World Economic Forum

Global Health Initiativein cooperation with

September 2006

The State of Business Coalitions in Sub-Saharan Africa

COMMITTED TO IMPROVING THE STATE

OF THE WORLD

The views expressed in this publication do not necessarily reflect those of the World Economic Forum.

World Economic Forum91-93 route de la CapiteCH-1223 Cologny/GenevaSwitzerlandTel.: +41 (0)22 869 1212Fax: +41 (0)22 786 2744E-mail: contact@weforum.orgwww.weforum.org

© 2006 World Economic ForumAll rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means, including photocopying andrecording, or by any information storage and retrieval system.

REF: 180906

Principal Authors: Francesca Boldrini and Chris Trimble

The World Economic Forum, with Elizabeth Ashbourne of the World Bank and Ed Vela of UNAIDS have been working in a

partnership over the past four years to increase and improve the engagement of African-based private sector organizations in

the fight against HIV/AIDS. One of the most successful strategies to forge closer relationships between the public and private

sector has been to develop and support coalitions of businesses to address the many challenges of HIV/AIDS in societies and

communities. This report represents and reviews the current status of the 20-plus coalitions that are in various stages of

development in sub-Saharan Africa.

For their significant contributions to this report, we would like to thank Caroline Hope from the Corporate Council on Africa

(CCA), Saskia Kersemaekers from PharmAccess, and the many Business Coalitions that have generously given their time and

effort to provide the information that is central to this report’s analyses.

The World Economic Forum would specifically like to acknowledge the comments and contributions of Protais Ayangma

Amang of the Coalition of Community Affairs for AIDS, TB & Malaria, Cameroon; Kyeremeh Atuahene of the Ghana Business

Coalition against HIV/AIDS; Cornelio Balane of Business Against HIV/AIDS (Mozambique); Victor Barnes of the Corporate

Council on Africa (CCA); Esther Dassanou-Reeves of the Corporate Council on Africa (CCA); Dr Moctar Diallo of the Coalition

du secteur privé au Mali dans la lutte contre le VIH-SIDA; Olusina Falana of the Nigeria Business Coalition on AIDS; Elisabeth

Girrbach of GTZ ACCA; Jenny Gold of the Ethiopian Business Coalition against HIV/AIDS; Khosi Hlatshwayo of the Business

Coalition on HIV/AIDS (Swaziland); Wame Jallow of Botswana Business Coalition on AIDS; Zadi Kessé of Coalition of Ivorian

Businesses against HIV/AIDS; Ahmed Mohamed Khairou of the Comité National de Lutte contre le SIDA Secrétariat Exécutif

(Mauritania); David Kim of the World Economic Forum; Rose Kumwenda of the Malawi Business Coalition Against AIDS; David

Kunzekweguta of the Zimbabwe Business Council on AIDS; Maximilien Nkiesolo Luaka of Le Comité Interentreprises de Lutte

contre le VIH/SIDA (DRC); Brad Mears of the South African Business Coalition on HIV/AIDS; Vesine Mutarabayire of the

Association du privé et para-étatique dans la lutte contre le VIH/SIDA (Rwanda); Erick Mwanza of the Zambia Business

Coalition on HIV/AIDS; Victoria Ndlovu of the Zimbabwe Business Council on AIDS; Dr Dickson Opul of the Uganda Business

Coalition on HIV/AIDS; Jones Sikira of the AIDS Business Coalition Tanzania; Julian Stanning of Unilever; George Wainana of

the Kenya HIV/AIDS Business Council; and Peter van Wyk of the Namibia Business Coalition on AIDS. The contributions of

the above individuals have been invaluable in creating and reviewing this report.

Table of Contents

3

Foreword 4

Preface 5

Executive Summary 6

Introduction to the report and to business coalitions 6

Key findings on sub-Saharan African coalitions 7

1. Introduction and Overview 9

1.1. Context of Business Coalitions 9

1.2. The Pan-African Business Coalition 10

1.3. About this business coalition mapping exercise 10

1.4. Limitations of this report 10

1.5. Methodology 11

2. The Phenomenon of Business Coalitions 12

2.1. When Business Coalitions were created 12

2.2. Business Coalition governance 12

2.3. Secretariat capacity: employees and skills 13

2.4. Coalition relationships 14

2.5. Coordinating mechanisms – could the PABC be a solution? 14

3. The Approach and Scale of Business Coalition Activities 15

3.1. Models for fees and business outreach 15

3.2. Companies being served by business coalitions 17

4. Coalition Functions and Activities 19

4.1. Internal activities 19

4.2. External activities 20

4.3. Strategic focus: disease area 24

5. Financing of Coalitions 25

5.1. Membership fees 25

5.2. Coalition finances 26

5.3. Funding gap 27

5.4. Support from international partners 28

6. Conclusions and Opportunities for Business Coalitions 29

7. Appendix: Summary of Basic Data 31

Footnotes 32

4

We are delighted to release this new report, “TheState of Business Coalitions in Sub-Saharan Africa”,from the Global Health Initiative (GHI) of the WorldEconomic Forum.

The GHI’s mission is to catalyse public-privatepartnerships to fight HIV/AIDS, TB and malaria. Todo this, we work in partnership with UNAIDS andthe Stop TB and Roll Back Malaria partnerships ofthe WHO. We also report on the global voice ofbusiness and HIV/AIDS through the annual GlobalBusiness Survey and serve as a permanent memberto the private sector delegation of the Global Fundto Fight AIDS, Tuberculosis and Malaria.

This new report on business coalitions is a goodexample of how we are trying to track and supportbusiness action against HIV/AIDS in Africa. Businesscoalitions are a critical component of the privatesector response to the pandemic and the creation ofmany national business coalitions over the last fouryears represents strong progress. However, weknow a good overview of the state of coalitions hasso far been lacking and is what this report aims todeliver. It is a benchmark and source of informationto help business coalitions and related stakeholdersidentify their priorities and next steps.

I would especially like to thank Accenture for theirsecondee, Chris Trimble, who led and managed thismapping exercise with exceptional drive anddedication, and the World Bank and UNAIDS fortheir support in making this programme a reality. Iwould also like to acknowledge the activeparticipation and contributions of over 20 businesscoalitions for their commitment to this mappingexercise.

Richard SamansManaging Director, Centre for Public-PrivatePartnerships, World Economic Forum

Foreword

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It is abundantly clear that the private sector must bea partner in addressing the human drama ofHIV/AIDS. It is a scourge that feeds global povertyand inequality. It is the plague that undermines anyhopes of peace, opportunity and sustainableeconomic development in many of the world’spoorest places.

HIV/AIDS is a problem of such magnitude that nopillar of state or economic entity can deal with italone. No individual government can, alone, hope tostem the tide of the growing epidemic. Industrycannot protect the economy in which it operates.HIV/AIDS can only be dealt with through collectiveefforts – a partnership of governments, the privatesector, civil society, faith-based organizations, tradeunions and the global community. Together, we mustall play a strategic role in mitigating the impacts ofpeople being sick, of families torn apart, and ofmarkets and countries threatened and disrupted.

Whether in Ouagadougou or on Wall Street, thefacts are that 14,000 people contract HIV/AIDSevery day and, of these, some 8,500 people die ofthe disease. In just over a decade, the HIV/AIDSpandemic has reversed many of Africa’s proudestachievements. It has reduced life expectancy insome countries by nearly four years and is now aleading cause of death on the continent. Thepandemic is emerging as the paramount threat toinvestment in the region and subverts efforts to liftpeople out of poverty.

In this global battle, business has an obvious andimportant role to play. Those firms which understandthe dangers and play an active part in combatingthe disease will reap the economic benefits overtime. Confronting the problem is, at least in part, thebusiness of business. From the private sector, weneed collective involvement, awareness and action.Companies are uniquely positioned to use theirglobal reach to protect their employees from thestigma and fear of HIV/AIDS. Investment in creatingawareness of the disease, and taking action toprotect workers, customers and communities, canensure that people are free to pursue careerswherever they live, to learn skills and to care for theirfamilies.

