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Global Fund Observer

Newsletter

Issue 233: 10 December 2013

GFO is an independent newsletter about the Global Fund.
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CONTENTS OF THIS ISSUE:

1. NEWS: Donors Pledge $12 Billion for 2014–2016

The $12.007 billion for 2014–2016 is a considerable improvement over the $9.2 billion pledged at the last replenishment conference, but the pledges fell short of the hoped-for $15 billion.

2. ANALYSIS: Reflections on the Global Fund’s 2014–2016 Replenishment

In this article, GFO Editor Lauren Gelfand reflects on the results of the Global Fund’s latest replenishment and on the main themes that emerged from the replenishment conference.

3. NEWS: Renewal Funding of $46.4 Million Approved for Three Applicants

Incremental funding of up to $46.4 million has been approved for the renewal of four grants in three countries. The largest amount of funding went to Eritrea for HIV and TB.

4. NEWS: Seven Interim Applicants Receive Funding for HIV and TB

Funding in the amount of up to $30.8 million has been approved for seven interim applicants. This brings to 37 the number of interim applicants for whom funding has been awarded, out of the 48 invited to apply when the transition phase of the new funding model was launched.

5. NEWS: Regional Latin America HIV Grant Funding to Be Discontinued

A regional HIV grant that targeted military and police personnel in Latin America and the Caribbean was discontinued by the Grant Approvals Committee as it was deemed low value for money, following a recommendation by the Technical Review Panel

6. NEWS: Eastern Europe/Central Asia network chooses in-country partners for its regional harm reduction project on HIV in EECA

The Eurasian Harm Reduction Network is implementing a $6 million regional programme which seeks to facilitate effective regional advocacy for harm reduction among injection drug users across five countries in EECA.

7. NEWS: Peru CCM Submits Request for Phase 2 of HIV Grant

Peru’s Phase 2 request for continued funding proposes specialised centres to provide services to men who have sex with men, transgendered persons and sex workers.

 
See section near the end of this newsletter listing additional articles available on GFO Live.
 
ARTICLES:

1. NEWS: Donors Pledge $12 Billion for 2014–2016

Well ahead of the $9.2 billion pledged at last replenishment conference, but short of $15 billion goal

Donors pledged an historic $12.007 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria for implementation of its new approach that will see more resources targeting key affected populations in the countries least able to pay. The pledges were made before and during the Fourth Replenishment conference in Washington, DC on 2–3 December.

While a considerable improvement over the $9.2 billion in pledges made at the last replenishment conference in 2010 for the 2011–2013 period, the pledges fell short of the hoped-for $15 billion the Global Fund has estimated is required to meet the needs in the 150 countries where prevention and treatment programmes are currently supported.

A needs assessment, jointly conducted by the Fund with the World Health Organization, UNAIDS, Roll Back Malaria and the Stop TB Partnership, determined in April 2013 that $87 billion from both domestic and external sources was needed to completely vanquish the three diseases.

The commitments to the 2014–2016 cycle from countries included a promise by the US government to match every $2 raised with $1, subject to approval from the US Congress, up to $5 billion. “Don't leave our money on the table,” US President Barack Obama said on 2 December at an event to open the pledging conference.

The UK government also conditioned its pledge of up to £1 billion ($1.64 billion) to match 10% of the global contribution to the Fund. “What is needed more than ever is political commitment” to the global fight against three of the biggest killers and inhibitors of economic development in low-income countries, UK Prime Minister David Cameron said in a video message.

Twenty-three other countries and the European Commission joined the US and UK in pledging to support the next cycle of programming under a soon-to-be inaugurated new funding model (NFM) that will require a deeper commitment to responding to the needs of vulnerable populations, including men who have sex with men, commercial sex workers, injection drug users and prisoners.

France, which has traditionally been the second-largest contributor to the Fund after the US, was slightly edged out in this round by the UK promise, offering €1.08 billion ($1.4 billion), which includes some €20 million in technical assistance to Francophone countries, mostly in West and Central Africa, for proposal development under the NFM and for grant implementation. Germany and Japan tied as the Fund's fourth largest contributors, each offering $800 million over the next three years.

