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Source: Corresponsales Clave

After achieving the fund replenishment goal, the Global Fund Board will meet soon to discuss the allocation of financial resources and to shape the Sustainability, Transition and Co-funding Policy. This editorial is a critical look to such transition process and the role that civil society should play.

By: Javier Hourcade Bellocq

The Board of the Global Fund to fight AIDS, tuberculosis and malaria approved at its meeting at the beginning of the year in Ivory Coast, the Sustainability, Transition and Co-Funding Policy (see  article). In one week, they will meet again in Montreaux, Switzerland to discuss the allocation of financial resources for the next years. This, after finishing the replenishment process of funds, where the goal to raise 13 000 million dollars for the next three years was achieved. This result is at least public information, the small print is still to be read in the commitments of the donors and see when and how those commitments will be honored.

Anyway, the money raised is very limited and will not be sufficient to keep funding the fight against the three diseases in the least priority regions such as Latin America, part of the Caribbean, East Europe and part of Asia. The Global Fund asked for what the donors were willing to give and they in turn directed them to the countries that they have prioritized; pleasing the donors, which explain why many of our countries will be expelled from the Fund’s portfolio in the coming years.

Transition, the trendy word

The process has already begun and also the approach chosen to enter the next Fund projects in our countries, with a Troy Horse, that comes disguised of transition and sustainability; not necessarily because the Global Fund, which is a partnership where donors have a strong influence, worries about what will happen to the responses to the diseases in our countries, but because it is a more elegant way to leave, or as they said “off the record”(without microphones) a more responsible and politically less costly withdrawal. This time they will go, unless something dramatic happens.
Therefore, working on transition is the “trendy word”. I have lost the account, but the last time I checked there were at least 10 international organizations, some NGOs and “transient unions of wills”working on the same topic. The Global Fund Secretariat hired    “experts”on the matter and so did many organizations. Where do these international experts come from? It is difficult to know. In how many successful experiences on sustainability and transition have they participated?, we do not know. What did such experts produce? These are also very good questions to ask. We do not know of any case where the transition from a donor has not had a high program and public health cost.

CCMs, sub-recipients, NGOs and networks have been invited to meetings and workshops since the beginning of this year, where they try to explain or teach them how to diagnose their preparedness condition for transitioning (that is to say, to work and survive without economic resources), social contracts (or how to be employees and suppliers of our States/Governments) and, finally, how could governments be pressured to put more money. There are people that so far this year have already attended 3 or more events of similar characteristics. Why? Because there is money for “suppliers and contractors”for this type of work, and once more, because there is very poor alignment and coordination between the stakeholders “embarked on such a noble deed”, tied to a strong disconnect, because there is a need to raise that money and pretend that we are doing something.

 

Sustainability and Transition are political issues

Despite the fact that many techno-bureaucrats may disagree with me, Sustainability and Transition are not only technical and process related issues, they are purely political issues.

The donor’s community is not interested in funding our countries where we have the largest number of people with HIV: middle-income countries. They are only interested to allocate their resources that are not theirs as they belong to the taxpayers in the least developed countries, in “the poorest countries among the poor”. Since 10 years ago, when the first work group on eligibility was created at the Global Fund Board they have been obsessed with this topic; today they are closer than ever to achieve their long-awaited dream.

They do not seem either to be interested on future sustainability; not because they are bad guys but because they are politicians. It is not their money, they represent a government and its agenda. No matter how much you talk to them and argue, believe me, nothing happens. There is no evidence, among the little evidence available that will make them change their view.

Governments in our developing countries are not very much interested either in sustainability or in transition. Some of them, the best and most organized ones, have already designed scenarios on the amount of money that they have to allocate in the budget of the AIDS National Program to provide treatment and some services. Other politicians will not even be in the government when this happens. Some calculations include the money to buy antiretroviral medication, some inputs and in the best of cases, some condoms. That is all in terms of political will; zero prevention and much less financing for civil society work.

And our colleagues and friends in civil society are suffering from the “Titanic syndrome”dancing in a state of religious denial. Maybe they will wake up when the water reaches their waist, meanwhile they complain: how is it possible that this would happen? Unfortunately, the concern, vision and anger still have not moved us enough. Many of those who know that “the wolf will come to town for sure this time”lock themselves in their houses with resignation or get busy in an endless number of workshops about, once more: sustainability and transition.

