Global Fund Observer Issue 129

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GLOBAL FUND OBSERVER (GFO), an independent newsletter about the

Global Fund provided by Aidspan to over 8,000 subscribers in 170 countries.

Issue 129: 20 September 2010. (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: Petition to Fully Fund the Global

Fund Seeks 500,000 Signatures

Organisers of an online petition

seeking full funding for the Global Fund are hoping to obtain 500,000

signatures by 30 September 2010, and are planning to submit the petition to

world leaders at the Global Fund's replenishment meeting in New York on 4-5 October 2010.

2. NEWS: Global Fund Secretariat Responds to OIG Reports

In a report prepared for the last Board meeting in

April 2010, the Secretariat says that it has acted quickly and decisively

whenever Global Fund monies were at risk, but acknowledges that it has not done

all it could have done to systematically tackle issues related to its

grant-management processes raised by the Office of the Inspector General.

3. NEWS: Global Fund Releases Detailed Operational Guide

The purpose of the new Operational

Guide is to help implementers understand Global Fund policies and to provide

guidance on the various processes that have to be followed during the lifetime

of a grant.

4. NEWS: Call for the Global Fund to More Actively Fund and Promote

Harm Reduction

The Global Fund urgently needs to increase the amount

that it spends on harm reduction, and to encourage applicants to build harm

reduction into their proposals, according to a report from the International

Harm Reduction Association.

5. NEWS: Global Fund Launches Its SOGI Strategy

As part of its Sexual Orientation

and Gender Identity Strategy, the Global Fund plans to monitor and publicise

cases where funding proposals have been, or might be, rejected due to policy

environments where human rights violations are impeding the implementation or

impact of interventions to address AIDS, TB and malaria.

6. NEWS: Recent Developments in Global Fund's Gender Equality

Strategy

Forthcoming revisions to the CCM

Guidelines will include strategies to strengthen gender expertise and achieve

balanced gender representation on CCMs. In addition, gender-related indicators in

the Global Fund's CCM funding policy will allow the Fund to monitor the number

of CCM members with gender experience.

7. NEWS: Report Documents Rise in Official Development Assistance

In the last decade, official development

assistance from donor countries has been increasing, as has the proportion of

this assistance going to health, according to a report released by the Global

Fund.

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1. NEWS: Petition to Fully

Fund the Global Fund Seeks 500,000 Signatures

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An online petition campaign has been organised in

support of an effort to " fully finance " the Global Fund. The campaign

is aiming to get 500,000 signatures by 30 September 2010. Organisers plan to

submit the petition to world leaders at the Global Fund's replenishment meeting

in New York

on 4-5 October 2010.

The campaign is being organised by the Communities

Delegation on the Global Fund Board, with assistance from other concerned

organisations. Individuals interested in signing the petition can find it at www.globalfundreplenishment.org.

The petition is available in English, French, Spanish, Russian and Chinese.

The petition says that the replenishment " must

raise at least $20 billion if the extraordinary gains made by the Global Fund

over the past decade are to be sustained and accelerated.... If adequately

resourced, the Global Fund can eliminate malaria in endemic areas, prevent millions

of new HIV infections, virtually eliminate the transmission of HIV from a

mother to her child, and achieve significant declines in TB prevalence and

mortality by 2015. "

The petition also says that some

international donors have " pre-empted " the outcome of the

replenishment meeting by " calling for caps on the amount of funding to be

made available for each round. This would be a disastrous consequence.... "

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2. NEWS: Global Fund

Secretariat Responds to OIG Reports

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The

Global Fund Secretariat acknowledges that it has not done all it could have

done to systematically tackle issues related to its grant-management processes

raised by the Office of the Inspector General (OIG). But it says that it has

acted quickly and decisively whenever Global Fund monies were at risk.

This

information is contained in " Secretariat

Follow-Up on Inspector General Findings and Recommendations, " a

report prepared for the Global Fund Board meeting in April 2010. The report was

written in response to concerns raised by the OIG about the low implementation

rate of OIG recommendations, about the Secretariat's commitments to improving

its processes and approaches, and about weaknesses in the Global Fund model.

