Global Fund Observer Issue 104

[Guest guest]

GLOBAL FUND OBSERVER (GFO), an independent

newsletter about the Global Fund provided by Aidspan to over 8,000 subscribers

in 170 countries.

Issue 104: 7 May 2009. (For formatted web,

Word and PDF versions of this and other issues, see www.aidspan.org/gfo)

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CONTENTS

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1. NEWS: Main Decisions Made at May Board Meeting

All key decisions made at the

just-completed Global Fund board meeting are summarized.

2. COMMENTARY: A Board in Search of a Chair

" No Global Fund board meeting would be

complete without there being at least one issue involving high drama. This time,

the drama arose over the inability of the board to elect a new Chair. "

3. NEWS AND ANALYSIS: Several CCMs Have Established

Their Own Websites

At least 11 CCMs have established their own

websites, and at least two others are in the process of doing so.

4. NEWS: Report Finds that Organisations of Key

Populations in LAC Have Little Access to Global Fund Money

Although the HIV epidemic in Latin America and

the Caribbean is largely concentrated among men who have sex with men and sex

workers, organisations representing these " key populations " receive

very little of the Global Fund money being spent in the region, according to a

recent study.

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1. NEWS: Main Decisions Made at May

Board Meeting

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On Tuesday and Wednesday (May 5-6), the

Global Fund Board held its nineteenth board meeting, in Geneva, Switzerland.

GFO was present, with observer status.

The main decisions made at the meeting were as follows. (For precise

wording of what the Board agreed, see the Decision Points document at www.theglobalfund.org/en/board/meetings/nineteenth.

Background documentation will also, in time, be posted by the Fund at the same

location.)

1.

Increased

funding for CCMs: The Board agreed that with effect

from the start of 2010, CCMs may apply to receive increased amounts of money to

support their operations. At present, the Fund is willing to provide up to

$43,000 per CCM per year. This amount will increase to $50,000. And under

certain strict conditions, CCMs may be permitted to receive a significantly

larger amount (possibly – though this was only stated verbally at the meeting,

not in writing – up to about $200,000 per year). To receive these larger

amounts, CCMs will be required, among other things, to develop annual strategic

objectives with work plans and related performance targets. CCM performance

will be monitored through a transparent reporting mechanism and verified by

LFAs where necessary. The precise policy to govern such funding will be

developed by the Portfolio and Implementation Committee during the coming

months, and is expected to take effect next January. [see Decision Point 20.]

2.

Working Group to

recommend how to handle shortages of Global Fund money: The Board is very concerned that the Fund is likely to have

significantly less money than will be required for funding Rounds 9 and 10. It

does not want a repeat of what happened at the November 2008 Board meeting,

when members had to work through the night devising a policy to handle the

financial shortages that arose as a result of the unexpectedly large size of

Round 8. Accordingly, the Board established a thirteen-person Working Group,

under the co-chairmanship of van Rooijen and Sigrun Mogedal, to

" develop a framework for managing the tension between resource demand and

supply in a resource-constrained environment, " and to propose options for

" an increased and urgent resource mobilization effort. " The Working

Group will consult widely, and will report to the Board before the November

meeting, at which point Round 9 grants will be approved. [see Decision Point

26.]

3.

Election of

Chair and Vice-Chair of the Board: The Board failed

to agree on who to elect as the next Chair. (For details regarding the failed

election, see the Commentary article below.) The Board agreed to hold a

postponed election for Chair and Vice-Chair no later than July 15. It asked the

Implementing Block (defined in the Commentary article) to work hard to

recommend one or more candidates for Chair from that group. If there is only

one such candidate (which, it’s clear, everyone would prefer), the election

will take place by email. If there is more than one candidate, the election

will take place at a special in-person board meeting, to be attended only by

board members and alternates. The terms of office of the current Chair and

Vice-Chair were extended until the election takes place. The leadership and

membership of the current board committees will continue until after the

November board meeting. A Board committee will review procedures for subsequent

elections and make recommendations in a year’s time. [see Decision Point 32.]