Those who have the power for financial decision making, the governments of the donor States, have already made a decision, to withdraw from the countries as soon as possible and they mark their calendars for the longed day. Our governments pretend they do not know or look forward to the day when the Global Fund leaves so they do not have to seat at a CCM to make decisions and not be accountable to “those people” with whom they believe they should not meet, coordinate and be accountable. Ultimately, they will say, we live in representative democracies and we have the mandate of the voters to manage for 4 or 6 years, let us do our job.

On the other hand, civil society has not implemented a contingency plan in order not to lose those key spaces of collaboration and oversight. Money is, believe me, in the governments at the “North”and “South”, what is missing is the political will. Then we are facing a serious political problem that we attempt to solve and minimize with tools. But a screwdriver is not the best tool to hammer nails.

What can be done?

I have taken the trouble to look at the tools aimed at measuring our preparedness for the transition process, and in some cases the results from those measurements. It is about percentages and key words that only over diagnose what we already know or at least sense: no country is ready to transition and there is little chance to be sustainable.

We are confusing the thermometer or the X-ray as if they were the treatment. If the patient has pneumonia or tuberculosis, he needs to be treated and does not need 100 X-rays or to check his fever one hundred times, at the risk of getting worse due to lack of treatment and an irrational fixation on the diagnosis. What good is it for us to know that the response of civil society in any given country has a 65% of preparedness to be sustainable or to transition with fewer traumas?  Which is the 0% or the 100? A common pattern in most tools is the superficial, hurried, symptomatic measurement with a very low participation of civil society actors that will be most affected.

Our major problem is Sustainability, not transition. Transition is irremediable and many actors are trying to push the iceberg away from the ship, to buy more time. At risk of being reductionist, when I have been asked about sustainability at a meeting or interview, I usually have said the following:

– Before discussing transition, it is urgent to discuss a medium and long term plan on sustainability and to stop putting the car in front of the horse.

– It is worthless to measure preparedness if you do not have the means to solve what has been diagnosed.

– Diagnostics must be serious, deep and participatory. Diagnostics should be made within the countries.

– The Global Fund Secretariat can promote the concept of Sustainability and Transition by supporting the operationalization of the policy, but it has a severe conflict of interest by being directly involved. If it has resources, it should transfer them to a neutral organization with high reputation, for instance the Robert Carr Fund, so they will build the grants for civil society in the most affected countries.

– “Organized”civil society should start working on a broad multisectoral coalition (with actors with experience on transparency and budgetary work, with organizations that work in other health problems) to develop a budgetary advocacy plan for the countries, which includes components of resources for prevention and for civil society.

Mark Dybul, Global Fund Executive Director

– An analysis should be made on those organizations that are most exposed politically due to their role in political advocacy, denouncement, oversight and social control, and mobilize external resources for their survival (I cannot imagine that our governments like to feed mastiffs that bark and bite).

– The creation of a national multisectoral committee should be promoted, a CCM (better and expanded) to ensure a space for civil society, including key populations, people living with HIV and other communities. If this is part of a decree or law it is likely that it will have more chances of surviving over time.

– Take ownership of the transition resources of the next concept notes and programs of the Global Fund, to do part of the work described above. In reality, so many resources are not necessary to implement what was described, but we need commitment and a sense of urgency. We should stop enchanting with the mermaids song that comes from outside with magic recipes, remember they are contractors, and the longer the work lasts, the better, which does not guarantee a better work.

I can assure you that some of the things that I am sharing with you and others more, were possible in three countries where we have worked together with the Alliance; but still after three years of joint work, the conclusion is that these processes need not 3 but 6 or more years to change something, and most of all they need a lot of political generosity from our colleagues.

I do not think that some of my colleagues, currently turned into missionary pastors of transition and sustainability are bad people. I think they will do their best to help, but there are also particular motivations to benefit from this opportunity of contracts and resources, although I think they are the least likely to perform this task, basically because of their lack of knowledge and experience. This work has nothing to do with great conceptualizations, recipes or many tools, but with common sense and knowledge of the reality. Let us not lower our arms in denouncing impunity with which the donors, through the Fund, escape from our countries. Let us break the inertia that this is not more of the same thing.

To review the Sustainability, Transition and Co-funding Policy of the Global Fund, click this link.

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