A packed agenda for a workshop to prepare Anglophone African countries for the next Global Fund funding cycle
Maryline MirekuArticle Type:
Article Number: 6
Nonetheless, particpants felt they learned a lot
ABSTRACT The UNAIDS Techncial Support Mechanism, in partnership with the Global Fund and its co-sponsors, organized a workshop in Nairobi to prepare English-speaking countries in West and Central Africa and from East and Southern Africa for the upcoming submission of proposals for the Global Fund (2024-2026). Presentations and discussions were held on the experiences with the current allocation period and priorities and guidance given for the next funding cycle.
The Technical Support Mechanism (TSM) of the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with the Global Fund and UNAIDS co-sponsors, held a workshop in Nairobi from 17 to 21 October to share the latest technical guidance and best practices in HIV programming, gender and human rights, and community engagement.
The primary aim was to support country delegations and independent TSM consultants to prepare for the forthcoming round of Global Fund grant applications for the 2024-2026 period.
Attendees at the workshop included members of Country Coordinating Mechanisms (CCMs), Global Fund grant recipients and implementers, civil society organizations (CSOs), and consultants contracted by the UN system to support national teams in preparing their funding requests. The targeted countries were from West and Central Africa (Gambia, Ghana, Liberia, Nigeria, and Sierra Leone) and East and Southern Africa (Angola, Malawi, Mozambique, Namibia, Southern Sudan, Tanzania, Uganda, Zambia, and Zimbabwe).
The specific objectives of the workshop were:
- Ensure each country delegation and consultants are clear on the status of their HIV programs and agree on major gaps across the service cascade and what areas require priority investments.
- Ensure each country delegation and consultants are clear on what is new in this Global Fund application cycle and how it affects each country.
- Develop a common understanding of key technical areas that cuts across countries and practical strategies for addressing them based on lessons learned from countries.
- Develop greater awareness of the technical resources available to countries through all the stages of the cycle (in the form of tools, guidance, and technical expertise) at the regional and country level and how to access them.
- Provide countries with time and space to start reflecting on their Global Fund application requests, using the information and resources available during the five days of the workshop.
Best practices in the current Global Fund cycle (2020 -2022)
The recently published Technical Review Panel’s Obervations report 2022-2022 provided a synopsis of what had worked well and what required more effort in the current NFM 3 funding cycle.
Addressing human rights-related service barriers
Some countries had made progress in the reduction of human rights‐related barriers to HIV and TB services. The Global Fund’s Breaking Down Barriers (BDB) initiative launched in 2017 had supported some countries in developing such programs. The National AIDS Commission of Sierra Leone had rolled out a BDB-supported program and described how it applied multi-sectoral engagement to reduce stigma and discrimination in HIV and TB service provision for key and vulnerable populations (KVPs). Stakeholders engaged included community members, health service providers, government officials, law enforcement, religious institutions, and local media. Specific strategies involved included sensitization on human-rights-related barriers to services, policy advocacy, and programs on stigma and discrimination reduction, as well as support to CSOs. Another BDB country, Mozambique, described how its CSO LAMBDA (Mozambique Association for Sexual Minority Rights) advocated for revising the HIV strategy and national guidelines for the HIV response for KVPs.
Regarding enhancing community-led responses, Ghana reported that it had developed a policy on social contracting. Although the policy is yet to be implemented, the government, via the AIDS Commission, has contracted CSOs to deliver health services to KVPs. Zimbabwe is also practicing social accountability in the same manner as Ghana, although it reported facing challenges such as limited resources to fund CSOs and CSOs’ inadequate capacity.
Concerns about the current Global Fund cycle
Some countries raised concerns about the sub-optimal commitment of their governments, especially towards COVID-19 and co-financing. They were encouraged to include this concern in their forthcoming applications as the advocacy part of their policy advocacy efforts.
Countries also questioned the apparent inflexibility of the Global Fund’s grant administration processes which failed to allow for country contexts to be taken into account. Several countries complained that some expenditures were flagged as ineligible by the Global Fund due to its failure to recognize the impact of country contexts; for example, making payments via mobile phone to KPs in Sierra Leone was a challenge since recipients were required to provide additional identification that the program was unwilling to disclose without jeopardizing recipients’ confidentiality.
Discussions were held on Global Fund consigning countries to Challenging Operating Environments (COEs) status. The Global Fund has a COE Policy, and once a country receives COE status, the Fund is expected to guide the effectiveness of grant administration. While this guidance is country-specific, the countries called for the need for the Global Fund to develop a generic roadmap that can guide countries to transition out of COE status.