4.

Enhancing the

Fund’s response to HIV/AIDS: The Board held an

in-depth discussion on HIV/AIDS issues, mirroring similar discussions on TB and

malaria at previous Board meetings. The discussion focussed in particular on

HIV prevention, cost projections, resource mobilization needs, new

technologies, prevention of mother-to-child transmission, and paediatric HIV

issues. Some of these topics were referred to Board committees for further

discussion. [see Decision Point 34.]

5.

Strategy in

Relation to Sexual Orientation and Gender Identities: The Board approved a strategy in relation to " Sexual

Orientation and Gender Identities " . This strategy notes that men who have

sex with men, transgendered people, and sex workers face challenges in being

able to access or benefit from Global Fund grants. It outlines concrete actions

that the Global Fund can take to address the vulnerabilities and needs of such

people in the fight against the three diseases. [see Decision Point 7.]

6.

Review of Board

Committee structure: The Board agreed to make small

modifications to the mandates, rules and procedures of its existing committees;

to rename the Portfolio Committee to the Portfolio and Implementation

Committee; and to establish an ad hoc Market Dynamics and Commodities

Committee. The latter committee was set up because over fifty percent of Global

Fund money is spent on the purchase of commodities, and the Fund would like to

use this enormous purchasing power in a way that achieves better economies of

scale. [see Decision Point 8.]

7.

Executive

Director as non-voting Board member: The Board resolved

that the Executive Director shall become a non-voting member of the Board. In

the past, the Executive Director attended Board meetings but generally only

spoke when asked for information or an opinion. Now, he can take part more

freely in the discussion. [see Decision Point 9.]

8.

Terms of

Reference for Chair and Vice-Chair of the Board:

The Board agreed on TORs for its Chair and Vice-Chair. [see Decision Point 10.]

9.

Additional

non-voting Board seat: The Board, after many

efforts to agree on this over the past year or two, resolved to add one

non-voting Board seat to represent what it called the Partners’ Constituency.

Since the start of the Fund, there has been a non-voting board seat for UNAIDS,

but not for organizations dealing specifically with TB or malaria. The new

Partners’ seat will be used by the Stop TB Partnership, Roll Back Malaria,

UNITAID, and potentially others in the future. [see Decision Point 11.]

10. Technical Review Panel (TRP) composition: The Board increased the maximum size of the TRP from 35 to 40

members, added a second Vice-Chair, and chose some new TRP members. [see

Decision Points 16 and 17.]

11. Actions to be taken when there is fraud or

corruption regarding Global Fund grants: The Board

made it clear that the Fund does not tolerate corruption, fraud,

misappropriation or abuse of any kind in relation to its grants. Accordingly,

it specified a range of actions that the Executive Director must take when the

Inspector General has determined that there is credible and substantive

evidence of such things having taken place. [see Decision Point 25.]

12. Affordable Medicines Facility for Malaria

(AMFm): The most effective anti-malaria drug is

artemisinin combination therapy (ACT), but for many people it is too expensive.

To help in this regard, the Board agreed 18 months ago to look into the Fund

hosting the Affordable

Medicines Facility – malaria (AMFm), formerly known as the

Global ACT Subsidy. The idea is to help reduce the price for ACTs by negotiating

with drug companies as well as by providing co‑payments or subsidies to

purchasers of the drugs. Six months ago, the Board approved a policy framework

and implementation plan that was developed under the oversight of an Ad Hoc

Committee of the Board and others, and asked the Secretariat to start hosting

and managing the AMFm for an initial Phase 1 in a limited number of countries.

At this week’s meeting, the Board agreed certain further details regarding how

Phase 1 will be run and evaluated. [see Decision Points 27 and 28.]

