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Issue 206: 13 December 2012

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CONTENTS OF THIS ISSUE:

1. NEWS: Aidspan Releases Analysis of Pledges and Contributions to the Global Fund

The countries whose recent pledges to the Global Fund have been the largest in relation to their gross national income are Sweden, Norway, France, the United Kingdom and Canada, in that order. This is one of the findings of an analysis conducted by Aidspan on pledges and contributions to the Global Fund.

2. COMMENTARY: Global Fund Programmes Are Far from Being Gender Transformative

“Few Global Fund programmes seem to be reaching women and girls in ways that will genuinely transform their lives and turn the HIV epidemic around,” says Robin Gorna. In this commentary, Ms Gorna asks why the Fund’s Gender Equality Strategy is not being translated into action, and she advances suggestions to address the problem.

3. NEWS: Board Imposes Conditions on Renewal of India HIV Grant

The Global Fund says that increased spending on antiretrovirals by the Government of India is a condition of continued support from the Fund for the next implementation period of a Round 4 HIV grant.

4. COMMENTARY: Three Months, and Rising

Pausing to catch her breath after three months on the job as Executive Director of Aidspan, Kate Macintyre introduces herself and talks about where Aidspan is going. Given her academic background, Kate is adept at writing abstracts. She summed up this commentary in 12 words: “A full three months, a steep learning curve and a few ideas.”

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

1. NEWS: Aidspan Releases Analysis of Pledges and Contributions to the Global Fund

Analysis includes the use of a “Global Fund donor score”

The countries whose recent pledges to the Global Fund have been the largest in relation to their gross national income are Sweden, Norway, France, the United Kingdom and Canada, in that order.

This is one of the findings of an analysis of pledges and contributions conducted by Aidspan. A report on the analysis, entitled "Donors to the Global Fund: Who Gives How Much?", has been published on the Aidspan website. The analysis was conducted by Bernard Rivers, Aidspan’s Senior Fellow.

To help with the analysis, Aidspan created a “Global Fund donor score,” explained in Table 1.

Table 1: Explanation of Aidspan’s Global Fund donor score

Global Fund donor score
Average annual pledge to the Global Fund during 2011 - 2013 as a % of 2011 gross national income (GNI)
A
Greater than 0.010%
B
From 0.007% to 0.010%
C
From 0.003% to 0.006%
D
From 0.001% to 0.002%
E
Below 0.001%
F
Zero

Aidspan then calculated the Global Fund donor score for each of the 30 countries that have the largest economies and that are defined by the World Bank as “high income.” (The definition of “high income” is based on standard of living, not size of economy.) The results are shown in Table 2.

Table 2: The “Global Fund donor scores” for the 30 high-income countries with the largest economies, based on pledges for 2011–2013


Global Fund donor score
Donor
Pledge to the Global Fund
Average annual pledge, $m.
As % of GNI *
 
A
Sweden
99.1
0.0197%
Norway
76.5
0.0174%
France
477.7
0.0172%
United Kingdom
340.0
0.0144%
Canada
179.0
0.0114%
B
United States
1,333.3
0.0088%
Denmark
27.0
0.0080%
Netherlands
63.5
0.0076%
Germany
263.4
0.0073%
Australia
72.7
0.0071%
C
Belgium
18.0
0.0035%
Japan
200.0
0.0035%
D
Finland
5.2
0.0020%
Switzerland
8.3
0.0014%
Saudi Arabia
5.6
0.0011%
E
Kuwait
0.5
0.0004%
South Korea
2.0
0.0002%
F
Austria, Czech Republic, Greece, Hungary, Ireland, Israel, Italy, Poland, Portugal, Qatar, Singapore, Spain, United Arab Emirates
0.0 each
0%
*    This column shows each country’s average annual pledge to the Global Fund during 2011–2013 as a percentage of its 2011 gross national income

It is important to note that the Global Fund donor scores shown in Tables 1 and 2 are based only on direct pledges to the Global Fund. Some of the countries listed also contribute indirectly, via the European Commission (pledges from the European Commission make up 4% of total pledges to the Fund), UNITAID or Debt2Health. Some countries also donate considerable amounts of money for non-Global Fund programmes to fight AIDS, TB and malaria (such as through bilateral aid). Others don’t give much money for the three diseases, but may give to other charitable or development causes.