Italy proudly returned to the ranks of contributing nations after five years of absence with a pledge of €100 million. Other countries that upped their contributions significantly included The Netherlands, from $210 million to $250 million, and Sweden, which attributed a more than 30% increase in its pledge to $382 million to the strength of its economy and its currency, the kroner.

But if there were countries whose largesse to the financing mechanism befitted the strength of their economies, so too were there others whose modest national coffers were also tapped to contribute to the financing mechanism.

Malawi, which has benefitted from some $834 million in Global Fund grants since 2002, committed “in [their] own small way” $500,000 to show support. Namibia vowed to make good on its commitment in the previous funding cycle before the end of the year and pay its balance of $250,000 on a $750,000 pledge. Meanwhile Nigeria, a billion-dollar recipient of Global Fund aid, announced its intention to spend more than $450 million domestically on its fight against the epidemics and offered another $30 million back to the Fund's coffers.

Other implementing countries making contributions included India, at $16.5 million, China, at $15 million, and Mexico, which committed to redirecting $30.5 million in assistance back to the global coffers.

Private sector contributions were assessed at $108 million for the next funding cycle. But Aidspan understands from sources within the private sector delegation that more could be forthcoming as the Fund implements its new approach and generates impact and results data that show better value for money.

The United Methodist Church became the first faith-based organisation to pledge support for the Fund, offering $19.9 million. The Bill and Melinda Gates Foundation remained the single largest foundation supporter of the mechanism, offering $200 million in matching grants for private sector contributions in addition to $300 million in promissory notes already extended.

“The Global Fund is one of the smartest investments that the world can make toward a better future,” Bill Gates told assembled delegates on 2 December. “The Global Fund helps provide treatment and prevention so communities and countries get the chance to be healthy and productive.”

Despite the not-insignificant boost in contributions over the last funding cycle, there were some disappointments. Neither Japan nor Australia increased their contributions from the previous replenishment. Both Spain and Brazil cited their current financial crises as the justification for their inability to commit funds, despite their continued support for the Fund. And Switzerland and Russia were unable to announce their commitments due to ongoing budgetary negotiations at the legislative level.

Aidspan will publish a complete table of contributions shortly.

[This article was first posted on GFO Live on 09 December 2013.]

To comment on this article, click here.

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2. ANALYSIS: Reflections on the Global Fund’s 2014–2016 Replenishment

The Global Fund set itself no small task in seeking $15 billion for the next three years of work to support prevention and treatment programmes that will lead to the vanquishing of AIDS, TB and malaria as leading killers and inhibitors of economic development in the world's poorest countries.

Facing scrutiny about how it measures its impact at country level, its management of fraud and corruption, its reform agenda ahead of the full roll-out of a new funding model, and in the midst of a seemingly ceaseless global economic crisis, the Fund plunged into a very high-profile fundraising campaign. Activists the world over took to social media in support of the replenishment drive, generating worldwide attention for an organisation that has traditionally carried out its mission in a fairly discreet way.

Did the attention pay off? It's hard to say. Pledges from the Fund's traditional coterie of donors came in about as expected, and there were no major surprises or disappointments. Though the target of $15 billion was not achieved, challenge grants from the US and UK governments, as well as the promise of matching funds from the Bill and Melinda Gates Foundation, pulled in a respectable $12.007 billion for the next three years of the fight against the epidemics: a decent-sized war chest.

What was more interesting was the way donors committed to provide funds on behalf of their national taxpayers. The two-minute slot each presenter was allotted by Board chair Dr Nafsiah Mboi during the pledging opportunity in a windowless Washington ballroom on 3 December provided a certain insight into the priorities established over the course of the year during hallway chats, boardroom and parliamentary floor debates.

As an observer of the session arranged around an open rectangle configuration of banquet tables, opened by US Ambassador to the United Nations Samantha Power, Aidspan identified four key themes that will likely be scrutinised by donor country representatives going through this next cycle at the Fund.