The World Bank and its partners are committed tosupporting a strategy to engage the private sectorthrough the national strategies of the countries inwhich we work. Reaching out to organizations thatare able to convene industry – business coalitionsagainst HIV/AIDS, labour unions, employerfederations, chambers of commerce and otherorganizations dedicated to the health and growth ofnational economies – and all that speak with apowerful and common voice, is perhaps our bestchance of ensuring sustained attention and action toaddress the effects of HIV/AIDS. This report willcertainly provide us all with important guidance onthe opportunities to join forces and leverage theefforts of the private sector throughout the continent.

Debrework ZewdieDirector, Global HIV/AIDS Program of the WorldBank Human Development Network

Preface

6

Introduction to the report and tobusiness coalitions

The emergence of businesses coalitions is a recentdevelopment in sub-Saharan Africa: most have onlybeen created in the last two to five years. Most wereset up by a small caucus of businesses that realizedthe value of coming together to fight the pandemic.

Business coalitions provide a vital platform in theprivate sector response to HIV/AIDS. They advocatefor business action, help mobilize business efforts,ensure a coordinated and nationally aligned businessresponse and facilitate sharing of best practicesbetween businesses. This enables companies toleverage their resources more effectively and bringtogether the critical mass of business action neededto mobilize multinational, as well as large andsometimes small national, businesses.

This report provides an overview of the state ofbusiness coalitions in sub-Saharan Africa. It drawson data from the profiles of 20 coalitions createdduring a mapping exercise (see Figure 1) undertakenover the previous 12 months. Individual profiles canbe found at www.weforum.org/globalhealth1.

We hope the lessons learned from this report will beuseful to help inform and strengthen the existing 20business coalitions in sub-Saharan Africa, the manymore being created around the world during thetime of this report’s publication and all thoseinterested in working with or in support of businesscoalitions.

Executive Summary

20 business coalitions formally exist

2 countries have kicked off a formal process to establish a business coalition

3 countries do not have a coalition, or have formal plans to create one

Private sector response TBC

Figure 1: At least 20 business coalitions formally now exist in Sub-Saharan Africa

7

Key findings on sub-Saharan African coalitions

The state of African business coalitions is varied andcomplex: it does not lend itself well to broadoverviews. There are significant differences inmembership models, financial models and activities.Furthermore, coalitions often operate in complexpolitical environments, sometimes involving multiplebusiness coalitions in one country. Such situationshave led to duplication of work and inefficiencies.There are, however, a number of characteristics weobserve across coalitions, particularly in terms of thechallenges coalitions face.

Looking first at what coalitions actually do, we seethem engaging in a broad range of activities andfulfilling several functions: from acting as the voice ofthe private sector to advocating increased action orbeing a facilitator of treatment programmes. Most ofthem, however, spend the largest proportion of theirtime and effort supporting company action againstHIV/AIDS in the workplace. This ranges fromdeveloping country-specific toolkits to implementingtailored employee training programmes.

In terms of how coalitions are choosing to engagebusinesses, we observe two schools of thought:serve-all models, which behave like NGOs andserve any business without charging membershipfees and membership-based models, whichcharge membership fees, either as a flat fee orbased on company size/service provision. While theserve-all coalitions typically reach more businesses,the degree of support provided to all thesebusinesses remains unclear, compared to thesupport provided to businesses that belong to amembership-based coalition.

Linked to this question is the financialsustainability of coalitions. One of the mostimportant challenges reported by coalitions,membership-based or not, is the heavy reliance onunpredictable funding. While membership fees – andin some cases income generating activities –typically bring in some revenue, all coalitions remaindependent on donor funding to cover the majority oftheir costs. This funding is typically short-term anddifficult to renew, which makes it difficult forcoalitions to engage in long-term planning orimplement programmes with longer time horizons

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140Non-paying organizations reached

Fully paid members 800 280

'Serve-all' coalitions typically reach more businesses

Keny

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iland

Figure 2: The established, membership-based coalitions are typically reaching 30-100 organizations

* This chart represents organizations reached by coalitions, as reported by each coalition – this includes business members but may also extend toother organizations, according to how each individual defines its members

with certainty. In response, some coalitions are nowaiming to have membership fees cover the core staffsalaries, so there is at least some stability within thesecretariat.

In addition, coalitions typically struggle to meetcompany demand, meaning their staff areoverstretched. Established coalitions typically have30-100 members (see Figure 2), often representingmostly large multinationals in the country. Thistypically represents 1-5% of the total formaleconomy. Most coalitions only employ 3-7 people,making it entirely unrealistic to consider serving thefull private sector.

Linked to these capacity challenges is the lack ofkey skills in coalitions. The most consistent skillsreported as lacking are programme managementand strategic marketing skills. Coalitions requirebetter programme management skills in order tohelp them plan and execute their activities efficientlyand enable them to bring more value to the privatesector. Better strategic marketing skills are required,both to help attract new members and to helpcoalitions sell themselves better to internationalpartners and secure donor funding.

With respect to scaling up the private sectorresponse, coalitions face a particularly difficultchallenge in engaging small and mediumenterprises (SMEs). While large companies havethe resources to invest in comprehensive HIV/AIDSworkplace programmes – and tend to be the mostactive – SMEs remain largely unresponsive toHIV/AIDS. For coalitions, SMEs are harder toconvince and require greater support than largecompanies when they do become active. They are,however, a critical sector to activate, particularly insub-Saharan Africa, where some countries reportthat SMEs employ up to 80% of the formaleconomy’s workers.

In conclusion, this report highlights the significantprogress that has been made in the private sectorresponse through business coalitions. There is nowreal experience available as to what can work, withan interesting diversity of coalition models. To buildon this progress and bring business coalitions totheir full potential, work clearly needs to be done toovercome some of the challenges highlighted above.

All stakeholders – business coalitions, businessesand international partners – will need to worktogether to clarify the long-term vision of coalitions(in particular if serving the full private sector is thevision) and understand what priority actions arerequired to fulfil this vision.

8

1.1. Context of Business Coalitions

HIV/AIDS undermines social and economic well-being. Beyond the human tragedies, HIV/AIDSdegrades the health and education of a nation’scitizenry. Current and future workforces are at anincreasingly higher risk as the epidemicdisproportionately affects people during their mostproductive years. HIV/AIDS can increase the costsof doing business and reduce the long-termbusiness potential of markets. It can also impact theinvestment environment and inflows of foreigncapital.

As a vital part of society, businesses are increasinglyresponding to the epidemic. Some respond from asense of enlightened self-interest and corporatesocial responsibility. Others respond because of thedirect effects that HIV/AIDS has or could have ontheir own business operations, including:

• Increased costs: With an increasing number ofemployees contracting HIV/AIDS, companiesmust cover the rising costs of health insurance,sick leave and funeral benefits, as well as therecruitment and training of new staff.

• Weakened business environment: HIV/AIDS putsnational economies at risk. The increasing impactof HIV/AIDS on business deters investment anddecreases output for foreign exchange.

• Threats to the consumer base: Overall, demandfor goods and services decreases and companiesmust be less dependent on their consumer base.Households are faced with increased healthexpenditures leading to reduced disposableincomes and risk losing their income base.

Often companies respond to these threats inisolation. More effective, however, is the formation ofbusiness coalitions or associations, allowingmembers of the business community to share bestpractices and to develop coordinated responseswithin the framework of national strategies. Nationalbusiness coalitions against HIV/AIDS provide forumsfor cooperation and partnership and serve as anintermediary on HIV/AIDS matters between theprivate sector and the broader HIV/AIDS community(governments, NGOs and faith-based organizations,known as FBOs).

