Governance of HIV/AIDS

Sophie Harman, Franklyn Lisk, Sophie Harman, Franklyn Lisk

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134012008
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

Nearly thirty years since HIV/AIDS was first identified, confusion over effective mechanisms of controlling and eradicating the illness remain prevalent. This book highlights the need for comprehensive approaches to governance, as responses to HIV/AIDS become increasingly focused upon the health aspect of the epidemic, and financial commitments become subject to aid fatigue.

This book examines the roles and influence of multiple actors and initiatives that have come to constitute the global response to the epidemic. It considers how these actors and structures of governance enhance, or limit, participation and accountability; and the impact this is having upon effective HIV/AIDS responses across the world. The book addresses participation and accountability as key elements of governance in four thematic areas: the role of the state and democratic governance; non-state actors and mechanisms of political governance; public-private partnerships and economic governance; and multilateral institutions and global governance. Drawing on the insights of public health specialists; political scientists; economists; lawyers; those working with community groups, and within international organisations, it offers valuable perspectives on the governance of HIV/AIDS.

Aimed at both academics and practitioners throughout the world, this book contributes to the academic debate surrounding global governance, health and development economics, and the work of multiple international organisations and civil society organisations.

Part I
Role of the state and democratic governance in the HIV/AIDS response

1 AIDS, politics and governance

The impact of HIV/AIDS on the electoral process in Namibia, Malawi, Senegal, South Africa, Tanzania and Zambia

Kondwani Chirambo

Seeking knowledge on the impact of AIDS on democracy and governance in Africa has been at the core of social science for the past decade. Most of the empirical work in this field has tended to interrogate the socioeconomic implications of AIDS, however, presumably due to the availability of data. It is therefore barely five years since any serious attempts were made to unravel the political dynamics of the AIDS pandemic in Africa. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates, between 33.4–46 million people worldwide are living with HIV (UNAIDS 2006). Sixty-three per cent of the cases (25.4 million) are in Sub-Saharan Africa (UNAIDS/WHO global reports 2004; 2006). HIV prevalence in Africa ranges from 0.7–9 per cent in countries such as Senegal in West Africa; one per cent in the North Africa region; to between 15–30 per cent in adult populations in most of Southern Africa – the region most affected by the epidemic (CHGA 2005; UNAIDS/WHO 2005).

Because the trends in mortality suggest that the relatively younger, and certainly the skilled and semi-skilled segment of the labour force are bearing the brunt of AIDS, these scenarios in turn have begun to generate a new wave of academic inquiry regarding the future of Africa’s democracies: the unprecedented attrition of AIDS amongst the skilled labour force could possibly have severe effects on productivity, service delivery and subsequently citizen confidence in elected government if electioneering promises remained unfulfilled (Youde 2001; Mattes 2003: IDASA /HEARD/DARU Report 2002). The loss of elected leaders and professionals running political institutions such as parliament, political parties, electoral systems, electoral management bodies, judicial systems, finance ministries among others, was expected to undermine the mechanics of decision-making, institutional sustainability and effectiveness (Chirambo and Caesar 2003). Schonteich (2003) assumed that the higher incidences of orphaning would also increase crime and contribute to policing headaches in countries such as South Africa. In addition, it was posited that a disgruntled and largely unhealthy citizenry would likely rebel against the state, or withdraw from political life – a general weakening of social cohesion in the long term was envisaged (Mattes 2003).

While the Institute for Democracy in South Africa (IDASA) has investigated some of these phenomena, its ambition was to map areas of the political landscape that would effectively demonstrate the impact of, and also provide a basis for, targeted strategies against AIDS. IDASA’s research was designed at a time when much of the region that comprises the Southern African Development Community (SADC)¹ was involved in protracted discussions on electoral reform to deepen democracy amongst its members. Several countries in the region had already been engaged in national debates on changing electoral models that were largely inherited from colonialism. These debates on reform have been motivated by many factors, some of which are attributed to opposition demands for fair representation, gender balance and ethnic diversity. Except for Lesotho, where the electoral system was changed following post-election conflict in 1998, none of the other SADC countries have concluded talks, presumably due to the reluctance of incumbents who view these changes as potentially denuding their authority (Chirambo 2008: 8). Elections, a defining feature of modern democracies, can evidently be undermined by many factors, including corruption, and unfairly unequal access to resources and communication systems. The significance of AIDS in this equation is only beginning to be understood and appreciated by some of the influential regional bodies involved in electoral processes such as the SADC Parliamentary Forum. In what ways therefore, one might ask, does AIDS impact on the electoral process? What are the governance implications of these impacts? How should governments respond, if there are any impacts at all?