Reform

The overhaul of processes and procedures at the heart of the Fund was warmly welcomed by many of the donor agencies, many of whom credited the tireless work of Secretariat Executive Director Mark Dybul for continuing and expanding the work of his predecessor of streamlining a bloated institution and setting it on track to achieve the best-possible results and improve value for money.

As US Secretary of State John Kerry said in his speech on 2 December to open the replenishment conference, reforms at the Secretariat level were one of the drivers of his government's continued support of the Fund.

 “No other international organization has undergone such profound changes in its business model, its management team, and the financial systems that have swept through the Global Fund over the course of this last decade,” he said. “It’s important to underscore the reforms are not cosmetic. They are real. They’re tangible. And they are going to help save more lives, there’s no question.”

But where the Fund has developed and carried out strategies for risk management and data-driven decision-making, many donors reiterated a need for more attention to be paid to similar work at the country level -- and made it clear that they expected the Fund and its personnel to effectuate those strategies.

In pledging their support, donors were insistent that the Fund adhere to a zero-tolerance policy for corruption and make a greater push for national accountability and transparency, particularly among the country coordination mechanisms (CCMs) that are supposed to oversee the implementation of Fund grants.

Human Rights and Gender

Donor after donor reiterated the message delivered by Ambassdor Power in her keynote address: "that there is no sin in being sick, no justification for bigotry, and no license to marginalize anyone based on their HIV status, gender, or sexual orientation." Working to eradicate stigma and reducing the inequity in distribution of resources among men and women will be critical to the Fund's achievement of its objectives and ability to tap future resources from many countries.

Both France and the UK emphasized the need for the Fund to fully implement its gender strategy, with Justine Greening, the UK secretary of state for international development calling the Fund "a key jigsaw piece for moving forward for women and girls".

Support for this objective also came from an unlikely source prior to the launch of the replenishment conference; at a panel discussion hosted by Friends Africa and the Woodrow Wilson Center, Rwanda's first lady, Jeanette Kagame, said that it was imperative that Fund-supported programmes do more to target commercial sex workers, for whom prevalence rates of HIV remain unacceptably high and engagement by the global health community remains unacceptably low.  

But while the Fund has been promoting a general  human rights approach over the last 12 months in a manner that dwarfs previous years, there has been little progress in setting a concrete framework for response to stigma. Equally, the commitment to women and girls has been mostly rhetorical as a 2008 gender strategy was only partially implemented and is being revitalized as a theory rather than a framework for action. Most distressing is the missed opportunity to address head on the challenges to programme implementation derived from the deep and unabiding stigma that exists in many of the countries where the Fund operates.

Domestic co-financing

"Morally and financially responsible investment in our shared future": this was the theme of a second keynote address delivered by UNAIDS executive director Michel Sidibé.

Certainly, the $12 billion raised by the Fund for the next three years will help considerably in achieving the targets of $87 billion needed to truly eradicate AIDS, TB and malaria.

But co-financing by governments to address the problems in their own countries is even more important, and that was a message that many implementing countries present at the replenishment session took pains to make clear they understood.

Representatives from Kenya, Malawi, Namibia and Nigeria in rapid succession outlined the financial support they intended to draw from national resources to bridge the gap in unmet needs among their populations.

Whether it was boosting the number of people on anti-retroviral treatment, sleeping under bednets, or having access to TB tests and first-line drugs, the countries all acknowledged the imperative of supporting their national strategic objectives with ample resources, both in terms of money and trained personnel to strengthen their national health systems.

Equally, whatever the co-financing responsibility, many donors emphasised that the Fund needed to make sure that key populations -- in all countries, including MICs -- remained under the umbrella of coverage: both for prevention as well as for treatment, irrespective of the funding source.

Integration

As Lucica Ditiu of the Stop TB partnership put it at the end of the pledging opportunity, "there's no point keeping people alive on ARV treatment if they are going to die from TB."

This emphasis on integration, both of the response to the three diseases and the global health agenda with other development priorities, aims to be central to strategic planning at both the Geneva and national level over the course of this next cycle.

