What is AIDS Accountability International (AAI)?

AIDS Accountability International (AAI) is an independent non-profit organization established to increase accountability and inspire bolder leadership in the response to the AIDS epidemic. It does this by rating and comparing the degree to which public, private and civil society actors are fulfilling the commitments they have made to respond to the epidemic. About us.

How was AAI established?

AAI was established as a result of a series of consultations held with key stakeholders across the world, including representatives of governments, multilateral and bilateral agencies, civil society, and the private sector, as well as public health experts and scientists on the need for accountability in AIDS.

From this process there emerged a clear demand for an independent entity to:

- monitor performance of key stakeholders in the response to the AIDS epidemic;
- promote improved availability and analysis of data;
- provide assessment tools for advocacy purposes and to guide policy debate;
- hold leaders and institutions accountable for how their policies and programmes impact countries;
- reinforce leadership and ownership of the response, in particular in high-burden countries.

AAI was created to respond to the demand for a scientifically-based independent assessment tool to measure progress towards agreed targets. An initial project, therefore, of AAI has been to develop a mechanism to rate country performance. It is intended that this mechanism will serve as one of a series of tools and initiatives to help promote increased responsibility, leadership and transparency among key actors in the response to the AIDS epidemic. Our Approach

How is AAI funded and what is its budget?

AAI receives support from the governments of Norway and Sweden, as well as the Ford Foundation. Its annual budget is approximately US$1 million.

How is AAI organized and governed?

AAI is governed by a globally diverse Board of Directors, and is lead by its founder and Executive Director Rodrigo Garay. A small secretariat coordinates network and resource development in Stockholm, Sweden, while the development of AAI’s accountability tools is coordinated at its International Ratings Centre in Cape Town, South Africa (opening 2009). People

What is the purpose of the Country Scorecard?

Through the Millennium Development Goals and the 2001 Declaration of Commitment on HIV/AIDS, all United Nations Member States have committed to a series of actions and concrete time-bound targets to reverse the spread of HIV and mitigate the impact of the AIDS epidemic. In adopting the United Nations Declaration of Commitment, all Member States also committed themselves to report regularly on progress made in responding to the AIDS epidemic via the UNAIDS monitoring framework. The AIDS Accountability Country Scorecard aims to help evaluate and rate these country responses to HIV and AIDS.

In this first phase, the Country Scorecard only reflects how governments rate their own responses to AIDS through the UN process.  Subsequent iterations of the scorecard will seek to improve on this by encouraging independent validation of the data submitted and the inclusion of additional indicators as well as data from other sources. Read more in The Scorecard Report

What does the scorecard tell us?

The Country Scorecard includes assessment of eight key elements required for an effective national response to AIDS, based on the latest data on progress (2008) reported by 190 countries against the core indicators used for monitoring the United Nations Declaration of Commitment.  It also provides an AIDS Reporting Index that measures failure of countries to report.

The eight elements of national AIDS responses included in the scorecard are: Data Collection, Focus on Most-at-Risk Populations, Treatment, Prevention, Coordination, Civil Society, Financing, and Human Rights Mainstreaming. Read more in The Scorecard Report

How were the eight elements of the scorecard selected?

After widespread consultation with stakeholders worldwide, and taking into consideration the UNAIDS monitoring framework, the key elements of an effective response to AIDS were identified and corresponding indicators that could be used to express the quality of country responses were selected. AAI has elicited the feedback of a large group of experts from academia, public health, the UN system and WHO, non-profit organizations, governments, PLWHA, and others in the development of scorecard parameters. Read more in The Scorecard Report

How were the scores developed?

Under every element, countries are given a score for their responses to one or a set of questions in the UNAIDS monitoring tool, selected to measure the quality of their response in that area. These scores are then aggregated and expressed in grades, from A (very good) to E (very poor). Countries that fail to submit the required data for one or more of the questions receive a zero score, which lowers their aggregate grade for that element. Read more in The Scorecard Report

How are different criteria evaluated and weighted in the scores?

The AIDS epidemic presents itself differently in each country. AAI took this into account, for example, in selecting data for the construction of element four, the coverage of prevention among most-at-risk populations. AAI used prevention of mother-to-child transmission (PMTCT) for countries in Eastern and Southern Africa, a combination of PMTCT and prevention interventions for sex workers for the rest of sub-Saharan Africa, and prevention towards men who have sex with men, injecting drug users, and sex workers in the rest of the world. For detailed information about the data used and the construction of the eight elements, visit the scorecard online or download the AAI scorecard report. Read more in The Scorecard Report

How accurate or comprehensive is the Country Scorecard?

The scorecard is a reflection of the self-reported data provided to the UN  by the countries themselves. It is also based exclusively on the monitoring framework developed by UNAIDS. AAI has not altered any data received from UNAIDS. The only data that has been added is information on population size and Gross National Income for the construction of element seven.  It is AAI’s hope that the Country Scorecard may eventually help stimulate improved reporting and increased independent validation of data, as well as the improvement and fine-tuning of the UN reporting framework. The Country Scorecard Process

What country is doing the best? The worst?

It is not for AAI to say which country is doing the best and which is doing the worst. AAI has aggregated the data into the eight elements so that stakeholders can better assess this for themselves.

Under each of the eight elements, countries receive a score from A (best performance) to E (worst performance). Most countries perform well in some elements and not as well in others.

