First look: the new Global Fund Strategy Narrative
Article Number: 2
But will partners end up with indigestion from too many cooks spoiling the broth?
ABSTRACT The Global Fund’s endorsed Strategy Framework has now been translated into the draft Strategy Narrative. The Global Fund Observer has obtained a copy of the internal document, which is not for external circulation, and describes its content and aspirations.
In a sneak preview of the Global Fund’s new draft Strategy Narrative, Aidspan has been able to see how the Strategy Framework, developed and endorsed after lengthy and extensive consultations with the various stakeholders, partners, and constituencies, has been fleshed out.
While this is an internal document and not for external circulation, we can provide you with an overview of what to expect. And our regular readers will be familiar with the exhaustive and inclusive process of developing this Strategy through our earlier articles, listed at the end for ease of reference. We have listened to the voices of the various stakeholders, the controversy surrounding pandemic preparedness and response (PPR), and the dissatisfaction of some implementer partners. How have the tensions, demands, and battle lines drawn between the different factions been reflected in the Narrative to ensure that no one is left out or left behind? Has this been translated into a cohesive and comprehensive Strategy Narrative? Well, one has to sympathize with the Secretariat and the Strategy Steering Committee: it cannot have been an easy task, and it is impossible to please everyone.
And if you do manage to struggle to the end of the 46 pages of Strategy Narrative, your first and overriding feeling may well be of someone who has just eaten a very rich dinner. By trying very conscientiously to be all things to all people, this Strategy Narrative is hard to eat and harder still to digest.
Unpacking the Strategy Narrative
Navigating the Strategy
The first four sections of the draft Narrative set the scene for the Strategy. They start by summarizing what to expect and explain how the Strategy is laid out. They go on to describe the Strategy development process and then the global context within which the Strategy will have to deliver its programs; the global targets, progress and challenges, and those of each disease. The fourth section stresses that communities are at the centre and how the Global Fund is working with and to serve the health needs of people and communities.
Section five onwards describes: (i) the Strategy’s mission and vision; (ii) the primary goal of the Strategy which remains the same as previously ― to ‘End AIDS, TB and Malaria’; (ii) what the Strategy calls four ‘Mutually Reinforcing Contributory Objectives’; (iii) the fifth ‘Evolving Objective: Contribute to Pandemic Preparedness and Response’; (iv) ‘Partnership Enablers: How We Work’; and finishes with (v) ‘Implementation, Performance and a Call to Action’.
The first nine sections are well developed, but the final section on Implementation seems to be incomplete.
The context shaping the new Strategy
The Global Fund introduces its new Strategy by congratulating its diverse partners (implementer governments, civil society, technical partners, development partners, the private sector, and people and communities affected by the three diseases) for almost 20 years of increasingly successful work in saving innumerable lives from the three diseases of HIV, tuberculosis (TB) and malaria (HTM).
However, it recognizes that the milestone of the 2030 Sustainable Development Goals (SDGs) is fast approaching and that the world is not on track to end the three diseases. Moreover, nearly two decades of gains have been set back by COVID-19. The Global Fund now finds itself battling a new pandemic whose impact on the fight against HTM has been overwhelming.
The Global Fund’s response to this difficult environment has been to develop an extremely ambitious Strategy which, it feels, is the only way to level the playing field. It hopes that through this Strategy it will regain earlier momentum and restore the lost achievements, address the new challenges arising from COVID-19 and strengthen its mandate to improve the health and well-being of people and communities, thus putting the world back on track to meet the SDG targets.
The Global Fund’s vision and mission
|2023-2028 Strategy Vision
|A world free of the burden of AIDS, tuberculosis and malaria with better, equitable health for all
|2023-2028 Strategy Mission
|To attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria, reduce health inequities and support attainment of the Sustainable Development Goals
The Strategy states that the Global Fund’s main intention is to accelerate progress to end the three pandemics, including through a focus on incidence reduction and innovations, and putting people and communities at the heart of its work. This emphasis on a more overtly people-centred approach has been a continued focus of deliberations on the Strategy Framework over the past 18 months.