National business coalitions enable companies tomore effectively leverage their resources and bettercombat HIV/AIDS. Coalitions assist companies byfacilitating information sharing, permitting economiesof scale in the development of workplace HIV/AIDSproducts and services and creating a strong, unifiedfront for public policy debate and advocacy. Theymay act as service and product providers, offeringconstituents help with impact analyses, developmentof education, testing and treatment programmes,training of peer educators and design andimplementation of other workplace and evencommunity interventions. National business coalitionsagainst HIV/AIDS often serve as important focalpoints for engaging with other stakeholders withinthe UNAIDS Three Ones framework and in particularwith the national governmental HIV/AIDS programme.

Coalition member companies often have substantialfinancial resources, well-established businessnetworks, political networks and strong incentives tocombat the disease. Through partnerships, theseattributes can be combined with existing knowledgeand expertise on HIV/AIDS interventions in the publicsector, providing greater outreach and impact.Acting through a business coalition also reducespotential public relations challenges that a singlecompany might face when tackling alone a sensitiveand politicized topic such as HIV/AIDS.

Business coalitions have generated someextraordinary results over the last 2-5 years. At least20 business coalitions now exist in sub-SaharanAfrica, and more are being created every year. Theyare mobilizing private sector action against HIV/AIDSin a way never seen before, helping not only tostrengthen the response of businesses alreadycommitted to fighting HIV/AIDS, but also helping toscale up the private sector response by engagingbusinesses not previously active and in some casesexpanding into new disease areas.

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1. Introduction and Overview

1.2. The Pan-African BusinessCoalition

It is important to note that we have seen someimportant steps towards creating a coordinatingframework for coalitions in Africa with the creation ofthe Pan-African Business Coalition (PABC). Thecreation of this continent-wide network has beendriven by National Business Coalitions, who haverecognized the need for increased cooperation witheach other.

At a minimum, the vision of the PABC is to facilitatelearning between coalitions by sharing informationand best practices about member services (e.g.supporting workplace action), as well as at anoperational level, on how to run a business coalitioneffectively. Beyond this, there are a number of rolesthe PABC could develop. These include becomingthe voice of business coalitions across Africa oracting as a coordinating and disbursementmechanism for the funding of business coalitions.Although initial discussions took place betweenmember coalitions in 2004, the PABC has yet toreach operational capacity. The PABC was officiallylaunched in December 2005 at ICASA (Abuja) and isnow in the process of identifying funding to becomeoperational. The current chair of the PABC isSABCOHA (South African Business Coalition onHIV/AIDS).

1.3. About this business coalitionmapping exercise

Despite the many positive developments andachievements of business coalitions in-country, anoverview of the activities, scope and models ofbusiness coalitions in sub-Saharan Africa has beenlacking to date. Despite the multitude of internationalpartners involved in supporting business coalitions,and the multiple coalitions each partner supports,they have yet to come together to create anoverview of the state of business coalitions.

This report therefore represents an important steptowards creating both a broad overview as well as adetailed understanding of business coalitions againstHIV/AIDS. It is the result of a mapping exercise

conducted within 20 countries in sub-Saharan Africaover 12 months and fulfils five purposes:• Clarify the status of African Business Coalitions –

what coalitions exist today and what are theydoing?

• Facilitate learning between coalitions – helpingthem to understand individual success storiesand best practices, as well as commonchallenges and the solutions to overcome them

• Help donors and international partnersunderstand where their support is most neededand could have the most significant impact

• Provide input for the Pan-African BusinessCoalition in setting priorities

• Raise the global profile of business coalitions inAfrica and awareness of the good work they aredoing

This report is intended for all stakeholders ofbusiness coalitions: the coalitions themselves,businesses actively involved and supportingbusiness coalitions, the Pan-African BusinessCoalition, international support partners and donorsand academics interested in this field.

1.4. Limitations of this report

This report is not intended to provide acomprehensive and detailed insight into everycoalition. Rather, it is intended to represent a firststep towards creating a high-level overview of thestate of business coalitions, in order to fulfil thepurposes outlined above as efficiently as possible.

To build on the foundation provided by this report,there is a strong case for widening the scope of themapping exercise. We have an opportunity for muchdeeper and comprehensive analysis within:• The business coalitions already included in

this report. The results of this report highlightareas for deeper analysis that were not includedin the original data collection outlines (e.g. one ofthe primary challenges being reported bybusiness coalitions is financial sustainability).There is scope for much deeper financial analysisto understand how to best support them. This willinclude basic income and expenditure (which hasnot been included in this exercise) and a betterunderstanding of how business coalitions plan andorganize their finances.

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• Additional business coalitions. In this mappingexercise, we have only included one coalitionfrom each country. In some cases, there existsmore than one coalition against HIV/AIDS, and insome cases non-HIV/AIDS coalitions. This reportincludes only HIV/AIDS-specific coalitions. Wheremultiple coalitions exist (e.g. Kenya and Uganda),we profiled the coalition that was a member ofthe PABC2. A more comprehensive report couldprofile all the coalitions related to HIV/AIDS ineach country.

• Other countries in sub-Saharan Africa. Twenty-five countries were included in the mappingexercise, of which 20 had business coalitions.There may be coalitions in the remainingcountries in sub-Saharan Africa of which we arenot aware. These should clearly be part of anyfurther analysis in mapping business coalitions.

In addition, we were pleased to realize someadditional benefits in conducting the mappingexercise. For example, many coalitions providedfeedback that the process of creating the profileswas in itself very useful, helping them clarify thestatus of their coalition and identify their own issuesand challenges.

1.5. Methodology

The aim of the mapping exercise was to produceprofiles for each coalition, which would serve as thebasis for analysis and comparison in this summaryreport. Each of the coalitions was profiled using asuite of standard assessment metrics in order toenable consistent and comparable profiles:• Profile building started with outlining clear data

requirements and format for the profiles.• Coalitions were contacted on an individual basis

to create country profiles. This step includedclarifying exactly which coalitions existed.

• All 20 coalitions were profiled (approx. 4-6 pageseach)- Profiles were created in close partnership with

each coalition, via interviews, when possible inperson, or by telephone. In some casescoalitions took the lead to write their ownprofiles. Every coalition reviewed and validatedthe information and data included in the profiles.

- The profiles can be found atwww.weforum.org/globalhealth

• Each profile had nine sections, including:- Contacts- Background- Organization- Membership Analysis- Coalition Activities- Coalition Relationships- Funding- Success Stories- The Future

• A situation analysis was written for five countriescurrently without a coalition.

• This summary report included a feedbackprocess at the individual level (business coalitions,businesses and international partners) alongsidegroup feedback at a number of events, includinginterim report presentations at ICASA (Abuja,December 2005) and the Forum for Mobilizing thePrivate Sector in Francophone Africa (Marrakech,June 2006).

Appendix 1 provides an overview of the coalitionsincluded in this mapping exercise.

2.1. When Business Coalitions were created

• Figure 3 illustrates that business coalitions are arelatively new development in Africa. Most havebeen created in the last five years, and in the lasttwo years at least six new coalitions have beenlaunched.

• Of the 20 coalitions that have now beenestablished, 14 are based in anglophone Africaand six are based in francophone Africa. Typically,francophone coalitions are younger thananglophone coalitions. The coalitions in DRC andRwanda are the longest established francophonecoalitions (launched in 2001), with most otherfrancophone countries having launched in the lastyear or planning a launch in the next year(including Burkina Faso).

Additional trends observed in business coalitions tonote include:• Most business coalitions started with a small

group (3-5) of very committed companies, whichtend to be multinationals (e.g. Unilever, StandardChartered Bank, Merck, etc.) and/or through thechambers of commerce.

• Coalitions often have to operate in difficult andcomplex political environments, and in a number

of cases a number of business associationsoperate alongside one another within one country.

• Some business coalitions (including Mozambique,Botswana and Zimbabwe) have undergone a re-launch since first being created, which enabledthem to fine tune their business model.

2.2. Business Coalition governance

Typically business coalitions are organized aroundtwo bodies: a secretariat and a board. Thesecretariat is comprised of permanent staff membersand is responsible for day-to-day operations anddelivery of the coalitions’ services and activities. Theboard is typically made up of 4-8 senior companyrepresentatives, usually CEOs, and is in some caseschaired by a senior official in government (e.g. theNigerian Business Coalition on HIV/AIDS is chairedby the President of Nigeria). The board is usuallyresponsible for setting the long-term strategicdirection of the coalition and holding the secretariataccountable for its activities.