Hypothesis and conceptual frameworks

This paper presents the findings of studies conducted between 2003 and 2007, which attempt to respond to these and other related concerns. The studies covered Namibia, Malawi, Tanzania, South Africa, Senegal and Zambia. They also make reference to Lesotho and Zimbabwe in respect of the electoral system. IDASA chose the countries based on the HIV prevalence rates and the electoral model in order to achieve comparability. The central analytical concept, operationalised through a focus on the electoral process, is democratic governance with particular regard to the notions of participation and accountability. The main hypothesis is that the impact of HIV/AIDS undermines the electoral process. The electoral process as defined in this study is characterised by rules, institutions and a set of political actors. Because of the significance of the electoral system to the political trajectory of the modern state, this paper will dedicate itself largely to relating to this institution. The first part of this paper presents the problems and key findings of the research. The second section engages in more depth with these findings, their implications and recommendations.

The project responds to the question: What is the impact of HIV/AIDS on the electoral process in Africa? To explore the question, the project has investigated the following areas of the electoral process:

• Electoral systems: Increased deaths amongst elected representatives will be financially demanding on the state as by-elections mount in countries employing simple member majority (SMM) systems and mixed member proportional (MMP) systems. These electoral models may in time be rendered unsustainable
• Parliamentary configuration: Weaker political parties will likely lose policy influence as they fail to recapture seats that are declared vacant following deaths amongst their elected representatives. By-elections will likely favour parties with the most resources
• Electoral management and administration: The management of the voters’ roll will be problematic because of too many dead voters might overburden institutions that do not employ modern technology. The loss of skilled and support personnel employed by the electoral management boards (EMBs) might affect service delivery
• Political parties: Succession, finances and support bases may all be affected by attrition to AIDS amongst cadres, leaders and stalwarts. This might weaken viable opposition over time.
• Voter and civic participation: People infected and affected by HIV/AIDS will withdraw from elections due to lack of enthusiasm, the impact of sickness, stigma and discrimination.

All the five areas of focus have some influence on the nature and quality of governance. Of these, the electoral system will be paramount in the configuration of power. Electoral systems are the institutional devices that translate votes cast into seats in parliament. Depending on the model adopted by a particular country, electoral systems can maximize diversity in governance and afford marginalised sections of society opportunities to contribute to the setting of national priorities, including AIDS polices. While elections may be understood as the process through which citizens choose their leaders by casting ballots; electoral systems are explained here as the method or formula that translates the votes cast into seats in parliament (Matlosa et al. 2007).

Parliament, therefore, is the outcome of the operationalisation of electoral systems and elections. Oversight on government conduct is essential to the functioning of a democracy, and in many ways a representative parliament should be able to deliberate and enact laws that positively affect the welfare of the majority of the people. The relative independence of the electoral commission as defined in the legal and constitutional framework, and the integrity of its commissioners and professional staff, will also have a profound effect on how the outcomes of the poll are perceived. In the context of the AIDS pandemic, we would view the electoral management body as the institution that must institute measures to ensure that disadvantaged persons, including the infirm, pregnant women, and among others, people living with HIV/AIDS (PLWHAs), are able to vote without hindrance. Given the large numbers of citizens across Africa who are either infected with, or affected by, HIV/AIDS, facilitating reasonable access to the poll might have significant value in terms of levels of participation and, consequently, the legitimacy of the winners.

The political impact of the electoral system

Researchers on electoral systems underline the pivotal role these institutions play in influencing the future of a nation. Made up of laws and rules, the electoral system has been found to be critical to the configuration of power in governance structures and therefore influencing who decides on national priorities (Reynolds et al. 2005). The electoral system, in this regard, is one of the key institutional devices that facilitate participation of citizens in selecting policy options that would potentially improve their welfare and, more specifically, their access to life-sustaining opportunities of education, employment and health.

Electoral system types

There are four electoral systems that have been compared by IDASA in respect of the AIDS pandemic. For the purposes of this discussion, however, we shall focus mainly on three electoral system types – first-past-the-post (FPTP), proportional representation (PR) and MMP – and compare how they may be affected by HIV/AIDS.

Single member plurality or first-past-the-post

The FPTP system is defined by small voting districts or constituencies. The country is demarcated into electoral zones (constituencies) and political parties field one candidate each to compete for the constituency seat. Independent candidates can compete as well in most cases. The candidate who receives the most votes is declared the winner. In FPTP, when the seat falls vacant, a new election or by-election is called and all registered political parties may compete for it all over again. This is regardless of whether the vacancy arises as a result of a parliamentary representative resigning from their party or by dying. Botswana, Malawi, Mauritius, Swaziland, Tanzania, Zambia and Zimbabwe employ this model, inherited from British colonialism. FPTP or SMP are relatively stronger on accountability, as leaders are directly elected by the voters and may lose power in succeeding polls if their performance is adjudged to be poor. Some of the main criticisms of this system include its tendency to lead to the marginalization of ethnic minorities. It is also weak in terms of promoting gender balance due to the difficulties women face in highly competitive patriarchal environments. The FPTP model usually leads to a de facto bi-party system.