The Strategy Narrative follows the structure of the already endorsed Strategy Framework
In order for the Global Fund’s primary vision of ending the three diseases to be achieved, the Global Fund emphasizes ‘four mutually reinforcing contributory objectives that explicitly leverage the core strengths and comparative advantages of (the Global Fund’s) unique partnership’. These are:
- Maximizing People-centred Integrated Systems for Health to Deliver Impact, Resilience, and Sustainability.
- Maximizing the Engagement and Leadership of Most Affected Communities to Leave No One Behind.
- Maximizing Health Equity, Gender Equality, and Human Rights.
- Mobilizing Increased Resource
This last objective actually underpins the first three and as such is a cross-cutting objective, as can be seen from Figure 1 below. It is also reflected in the Mission statement above, demonstrating the increased importance of its role.
The Global Fund chose these objectives because it feels they best reflect the major efforts required to strengthen health systems and push for increased disease-specific and broader health impact. Having identified obstacles impeding progress, and again based on extensive stakeholder consultations, the Strategy focuses on addressing health inequities, gender inequalities, and human rights barriers to services. Likewise, the Global Fund has added a new objective on strengthening community engagement and leadership to be responsive to meeting the needs of those most affected.
Figure 1. 2023-2028 Global Fund Strategy Framework Overview
The Full Strategy Framework including an overview of sub-objectives is available on the Global Fund Website here.
The Global Fund’s principal goal of ending ATM is described in three individual sections (Figure 2).
Figure 2. Global Fund Strategy’s Goal and Sub-Objectives by Disease
This is followed by sections on each of the four mutually reinforcing contributory objectives.
Figure 3. Mutually reinforcing contributory objectives and crossing-cutting sub-objectives
As the figures above show, the goal and objective sections each contain the sub-objectives that were approved by the Global Fund Board as part of the Strategy Framework:
- Under each of these sub-objectives, there is a description of the key areas of work that will be taken forward by the Global Fund partnership in support of country-owned programs.
- At the end of each overarching goal and objective section is a description of the roles and accountabilities of the Global Fund partnership’s actors, listed in alphabetical order. These roles and accountabilities are specific to the sub-objectives in the respective sections and are intended to complement the overarching description of the roles and accountabilities of all stakeholders in the partnership also described within the section on Partnership Enablers.
Accelerating progress to end the three diseases and achieve better, equitable health for all
Amid a rapidly evolving global health climate and changing health priorities, the Global Fund wants to ensure that its new Strategy maintains the vision on which it was founded, that of fighting HTM. The Strategy emphasizes that this is why the Global Fund was created and what it will ultimately be judged for in the future while acknowledging that there is still a lot to be done. The Strategy notes that this will not happen without supporting the ‘catalytic and people-centred’ investments in HTM needed to reduce disease, address structural barriers, and save the most lives.
The evolving fifth objective of ‘Contribute to Pandemic Preparedness and Response’
The Strategy acknowledges that it has to address the biggest threat of the current global health environment with a new objective that contributes to the Global Fund’s core capacities to strengthen HTM programs and systems for health to withstand new pandemics, as well as to adapt to challenges such as climate change.
In fighting HTM, and to protect the gains of the last two decades, the Global Fund feels it has no choice but to continue its recent support, through the COVID-19 Response Mechanism (C19RM) in 2020 and 2021, to help countries contend with the existing COVID-19 pandemic as well as be better placed to tackle future health threats of a similar magnitude. Accordingly, the new Strategy introduces what it calls an ‘evolving objective’, Contribute to Pandemic Preparedness and Response (PPR), to leverage the Fund’s unique expertise and partnership model to protect HTM programs, build more buoyant systems for health, and better prevent and respond to future pandemics.
Figure 4. The evolving objective of ‘Contribute to pandemic preparedness and response’ and sub-objectives
This ‘evolving objective’ and its placement have been the single biggest issue causing dissent and disharmony, with people taking a passionate stance either ‘pro’ or ‘anti’ the inclusion of the objective at all, let alone where it sits in the Strategy Framework.
The Global Fund defends the inclusion and positioning of PPR because, it says, pandemics ‘are the largest infectious disease threats to the people and communities we serve at the heart of this Strategy’.