Integration is manifesting itself in a number of ways as the Fund moves through its next cycle, beginning most visibly with the decision to integrate funding for AIDS and TB programmes in a number of countries. There are also other nuanced and subtle changes under way that will influence the Fund's relationships over time that will help it remain a relevant force, both as a funding mechanism and shaper of policy.

At the first regional new funding model (NFM) meeting in Lusaka, Zambia just weeks before the replenishment conference, Fund representatives repeatedly emphasised the importance of using National Strategic Plans to drive concept note development, ensuring that the Fund's objectives were synced with national ones.

Assiduous cultivation of relationships at the global as well as country level is a new approach for the Fund, which had in the past operated at times in parallel, rather than in concert, with other technical partners.

But with the announcement that it would coordinate with DFID, UNICEF and the (US) President’s Malaria Initiative on the purchase of commodities, beginning with mosquito nets, the Fund is heralding a new era of working with other actors. This is an excellent step forward because it will allow for even stronger negotiation on the lowest-possible unit cost for life-saving drugs and products. Such strength will be inevitably balanced by continued weakness within national procurement systems but this can be tempered by a close working relationship between procurement officers and their national counterparts to help develop indigenous skills that will not be lost to bureaucratic swaddles in red tape or the temptation of corruption.

[This article was first posted on GFO Live on 10 December 2013.]

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3. NEWS: Renewal Funding of $46.4 Million Approved for Three Applicants

Largest awards go to Eritrea

The Board of the Global Fund to Fights AIDS, Tuberculosis and Malaria has approved continued funding of up to $46.4 million for three applicants. The Board decision was announced on 26 November.

The Board’s approval followed recommendations from the Technical Review Panel (TRP) and the Secretariat, including the Grant Approvals Committee (GAC). See the table for a full breakdown.

Table: Funding Awards for Grant Renewals,from GAC Report GF-B30-ER1

Country
Component
Grant Number
Ceiling($US million)
Eritrea
HIV
24.5
TB
8.5
Iran
Malaria
7.4
Timor-Leste
HIV
6.0
TOTAL
$46.4

All of the amounts shown in the table are ceilings. (Note that the amounts shown in the table represent incremental funding for the grants. The total budgets for the next implementation period will usually be higher than what is shown because they include unspent funds from the last implementation period.)  

The breakdown of funding by disease is as follows: HIV $30.5million (66%), TB $8.5 million (18%) and malaria $7.4 million (16%).

Iran (malaria)

The next implementation period of this single-stream-of-funding grant will see a continuation of the activities in the current implementation period. The principal recipient (PR) is the United Nations Development Programme. The goal of the national malaria elimination programme, which is the basis for the strategy followed by the grant, is to eliminate local transmission of falciparum malaria by 2015 in target districts and to reduce local malaria transmission by 80% by the end of 2015.

Timor Leste (HIV)

The PR, the Ministry of Health, will use the $6.0 million in new funding primarily to support implementing prevention activities targeting key populations, providing treatment, care and support to persons living with HIV, and strengthening civil society to deliver services. The emphasis will be on consolidating and improving services in districts where services are already being delivered. The GAC recommended that any expansion to other districts be phased in.

GFO will publish a separate article on the renewal of the two Eritrea grants.

Information for this article was taken from Board Decision GF-B30-EDP1 and from B30-ER1, the Report of Secretariat Funding Recommendations. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 29 November 2013.]

To comment on this article, click here.

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4. NEWS: Seven Interim Applicants Receive Funding for HIV and TB

$30.8 million awarded

The Board of the Global Fund to Fights AIDS, Tuberculosis and Malaria has approved funding in the amount of up to $30.8 million for seven interim applicants in the transition phase of the new funding model (NFM). The Board’s decision was announced on 26 November.

In approving the funding, the Board was acting on recommendations from the Technical Review Panel (TRP) and the Secretariat, including the Grant Approvals Committee (GAC).

This brings to 37 the number of interim applicants for whom funding has been awarded. When the transition phase of the NFM was launched, the Global Fund said that 48 interim applicants had been invited to apply. More approvals are expected in coming months.

The largest awards went to Togo ($11.8 million for two HIV grants) and Viet Nam ($7.0 million for a TB grant). See the table for the full breakdown.

