Developing Country NGO Delegation: Insights from the 51st Global Fund Board Meeting
Author:
George Njenga Kiai
Article Type:Article Number: 4
The 51st Global Fund Board Meeting, held in Geneva from April 22-24, 2024, addressed crucial issues impacting global health, particularly in developing countries. This article summarizes the main feedback and highlights presented by the Developing Country NGO delegation, emphasizing their concerns and proposals for advancing global health initiatives.
Introduction
The Developing Country NGO (DCNGO) delegation, is a stakeholder in the Global Fund and “works to strengthen the engagement of civil society actors and organisations in developing countries to contribute towards achieving its vision which includes living in a world in which AIDS, TB and malaria are no longer global, public health and human rights threats”. The 51st Global Fund Board meeting in Geneva, held from April 22-24, 2024 was attended by ten DCNGO members, namely, Elie Aaraj (new member), Ángela León Cáceres (new member), Sophie Dilmitis (Focal Point), Carolyn Gomes who attended the Board meeting in her official governance capacity as Vice-Chair of the Strategy Committee, Hristijan Jankuloski, Anushiya Karunanithy, Andriy Klepikov, Yolanda Paul (Alternate Board Member), Cecilia Senoo (Board Member), and Joseph Wato.
The Board meeting underscored the evolving challenges facing the Global Fund partnership, focusing on realigning priorities in light of a review of the allocation methodology and the overarching goals of the 8th Replenishment. Despite progress in addressing HIV, TB, and malaria, growing authoritarianism, hostile legal environments towards human rights and gender equality, and shrinking space for civil society pose significant threats to public health gains. Additionally, the global health landscape is marked by increasing poverty, conflicts, and political instability, further complicating efforts to provide essential healthcare services. The DCNGO delegation called for collective action and strategic reorientation to address these issues effectively, stressing the urgency of adapting to a complex, multi-dimensional crisis.
Strategic Performance and Risk Management
The Strategic Review 2023 highlighted good performance in key indicators, but challenges remain in ending the three diseases by 2030 and meeting Sustainable Development Goals (SDGs). While service delivery and resilient and sustainable systems for health (RSSH) have rebounded well post-COVID-19, concerns persist with human rights programming and HIV key populations indicators (Summary of the Strategic Performance Report 2023-2028). The delegation stressed the need for the Global Fund to lead a response to punitive laws and growing policy restrictions that undermine human rights and gender equality, impacting public health outcomes. They advocated for higher impact interventions and greater inclusion for key populations, such as transgender people, people who use drugs, and prison populations, emphasizing gender equality and addressing issues like cervical cancer and gender-based violence. The delegation also called for continued communication to countries about the critical importance of these efforts.
Sustainability
The discussion on the Global Fund sustainability, transition, and co-financing policy (STC) (which we have covered in Sustaining Sustainability) highlighted the need for a multi-stakeholder approach and shared responsibility. The delegation emphasized the importance of not compromising on the principles of ending HIV, TB, and malaria and ensuring that public financial management efforts, such as the 3ONEs (One Plan, One Budget, One Report), adhere to these principles. They expressed concerns about the potential risks of shifting focus from these diseases to broader national health plans, which might deprioritize human rights and gender equality. The delegation highlighted the necessity of documenting what has worked well in the STC policy and identifying areas for improvement to better support countries transitioning away from Global Fund assistance. They also underscored the need to maintain the involvement of all stakeholders, including civil society and communities, in the sustainability planning process.
Allocation Methodology
The allocation methodology discussion revolved around the Global Disease Split (GDS) and its implications for resource distribution. The delegation supported revising the GDS to favor TB, citing the Stop TB Partnership’s justification and scenarios for such changes. They advocated for a person-centered approach to allocation, recognizing that HIV, TB, and malaria often occur together and require integrated interventions. The delegation emphasized the need to scale up catalytic investments to support community, rights, and gender initiatives, ensuring that the allocation reaches all people in need.
Resource Mobilization
The delegation raised concerns about the timing of the 8th Replenishment and the need for a robust Investment Case demonstrating the impact of investments in communities, key populations, civil society, human rights, and gender equality. As of December 31, 2023, 28% of 7th Replenishment pledges and 96% of 6th Replenishment pledges had been paid in cash, indicating good progress in pledge conversion. The delegation stressed the importance of continuing efforts to meet global health commitments and not being constrained by ‘realism’ in fundraising and resource allocation. They also highlighted the need for effective positioning, advocacy, and communication to mitigate fundraising risks in a volatile external landscape.
Collaboration with GAVI and Global Financing Facility
The collaboration between the Global Fund, Gavi, and the Global Financing Facility (GFF) (A Transformative Partnership) was discussed, with the delegation emphasizing the need for clear terms of reference and inclusive representation. The four workstreams launched in October 2023 (Malaria, Health Systems Strengthening, Country Engagement, and Enabling Functions) are part of this collaboration, which aims to enhance coordination and impact. The delegation called for regular reviews to optimize the impact of this collaboration and ensure it aligns with the Global Fund’s vision and principles. They also stressed that the collaboration should be integrated into the existing Global Fund governance structure and adhere to selection processes that reflect inclusive representation, including civil society and communities.
The Lusaka Agenda
The Lusaka Agenda, aimed at accelerating country-led progress to Universal Health Coverage, was critiqued by the delegation for its lack of community engagement and ambiguity on human rights and democratic principles. While the Lusaka Agenda implies enhanced collaboration with other Global Health Initiatives (GHIs), it imposes a much broader scope, which doesn’t align with the Global Fund’s 2023-2028 Strategy to end HIV, TB and malaria with communities at the center. The delegation noted that the Lusaka Agenda was conceptualized without adequate input from communities and civil society, and it lacks a clear strategy for engagement. They urged the Board to reaffirm its commitment to ending HIV, TB, and malaria with communities at the center, ensuring equitable representation and accountability. They also called for clarity and direction to the Secretariat to avoid overextending their mandate beyond the agreed vision and principles of the Global Fund and ensuring that as a Board we honour our duty of care to fulfilling the Global Fund Strategy.
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Quality Assurance Policy for Vector Control Products and Related Equipment and Procurement Policy
A new quality assurance policy for vector control products and related equipment was approved, aligning with WHO standards and other Global Fund policies. The policy includes reliance on WHO’s Prequalification Programme, establishment of an Expert Review Panel, post-market surveillance, and risk-based approaches for handling quality-related issues.
An updated procurement policy was also approved. This policy sets out principles for procurement to ensure it achieves value for money, is aligned with public procurement principles, and supports the organization’s strategy implementation effectively.
Conclusion
The DCNGO delegation’s feedback emphasized the need for inclusive, human rights-based approaches and strategic investments to achieve the Global Fund’s goals. Their active participation and proposals at the Board meeting underscore the importance of civil society and community engagement in shaping global health policies. Moving forward, the delegation’s insights and advocacy will be crucial in ensuring that the Global Fund remains committed to ending HIV, TB, and malaria, while promoting human rights and gender equality in global health initiatives.
