Ministerial Council on HIV/AIDS

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Towards a Broader View of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada

Appendix III
Inter-Ministerial Collaboration On Hiv/aids In Other Countries

This section provides brief descriptions of inter-ministerial collaboration on HIV/AIDS in eight countries: Australia, India, Sweden, Switzerland, Thailand, Uganda, United Kingdom and United States of America.

Australia

Australia has used inter-ministerial collaboration at the federal level from the early days of the epidemic. For the most part, collaboration has been between individual departments and agencies on an as-needed basis. There is no overarching inter-departmental committee on HIV/AIDS. Instead, inter-departmental committees and working groups are formed when required for specific purposes. For example, there is an inter-departmental committee established each year to plan World AIDS Day activities. Recently, an inter-departmental committee was formed to oversee the implementation of a programme on AIDS vaccine research (funded by a grant from the National Institutes of Health in the United States). The committee includes representation from the health department, the agency that regulates drugs, the National Health Medical Research Council, the taxation department and the Australian Agency for International Development.

In many cases, collaboration in Australia has involved other players besides federal government departments and agencies. A good example of this was the inter-departmental working group that was formed in the early 1990s around legal reform issues. It involved the federal department of health, the federal Attorney General department, the state Attorney General departments, and community-based HIV/AIDS organizations. The report from this working group led to important changes in the law.

Some of the departments and agencies outside of the health department participate on the Australian National Council on AIDS, Hepatitis C and Related Diseases, the equivalent of Canada's Ministerial Council on HIV/AIDS.

India

There is good coordination and convergence of HIV/AIDS activities with other programmes in India. The lead agency in government on HIV/AIDS is the National AIDS Control Organisation (NACO) in the Ministry of Health. NACO has started involving various ministries, departments and institutions in its HIV/AIDS programme. The following is a partial list:

• National Institute of Public Cooperation and Child Development (NIPCCD)
• Social Sciences
• Ministry of Health
• National Labour Institute, Ministry of Labour
• Confederation of Indian Industries
• National Law Institute
• National Institute of Mass Communication

NIPCCD is an autonomous body working under the aegis of the Department of Women and Child Development. NIPCCD has been given responsibility for planning and guiding NACO on issues related to women, children and HIV/AIDS. Similarly, several other institutions located under different ministries have been given responsibility for guiding NACO in their respective specialties.

Sweden

In Sweden, the Ministry of Health and Social Affairs is responsible for the HIV/AIDS strategy. In terms of implementation of the strategy, three authorities have responsibilities in different areas:

• the National Institute of Public Health is responsible for coordinating the preventive measures for HIV/STD at the national level;
• the Swedish Institute for Infectious Disease Control coordinates research activity; and
• the National Board of Health and Welfare is the authority responsible for supervision of health care and efforts to prevent the spread of disease (under the Communicable Diseases Act).

At times, coordination between these three authorities is not as effective as it needs to be. Sweden is attempting to address this problem in a new National Action Plan on prevention of STD/HIV which is being developed. The plan will cover the period 2001-2005.

To coordinate its work at the national level, the National Institute of Public Health has set up two expert groups:

• the National AIDS Council, with representatives from central authorities, the county councils, municipalities, NGOs and other interest groups; and
• an authority group with representatives from a number of central authorities, such as the National Agency for Education, the National Prisons and Probation Administration, the Board for Occupational Safety and Health, and the Immigration Board.

Most of the programmes regarding HIV/AIDS are carried out on the national level.

Support to United Nations organizations and development cooperation are handled by the Ministry of Foreign Affairs. There is collaboration between the Ministry of Health and the Ministry of Foreign Affairs regarding Swedish international policy for HIV/AIDS.

Switzerland

Currently, there is no formal mechanism for inter-ministerial collaboration in Switzerland. An inter-department working group was formed in 1990, but it only lasted a few years and is expected to formally disband this year. Its role was mainly limited to the exchange of information.

There have been a few instances of one-on-one collaboration between the health department and individual departments. One example involved the department that handles internal personnel matters in the federal public service, which conducted an information campaign on HIV/AIDS within the public service.

Thailand

Unlike Canada, Thailand is a unitary state. Inter-ministerial collaboration has played a very important role in the response to HIV/AIDS in that country.

An inter-departmental committee was formed in the late 1980s. However, it did not start functioning effectively until 1991 when the Prime Minister agreed to chair the meetings of the committee. The level of representation from the various departments went up significantly once the Prime Minister became the chair. So did the allocated budgets. For the next two years, it was the Prime Minister's Office that coordinated the response to HIV/AIDS in Thailand. In 1993, responsibility for coordination shifted back to the health department, but the inter-departmental committee remains active and is still chaired by the Prime Minister. The committee meets four times a year. Strategic Planning for the HIV/AIDS strategy is coordinated by the National Economic and Social Development Bureau, which is in the Prime Minister's Office. Each year, the bureau collects the plans from each department and rolls them into one.