Table: Interim Funding Awards from GAC Report GF-B30-ER1

Country
Component
Grant Number
Ceiling
($US million)
Benin
TB
2.0
Dominican Republic
TB
3.0
Mongolia
HIV
0.3
Multi Country Western Pacific
HIV
4.0
Nicaragua
TB
2.7
Togo
HIV
10.5
1.3
Viet Nam
TB
7.0
TOTAL
30.8

All of the amounts shown in the table are ceilings; committed amounts could be less.

There was no funding for malaria grants during this wave; instead, it was 52% for HIV grants, worth up to $16.1 million (52%) and  48% for TB, for up to $14.7 million.

The GAC decision allocated the funds as below:

Benin (TB)

Benin’s principal recipient (PR), the Ministry of Health will receive up to $2 million in new funding to initiate active case-finding at the community level; to purchase drugs for, and provide other services to, patients with multiple-drug-resistant TB (MDR-TB); and to extend the duration of the grant by six months (to 31 December 2015). Other activities to be supported by the new funding are: (a) a national workshop for the detection and management of childhood TB; (b) a national guide on managing childhood TB; and (c) refresher training for health and laboratory staff.

Dominican Republic (TB)

The $3 million in new funding will be used by the PR, the Ministry of Health, to support activities aiming to increase TB detection from 70% to 80%, and treatment success from 83% to 87%, in the process reducing the mortality rate from 6.1% to 4.0%. Outpatient care for MDR-TB will be expanded nationwide, to bring treatment closer to patients and lower drop-out rates. Because national resources are expected to cover costs of first-line treatment (as well as second-line treatment as of January 2015), some of the new funding may be directed towards reagents for testing, laboratory equipment, transport, human resources and capacity building.

Mongolia (HIV)

The $300,000 in new funding will enable Mongolia to extend its existing HIV grant until December 2014. The PR is the Ministry of Health.

Multi-Country Western Pacific (HIV)

The Multi-Country Western Pacific HIV grant includes Cook Islands, Kiribati,Marshall Islands, Micronesia (Federated States), Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu.

The $4 million in new funding means that the grant managed by the PR, the Secretariat of the Pacific Community, can be extended by two years (to 31 December 2015.) Some of the funding will be used to address gaps such as (a) the lack of reliable data regarding key populations; (b) the lack of a costed strategic approach to HIV and sexually transmitted infections; and (c) insufficient engagement of civil society.

Nicaragua (TB)

The $2.7 million in new funding will support the planned decentralisation of MDR-TB management, as well as activities addressing weaknesses in infection control and biosafety conditions. The PR is the Instituto Nicaraguense de Seguridad Social. Specifically, the funds will be used to (a) improve diagnosis of TB and MDR-TB cases; (b) scale up the management of MDR-TB (goal: to diagnose and provide treatment to 87% of estimated MDR-TB cases); (c) improve the capacities of health personnel on MDR-TB health care and on the use of a new information and surveillance system; and (d) improve warehousing conditions for TB medicines.

Togo (HIV)

Togo will use the $11.8 million in new funding to scale up existing Phase 2 activities of HIV grants and to extend the grants by seven months (to 30 June 2015). The PRs are the Ministry of Health and Population Services International (Togo). The funding will cover activities in four areas: (a) prevention among key populations; (b) provision of services to HIV-positive pregnant women to prevent mother-to-child transmission; (c) comprehensive quality care for persons living with HIV; (d) and strengthening governance.

Viet Nam (TB)

The $7 million in new funding will be used by the PR, the Ministry of Health, primarily to (a) strengthen and scale up the management of MDR-TB; (b) expand childhood TB interventions to 15 additional provinces; (c) increase case finding in eight provinces with low TB detection rates; (d) scale up TB/HIV activities; and (e) strengthen laboratory capacities.

Information for this article was taken from Board Decisions GF-B30-EDP2 and from GF-B30-ER1, the Report of Secretariat Funding Recommendations. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 29 November 2013.]