Table 1.1

The SMM system bears similarities to FPTP, in that the country may be divided into electoral constituencies. However, the SMM requires that the winner achieves an absolute majority of votes (over 50 per cent). Employed largely in presidential polls, the SMM will normally provide for a run-off if none of the candidates attains 51 per cent of the vote. In the SADC region, Angola has used this model for its presidential elections. The SMM’s main advantage is its facilitation of a legitimate winner of elections.

Proportional representation

Although global trends suggest that the PR systems are gaining in popularity due to their supposed contribution to conflict resolution (Matlosa et al. 2007), they do have their critics. There are many varieties of PR, of which the list systems are most common. PR systems are defined by large voting districts with an entire country constituting the constituency, for instance. The competition is between political parties and the seats in parliament are allocated on the basis of the proportion of the national vote that each party gains. For example, a party that wins 65 per cent of the total votes casts will theoretically secure 65 per cent of the seats in parliament. The parties will appoint its representatives from a list submitted to the EMB prior to the election, usually with the names in the upper sections occupying the available slots first. Of the SADC countries, Angola, Mozambique, Namibia and South Africa use the PR model.

Unlike FPTP, which is often linked to a proliferation of political parties that lack policy focus and ideology, PR models are linked to the opposite effect. This is because political parties will need to have wide-ranging and broad-based policies to ensure they attract enough of the national vote to reach the minimum threshold to secure a presence in parliament. The PR model facilitates gender diversity as women can be deliberately infused into party lists for parliament. It is suitable for conflict resolution as minority parties will have an opportunity to gain a foothold in parliament, particularly when there is a low minimum threshold; in this model, because of the low thresholds, nearly every vote contributes to electing a candidate. Other advantages are:

• promotes nationwide campaigns as opposed to parties restricting themselves to (ethnic or traditional) strongholds;
• power-sharing between parties is possible; and
• greater stability and longevity of government. No recourse to by-elections is necessary when vacancies occur, and there is therefore no disruption to power configurations in parliament.

The PR system’s weaknesses include:

• party coalitions can cause a paralysis of governance when no consensus is reached on critical national issues;
• it might provide opportunities for the presence in parliament of extremist parties; and
• citizens cannot hold elected leaders accountable because the political party retains the mandate to appoint MPs from its dedicated list. There is no public input into who goes onto the closed party list (Reynolds et al 2005; Matlosa et al. 2007).

Mixed systems

Although MMP and the parallel system are both categorised as ‘mixed’, they have distinct differences. The MMP, by implication, minimises the weaknesses of both PR, FPTP and other systems by combining them. The MMP system facilitates the election of one group of members of parliament (MPs) or councillors through FPTP, and the other through the PR system. In MMP any disproportionalities arising from the FPTP (or other system) is compensated for by the PR element. Only one SADC country has adopted the MMP system at national level thus far, namely Lesotho (EISA 2003). While employing PR for national elections, South Africa uses MMP for its local government polls.

The parallel system is also classified as mixed. These models use PR and FPTP (or other system), operating side by side. The main difference with the MMP, however, is that while in the former the PR component compensates for disproportional outcomes from FPTP (or other system), in the parallel model the two systems are independent of each other and are separately managed. Seychelles is the only country in the SADC region that uses the parallel system (Reynolds et al. 2005); of the six countries in the IDASA’s studies, Senegal is the only country employing the model. While it is logical to assume that the mixed systems inherit both the strengths and weaknesses of PR and FPTP, more studies need to be undertaken in regard to how MPs view each other in terms of their legitimacy: would directly elected MPs see themselves as being the ‘true’ representatives of the people, for instance, given their clearly defined relationship with the voter?

The impact of AIDS on governance

Barnett and Whiteside (2002) describe AIDS as ‘a long wave event’, one that demands strategic visions to address the impacts on current and future generations. A review of literature on AIDS suggests the pandemic has social, economic and political dynamics (Poku et al. 2007). As a result of AIDS, life expectancy in Southern Africa has declined from 60 years to below 40 years in the most affected countries, particularly in the sub-region defined as the SADC. Although the SADC region constitutes less than two per cent of the global population, it accounts for approximately 39 per cent, or 14.9 million, of the 38.6 million people living with HIV (end 2006). The added burden of 41 per cent of all children orphaned by AIDS exacerbates the side-effects of this pandemic (SADC 2006).

In this regard, social scientists present some compelling arguments on why the path of the pandemic may, over time, compromise governance: the manner in which countries manage their political, economic and social affairs. The pandemic’s unprecedented effects on the adult populations, particularly on the most skilled of these populations who fall within the highly vulnerable 15–49 age cohort, raised concerns about economic performance, food security, public service efficiency and social cohesion. These assertions have in some cases been supported by empirical ...