Global Fund report to civil society organizations calls for paradigm shift

Author:

Aidspan

Article Type:

Article Number: 8

This article analyzes the complex relationship between the Global Fund and civil society organizations (CSOs) in the field of health, particularly in the fight against the three major pandemics. While enabling many CSOs to develop by providing them with substantial funding, the Global Fund has often used these organizations as levers to achieve its own objectives, without always contributing directly to their structural strengthening. Today, CSOs are at a crucial turning point, and must evolve to continue to meet the needs of vulnerable populations, enhancing their community-based approach and advocacy capacity. The Global Fund, for its part, must review its practices to support the sustainability and autonomy of local CSOs, notably by adapting its funding methods, introducing flexibility measures and promoting partnerships with other donors.

Context

For over 20 years, the Global Fund (GF) has been a major player in the field of global health. Its contribution to the fight against the 3 diseases no longer needs to be proven, and its partnership model has led to the emergence of numerous local players, including civil society organizations (CSOs). Placed at the heart of decision-making through their participation in local governance bodies (national coordinating bodies, CCMs) and international bodies (3 delegations on the Global Fund Board), they are the exception in an aid system whose governance is mainly devolved to States, or reduced to a minimum for reasons of presentation.

 

The Global Fund’s propensity to engage stakeholders echoed the movement for patients, particularly those living with HIV, to take charge of their own health, becoming experts and agents of change. For over 20 years, civil society organizations have taken part in the Global Fund’s major discussions and strategic decisions, and have benefited from funding to implement prevention, promotion and linkage-to-care programs, as well as support to structure their action. It was mainly HIV organizations that began this partnership, followed much later by TB and malaria organizations. Today, in all the countries where the Global Fund has financed programs, civil society organizations have emerged and structured themselves around the fight against the three pandemics, and have demonstrated the undeniable added value of their action in strengthening the healthcare system and access to care.

 

However, there are many reasons for CSOs to reflect on their future and question their raison d’être and sustainability beyond the fight against the 3 pandemics:

• The One Health concept, which links human and animal health, and takes into account the environment and climate change that affect many populations, particularly in the poorest countries;
• The repositioning of a large number of financial backers around this concept and, more generally, an integrated vision of healthcare that places the patient at the center and provides accessible and diversified services that reflect the needs expressed;
• Anticipation of a stagnation or decline in available funding from the Global Fund, the central donor for CSOs fighting the 3 pandemics.

 

It is against this backdrop that we propose to reflect on new strategies to support the sustainability of CSOs and their natural evolution, to which the Global Fund can make a major contribution.

 

How civil society organizations project themselves

Civil society is an essential component of a plural society, which accepts the wealth of ideas and diversity of viewpoints. A civil society whose vitality is intact is both a counterweight to the State, an important voice in public debate, and the manifestation of a civic commitment to solidarity and concern for one’s fellow man.

 

Maintaining an active and independent civil society is an ongoing effort, particularly in countries where power is concentrated in the hands of a small portion of political and administrative personnel. In the current context of growing conflict, political instability, deteriorating purchasing power and public services, and the accelerating effects of climate change, CSOs have a central role to play:

• They carry the voice of the voiceless, those who are stigmatized, discriminated against, left behind because of their poverty, their lack of access to education and basic services, and whose demands are rarely heard;
• They question their governments on the proper use of public money, the quality of public services and demand the transparency necessary for the rule of law to function properly;
• They themselves provide services on behalf of users in need, adapted to situations of discrimination and stigmatization, and complement the efforts of the State;
• They act as whistle-blowers on issues that are intentionally or unintentionally overlooked by public authorities, and which require an institutional response.

 

To be able to play this role, civil society organizations need a stable organizational and financial structure, to support activism and recreate social ties.

 

What role can donors, in particular the Global Fund, play?

The Global Fund is developing an instrumental vision of its relationship with civil society, which it sees as an agent of change that improves the environment for vulnerable and key populations, and facilitates access to people who are discriminated against and stigmatized. The Global Fund also relies on CSOs to advocate for the mobilization of domestic resources, and to hold the state accountable for the proper use of funds. However, the Global Fund does not appear to support the strategic development of CSOs, nor their long-term structuring, beyond the requirements it places on the proper management of the funds it entrusts to them.

