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Sustainable Transitioning from international donor support to domestic funding
External donors have historically contributed a significant amount of financing for health programs in low and middle income countries. However, as countries grow economically, donors expect countries to progressively and sustainably transition away from external financing and toward domestically funded health programs.
Reaching Key Populations
To achieve Universal Health Coverage and the UNAIDS 90-90-90 targets, more extensive and comprehensive efforts are required to reach all populations, especially those most affected by and at risk for HIV, TB and malaria, which are often the most vulnerable, isolated and ignored. Communities of key affected populations and civil society are of critical importance in this process. Since the onset of the epidemic, the HIV response was largely driven by the communities which were most affected. While civil society has played a critical role in rights advocacy, activism, and serving as government watchdogs, it has also played an important role in providing essential HIV prevention, treatment, care and support services. Hence there is a need for governments to ensure that there are mechanisms in place to provide resources to civil society, including key populations’ communities using domestic financing, and to forge working mechanisms for their meaningful engagement in effective and cost-efficient service delivery.
What is Social Contracting
While there is no universally adopted definition of social contracting, it is broadly understood as civil society organisations (which include and serve key populations) receiving government funding to deliver health prevention, treatment, care and support services.
Legal and structural frameworks around the world are diverse, as are healthcare systems and methods for service delivery. It is important to understand that social contracting is not an universal solution to service delivery challenges. However, there is increasing global evidence that social contracting can be an efficient and cost-effective method of service delivery that strengthens national responses to the three diseases while leaving no one behind.
UNDP identifies NGOs as key players in the transition process towards domestic financing of national HIV responses. UNDP carries out analyses of legal frameworks, related to social contracting of NGOs as providers of health-related services, particularly HIV related, and makes recommendations to countries on legal frameworks and the current practice of social contracting between governments and NGOs. UNDP works with national stakeholders to ensure that NGOs are explicitly recognised as partners and service providers in public health legislation and policies.
Global Consultations on Social Contracting
In 2017, UNDP, the Global Fund, and the Open Society Foundations partnered in convening a global consultations about social contracting, including more than 60 stakeholders representing national governments, civil society groups, multilateral organizations and donors from around the globe.
These consultations offered an opportunity for dialogue and discussion from both sides of the social contracting relationship in a range of contexts. Input from these participants included perspectives on existing approaches, as well as reflections from donors and technical partners about their experiences to date. Legal, policy and structural barriers to social contracting were analysed and the meeting reviewed opportunities for mitigating them.
The findings of the global consultation were documented in the report ‘A global consultation on social contracting: working toward sustainable responses to HIV, TB, and malaria through government financing of programmes implemented by civil society’, which features nine models of healthcare service delivery through social contracting from various parts of the world.
Social Contracting Best Practice Guide
Following the global consultations UNDP and the Global Fund have agreed on partnering to develop a document of global good practices in social contracting services which is expected for completion in 2019.
The good practice guide aims to identify and present practices that have successfully addressed needs, providing services in an inclusive, effective and cost-efficient manner, particularly to key populations.
The good practice guide will further analyse legal and structural environments that are conducive and supportive of social contracting, challenges and how these challenges were addressed. Lastly, it will provide an economic analysis of the social contracting modalities demonstrating their value for money.
The good practice guide will aim to provide examples from various countries and regions, with diverse legal systems, including from challenging legal environments where partnerships between government and civil society are not common and often quite complex.
Conditions and Principles for Social Contracting
Participants at the global consultation determined a core set of seven conditions and principles for social contracting.
- Goals-oriented arrangements
- Free and fair competition
- Equal treatment of applications
- Proportionate supervision and oversight
The legal, policy and regulatory environments are of great importance. The legal environment for social contracting is shaped by a range of laws, policies, and implementation practices related to CSOs, including those facilitating CSO registration, and their legal ability to receive and manage funds. Equally important is the legal and policy ‘enabling environment’ to ensure there are no punitive laws, policies and practices against Key Populations (for example, criminalization of same sex relations) that can serve as additional barriers for funding CSOs with domestic resources.
Other priority areas mentioned in regard to an enabling environment included the capacity of civil society to serve as implementers; accountability mechanisms for all involved parties; high-quality planning and communication by government actors on contracting processes; robust assessment and monitoring systems; and trust between government and non-government actors.