In

the report, the Secretariat said that the low implementation rate of OIG

recommendations should not be misread for Secretariat acceptance of unmitigated

risk. Where OIG recommendations have touched upon immediate risk for Global

Fund resources (as was the case recently in the Philippines,

Mauritania, or Mali),

the Secretariat has put in place immediate and comprehensive measures to

safeguard its assets and protect patients' access to treatment. "

The

Secretariat, which said that it is caught in a " constant fire-fighting

mode, " added that its " rate of delivery against OIG recommendations

is in direct relation to the nature of the threat identified - adequate when

the situation to be addressed poses an immediate threat to funding and programs,

but not satisfactory when longer-term but nevertheless critical improvements

are at stake. "

Country-focused recommendations

When

it prepared its report on lessons learned from country audits and reviews, in

September 2009, the OIG said that only 48% of its 66 " in-country "

recommendations had been fully implemented. In its report to the Board, the

Secretariat said that by February 2010, the implementation rate had gone up to

73%. However, the Secretariat added, by the beginning of that same month, seven

new reports, with a total of 357 recommendations, had been issued by the OIG.

The

Secretariat said that, in each country, the PR is responsible for developing

and implementing an action plan addressing the OIG's recommendations, with

support and oversight from the CCM and the Fund Portfolio Manager. The

Secretariat acknowledged that it has not focused sufficiently on the CCM's role

with respect to OIG reports, but added that this is now being addressed.

Recommendations addressed to the Secretariat

In

its report, the Secretariat said that by September 2009, the OIG had issued

three reports focusing on the Secretariat, but that only 14% of the 76

recommendations in these reports had been implemented by February 2010. The

Secretariat added that another 78% were on track to be implemented " within

the next three to six months. "

The

Secretariat said that, in a number of areas, it and the Board were already well

aware of deficiencies in key functions of the grant model, including CCM

oversight of implementation, sub-optimal use of technical assistance, variable

quality of LFA services, variable quality of PR and SR reporting - and of

challenges within the Global Fund model caused by total reliance on the PR for

oversight of SRs. However, the Secretariat said, it is vital that it now

" take the lead in defining those areas where improvements are needed -

rather than letting the schedule of improvements be exclusively driven by the

outcomes of audits, " and that it was ready to do so.

The

report said that Office of the Executive Director has now assumed direct

responsibility for " transforming the way in which the Secretariat

prioritizes and carries forward OIG recommendations and findings; and, more

generally, organizes itself to identify strategic gaps in its grant operations

and implement improvements. " Three specific initiatives are underway: (1)

the establishment of three cross-Secretariat task forces to work on improved

processes for disbursements and signing, and on a more systematic approach to

prioritising and implementing OIG recommendations; (2) the drafting of two

protocols between the Secretariat and the OIG; and (3) reinforcement of the

" Country Team " approach.

One

of the protocols defines the working relationship between the OIG and the

Secretariat for country audits; the other protocol outlines the coordinated

approach that the Secretariat and the OIG will adopt when allegations of

wrongdoing have been made and the OIG decides to investigate.

The

Country Team approach, originally set up to improve the effectiveness of the

grant negotiations process, brings together all Secretariat actors involved in

grant operations to promote a culture of team work and accountability across

clusters and units. The Secretariat said that it will develop terms of

reference and detailed workplans for the country teams, including a clear

definition of roles and work processes in relation to the OIG.

Tanzania audit

An

audit of Tanzania

grants from the early rounds of funding was conducted in early 2009. The audit

identified serious problems, particularly with respect to supply chain

management and financial and programmatic reporting. GFO reported on the

results of the audit in GFO 108.

In its

report, the Secretariat said that a number of steps have been taken to address

problems with these grants. The report said that both the Global Fund

Secretariat and the OIG consider that the response to the Tanzania audit findings represents

an example of best practice in the joint country-Secretariat response to OIG

recommendations.

When

the results of the audit were released, the Government of Tanzania, with

support from USAID, hired a consulting firm to help build capacity at the

programme's procurement management unit; the Medical Stores Department procured

a new IT system; and storage capacity was enhanced. In addition, a

recently-signed Round 8 HIV grant contained requirements to ensure that the PR

develops a comprehensive plan of action to strengthen supply chain management,

enhance storage and distribution, instil better forecasting, and ensure better

inventory control and stock management.

The

report said that in the area of financial and programme management,

coordination and financial reporting capacity for the HIV Program was being

strengthened at the Ministry of Finance (a PR), the Tanzania Commission for

AIDS (TACAIDS, an SR), and the district government offices; and that a

programme management unit was being set up at the Ministry to ensure improved

oversight. In addition, under the Round 8 grant, TACAIDS will hire additional

staff, including accountants and 21 regional coordinator positions, to

facilitate better management and quality control at regional and district

levels.

