Unveiling Sexual Exploitation and Abuse: A Comparative Analysis of Health Programs in South Africa, Uganda, and Zimbabwe
Samuel MuniuArticle Type:
Article Number: 4
Gaps in reporting and response to sexual exploitation and abuse in Global Fund-supported programs
Recent investigation reports from the Global Fund's Office of the Inspector General revealed cases of sexual exploitation and abuse within Global Fund-supported programs in South Africa, Uganda, and Zimbabwe. These incidents involved individuals in positions of power targeting vulnerable beneficiaries. The investigations exposed the delayed reporting of allegations to the Global Fund and inadequate support for victims, highlighting the need for urgent reforms in accountability and safeguarding within the global health sector.
Investigation reports from the Global Fund’s Office of the Inspector General (OIG), published on 19 May 2023, uncovered cases of sexual exploitation and abuse within Global Fund-supported programs in South Africa, Uganda, and Zimbabwe. These reports emphasized the exploitation of vulnerable individuals through coercive practices. The investigations also revealed a significant delay in reporting the allegations to the Global Fund and a lack of proper response and support for the victims. As a result, comprehensive and immediate reforms are necessary to enhance accountability and safeguarding within the global health sector.
The Global Fund takes a victim/survivor-centered approach with zero tolerance for sexual exploitation, abuse, and harassment, aligning with the principle of “do no harm.” This principle emphasizes the obligation of healthcare professionals to prioritize the well-being and safety of patients, avoiding actions that may cause harm or further exacerbate their conditions. The Global Fund emphasizes a comprehensive strategy that includes prevention and response measures to protect individuals from sexual exploitation, abuse, and harassment. The organization has a Code of Conduct for Recipients of Global Fund resources that explicitly prohibits all forms of sexual exploitation, abuse, and harassment. The code defines sexual exploitation as the misuse of power, vulnerability, or trust for sexual purposes, while sexual abuse refers to actual or threatened physical intrusion of a sexual nature, often involving coercion or unequal conditions. Sexual harassment is described as unwelcome conduct of a sexual nature that can reasonably be expected to cause offense or humiliation.
Similar observations from three investigations on sexual exploitation and abuse
Instances of sexual exploitation and abuse that are deeply troubling
The investigations conducted in South Africa, Uganda, and Zimbabwe confirmed distressing instances of sexual exploitation and abuse perpetrated by individuals in positions of power against vulnerable beneficiaries.
In South Africa, an executive from a sex work program used coercion to engage both staff members and beneficiaries in sexual acts. The executive abused his authority to force victims into sexual acts by threatening them with physical harm. He also exploited the vulnerability of peer educators and beneficiaries by offering financial incentives, employment opportunities, or program benefits in exchange for sexual relationships. Moreover, the executive violated the privacy and safety of beneficiaries by publicly disclosing their involvement in sex work without their consent, leading to stigmatization and jeopardizing their reputation and well-being.
In Uganda, an employee of a Global Fund grant Sub-Recipient organization exploited beneficiaries of the Adolescent Girls and Young Women program, threatening their well-being and mental health. The employee, leveraging his position, sexually exploited and abused at least three vulnerable beneficiaries between 2019 and 2020. He engaged in sexual intercourse, took beneficiaries on overnight trips, and showed preferential treatment to those who complied with his demands. The investigation uncovered that some beneficiaries did not receive promised materials, potentially due to their refusal of the employee’s advances. Certain beneficiaries mentioned that the employee showed favoritism, granting specific activities and financial benefits like per diems and food to his chosen favorites.
In Zimbabwe, a staff member at a government hospital exploited a vulnerable patient by taking advantage of her desperate circumstances. The victim-survivor reported that the staff member propositioned her while carrying out his duties at the hospital. The OIG also learned that beneficiaries, who relied on their families for food and supplies during their hospital stay, were sometimes exploited by the staff member who offered them food in exchange for sex. These cases expose systemic flaws and a decline in moral standards within health programs.
Delay in reporting allegations of sexual exploitation and abuse
The three investigations revealed a troubling pattern of failure to promptly report allegations to the Global Fund, violating the Fund’s Code of Conduct for Recipients. This showed a significant deficiency in ensuring accountability and transparency within the programs. In Uganda, both the Sub-Recipient, the Programme for Accessible Health Communication and Education (PACE), and the Principal Recipient, the AIDS Support Organization (TASO), did not report incidents of coercion to the Global Fund, indicating a culture of concealment and negligence.
South Africa witnessed a similar scenario, with the National AIDS Council of South Africa (NACOSA) and the involved Sub-Recipient failing to address or report the sexual misconduct cases. Zimbabwe also didn’t report the issue; the hospital administrators did not inform the Ministry of Health and Child Care (MOHCC), a Sub-Recipient of the HIV grant, nor the Principal Recipient, the United Nations Development Programme (UNDP). These failures not only violated the Global Fund’s Code of Conduct but also undermined the credibility and effectiveness of the programs themselves.
Lack of adequate assistance and support for victims of sexual exploitation and abuse
The investigations revealed a common and concerning theme of inadequate response and support for the victims of sexual exploitation and abuse. In Uganda, the initial investigation conducted by Population Services International (PSI) failed to provide necessary support to the victims, highlighting the need for robust victim support mechanisms to be in place and observed. Similarly, in South Africa, the victims did not receive an effective response nor support, reflecting a lack of victim-centric measures within the programs. In Zimbabwe, the victim was left to navigate legal procedures alone, despite her bravery in coming forward. This lack of support demonstrated neglect and insensitivity towards the victim’s well-being and rights. The OIG reports emphasize the urgent need to prioritize victim assistance, support, and justice in these programs.
Conclusion and recommendations
The findings of the three investigations call for strengthening safeguarding measures, reporting mechanisms, and victim support systems. The reports emphasize the need for enhanced measures to prevent and address sexual exploitation and abuse. They also reveal a lack of accountability among the individuals and organizations involved. The Global Fund’s commitment to its Operational Framework on Protection from Sexual Exploitation and Abuse, Sexual Harassment, and Related Abuse of Power is a positive step, but effective implementation and scaling up across all grant lifecycles is crucial. Stronger punitive measures for perpetrators and increased support for those affected are necessary to ensure accountability for such actions.
The reports highlight a significant concern regarding the delayed reporting of allegations and investigation findings to the Global Fund, stressing the importance of immediate reporting to address misconduct, support victims, and take appropriate actions. Clear and robust reporting mechanisms are necessary, with organizations required to promptly report all allegations and take appropriate action. This entails not only procedural changes but also a shift in organizational culture. Victim support is highlighted as a crucial aspect, encompassing immediate assistance, psychological support, and guidance through legal processes. Prioritizing victim-centric measures within health programs is essential to protect victims and ensure justice is served.
The past experiences of global health initiatives (GHIs) underscore the importance of clear policies and robust training on sexual exploitation and abuse for both staff and program beneficiaries. GHIs like the United Nations Joint Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), and Médecins Sans Frontières have established comprehensive frameworks, codes of conduct, and guidelines to prevent and address sexual exploitation and abuse. They prioritize mandatory training for staff members and provide support for victims. Their proactive strategies and victim support systems can serve as a valuable model for the Global Fund and its recipients in effectively combating sexual exploitation and abuse.