Aid (In)dependence? Promoting long-term sustainability in the response to HIV/AIDS: the case of the Global Fund in Peru

In the current scenario of decreasing aid, it is critical to develop mechanisms to guarantee the sustainability of programmes once donors exit a country. This study seeks to provide an indepth understanding of this process in Peru, an upper-middle income country and recipient of multiple HIV/AIDS Global Fund grants that, given recent economic growth, has allocated strategic funding for HIV/AIDS activities within the national budget. The aim of this study is to evaluate the transition of Peru from receiving Global Fund financing for HIV/AIDS to the increasing role of national institutions and capacity for policy development. For this, an original framework was employed, which allowed for the analysis of inputs (resources invested), actor motivations and incentives, HIV policies and plans, and their effects on programmatic sustainability; finally providing recommendations to inform decision-makers on priority areas that must be strengthened to ensure sustainable HIV/AIDS programming. To achieve these objectives, a case study (2004–2012) was conducted, employing a review of the literature and in-depth interviews among the main actors working in HIV in Peru, carried out between October–December of 2011. Findings demonstrate that Peru has made important progress towards ensuring a sustainable response for HIV/AIDS, primarily in the allocation of government funding and creation of spaces for actor discussion. Yet, this is not without challenges. The weak leadership and lack of coordination between the central and regional levels has exacerbated the already existing capacity issues in the regions, in this case related to HIV activity planning and implementation. Moreover, in order for HIV to remain a policy priority, mechanisms of accountability must be strengthened, as well as information systems to demonstrate need and key areas for action. Although findings are specific to the Peruvian context, this experience leaves important lessons learned in programmatic sustainability for other countries.