In

the M & E area, the national HIV management information system was being

strengthened; and satellite monitoring stations at district level have been

established to enhance the quality and timeliness of data.

The

Secretariat said that a " quick and comprehensive " response was

achieved because the regional team in the Secretariat maintained close working

relationships with the OIG and with country players; because the CCM and

in-country partners were actively involved in the response; because the role of

the LFA was enhanced; and because of good follow-up and coordination of

feedback.

" Secretariat Follow-Up on Inspector General Findings

and Recommendations, " is available as Document GF/B21/12 at www.theglobalfund.org/en/board/meetings/twentyfirst.

GFO 128 contains an interview with Parsons, the Global Fund's Inspector

General. Recently, GFO has written about the reports issued by the OIG in GFO

127, 126, 125, 119, 116, 115, 113, 108 and 107. All issues of GFO are available

at www.aidspan.org/gfo.

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3. NEWS: Global Fund Releases

Detailed Operational Guide

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The Global Fund has issued a new Operational Guide

targeted primary at implementers of Global Fund grants. Entitled " Operational Guide: The Key to Global Fund

Policies and Processes, " the 118-page document is available (in

English) at www.theglobalfund.org/en/policies.

French- and Spanish-language translations are underway.

The purpose of the guide is to help implementers

understand Global Fund policies and to provide guidance on the various

processes that have to be followed during the lifetime of a grant. Most of this

information already exists on the Global Fund website and in existing

guidelines; the Operational Guide brings the information together in a single

document.

To keep the guide to a manageable size, some of the

information is in shortened form. For example, the Operational Guide may

summarise a policy and then provide information on where to obtain the full

policy. However, the Operational Guide is still quite detailed. For example,

the part on grant signing lists the documents required for signing, explains

how grant negotiations are organised within the Global Fund Secretariat,

discusses the roles of the LFA and CCM in grant negotiations, and provides

guidance on issues such as how much money the PR can expect upon signing, and

whether the PR can access grant funds prior to signing.

In addition to the section on grant signing, there

are sections on implementing grants, requesting continued funding, closing

grants, and risk management. Although the guide is targeting implementers,

there is also a section on accessing funding, as well as an introduction to the

Global Fund. In addition, there is a section describing the new grant

architecture.

The Global Fund used to have an Operations Manual,

which covered some of the same areas as the Operational Guide, but the manual

was not widely available and has not been kept up to date. The Fund plans to

release some " operational policy notes " in the near future. These

notes will provide more in-depth information on some of the implementation

topics covered in the Operational Guide.

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4. NEWS: Call for the Global

Fund to More Actively Fund and Promote Harm Reduction

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The Global Fund is underperforming when it comes to

support for HIV-related harm reduction programmes. The Fund urgently needs to

increase the amount that is spends on harm reduction, and encourage applicants

to build harm reduction into their proposals. These observations and recommendations

come from a report recently released by the International Harm Reduction

Association (IHRA), entitled " Three

Cents a Day Is Not Enough. "

The IHRA said that all applications for funding from

the Global Fund should be required to state whether and how they have addressed

drug use issues; and if they have not, to explain the reasons why. The IHRA

also stated that the Global Fund must also take measures to ensure that NGOs

and organisations that represent drug using populations are properly involved in

proposal development, and to facilitate more NGO-led applications.

The IHRA said that although it is difficult to

measure how much of global HIV spending actually goes into harm reduction,

there is no doubt that the amounts are very small. According to the IHRA, a

generous estimate for 2007 is that approximately $160 million was invested in

HIV-related harm reduction in low and middle income countries. This spending

equates to $12.80 for each injector each year in low and middle income

countries, or just three cents per injector per day. To put this $160 million

in context, the IHRA said, UNAIDS estimates that the resources needed for harm

reduction were $2.13 billion in 2009 and $3.2 billion in 2010.

The IHRA report said that the Global Fund invested

$45 million in harm reduction in 2007, and a total of $180 million in the

three-year period from 2007 to 2009. [The source for these figures is an

article by R. Atun and M. Kazatchkine, " The Global Fund's leadership on

harm reduction: 2002-09, " International

Journal of Drug Policy 21(2).]

The IHRA said that resources for harm reduction and

HIV services for people who use drugs should be proportionate to the need

within countries. The IHRA recommended that, globally, 20% of prevention funds

be allocated to harm reduction.

