L’ Initiative /Expertise France is more than ever at the side of those involved in the fight against tuberculosis in French-speaking Africa. Interview with Adeline Battier

Author:

Christian Djoko

Article Type:

Article Number: 2

This article features an interview with Adeline Battier of L’ Initiative /Expertise France, conducted during the regional meeting in Yaoundé, Cameroon from June 11 to 13, 2024, on advancing community, rights and gender for an equitable response to tuberculosis in Francophone Africa.

 Introduction and background

• If I had to introduce you in a few words, what would you say?

I’ve been in charge of projects at L’ Initiative since 2020, and I also take on the role of gender referent. I’m particularly involved in monitoring our partnership with Stop TB Partnership as part of The Accelerator – the new modality of L’ Initiative launched in 2023 that notably enables investment in neglected challenges in the fight against the three pandemics.

 

• Can you give us a brief overview of L’ Initiative /Expertise France and its role in the fight against tuberculosis in French-speaking Africa?

L’ Initiative is part of France’s contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In short, part of this contribution is directly allocated to L’ Initiative (implemented by Expertise France) to finance technical assistance and projects for the benefit of national programs, civil society organizations and research institutes – in addition to Global Fund grants in over 40 eligible countries. In terms of the fight against tuberculosis specifically, we have invested over €54.7M since our creation in 2011, almost 60% of which in West and Central Africa.

 

Since 2023, we’ve also been co-financing Stop TB Partnership’s Challenge Facility for Civil Society, as well as translating their tools into French.

 

• Why was it important for L’ Initiative to be present at the regional meeting “Advancing community, rights and gender for an equitable response to tuberculosis in Francophone Africa”?

 

L’ Initiative has been keen to support Stop TB since last year, in order to extend investments to benefit French-speaking African countries. It was therefore particularly important for us to be able to reaffirm our support and commitment at this regional meeting, for the first time in French, and particularly on the issues of communities, rights and gender.

 

 Community approaches and rights

• How does L’ Initiative /Expertise France integrate community, rights and gender-based approaches (CRG) into its tuberculosis projects?

 

Since its creation in 2011, L’ Initiative has always been committed to defending the rights of vulnerable populations in all its investments. In particular, we have an annual call for projects dedicated to vulnerable populations, which has enabled us to fund numerous projects targeting people particularly affected by tuberculosis, such as healthcare workers, prison inmates and people living with HIV. We also pay particular attention to gender equality issues in the projects we support, which we measure using the Organization for Economic Cooperation and Development (OECD) Development Assistance Committee (DAC) indicator.

 

What are the main barriers you have identified to the implementation of these approaches in French-speaking African countries?

 

The community, rights and gender (CRG) approach comes up against fairly classic obstacles to strengthening the healthcare system: lack of political will leading to a lack of investment, particularly domestic investment, low levels of knowledge about these issues, lack of coordination between the various national players (national programs, civil society organizations, research institutes and universities) – which is why this regional meeting is particularly important. It will create synergies, new alliances and new networks, enabling all participants to draw inspiration from what is being done in the region and elsewhere to break down the barriers to better tuberculosis care for all. The fight against discrimination and stigma must necessarily involve the communities and patients themselves, for example through the use of the OneImpact application.

 

Collaboration and partnerships

• Can you tell us how you work with the Global Fund, governments, non-governmental organizations, local communities and other global health initiatives to achieve your goals in the fight against tuberculosis?

 

All our actions are carried out in coordination with Global Fund teams, who are systematically informed of our investments and asked to give their opinion. We also work closely with national tuberculosis programs and national coordinating bodies, providing technical assistance for Global Fund funding applications and for the development of national tuberculosis strategic plans. Finally, civil society is at the heart of a large proportion of our investments, with a wide range of support: technical assistance, grants and dedicated schemes such as SOFIA CSO fund, which targets the smallest civil society organizations. We also work with the world of research to create greater synergy, as demonstrated by the Masterclass on tuberculosis organized last year in Yaoundé.

 

• What are the benefits of these collaborations in strengthening the fight against tuberculosis in the region?

 

The fight against tuberculosis will not be won if we don’t collaborate with all the players involved. We need to listen to the voices of communities and TB survivors, as well as those of researchers, government ministries and major international technical and financial partners. Every voice must count, including that of women, in the fight against tuberculosis.

 

Impact of the 2023 political declaration on tuberculosis

• How has the 2023 political declaration on tuberculosis influenced your strategies and interventions?

