According to a new report, children may still not be prioritized under the new funding model. Released by Aidspan, the report highlights the results of an analysis of 22 concept notes submitted to the Global Fund and grant agreements (usually referred to as grant confirmation forms under the NFM) signed between the Global Fund and 16 principal recipients. The report is available here (listed under Recent Reports).
In its Strategy 2012-2016: Investing for Impact, the Global Fund committed to strengthen content relating to maternal, newborn, and child health (MNCH) in proposals. However this analysis reveals that child-related interventions in relation to HIV may still be underrepresented within HIV concept notes.
The study examined the inclusion of 47 key child- and adolescent-related interventions within concept notes. The list of interventions came from a review of scientific papers and guidelines on this topic. The interventions were classified into five broad elements:
- prevention of mother to child transmission;
- pediatric treatment, care and support;
- adolescent prevention, treatment, care and support services (including the adolescent key population groups);
- laws and policies to reduce vulnerabilities and increase access to HIV services; and
- addressing gender based violence.
Representation of child-related interventions was generally low; 45% of the concept notes contained less than 10 of the 47 interventions. Five percent contained none of the interventions.
According to a recent report by UNICEF, the number of AIDS-related deaths among adolescents has tripled over the last 15 years. Despite the large number of children transitioning into adolescence without knowing their HIV status, less than 40% of the concept notes in the study included provider-initiated HIV counseling and testing targeting children in immunization clinics, outpatient clinics and pediatric wards.
According to UNICEF, a majority of adolescents have no access to prevention interventions. This is consistent with the findings in this study where 27% of the concept notes reviewed did not contain any of the adolescent key interventions. Interventions targeting adolescents in the each of the areas of HIV testing and counseling, antiretroviral therapy, family planning, and voluntary medical male circumcision were included in less than 30% of the concept notes.
A review of grant agreements revealed that 87% had child-related indicators. However, a majority of the indicators included children only as part of the broader age groups. Half of the grant agreements had an indicator on provision of ART for pregnant women, while none had indicators on distribution of condoms, family planning for women living with HIV, infant feeding counseling or capacity building of health care workers.
It is not possible to determine from the concept notes and grant agreements the specific budget amounts allocated to children. However, our analysis revealed that funding for crucial interventions, particularly for the adolescents, was, in some instances, requested in the above-allocation portion of the concept notes. These included promotion of youth friendly services in health services; combating gender-based violence, early marriage, and intergenerational and transactional sex; providing economic support to orphans and vulnerable children; offering family planning counseling services; scaling up pediatric ART; and providing in- and out-of-school youth programs.
(The above-allocation portion of the concept note contains interventions that are not covered by the allocation to the country and that would only be financed if additional funding were to become available.)
The Aidspan study revealed gaps in child HIV programs. Some of these gaps were highlighted during the 2015 Global Fund partnership forums aimed at providing guidance and input for the development of the Global Fund Strategy 2017-2022. The stakeholders called for increased focus on gender, human rights and key populations including during transition planning. They recommended more focus on gender issues, advocacy and support for the introduction of laws that enhance the rights of women and girls.
The stakeholders also highlighted the need for quality disaggregated data and incentives to motivate human rights and gender-based funding and also gender-specific interventions. They also recommended the development of key performance indicators (KPIs) to measure gender outcomes for women and girls. Finally, they said that gender-based violence should be addressed through the concept notes and programming within the countries.
As the Global Fund comes up with their new strategy 2017-2022, there is need for more focus on children HIV programming. The Global Fund needs to push for more MNCH content in the concept notes. Data is also required to assess the impact of Global Fund on HIV in children. Countries should also use the opportunity provided in drafting concept notes to scale-up child-focused interventions.