COMMUNITIES AND HUMAN RIGHTS MUST BE AT THE CENTER OF THE NEXT GLOBAL FUND STRATEGY
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Download PDF The next Global Fund Strategy must put into practice the current principle of a greater involvement of civil society and communities in decision-making and implementation. Without the leadership of communities and civil society, together with strong and resilient community systems, we cannot end HIV, tuberculosis (TB) and malaria. Leaving communities and civil society behind will further prevent them from responding…
Article Type:Article Number: 5
More than lip service is needed to put human rights and communities at the heart of the Global Fund’s work
ABSTRACT In this opinion piece, NGO Delegations from Developing and Developed Nations call on the Global Fund to put communities and human rights at the center of the next Global Fund strategy. The Delegations emphasize the need for increased investments, strong leadership of communities and civil society and stronger community systems.
The next Global Fund Strategy must put into practice the current principle of a greater involvement of civil society and communities in decision-making and implementation. Without the leadership of communities and civil society, together with strong and resilient community systems, we cannot end HIV, tuberculosis (TB) and malaria. Leaving communities and civil society behind will further prevent them from responding effectively to health emergencies and global pandemics such as COVID-19.
The Global Fund’s strategy for 2023 and beyond can only be successful if communities and civil society are treated as equal partners and given the space and resources to lead the response to the three diseases. While the current Global Fund Strategy ensures that civil society and communities are involved in decision-making and implementation in principle, the next Global Fund Strategy must focus on how this principle will be put into practice to make this a reality.
As part of the consultation process to gather inputs on the focus, priorities and direction of the next Strategy, three regional consultation meetings, commonly known as Partnership Forums, attended by civil society, communities, government, academia and private sector, are taking place in the next month. The Global Fund has planned three regional Partnership Forums. The Regional Forum for Eastern Europe and Centra Asia (EECA) was combined with that for the Latin America and the Caribbean (LAC), and took place between 9 and 11 February 2021. The Forums for Africa and the Middle East and North Africa (MENA) regions will take place between 17 and 19 February 2021, while the Asia and the Pacific Forum will take place on 3-5 March 2021. With the Forums having moved to a virtual modality, it is more important than ever to ensure that the priorities of civil society and community are at the center of the next Strategy.
Editor’s Note: The launch of the 6th Partnership Forums is reported on later in this issue; and issue #394 next month will contain articles reporting back on the discussions and recommendations of the three Regional Forums.
Communities and human rights must be central in the next Global Fund Strategy
Without strong community leadership and people-centered systems, we cannot dismantle structural barriers, bend the curve on HIV, TB and malaria incidence or get the Sustainable Development Goals back on track. The next Global Fund strategy must steer all partners from lip-service to action. It must guide all partners to take the steps needed to reduce inequity, promote human rights, and guarantee the involvement of communities and civil society at every level and in all situations, including in times of emergency, pandemic or challenging operating environments.
Invest more in community systems and civil society
Strong community systems are vital for preventing and responding to HIV, TB, malaria and other infectious diseases. In the face of COVID-19, communities around the world have demonstrated their resilience and ability to sustain essential services, including developing innovative and effective approaches.
To tackle current levels of under-investment in community systems and civil society, the Global Fund should ensure that community systems strengthening (CSS) is a requirement and prioritized in future funding cycles. In addition, the Global Fund must provide clear guidance to countries on what can be funded with these resources and ensure these funds are not deprioritized or added as unfunded quality demand (UQD) during grant making. This was clearly stated in the TRP review of Window 2. Funding for community systems is often included in the Prioritized Above Amount Request (PAAR) rather than prioritized in the main allocation. As there is no guarantee PAAR will be funded, community systems are effectively deprioritized.
The Global Fund could make available a proportion of CSS money for building the capacity and resilience of community organizations and a fund could be created specifically to mentor and support the next generation, especially the diversity of young people affected by the three diseases, to lead the future response.
Civil society and communities effectively monitor the implementation of Global Fund grants and increase transparency and accountability among policy-makers and partners. Communities play a critical role in tackling human rights violations and other barriers that prevent key populations from demanding and using health systems. Unfortunately, community-generated data have not been given sufficient consideration to inform subsequent programming and funding decisions.