 

France is pursuing its commitment to the fight against tuberculosis through L’ Initiative, which is fully in line with the elements contained in the declaration: investment in research, support for the strengthening of health systems, notably through the training of human resources, support for national programs and civil society, to guarantee equitable access to prevention, diagnosis and treatment services for all, and to overcome structural inequalities, stigmatization and discrimination.

 

•  What concrete changes have you seen in the field following this declaration?

It is always difficult to assess the direct impact of a political declaration, but the presence of national programs from nearly 15 French-speaking African countries at this regional meeting is a fine testament to the growing commitment of a region that has been silent for too long in the fight against tuberculosis.

 

Assessment and follow-up

• How do you measure the impact of your tuberculosis projects and programs?

We have a specific approach to each project we fund, with dedicated monitoring and evaluation teams in addition to external evaluations carried out by consultants. We support project leaders at the time of grant contract negotiation, with the logical framework, but also throughout grant implementation. We also report to our steering committee on this point. We recently carried out a transversal evaluation of our investments in tuberculosis, which showed good results in reducing transmission. Nevertheless, this exercise also highlighted the fact that gender barriers were not yet fully taken into account in funded projects – an important point for improvement in the coming years.

 

• Can you share a few success stories or best practices from your projects?

First and foremost, we note the importance of screening as early as possible, by mobilizing community health workers to work directly with vulnerable and discriminated populations (including outreach strategies such as with prison populations). It should also be emphasized that the projects with the best results work systematically with national tuberculosis control programs. This has led to the adoption of certain strategies tested within national strategies, with the support of Global Fund grants. Finally, screening activities must be carried out at the same time as prevention, particularly among the relatives of infected people, in order to minimize the risk of transmission.

 

More detailed information is available on our website: https://linitiative.expertisefrance.fr/en/our-fields-of-action/tuberculosis/

 

The role of women

• During this meeting, the TB women movement was launched. How does this inspire you?

It’s a unique opportunity for the region’s women, especially tuberculosis activists, to make their voices heard. Tuberculosis is often seen as a male disease, as it affects men in the majority. But for this reason, women are proportionally less well diagnosed and therefore less well treated. Women also face discrimination, sometimes even from their partners. We mustn’t forget that women are also often responsible for their children’s health, even when their children are also affected by the disease. It is therefore crucial to give them a more prominent place in decision-making and advocacy bodies.

 

For many years, L’ Initiative has been committed to promoting gender equality and, more broadly, the gender approach in the projects it finances, with a strong priority given to interventions that aim to take into account the specific needs of women and men and of all key populations in the fight against tuberculosis, HIV and malaria. These efforts must continue.

 

• How does L’ Initiative /Expertise France support this specific group in its projects?

For the moment, the TB Women movement is just getting off the ground, but we could obviously consider supporting them in their structuring, notably through the Stop TB Partnership and our technical assistance mechanism (Expertise Channel).

 

Call to action

• At the end of this regional meeting, which was made possible thanks to your support, what opportunities do you see for improving health outcomes through your interventions?

Our support for the Challenge Facility for Civil Society has already enabled us to extend CRG subsidies to certain French-speaking African countries. We intend to continue this support. We also look forward to seeing how the French-speaking community will be able to take advantage of the tools recently translated into French and presented during the meeting.

 

• How do you see the fight against tuberculosis in French-speaking Africa evolving over the next few years?

Indicators for tuberculosis control in French-speaking Africa are not yet commensurate with the capacities of the partners with whom we have exchanged ideas over the past three days. We hope to see more alliances formed within countries, between civil society organizations and national programs, including outside the world of tuberculosis, but also at regional and international level. The fight against tuberculosis will necessarily involve all players in the healthcare system, including patients and communities. There are great prospects for this!

 

• What key messages would you like to convey to the various stakeholders (communities, CSOs, political decision-makers, financial partners, etc.) to strengthen the fight against tuberculosis?

I’d like to encourage them to forge new partnerships, to look beyond those specialized in tuberculosis: there’s a lot to be done in connection with HIV players, vaccination programs, anti-malnutrition programs or, more generally, programs working for the health of populations (including mental health and social integration).

 

Furthermore, taking into account human rights and gender is above all an opportunity to improve the quality of tuberculosis control programs. To achieve this, solutions will have to come from those involved in the fight against tuberculosis at national level.

 

• Is there anything else you’d like to add about the importance of this regional meeting and expectations for the future of tuberculosis control in French-speaking Africa?

Over the past few days, we’ve seen just how important the subject of CRG is for improving the fight against tuberculosis. This implies the effective participation of communities, patients and women in particular. I hope that this meeting has helped to convince even the most reluctant to forge new partnerships, and to encourage countries to invest more in the fight against tuberculosis.