Three of the countries shown in Table 2 as having a Global Fund donor score of F – Italy, Spain and Ireland – pledged substantially to the Global Fund prior to 2011. Because of their domestic economic difficulties, none of these countries pledged anything for 2011–2013, and each of them failed to fully cover its pledge for at least one year before 2011. However, during 2011–2012, Ireland did make some contributions to cover part of the unpaid portion of its 2010 pledge; and there are signs that Spain may again become a donor to the Global Fund.

Five of the countries shown in Table 2 as having a Global Fund donor score of F – Austria, Czech Republic, Israel, Qatar and United Arab Emirates – have never donated to the Fund.

Based solely on the size of the pledges, and looking now at all donors to the Global Fund, not just the 30 largest economies, the largest pledges for 2011–2013 were made, in decreasing order by the US, France, the UK, Germany, Japan, Canada, the Bill and Melinda Gates Foundation, the EC, Sweden, Norway, Australia, Netherlands, Denmark, Russia and Belgium.

During the years 2001–2005, every pledge made to the Global Fund was fully paid. Since then, this has not been the case: $645 million in pledges made to the Global Fund for the years 2006–2011 has not yet been paid. Details are provided in the report.

Table 3 shows the pledges for 2011–2013 made by each of the main donor groups.

Table 3: Pledges to the Global Fund for 2011–2013 from the main donor groups

Donor group
Pledges
Average annual pledge by each group, $m.
As % of all pledges
The 30 largest high-income countries
3,171.8
90.0%
Other countries that have given to the Global Fund
34.1
1.0%
European Commission
140.9
4.0%
Foundations and other charitable donors
152.9
4.3%
Private sector
10.5
0.3%
Other
13.8
0.4%
GRAND TOTAL:
3,523.8
100.0%

The private sector provided only 0.3% of total pledges for 2011–2013 (about $10 million annually). However, this does not include (Product) RED, an alliance of various private sector companies, which, without making pledges, contributes about $20 million annually.

[This article was first posted on GFO Live on 13 December 2012.]

To comment on this article, click here.

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2. COMMENTARY: Global Fund Programmes Are Far from Being Gender Transformative

by Robin Gorna

Despite a forward looking Gender Equality Strategy (GES), few Global Fund programmes seem to be reaching women and girls in ways that will genuinely transform their lives and turn the HIV epidemic around.

There is substantial analysis showing what needs to be done to make HIV programmes gender transformative – i.e. programmes that will not only meet the immediate HIV needs of women and girls, but also address underlying conditions that enhance HIV vulnerability and risk for men and boys, as well as women and girls, because of gender stereotypes and dynamics prevalent in many societies. (Levels of gender awareness are described by the USAID Interagency Gender Working Group as gender exploitative, gender sensitive, and gender transformative.)

Despite this substantial analysis, the right programmes are still not being implemented with Global Fund resources – or if they are, it is nearly impossible to track.

Throughout 2012, AIDS Strategy Advocacy and Policy (ASAP) has been working with the Global Fund Secretariat and UN Women to review nine HIV programmes funded through Rounds 8 and 9 to establish the extent to which gender responsive programmes have been supported since the introduction of the GES. ASAP’s review found limited implementation of programmes that would transform local responses to HIV and better the lives of women, their families and communities. The review highlighted that – despite guidance in many documents from UNAIDS, UN Women and others – countries have a weak understanding of the most strategic gender-transformative programmes, and that structural barriers within Global Fund processes have limited strategic investments and have not created incentives for gender programming.

So, why is the clear direction of the GES not translating into action? Responsibility for this insufficient response falls across many actors in the global and local response. At a national level, the locus of responsibility for all aspects of the response, including gender, lies with national AIDS commissions, the government and the many partners the government does – or does not – bring together. That includes responsibility for not forging adequate links with women’s organisations, especially networks of women living with HIV. The UN too – and the myriad technical agencies present in many countries – also bear responsibility. It is concerning that although a number of countries we reviewed had national gender strategies, as well as national AIDS strategies, these were not well reflected in programming. Several countries have good and forward looking gender programmes – e.g. within women’s ministries – but these rarely become visible within AIDS planning processes.

What can the Global Fund do?