The Global Fund’s reviews of community-led monitoring and thematic reviews of community health programs reinforce the value and impact of investment in CSS. The overarching finding from the published thematic review of community health investments in five countries published in January 2021 was that a diverse range of community programs can combine effectively with formal health care provision to improve results significantly. The review reinforced the positive value of advocacy and accountability interventions, as well as activities designed to reduce human rights-related barriers. Fieldwork revealed consistent positive feedback on these interventions from managers, health care providers, community cadres and service users on the roles played by community health programs. Accountability efforts such as community-led monitoring and local consultative committees showed an important contribution and should be considered part of a comprehensive community program.
In the development of the next Strategy, the Partnership Forums and the Global Fund should reflect critically on why the Global Fund’s existing partnerships and financing models have so far failed to sufficiently increase investment in, and accelerate progress on, community and civil society leadership of the response, and equity, human rights and gender equality.
Support local organizations to implement community programs rather than international ones
To ensure community-led service delivery, dual-track financing, which encourages countries to include Principal Recipients (PR) from both the government and non-government sectors in each disease proposal, should become a requirement rather than a recommendation.
Dual-track financing guarantees resources to civil society and communities, and strengthens community leadership and ownership – which are critical to sustainability. Where possible, resources should go to local non-government organizations (NGOs) instead of repeatedly supporting the same large international NGOs. In contexts where the local capacity is alleged to be missing, an independent assessment should be conducted and a time-bound roadmap for capacity development of local organizations should be developed and implemented to facilitate the transition to localized ownership. In addition, fully functioning and inclusive Country Coordinating Mechanisms (CCMs) should lead the identification of non-government PRs.
Strengthen human rights, gender and equity
To uphold the core principles of human rights, gender equality and equity, the Global Fund must take more forceful and comprehensive action towards eliminating related barriers in all aspects of its work. The next Strategy must focus on removing structural and systemic barriers which requires greater investment in civil society and community systems; longer-term programs; and rethinking of transition processes. The Global Fund should leverage its resources to support the decriminalization of key populations and other major barriers, and introduce measures to hold all partners accountable for delivering on community leadership and human rights objectives.
Particpants in the recently held EECA- LAC Partnership Forum rated human rights and gender as the weakest area of the Global Fund, with a rating of 2.3 out of 10, the lowest score of any of the areas (to be further elaborated on in the forthcoming article in issue #394 next month). The participants recommended the need to redouble efforts to address equity, rights, gender and other structural barriers.
Regional and multi-country grants, in particular, are highly valued by civil society organizations as a way of addressing these structural barriers. Such investments enable civil society and key populations to overcome opposition from CCMs to address challenging issues such as removing legal barriers through litigation, legal reform and tackling gender-based inequities. Multi-country grants such as Key Populations Reach (in the Middle east Region), Harm Reduction Advocacy in Asia (HR Asia), Shifting Social Norms and Removing Legal Barriers have successfully strengthened the capacity of communities to overcome barriers to treatment through addressing social norms, attitudes and legal barriers. Such investments have created spaces for key populations to engage decision-makers and allowed for the development of regional strategies and policy guidance with clear monitoring frameworks. The investments have also strengthened regional and sub-regional institutions and their accountability mechanisms, built an evidence base on creating an enabling environment, facilitated a south-south learning of good practice and, by so doing, galvanized the national-level responses and addressed gaps in national delivery, among other responses. The next Global Fund strategy should support greater and longer-term investment in regional and multi-country grants necessary for addressing structural barriers to prevention and treatment. This will further strengthen the role and independence of civil society organizations to ensure accountability across all levels.
Community and civil society engagement and leadership of the response, and the focus on human rights, equity, gender and the most vulnerable populations, have been identified as areas of strength and comparative advantage for the Global Fund. However, the reality is that existing funding and partnership models have prevented the Global Fund from delivering to its full potential in these two areas. The next Global Fund Strategy will only succeed if communities and the human rights they are entitled to are front and center in the next Global Fund Strategy.
* The Developing Country NGO and Developed Country NGO delegations to the Board of the Global Fund are voting constituencies that represent NGOs from countries that are eligible for Global Fund grants and those that are not, respectively.
For more information on the delegations please contact Lesley Odendal (l.odendal@developingngo.org) for the Developing country NGO delegation or Kataisee Richardson (kataisee@yournextconsultant.com) for the Developed country NGO delegation.
