Generally speaking, work to implement the third objective of the Global Fund Strategy 2017-2022 – to promote and protect human rights and gender equality – is making steady progress, although the majority of the sub-objectives have experienced what the Global Fund calls “minor issues and delays.” These issues can be attributed in part to a lack of resources and insufficient internal capacity on human rights issues.
This is the third in a series of articles chronicling progress on implementing activities to achieve the objectives of the Strategy. As previously described, a report was presented at the Board meeting on 14-15 November in Geneva, Switzerland. For each sub-objective, the report described the progress achieved to date, as well as key challenges and risks, and future plans. In addition, the report identified the key performance indicator (KPI) tied to each sub-objective. In most cases, full reporting on the 2017-2022 KPI Framework will not be available until early 2018.
An article in GFO 325 provided a general overview of progress to date related to the first strategic objective, “Maximize Impact Against the Diseases.” Progress towards the second objective – “Build Resilient and Sustainable Systems for Health” is described in a separate article in this issue.
Examples of progress and challenges related to the third objective are summarized below under the five corresponding sub-objectives:
- Scale-up programs to support women and girls, including programs to advance sexual and reproductive health and rights.
- Invest to reduce health inequities, including gender- and age-related disparities.
- Introduce and scale-up programs that remove human rights barriers to accessing HIV, TB and malaria services.
- Integrate human rights considerations throughout the grant cycle and in policies and policy-making processes.
- Support meaningful engagement of key and vulnerable populations and networks in Global Fund related processes.
For space reasons, we have had to be selective about which examples we include.
Scale-up programs to support women and girls
Thirteen countries are eligible for matching funds for adolescent girls and young women (AGYW) (see GFO article). MOUs have been negotiated with UNICEF and the World Health Organization (WHO), whereby each organization will provide technical support to priority countries among the 13 countries. Four of the 13 AGYW countries submitted their funding requests in the first funding window (20 March 2017), which was only a few months after the start of the new Global Fund Strategy and the approval of the Community Rights and Gender Strategic Initiative (CRG-SI). There was limited time and capacity, therefore, to adequately mobilize civil society. The Global Fund has established an AGYW learning group to address bottlenecks and gaps in technical assistance.
In addition, the CRG-SI has launched a meaningful engagement fund of $500,000 for organizations led by and for women and girls in the AGYW priority countries in 2017-2018 (see GFO article). The fund will be jointly managed by the Southern African AIDS Trust and the Eastern Africa National Networks of AIDS Service Organizations, and will be supported by two AGYW Advisors recruited to the Grant Management Division.
Also, a private sector engagement campaign around HIV programs for AGYW has become the HER (HIV Epidemic Response) campaign. A collaborative initiative involving the communications, CRG and private sector engagement departments in the Secretariat, the HER campaign will include several events leading up to its official launch at the World Economic Forum 2018 in Davos.
Invest to reduce health inequities, including gender- and age-related disparities
Gender-related issues have taken on renewed importance at the Secretariat. Gender-related initiatives have been embedded into the human resources’ portfolio of projects and tracked closely. For example, there are now gender components included in staff on-boarding, learning and leadership training. A comprehensive gender audit will be conducted next year.
Also, there is now a framework to conduct a global analysis of gender-related barriers and risks related to TB and TB services. At the time of the report, four gender assessments had been completed and the Stop TB Partnership had mobilized additional funds to support at least seven more before the end of 2017. The assessments are conducted by technical partners at their own pace in accordance with their capacity. It is expected that a global review of these surveys will highlight trends to inform programmatic interventions by early 2018.
The Global Fund has also developed a draft accountability framework on gender. The framework still requires further consultation with internal stakeholders before it is finalized. A first report will be shared in the first quarter of 2018.
Lastly, there are two initiatives underway to provide better analysis of incidence. A new age- and sex-disaggregated model for gender responsive programming is being proposed by Avenir Health (formerly Futures Institute). At this stage, a comprehensive review of the evidence and efforts to fill any gaps is still required for validation. Planning for country-level meetings to review incidence figures to align with the new model is also in progress. Moreover, a mapping of incidence indicators for females aged 15 to 24 is being conducted, with a grant review of AGYW programs planned for 2018.