Some coalitions also have advisory/technical boardswhich sit alongside the main board to provide adviceon specific issues/areas of expertise for particularindividuals (see the Côte d’Ivoire example in Figure 4).

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2. The Phenomenon of Business Coalitions

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More than five years (launched before 2001)

2-5 years(launched 2001-2004)

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Botswana 1994

Kenya 2000

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Zambia 2000

DRC 2001

Rwanda 2001

Swaziland 2001

Uganda 2001

Namibia 2002

Malawi 2003

Nigeria 2003

Ethiopia 2004

Tanzania 2004

Zimbabwe 2004

Mali 2005

Mozambique 2005

Cameroon 2006

Ghana 2006

Côte d'Ivoire 2006

Mauritania 2006

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Figure 3: Most coalitions have been created in the last 2-5 years, but many new coalitions are still being created

2.3. Secretariat capacity: employees and skills

• Figure 5 illustrates that most coalitions employ 3-7 people in their secretariat. This will typicallyinclude a director/coordinator role, whichoversees the day-to-day activities of thecoalitions, alongside 2-3 programme officers, whodeliver the activities of the coalitions and 1-2support staff for assistance in the office, etc.

• Most aim to expand capacity soon: 11 coalitionswant to employ at least two more employees in

the next 6-12 months. This is in response tomany coalitions being overstretched andstruggling to meet demand from members. Whilemost coalitions do have a vision of expandingcapacity internally, they typically have not securedfunding for these additional staff.

• Uganda is the one outlier in staff capacity,employing 45 people. This is the result of theunique model it has adopted in providingworkplace treatment centres for companies (seethe UBC example in section 4.2.3. below).

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Constitutive General Meeting

Standing Technical Secretariat

Technical CommitteeBoard of DirectorsAudit Firm

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Figure 4: Example Structure: CECI (Côte D’Ivoire)

Figure 5: Most coalitions have ambitious plans to expand internal capacity

Note: Includes full-time staff in kind; does not include volunteers or part-time staffNote: Chart does not include Mauritania, which is still establishing its secretariat

• Coalitions report that they need support on somespecific skill areas: specifically, projectmanagement and marketing:- Basic project management for planning activities

and delivering services effectively and on time- Marketing to help attract members and better

funding from international partners• Some coalitions aim to fund staff salaries through

membership fees (e.g. Tanzania), while othersonly recruit staff on a project basis (e.g. Namibia).

2.4. Coalition relationships

Apart from businesses, coalitions work with a widerange of both national and international partners.Typically, coalitions will partner closely with up to 10-15 organizations, with the most important tending tobe the local National HIV/AIDS Council (NAC) andtheir donor organizations.

In addition to working with NACs, coalitions will workwith local service providers and NGOs to partner onspecific initiatives. In an international context,coalitions are partnering with a wide range oforganizations. These relationships tend to be in asupport capacity, be it technical support or funding(in-kind or direct donations).

2.5. Coordinating mechanisms – couldthe PABC be a solution?

To date, despite so many coalitions now existingand the multitude of international organizationssupporting these efforts, there remains no regionalcoordination mechanism. There are just a fewexamples where coalitions are speaking to one

another on a bilateral basis to share experiences,e.g. Kenya with South Africa, and Namibiasupporting Swaziland.

Despite this, coalitions unanimously recognize theneed for a coordinating mechanism, with all offeringtheir support and interest in the PABC (see‘Introduction and Overview’ for an outline of thePABC). Coalitions report they would like to see thePABC play a wide range of roles, e.g. to:• Facilitate exchange of experiences between

coalitions, helping each coalition to avoid re-inventing the wheel:- A PABC website may enable such exchanges- Create forums for dialogue, benchmarking,

sharing of best practice and discussion ofchallenges

• Provide technical support to national coalitions tohelp them build their capacity

• Help national business coalitions better leverageresources and support (at an international level)

• Act as a distributing mechanism for internationalfunding

• Act as the voice of African business coalitions atinternational meetings/forums

• Help develop a common framework for businesscoalitions in Africa, based on shared experienceand understanding of running business coalitions

• Create an evaluation framework for theperformance of business coalitions

Due to a lack of funding, the PABC has yet to reachoperational capacity and begin fulfilling these roles.As the PABC increase its capacity, it is critical thatthe coordinating body has sufficient capacity (timeand skills). Particularly in the beginning, thecoordinator will need a strong vision andcommitment to get the PABC up and running to itsfull potential. Likewise, it is important that the PABCdoes not itself try to become another coalition,which risks resulting in the inefficiencies we haveseen already when multiple coalitions exist in onecountry. Rather, the coordinating body should be aneutral body that exists to maximize cooperationand coordination between business coalitions.

An additional practical challenge is for thecoordinating body to be bilingual, so bothanglophone and francophone coalitions can beincluded in the PABC.

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Common international partners include:

• World Bank• GTZ / ACCA• UNAIDS• UNDP• ILO• World Economic Forum• Global Fund• GBC• SIDA ENTREPRISES

• PharmAccess• CCA• Action AID• VSO• USAID • DFID• SIDA • DANIDA• NORAD

This section provides an overview of the variousmodels for fees and business outreach currently inoperation; and the number of companies coalitionsare reaching through these models.

3.1. Models for fees and business outreach

Perhaps one of the most debated questions amongbusiness coalitions is the best approach to engagethe private sector. This debate raises somefundamental questions about the purpose of thecoalition to engage the private sector and thefinancial sustainability of coalitions. As illustrated inFigure 6, we see two schools of thought at a highlevel:• Membership-based coalitions that charge fees• ‘Serve-all’ coalitions that do not have members

and do not charge fees for services

The philosophy of the membership school is that ifbusinesses want the coalition to exist, they shouldpay for it. Coalitions should be working towardsbeing a sustainable organization and if there issufficient demand from the private sector for thecoalition’s services, this demand will facilitate thecoalition’s existence. Further, this school believesthat if companies really are committed to fightingHIV/AIDS, they will be willing to pay fees as a sign ofthis commitment.

In contrast, the ‘serve-all’ school argues thatexperience shows that the fees model does notwork: business coalitions are plagued byinconsistent fees payments, with a few verycommitted companies paying above their requiredfees, while many companies pay fees only in part, ifat all. Indeed, looking at coalitions today, we seeoverall fee payment rates as low as 20-30% in somecountries.

15

3. The Approach and Scale of Business Coalition Activities

Figure 6: Models for fees and business outreach

Serve-All Model• Approximately 15% of coalitions employ this model• These coalitions are not membership-based, rather, they serve the entire private

sector, and do not charge fees, e.g. Botswana moved from a membership modelin 2002 to serve the entire private sector

Flat Rate Model• Approximately 20% of coalitions employ this model• A one-size-fits-all approach, e.g. Mali charges all companies – big or small – US$

600 per annum for membership. All members are entitled to the same level ofservices

Company Size Model• Approximately 50% of coalitions employ this model• Coalitions typically define companies as small, medium and large according to

employee count or turnover, e.g. per person (Zambia) or by defining a largecompany as having more than 500 full time employees (Namibia) or a turnovergreater than US$ 7.5m (Nigeria)

Membership Tier Model• Approximately 15% of coalitions employ this model• The coalition will define 2-4 tiers of membership, with each tier entitling members

to a clear set of benefits. See Malawi example below

Serv

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-Base

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The philosophy of the ‘serve-all’ school is thatcoalitions not only meet the demand of the privatesector, but are also generating a public good:supporting the public sector by using the privatesector as a channel to reach people. Thus, inserving this public need, coalitions should serve allof the private sector: it should not be an exclusiveorganization for companies who pay fees. Indeed,Botswana moved from a membership-based modelin 2002, to a serve-all model. Previously, the coalitiononly managed to reach 40 businesses in Botswana.