13. Follow-up to the Five Year Evaluation: The Technical Evaluation Reference Group (TERG) provides

independent advice, assessment and oversight regarding the Global Fund’s work on

monitoring and evaluation. The TERG recently completed a Five Year Evaluation

of the Fund and its work. The Board welcomed this evaluation, and asked the

Secretariat to develop a plan for responding to and implementing the

recommendations contained in the evaluation. [see Decision Point 29.]

14. Partnership Forum 2008: The Board assigned to its various committees responsibility for

following up on the recommendations produced at the December 2008 Partnership

Forum. The next Partnership Forum is likely to take place in early 2011. [see

Decision Point 30.]

15. Preventing treatment disruption: The Board expressed concern at reports of actual and potential

stock-outs of key drugs in various countries that have been purchasing these

drugs using Global Fund grants. (Treatment interruptions of some drugs can be

medically very harmful.) The Board asked the Secretariat to put in place

various procedures for monitoring the situation. [see Decision Point 31.]

16. Other points: Other Decision

Points dealt with an MOU with the Organization of Islamic Conference (Decision

Point 5), extension of the contracts of some members of the Fund’s Technical

Evaluation Reference Group (TERG) (Decision Point 6), who may attend restricted

sessions of the Board (Decision Point 12), timing for the determination of

income level eligibility (Decision Point 13), affirmation that there are no

exceptions to its rule that high-income countries are not eligible for Global

Fund grants (Decision Point 14), the handling of a quality assurance review of

certain medicines (Decision Point 18), the creation of increased flexibility in

the setting of grant start dates (Decision Point 19), seeking greater

cooperation from UNDP regarding audits and investigations where UNDP acts as

Principal Recipient (Decision Point 22), rules regarding who may sign

agreements on behalf of the Fund (Decision Point 23), and use of the Fund’s

Credit Suisse bank account (Decision Point 24).

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2. COMMENTARY: A Board in Search of a

Chair

by Bernard Rivers

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No Global Fund board meeting would be complete without there being at

least one issue involving high drama. This time, the drama arose over the

inability of the board to elect a new Chair.

The board’s bylaws specify that a new Chair and Vice-Chair must be

elected every two years. On this occasion, the Chair was to be from the

" implementing block " (that is, from the seven board members who

represent developing country governments, plus the two who represent NGOs, plus

the one who represents people living with or affected by the three diseases),

and the Vice-Chair was to be from the " donor block " (that is, from

the eight board members who represent governments that are major donors to the

Fund, plus the one who represents the private sector, plus the one who

represents foundations).

As with all important board decisions, the vote had to be approved by

at least two thirds of the board members from each of the two blocks. However,

the board failed to agree on who would be the new Chair, so the current Chair

(Rajat Gupta, who represents the private sector) and Vice-Chair (Liz Mataka,

who represents developing country NGOs) were asked to stay in office until a

new election takes place some time before July 15.

The primary cause of the difficulties, but not the only one, resided in

one of the Fund’s bylaws, which specifies that the Chair and Vice-Chair have to

be elected not just by the board members, but from among the current

board members. Thus, if a candidate is being considered who is not a board

member, that person has to be made a board member for five minutes before they

can then be elected Chair. And that, in turn, requires a current board member

to stand down – which is not a trivial matter, when in many cases a board

member represents multiple countries.

" Mr. A, " a government minister from a developing country who

is not a board member and was not present at the meeting, was nominated by the

board member who represents the group of countries that includes Mr. A’s

country. However, there was a problem; although Mr. A is widely respected for

his skills, his experience, his understanding of Global Fund issues, and his

commitment, he serves as a minister in a government that is not famed for its

respect for civil liberties. To make things worse, when he was informally

interviewed by some board members via video-conference, he left a number of

members unexcited, if not unhappy, by what he had to say. As a result, it appeared

that only a minority of the " implementing block " board members were

prepared to vote for him. This was not good enough: it seemed unlikely that Mr.

A would be able to obtain a " double two-thirds majority " , and anyway,

everyone was very anxious to find a Chair who could be supported by all.

