commonly identified key consequences of HIV/AIDS by respondents 157
Trang 10Development planning is a contested terrain, particularly
in sub-Saharan Africa Historically, the approach to
African development has been externally oriented For the
past four decades, the subcontinent has been negotiating
its development with external partners More often than
not, this has meant that the process, instruments and
outcomes of development have been determined by
external partners, rather than by African societies and
their leaders
At the same time, development planning has been
approached as a largely technical, or even technocratic,
exercise Despite the more recent discourse on
democratising and decentralising planning processes,
development planning still tends to be located in the
domain of planners, and more especially of economists
Elected representatives, local communities and
organisations representing their interests are only
marginally involved in these processes
In addition, HIV/AIDS is posing a fundamental challenge
to the conceptual foundations and the practice of
development planning on the subcontinent The human
tragedy and devastation associated with the HIV/AIDS
epidemic can no longer be ignored by anyone or any
organisation with an interest in Africa’s development
Even though many dimensions and impacts of HIV/AIDS
are as yet unknown, the time to safeguard the rights of
those infected and affected by HIV/AIDS and change the
course of the epidemic is now
Against this background, UNDP initiated the study on
“Assessing the Link between National Development
Planning and HIV/AIDS in sub-Saharan Africa” It starts
from the premise that effective HIV prevention requires aparadigm shift: one that looks beyond individualknowledge and behaviour as the most important factorsinfluencing the spread of HIV to factors in the social,economic and political environment that render certainindividuals and social groups more vulnerable to HIVinfection than others Although at the level of rhetoricthere appears to be widespread acceptance thatHIV/AIDS is a development issue, in practice the factorsassociated with HIV vulnerability are not sufficientlyunderstood, let alone responded to It is here wheredevelopment planning can make the most effectivecontribution to curbing the spread of HIV At the sametime, development planning has to pre-empt and mitigatethe current and anticipated impacts of HIV/AIDS, as thesehold the danger of undermining the very goals, targets,tools and instruments of development Moreover, ifdevelopment planning continues to ignore the develop-mental dimensions of HIV/AIDS, it may unwittingly fail tocurb – and worse still, even facilitate – the spread of HIVand it may aggravate the impacts of the epidemic This report makes a valuable contribution to the requiredparadigm shift in development planning, especially at aconceptual and practical level It draws from a broaddevelopment literature and local studies at country level tosubstantiate its findings, analysis and recommendations
It exposes HIV/AIDS as a blind spot in developmentplanning and makes recommendations to ensure thatHIV/AIDS becomes a central concern in developmentefforts in sub-Saharan Africa It is hoped that the reportwill find a wide audience and will contribute to better, moreattuned and locally owned development planning on thesubcontinent
1
Foreword
By Prof John Ohiorhenuan, Chairperson of the Reference Group and
former Resident Representative UNDP, South Africa
Trang 11This report has been prepared by Mirjam van Donk for theUNDP Regional Project on HIV and Development in sub-Saharan Africa as part of the study “Assessing the Linkbetween National Development Planning and HIV/AIDS
in sub-Saharan Africa” Mirjam van Donk has acted as theLead Consultant on this project
The study and this report have benefited from the adviceand support provided by members of the ReferenceGroup Members of the Reference Group included: ProfJohn Ohiorhenuan (Chairperson), Prof Fantu Cheru, MrMamadou Goudiaby, Mr Edward Kapwepwe, Mrs EleanorMaeresera, Dr Roland Msiska, Mrs MwanakomboNgingite, Mr Manual Pinto, Mr Antoine Marie Sie Tioye, DrAbdoulmaliq Simone, Dr Alex de Waal and Mr DemileYismaw
Country assessments have been conducted by ProfEvina Akam (Cameroon), Mr Narathius Asingwire(Uganda), Mr Amadou Ba (Senegal) and Prof MarvelousMhloyi (Zimbabwe) Chapters 6-9 are based on thesecountry assessments For the purpose of this report, thefour country assessments have undergone significantrevision by the Lead Consultant
Administrative support to the project has been provided
by the UNDP Regional Project on HIV and Development
in sub-Saharan Africa Special thanks are due to DrRoland Msiska, Christophe Ahouansou, Jackie Nzisabiraand Leonce Hounkponou
The author wishes to extend a special thanks to EdgarPieterse
ments
Acknowledge-2 D E V E L O P M E N T P L A N N I N G A N D H I V / A I D S I N S U B - S A H A R A N A F R I C A