Since this change, the coalition now reaches over800 businesses with its activities.

The membership-based school argues that thisapproach creates too much dependence on donorfunding: relying completely on donors challenges theindependence of the coalition and makes it difficultto plan for the long term, since donor funding istypically given on a 12-24 month basis. Furthermore,there is no guarantee that donor funding will continue.

Example MBCA (Malawi)

Tiers for MembershipMBCA has developed a tier-based system formembership (Bronze, Silver, Gold and Platinum).Under this approach, each level entitles membersto a clear list of services, but the cost ofmembership for each tier does not changeaccording to company size (SMEs may be offeredconcessions, on a case-by-case basis). If amember company wants services above whatthey are entitled (e.g. peer education training),they have to pay for the specific service or moveto a higher tier.

Bronze Under the Bronze membership (minimum),companies have access to:• Information on workplace programmes

including where they can get resources• Technical assistance on workplace programme

development including M&E assistance• Access to ARV treatment (through the ministry

of health partnership)• One vote at the Annual General Meeting

(AGM); cannot sit on the board

Silver• In-house training programmes (e.g. peer

education training), executive managementbriefing

• Research support (e.g. situation analysis)

• 10% discount on training facilitated by MBCA• Two votes at the AGM, but cannot sit

on the board

Gold • Provides access to personal company support,

tailored to their company• Features within the MBCA’s magazine and radio

programmes• Three votes at the AGM• Directors can sit on the MBCA board; can

represent the business coalition in nationalforums; some are members of the technicalcommittees

Platinum• CEOs act as champions for HIV/AIDS, e.g.

mobilizing businesses to create new treatmentclinics

• Featured on billboards and television coverage ofMBCA

• Buddied with smaller companies who want toemulate their programmes

• Tasked to develop with sector initiatives, e.g. act as buddies or mentors for other companiesin their sector

• 50% discount on training facilitated by MBCA• Four votes on the board• Can chair the coalition board; can represent the

coalition at international meetings

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3.2. Companies being served bybusiness coalitions

This section explores what organizations are beingserved by business coalitions, as members and non-members, and how this relates to the privatesector at large.

3.2.1. Membership-based coalitions

Looking first at the membership-based coalitions, as illustrated in Figure 7, we can make a number of observations:• The established, membership-based coalitions

typically reach 30-100 companies.• While a detailed breakdown of these companies

is not available – making it difficult to estimate thenumber of people reached through thesebusinesses – we do know that the majority tendto be large companies, often multinationalcorporations.

• We estimate that this represents 1-5% of the totalpeople employed in the private sector (formaleconomy). A number of coalitions are reaching asmuch as 10-15% of the formal economy (e.g.Namibia, Botswana).

• SMEs are typically much less active in coalitionsor with HIV/AIDS workplace programmes. Mostcoalitions report that this is one of the keychallenges they face: how to engage this sector,which typically employs more people than thelarge companies, but which struggles to find the resources and incentives for workplaceprogrammes.

• Fees payment rates are very low in some cases.Across all coalitions, fees payment rates averageapproximately 60%, though in some cases this isas low as 20-30% (e.g. Mozambique, DRC).

• Most coalitions only accept companies asmembers, though some, such as the DRC,extend their membership to any organization thatwants to make a commitment to HIV/AIDS (e.g.federations, unions, parastatals, NGOs).

• In terms of membership engagement, typicallybusiness coalitions report:- A core group of companies that are particularly

committed – usually 30-50% of members –that pay their fees and are actively engaged incoalition activities (e.g. attending membermeetings, training sessions, etc.).

100

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Fully paid members 800 280

'Serve-all' coalitions typically reach more businesses

Keny

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Figure 7: The established, membership-based coalitions are typically reaching 30-100 organizations

* This chart represents organizations reached by coalitions, as reported by each coalition – this includes business members but may also extend toother organizations, according to how each individual defines its members

- A second group (typically 10-20%) will join thecoalition with some initial interest (e.g. attendinga couple of training sessions) but without beingparticularly committed, though they willcontinue to pay some or all of their fees.

- A final group (30-40%) will join with the sameinitial interest that dissipates, but do not paytheir fees.

- In some cases, e.g. Ethiopia, engagement isvery high and more companies attend activitiesthan there are members.

3.2.2. Serve-all coalitions

Secondly, we observe some different dynamics forthe serve-all coalitions:• No-fees business coalitions tend to reach more

companies, because they can serve any businessin the private sector. Botswana is the leadingexample, with over 800 companies that havebeen reached through the coalition’s activities.- This means a minimum of attending the BBCA

activity and registering for activities, e.g.seminars

- Of these 800, over 300 companies have beenactively engaged (over 200 have implementedthe BBCA toolkit, and over 100 companieshave been reached through the capacitybuilding training – see the activities list below)

3.2.3. General comments

Finally, there are a few general comments we canmake about organizations being served by businesscoalitions:• All coalitions continue to encourage non-member

companies to become members. There are anumber of different approaches taken to achievethese targets:- Company outreach visits, where the coalition

will visit companies on a one-to-one basis toencourage companies to become members

- Using existing business organizations to recruitcompanies (e.g. working through localchambers of commerce)

- Offering incentives to join: Kenya offers a freesensitization course for HR representatives asthe first step in establishing a workplaceprogramme. Out of each training session

attended by approximately 35 companies,usually 5-6 will proceed to request additionalservices from KHBC

• Some business coalitions employing amembership-fee structure report spending adisproportionate amount of time and resourcesservicing a few fee-paying companies withspecific demands.- This may lead to the coalition being

sidetracked from its overall founding directionand strategy, because of the immediate needsof a small group of fee-paying companies

18

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This section takes a detailed look at the functionsthat business coalitions are serving across Africa,both internally and externally (see Figure 8). Inaddition, this section analyses the strategic disease-focus that business coalitions currently have, and inwhat direction they are headed.

4.1. Internal activities

All coalitions spend a certain proportion of timefocused on internal activities. For coalitionsestablished in the previous two years and stillfocused on creating the organization3, such activitiestend to take up most of their time, e.g.:• Creating and defining the package of services

and activities for members sometimes includes

conducting a needs assessment of companies, tounderstand what services are needed most

• Recruiting a membership base as a foundation forthe coalition

• Mobilizing funds from companies and/or theinternational community

• Establishing and implementing the structure ofthe coalition, from basic activities such asrecruiting the secretariat, to more complexquestions such as how to structure the coalitionto best reach SMEs, e.g. given the strategicfocus of Cameroon on SMEs (one objective is toreinforce the capacities of 100 SMEs by the endof 2008). What structure will enable it to achievethis target?

4. Coalition Functions and Activities

Business Coalition functions

External (fulfilling the coalition’s mission)

Internal (operational / organization)

Voice of private sector

Advocacy

Supporting workplace

programmes

Specific activities

NAC

Events

Written communications

Define activities

Recruit members

Mobilize funds

Establish the organization

Materials

Tools

Training

Tends to be the focus of start-up coalitions, i.e. established in the last 1-2 years

Specific activities: only 1-2 coalitions are carrying out

Figure 8: The functions and activities we observe internally and externally

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4.2. External activities

Once a coalition is established, the activities tend tofall into three main categories, though most activitiesare focused on supporting business action.

4.2.1. Voice of the private sector atkey national and international forums

Most coalitions represent the private sector innational HIV/AIDS policy forums. In this capacity,coalitions can reconcile the diverse interests andapproaches of private sector actors and act as acredible interface between the public and privatesectors when lobbying the national government andthe international community for a more enablingenvironment for the private sector response. Forexample, coalitions can assist with the creation ofnational guidelines for workplace policies, legislationthat protects the rights of people living withHIV/AIDS, increased access to ARV treatment,construction of more VCT clinics, etc.

Currently, most coalitions are recognized by NationalAIDS Committees (NACs) as the focal point for theprivate sector. Botswana is a particularly strongexample of a coalition working closely with the localNAC and working within the National StrategicFramework.

