For several weeks, civil society organizations in Tunisia have organized demonstrations and issued press releases to ask for the signature of the framework agreement that is required prior to funding. An HIV grant worth $11 million was approved in December 2015 but can only be disbursed after the agreement is signed.
According to Souhaila Bensaid, director of the Association pour la Prévention Positive, three provisions of this framework agreement (which incorporate Global Fund grant regulations) are not compatible with the new Constitution adopted in 2014: indemnification and arbitration (which were already included in the previous grant agreement) and privileges and immunities which confer on the Global Fund the status, capacities, privileges, and immunities equivalent to those enjoyed by other international organizations.
The principal recipient of the grant which was approved on 24 December 2015 is the Office National de la Famille et de la Population, an entity of the Ministry of Health. “The Global Fund has been in contact with the Ministry of Health since September 2015 in order to obtain the signature of the framework agreement before signing the grant confirmation,” Marcela Rojo, a Global Fund spokesperson said. “The legal department informed The Global Fund that they are not in a position to sign the agreement and that it needs to be approved in parliament under the country’s constitution.”
So far, discussions have not resulted in a concrete solution. “I don’t think it is possible to change the laws that fast in order to keep the provisions in the agreement,” Ms Bensaid said. “Our country has been in a very peculiar situation since the Revolution. The Global Fund should have thought about initiating a specific dialogue for developing countries that are going through major political changes like Tunisia.”
Because the Global Fund grant focuses primarily on prevention activities and only covers 10% of some HIV drugs, “it is our understanding that there is no likelihood of treatment disruptions,” Ms Rojo said. “A consequence of the delay, however, is the potential loss of human resources. If staff moves to other organizations, this could incur a loss of know-how should the prevention program resume when the framework agreement is signed.”
The grant covers key services that have been suspended since 1 January 2016, such as food support, procurement of complementary medicines, psychological and social support, sensitization among key populations, and support to hospitalized patients. “To get ARV treatment without the crucial services that go with treatment is not very useful,” Ms Bensaid said.
According to Ms Rojo, discussions are ongoing and no date has been set for the signature.