“There is a painful awareness among communities in countries whose economies are growing that donors are pulling out and abandoning them… This [transitioning] process is driven by the criteria donors have laid out for eligibility, and demonstrated by the actual level of disbursements going to some countries. But communities know that growing economies do not equal growing domestic support for communities in the HIV response.”
This was one of many challenges to financing the community response to HIV identified in a report prepared for the UNAIDS Programme Coordinating Board (PCB) in November 2016 (Report by the NGO Representative – An unlikely ending: ending AIDS by 2030 without sustainable funding for the community-led response).
The report is the product of regional consultations and a global web-based survey conducted by members of the PCB’s NGO Delegation. The regional consultations consisted of structured interviews with 30 key stakeholders. The survey was completed by 156 respondents from over 60 countries.
Survey respondents indicated a general downturn in available funding from international donors. Among survey respondents, 53% reported losing access to Global Fund support; 26% reported losing funds from the U.N. system; 24% reported losing funds from private donors, 12% reported losing bilateral funding; and 12% reported losing funding from their own governments. According to the report, these trends were most pronounced in regions where donors are “transitioning” away from providing funding to countries moving out of the low-income and lower-middle-income categories into upper-middle-income and high-income categories.
“The Global Fund is leaving the [EECA] region,” said Michael Krone from AIDS Action Europe (as quoted in the report). “Most countries in transition, or those that have transitioned, don’t develop proper mechanisms to replace Global Fund money with domestic resources when it comes to prevention work, especially [the work] done by communities. Most domestic resources go into treatment provision. The Open Society Foundations and other private funders disappeared from Russia and communities and civil society have difficulties accessing funds from these sources in other countries as well due to the challenging political or legal environment.”
In October 2016, the Global Fund produced a list of 34 components from 25 countries that either had become ineligible since the 2014-2016 allocations, or were projected to become ineligible by 2025. The report for the PCB stated that these components represent about one-fifth to one-quarter of all Global Fund recipient countries. “These are the … countries where communities and key populations are at high risk of losing funding,” the report said.
“This not only means reduced funding for activities, but also the complete disappearance of activities like advocacy and service delivery, and of organizations,” Krone said.
Editor’s note: Although it is accurate to say that the 25 countries represent about one-fifth to one-quarter of all recipient countries, it should be noted that in terms of actual funding the 34 components received just 2.1% of total allocations for 2014-2016.
“What we see in the country level is that since the budget level has been cut, you have different provinces or districts and in the past they have been providing services in [many] districts. Now they are only delivering in five districts,” said Shiba Phurailatpam, regional coordinator of the Asia Pacific Network of People Living with HIV (APN+). “Also, in the past you have 20 outreach workers and now you only have three. The kinds of changes that you see are very visible for PLHIV networks.”
“What is the worst about [the Global Fund exiting countries] is that the other donors follow the Global Fund and cut their budgets for that activity as well,” said Igor Gordon, who heads the Community and Membership Strengthening Team for the Eurasian Harm Reduction Network.
The report said that there is not enough coordination among donors or supportive architectures for communities in the HIV response to adequately mitigate the effects of reductions in funding for communities.
“The reality of donors ‘transitioning’ out is that the community response is at risk of transitioning out as well,” the report said. “This is incongruous with the global consensus on the importance of the community response to HIV.… There exists a grave threat to our aspirations to end the AIDS epidemic, by 2030 – or even 2080. The asserted importance of communities to the response must be backed up with increased, not reduced, investments.”
Funding for advocacy work
For funders, advocacy is often a “nice-to-have” rather than a “need to have,” the report said. “But for communities, advocacy is very much a ‘need-to-have,’ as it always has been. This ‘disconnect’ means that much of the advocacy work that communities do – and do better than any other sector – is under-funded or entirely unfunded.”
For countries doing transition planning, the report said, strengthening the advocacy capacity of communities is important, especially where governments may not want to support marginalized populations. “Advocacy should be among the top priorities that international donors support when they are leaving a country.”
The report suggested that large recipients of Global Fund money be required (rather than encouraged, as at present) to set aside a portion of their funding for advocacy programs.
As its own capacity diminishes, the report recommended, UNAIDS should transition the national coordination and policy roles of its own country offices to “capacitated and robust community structures,” and it should ensure that such structures are in place before exiting or downsizing. The report said that in support of such funding streams, donors should invest in comprehensive evaluations of existing advocacy programs so that their impact can be demonstrated more clearly.
The report noted that the HIV funding architecture has changed the power dynamics within communities, by depoliticizing community responses and by conflating service delivery with advocacy: When organizations take on funding for service provision, their ability to be the fierce advocates their communities need is often compromised.
Other challenges identified in the report include the following:
- Donor expectations and priorities. Donors tend to have expectations for recipients that are not aligned with the capacity or the realities of community-based organizations. Funding tends to go to organizations that best fit the expectations of donors, and it is often channeled through large NGOs or governments. This can have the effect of isolating the most grassroots groups or of considerably reducing the amount of funding that reaches the community level. If community organizations want to survive, they must accept donor priorities and measures of success. Community organizations may also have to re-align a significant portion of their work to satisfy heavy donor reporting and monitoring requirements, shifting the organizations away from their core focus.
- Unfavourable political and legal environments are perhaps the most significant and intransigent challenges faced by community organizations, particularly those that serve key and vulnerable populations. Further investigation and action by U.N. bodies and Member States is urgently needed to address persistent political, legal and human rights barriers. Environments that present a challenge to community-led AIDS responses are generally marked by poor human rights records, the criminalization of people living with HIV or who are at risk for HIV infection, and low levels of inclusion and engagement of civil society in decision-making processes. The threats and other complications of managing programs for criminalized populations can discourage community organizations from even pursuing funding, while also discouraging larger NGOs from implementing programs for those communities. Furthermore, these conditions can encourage or force international donors to exit countries prematurely.
- Accessing funding. Survey respondents from low- and middle-income countries overwhelmingly reported that communities generally have to partner with a large NGO or other non-community institution to access funding. To be eligible to receive funds from most donors, organizations must be formalized and have financial controls in place. While it may seem obvious for a funder to require such protections, the expectation is not aligned with the reality of many actors in the community response. Obtaining registration or having solid financial protocols can be impossible for some key groups, since they are not “organizations” in a traditional sense, but rather networks or informal associations of affected people.
- Managing risk is a shared concern for donors and communities. Too frequently, however, donors demand risk-free or minimum-risk scenarios that attempt to ascribe the norms of sophisticated, large and well-funded institutions to small community groups. That approach sets the bar too high, and it does not match the nature and strengths of communities. Communities are set up for failure because donors fail to recognize the actual conditions of risk in which communities operate.
In its 2017-2022 Strategy, the Global Fund states that “civil society and communities must play a central role in the design, delivery and oversight of the response, including community-based service delivery.”