So what of donors, and in particular the Global Fund? As a non-technical partner, how can the Fund be held accountable for inadequate progress with gender transformative programmes? Our review has found that there are many aspects of Global Fund processes that could be enhanced so that programmes really meet priority needs for women and girls. At this important moment of transition for the Fund, several actions should be taken to ensure that funds go to the right places and support strategic programming that will turn the epidemic around by addressing the inequalities and drivers of HIV, as well as their more direct impacts on girls and women.

First, the Global Fund Board needs to ensure that the strategies they agreed on –Gender Equality, and Sexual Orientation and Gender Identity (SOGI) – continue to be core and do not get lost in the pressure to develop new, and often “gender blind,” approaches and processes to support grant management. But – as our review finds – simply having the GES is not enough. Strategies are only as good as their implementation.

A big part of the problem is that data is not available to tell whether the GES is being implemented. Sex- (and age-) disaggregated data needs to become the norm for Global Fund reporting so that we can track whether spending and programme implementation have the right impacts. For example, is antiretroviral therapy scale-up reaching women and men equally (or at least proportionate to the epidemic profile)? Are there gender differences in survival rates? This is a simple step, and not an unusual one for donors. (The UK Department for International Development [DFID], for example, requires that sex-disaggregated indicators be included in logframes wherever possible.)

The Global Fund has placed huge store on effective M&E systems; tweaking them to be gender sensitive would not be hard, and would have a huge impact. This includes simple steps like requiring gender programmes to be tracked in performance frameworks. It’s the old story: “What gets counted gets done.” Not only will sex-disaggregated data assist in monitoring, it will also remind principal recipients and others that gender transformative programming matters, and should be the norm – tailored, of course, to local epidemic realities.

The Global Fund’s new funding model provides real opportunities for improvement. As the model is further developed, in addition to requiring sex-disaggregated data, other “check points” should be put in place. For a start, the applicant’s concept note should always include a gender analysis of the country’s needs. And the SIF (Strategic Investment Framework) guidance provided by the Global Fund needs to include clear direction on gender responsive programming (as opposed to just relying on the current UNAIDS SIF which is “gender blind”).

Just having a gender analysis in the concept note would not be sufficient. The membership of the Technical Review Panel needs to include people with the gender skills to judge whether the analysis and proposals are sound, and to provide feedback to countries where strengthening is needed.

Our review – and the precursor review commissioned by the Global Fund Secretariat that looked at the quality of gender analysis in proposals (but not implementation) –found that following adoption of the GES, most countries integrated gender analyses in their proposals. The analyses were rarely perfect; but the real problem was at the point of transition from proposal to implementation.

Equally important, if not more important, is the quality of grant management and advice as proposals move into the implementation phase. ASAP found no evidence of fund portfolio managers (FPMs) intervening to support countries to deliver the gender aspects of proposals. Nor was there any evidence that FPMs saw it as their role to track the implementation of gender transformative responses. As the Global Fund evolves its model to take on a more active grant management role, FPMs must take some responsibility for ensuring that countries deliver on their proposals, and implement Global Fund Board–agreed policies and strategies, including the GES and the SOGI Strategy. This boils down to sharper grant management and making sure that FPMs have the right skills and incentives to be most effective as grant managers.

Ultimately, as with all things concerning the Global Fund, it is how the partnership works best – through the country coordinating mechanisms (CCMs), and through the broader partnership between technical partners, civil society and government. We found examples of countries with strong and effective women’s rights organisations, and vibrant networks of women living with HIV – yet these groups seemed to be distant from the central decision-making processes. And we never found gender parity or strong representation of gender experts on the CCMs we looked at.

Hard questions must be asked about the Global Fund’s internal procedures, and how these incentivise stronger performance by partners. What are the triggers to ensure that Board-agreed strategies and guidance notes are fully implemented? How can the people and processes responsible for grant management be most effective so that countries are guided to deliver programmes that are most strategic and will have maximal impact?

A simple first step is for the Global Fund Secretariat to require sex-disaggregated data in all reporting. This will ensure that the reports generated to meet the needs of this (very special) donor tell the story as to whether or not the funds are transforming societies so that women and girls are best able to resist the impacts of HIV. The Global Fund is well placed to take this simple action now, and to take further action to ensure that all the good words and intents in existing strategies and policies really translate into action where it matters.

