Organization of funding for community-based HIV testing in Côte d'Ivoire: potentially counterproductive search for efficiency?

Since the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have stiffened their result-based management strategies. Disbursement conditions are increasingly demanding for funded NGOs (achievement of quantified objectives, frequent reporting, and monitoring of activities), and their remuneration depends on the results achieved. This article aims to analyze the effects of this strengthening of policies based on New Public Management on local implementation of activities, based on the example of community-based HIV testing. In three health districts of Côte d'Ivoire, in 2015 and 2016, we mapped the actors involved in community-based HIV testing and conducted semi-directive interviews with members of the community-based NGOs (n = 18). The funding of local HIV testing organizations is channeled through intermediary organizations according to a complex pyramid system. This, combined with cumbersome activity reporting and data validation, results in delays in the disbursement of funds and significantly reduces the actual time available to implement activities, i.e., to less than half the time planned for this purpose. This managerialization -of both Pepfar and the Global Fund - produces the counterproductive effects against which it was supposed to fight.