The initial draft of the concept note that Zimbabwe was planning to submit to the Global Fund included funding for studies on the population sizes of sex workers and men who have sex with men (MSM), but did not include specific interventions that could address the needs of these groups while the data were being collected. However, feedback on the initial draft from the Global Fund Secretariat’s country team for Zimbabwe and from the Grant Approvals Committee led to the inclusion of specific interventions in the final concept note. This is an example of the Global Fund’s new iterative approach at work.

This was one of the findings of a preliminary report from the Open Society Foundations (OSF) on local civil society participation in the new funding model (NFM). The OSF conducted 24 interviews with persons involved in the development of the concept notes in Zimbabwe and Myanmar, and an additional two interviews with civil society representatives who were not directly involved. OSF was not able to include data from El Salvador, the third early applicant country, because government and Global Fund officials requested that surveys in that country be postponed until after the concept note was submitted and the grant making was complete.

Two-thirds of the interviews were conducted with civil society representatives. Others who were interviewed included representatives of country coordinating mechanisms, UNAIDS staff and fund portfolio managers. Of the 26 interviews, 18 were with people from Zimbabwe, and eight were with people from Myanmar.

The OSF study looked at both the process of developing the concept notes and at the content of the notes. This article provides a summary of the findings in each area.

Process of developing the concept notes

A major finding of the study was that the country dialogue process involved a wide range of civil society stakeholders, including most-at-risk populations (MARPs) such as sex workers, MSM and people who inject drugs. At the same time, survey respondents pointed out that people living with disabilities, migrants, internally displaced people and youth could have been better represented. In addition, OSF said that participation in the country dialogues was mainly confined to people living in the main cities (Harare and Yangon), at the expense of people from rural areas.

Survey respondents told OSF that the Global Fund Secretariat played a positive role in encouraging the involvement of civil society, including MARPs. For some respondents, this was the first time they were able to input into, or see, Global Fund grant proposals prior to grants being awarded.

Another important finding from the study was that that there were several civil society representatives on the proposal writing teams in both countries. In Zimbabwe, respondents said that the four civil society representatives on the proposal writing team kept in close contact with other civil society stakeholders during the writing process. However, some respondents said it was unrealistic and unfair for a limited number of civil society representatives on drafting teams to shoulder the burden of ensuring this kind of engagement.

The Myanmar CCM had started working on its concept notes in October 2012, prior to the launch of the NFM. This is because the Global Fund had invited Myanmar to apply for some “extra” money it had on hand at the time. When Myanmar was formally invited to participate in the NFM transition phase, the concept notes were redrafted. (Myanmar submitted three concept notes, one for each disease.) Some respondents said that the use of the 2012 concept notes as the basis for the country’s final submissions detracted from the spirit of country dialogue because much of the drafting had already been done.

Respondents from Myanmar also said that language barriers posed a challenge to the broad inclusion of civil society. While interpreters were present at some country dialogue meetings, none of the related documents were translated from English into Burmese.

Respondents from both countries noted that several aspects of the new funding model were confusing, including (a) the way in which the indicative and incentive funding streams worked; and (b) the use of a modular, web-based system for preparing the concept note. One person said that the use of the web-based system was not conducive to sharing drafts among the members of the writing teams because the system could not produce drafts in Word.

Content of the concept notes

OSF said that its findings concerning the content of the concept notes should be interpreted with caution because most of the people it interviewed had not seen the final version of the notes.

OSF said that the draft concept notes in both Zimbabwe and Myanmar included aspects of community mobilisation, community-based programming and community systems strengthening (CSS). In Myanmar, the Global Fund Secretariat specifically asked the country to include a human rights and CSS component, a request that was supported by UNAIDS.

According to one country-level Global Fund official, OSF said, the Fund’s Senior Human Rights Specialist also travelled to Myanmar in March to hold a workshop with civil society that included all nine national networks, as well as representatives of sex workers, persons living with the disease, MSM and transgendered persons.

OSF said that the Myanmar draft concept note contained the following CSS- and human rights–related activities:

• strengthening the support for antiretroviral (ARV) treatment adherence provided by peer counsellors;
• the creation of a community feedback mechanism to allow civil society to monitor the scale-up of, and access to, HIV and TB treatment; and
• policy and law reform to protect the rights of persons living with HIV.

The draft concept notes from Myanmar also included harm reduction activities targeting people who inject drugs, OSF said.

Respondents reported that the Zimbabwe concept note included community-based adherence support for patients on ARVs, as well as funding for community health workers and treatment buddies. It also included support for civil society monitoring of access to treatment.

One of the civil society representatives on Zimbabwe’s drafting team said that it was difficult to argue for the inclusion of CSS-related activities because other proposed activities were easier to cost and monitor. For this reason, this person said, if something had to be cut from the budget, the CSS activities were vulnerable.

Civil society respondents in both countries said that the PRs appeared to be negotiating directly with the Global Fund concerning the final draft of the concept note.

Respondents in both countries noted that data on MARPs is scarce. Respondents from Myanmar said that data on MARPS was included in the draft concept note in order to justify the proposed interventions, but that this data was outdated.

Recommendations

In its report, OSF recommended that the Global Fund develop clear guidance on the steps involved in country dialogue. It also recommended that technical partners produce a costed package of minimum services for CSS interventions and programmes aimed at MARPs.

Next steps

OSF told GFO that it is continuing to interview participants from Myanmar and El Salvador, and that it hopes to release a final report by the end of July. Persons who were involved in the country dialogues in these two countries, and who would like to participate in the survey, can contact Krista Lauer at OSF.

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Editor’s Note: The report of the Grant Approvals Committee on the concept notes approved for early applicants confirms that many of the elements described above were included in the final drafts of the notes. The concept notes from Myanmar included an expansion of harm reduction activities; and interventions targeting sex workers, MSM and people living with the diseases. The concept note from Zimbabwe included activities related to human rights, policy reform and CSS; and interventions targeting MARPs. (See GFO articles here and here.) However, it should be noted that final versions of the concept notes have not yet been made public, so we don’t yet have many details on the contents of the notes.

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The OSF report – entitled “Rapid Assessment of Local Civil Society Participation in the Global Fund to Fight AIDS, TB and Malaria’s New Funding Model: Preliminary Results, June 2013” – will not be posted. However, the final report will be posted on the OSF website once it is published.