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5. NEWS: Regional Latin America HIV Grant Funding to Be Discontinued

Failure to achieve good value for money or to fulfill conditions previously imposed by the Board were cited as key drivers of the GAC recommendation

A regional HIV grant with a checkered history and serial problems in its aim to respond to stigma and human rights challenges across Latin America and the Caribbean has been discontinued for its failure “to deliver on the original goal of reducing stigma and discrimination and promoting understanding of human rights and gender equity among military and the police,” according to a recommendation by the Grant Approvals Committee.

The project was meant initially to serve as a replicable model for how to support universal access to HIV prevention and support to people living with AIDS among military and police personnel. But in May 2013, directives from the Board for its approval required significant revision and reprogramming.

The HIV/AIDS Prevention and Control Committee for the Armed Forces and National Police of Latin America and the Caribbean (COPRECOS LAC) covered Argentina, Brazil, Colombia, El Salvador, Dominican Republic, Guatemala, Nicaragua, Panama, Paraguay, Peru and Uruguay in Phase 1. Costa Rica, Ecuador and Venezuela were included in Phase 2 in programmes foreseen under the grant

The decision’s approval announced by the Board on 26 November is the final nail in the coffin of the beleaguered programme. A first request funding request in 2008 under Round 8 was denied, but on re-application a year later, during Round 9, Phase 1 funding was approved at $13.9 million. A Phase 2 request of $38.1 million was modified and approved provisionally and incrementally, with the Board predicating the release of $16.7 million on a slate of conditions and modifications.

While Phase 1 of the grant was to provide a coordinated response to the AIDS epidemic within the military and police and their communities, in approving funding for Phase 2, (see GFO article), the Board demanded a shift away from the security personnel focus to other key populations, including commercial sex workers, MSM and transgendered people.

According to the Technical Review Panel, neither of those approaches, led by the principal recipient (PR) Cicatelli Associates Inc., were successful.

In the decision presented to the Board, the Secretariat considered that the applicant for the grant had failed to implement a new strategy to focus on key populations or to work together with existing networks of key populations to promote respect for human rights and to reduce stigma and discrimination in the region.

Nor did the PR submit required documents detailing capacity-building or a revised work plan and budget that reflected the revision and reprogramming of the grant; it was further criticized for its failure to provide “convincing evidence of sufficient experience in advocacy for human rights to carry out the required activities.”

In its statement to the Board, the Secretariat added: “based on the documentation received, the TRP does not feel that the grant applicant has responded adequately to previous concerns raised by the Global Fund. The TRP observes that direct service provision remains the focus of the proposed project to the detriment of other (more essential) advocacy components and that it remains unclear from the revised budget and description of revised activities what proportion of the resources would actually be directed to key population partners. In addition, the revised budget remains extremely high on staff costs, and there seems to be little budget for actual implementation of program[me] activities.”

In its strongly worded review, the language of which was adopted by the Secretariat in its recommendation, the TRP considered the submission for renewal “[did] not represent good value for money in that it shows no convincing evidence it will be able to achieve its primary goal of reducing stigma and discrimination in the region… [In] addition, the TRP does not see that any further reshaping of this current investment will result in achieving that goal.”

[This article was first posted on GFO Live on 29 November 2013.]

To comment on this article, click here.

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6. NEWS: Eastern Europe/Central Asia network chooses in-country partners for its regional harm reduction project on HIV in EECA

Five NGO partners from Belarus, Georgia, Kazakhstan, Moldova and Tajikistan were selected by the Eurasian Harm Reduction Network

The Eurasian Harm Reduction Network issued a tender in September 2013 for in-country partners to implement the regional programme, "Harm Reduction Works. Fund it!" Developed as part of the network's concept note for the transition phase of the new funding model, the programme seeks to facilitate effective regional advocacy for harm reduction among injected drug users across five countries in EECA.

The three-year, $6 million programme is a central component of the draft project concept note that the EHRN has submitted to the Global Fund for review. It was at a 13-14 June regional dialogue meeting in Lithuania that the open competition to select the national partners was first announced to support the initative. Submissions followed a tendering period from mid-September until mid-October.

