A workshop attended by representatives of networks of men who have sex with men (MSM), and other Global Fund stakeholders, has produced a series of country work plans designed to “assert the voice of key populations in country coordinating mechanisms (CCMs)” throughout the Middle East and North Africa region (MENA).

“The most important outcome of the workshop, in my view, was the work plans that participants developed,” said meeting co-organizer, Zakaria Bahtout of the Marrakech-based International Treatment Preparedness Coalition-MENA, or ITPC-MENA, host of the Fund’s MENA Regional Coordination and Communication Platform. “They will be a kind of road map that will guide them to have more impact on the work of CCMs,” including the development of funding requests and oversight of program implementation. The country work plans, which are owned by the organizations who attended the workshop, were careful to consider the particulars of each country’s CCM membership, and the funding request’s application type, scope, and timeline (i.e. anticipated submission window).

The workshop, part of a larger effort to strengthen the engagement of key population networks in Global Fund grants in the MENA region, was held in Marrakech, Morocco on 19 and 20 December 2016. It was co-hosted by ITPC-MENA, M-Coalition – a fairly new network of MSM organizations in MENA – and the Global Forum on MSM and HIV (MSMGF). The MENA Regional Coordination and Communication Platform, a component of the Community, Rights and Gender Strategic Initiative, which is hosted by ITPC-MENA, developed a strategic partnership with M-Coalition and, jointly, they convened the workshop.  Participants included MSM advocates and CCM members from Algeria, Egypt, Lebanon, Mauritania, Morocco and Tunisia.

According to the meeting organizers, the goal of the workshop was, “to support key population leaders and organizations in the MENA region to engage with and make the best use of the Global Fund or other relevant funding opportunities to support their country-level programming.” The workshop facilitator, Canadian Global Fund veteran and independent health and development consultant Michael O’Connor, led the group through sessions on understanding and engaging with Global Fund processes, such as country dialogue, funding request development, grant-making, grant implementation and program monitoring.

“The emphasis was on equipping specific key population representatives and getting them up to speed on Global Fund processes. But having CCM representatives was also very helpful, as they are direct entry points for follow-up back in their respective countries,” said Nadia Rafif, an ITPC-MENA board member, MSMGF’s policy director, and a meeting co-facilitator.

The exchange among CCM members was a key added value of the workshop, according to M-Coalition’s Executive Director Elie Ballan. “In my opinion, the most important outcome of the meeting was the sharing of experiences of CCM representatives among each other. Being a representative of a key population on a CCM has its own obstacles, from having one’s voice heard and input taken into account, all the way to defying stigma surrounding one’s position. Thus having CCM members explain their experience and how they dealt with different situations [helped advocates see] better ways to raise concerns and key issues in CCM meetings.”

“Although … there were representatives of MSM and people living with HIV at the workshop, it would have been even more impactful to also have representatives of other key populations and more countries working with the Global Fund, as that would have given a deeper perspective and further discussion to examine and learn from more case studies from the region,” noted Mr Ballan.

Next steps

Mr Bahtout, the workshop co-organizer, felt good about the fact that the meeting accomplished its objectives. He indicated that many of the MSM representatives described themselves as ignorant about the Global Fund at the beginning of the meeting, but left feeling “enabled to get more involved in all negotiations related to the Global Fund and their CCMs.”

At the end of the workshop, representatives of each country made commitments to specific actions they would take once they got home, in the form of the country work plans.  Commitments included reporting back to local civil society and key population stakeholders, and their CCMs, on what was learned at the Marrakech meeting; finalizing and implementing the country work plans they developed; and ensuring the participation of key populations in upcoming CCM meetings and funding request development processes. The work plans, which are owned and implemented by the country-level organizations themselves, will all be finalized and activated by the end of the first quarter of 2017.

For its part, ITPC-MENA, as host of the Regional Communication and Coordination Platform, reiterated its mandate to “provide support to all civil society organizations in the region to access technical assistance regarding Global Fund processes as needed.”

Barriers to working in MENA region surface

Although the workshop was a generally positive experience for those in attendance, some of the major challenges of working in the region were evident even before the workshop began.

“One problem is the under-representation of certain countries in the region which face extraordinary challenges, leaving them isolated from these kinds of dialogues,” said Ms Rafif. For example, participants from Syria, Palestine, Yemen and Iraq were unable to attend, due to ongoing political and military conflicts in those countries, and the resulting barriers to international travel for residents. Ms Rafif added that some invited participants from Sudan and Egypt were unable to attend because their visas were denied.

Early in the proceedings, one participant inquired about the absence of representatives from the Gulf States (specifically Bahrain, Kuwait, Qatar, Saudi Arabia and United Arab Emirates).  The facilitators explained that because these countries were classified as “high income,” the Global Fund did not support any programs there. The absence of the Fund, and the political realities of some of the Gulf States means that there are few, if any, active networks of MSM there. Nonetheless, Mr Ballan made clear that M-Coalition was ready and willing to accept new members from the Gulf States, or anywhere else in the region.

The path forward for MENA Global Fund recipients is fraught with challenges and questions. When MENA countries do receive grants, they tend to be small – based on the Fund’s allocation model – and focused on services for key populations. The expectation is that the mostly middle-income countries will shoulder the bulk of the cost of their HIV, TB, and malaria responses. In fact, some MENA countries, such as Algeria, are marked for complete “transition” out of Global Fund support over the 2017-2019 period, with others to follow.

Thus a specter hangs over all the discussions in Marrakech and beyond: What will MSM and other key populations in the region do when the Fund leaves? The workshop’s organizers, presenters, and participants all hope that events like this will strengthen bonds and supports among marginalized communities in MENA so that they too can realize the Global Fund’s goals of ending the epidemics, with or without the Fund’s direct support.

In this context, Mr Ballan highlighted the importance of these types of dialogues, which involve stakeholders working in countries at various stages of Global Fund transition, and having a range of familiarity with the Fund and its processes.

“CCM representatives were able to understand different approaches to participating in CCM meetings through the experiences of CCM members from other countries,” Mr Ballan said. “Representatives of countries transitioning out or no longer eligible for the Global Fund had opportunities to discuss further planning to bridging the gap in the funding. It was also very beneficial for representatives who were working on the Global Fund for the first time,” allowing for a more in-depth understanding of the Fund and how to make it work best for key populations.

The overall trend is one of progress. As Ms Rafif observed, “Five years ago it would have been impossible to imagine key populations even having seats on CCMs in MENA. Now we have KP seats in Morocco, Tunisia and Algeria, and more to come soon.”