Leadership and reproductive health

HIV/AIDS is a recent issue in contrast to reproductive health, which has been discussed for decades under the name of family planning. In the late 1960s and early 1970s, there was considerable fear of a "population explosion," particularly in Asia. In the 1970s, large amounts of resources, both human and financial, were provided to set up family planning programmes in Asia. One also finds this sense of urgency, not to say emergency, with AIDS today.
A look at the proceedings of the 1972 Second Asian Population Conference (Tokyo) and its Population Strategy in Asia reveals no discussion of leadership or recommendations on leadership in its chapter devoted to family planning programmes. Such programmes were mainly perceived from their technical and organisational dimensions.
More recently, the 1994 International Conference on Population and Development (ICPD), the first global population conference with a major breakthrough in reproductive health and taking HIV/AIDS into account, does mention leadership a few times. The main occurrence is in the chapter on ‘National Action', which notes that a strong commitment of leadership leads to better results. Chapter VII on ‘Reproductive Rights and Reproductive Health', which also includes a section on HIV/AIDS, mentions leadership once in relation to advancing the rights of women. A section in the chapter on ‘Health, Morbidity and Mortality' covers HIV/AIDS, but does not mention leadership. In the follow-up conference held in 1999, ICPD+5, leadership is mentioned a few times only in reference to institutional leadership within the UN system.

Leadership and HIV/AIDS

In contrast to the area of sexual and reproductive health, one is struck by the emphasis placed on leadership in conferences on HIV/AIDS. For example, leadership is the subject of the African Development Forum 2000, which adopted the African Consensus and Plan of Action: "Leadership to Overcome HIV/AIDS." This plan highlights different levels for leadership: personal, community, national and regional. Similarly, the Abuja Declaration on HIV/AIDS, Tuberculosis and other related Infectious Diseases (April 2001) emphasises the role of leadership from Heads of State down to individuals in their own areas of responsibility. Most recently, the UN General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS devotes an entire section to leadership.
A search on the Internet confirms the differences in importance given to leadership in the field of HIV/AIDS compared to that of sexual and reproductive health: 14% of the citations related to HIV/AIDS refer to leadership, whereas the percentage drops to 10% for family planning, 8% for reproductive health and 3% for sexual health. For tuberculosis the proportion is 7% and for hepatitis, 3%. Two questions come to mind when one considers these differences. Why is leadership perceived as especially important for HIV/AIDS, but less so for reproductive health? Could this difference have implications?
The most obvious answer to the first question may be the sense of urgency to bring under control a devastating epidemic resulting in deaths on an unprecedented scale. This factor certainly plays a role. In the 1970s in Asia, however, a similar sense of urgency to control fertility did not provoke the same response. Other factors could also play a role. One of the key dimensions in the concept of leadership is the ability to have a vision and steer a course. HIV/AIDS frightens and disorients; many people cannot see clearly issues that have many facets and dimensions. They rely on someone else's vision to facilitate things and reassure. This would be true at all the levels, whether national, community or for groups such as youth, women and others.

Furthermore, the concept of leadership carries with it dimensions of authority and power. These are important because many people understand the need to get things moving, that there is no time for business as usual. Perhaps no other issue has resulted in such mobilisation for action as that of HIV/AIDS and as it has so many facets and dimensions, there is room for multiple forms and levels of leadership.
Family planning and reproductive health have certainly had – and continue to have – their crusaders and missionaries, as well as deeply committed activists. Still, with HIV/AIDS, leaders are more sought after and are perhaps more personally (rather than intellectually) involved.
The second question on the possible implications of the differences is that if leadership can be essential to kick-start programmes, combat discrimination and mobilise resources, does it have limits? Can one attach too much importance to leadership or is there an optimum "dosage": too little is ineffective, while too much could end up disempowering people who rely on the leaders? There is a paradox: leadership can be essential, but providing inspiring and effective leadership is a complex task and is found relatively rarely.

Leadership in civil society

Against this general background, the articles in this issue illustrate many forms of leadership in civil organisations. They present some factors for success, in particular that adaptation to local circumstances is crucial. They also highlight that real leadership requires professionalism and the ability to network, and empower others. The danger of leadership becoming a goal in itself is that this will increase authority, power and resources, at the expense of the original altruistic objectives. Preventing this requires improved accountability and monitoring systems.
The articles reveal that the common denominator in many civil organisations is their crucial role in advocacy and IEC, at both the local and international levels. One also notes that national or government organisations are often viewed with concern or suspicion. It is a real challenge for leaders to rise above such perceptions in order to build coalitions or partnerships, creating positive synergies between civil society and various forms of public authority (ranging from ministries to local chiefs). As some articles point out, the rewards can be great in terms of effectiveness in combating HIV/AIDS.
In many ways, the AIDS epidemic has brought out the best in thousands of human beings in all walks of life, including qualities of leadership, among people as diverse as sex workers and State leaders. This is in itself a message of hope, but it also requires that each individual be in a position to decide on his/her own life.