" Three Cents

a Day Is Not Enough: Resourcing HIV-Related Harm Reduction on a Global

Basis, " is at www.ihra.net/reports.

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5. NEWS: Global Fund Launches

Its SOGI Strategy

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The Global Fund plans to monitor and publicise cases

where funding proposals have been, or might be, rejected due to policy

environments where human rights violations are impeding the implementation or

impact of interventions against AIDS, TB and malaria. This is one of the

highlights of the Global Fund's policy and implementation plan on Sexual

Orientation and Gender Identity (SOGI), collectively referred to as the

" SOGI Strategy, " adopted by the Fund during the course of 2009.

The Global Fund says that its SOGI Strategy applies

" to all people whose sexual orientation, gender identity and/or sexual

behaviors do not conform to majority norms and values, focusing on adults

engaging in consensual sexual behaviours that increase their health-related

vulnerabilities. " In practice, this primarily means men who have sex with

men (MSM), transgenders, and female, male, and transgender sex workers.

Earlier,

the Global Fund adopted a policy and an implementation plan on Gender Equality

(see GFO

100 and 113.) The Global Fund says that while its SOGI Strategy

and its Gender Equality Strategy have been developed as two separate documents

through separate consultations, they are considered to be components of a

single Global Fund Gender Strategy.

HIV/AIDS

disproportionately impacts MSM, transgenders and sex workers. HIV prevalence

among sex workers is higher than in the general population. Among MSM, both the

incidence and prevalence of HIV/AIDS is high in all regions of the world, with

recorded HIV prevalence rates as high as 25% in Africa, 11% in the Caribbean,

28% in Southeast Asia, and 51% in some parts of Latin America. Among

transgendered persons, HIV prevalence is believed to be even higher than among

MSM.

Criminalisation of people due to

their sexual orientation or gender identity impacts their ability to negotiate

health and health services. In some countries on every continent, rights related

to SOGI populations and access to health are still explicitly or implicitly

denied through laws, religion, social institutions and cultural traditions.

This includes vocal hostility and incitation to violence by political leaders

and religious leaders. Sex between consenting adults of the same gender is

criminalized by approximately 85 countries, including 34 African countries,

with 10 countries having death penalties for homosexual relations between

consenting adults.

The

SOGI Strategy acknowledges that in terms of being able to access or benefit

from Global Fund grants, MSM, transgenders and sex workers face serious

challenges. They face limited access to decision-making or control in CCMs, PRs

and SRs, and there are many social and structural barriers to the realisation

of health and rights for these populations. Around the world, even in countries

where SOGI populations are nominal beneficiaries of Global Fund funding, there

are consistent and extensive reports of funds not being allocated to appropriate

interventions, a severe lack of services related to health and rights, and

continued disregard for human rights.

The

strategy acknowledges that work in this area is " difficult and sometimes

controversial in many part of the world, " and that " there is no one

approach for every situation. "

The

SOGI Strategy contains 19 activity areas, including the following:

·

strengthening CCMs;

·

strengthening the proposal and

application process;

·

strengthening the expertise and

capacity of the Technical Review Panel; and

·

ensuring that monitoring, evaluation

and reporting is positively oriented toward work addressing sexual orientation

and gender identities.

The

strategy also contains a " logical framework, " which identifies, for each

activity area, activities, planned outcomes and indicators. For example, for

strengthening CCMs, the following activities are listed:

·

Analyse CCM capacity related to

SOGI.

·

Review and strengthen CCM guidelines

and tools.

·

Include SOGI training and briefings

during regional CCM meetings, and other relevant national and regional

meetings.

" The Global Fund Strategy in Relation to Sexual

Orientation and Gender Identities (SOGI) " is at www.theglobalfund.org/en/publications/other.

Some of the information for this article was taken from " Sexual

Orientation and Gender Identities Strategy: Plan of Action 2009-2012, " 11

December 2009, and " Analysis of Sexual Orientation and Gender Identity

Related Activities in Round 8 and 9 Global Fund Proposals, " undated.

Neither document is currently available on the Global Fund website, but both

are mentioned in " The Global Fund, HIV and Sexual Orientation / Gender

Identities Strategy Update, " a report prepared for the Global Fund's Third

Replenishment meetings in 2010, available at www.theglobalfund.org/en/replenishment/hague/documents.

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6. NEWS: Recent Developments

in Global Fund's Gender Equality Strategy

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When the Country Coordinating Mechanism (CCM)

Guidelines are revised later this year, they will include strategies to

strengthen gender expertise and achieve balanced gender representation on CCMs.

