Changing Global Fund priorities and a new NSP prompt discussions on sustainability
In a recent ICASO discussion paper called “Handing over Health”, a review of sustainability and transition literature is complemented by country case studies from Serbia, Thailand and South Africa. GFO has previously reported on the Thai case study from this paper.
The South African example is perhaps the most interesting of the three, as it is not a country that typically enters the conversation on transition. South Africa is a middle-income country, prompting many funding partners to either leave or reconsider their role (often referred to as a donor “transition”). Britain’s Department for International Development (DfID) stopped direct aid to South Africa in 2015. The United States President's Emergency Plan for AIDS Relief (PEPFAR) is currently in the midst of a gradual transition from providing direct clinical services towards being a technical support partner to the South African government for things like systems strengthening and health innovation.
Unlike DfID and PEPFAR, Global Fund grants are determined by a systematic allocation methodology, for which a country’s disease burden is an important weight. With nearly 7 million people living with HIV and 450,000 TB cases each year, South Africa remains eligible for significant investment from the Global Fund for these two diseases. In April 2016, the country began implementing a three-year Global Fund grant worth some $314.5 million. GFO has previously reported on the concept note development process and the implementation arrangements for this new grant.
GENEVA - The Global Fund made a strong appeal to address human rights issues as a key component of efforts to end epidemics such as AIDS, tuberculosis and malaria.
"To end HIV, we must overcome discrimination in laws and policies, in practice and in our hearts," Mark Dybul, Executive Director of the Global Fund, said at a session of the United Nations Human Rights Council. "We must grasp the historic opportunity to become better people and societies built on the firm foundation of an inclusive human family."
Despite extraordinary progress against HIV in the last decade, human rights barriers are preventing millions of people from being able to access prevention, treatment and care, Dr. Dybul said. In order to maximize health investments and achieve greater impact, the global community needs to do more to overcome these barriers, including by increasing investment in programs to fight stigma and discrimination, reduce violence against women, provide access to justice, and sensitize law-makers and law enforcement officials, Dr. Dybul said.
There is lesser participation from key populations than from civil society organizations in country and regional dialogues, according to survey conducted by the Eastern Africa National Networks of AIDS Services Organizations on civil society and community perspectives on Global Fund processes. EANNASO has released a short report on the survey.
The report was produced by the Regional Platform for Communication and Coordination for Anglophone Africa, which EANNASO hosts. The Regional Platform is funded by The Global Fund as part of the Community, Rights, and Gender (CRG) Special Initiative.
The regional platforms (of which there are six, globally) are intended to build knowledge and capacity of civil society and community groups on the Global Fund, as well as to promote access to technical assistance. The aim of the survey was to guide the CRG Special Initiative in Anglophone Africa, providing important information on knowledge gaps and capacity development needs in the region.
A total of 33 people from 15 Anglophone African countries completed the survey. The majority of respondents were from the East African region (61%), followed by Southern Africa (27%) and West Africa (12%). Respondents were from a wide range of constituencies including civil society, key populations, young people, PLHIV networks, technical assistance providers, multilateral and bilateral partners, women’s groups, and community-based organizations.
Two thirds of respondents had heard about the Global Fund’s CRG Special Initiative before. Knowledge on the Regional Platform was slightly lower: 58% of respondents said that they knew about the platform.
The survey found distinct gender imbalances in knowledge about the Regional Platform. Although equal numbers of men and women were surveyed, those who identified as male were much more likely (71%) to have prior knowledge of the Regional Platform than those who identified as female (53%). Of the two respondents who identified as being transgender, neither had previous knowledge of the Regional Platform.
The majority of respondents said that concept note development was the most open part of the new funding model for civil society organizations and community groups. Most of those surveyed had participated in at least one country dialogue or regional dialogue as part of concept note development. However, respondents from civil society organizations were far more likely to have participated in country dialogue than respondents from key populations (Figure 1).
Figure 1: Participation in country dialogue among civil society and key populations
The same is true for regional dialogues (the consultative processes that led up to the development of regional concept notes): 53% of respondents from civil society organizations participated in at least one regional dialogue, compared to 43% of respondents from key populations surveyed. It is noteworthy that participation in regional dialogues was lower for both civil society and key populations, as compared to participation in country dialogues.
Just over half of those surveyed agreed that the biggest challenge with regional grants is a lack of accountability, monitoring, and oversight. This challenge is likely exacerbated by the limited understanding of regional grants among civil society and key populations: The survey revealed that the majority of respondents perceived a lack of understanding of regional grants to be their largest Global Fund knowledge gap.
Just as key populations were less likely to have participated in dialogues, they were also less likely to be aware of available support to help improve their engagement. Indeed, the most commonly-cited benefit of Global Fund TA was that it enables meaningful participation of civil society and key populations in Global Fund processes. But, compared to respondents from civil society organizations, respondents from key populations were half as likely to know that they could request TA from the Global Fund CRG department and its partners.
Among respondents who had previously accessed TA, the most commonly cited providers were the German Back-Up Initiative (GIZ) (33%) and the UNAIDS Technical Support Facility (33%). In addition, 27% of those surveyed had accessed TA through the Global Fund CRG department itself, and 21% had received it through the Stop TB Partnership.
Importantly, the majority of survey respondents said there needs to be more TA available after concept note submission to support watch-dogging of implementation.
The fact that concept note development (including country dialogue) was perceived to be the most open part of the NFM for civil society and communities is consistent with the findings of a previous survey conducted by The Global Fund. The Fund’s CCM and Country Dialogue Participant Survey (a global survey with 2,070 responses) found that country dialogue and inclusivity was cited by the greatest number of respondents as the best part of the NFM.
The results of the EANNASO survey presented in Figure 1 may help explain some of the findings from the Global Fund survey. The Fund’s survey found that fewer key populations than other respondents indicated that their recommendations were discussed and considered seriously in their country concept notes. With lower levels of country dialogue participation, it is perhaps not surprising that key populations felt their issues did not carry equal weight.
If key populations are to participate at a greater rate in dialogues, and if their issues are to be included in concept notes, key populations’ access to TA must be improved. A targeted effort to boost awareness of available TA among key populations could be a useful follow-up to the EANNASO survey.