The process of selection of sub recipients was also discussed. It was generally felt that it took longer than expected and stakeholders involved in the process were encouraged to improve their efficiency in this area. Some countries also failed to prioritize CSOs and other community-led organizations in the allocation of funding; for example, CSOs in Angola were reportedly facing difficulties in accessing funds despite the government lifting an initial limitation that barred them from access to such funding.
The application process and priorities for the Global Fund 2024-2026 Cycle
Participants were informed that overall the application process for the upcoming cycle had not changed significantly with the exception of a few changes in the annexes, which required some new guidance documents to be included, and some details of the application form. The workshop facilitators took participants through a guided tour of the Global Fund website page for funding applications, pointing out where to access documents and other application guidance materials.
Countries reported the need for more support with their data needs. Such support was needed for countries to assess where they are in their national HIV response and articulate how best to fill the gaps using the application mechanism.
Alignment of data reporting in-country was seen as an essential factor for the upcoming cycle. There was a concern that some countries would struggle to report on some indicators since the existing sources of information were insufficient. There were reports of outdated population census data, for example, in Namibia and Southern Sudan. Other missing data include gender and human rights data and KVP data. Countries reported the need for baseline data collection for missing information, for example, Knowledge Attitude Practice (KAP) studies, especially to provode the evidence base to scale-up services and programs.
The Global Fund said that it is striving to align its data methodology to country data methods and processes. Further, the Fund representative mentioned that it was also developing plans with the US President’s Emergency Fund for AIDS Relief (PEPFAR) to enhance data alignment at the global reporting level.
UNAIDS encouraged delegates to refer to the UNAIDS Condom Needs Assessment Tool to efficiently estimate condom needs at the national level. The tool provides estimates of the national target of condom quantities and can disaggregate needs by populations and programming needs.
The workshop’s presenters also stressed the need for HIV prevention within countries to be scaled up, especially pre-exposure HIV prophylaxis (PrEP), and most countries committed to including this in their applications.
Human rights and gender
The Global Fund recognizes that effective responses to HIV, TB, and malaria are affected by human rights and gender barriers. Countries were encouraged to ensure that their applications focused on removing gender and human rights barriers. There were calls for services to be inclusive for KVPs and strive to eliminate inequities. The gender and human rights session presenters informed participants that the Global Fund had developed a new Gender Equality Marker (GEM) that will be used to assess gender mainstreaming in applications. They were encouraged to access the UNAIDS Gender Assessment Tool (GAT), designed to inform Global Fund submissions on national HIV responses and gender.
Discussions on human rights and gender also focused on integrating the UNAIDS 10-10-10 targets in applications. These ambitious targets call for less than 10% of countries to have punitive legal and policy environments that deny or limit access to services, less than 10% of people living with HIV (PLHIV) and KPs to experience stigma and discrimination, and less than 10% of women, girls, people living with HIV, and key populations experiencing gender inequality and violence. The 10-10-10 targets were discussed as necessary for providing an enabling environment for people to access services, especially vulnerable populations.
Countries had some process-specific questions which they were encouraged to follow up with their Fund Portfolio Manager; for example, there was a question about whether a country should provide its procurement plan prior to receiving its Allocation Letter.
Stakeholder engagement was emphasized as necessary in the next funding cycle. It was identified as a “living” and ongoing process that went beyond the mere engagement of stakeholders in prioritization of activities for the forthcoming grants. Indeed, the Global Fund was keen to ensure that there would be evidence that stakeholders are engaged throughout the life cycle of the grants and not just at the grant preparation stage.
Participants continued to raise concerns that some countries did not prioritize funding for community-led organizations. According to the Global Fund, its expectations for the forthcoming applications were that these would prioritize community engagement and empowerment, as embodied in the new Global Fund Strategy. National HIV responses need to focus on KVPs with terminology such as woman-led, PLHIV-led, KP-led, and Youth-led. To support the development of community-led responses, countries were encouraged to utilize data from community consultations and dialogues, allocate sufficient funding for community-led interventions and prioritize community systems strengthening activities.
To kick start the application process, countries will begin their country dialogue processes. These have already been planned in some countries, and some have reportedly already started the process. The participants were encouraged to reach out to UNAIDS-TSM and the Global Fund for technical support in their applications. The week’s agenda was packed and although some workshop attendees raised concerns about its intensity, the organizers managed to deliver all the agenda items. Participants reported appreciating the experience-sharing and guidance given in the workshop and felt more prepared for their applications.