The importance of increased attention to health financing
As overseas development aid to health budgets shrinks while the richer countries battle the pandemic’s impact on their own economies, poorer countries are left fighting an even more unequal war with health systems that are already struggling to cope with HTM, and disruptions to key services including antenatal care and other priority health programs. Mobilizing more financial resources to mitigate the pandemic’s impact and finance investments in health, including domestic resources, is a very clear priority for this proposed Strategy.
The Global Fund paved the way for the new Strategy’s increased emphasis on health financing by establishing a standalone Health Financing Department earlier this year, which is also working on advocacy for increased domestic financing for health.
Through the new Strategy, the Global Fund hopes to reorient HTM programs, making significant investments in strengthening people-centred and integrated systems for health, maximizing the engagement and leadership of most affected communities, and enhancing health equity, gender equality, and human rights. These efforts will heighten the effectiveness and sustainability of HTM programs and generate broader improvements in the health of people and communities. Successful delivery of these aims will depend on the effective mobilization of international and domestic resources in the context of unprecedented fiscal challenges stemming from the COVID-19 pandemic.
Renewed and greater emphasis on partnership
Increased efforts to leverage more financial resources for HTM and COVID-19 mean, in turn, that the Global Fund partnership model will have to be the focus of renewed action and collaboration.
Country ownership is critical to the success of the Global Fund model, with all partners playing their individual and harmonizing roles. Implementer governments are responsible for delivering strong, equitable health systems and disease programs that respond to people’s and communities’ needs, Civil society, technical partners, development partners, the private sector and the Secretariat are responsible for playing their own distinctive role.
Figure 5. The new Strategy’s Partnership Enablers
The Strategy notes that effective collaboration between partners is critical to address core barriers to impact and scaling up new and proven approaches to end the three diseases. In this way, the Global Fund partnership will be able to recover the recently lost gains, prepare for and fight both old and new infectious diseases and pandemics, and equitably serve the health needs of people and communities. The Strategy Narrative, therefore, lays out the roles and accountabilities of all partners for realizing these aspirations, including the areas of intensified partner focus required to achieve collective goals in a rapidly changing environment by 2030.
And unlike previously, this Strategy has explicit roles and responsibilities to drive accountability for shared results.
What makes this new Strategy different from the old Strategy?
|What remains the same
The primary goal of the Global Fund is still to end AIDS, TB, and malaria.
What is different
The Global Fund says that there is so much that is different that providing an exhaustive list would be repetitive. However, it provides ten examples of aspects that will change the work of the Global Fund partnership:
The timeline for the remainder of the Strategy’s development culminating in its presentation to the Board in early November is as follows:
|Distribution of Draft Strategy Narrative to Board and Strategy Committee (SC) (deadline for input 10 September)
|Board information and feedback call on draft strategy narrative (SC invited to observe)
|Deadline for submission of comments by constituencies/SC on Draft Strategy Narrative
|11 to 21 September
|Secretariat considers written input and develops Strategy Narrative for submission to the SC for recommendation to the Board (under Board Leadership/SC Leadership steer)
|Distribution of draft Strategy Narrative to SC for recommendation to the Board
|27 September (date TBC)
|Strategy Committee pre-call on strategy narrative
|5 to 6 October
|17th Strategy Committee Meeting:
For recommendation to the Board: Global Fund Strategy (Narrative)
|Distribution of decision document to the Board on the Global Fund Strategy
|19 October to 8 November
|Engagement with constituencies on Strategy Narrative including pre-board call
|Deadline for submission of constituency statements
Deadline for submission of any amendments (48 hours before the start of the Board meeting)
|8 to 10 November
|46th Board meeting
If you think it sounds complicated you are right: it is. The 46 pages of the Narrative are not an easy read. By wanting to make all stakeholders happy, the Strategy appears convoluted.
Yet the Global Fund must also be commended for attempting the herculean effort of reflecting the various viewpoints and the impossible feat of trying to be all things to all people. But this Strategy will be challenging to implement and even more so to measure. The old adage of too many cooks spoiling the broth certainly rings true here.
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