Daniel Low-Beer, Musoke Sempala
Most work on health governance has been concerned with global and national coordination; this paper assesses the governance challenge of building HIV prevention programs on community responses. It analyzes situations where HIV prevention has been successful, suggesting they developed multi-level governance integrating the national program with the community response. This ensured national HIV programs were built on the basic governance unit of the community. This governance approach allowed HIV programs to mobilize the important resources for HIV prevention which reside in social networks as social capital. The paper first assesses the links between governance and social capital, following which case reviews of HIV program data are used to highlight the importance of community level responses in effective HIV prevention. Finally, detailed community interview data are analyzed to identify key governance barriers and linkages to better integrate community responses into national HIV programs (from the Communicating AIDS Needs Project). As with the growing understanding of aid and development, HIV prevention programs need to leverage a much greater source of resources than exist in programs in order to deliver population health outcomes. This requires a wider view of governance, which can build national HIV prevention programs on the basic unit of community responses.