In addition, gender-related indicators in the Global Fund's CCM funding policy

will allow the Fund to monitor the number of CCM members trained on

gender-related issues or representing organisations with a documented

gender-related mandate.

The guidelines will also include sections on

strengthening representation from sex workers, men who have sex with men,

transgender people and/or other sexual minorities. The revised CCM Guidelines

will be submitted to the Global Fund Board in December.

The above information is included in two reports

prepared for the Global Fund's Third Replenishment meetings that took place in

March 2010. The reports said that a framework to assess the scope of activities

that promote gender equality in the overall Global Fund portfolio has been

developed and will be finalised in collaboration with partners during the first

half of 2010. They also said that a gender analysis of HIV proposals approved

in 2008 and 2009 is underway, and that the findings should be available

shortly.

Other related developments include the following:

·

a key performance indicator on

gender and key affected groups has been developed, for use in measuring the

overall performance of the Global Fund;

·

gender issues will be integrated

into the Grant Scorecard (used to measure the performance of individual grants

at Phase 2 renewal);

·

partner organisations - such as

UNAIDS, the World Health Organization (WHO), the United Nations Development

Programme (UNDP), the German development agency GTZ, the United Nations

Children's Fund (UNICEF), and the Open Society Institute - have supported

countries to include strong gender components in their Round 10 proposals; and

·

three technical seminars and two

induction courses on gender have been conducted, reaching more than 250 staff

at Global Fund headquarters.

In addition, a gender toolbox has been developed by

UNAIDS and the WHO, consisting of technical resources to assist in the planning

of gender programmes. See " Addressing

Gender Inequalities: Strengthening HIV/AIDS Programming for Women and

Girls. "

Information for

this article was taken from " Implementation of the Global Fund Gender

Equality Strategy, " and " The Global Fund, HIV and Sexual

Orientation/Gender Identities. " Both documents are at www.theglobalfund.org/en/replenishment/hague/documents.

Also available on that site is a report entitled " Investment in the Health

of Women and Children: Global Fund Support of Millennium Development Goals 4

and 5. "

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7. NEWS: Report Documents Rise

in Official Development Assistance

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In

the last decade, official development assistance from donor countries has been

increasing, as has the proportion of this assistance going to health. This

information is contained in a report recently released by the Global Fund.

In

2008, development assistance reached its highest level ever at $121.5 billion,

up from $53.7 billion in 2000. In terms of the proportion of gross national

income (GNI) of donor countries, development assistance rose from 0.22% in 2000

to 0.31% in 2008. Of the total development assistance, 70 percent was provided

through bilateral organisations, with the remaining 30 percent disbursed

through multilateral organisations.

The

proportion of official development assistance that was earmarked for health

increased from less than 10% in 2000 to 17.6% in 2007. Over this period,

development assistance for health (DAH) grew at an annual rate of 17%. In

dollar terms, DAH went from $10.7 billion in 2000 to $21.8 billion in 2007.

The

report says that the increase in DAH in the last decade is attributable to a

significant rise in funding from the U.S. through the President's Emergency

Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative (PMI); and

large flows of resources from new global health actors such as the Global Fund,

the Global Alliance for Vaccines and Immunisation (GAVI), and the Bill and

Melinda Gates Foundation. In 2007, the Global Fund, GAVI, the Gates Foundation

and NGOs accounted for over 40% percent of total DAH.

Sub-Saharan

Africa has benefited significantly from the

increases in DAH. Sub-Saharan Africa's share

of global DAH grew from 33% in 1990 to over 50% in 2007.

Editor's note: This report covers the period from

2000 to 2008. In 2009 and 2010, development assistance has either levelled off or

begun to decline.

" Trends in Development Assistance and Domestic

Financing for Health in Implementing Countries, " is available at www.theglobalfund.org/en/replenishment/hague/documents.

Forwarded by:

---------------------------

Yours

in Global Concern,

A.SANKAR

Executive

Director- EMPOWER - Professional Civil Society

Organisation

Vice Chairman -Initiatives of Health Net

(IHN)

National Convener- National Alliance for Health,

Environment and Rights ( NAFHER)

Founder and General Secretary - Confederation

of Indian Civil Society Organisation’s (CICSO)

107J / 133E,

puram

TUTICORIN-628

008, TN, INDIA

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461 2310151; Mobile: 91 94431 48599: www.empowerindia.org

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