5. HIV/AIDS and the private sector response in Cambodia
5.5. Conclusions to Cambodian private sector response: Private Sector and hopes for economic
In Cambodia, rapid changes have taken place in the past decades, from the fall of the Khmer Rouge regime, the arrival and withdrawal of the Vietnamese forces, the UNTAC led elections of 1992, and the country’s rapid marketization. The approach to change has largely been one in which policies and programs initiated at the central level are assumed to filter down to the grassroot level.
However, as is true of governance in general (Rose & Miller 1992), ideas mediated from a central level change and transform, even mutate, on their way to the local level, gaining, revising and losing meaning in this process. In Cambodia, this process is exarcebated by weak law enforcement, inadequate financial and human capacity, complex and bureaucratic government procedures.
Initiatives and results targeted to private sector response in Cambodia have been heavily related to ILO’s approach. This is partly due to the small number of multinational companies and businesses in Cambodia, correspondent with the lack of experience in country of the corporate social responsibility-approach promulgated by key UNAIDS’ documents (Chapter 4). Reflective of the Southeast Asian situation in general, in Cambodia the private sector is mostly comprised of the informal sector and of SMEs, which together represent the vast majority of the workforce (NIS 2004c; UNDP & MoP 2007). Whilst the ILO approach has concentrated on prevention in workplaces – which in Cambodia has basically come to mean garment sector factories – this approach has left out the large majority of the workforce in Cambodia.
The legal, policy and strategic framework environment in Cambodia picks up much of the urgency accredited to HIV/AIDS as articulated by UNAIDS documents, and the rationale of change, as reflected by various official, national documents, utilizes and deploys much the same discourse suggested in UN documents (chapter 4). At the level of practice and in the absence of multinational companies familiar with the concept of corporate social responsibility and the lack of imaginary of how to engage SMEs in the response, measures to date in Cambodia have largely focused on ILO’s approach to addressing HIV as a critical issue in the workplace. However, whilst official document environment in Cambodia is quite crowded, a significant challenge is that of maintaining that commitments on paper are translated into work ‘on the ground’. Further, the rhetoric of urgency embraced by many of these documents, reflecting global guidelines and policies, does not, in fact, reflect Cambodian business realities nor the status of the HIV epidemic very well. Cambodia has
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been identified as being one of the few countries in the world to be actually achieving the MDG 6.
0.9% prevalence in Cambodia in practice means that HIV does not pose an imminent threat to the private sector. Conversely, implementing the codes of practice articulated by Prakas 086 is definitely a time consuming task which, in a business environment that is volatile to fluctuations in the global economy and struggles with already existing complex and time-consuming bureaucratic hurdles, from the business point of view, often does not make sense.
The rationale suggested by various official documents in Cambodia reflect a trend towards neoliberalism in governance, placing emphasis on private enterprise and marketization. The public sector, for example health care, is largely recognized as inefficient in Cambodia, and as a recipe to cure the ills of the public sector, official documents place emphasis on private service provision.
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6. Conclusions
The body politic can no longer contemplate the nation’s health as simply a civic virtue; it must rethink the question of rights for the entire national, and international, community, from the AIDS perspective. (Bhabha 1994, 8-9).
In my work, I have examined various shifts in thinking about development aid and aid for AIDS, beginning with an analysis in Chapter 3 of shifts in the rational of development aid, underlining the ways in which these have goes hand in hand with shifts in thinking about economy – and society.
Development aid, in its initial stages, strongly reflected the national interests of the colonial powers, and following the era after WWII, development aid was strongly affiliated with the ideological battles of the time, of which the period of Vietnamese rule following the Khmer Rouge regime in Cambodia is a good example. Between the 70s and 80s, the dominant approach to development aid was premised on the provision of advisory functions in developing countries, which took the form of advice to also private entrepreneurs and providing funding for development finance institutions (DFI’s). In the 80s, the focus turned more into poverty (which was associated with security), and this began the golden era for non-governmental organisations which began to take the lead in areas that traditionally had been seen as part of governments’ responsibilities. In late 80’s onwards questions of effectiveness gained increasing presence, reflecting a global shift towards neo-liberalism. This pro-market pro-private sector approach moved away from the previous emphasis placed on state-led change in development aid towards a new thinking in governance. The new millennium, in turn, brought further emphasis on globalisation and on the creation of environments conducive to business sector development, as economic development was increasingly viewed as the motor of change in society. Shifts in thinking about development aid have thus closely reflected shifts in thinking of economy, that is, the economic rationale suggested for social change.