4.2.2. Advocating increased business action

A fundamental raison d’être of business coalitions isto encourage increased action against HIV/AIDSwithin the private sector. This usually meansengaging in activities that facilitate informationsharing among companies and sharing of bestpractices. These activities are also a criticalapproach for coalitions to recruit new members tothe coalition.• At a minimum, coalitions advocate for increased

action with companies who are members of thecoalition (if the coalition operates on amembership model), but it can also extend thisactivity to reach non-members as well.

Example ABCT (Tanzania)

Needs Assessment• As a starting point for strategic planning,

ABCT conducted a needs assessment among27 companies in Tanzania to understand theirHIV/AIDS workplace priorities and gaps

• This study provided a blueprint for the ABCTplan of action

• It was also used to sell ABCT to newcompanies

Example CIMA VIH/SIDA (Mauritania)

Situational AnalysisThe creation of the Mauritanian coalition includeda situational analysis of the private sector’sresponse to HIV/AIDS in Mauritania. This analysiswas very similar to basic market research in theprivate sector. It included interviews and surveys,and fulfilled a dual role:• Primarily, the analysis was an opportunity to

clarify existing initiatives and programmesamong potential members (companies andfederations), and what support they neededmost

• It was also an opportunity to engage keystakeholders from the beginning of thecoalition’s existence, not only to raiseawareness among key stakeholders, but alsoto engage them in shaping the coalition’scharacteristics (e.g. name, plan of action, etc.)

21

• Advocacy takes place through events and writtencommunications:- Examples of events include monthly

breakfasts/dinners for members, which usuallyinvolve 1-2 businesses sharing examples oftheir workplace activities, and which may beattended by a guest speaker, e.g. a highranking politician, international guest, etc.

- Examples of written communication includeinformation shared through a coalition website,monthly newsletters, etc. This will usuallyinclude case studies highlighting bestpractices.

- Some coalitions also extend their advocacyand communications activities to television andradio programmes or advertisements, in orderto reach a mass market (e.g. the ZambianBusiness Coalition speaks regularly on nationalradio shows, the DRC coalition has occasionalTV spots and encourages media coverage ofsensitization activities).

4.2.3. Supporting workplaceprogrammes

Almost all coalitions offer direct technical support forcompany workplace programmes:

Materials for workplace programmes. At aminimum, this means providing supporting materialsfor the workplace programme. This usually includesdeveloping Information, Education andCommunication (IEC) materials for membercompanies. These can usually be tailored to aparticular company’s branding, etc. It can alsomean:• Helping companies source condoms (e.g. CIELS

in the DRC distributed 216,000 male condomsand 2,500 female condoms to companiesbetween 2005 and 2006).

• Operating a resource centre that providesmaterials for borrowing (e.g. KHBC in Kenya runsa resource centre that has over 100 videos thatcompanies can borrow for their workplace).

Tools for workplace programmes. Most coalitionswill also provide some kind of a toolkit forcompanies to support and guide workplaceprogrammes.• General workplace programme toolkits for all

companies (e.g. Côte d’Ivoire encourages itsmembers to use the GTZ/ACCA toolkit forworkplace programmes) or these may be tailoredfor the region, e.g. Tanzania has tailored aworkplace toolkit to a national setting, includinglocal contact information, Tanzania branding, etc.

• Some coalitions have also developed tools forspecific workplace challenges, e.g. EBCA(Ethiopia) has developed tools for monitoring andevaluation, report cards, action frameworks, etc.

Example BBCA (Botswana)

Red Ribbon Awards• BBCA launched an annual competition in

2005, with a dual objective of sharing lessonsand ideas on how to best mitigate HIV/AIDS inthe workplace, and promoting HIV/AIDSmonitoring and evaluation

• The awards have so far recognized a total of13 companies in 2005-06 (9 and 4, respectively)

• The competition in 2006 recognized fourbusinesses according to size (small, medium,and large) and programme comprehensiveness(business excellence in HIV/AIDS)

Example ECO-SIDA (Mozambique)

CEO Public Testing for World AIDS Day• World AIDS Day public HIV testing of senior

managers (CEO/financial director) of large andmedium companies

• 26 companies tested themselves publicly onnational TV and in front of their employees topersuade them that this is a good thing

Training for workplace programmes. Beyond this,coalitions will offer training to companies. However,exactly what form this takes, how frequently ithappens, who has access to these services andwho implements training varies significantly.• What form this takes: training can include

- Supporting the development of a workplaceprogramme, e.g. policy design, structuring ateam

- Sensitization visits as an initial outreach to staffto expose them to basic facts of HIV/AIDS,e.g. APELAS (Rwanda) sensitized 30companies in 2005 (approx. 22,000 people)

- Peer education training- Arranging VCT sessions to allow employees to

be tested• How frequently it happens: some coalitions

hold regular training sessions, e.g. EBCA(Ethiopia) provides monthly practical trainingmodules or workshops, whereas some coalitionshold training sessions based on demand fromcompanies, e.g. NABCOA (Namibia) has providedtwo company-specific training sessions, which isa profit generating service

• Who has access: some coalitions offer trainingto members only and do not charge anything;some offer it to all companies, and offer areduction in cost for members (see the Malawiexample below)

• Who implements training: some coalitionsfacilitate the training themselves, while otherswork through local service providers andconsultancies (e.g. SABCOHA working throughAGNANG to implement the SABCOHA toolkit,Zambia moving to a role of coordinating theservice providers, DRC facilitating VCT sessionsthrough a local consultancy, etc.)

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Example: NABCOA (Namibia)

Cost Benefit Analysis Service in Namibia: inpartnership with GTZ/ACCA, Namibia hasdeveloped a cost-benefit analysis of workplaceprogrammes, which helps companies decide howto optimally invest in their HIV/AIDS programmes• Provide members with cost-benefit ratios to

actual financial investment (or lack thereof) inworkplace programmes

• Cost-Benefit Analysis (CBA) estimates theshort- and long-term impact of three separatecourses of company action

• Ten major companies have already benefitedfrom the analyses.

Example: UBC (Uganda)

Service Provision in Uganda: UBC has takentheir level of service to companies beyondsupporting the creation of workplaceprogrammes, to providing intense treatmentsupport through their Workplace TreatmentCentre (WTC) Programme• Through its WTC programme, started in 2003,

UBC has now established three WorkplaceTreatment Centres (WTCs) across the country

• Through the centres, UBC has now tested andcounselled more than 10,000 workers andtheir families. They currently providecomprehensive HIV/AIDS managementservices to almost 4,000 workers and theirfamilies. These workers may not necessarilybelong to companies who are members of UBC

• Each Centre employs close to 12 workersincluding doctors, laboratory technicians,pharmacists, counsellors, data managers, etc.

• Funding for the WTC programme is secureduntil 2008 (US$ 3.5 million received so far, US$ 2 million committed until 2008 from Pepfar).

4.2.4. Specific examples

Beyond this, some of the more establishedcoalitions are developing specific services andactivities that are not seen in other coalitions. Threeexamples of emerging good practices arehighlighted here:

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Example: SABCOHA (South Africa)

Innovation ResearchSome coalitions are playing a research role,exploring new and innovative solutions for theprivate sector response. SABCOHA (South Africa)recently completed the Cleaners Project reachingnew industries:• Focused on introducing workplace programmes

in the cleaning industry of South Africa• Successful implementation created a domino

effect to other industries penetrated throughthe cleaning industry

• As a direct result, three industries now want toestablish workplace programmes (hospitality,tertiary education and gambling services)

Monitoring & EvaluationActing as the private sector focal point, somecoalitions are starting to conduct regularassessments of the private sector response in theircountry, which optimally feed into the NationalMonitoring & Evaluation system. This is inaccordance with the Three Ones principle: everycountry’s HIV/AIDS response should operate underOne National Strategic Plan, One CoordinatingBody and One Monitoring and Evaluation system.SABCOHA (South Africa) partners with the Bureauof Economic Studies to produce an annual reporton the business response in South Africa.