Robin Gorna (email) is the Director of ASAP, a small consultancy of associates working globally to deliver a better response to AIDS, women’s health and global health more broadly. Robin has worked in HIV since 1986; she has been involved with the Global Fund since 2003 when she headed up the Global AIDS Policy Team of the DFID and was a member of the UK-Australia delegation to the Global Fund Board. The ASAP website contains further details of the project described in this article, which benefited from the work of associates Hanke Bokma de Boer-Nubé and Sophie Dilimitis.

[This article was first posted on GFO Live on 08 December 2012.]

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3. NEWS: Board Imposes Conditions on Renewal of India HIV Grant

Global Fund wants more government funding for ART

The Global Fund is calling on India to increase government funding for the provision of antiretroviral treatment (ART) for people living with HIV.

The Global Fund is concerned about the sustainability of the National AIDS Control Programme (NACP) in India because the NACP is relying 100% on Global Fund resources to finance its ART budget. The Fund would like to see India pick up the bill for a significant portion of ART expenses, which would permit Global Fund resources to be re-directed to programmes that support vulnerable and high risk groups, community systems strengthening and accelerated expansion of community based interventions in high prevalence states.

The Global Fund said that it will include a Board Condition in the grant agreement for the next implementation period of a Round 4 HIV rolling continuation channel grant (Grant No. IDA-405-G06-H RCC) requesting an action plan on how India will increase funding for ART “such that Global Fund funding is reduced to a minimum within a reasonable time frame.” Specifically, the Board Condition states:

The CCM shall submit, in form and substance satisfactory to the Global Fund, a sustainability plan for the National AIDS Control Program, including:

1. An action plan describing the National Government’s plan of continuing the increase of its share in funding the National AIDS Control Program such that Global Fund funding is reduced to a minimum within a reasonable timeline;

2. A comprehensive three-year RCC Phase 2 workplan and budget for IDA-405-G06-H RCC that accurately captures the key service delivery areas, goals and objectives of the original proposal and continuation of the main elements of Global Fund support in Phase 1; and

3. A finalized NACP-IV budget with components clearly identified by funding source (including without limitation the National Government and states (if applicable), lenders and other donors), including the planned five-year, US$ 250 million loan from the World Bank for the National AIDS Control Support Project (NACSP).

As its name implies, a “Board Condition” is a condition imposed by the Global Fund Board. It is different from a “regular” condition in that the Board has to agree when a Board Condition is waived or changed. Regular conditions can be waived or changed by senior Secretariat management.

The principal recipient for the Round 4 grant is the Ministry of Finance.

Information for this article was taken from the “Report of the Grants Renewal Panel – November 2012” (Document B28/ER/05). The report contain several decision points which the Board approved by electronic vote in early December. The portion of the report concerning India was for information only; no decision was involved. The report is not available on the Global Fund website.

[This article was first posted on GFO Live on 12 December 2012.]

To comment on this article, click here.

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4. COMMENTARY: Three Months, and Rising

by Kate Macintyre

Close readers of Global Fund Observer (GFO) will know that I took over from Bernard Rivers as Executive Director of Aidspan just over three months ago. It was a smooth transition. On a nearly hourly basis, I am impressed by the way the staff have continued to run the systems that Bernard founded and ran for ten years. He created a remarkable organisation. I knew this from watching GFO over the years; now I am beginning to know it from the inside of the organisation that houses the newsletter.  

Today I live in Nairobi, and this has been my home for the last six years, but Kenya has been my intellectual home since I first came here in 1984 after finishing a university degree in modern history. After a stint as a journalist and as a director of a health-focused NGO, I then moved my career towards infectious disease evaluation, using my training in demography and health policy to understand how people responded to the diseases and how we (as scientists and managers) measure those responses. I held a tenured research and teaching position at Tulane University in the US until the end of August this year. 

I have lost friends to all three epidemics, but I also now have many friends who are alive because of the actions of the global community towards rolling out treatment and prevention. In 1997, when my work as a researcher began, there was no talk or idea of the Global Fund. There was no Roll Back Malaria, no Stop TB, no UNAIDS; PEPFAR was very far away; and countries heavily affected were in crisis. My first years as an infectious disease evaluation specialist were cautious ones, even depressing. What an incredible 15 years it has been, and the future is now more exciting than even the early 21st century years were for these infectious diseases.

