Survey finds African key populations still largely excluded from decision-making, despite NFM promises
According to a new report, cornerstone principals of the new funding model, such as inclusive country dialogue and meaningful participation, have not translated in practice for key populations in sub-Saharan Africa. Released by African Men for Sexual Health and Rights (AMSHeR), the report highlights the results of an online survey, profiling the experiences of organizations working with people living with HIV, men who have sex with men, and sex workers in 13 African countries.
The survey asked questions along the continuum of the NFM timeline, interrogating how key populations were able (or unable) to participate in the review of national strategic plans, national priorities setting during country dialogue, concept note development and the selection of principal recipients. Thirty respondents completed the survey.
The findings paint a rather disappointing picture. While recent research conducted by Aidspan found that key population representation on African country coordinating mechanisms was improving, AMSHeR’s survey indicates that significant barriers still exist for those sitting outside Global Fund structures.
The results reveal something of a “participation cascade,” where key populations are involved less and less as the country moves through the NFM process. From Figure 1, it is clear that all three key populations are increasingly excluded as the country gets closer to grant implementation.
Figure 1: The participation cascade of key populations through stages of the NFM
A fair number of respondents (60%) indicated that key population organizations had participated in national consultations leading up to concept note development. In some countries, such as Cameroon and Nigeria, groups were able to hold sub-national focus groups for key populations, feeding into national priorities setting. In East Africa, the International HIV/AIDS Alliance supported key populations in Tanzania, Zanzibar, and Uganda to hold similar “pre-meetings” ahead of their national dialogues.
For those who did not participate it was not for lack of knowledge. Almost all (90%) respondents said they knew about Global Fund and NFM processes, with 47% saying that their knowledge was either good or in-depth. But awareness was not enough.
“It took more than just having knowledge to be able to engage with a mechanism that is very complex, that is power imbalanced, and that requires a particular kind of civil society organizing,” said Kene Esom, AMSHeR’s Executive Director. “They thought if they knew what the model was about and they knew what was supposed to go on, that they could march into those spaces and make things happen. They weren’t prepared for the political process and the power imbalance against them.”
Along with being ill-prepared, the main reason given by respondents to explain non-participation in national dialogue was the lack of CCM and government consideration to include them in this conversation. Some respondents indicated that this might be a result of organizations not being legally registered.
While participation in consultations was relatively high, the involvement of key populations in the actual concept note development was significantly less – just 40% of respondents indicated that key population organizations participated in this facet. This may help to explain why 33% of respondents believed that concept notes met very few key populations needs, with 10% indicating they met none at all. This dissatisfaction was proportionally higher for PLHIV groups, with 57% of these respondents expressing that concept notes met few or none of their needs.
One survey respondent, representing a sex worker organization in Tanzania, said that “few key population representatives participated and their number was not enough to be able to argue. So their presence could not result in any change that would meet our needs. It’s rather what had been suggested by the government which was presented at the end.”
The process for PR nomination was the least inclusive aspect of the NFM (so far), according to the report. The majority of respondents believed that the voices of key populations did not count at all (40%) or counted only a little (37%) in nominating PRs. It remains to be seen to what extent key populations will be able to play a watchdog role during grant implementation, or hold implementers and CCMs accountable for results. As AMSHeR’s survey is a preliminary one, they intend to follow-up the results with more in-depth research into key populations’ ability to perform community monitoring of Global Fund activities.
“The NFM delivered hope. There were expectations,” said Esom. To see that it was not as inclusive and open for key populations as it had promised was a big disappointment, he told GFO. So what can be done? “Our sense is that for groups that have been perennially disenfranchised, you don’t just throw them into the mix,” Esom concluded. “You have to take further steps to ensure that the quality that was promised in the process is realized.”
Based on these research findings, AMSHeR is currently in discussion with Global Fund and other partners to explore options for ensuring that key population constituencies are better equipped to engage with the more political dynamics of the process.