REPORT CALLS FOR A FULLY FUNDED GLOBAL FUND AND A FOCUS ON THE LEADERSHIP OF NETWORKS OF KEY POPULATIONS

Author:

Mark Daku and Gemma Oberth

Article Type:

Article Number: 1

Report builds on advocacy brief released earlier

ABSTRACT A new report released by the Global Fund Advocates Network and the Free Space Process partnership says the Global Fund is uniquely placed to maximize investments in key and vulnerable populations.

To achieve the Sustainable Development Goals (SDGs) requires not only a fully funded Global Fund, but also an approach that focuses strongly on the leadership of networks of key and vulnerable populations to deliver results. This is the central message of a report entitled “Key Populations and the Global Fund: Delivering Key Results,” which was released on 20 July 2016, at a press briefing at the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa.

(In early June, GFO published a summary of an advocacy brief based on the research done for this report, which targeted stakeholders involved in the 2016 High Level Meeting on Ending AIDS. In that article, we committed to publishing a follow-up article on the full report when it was released.)

The report is a collaborative initiative of the Global Fund Advocates Network (GFAN) and the Free Space Process partnership, supported by the International Council of AIDS Service Organizations (ICASO) and International Civil Society Support (ICSS).

The report contains five key advocacy messages related to the need for a fully funded Global Fund:

1. Investment in key and vulnerable populations is needed now more than ever.
2. The Global Fund invests in rights- and evidence-based interventions for key and vulnerable populations.
3. The Global Fund plays a catalytic role in improving national responses.
4. The Global Fund amplifies key and vulnerable population voices and leadership.
5. The Global Fund places key and vulnerable populations at the heart of its work.

We have structured this article based on these five messages, as we did in our article on the advocacy brief. We have focused on new content in the full report that was not part of the brief.

Key Message #1: Investment in key and vulnerable populations is needed now more than ever.

The key argument of this section of the report is that in order to achieve the objectives of the Global Fund, the Sustainable Development Goals (SDGs), and other global partners, higher levels of engagement with key and vulnerable populations is needed. Specifically, to achieve the UNAIDS Fast-Track targets, an additional 6.9 million men who have sex with men (MSM), 4.9 million sex workers, and 2.2 million people who inject drugs (PWID) need to be reached with a comprehensive package of services. The report provides a detailed year-by-year breakdown of the investments for HIV needed for key populations programs. See Table 1 for a summary of the figures.

Table 1: Resource needs for key populations to end AIDS by 2030 ($ millions)

Intervention	2016	2020	2025	2030
Sex worker outreach	422 m	536 m	573 m	612 m
MSM outreach	440 m	603 m	642 m	681 m
Transgender	25 m	34 m	36 m	39 m
PWID: Outreach	546 m	653 m	702 m	753 m
PWID: Drug substitution	435 m	812 m	704 m	409 m
Prisoners	33 m	60 m	80 m	102 m
Cash transfers for girls	130 m	560 m	1,027 m	397 m
Pre-exposure prophylaxis (PrEP) for key populations	90 m	669 m	1,067 m	1,112 m

Importantly, the paper also argues that above these numbers, investment is also needed in reaching, strengthening, and empowering networks of key and vulnerable populations. It is not simply that these populations are most vulnerable to these three diseases, but also that in order to reach these populations and address their vulnerabilities, key and vulnerable populations organizations must lead the response.

Key Message #2: The Global Fund invests in rights- and evidence-based interventions for key and vulnerable populations.

The report argues that, historically, the Global Fund has contributed much to the expansion of rights- and evidence-based interventions to key and vulnerable populations. It remains a large (often the largest), stable and consistent source of funding for these populations in contexts where funding can be volatile. Even in a country like South Africa, where the government funds upwards of 80% of the HIV and TB response, the Global Fund is still the single biggest investor in key and vulnerable populations (see GFO article). The Global Fund’s unfunded quality demand (UQD) register is an unique and important mechanism for attracting attention and funding to under-resourced areas, particularly for key populations. The Russian Federation alone has a $44.17 million funding gap for key populations. Vietnam needs $18.7 million specifically to address HIV in people who inject drugs. GFO has previously reported on how the UQD register provides valuable insights into funding gaps for these interventions.