Most of the inter-ministerial collaboration in Thailand occurs on a bilateral basis between the health department and individual departments. The following are examples of this collaboration:

• Education department (inclusion of HIV/AIDS in the school curricula, training of teachers, etc.)
• Interior department (programmes in rural areas)
• Labour and social welfare department (workplace education; support for persons living with HIV/AIDS)
• Agriculture department (prevention education, dealing with mobile populations)
• University affairs department (research, technical development)
• Communications department (working with mobile populations)

Uganda

Uganda's structural approach to control HIV/AIDS started in 1986 with the establishment of the AIDS Control Programme in the Ministry of Health. In 1992, the government realized that HIV/AIDS was more than a health issue and that it needed a more high profile response. As a result, a statutory body, the Uganda AIDS Commission, was created to coordinate HIV/AIDS activities. The commission is attached to the President's office. It coordinates and harmonizes AIDS control activities in Uganda and is in charge of formulating policy guidelines. In 1993, the Commission began to oversee a multi-sectoral approach to control AIDS.

In Uganda, HIV/AIDS is everybody's disease; there is no one group which is more vulnerable than the other. Rather, vulnerability is more influenced by the context. Because ministries deal with contexts (e.g., environment), this underscores the need for collaboration. In Uganda's multi-sectoral approach, AIDS control programmes have been established in all the line ministries, each of which has a budget and specific activities.

However, many of the ministries have struggled. The government grants were not designated specifically for HIV/AIDS activities. Integration of HIV/AIDS into the normal activities of the ministries did not go smoothly. Another problem arose when no one was put specifically in charge of the AIDS Control Programme; instead, it was left in the hands of the Permanent Secretary, whose many other duties made it difficult for him to pay attention to HIV/AIDS issues. However, the Ministry of Health managed to organize itself well and carries out many prevention and care activities. Some of the other ministries have done work in prevention, sensitization and education (e.g., Ministry of Education and Sports).

In Uganda, the following ministries are considered key in confronting the HIV/AIDS epidemic: Health, Local Government, Agriculture, Education and Sport, Internal Affairs, Defence, Transport and Communications, Gender, Culture and Community Development, Labour, and Information and Broadcasting.

United Kingdom

The United Kingdom (U.K.) does not have a lot of inter-ministerial activity. Collaboration happens on an ad hoc, as-needed basis. Here are some examples of the work being done in departments and agencies other than the health department:

• International Aid. The Department for International Development supports some programmes outside of U.K., specifically vaccine development. The department has established links with NGOs and colleagues in the health department.
• Drug use. There is a team within the health department that makes contact with the Home Office regarding legal issues.
• Prisons. Until recently, the Prison Health Care System was the responsibility of the Home Office. However, this responsibility has now shifted to the health department.

The U.K. has drafted a new HIV/AIDS strategy and a sexual health strategy, and these have been integrated. Another positive component of the U.K. approach is the existence of an all-parliamentary group on HIV/AIDS. This group crosses party lines, so this helps to keep HIV politically non-partisan.

Community-based organizations have identified collaboration as an area of weakness in the U.K. response. Although people living with HIV/AIDS have needs that cannot be addressed by the health department (in areas such as social security and employment), government departments in the U.K have a history of being competitive. This makes collaboration difficult. So does the fact that the health department is also one of the least powerful departments. There is talk in government circles about "joined-up government," a concept that refers to developing seamlessness between departments, but this has not yet led to a lot of collaboration.

An interesting development outside HIV/AIDS is the establishment of a new governmental structure called the Social Exclusion Unit. This unit, which is removed from individual departments, is designed to deal with issues that are significant, that are identified as priorities and that impact disproportionately upon marginalized groups. The issues are dealt with by seconding people from different departments into the unit. Teenage pregnancy is one of the issues being dealt with in the unit. It is an issue that shares some of the same messages as HIV/AIDS education.

United States of America

Most of the inter-ministerial collaboration that occurs at the federal level in the United States of America (U.S.) involves international HIV/AIDS issues. The identification of AIDS as a security issue in the U.S. (in 2000) has led to the establishment of an initiative that involves a number of agencies and departments and that is designed to address international HIV/AIDS issues. The organizations involved in this initiative are:

• Department of State
• Centers for Disease Control and Prevention
• United States Agency for International Development (USAID)
• National Institutes for Health
• Department of Defence
• Human Resources and Services Administration, in the Department of Health and Human Services
• Central Intelligence Agency
• Department of Treasury
• International Trade, Department of Commerce
• Office of International and Refugee Health

The Department of State is the lead agency. Three or four working groups have been formed to address specific issues, such as legislation and funding. This project is just getting underway. The working groups are currently trying to define roles, objectives and initiatives.

This initiative was set up very quickly, without a lot of time for planning. However, it is too soon to evaluate its effectiveness.

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