The HIV/AIDS response as led by UNAIDS began at the shift in emphasis toward neo-liberal reform in public administration and in development aid. It gained momentum, in part, through the new emphasis placed on governmentalization which incoporated a public – private divide. In the effort to scale up HIV/AIDS efforts, the private sector response was recognized as a necessary element of national responses to HIV/AIDS. As the 1990s wore on and the years turned into the new millenium, UNAIDS documents and official statements have become more pronounced and more proactive in their calls made for private sector engagement, with calls being made simultaneously for stronger government administration of the HIV/AIDS response through the
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‘Three Ones’. However, the global guidelines issued by UNAIDS in part reflective, no doubt, of their nature as being ‘global’ and written in the mode of providing direction to national counterparts, in part due to the simplistic rationale of change that they promote, have not been self-reflective of internal bias nor have they questioned the kind of state models or economic thinking on which their propositions are built. A conceptual fuzziness is apparent in UNAIDS’ discourse, which suggests that the interests of UNAIDS, the private sector and of national counterparts are, in fact, the same; at the same time placing moral demands on the private sector to respond and play a more active part in the HIV/AIDS response. Contrary to the rational approach reflected by UNAIDS guidelines, and the idealism attached to monitoring, to ‘knowing the response’, the guidelines are, I have argued, western-centred and to a great extent unreflective of the models of change which they propose.
I then moved on to examine the context for business and aid in Southeast Asia and Cambodia, before analyzing the private sector response to HIV/AIDS in Cambodia. In Southeast Asia, the business environment has evolved in the context of a world largely dominated by China and India before the beginning of colonial rule. As a region largely accessible by water, this has fostered localism and self-reliance as opposed to a strong, regional identity and dependence on broader political identity. Southeast Asia is a populous region, and its markets, particularly in smaller countries such as Cambodia, are largely focused on responding to domestic and regional demand.
Most businesses are small and medium sized enterprises (SMEs), which originally evolved as small family enterprises. This presents a different business environment to that proposed by various UN documents.
Southeast Asia has never been the target of financial aid in the proportion as, for example, Africa.
However, in the 1990s, as microfinance and individual flows to development increased, Southeast Asia, with its history of family enterprise and self-reliance, has benefited from these financial flows more, in proportion, than Africa. (Hjerthom & White 2004.) Whilst research on HIV/AIDS and the private sector suggests the continuing influence of close ties and connections in business culture in Asia (cf. Baker et al. 2004), UNAIDS’ (and partners such as ILO) efforts to mobilize that private sector have largely ignored this trend, promoting, instead strong national leadership of the state on these matters. The private sector is idealized in terms of large companies, rather than the SMEs of which it is mostly composed of. This positions UNAIDS’ claims to urgency, taking all possible measures, in contradictory light as it overlooks perhaps the most significant kind of businesses that have emerged within the region.
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Cambodia, in comparison to other Southeast Asian countries, has received large flows of financial aid from bilateral and multilateral partners. Whilst there have been and are ongoing efforts to decentralize administration and promote ‘good governance’, development has evolved into a business of its own right, employing the discourse of global documents, developing many documents promoting change, but the trickle down effects to the poorest of the poor have been weak. Whilst efforts to involve businesses in corporate responses to HIV/AIDS have taken place, there is more taking place on paper than in practice, and the focus to date has been on large companies (rather than SMEs which compose the vast majority of businesses), and the level of local business engagement, compared to international/multinational companies has been weak.
Whilst the analysis of this thesis should not be read as a critique of the rationale suggested by UNAIDS’ discourse, as a taking of sides ‘for’ or ‘against’ ways of thinking about social change, development aid or aid for AIDS on a continuum of ‘good versus bad’, the lack of attention to local history and local circumstances, circumvented through a universalizing discourse and neoliberal emphasis in governance, overlooks some of the broader challenges in developing countries such as Cambodia, and demonstrates what could be classified as a lack of imagination about the purpose of aid – about the concepts equality and solidarity. My purpose has been to ask questions, interrogate and disturb given meanings, some which have been sung by Hilman, Rotsey, Hirst, Garrett, Moignie and Morris (1989) poignantly as follows:
Who’d like to change the world?
Who wants to shoot the curl?
Who gets to work for bread?
Who wants to get ahead?
Who hands out for equal rights?
Who starts and ends that fight?
And not rant and rave, Or end up a slave.
- -
Who wants to please everyone?
Who says it can be done?
- By Midnight Oil
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