It then became known that " Mr. B, " a government minister from

another developing country, who had the advantage of already being a board

member, would be willing to stand – but not if the vote was contested. But Mr.

A did not withdraw his candidacy, so Mr. B was not prepared to have his name

put forward.

Finally, word spread that another developing country wished to propose

" Mr. C, " one of its ministers, who, like Mr. A was not a board member

and was not present at the meeting. However, Mr. C’s potential candidacy

encountered even more problems, because he could only stand if the board member

who currently represents the group of countries that includes Mr. C’s country

was willing to make way for Mr. C. But the board member in question was not

prepared to stand down, apparently because he had not been consulted on the

matter during the period leading up to the election, and perhaps also because

(are you still with me?) he had already pledged his support to Mr. A.

So it was a mess. Maybe there could have been an acceptable result if

Mr. A had handled the video interview more effectively, or if Mr. A had seen

the writing on the wall and withdrawn his candidacy to make way for Mr. B, or if

Mr. C had prepared his candidacy more effectively, or if the Board had

recognized (as some had been urging for years) that the bylaws are too

restrictive and need to be changed. But none of these things happened, and the

board found itself in a complex trap from which it could not escape.

The Global Fund is a little over seven years old. In most ways it is,

by now, hugely experienced and effective; but in others, it is still learning

its way.

[bernard Rivers (rivers@...) is Executive Director

of Aidspan and Editor of its GFO.]

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3. NEWS AND ANALYSIS:

Several CCMs Have Established Their Own Websites

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At least 11 CCMs have established their own

websites, and at least two others are in the process of doing so. The following

websites are already operating:

China: www.chinaccm.org.cn/en

Languages: Chinese and English

Cote

d’Ivoire:

www.ccm-ci.com/ccm.php

Language: French

India: www.india-ccm.org

Language: English

Kenya: www.globalfundkccm.or.ke

Language: English

Madagascar: www.ccm-madagascar.mg

Language: French

Morocco: http://ccm.tanmia.ma

Language: French

Nigeria: www.ccmnigeria.org

Language: English

Tanzania: www.gf.or.tz

Language: English

Thailand: www.thailandccm.org/en

Language: English

Peru: www.conamusa.org.pe

Language: Spanish

Russia: www.hivrussia.org/skm/index.shtml

Language: Russian

In addition, the Pakistan

and Honduras CCMs are currently developing websites.

The information available varies considerably from one website to

another, with the China

site being by far the most comprehensive. Portions of some of the websites are

still under construction.

The following is a list of the major types of information, and

features, that Aidspan believes would be useful for any CCM website to have:

the terms of reference (TOR), bylaws or

constitution of the CCM;

a list of CCM members, including (a)

the sector each member represents, ( the position (if any) that member

occupies on the CCM; and © contact information for the member;

information on the CCM Secretariat, including: (a) TOR (or equivalent) for the Secretariat; ( a

list of staff; and © contact information for each staff person;

information on future CCM meetings, including: (a) dates; ( the agenda for the next meeting;

and © copies of, or links to, documents that will be discussed at the

next meeting (where available);

the minutes of past CCM meetings;

information on each of the CCM’s committees or working groups, including: (a) a list of members; ( dates of future

meetings; © the agenda for the next meeting; (d) copies of, or links to,

documents that will be discussed at the meeting (where available); and (e)

the minutes of past meetings;

information related to proposal development, such as calls for in-country submissions and copies of draft

or final proposals;

information regarding grants that have been approved;

information related to grant implementation, such as the latest Progress Update / Disbursement Requests

from the PRs, and oversight reports produced by the CCM or any of its

committees, and Grant Performance Reports produced by the Global Fund;

links to the websites of other relevant organisations, such as the Global Fund itself, multi- and bi-lateral

development organisations, the Local Fund Agent (LFA) and Aidspan;

a dedicated

space on the home page to announce important

recent developments and upcoming events; and

a forum or feedback mechanism that would

allow CCM members and non-members to discuss issues relevant to the CCM

and to Global Fund grants currently being implemented.