Example: MBCA (Malawi)

Public-Private Partnership for deliveringtreatment in Malawi: MBCA has been chosen tocoordinate the national private sector treatmentprogramme. This has involved working closelywith the Ministry of Health (MoH). Started inSeptember 2005 and lasting five years, thisprogramme is embedded within the National ARVScale-up plan, which includes using the privatesector for channelling treatment. While theprogramme is subsidized, it still costs companiesUS$ 5 per patient per month.• Roles and responsibilities are clearly defined

- Funded by the Global Fund for the procurement of drugs and training ofhealthcare workers in the private sector.

- WHO provides operational and administrativecosts, including salaries

- MoH, in collaboration with the NAC andUNICEF, procures the drugs for the privatesector. MoH trainers are also using the MBCAprogramme to train the private sector

- MBCA identifies private sector companiesthat will be part of this programme

• This programme is now also helping to attractnew members, because companies know thatthrough the programme, they can access thelowest priced medication available

Figure 9

Cameroon

Malawi

Swaziland

Uganda

South Africa

Mauritania

Mozambique

Ethiopia

Namibia

Nigeria

Rwanda

Tanzania

Zambia

Zimbabwe

DRC

Côte d'Ivoire

Mali

Botswana

Ghana

Kenya

HIV/AIDS TB Malaria Wellness

Key

Primary disease focusof the coalition

Secondary diseasefocus of the coalition,i.e. active in this disease

Disease the coalition is most likely toconsider, if any

Coalition not workingon this disease, andunlikely to consider

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4.3. Strategic focus: disease area

Figure 9 illustrates that the primary focus of mostcoalitions remains HIV/AIDS, though most businesscoalitions are open minded about expanding to otherdisease areas, if they have not already done so.

This is partly driven by a trend to destigmatizeHIV/AIDS by building it into an overall wellnesscampaign and treating it like any other disease.Some businesses report that, while HIV/AIDS isimportant, having a programme exclusively dedicatedto it makes it stand out as an issue and compoundsan already strong stigma against the disease.• Some coalitions were set up from the beginning

to include the three major diseases (HIV/AIDS, TBand malaria), e.g. Cameroon

• Some have begun extending to other diseaseareas, e.g. Uganda

For most coalitions, TB is the most natural extensionbecause of the high correlation between TB andHIV/AIDS; though some coalitions report theirmembers saying they need more support withmalaria, e.g. DRC.

Example: MBCA (Malawi)

MBCA is changing its approach by encouragingcompanies to make HIV/AIDS just one diseasewithin a broader health programme. A number offactors have driven this:• Companies in Malawi are reporting that uptake

of services within companies is low because ofemployees fear (of dismissal if disclosed, or ofbeing shamed by their peers – “you are asinner”). Workers would rather travel far toremain anonymous.

• MBCA wants companies to provide betterinformation on the importance of better nutritionalwellness (achieved through counselling).

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5.1. Membership fees

Figure 10 illustrates the variation in coalition fees thatexists across business coalitions. As discussedabove, approximately 50% of coalitions set their feesaccording to company size or according to amembership tier system. In those cases, the chartillustrates the highest membership bracket.

For coalitions that operate a membership basedmodel for companies, one of the most difficultquestions coalitions report is the level at which to settheir fees. One important factor driving this decisionis the level of services offered – clearly coalition feesneed to reflect the support that will be offered tocompanies that pay membership fees.

Another factor is the ability of their members to pay.With this in mind, one additional benchmark whichmay be useful is Gross National Income (GNI) percapita, which as a measure of an economy’sstrength may be used as an indicator of companies’ability to pay.

The chart above also plots each country’s GNI percapita4. This should provide a useful chart forcoalitions to benchmark themselves against otherbusiness coalitions in Africa. In some cases, thehighest fees are approximately twice the GNI percapita (e.g. South Africa, Namibia, Mali andTanzania). In other cases, the highest fees are morethan five times the GNI per capita (e.g. Mozambique,Kenya, Malawi, Ethiopia, etc.).

5. Financing of Coalitions

$7'800

$7'000

$5'200 $5'000$4'600

$2'000$1'700 $1'500 $1'300

$1'000 $600 $600$200 $200 $0 $0

$0

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GNI pc (2004)

'Serve-All' coalitions

$18,200

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$, 2

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Fees

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Figure 10: We see significant variation in membership fees charged by coalitions*

* Chart does not include data from Ghana and Cameroon: both coalitions are still deciding at what level to set fees

5.2. Coalition finances

We do not have a clear picture of coalition finances.Even information on basic revenues andexpenditure, past or forecast, is lacking. Nor does aclear picture exist of how coalition revenues are splitbetween the three sources (see Figure 11), or howcoalitions split their expenditure across the differentareas of activity.

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Example: Namibia Finances

Coalition income and expenditure

Coalitions typically get revenues from threesources:• International donors• Membership fees• Services provided

Expenditures typically fall into two categories:• Operational costs, e.g. staff salaries,

office space, etc.• Programmatic activities, e.g. training program-

mes, company specific programmes, etc.

Figure 11

2006 (000’s US$) 2007 (000’s US$)

Budget $440 $500Secured 100% 80%

Fees $70Revenues from services $10 Expect to increase from 2006Donors $360

Donor Amount (000’s US$)

German government (via GTZ) $50PharmAccess / Hivos $50 SIDA $50World Bank $50Global Fund $120 UNAIDS $40

Donor Funding

27

5.3. Funding gap

Most coalitions remain dependent on donor funding,at least in part, if not in full (as is the case forcoalitions employing a serve-all model). Coalitionsreport being constrained by the funding they canaccess. While no “funding gap” has necessarily beendefined, there is clear scope to scale up coalitionactivities. As mentioned above, all coalitions are onlyreaching a small proportion of the total privatesector. Furthermore, most coalitions report beingover-stretched, struggling to meet demand fromcompanies, and are under capacity, both in terms ofstaff and skills.

In some cases, coalitions are taking a proactiveapproach and defining what the ‘gap’ is. In mostcases, coalitions do not have the capacity to do

even this – they operate on a reactive basis,according to how much funding is available, andthey then define their activities from there.

Some coalitions are trying to make a move awayfrom this dependence. Malawi and Namibia are theleading examples of coalitions that charge membersfees for services on a for-profit basis (which isredistributed to finance other not-for-profit activitieswithin the coalition). Both coalitions remain 80-85%dependent on donor funding, so even theseimpressive moves towards income generatingactivities will require implementation on a significantlylarger scale to bring coalitions to a point where theyare sustainable and self-sufficient.

Example: MBCA (Malawi)

Training in managing HIV in the workplace,November 2005MBCA facilitated a successful two-day training onmanaging HIV/AIDS in the workplace, which wasopen to members and non-members alike (US$ 100 for members; US$ 200 for non-members). This was the first training sessionopen to non-members, and it was so successfulthat several sessions similar to this have beenheld since.

The training was very well attended, reaching fullcapacity of 120 companies. In fact, MBCA wasforced to turn away some public sectororganizations due to space constraints. Eightynon-members attended, alongside 40 members.Unexpectedly and unprompted by MBCA, theNAC noticed an advertisement for the training ina local paper and decided to provide the moneyto fund participation for 40 of the non-members.

Of the companies that attended, few hadworkplace programmes in place already:• 30 companies had no policies in place.• 30 companies had a policy developed by the

HR manager, but it was not implemented.• 20 had no policies implemented.

Training included:• Basic facts on HIV/AIDS• Economic impact of HIV/AIDS• How companies respond• HIV mainstreaming• Putting a policy in place that governs response• M&E• Resource mobilization (requirements,

collaborative partnerships).

This training actually generated a profit of US$ 19K for MBCA.• Total revenues raised were US$ 24K (K2.4m).• The total cost for all the materials,

etc., was US$ 5K.- This included three facilitators costing US$

360 for two days.- Donors paid for the training materials.- Consultants were not used: ADRA, PSI and

partners provided people for the day.

