Challenging operating environments (COEs) are countries or sub-regions of countries that the Global Fund characterizes as having weak governance, poor access to health services, manmade crises (such as conflict) or natural crises (such as famine).
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Six African countries classified as challenging operating environments craft tailored funding requests to the Global Fund
Violent clashes between demonstrators and security forces in Burundi sent tens of thousands of people fleeing both inside and beyond the borders of the central African state. These displacements were only one consequence of the crisis in the capital that stretched the capacity of an already-strapped health system: demonstrating a need for flexibility in resourcing in so-called challenging operating environments.
Ten years of armed conflict and perpetual insecurity have driven HIV prevalence in Côte d'Ivoire higher -- especially among women in the western zone on the Liberian border. Many of these women were infected as a result of sexual violence perpetuated by one or another of the marauding armed groups that terrorized the region for over a decade; others were infected after turning to prostitution to escape extreme poverty.
More than 700,000 people have fled their homes since conflict erupted in mid-December in South Sudan, which has compromised their safety and security and made them more exposed to the risk of illness and other public health challenges. But for the estimated 6,617 people living with HIV who are taking anti-retroviral treatment supported by the Global Fund, being far away from their home clinic has become a matter of life or death.
Ukraine's HIV community including principal recipients of Global Fund grants have formally requested that grant signing for Phase 2 of a Round 10 HIV grant be expedited to mitigate the potential impact of the current political turmoil roiling the country.
The town of Minkammen, on the banks of the White Nile, has been inundated with thousands of South Sudanese fleeing the conflict pitting rebel against government fighters upstream.
Since mid-December 2013, ethnic clashes in South Sudan have displaced about a half-million people and sent more than 100,000 fleeing across borders seeking refuge. That insecurity, and the attendant mobility of the population, has interrupted a number of development programs, including several that are receiving financial support from the Global Fund.