Key Message #3: The Global Fund plays a catalytic role in improving national responses.

The report argues that the Global Fund, beyond funding interventions and identifying resource gaps, plays a catalytic role in improving national responses in three key ways: (1) identifying additional sources of domestic funding; (2) encouraging the creation of policies that have an effect that extends beyond Global Fund programs; and (3) prioritizing key and vulnerable populations in the new funding model. Through tools such as counterpart financing and the willingness-to-pay policy, the Global Fund encourages increased domestic investment in key and vulnerable populations. Referencing Aidspan’s recent publication on willingness-to-pay, the report points out that Suriname will invest $18.4 million to build and fund a clinic that specifically meets the HIV, TB, and malaria needs of migrant populations in mining areas; Botswana will provide $68 million for antiretroviral treatment for all sex workers who test positive; and Bulgaria will invest $14.5 million in active case finding among TB key populations.

Key Message #4: The Global Fund amplifies key and vulnerable population voices and leadership.

The report argues that the Global Fund also has been, and continues to be, an important vehicle for the voices and views of key and vulnerable populations. It highlights several critical areas where key populations have achieved considerable impact, including governance, engagement in concept note development, and implementing programs. The report is rich with personal accounts from key populations from around the word, sharing first-hand experiences in Global Fund processes. The full report builds on the Zambia and Botswana case studies that were shared in the advocacy brief, highlighting cases from Suriname and Costa Rica, where key populations have meaningfully engaged in Global Fund decision-making. To emphasize this key message, there is a supplementary report which shares an extended bank of case studies, interviews, and quotes.

Key Message #5: The Global Fund places key and vulnerable populations at the heart of its work.

Finally, the report highlights how the Global Fund has historically been committed to developing a comprehensive package of strategies, policies, and processes that enables its commitment to key and vulnerable populations to become a reality. This support includes technical assistance; policies that encourage the participation of key and vulnerable populations in country coordinating mechanisms and concept note development; and the production of tailored information specific to particular diseases and groups. Once again, the report emphasizes the critical nature of a fully funded Global Fund, so that the programs proposed by and for key and vulnerable populations can be implemented at scale.

Conclusion

The report closes by reminding the reader of the Global Fund’s investment case. For every US$100 million contribution to the Global Fund, it is possible to:

• save up to 60,000 lives through programs supported by the Fund;
• avert up to 2.3 million new infections across the three diseases;
• support partners in domestic investment of $300 million toward the three diseases; and
• spur $2.2 billion in long-term economic gains.

Lead author of the report, Michael O’Connor reflects on these figures, saying, “The return on investment in the fighting the three diseases is high and the consequences of inaction are severe.” O’Connor is a special advisor to ICASO, one of the report’s co-sponsors.

“In preparing this report, we were struck that such an important topic had not been tackled previously,” O’Connor remarked. “We quickly discovered that the leaders among the key and vulnerable population networks were emphatic that a fully funded Global Fund is essential; otherwise gains made will be reversed.”

This is Mark Daku’s first article for GFO. Dr. Daku is a Postdoctoral Fellow at the Institute for Health and Social Policy at McGill University in Montreal, Canada. He can be reached at: mark.daku@mcgill.ca. Dr. Gemma Oberth is a regional correspondent for GFO, specializing in issues related to sub-Saharan Africa, health financing and key and vulnerable populations. Oberth is a co-author of the GFAN/Free Space Process/ICASO/ICSS report, written in her capacity as the Technical Support Consultant to the Regional Platform for Communication and Coordination for Anglophone Africa, hosted by EANNASO.