Côte d'Ivoire, a case study of power relations PEPFAR - Global Fund (eng)

Résumé 0

Executive Summary Today, the Presidential Emergency Plan for AIDS Relief (Pepfar) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria contribute 67% and 21% respectively (including 30% from the United States) to the fight against HIV/AIDS. Despite different principles, these two initiatives are generally presented as complementary and united towards the same common goal: ending the HIV epidemic. This contribution analyses the power relations of these two actors in the field, through the case study of Côte d'Ivoire, which has the particularity of being mainly financed by Pepfar (70-80%), although not a priority; while being a priority country of the MF, although it only finances 10% of the AIDS budget. It is the result of qualitative research, combining observations from meetings of the Country Coordinating Mechanism - CCM (16) and interviews with members of the CCM Executive Board, civil society, international cooperation (French, American, Unicef) and the public sector. Within the CCMs, we have observed a dominance of the participation of international cooperation actors, and a relative minority of American partners in their positions, compared to an informal coalition of French and/or Francophones. Real influence is exerted outside the CCMs, through high-level negotiations that generate decisive scoping effects on CCM decisions; as well as through the Pepfar's operational mode of action, based on autonomy and the implementation of its own priorities, which devotes the FM to a reactive position. Since the adoption of the New Funding Model (NMF), the functioning of the FM has converged with that of the Pepfar. The risk is that it combines the disadvantages of both approaches, with the procedural and time-consuming nature of multilateral and "learning" organizations, without being able to justify a short-term impact equivalent to that of Pepfar.