Affiliated Network for Social Accountability (ANSA-Africa)

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AIDS accountability Country Scorecard Report
November 2008
AIDS Accountability International

AIDS Accountability International (AAI) is an independent nonprofit organization established to increase accountability and inspire bolder leadership in the response to the AIDS epidemic. The AIDS Accountability Country Scorecard is a rating of the degree to which governments are fulfilling the commitments they have made to respond to the epidemic. Without an evaluation of performance, there is no means to encourage governments that are succeeding, put pressure on those that are failing or stimulate constructive debate about what more needs to be done and how.

A comprehensive set of commitments were made by UN Member States in the Declaration of Commitment on HIV/AIDS in 2001 about how countries should respond to AIDS and how responses should be monitored and progress reported to the UN. These commitments were restated in 2006. Together with other global commitments for strengthening global publichealth, there are now definite targets in terms of universal access to ARV treatment by 2010 and reduced levels of HIV prevalence by 2015.

UNAIDS makes information and data from country reports available as narrative reports and large data files, neither of which allow for easy overview or specific exploration of the material by interested stakeholders. The AIDS Accountability Country Scorecard, for the first time, presents this information in an aggregated, transparent and analytical format that allows stakeholders to compare responses on several key issues across countries.

The Country Scorecard is the result of a comprehensive consultative process involving global experts in the fields of monitoring and evaluation of global public health and development of policy ratings, as well as civil society representatives from across the world. The Scorecard will be issued annually and developed and improved continuously as more and better data become available.

In this first phase, the Country Scorecard reflects how governments rate their own responses to AIDS through the UN process. Subsequent versions of the Scorecard will improve on this by encouraging independent validation of the data and the inclusion of additional elements. It is hoped that by the UN target date of 2010 the Scorecard will be a valid and comprehensive monitoring tool for rating country performance and will help guide rating and monitoring efforts into the future.

The Country Scorecard includes assessment of eight key elements required for an effective national response to AIDS: Data Collection, Focus on Most-at-Risk Populations, Treatment, Prevention, Coordination, Civil Society, Financing and Human Rights Mainstreaming. The assessment is based on 2008 data reported by 190 countries against the core indicators used for monitoring the United Nations Declaration of Commitment. The final element of the Country Scorecard, known as the AIDS Reporting Index, notes whether countries have failed to provide any data at all on one or more elements.

The development and analysis of the Country Scorecard motivates three general conclusions. First, there is a need to strengthen the validity of the data that countries submit. Country progress reports to UNAIDS reflect how national governments, and to some extent civil society, rate their country's response to AIDS, and whereas these reports may be a genuine attempt to reflect the various components of their response, there is currently no way of knowing which data may be flawed or biased. Whereas UNAIDS scrutinizes epidemiological and behavioural The AIDS Accountability Scorecard Report / AIDS ACCOUNTABILITY INTERNATIONAL 2008 data, it has no mandate to question the reporting of other, more political indicators. A process must therefore be developed to establish validating mechanisms for the data and ensure a correct understanding of strengths and weaknesses in reporting country responses to AIDS.

The second conclusion is that whereas more countries reported to the UN in 2008 than in 2006, far too many countries still do not report on one or more of the required indicators. A failure to report is a failure to live up to a central principle of the Declaration of Commitment: the need for transparency and effective monitoring. Without data, it is impossible to monitor and evaluate country progress, and hold governments accountable for their promises.

The final conclusion is that the 25 indicators used in the UN reporting system are necessary but insufficient. Additional indicators need to capture the quality of policy implementation, particularly in relation to gender, youth and human rights. The uncertain quality of current data and the failure of countries to report on many aspects of the response are major obstacles to holding governments accountable.

AAI will develop more detailed country profiles for all countries (a select set is already available for download on the AAI website). These profiles will also draw information from countries' narrative reports, any shadow reports that have been submitted to the UN by civil society stakeholders and analyses that are undertaken independently of the UN monitoring process.

The Country Scorecard is a dynamic tool that will be developed in different ways as more and better data become available and the methodology is improved. AAI intends to make the Scorecard more comprehensive by adding elements such as gender and youth, once the appropriate data and methodology have been identified. AAI is also interested in assessing the quality of a country's response in terms of care and support and the quality of national health systems more generally. AAI also intends to add data to its analyses that can complement the information contained in the UN data, such as human rights.

The UN monitoring of AIDS is gender sensitive in that the majority of core indicators require countries to report data separately (disaggregated) for males and females. However, the UN reports this data only where it is available, and there has been no systematic accounting of which countries report on it across the relevant indicators. Gender disaggregated monitoring and reporting are essential to identifying and addressing women's specific vulnerabilities to AIDS, and a failure to do so undermines claims by governments to a strong national response. In order to facilitate transparency and accountability, AAI will develop a Gender Reporting Index to be presented in 2009. The rating will detail which countries report gender disaggregated data adequately and on the basis of what indicators.