The national partners chosen from among nine country proposals submitted are: Positive Movement, in Belarus; Georgian Harm Reduction Network, in Georgia; Moldova's Union for HIV/AIDS Prevention and Harm Reduction; the Kazakh Union of People Living with HIV, in Kazakhstan; and SPIN Plus, in Tajikistan.

A sixth proposal, tendered by the I Can Live Coalition of Lithuania, was placed on a waitlist.

The harm reduction concept note developed by the EHRN fits squarely within a new regional strategy to respond to the expanding HIV epidemic in Eastern Europe/Central Asia being launched by the Global Fund.

The Fund's EECA regional team held a consultation in September to begin to plot how to achieve success in responding to the markedly different profiles and needs of countries across Eastern Europe and Central Asia grappling with a mounting HIV epidemic. According to the 2013 "AIDS by the Numbers" report released by UNAIDS, the region is facing a disproportional surge in infections, as compared to the rest of the world.

The development of a differentiated regional HIV/AIDS strategy with integrated TB components will seek to establish regional investment priorities that will be sustainable beyond Global Fund funding. This is particularly important in countries that will, under the new eligibility benchmarks for average per capita gross national income, no longer be able to access Global Fund grants because of their middle or upper-middle income status.

The consultation in September began to shape the regional strategy, resulting in what a statement from the EECA regional office called "broad consensus that the vast majority of Global Fund investments in the region on HIV should follow the UNAIDS regional strategy to prioritise scaling up anti-retroviral treatment (ART) and enhancing access to comprehensive harm reduction, prevention, and treatment and care services for people who inject drugs (PWID)."

Other regional targets established during the consultation included: expanded testing, treatment referral and adherence programmes; sustainable access to quality-assured and cost-efficient ART; and increased access to harm reduction interventions and their inclusion into national drug policies.

Some of the elements of the proposed regional strategy have prompted concern from civil society groups in EECA. In an open letter to those who attended the September consultation, 24 regional and national-level organizations cautioned the Fund against being too ambitious in expecting great leaps in the level of coverage by ART therapies funded domestically. The proposed transition timeline away from Global Fund-supported programmes towards state-funded programmes is too short, the CSOs said, and could widen the gap of unmet needs in many newly identified middle-income countries.

No strategy will be effective without better attention to a smooth transition, they said, urging greater flexibility in the development of allocation formulas under the new funding model that considers existing and potential barriers to access across the region – including, but not limited to, the ability and willingness of governments to fund these programmes in the future.

“Advocacy work at the national level and additional resources must be allocated and made available for civil society if the Global Fund expects UMICs such as Azerbaijan, Belarus, Kazakhstan and others to fully cover harm reduction programmes and ART treatment with domestic funding in the next 12 months,” said Dasha Ocheret, EHRN’s Deputy director for policy and advocacy in an emailed statement to Aidspan.

[This article was first posted on GFO Live on 29 November 2013.]

To comment on this article, click here.

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7. NEWS: Peru CCM Submits Request for Phase 2 of HIV Grant

Specialised centres will provide services to MSM, transgendered persons and sex workers

The Peru country coordinating mechanism (CCM) has submitted a request for continued funding for Phase 2 of its Round 10 HIV grant. The Global Fund Secretariat and the CCM have completed discussions on the request. Approval by the Board is expected later this month or in January.

This article describes the plans for Phase 2 and the process for developing the request.

Phase 2 plans

Phase 2 will focus primarily on scaling up services for the treatment of sexually transmitted diseases and HIV, and for monitoring the health of men who have sex with men (MSM), transgendered persons and sex workers. Specialised centres, linked to existing health facilities, will be established. They will provide gay, transgendered and bisexual (GTB) people with health services, counselling and information on human rights.

In addition, multidisciplinary teams, together with health providers, will visit GTB people in their own environments. Phase 2 will also see the establishment of working groups, made up of government and community representatives, to oversee the programme.  

