It might surprise you to learn that challenging operating environments account for a third of the global disease burden for HIV, TB, and malaria, and a third of Global Fund investments. (For malaria alone, the proportion is 50%.) This makes COEs particularly critical to the Fund’s mission and objectives.
At its meeting in Abidjan on 26-27 April, the Board adopted a policy on COEs.
The Global Fund defines COEs as countries or parts of countries or regions characterized by weak governance, poor access to health services, and man-made or natural crises. The policy classifies COEs based on countries with the highest external risk index (ERI) level in the Global Fund portfolio and allows for ad hoc classification to enable rapid responses to emergency situations. Classification as a COE is the first step towards potentially accessing the approaches and flexibilities described in the policy.
(The ERI is a composite index developed by the Secretariat. It is derived by compiling data from 10 authoritative published indices highlighting economic, governance, operational, and political risks in a country. The ERI is updated on an annual basis.)
The policy states that when operating in COEs, The Global Fund aims to increase coverage of HIV, TB and malaria preventive and therapeutic services, to reach key and vulnerable populations, and to save lives. It also aims to build resilience through stronger community and health systems, and to address gender-related and human rights barriers to services. During emergencies, the scope of Global Fund investments may be more limited, aiming to provide continuity of treatment and essential services for people affected by the three diseases, as well as to prevent and contain outbreaks.
Global Fund financing in a COE is generally provided through that country’s allocation. The relevant grants may be reprogrammed to respond to the crisis. During emergencies, the country allocation may be complemented by financing from the Emergency Fund.
In emergencies where there is significant cross border displacement, funds may be drawn from the allocations of more than one country.
The Secretariat will develop an operational framework to implement the new policy. As well, country teams operating in COEs will be strengthened to ensure they possess adequate experience and expertise in COEs. Finally, a COE Support Team will be established in the Secretariat to provide guidance to the country teams operating in COEs. In addition to ensuring a coordinated approach across COEs, the support team will document best practices and share learning experiences, monitor and report key risks, build partnerships at global level and facilitate partnerships at country level.
Certain flexibilities will be available to The Global Fund when it operates in COEs. This could include extending the length of existing grants; accepting applications under a non-CCM approach; waiving some requirements during the application process; adjusting targets, activities and budgets; and using third parties to manage the supply chain.
The policy affirms that national and global partnerships play a central role in COE situations. The policy states that linkages with health, logistics, protection, gender-based violence, and other clusters and sectors will be strengthened to improve coordination and foster integrated approaches during emergencies. Clusters consist of humanitarian organizations, both U.N. and non-U.N., working in specific areas, such as providing water and delivering health services.
When feasible, the Global Fund will support civil society organizations and communities to implement programs. It will also work towards greater involvement of private sector providers, particularly in settings where public health services are primarily provided by the informal sector.
The Challenging Operating Environments Policy, Board Document GF-B35-03, should be available shortly at www.theglobalfund.org/en/board/meetings/35.