Greater investment in community responses is needed to end AIDS. UNAIDS suggests that investments in community mobilization should increase threefold to 3%, and spending on social enablers should reach 8% of total expenditure by 2020. However, a recent survey showed that 40% of organizations tasked with implementing community activities reported a funding decrease since 2013. Two thirds expected flat or declining funding in the future. PEPFAR reduced its investments in community-based care, treatment and support by 12.6% from 2013 to 2014. The Global Fund’s Technical Review Panel has expressed concern that the majority of concept notes are not including funding requests for the community systems strengthening module at all. An investment case for community responses is needed to motivate the necessary levels of funding.
To make the investment case, a review of the peer-reviewed and grey literature was conducted and complemented by case examples. The findings were categorized in terms of evidence of impact and return on investment in three areas of community responses: (1) networks and linkages; (2) advocacy and influence; and (3) monitoring and accountability. Service delivery components of community responses were excluded from this analysis.
A significant return on investment was found in all three areas of community responses examined. Community networks of key populations were found to increase coverage of services and improve health outcomes for these groups. Linkages at community level, such as adherence clubs and anti-retroviral treatment (ART) refill groups, produced cost-savings in ART provision, as well as reduced total HIV program costs overall. Community advocacy was found to bring additional funding to the response as well as reduce the prices of medicines. Indicators on open and inclusive dialogue spaces were statistically significant predictors of how responsive HIV and TB funding decisions are to the needs of affected communities. In case law, law reform, and policy, developments came about directly as a result of community advocacy. Lastly, community-based monitoring increased accountability, and boosted uptake and quality of services, as well as increased domestic investments in HIV. This investment case presents compelling evidence that there are both allocative and technical efficiencies to be realized by investing more money in strengthening community responses.