Specific concerns spelled out
To achieve maximum impact, the Global Fund needs the full engagement of civil society (CS). However, CS has not been meaningfully involved in the critical decisions currently being taken by the Fund.
This was the view expressed by Nadia Rafif, one of the panellists at the session on "The Global Fund: The Next 5 Years" on 26 July at the International AIDS Conference in Washington. D.C. Ms Rafif is regional coordinator of the Civil Society Action Team for the Middle East and North Africa (MENA) Region, and executive director of L'association de lutte contre le SIDA, an AIDS service organisation in Morocco.
Ms Rafif said that CS is very concerned about the future of the Global Fund. "Gabriel," she said, addressing Global Fund General Manager Gabriel Jaramillo,
"you tell us not to worry, but we are all confused and we are all worried... Everybody is confused: we hear about the 55% rule or the 10% rule; priority countries; high impact interventions; abolishment of the civil society department; departure of more than 50% of the staff from the Geneva secretariat; a drastic reduction of the CCM unit, and so on... When we ask questions, we are told to wait, but time is running out."
Ms Rafif described four specific concerns of CS, as follows.
First, scaling back. The impact of the cuts in funding have been devastating. Programmes have been interrupted; countries are experiencing stockouts of antiretrovirals; and significant portions of national strategic plans are going unfunded. In addition, limiting the transitional funding mechanism (TFM) to continuation of essential services means that no new patients can be enrolled in treatment. "What could be more essential than getting new patients on treatment?"
Second, weakening of Global Fund structures that engage with CS. Disbanding the CS partnership team and gutting the CCM team will weaken CS communication and cooperation with the Secretariat. Joint efforts of the two teams were instrumental in bringing CS stakeholders into national decision-making and effective grant oversight. Having strong CCMs is critical. If the Global Fund's programmes are dictated from Geneva, the priorities will be wrong, there will be no country ownership, and implementation will be poor. The root cause of corruption and low programme performance is poorly functioning CCMs. "Gabriel, you tell us, 'Don't worry, the CCM function will be mainstreamed into grant management.' But this reassurance is too vague to be meaningful."
Third, the new emphasis on high-impact countries. What is going to happen to middle-income countries, with low general prevalence but with concentrated epidemics among key populations like men who have sex with men, sex workers, transgender people and injecting drug users? In the Fund's new paradigm, regions where concentrated epidemics are exploding - especially Eastern Europe, Central Asia and MENA - will go unfunded. "Despite the rhetoric, the key populations will be left out."
Fourth, the new funding model. CS is concerned that many governments are proposing a new model that abandons the demand-driven principle of the Global Fund and embraces hard caps or allocations on what countries or regions could receive. We believe this would be a disastrous mistake. Policies that restrict demand won't encourage country ownership, innovation and creativity, and flexibility. (See also Article 1 in this issue.)