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Subnational structures also lacked information on programmes run by other donors or international CSOs.
However, PEPFAR-funded implementers frequently remained outside subnational structures and worked directly with NGOs.
Subnational structures had very limited decision making power and minimal influence over local budgets for HIV/AIDS programmes [ 34, 35].
The studies in Zambia, Peru, Ukraine and Kyrgyzstan revealed that problems of limited decision-making and resource allocation powers were particularly acute within subnational structures [ 28- 35].
An important reason for this was that major donors for HIV/AIDS programmes including PEPFAR continued to set priorities outside national and subnational structures; and their participation in such structures was seen as a formality.
By comparison national and particularly subnational structures in Zambia, Mozambique, Ukraine and Kyrgyzstan had limited authority to make decisions or allocate resources to HIV/AIDS programmes [ 28- 31, 34, 35, 39].
Similar(52)
Informed by these studies and the major issues grounded in the findings of the seven country studies we developed a health systems analytical framework that captures a) GHIs and other financers of country HIV/AIDS programmes; b) aspects of the functioning of national and subnational coordination structures; c) and the effects of coordination structure functioning on programme coordination.
National as well as subnational coordination structures with a remit for HIV/AIDS are proliferating, and in some countries the multiplicity of parallel coordination structures has challenged the effective governance of HIV/AIDS programmes.
These include the need to augment the capacity of secretariats of both national and subnational coordination structures through financial and technical support, and to carefully consider how best to position a national coordination structure within the public administration system in order to boost its authority and ability to promote multisectoral working.
Systemic weaknesses in countries' national and subnational coordination structures were undermining the goals of the GHIs.
Subnational coordination structures in Kyrgyzstan also lacked authority since NGOs were mainly accountable to donors on whom they were highly dependent.
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