In South Africa, in 2000, I remember a conversation about stigma and disclosure that was so traumatic that even now I find it hard to believe the kind of fear that people lived under. A diagnosis literally seemed worse than death. My training in history means I often look to the past for lessons, and to know where we’ve come from. This recent history of stigma and discrimination is important. The fight is not over, indeed for many it may only have just begun. But I am conscious of being a part of that fight, whether as a researcher or, now, a commentator and observer: always, a witness.

In the past three months I have attended two Global Fund Board meetings, two pre-meetings, a replenishment review meeting, and an Aidspan Board meeting. I have co-written an Annual Plan for 2013. But beyond the “meetings and greetings,” above all I have been learning. Learning about people, systems, publishing, global reforms, country-level problems and acronyms. 

The acronym soup that is the Global Fund (and of course much else in the global health world), and the jargon it generates and illustrates, needs deconstruction and explanation. Clearly, one of the legacies of Bernard Rivers and David Garmaise is the clarity they force upon this obscure world of global health. GFO has always explained difficult, complex things carefully and clearly, and unpacked the jargon and overuse of words. It has punctured the pompous or unintelligible and maintained the highest standards of reporting and commentary as a small newsletter run by a very small team.  I will try to keep this tradition of high quality reporting during my tenure as director. 

But GFO will change and it will grow. The first change will be following up on Aidpsan’s commitment to communicate to a broad audience. In early 2013, we plan to launch Aidspan’s website in French, Spanish and Russian. Soon after this we plan to start editions of the GFO Newsletter in those same languages.     

GFO is also reaching out to more local correspondents to diversify the voices of those most directly affected by the programmes and to generate more stories from more regions. While observing global level policies and programmes emanating from Geneva remains a vital role for GFO, there is much to be watched and learned from how those policies affect implementation at the country and even the community level. GFO will try to increase the reportage from those levels, aware always that we have limits, and that with 151 countries receiving support from the Fund, we can’t hope to speak for all of those voices.  

We will also generate more commentary from our use of social media and through our main website. Finally, we continue to develop our outreach programmes which include efforts to encourage more “local watchdogging,” as we call it, by individuals and organisations best placed to do it.  

Next year, Aidspan will develop a new Strategic Plan (2014–2016). This is a great opportunity for a new Director to build her team and to strengthen the direction of Aidspan as a focused think tank. Our efforts will build on the past using high quality, evidence-based reporting and analysis to continue to observe the Global Fund and those who implement with its funds. We will continue to speak truth to those in power, and continue to broaden and deepen the communication tools we have created.  

I believe we at Aidspan are privileged to be able to watch and critique an organisation like the Global Fund. We witness rapid, sometimes chaotic, always interesting changes.  Our job is to be, as someone at the Secretariat once called us, the “Explainers.”  While this sounds like an aging rock band from the 20th Century, I’ll take the tag and run with it.         

Kate Macintyre (email) is the Executive Director of Aidspan. She took over from Bernard Rivers on 1st September 2012.

[This article was first posted on GFO Live on 12 December 2012.]

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 : OIG Releases Report on Diagnostic Review for Georgia Grants

The diagnostic review says that Georgia has made major achievements with Global Fund money such as attaining universal access to antiretroviral therapy and nearly eliminating malaria.

__________________________________________________________

This is an issue 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: Articles 1 and 3: David Garmaise (david.garmaise@aidspan.org), GFO Editor.

GFO Newsletter is an independent source of news, analysis and commentary about the Global Fund to Fight AIDS, TB and Malaria (www.theglobalfund.org). GFO is emailed to nearly 10,000 subscribers in 170 countries at least twelve times per year.

GFO Newsletter is a free service of Aidspan (www.aidspan.org), a Kenya-based international NGO that serves as an independent watchdog of the Global Fund, and that provides services that can benefit all countries wishing to obtain and make effective use of Global Fund financing. Aidspan finances its work through grants from foundations and bilateral donors.

Aidspan does not accept Global Fund money, perform paid consulting work, or charge for any of its products. The Board and staff of the Fund have no influence on, and bear no responsibility for, the content of GFO or of any other Aidspan publication.

GFO Newsletter is currently provided in English only. It is hoped to provide it later in additional languages.

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Aidspan Executive Director: Kate Macintyre (kate.macintyre@aidspan.org)

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