None of the websites listed above has all of these features.

If readers are aware of existing CCM websites not listed in this

article, we would like to hear about them. Please contact Garmaise at garmaise@.... If appropriate, we

will update the list of CCM websites in a future GFO article.

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4. NEWS: Report Finds that

Organisations of Key Populations in LAC Have Little Access to Global Fund Money

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Although the HIV epidemic in Latin America and the Caribbean (LAC) is

largely concentrated among men who have sex with men, sex workers,

transgendered people, and, in some countries, drug users, organisations

representing these " key populations " receive very little of the

Global Fund money being spent in the region. This is one of the findings of a

study undertaken by the International HIV/AIDS Alliance.

A report on the study, entitled " Report

on Access to Global Fund Resources by HIV/AIDS Key Populations in Latin America

and the Caribbean, " is available on the Alliance website at www.aidsalliance.org.

For the study, the Alliance

analysed 15 of the 35 HIV/AIDS Global Fund grants in LAC.

Amount of money going to key

populations

Of the 15 grants analysed (representing total expenditures of $170

million), only 4.6 percent of the funds (just under $8 million) was granted to

sub-recipient (SR) organisations representing the key populations.

A further 2.5 percent ($4.5 million) was earmarked for organisations of

key populations, but was first distributed to other civil society organisations

serving as SRs (the idea being that these SRs would pass on the funds to

organisations of key populations).

Of the approximately $8 million provided to SRs representing key populations,

organisations of people living with HIV received almost two-thirds of the

total; organisations of men who have sex with men 27.5 percent; and

organisations of sex workers 6.1 percent. No organisations of transgendered

persons served as SRs for any of the 15 grants.

The study found that where key populations were represented on CCMs,

these populations were more likely to receive money from Global Fund grants. It

also found that key populations are far more likely to receive money where the

grant’s principal recipient (PR) is from civil society.

Obstacles to accessing funding

The report identifies several obstacles to funding experienced by

organisations of key populations. For this part of the study, 18 key actors

working in HIV/AIDS were interviewed, 12 of whom were members of key

populations. The obstacles included the following:

Lack of organisational capacity. This includes not having the capacity to develop proposals, the

capacity to manage programmes, and the capacity to do strategic planning. It

also includes not having the capacity to maintain good financial accounting and

to implement a solid governance structure, both of which are required before an

organisation can be legally registered in most countries in the region.

Difficulties accessing and

understanding Global Fund-related information. This refers particularly to information from CCMs and PRs (e.g.,

minutes of CCM meetings). One person, from a transgender organisation, said

" The difficulty in accessing information suggests a lack of transparency

among those making the decisions. We do not understand how decisions are made

nor the reasons behind them. There is no explanation given for why some

organisations are chosen over others as sub-recipients, and we receive no

feedback on our own proposals. So we don’t know what to change or how to

improve before the next call for proposals. "

Lack of participation of certain key

populations in proposal development. The

report points out that sex workers and transgendered people have not yet had an

opportunity to participate in the development of a successful Global Fund

proposal in the region.

Lack of epidemiological data for

certain key populations. The report says

that although sex workers and transgendered people are well aware of rising

prevalence rates in their populations, " the lack of studies supporting

this informal knowledge weakens their advocacy work and power of

negotiation. "

Recommendations

The report calls for (among other things):

the provision

of technical support to address the capacity building needs of

organisations of key populations;

greater

transparency in decisions made by CCMs; and

a more active

role for the Global Fund Secretariat in promoting the participation of key

populations.

" Reproduced from the Global Fund Observer Newsletter

(www.aidspan.org/gfo), a service of Aidspan. "

Forwarded

by:

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Yours in

Global Concern,

A.SANKAR

Executive Director- EMPOWER

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