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:
- The Board should agree to issue a new call for applications as soon as possible. The new call for applications should emphasise the importance of investing in “critical enablers” to increase the effectiveness of core programme activities, including community-based programme design and delivery, and programmes to address human rights and barriers to access to services.
- The Board should reaffirm the importance of CSOs in health responses by calling upon the Secretariat to develop a strategy that outlines how CSOs will be supported through the implementation of the new Global Fund strategic plan (2012-2016) and restructured Global Fund secretariat. The strategy should reinforce the value of the Fund’s investments in community systems strengthening, including core support for community-based organisations, to enable them to facilitate community links to health services and retain skilled staff.
- Fund Portfolio Managers and Country Teams at the Global Fund Secretariat should ensure that funding for community-based service delivery and community systems strengthening is protected through the negotiation of Phase II renewals, recognising the essential role they play in increasing the efficiency and effectiveness of core HIV and TB programmes. Any reprogramming should be done transparently, in full consultation with sub-recipients in addition to principal recipients and CCMs.
- Technical partners, including UNAIDS, the Stop TB Partnership, the World Health Organisation (WHO), and others, should provide guidance and technical support to country coordinating mechanisms to ensure that support is retained for critical enablers, including community-based service design and delivery, and programmes to address human rights and barriers to access, in initial proposal development and Phase II requests. They should also provide concise guidance that draws on existing evidence demonstrating how these interventions represent good ‘value for money’.
- Donor countries, including new and emerging donors, must meet their commitments to funding sustainable HIV, TB and malaria programmes through increased pledges to the Global Fund at its next replenishment conference in 2013. They should adhere to their commitments to aid effectiveness by making long-term pledges that enable the Global Fund to offer predictable and sustainable funding.