Global Fund 2022 Performance
Article Number: 4
Global Fund 2022 Performance
The Global Fund achieved positive results on lives saved and financial and operational performance in 2022. However, disease incidence reduction progressed too slowly. While there were generally positive trends on key performance, indicators for resilient and sustainable systems for health final targets were not met for some of them. The OIG 2022 Annual Report warns that the confluence of many major global risks threatens the ability of the Global Fund to deliver on its mission against the three diseases. Attention must therefore be paid to the findings set out in that report. OIG has also drawn attention to the fact that inadequate risk assessment and prioritization of country level interventions have slowed progress in mitigating sexual exploitation, abuse and harassment. Also disappointingly, the Agreed Management Actions Progress Report shows a trend of increasing delays in AMA completion which poses risks for improved grant performance. Steps are needed to identify the reasons for those delays in order to take effective remedial action.
In 2022, the Global Fund launched its ambitious new Strategy 2023-2028. This represented a sea change in terms of the old way of working, written as it was long before the COVID-19 pandemic had had a devastating impact on reversing hard-won gains in HIV, tuberculosis, and malaria (HTM) and meaning a fundamental change to the way the Fund worked.
So the annual report on Community, Rights and Gender (CRG) starts by noting that, since the last CRG Annual Report, the world has continued to respond to the COVID-19 pandemic. This has necessitated shifts in how the Global Fund works and how it functions as a partnership, with a greater focus on pandemic preparedness emerging in addition to the continued urgency to respond ever-more effectively to HTM. Human rights and gender-related challenges, as well as deepening inequities within and between countries, have been exacerbated by the pandemic and efforts to control it, as has the need for strong and well-resourced community systems and responses.
At the same time, humanitarian crises ranging from Afghanistan to Ethiopia, from Myanmar to Ukraine, to the recent earthquakes in Syria and Turkey, further threaten the Global Fund’s community partners and put human rights, disease responses and lives at risk. The Global Fund is evolving its work to protect and advance human rights, gender equality and health equity, to be a champion for community leadership, and to further grow its work and partnership in these areas.
As the partnership entered the final year of its 2017 – 2022 Strategy and prepared to implement its next (2023 – 2028), the 2022 Annual Report reflected upon the progress that had been made and laid out the challenges that remain. With a view towards preparations to support implementation of the new Strategy, the report concludes with several matters which have been initiated, to varying degrees, to ensure that CRG areas are strengthened throughout the Global Fund partnership in the years to come. The report was structured around five mutually reenforcing areas which form the backbone of the Secretariat`s CRG portfolio: (1) Community leadership and engagement; (2) Community systems and responses (CS&R); (3) Human rights; (4) Gender equality; and (5) Key and vulnerable populations. The report provides a summary of the most significant highlights and critical challenges.
The Annual Report’s annex describes additional process and outcome details across these five areas. This includes country case studies on Nepal and Mongolia (Area 1 above), Greater Mekong and South Africa (Area 2), Cameroon, Cote d’Ivoire, Ethiopia and Uganda (Area 3), Ghana and Zambia (Area 4) and the Eastern Europe and Central Asia (EECA) region and Panama (Area 5).
Annua Report Highlights
Strong community engagement under COVID has continued
We are all aware of the pandemic’s far-reaching effects on the lives of communities living with and affected by the three diseases – from compromising the accessibility, quality and availability of core services, to exacerbating inequities and structural barriers and increasing human rights and gender-related risks. The strong engagement of and leadership by communities has contributed to significantly mitigating this impact. In the face of global and national challenges related to COVID-19 – notably around the increased human rights violations which aggravated many of the persistent bottlenecks faced by communities – the Global Fund notably supported scaling-up community-based and -led responses as core elements of a responsive and sustainable health system. This included a more intentional focus on community-led monitoring across all disease portfolios; the collection and use of data and evidence to inform programming and decision-making; and addressing the increase in gender-based and intimate partner violence.
Enhanced CRG-focused institutionalization
The Annual Report noted that progress had been made in embedding a CRG-related focus across the partnership’s work and processes. This ranged from strengthening inter-division coordination on adolescent girls and young women (AGYW) programming across different departments including Grant Management (GMD), CRG and Technical Advice Partnerships (TAP) to co-authoring the first State of inequality: HIV, tuberculosis and malaria report with the World Health Organization (WHO), to providing detailed cross-department input into the new Strategy. The Global Fund’s approach to and leadership in CRG-related areas has been more intentionally streamlined to improve impact.