 

While some donors, such as Expertise France, have developed a long-term approach and a flexible relationship with CSO partners and technical assistance recipients, the Global Fund sets rules that make collaboration difficult and destructure CSOs. For example, local and international civil society organizations are not treated equally. Certain management fees are accepted for international NGOs, but not for local organizations.

 

To rise to the challenges facing civil society, the Global Fund must be willing to open up the debate and take decisions on:

1. Supporting the sustainability of CSOs through the systematic granting of management fees: the primary need of CSOs is to ensure their financial and organizational sustainability in order to support a long-term strategic project. It is essential to fund key positions in resource mobilization, external partnership management, finance, management control and internal audit. So is the installation of efficient management systems, as well as good governance processes (dynamic associative life, planning and capitalization of actions). However, unlike other donors (USAID, Expertise France), the Global Fund does not pay management fees to local CSOs, creating an unacceptable double standard with international NGOs. It’s time to review the rules and grant management fees to all local CSOs, as PR, SR and SSR need to develop and diversify their funding in order to avoid an organizational crisis that many organizations have already experienced when a single donor withdrew.
   

2. Supporting CSOs’ strategic thinking: for those wishing to take stock of their added value and achievements, and to reflect on the next 10 years, the Global Fund must support this strategic evolution, to ensure the structure’s sustainability and adaptation to the challenges of the future. While CSOs have long served the Global Fund’s strategic objectives by focusing on the fight against the 3 pandemics in a win-win relationship, the Global Fund must now help CSOs to evolve, just as it has repositioned part of its investments towards RSS by supporting new players. GF grants must include medium-term support for repositioning CSOs in today’s civil society landscape.
   

3. The search for multi-donor partnerships: these partnerships could enable the long-term strengthening of civil society and a new kind of collaborative commitment between major donors. Strategic initiatives, one of which is dedicated to community involvement and associative networks, as well as grants from Grant Cycle 8 should include an envelope to support the structuring of CSOs, and these actions should become a catalyst for other donors wishing to join the initiative or traditionally committed to supporting civil society (Expertise France, GIZ, USAID, ENABEL).
   

4. A relaxation of management rules to enable CSOs to operate according to their tools and not be subject to Global Fund decisions. The Global Fund must stop agreeing with Principal Recipients on the positions to be financed for each Sub-Recipient and Sub-Sub-Recipient, as well as salaries, without taking into account existing salary scales, and stop imposing management tools that sometimes contradict existing procedure manuals and monitoring-evaluation systems already in place. The Global Fund must return to a modus operandi that leaves CSOs the flexibility to organize themselves as they wish in order to carry out their mission, while respecting their sovereignty and expertise, as long as the rules of good management are respected.

 

More generally, a rebalancing of the relationship between the Global Fund and local CSOs, which goes beyond an instrumentalist vision of civil society to support it in a way that respects its rules, will be a prerequisite for sustaining the efforts already underway to help CSOs grow.

 

The dangers of the status quo

If the Global Fund does not change its approach, it will be guilty of encouraging CSOs in a trend that will be detrimental to them: almost total dependence on its funding, incoherent management torn between processes copied from donor requirements (which sometimes contradict each other), hyper-specialization in the fight against 1 or 2 diseases for which funding is decreasing, and the running out of steam of their action, which will no longer respond to the issues and challenges of current crises to which civil society can contribute.

 

If the Global Fund fails to recognize the fragility of this system, it runs the risk of wiping out many of the organizations it has helped to bring into being over the last 20 years. With them will disappear good practices in community involvement, useful services for the population, and a healthy counterweight to the political and health authorities.

 

The Global Fund is considering the transition, and how to guarantee the sustainability of its action. Local CSOs are an essential element of this sustainability, and a guarantee that the action of this loyal donor over the past 20 years will endure over time. CSOs need to focus discussions on their future, and not just on the technical skills required to continue providing services (notably through contractualization with the State) to vulnerable groups. They are ready to lead this reflection and expect the Global Fund to make its governance bodies (Strategy, Audit and Finance, Ethics and Governance Committees, Board of Directors) available so that these requests materialize in resolutions that will eventually be applied by the Secretariat.