This profit will be contributed to finance otheractivities within the coalition (e.g. part of the feescollected from non-members are being used tosubsidize training for smaller companies).

5.4. Support from internationalpartners

We typically see three forms of support: directfunding, in-kind support through staff members(either on secondment or funded salaries) andtechnical support (via seconded technical advisers).• Technical support tends to range from support in

developing strategic plans and service offerings,to training in specific skill areas (e.g. accountplanning, monitoring and evaluation skills), tosupport on specific pieces of work (e.g.situational analysis).

There is significant variation in the number ofinternational partners each coalition is currentlyreceiving support from. Most coalitions receivesupport from only a few international partners(usually 1-3). A small number of coalitions, such asNamibia and Ethiopia, receive support from as manyas eight international partners.

A wide range of international partners are currentlysupporting business coalitions in some capacity(there are more support partners than coalitions).• Some partners are highly involved and committed

to coalitions across Africa, such as the WorldBank and UNAIDS (financial and technical), whileothers tend to focus their efforts in one or twocountries.

• Some partners focus on providing funding (e.g.World Bank, USAID), while some focus on in-kindsupport (e.g. GTZ/ACCA and UNDP focus mostefforts on providing full-time employees ortechnical assistance).

Local partners may also be a significant source ofsupport. In some cases, governments are providingsupport through particular ministries, e.g. Ministry ofHealth providing IEC materials. An important sourceof support can be in-kind donations from membercompanies. Members will often provide office spaceto house the coalition, or host meetings/conferencesin their own offices.

28

29

The data and analyses presented in this report offera new platform for discussion and decision-makingfor all stakeholders of business coalitions – publicand private. More specifically, the data from thisreport enables us to draw a number of conclusionsand identify certain opportunities that should beconsidered by business coalitions, businesses,national public sector partners and their internationalpublic sector partners.

Business coalition formation should be countryled and based on specific national needsThis business coalition mapping exercise has clearlyshown that coalitions can play a very diverse rangeof functions. Section 4 illustrates the wide range ofactivities and the different niches each coalition canplay according to the country context in which eachoperates and develops. Interestingly, this diversespread includes the traditional roles of private sectorcoordination and supporting business action. Itadditionally shows that there may also be a role forcoalitions in treatment roll-out and scale-up, e.g.Malawi and Uganda.

However, the most important lesson is that eachcountry business coalition should define its ownresponse by learning from challenges andopportunities from other countries and partners, bycoordinating with the national response to HIV/AIDSand by incorporating the needs of its own businesscommunity (potentially through a situational analysis,e.g. Mauritania) and the national situation. Questionsmight include:• What set-up would most help achieve the NAC

(as representative of the national response toHIV/AIDS) objectives?

• What types of private sector entities shouldbe members of the business coalition, but are critical to the private sector response, and howshould the coalition engage organizations that arenot businesses? For example, DRC extendsmembership to any organization or institution thathas an interest in addressing HIV/AIDS in theworkplace, including businesses, employerfederations, unions, individual entrepreneurs andthe informal sector.

• How does the model for fees and businessoutreach impact the activities of the coalition?

Potential total demand for coalition servicesexceeds supplyOn the one hand, the demand for coalition servicesand support is very high. Many business coalitionshave made significant progress in mobilizing theprivate sector. However, even the most advancedcoalitions are only reaching a small proportion of thetotal private sector. Specifically, SMEs and theinformal economy pose a particular challenge asthey are traditionally less responsive and requiredifferent services and approaches to largecompanies. Meanwhile, coalitions tend to have asmall group of very advanced companies that oftenneed specialized, and resource intensive, support.Therefore, the total potential demand is not only veryhigh, but could also grow in a number of differentdimensions.

On the other hand, coalitions today are not able tomeet this potential demand. Coalitions areconstrained by a lack of human capital, whichappears to be driven by two main factors: poorfinancial sustainability and a lack of specific skills. • Poor financial sustainability: As coalitions remain

dependent on donor funding, which is typicallyshort term, they find it difficult to plan for the longterm with certainty, which in turn makes it difficultto expand secretariats significantly.

• Lack of specific skills: Meanwhile, a lack of keyskills means that, in some cases, coalitions arenot able to make full use of their existing staff.The most important key skills coalitions reportthey lack are:- project management skills - strategic marketing skills (to help both recruit

new members and secure more fundraising).A number of organizations, such as the World Bank,GTZ and UNAIDS, are already helping businesscoalitions develop such skills, but there are certainareas where a more focused approach could helpfurther.

6. Conclusions and Opportunities for Business Coalitions

30

Opportunities

This section concludes with some of the majoropportunities that currently exist for all stakeholdersof business coalitions (though there are manyadditional opportunities to explore, e.g. leadership,etc., that we do not cover).

Engaging Small and Medium-sized Enterprises(SMEs) and the informal economyTwo primary methods for business coalitions toengage SMEs and the informal sector currently exist. 1) The supply chain approach – where large

companies support SMEs in their supply chain toestablish HIV/AIDS workplace programmes – maybe one solution. There are a number of examplesof this already happening, with close support frombusiness coalitions, e.g. SABCOHA (South Africa)is supporting Eskom, and VW reach out to theirsupply chains. This approach can help leveragethe vast supply chains of large companies – andthe hundreds of SMEs involved. They can alsoharness the capacity within large companies toreach out and support SMEs, potentially relievingcapacity constraints within coalitions. As in thecase of SABCOHA, it can also create a newrevenue stream for business coalitions. The WorldEconomic Forum’s Global Health Initiative haspartnered with several multinationals tounderstand how large companies can play thisrole better. See www.weforum.org/globalhealthfor guidelines and case studies of this approachin Africa.

2) Business coalitions have also been able tosuccessfully engage SMEs through existingstructures such as employer federations andtrade associations. For example, the DRCcoalition has worked with the Réseau des TrèsPetites Entreprises – RTPEC (an employers’federation of very small businesses) to obtainWorld Bank MAP financing for its HIV/AIDSactivities. RTPEC is one of the few private sectororganizations that has successfully disbursed andaccounted for 100% of its total MAP financing.

Increasing revenues and increasing financialsustainability Coalitions may need to explore alternative financialmodels. This may require an increased focus onincome generating activities. We have seen somecoalitions make the move towards greater serviceprovision for members, which earn profits for thecoalition. Coalitions can develop a menu and feestructure for services such as trainings, space foractivities and access to funding opportunities (seesection 4: Coalition Functions and Activities for moreservice provision options).

It may also mean exploring greater support fromnational governments. This could reducedependency on the international community, whichis perhaps less stable than national governmentsupport, but coalitions risk losing their independenceif they rely on funding from national governments.

Furthermore, a diversified funding portfolio willprovide coalitions with increased stability, whileinternational organizations, umbrella businessorganizations and NGOs can help businesscoalitions structure their funding in a moresustainable way.

Maximizing the quality of outputs There may be a role for the international communityto increase investment and support in focused skillsbuilding from organizations that have this expertiseand are willing to translate it to the national level.Groups such as the World Bank and GTZ shouldcontinue to support the business coalitions as theyhave done to date – by providing specific technicalskills and opportunities for coordination and sharingof experiences in annual workshops.

Coalitions may also explore increased partneringwith umbrella organizations for service delivery, inaddition to recruiting members, a role that someumbrella organizations currently fulfil.

31

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1 Profiles were created over a six month period – all informationwas correct at the time each profile was created.

2 To our knowledge, the countries where multiple coalitions existall had representation in the PABC.

3 For more information on setting up a business coalition, pleasesee “HIV/AIDS Business Coalitions: Guidelines for BuildingBusiness Coalitions against HIV/AIDS” available atwww.weforum.org/publichealth

4 Source: World Bank Africa Database, www.worldbank.org/

32

Footnotes

33

For Your Notes

Cover page, photo credits © Louise Gubb

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Incorporated as a foundation in 1971, and basedin Geneva, Switzerland, the World EconomicForum is impartial and not-for-profit; it is tied tono political, partisan or national interests.(www.weforum.org)