Phase 2 activities constitute a pilot of a model of health service that is oriented to the gay and transgender communities. The features of the this model include: (a) multisectoriality – it involves the health, education and work sectors, and the office of the human rights ombudsman; (b) community participation – community representatives will be involved as counsellors and as volunteers in the specialised centres; and (c) cooperation between community and government – not only at district level but also at provincial and national levels. The model aims to produce impressive results that will encourage provinces to cover some of the services in their own budgets once the grant is finished.

Process

The proposal for Phase 2 was initially developed by a consultant. It was then reviewed by a committee established by the CCM. The final version of the proposal was shared with the beneficiaries: gay men, other MSM and transgendered persons.

Teresa Ayala, an NGO representative on the CCM, told GFO that community representatives participated in the process in various ways. For example, “community agents” – representatives from gay and transgender people – from eight provinces were consulted by the principal recipient, Inppares, an NGO specialising in sexual and reproductive health services. Also, the CCM committee held in-person and virtual meetings with leaders of the gay men and transgender communities.; and solicited input via email. In addition, there were community representatives on the CCM committee.

According to Julio Gilvonio, representative of gay men on the CCM, despite the extensive involvement of community representatives, some things were omitted from the proposal that the community would have liked to see included – including the continued operation of a website and hotline for GBT people who are reluctant to approach a health facility or who simply need information; and activities addressing bullying. These initiatives had been part of Phase 1 of the grant. The reason they were not included was that resources were limited, and the CCM considered that establishing the specialised centres was a priority.

New PR

Phase 2 will also see a change in PR. Inppares will be replaced by Parsalud, a branch of the Ministry of Health, which has experience in managing Global Fund projects (it has been PR for a TB grant since 2009). The change was motivated by the lack of feedback the community had from the first PR; delays in implementation of the grant; and Inppares’ lack of knowledge of the GBT community.

According to representatives of civil society on the CCM, the change in PR will benefit the community because the community will be more involved in programme implementation. The new PR, and in particular, Ricardo Chuquimia, coordinator of Parsalud and the person who will be managing the programme, have a good understanding of the situation of gay men and transgendered people.

However, Mr Gilvonio said that the association of Parsalud with the Ministry of Health could reduce the independence of the PR, and reduce the involvement of GBT in the development of public policies related to human rights, stigma and discrimination.

Mr Chuquimia told GFO that Phase 2 has a “focus on rights and respect of diversity.” He said that the PR has planned different actions to assure the participation of gays and transgendered persons in the programme, including adding a well-known leader of one of these communities to the PR’s management team. Mr Chuquimia added that Parsalud will try to ensure that some of the sub-recipients are community-based organisations. Further, he said, the PR is planning some “positive discrimination” actions in order to ensure that transgendered people are involved in implementing programme activities.

[This article was first posted on GFO Live on 09 December 2013.]

To comment on this article, click here.

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AVAILABLE ON GFO LIVE:
 
The following articles have been posted on GFO Live on the Aidspan website. Click on an article heading to view the article. These articles may or may not be reproduced in GFO Newsletter.

NEWS : Campaign launched in Uganda to urge China to give more to the Global Fund

A group of civil society organisations in Uganda have launched a campaign to urge the Chinese government to contribute at least $1 billion to the Global Fund.

NEWS : Key Dates Related to the Implementation of the NFM

The Global Fund has released a partial calendar of events related to the new funding model.

NEWS : Ethics Official Handles Conflict of Interest Situations and Other Ethical Issues

The Ethics Official deals with matters such as improper conduct by governance officials and potential conflicts of interests.

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This is issue 233 of the GLOBAL FUND OBSERVER (GFO) Newsletter.

We welcome suggestions for topics we could cover in GFO. If you have a suggestion, please send it to the Editor of GFO (see contact information below).

Author: Author: Articles 1, 2 and 5: Lauren Gelfand (lauren.gelfand@aidspan.org), GFO Editor. Articles 3 and 4: David Garmaise (david.garmaise@aidspan.org), Aidspan’s Senior Analyst. Article 6: Tanatin Zardiashvili (tinatinz@hotmail.com), GFO regional correspondent for Eastern Europe and Central Asia. Article 7: Lídice Lopez (lidilt@hotmail.com), GFO regional correspondent for Latin America.

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