Introduce and scale-up programs that remove human rights barriers to access
Tools have been finalized to conduct baseline studies in 20 human rights priority countries. With the exception of the study in Kenya, which has been held up due to turmoil surrounding elections, all studies will be completed before the end of 2017. However, due to delays in securing funding for baseline studies and delayed recruitment, the drafting of many five-year plans and planning for multi-stakeholder meetings has also been pushed back and will, in most cases, happen in early 2018.
Also, work has been initiated to identify challenges and opportunities to scale up and sustain programs to reduce human rights–related barriers to service in countries where transition is imminent.
Additionally, the Global Fund finalized and disseminated three technical briefs that were posted on its applicant resources web page to drive greater investment in human rights programming. A brief on HIV, gender equality and human rights was launched in collaboration with UNAIDS and shared in webinars. Further dissemination is planned.
It is worth nothing that limited knowledge and ownership of human rights at the Secretariat has been a key challenge, particularly around understanding what programmatic interventions are necessary to decrease barriers. Further training activities with country teams are planned to address this.
Integrate human rights considerations in the grant cycle and in policies and policy
Terms of reference are being developed for a comprehensive review of human rights in Global Fund policies and processes. A review of the current human rights complaints procedure is being finalized with follow-up activities planned for 2018. Again, resourcing for this work has been identified as a challenge by the Secretariat.
Support meaningful engagement of key and vulnerable populations and networks
The CRG-SI is now up and running and a three-year expenditure forecast has been completed. Consultants have been hired and suppliers have been selected for all three components of the initiative – namely: short-term technical assistance, long-term capacity development, and the regional coordination and communication platforms. The CRG has begun supporting the deployment of technical assistance in response to country requests.
Additionally, a number of activities have targeted key and vulnerable populations. Four in-country consultations have been organized by global constituency-led key population networks – i.e. the Network of Sex Worker Projects, the MSM Global Forum, the International Network of People Who Use Drugs, the Global Network of Trans Women, and HIV/Action for Trans Equality. The consultations enabled local key population groups to have much-needed discussions on program barriers using HIV key population implementation tools as a benchmark to develop advocacy plans to scale up human rights–based services for these groups. The report highlights the need to ensure that the outcomes of these consultations actually inform grant-making.
The Global Fund has also tried to strengthen engagement through a series of actions targeted at 29 country coordinating mechanisms (CCMs) – all located in high impact and core countries – with the lowest performance scores for CCM engagement on the CCM performance appraisals. These actions have resulted in a 43% improvement in engagement among CCMs that have reported their progress to date.
Lastly, the Global Fund undertook work specifically to strengthen communities affected by TB and malaria. The TB work has centered around strengthening governance within the Global Coalition of TB Activists and supporting the network to either establish relationships with other networks or foster the establishment a regional network of people affected by TB – as well as provide capacity development activities to help communities advocate for a better TB response.
For malaria, four organizations receiving awards under a CRG-SI pilot program have completed their work. This includes the delivery of the “Malaria Matchbox: A Toolkit to Shed Light on Human Rights and Gender-related Barriers, Match Responses to Needs, and Ignite Action in the Malaria Response.” An external project review has been carried out and will inform future efforts to support malaria-related activities through the CRG-SI.
The report also identifies a few issues, primarily related to training and capacity building, that do not fit neatly within the sub-objectives in the strategy but rather cut across Objective 3. The Global Fund has developed modules on community, rights and gender in multiple languages. They are available online and have been included in the CCM orientation and induction process for CCM members in several countries (see GFO article). Uptake of the online modules has been slow; there is a plan to further promote the modules before the end of the year. Due to a lack of resources and a heavy emphasis on grant-making, the CRG department has not been able to conduct full country-level pilot testing of the modules.
In addition, community, rights and gender issues have been integrated into the Secretariat’s training program on sustainability and transition.
Board document GF-B38-11 “Update on the Implementation of the 2017-2022 Strategy,” should be available shortly at www.theglobalfund.org/en/board/meetings/38.