In November 2011, facing a deficit of about half a billion dollars due to unfulfilled donor pledges, the Global Fund to Fight AIDS, TB and Malaria was forced to cancel Round 11 of its funding. In March 2012, the Open Society Initiative for Southern Africa (OSISA) and the Open Society Foundations (OSF) undertook research to ascertain the impacts of the funding shortfall on civil society organisations (CSOs), particularly community-based non-governmental organisations (NGOs). Swaziland, Malawi and Zimbabwe were selected because all three countries had advanced draft proposals for HIV and/or TB programmes at the time of the cancellation.
The full report can be downloaded below
Round 11 would have been a watershed moment in southern Africa. Under their HIV applications, some countries - including Swaziland - would have moved to include interventions for sex workers and men-who-have-sex-with-men (MSM) in Global Fund proposals for the first time. In Swaziland, there were also plans to include activities addressing the HIV prevention needs of a small community of injecting drug users.
Round 11 funding would have also supported community-based NGOs to provide treatment literacy and adherence support; lead community education, mobilisation and prevention efforts; and address barriers to treatment, care, and support. A new funding window would have allowed countries to fill critical gaps in HIV and TB treatment, diagnostics, and other commodities; scale-up prevention interventions such as prevention of mother-to-child HIV transmission (PMTCT) services and medical male circumcision (MMC); and strengthen health systems.
After a history of failed proposals, Round 11 provided the opportunity for these countries to begin to close funding gaps and scale up essential services. Now, countries are forced to choose between funding the biomedical interventions highlighted in the UNAIDS Strategic Investment Framework and funding the supporting activities, or ‘critical enablers’, that the global HIV body has said are crucial to these interventions’ success.
When countries are forced to choose between providing essential services or the initiatives that support them, CSO-led supporting activities such as human rights programmes, community systems strengthening and, to a lesser extent, interventions among most-at-risk populations (MARPs) - are the first to go.
Civil society organisations in all three countries were already facing a funding crisis when Round 11 was cancelled; in Round 11, there was hope that CSOs might be able to access funding to sustain their work. OSF research reveals that the organisations most vulnerable to current cuts are community-based organisations (CBOs) working at the local or district levels. Years after UNAIDS and the Global Fund drove the involvement of people living with HIV (PLWH), pushing for their involvement in international decision-making bodies, CCMs and civil society, PLWH organisations are among those most affected.
This report begins by highlighting the importance of Round 11 as a new funding window among the three focus countries, all of which had been denied funding through previous rounds. It then describes what countries would have applied for under Round 11 before moving to discuss broadly some of the initial national and civil society impacts of both the cancellation and decreasing Global Fund money.
The document then argues that, due to funding constraints internationally and within the Global Fund, CSOs are unlikely to see much relief in the future due to an inability to source alternate donors, the structure of the Global Fund’s Transitional Funding Mechanism (TFM) and impacts of the Global Fund crisis on Phase II renewals of existing grants.
In light of the report’s findings OSF puts forth the following recommendations:
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