Civil society was involved extensively in the development of the concept note that El Salvador submitted to the Global Fund. This is one of the findings from interviews that GFO conducted with five people involved in the process, and from a review of related documents.
El Salvador was one of three countries that have been awarded funding in the transition phase of the new funding model (NFM). El Salvador was awarded $23.1 million for its HIV programmes (see GFO article). The country dialogue and concept note development process in El Salvador was described briefly in a GFO article here. This article provides more details.
El Salvador currently has two single-stream-of-funding (SSF) HIV grants. When Round 11 was launched, the El Salvador CCM began preparing a proposal. At that point, El Salvador had already updated its National AIDS Plan. The CCM undertook a small process of consultation that was abruptly interrupted by the cancellation of the round.
Then, in or around September 2012, the CCM began preparing a request for continued funding for the next implementation period of the SSF grants. The CCM initiated a process of consultation with affected populations – specifically, people living with HIV and men who have sex with men (MSM), both of whom were already represented on the CCM.
These consultations were already underway when the CCM received the invitation to participate in the transition phase of the NFM. According to some of the people interviewed for this article, the invitation was accompanied by a strong message from the Global Fund: A significant part of the project (i.e. at least 50% of the funding) had to go to activities that benefit three key affected populations – transgendered persons, MSM and sex workers.
After receiving this message, the CCM added representatives of these key populations to its Proposal Committee (which had been established to work on the requests for continued funding.)
The concept note development process consisted of three stages: (1) the country dialogue; (2) the work of the Proposal Committee; and (3) the work of the Editorial Committee.
With the support of its technical partners, the CCM hosted two very large meetings with different stakeholders. Called, “inter-sectoral meetings,” each one brought together more than 120 people, about 80% of whom were from civil society. The purpose of the meetings was to obtain the input of different populations and sectors regarding (a) their needs; and (b) the objectives and activities they thought should be included in the proposal. These were brainstorming sessions; no attempt was made to filter out suggestions which may not have been feasible or which may not have been pertinent to the nature of the epidemic in El Salvador.
“The result of the inter-sectoral meetings was a wish list,” commented Guadalupe de Castaneda, a member of the International Community of Women (ICW) in El Salvador, and a participant in the dialogue. “People could say whatever they thought.”
Most at-risk populations were included in the country dialogue. This was a very new experience for transgendered persons and sex workers, who hadn’t participated actively in the development of previous proposals.
Each population group was able to select the people that attended the country dialogue meetings. In the case of sex workers, since they had no national network, all four of the country’s sex worker organisations were invited. Since El Salvador is a very small country, it was not necessary to pay for hotel accommodation because people could come from their cities and return the same day after the meeting finished. Cost of transportation and food was covered by the organisers.
The information collected was discussed at the second stage of the process, by the Proposal Committee. This was where the proposal was shaped. The Proposal Committee discussed the feasibility and pertinence of the activities that emerged from the country dialogue, along with evidence that supported each proposed activity. This process involved constant negotiations. Participation in the Proposal Committee afforded the representatives of key populations an opportunity to participate in programme and budgeting discussions. A financial expert was on hand to help with the budget part.
The Editorial Committee was in charge of the actual writing of the proposal. It had regular communications with the Proposal Committee in order to request further information about a suggested activity, evidence to support it, or bibliographic references. No representatives of key populations participated directly on the Editorial Committee.
Content of the concept note
According to the people we interviewed, the participation of key populations led to the inclusion in the draft concept note of some activities that otherwise might have been neglected. One example of this was the decision to include promotion of an identity gender law. This is very important for the transgender population because, currently, they cannot obtain an identity document that says that they are transgender (or even where the photo suggests that they are transgender). Other examples are: (a) strengthening of health facilities (through training and infrastructure improvements) to treat transgendered population and sex workers; new infrastructure for community centres serving mainly MSM; strengthening of national groups of key populations; and food and nutrition support for persons living in HIV who could not afford these items.
“The inclusion of these activities, and others, were the result of long negotiations,” said a representative of the CCM secretariat. “We had to discuss what was possible to be done and what would help to stop the epidemic,” the representative added.
It should be noted that the people we interviewed had not seen the final proposal. A meeting to “present” the final approved proposal will be held on 25–26 July.
Editor’s note: The final concept note has not yet been posted on the Global Fund website. However, we noted in a recent GFO article: “When it reviewed the concept note, the TRP [Technical Review Panel] asked for several clarifications. When the GAC [Grant Approvals Committee] reviewed the concept note, it recommended that the funding allocation for PMTCT be reviewed and that the government be asked to finance a greater share of this programme; that more of the cost savings from efficiencies be directed towards prevention in key affected populations; that more funding be allocated to improving quality of care for persons living with HIV; and that more be done to improve the quality of epi data.”
People involved in the preparation of the concept note told GFO that it was not really any easier than preparing a proposal under the rounds-based system. The template may have been shorter, they said, but the amount of information required was not much different. The word limits on the concept note form meant that the CCM had to include a number of attachments in order to provide all of the information requested.
The people we interviewed said the concept note was prepared completely by Salvadorians, and that this was a matter of some pride. In the past, foreign consultants helped the country to prepare the proposals and little transference of knowledge happened; this time was different and all organisations involved in the country dialogue process have gained experience.
Young people participated in the process – their leaders were involved in the inter-sectoral meetings and some negotiations after that – but they were not able to influence the content of the draft proposal. The main reason is that because the epidemic is concentrated in specific groups, the evidence did not support activities focused on the general population. However, the people interviewed said that they will keep pushing for initiatives to address young people.
Although some human rights–related activities were included in the concept note, some participants were concerned that the Office of the Ombudsman was not involved in the development of the concept note.
None of the people we interviewed used the term “country dialogue” and only one used the term “concept note.” Most people just used the term “consultation.” This may indicate that at the country level, there is still not a very good understanding of the NFM process.
Editor’s Note: This is the first GFO article written by Lídice Lopez, our new regional correspondent for Latin America and the Caribbean. Lídice is based in Lima, Peru. Lídice collaborates with the International HIV/AIDS Alliance on its Corresponsales Clave (Key Correspondents) Initiative.