As a young NGO worker and HIV treatment activist who had been working for the World Health Organisation (WHO) in the late 80’s and early 90’s, Jeff O’Malley had the kind of unique experience and skills that the Rockefeller Foundation needed.
They asked him to become the Executive Director of a new organisation which aimed to help international donors support community action on AIDS. “That wasn’t the phrase yet; that phrase came later, but that was the idea” said O’Malley.
The roots of the Alliance go back to the late 80s. The AIDS epidemic was growing around the world. In 1987, WHO set up a multi-donor trust fund called the Special Programme on AIDS to coordinate international action. The Programme focused on trying to convince ministries of health in developing countries to take action on AIDS.
However, according to O’Malley, it was already clear that the people who were actually doing something already were people living with HIV themselves, and their partners and friends and families, and some community groups. Among staff involved at WHO and other institutions there was a common belief that community responses mattered, and that WHO systems were not set up properly to partner with or support those responses.
As these discussions were taking place, the Rockefeller Foundation had already commissioned some country studies and two years later made the decision to establish a new initiative which would be explicitly designed to support community action on AIDS in developing countries.
Securing funds and trustees
With O’Malley having agreed to take on the role of Executive Director (and George Zeidenstein, an ex-Population Council Director General, agreeing to become the first Chair), the Rockefeller Foundation organised a potential supporters meeting in Paris in late 1993.
The meeting was hosted by the French Ministry of international cooperation, and O’Malley and Zeidenstein pitched for funding for a three year proposal. The Rockefeller Foundation, the EU, and the governments of France, Sweden, the UK and USA all pledged money at this meeting.
A board of international trustees was brought together. O’Malley remembers “The vision was to have a small board of senior people who would bring political gravitas and wisdom and maturity to my immaturity and lack of wisdom – and I say that in all sincerity. I was 31 years old and bringing activism and passion and enthusiasm and energy, but they were bringing experience and connections.”
A unique model for an urgent challenge
O’Malley says the notion of an alliance of nationally-based, independent, civil society organisations was formed from the start, “From very early on, maybe from the beginning, the word intermediary was used. The notion was that the Alliance was something to connect between a kind of northern donor multilateral world and a southern community world”.
He and Zeidenstein were clear that there would not be country offices of the Alliance. It was felt this was particularly important when many southern governments still felt that AIDS was a northern issue, a gay issue. “We knew that having a bunch of foreigners coming in and saying ‘you need to do something about AIDS’ wasn’t the way we were going to make progress. Each country needed its own champions, and we had a vision that by supporting these champions, each organisation would serve as a national voice for communities within those countries.”
Where to start?
There was some debate about where to start and why. The global epidemiology of HIV was quite different in 1993 to what it is today. The African AIDS epidemic was at that time a Central and West African epidemic, and parts of Asia had a massive commercial sex industry, so there was an expectation that the epidemic would grow there. So the initial decision was to start-up in 12 countries, with the first two ‘linking organisations’ in the Philippines and Burkina Faso.
Our strength lay in the tension
Some of the early tensions of the Alliance are still evident now. Should programmes be secretariat-led or initiated by linking organisations? Should success be based on the number of people reached or the quality of programmes?
O’Malley describes one of the fundamental tensions at that time was “buying into the delivery of results defined by a donor.” There is a massive tension between that and a vision of the Alliance as something that has been set up to support community responses.
“Although that tension frustrated me at first and even made me angry, I concluded by the late 90s that our strength lay in that tension. There were organisations that did a better job of delivering on what donors wanted, and their work was more solid technically than the Alliance’s.
“However, if you evaluated other organisations’ impact compared to the Alliance’s over a defined period of time, it would often do better. But if you look at what is there a couple of years after the end of a project, I think the Alliance looks better.”
Reflecting now on the Alliance’s impact, O’Malley acknowledges that it is hard to measure precisely. But he says “I really believe that the Alliance has done a tremendous job of building the capacity of organisations and of individuals, of kind of building the critical mass of people who are committed to this work.”
Jeff O’Malley was one of the keynote speakers at the Alliance’s 20th anniversary convention last week – read more.