The CRG and the Risk Departments collaborated closely in evolving the Global Fund’s approaches to identifying and managing gender- and human rights-related risks. Overall human rights work benefited greatly from strengthened cooperation across the Secretariat and strengthening partnerships with communities and civil society, technical partners, bilateral partners, foundations, and the private sector. A deliberate focus of the past year was ensuring that community engagement was more structurally embedded in the COVID-19 Response Mechanism (C19RM) requests and processes. For example, the mandatory requirement requesting all requests to include a list of community priorities has resulted in significant improvements in understanding the needs of most affected communities and provides a lesson for how core processes can be strengthened in the next allocation cycle.
The Secretariat ensured that the voices of communities from all regions across the partnership were included throughout the process of developing the new Strategy. As a result of this diverse input, the new Strategy has a more explicit cross-cutting focus on human rights, gender equality, equity, and an expanded role for community leadership through community-led monitoring, social contracting, and non-public sector service provision. Accordingly, the direction of the new Strategy puts greater focus on equity as an objective and addressing the structural determinants of HTM outcomes within each of the specific disease areas.
Despite achievements in addressing equity and rights-related barriers, persistent challenges remain and have been exacerbated by the COVID-19 pandemic. Many national responses remain inadequate, particularly for young women and girls and key populations who face added safety and security concerns. Through an improved understanding of the patterns of inequalities, equity can be promoted by increasing the availability of essential health services and interventions among groups at increased risk of infection or mortality across the three diseases. As part of the preparation for the next funding cycle, the Secretariat has to systematically ensure that it fully leverages its human, financial and political resources to address gender and rights related barriers to critical services, and that approaches to equity considerations are strengthened throughout the grant cycle, including innovative and wide-ranging partnerships (across the three diseases and Pandemic Preparedness and Response (PPR)) to address structural and policy barriers.
The Annual Report’s findings have been reflected in plans to make the Secretariat “CRG-ready”
Building on the CRG Annual Report, the Update to the Board, “CRG Ready”, started with reminding Board members about the heightened focus for CRG whereby the 2023-2028 Strategy puts people and communities in greater prominence.
Figure 1. Case for Change – the new Global Fund Strategy
However, the Secretariat freely admits, at the time of developing the Strategy the CRG Department and the Secretariat were not adequately resourced or set-up to deliver on this new ambition.
Case for Change
The Secretariat held consultations and undertook analysis to identify the most important thematic area and establish the keep gaps to working in these areas.
|Support model needs to evolve to meet demand from GMD and implementers||
Current model does not meet business need for hands-on investment support throughout the grant lifecycle to achieve grant targets and ensure compliance
CRG-led Strategic Initiatives not adequately integrated with investment support work
|Ways of working within CRG department need to be formalized to increase clarity in roles and responsibilities||
Current levels of resourcing do not adequately cover thematic areas critical to GF Strategy, particularly in emerging and evolving areas like Health Equity, Gender Equality, etc.
Inadequate capacity for thematic thought-leadership, partnerships, and key performance indicator (KPI) attainment and reporting across each key thematic area
|Ways of working with other departments need to be codified and enforced||
Lack of structural authority for the department has resulted in CRG department heavily relying on persuasion, trust-building and goodwill of internal stakeholders to influence the delivery on CRG priorities at country and global portfolio levels
|Engagement from rest of Secretariat on CRG-related areas||
Broader and consistent understanding and engagement from the rest of the Secretariat is needed on issues regarding Communities, Rights, Gender and Health Equity and recognizing their critical role in reduction in incidence and achieving positive health outcomes on HTM
The Strategy’s new structure was informed by 10 mini-Theories of Change, also referred to as levers. These key levers had informed the design of the CRG Ready ‘To Be’ structure with its five main pillars or strategies:
|Dedicated Investment support focus, with the aim of stepping up the level of implementation support provided at regional and country level throughout the grant lifecycle.|
|Enhance thought leadership and policy engagement across existing and new thematic areas with dedicated teams of advisors leveraging up-to-date guidance and advice, working in close collaboration with invited support advisors.|
|Elevated, purpose-driven partnerships approach to engaging existing ad new global and local partners on CRG-related and CRG-led strategic priorities, in collaboration and coordination with other relevant departments.|
|Strengthened measurement and monitoring capabilities, with increased focus on tracking and measuring progress made across the five CRG-led KPIs and Evaluations|
|Improved cross-Secretariat collaboration and capability building on critical CRG-related topics to ensure greater alignment within SIID , with GMD and the rest of the Secretariat|
The “CRG-Ready” new structure
The Secretariat will address CRG through the proposed new structure in Figure 2:
Figure 2. The new CRG structure in the Global Fund
The timeline for the structure to take effect is shown in Figure 3. It is expected to “go live” on 1 September 2023.
Figure 3. Timeline for implementation process
This article is based on GF/SC18/08 Community Rights and Gender Annual Report and the Board paper GF_B49_CRG Ready Presentation which will shortly be available at https://www.theglobalfund.org/en/board/meetings/49/.