The final element of the Country Scorecard, known as the AIDS Reporting Index, tracks whether countries have failed to provide any data at all on the questions for one or more elements. The Index tallies up the number of elements that each country fails to report on and presents a ranking from best (all elements reported) to worst (no elements reported).

In some cases, the scorecard rates countries much higher or lower on elements of their responses than appears to make sense. How can this be explained?
Several factors may be at play in a country grade that seems unreasonably high or low.

The first is that country scores are reduced if a country fails to report some of the data required to evaluate their performance in a particular area.  Thus, a country score may be reduced for a particular element if data was not reported via the UNAIDS monitoring tool, even if it is doing well in that area in reality. These scores as still useful since they show that a country known to perform well is not taking reporting and accountability seriously, which all countries have agreed through the UN process is central to an effective AIDS response.

Another factor may be that the monitoring and evaluation instruments developed by UNAIDS and used in the country questionnaire fail to capture certain qualities of the response.

It is also possible that the perception of a country’s response is inaccurate, and that the response reported here, even if it goes counter to conventional wisdom, is actually a faithful reflection of a country’s response to the epidemic. A perception of a strong response may, for instance, be based on results achieved in a particular region, whereas the national performance, which is reported to the UN, fails to reach the same standard. Read more in The Scorecard Report

AAI has developed a number of more detailed country profiles for a selection of countries which can be downloaded from our website.

Does AAI expect this scorecard to make a difference?

Statistical indicators and rating mechanisms have proven to be powerful tools for ensuring accountability and advancing knowledge of good and bad practice. When Moody’s or Standard & Poor’s downgrade a country’s sovereign credit rating, investors and donors take note. Aid flows are influenced by the Human Development Index of the United Nations Development Programme and Transparency International’s Corruptions Perception Index has an impact on levels of public and private investment in countries.

More than twenty-five years into the AIDS epidemic, however, a methodologically rigorous independent rating system that holds governments and other actors accountable for their promises had not yet been developed. This is where AAI hopes the Country Scorecard will make a difference.

UNAIDS collects country progress reports.  Why can’t UNAIDS provide the greater accountability you seek?

UNAIDS is mandated to solicit and collect information on national responses according to a series of indicators agreed by the United Nations General Assembly. UNAIDS is not mandated or staffed, however, to translate the results of its monitoring process into more explicitly political demands for greater accountability for poor performance. AAI was formed in part to help draw attention to this gap, to support efforts to improve the quality of data and, by extension, the advocacy and policy decisions that are taken on the basis of the information that they provide.

Why does the Country Scorecard say nothing about gender?

The need to incorporate gender into the Scorecard was highlighted throughout the process of consultation that preceded the development of the current scorecard, however, no method or data were identified through which this could be done across all countries. We therefore committed ourselves to developing an advocacy tool focusing on gender during 2009. The Expert Panel’s assistance to us in realizing this initiative has been, and continues to be, invaluable.The process of generating the AIDS Accountability Scorecard on Women has gone through eight sets of consultations, two with the Expert Panel, four with the Development Team and two with the Group of Nine. Read more

Will the Country Scorecard be developed further?

Yes, AAI’s intention is for the Country Scorecard to be a dynamic tool that will be developed in different ways as more and better data become available and the methodology is further improved. AAI intends to make the scorecard more comprehensive by including additional elements, once the data and methodology for doing so have been identified. Two such additions will be gender and youth.

How will AAI’s rating initiative evolve moving forward?

Although governments have ultimate responsibility for the response to AIDS in any given country, other players are also critical.  For this reason, AAI is also investing in developing additional rating mechanisms to assess the accountability of other key actors in the response. Currently under development is a business ranking, the aim of which is to evaluate private sector performance against their own commitments in the response to HIV/AIDS.  The private sector has a role to play, not only in the best interests of society but also in the interests of their own business success and risk management. Investors, boards, non-governmental organizations, labour unions, and governments are increasingly pressing companies to take action and to be more transparent about their policies, procedures and results.

Subsequently, work will be initiated on rating mechanisms for donors and other civil society actors.
Although the epicentre of the epidemic is in the global South, home to more than two-thirds of all infections, the great bulk of academic and medical research, as well as advocacy activities, has been concentrated to date in high-income Northern countries. As a result, much of the research and debate about policy approaches are inevitably removed from the situation on the ground.

A founding principle of AAI has been to create a legitimate voice to hold leaders to account for promises they have made. This legitimacy must come in part from developing a rating mechanism that uses expertise from the South, and from investing in a sustainable structure in the South for the further development of AAI’s global ratings.

AAI is therefore establishing a Rating Centre in South Africa to develop, coordinate and manage the AIDS Accountability Expert Panel, a large interdisciplinary panel of experts that will contribute to the development of ratings and validation of data, and promote the use of AAI’s rating tools. The Panel will also serve to give experts across the globe a voice on current issues and controversies in the response to the epidemic.

The Rating Centre will coordinate AAI’s biennial Accountability Conference, bringing together members of the Panel to explore ratings and accountability issues, as well as to develop innovative approaches to furthering the academic basis for accountability and its application in effective policy making. An Accountability e-Journal will also be issued regularly to provide a forum for continuous debate. A network of Collaborating Centres in research institutions throughout the region will be piloted with a view to developing and improving the indicators and data needed to better monitor the epidemic.

How can I use the data to compare countries?

AAI has provided all of the data in an easy-to-use searchable online database. You can select the countries of interest, and the indicators and elements of interest to you and generate your own scorecards. Create your own Country Scorecard.