I am leaving VSO this week after five years working on international advocacy. As I clear my desk I have been thinking about some of the unanswered challenges – and the greatest of these is ‘value for money’. I have been asked many times how we can prove the effectiveness of our work. If we send a staff member to New York to lobby at the UN, can we be sure we get value for money? Is it cost-effective to employ an advocacy officer in Kenya? When we run a campaign on the importance of quality teachers, how can we prove the effectiveness?

These important questions are very difficult to answer. What can you count? We could in theory count the ‘decision-makers’ who have received our publications, or attended the key policy forums. But no one agency can truthfully claim accreditation for policy change. The best advocacy by NGOs is carried out through coalitions. For example, VSO has influenced DFID’s policy on HIV and gender – but through the UK AIDS Consortium. It is a wasted effort to spend much time trying to ‘prove’ the efforts of one agency.

This does not mean we can’t ever quantify the importance of advocacy – in certain cases we can put a figure to it. Thirty years ago today, Mexico announced it could not afford debt payments, triggering the start of the 'Third World Debt crisis'.

The development of most poor countries was put on hold for two decades. Health and education programmes were slashed as countries had to focus on paying back debts. This was a development crisis that could not be resolved through increased aid flows or the provision of technical volunteers. Only a policy response could resolve the debt crisis, and this was achieved by international development agencies.

From 1997 to 2000 hundreds of activists and development agencies came together in the Jubilee 2000 Advocacy campaign, which called for the worst debts to be cancelled. Petitions were sent, human chains were organised. Faced with massive public mobilisation, the World Bank and IMF agreed to write-off the debts. In the last decade Highly Indebted Poor Countries (HIPC) have had $120 billion in debt cancelled. If we assume that, at the most, development agencies all together invested $80 million in debt campaigning (which seems a lot), then that would mean that for every $1 spent, $1,500 of debt has been cancelled. Value indeed.

To finish with an up-to-date example: Jubilee Debt Campaign in the UK has spent around £250,000 campaigning against so-called vulture funds that buy up debt of poor countries and then insist on payment through the courts. After four years of careful advocacy, the UK government agreed to pass the The Debt Relief (Developing Countries) Act in May 2011.

The government said that the vulture fund law will save HIPC countries £145 million over six years. So for every £1 spent, around £600 will have been saved. Poor countries will be able to use these funds for their own development – for HIV services, schools or rural livelihoods.

So it is possible to give a quantifiable value to advocacy campaigns – occasionally. In most cases it will be difficult to ‘prove’ the value with such monetary result. What we can be sure of is that advocacy work, well planned and carefully carried out, does achieve long-term and sustainable benefit for the poor and the marginalised. I will look forward to hearing of many more advocacy successes from VSO country programmes when in my next job.

For more information on debt see The state of debt: Putting an end to 30 years of crisis

I must confess that as late as Sunday, as the International AIDS Conference (IAC) was opened officially, I kept on asking myself what would be new in this conference that people do not know already.  No, I am not a snob and neither can I say I know everything that is 'out there' on HIV and AIDS, but 30 years down the line, and it being so easy to share information online, one can be excused for wondering aloud!

Well, three days into the conference, it is a clear fact that the world has turned a new leaf on HIV and AIDS. Antiretrovirals (ARVs, the drug that controls HIV) are there for 'anybody' who needs them. Even for those people who have HIV but their partners are negative, new studies show that if both partners take ARVs, then the chances of the negative partner being infected are reduced by about 90%.

This is all very good news of course- except for a majority of people in Africa where the developments in diagnosis and treatment are yet to be enjoyed at such a huge scale. This is mainly because people discover their HIV status very late and those on ARVs are only a small fraction of those who need to be on treatment. So it is unthinkable for someone who is not infected to be put on treatment! The truth of the matter is, it can’t happen. Well, unless they buy the drugs for themselves. And how many can do that? The drugs are way out of reach for most people but thankfully governments supply them for free. But does the money for ARVs come governments or donor funds? And this introduces the next paradox; overreliance by governments on donors for ARV drugs.

It's also a paradox that even in the 'adult' stages of the disease, when everyone is expected to know about HIV and AIDS, newly infected people– especially in Africa– always outnumbers those newly put on treatment!  And the majority of those getting infected are young people and women. It's when the factors that contribute to this reality are dealt with, that the tide will truly turn for all.

But it is not all gloom at the IAC. Far from it. "Don’t criminalise HIV and AIDS" seems to be a very strong message that is coming out from the conference. So when the activists took to the streets of Washington on yesterday, this message was expressed in all its forms.

As you may have noticed, I haven’t mentioned caregivers. Sadly, it seems their tide is yet to change.

Yesterday I attended a session at the International AIDS Conference in Washington on building support and capacity for community based HIV and AIDS service delivery.

Distinguished researchers reported proudly how community health programmes across Africa and Asia were being delivered by dedicated community health volunteers in return for incentives such as t-shirts, training and transport costs. Due to the dedication of these community health volunteers, presenters from Nigeria, Ethiopia and Kenya were able to report improved community access and adherence to essential ARV [drugs used to supress the HIV virus] treatment, family planning, voluntary counselling and testing and a reduction in stigma and discrimination against people living with HIV and AIDS.

Working with community health volunteers was hailed as a cost effective approach. It all sounded wonderful...

However, I was proud to offer an intervention from the floor. I highlighted VSO’s commitment to supporting community health volunteers and home-based carers in a more holistic way. I stressed our  commitment to the principal that no volunteer should face the risk of further impoverishment as a result of their efforts to improve community health outcomes in high incidence HIV settings.

VSO promotes a complete package of interventions to support health and HIV and AIDS volunteer workers including the provision of volunteer stipends and access to income generating and livelihoods activities. We also support our partners to advocate for the development and implementation of national policy and social protection measures that enshrine the rights of volunteer health workers, whilst also recognising and adequately rewarding the essential work they do.

We need to ensure that our call to value health volunteers and home-based carers becomes even louder in future. Volunteers providing essential health and HIV and AIDS services for hard to reach rural communities depend on us to support them to raise their voice so that the cost to them of their courageous and unselfish contribution towards overcoming global health challenges – including HIV and AIDS – is not too high.