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On April 26 and 27, the 35th. Governing Board Meeting of the Global Fund on AIDS, tuberculosis and malaria, was held in Abiyan. In this meeting the new Fund strategy was approved as well as other policies affecting Latin America.
By: Javier Hourcade Bellocq
The Governing Board held its first meeting of the year where several topics were discussed; among the most relevant ones were the new strategy, the eligibility policy, the sustainability, transition and co-funding policy (STC), as well as the policy on resource allocation. This is a first summary of information on the decision in the last 48 hours. Later on, we will provide more detailed information on the policies.
There have not been significant changes for Latin America in terms of the eligibility policy, however it is worth mentioning: 1) a more clear definition that Islands with small economies, as part of the Caribbean and the Pacific are exempted from the eligibility policy (nothing new) and 2) in order to determine the income level of a country, the national gross income in the last three years and not only in the last year, will be defined.
An inevitable farewell
The STC policy has been more controversial; many delegations, civil society and the most affected countries, negotiated until very late at night seeking for some flexibility. Countries that will not be eligible in the future will soon start or have already started a transition process; in fact, the most recent allocation of national resources should have a clear plan to ensure an orderly exit from the Global Fund.
Regional and country teams will submit the evaluations on transition preparedness to the Board through the Strategies Committee. Although attempts were made to introduce flexibilities, for instance, extending the transition to two cycles (6 years instead of 3), there was no success.
If transition has been included in the projects of any of the countries, this new policy shall not apply retroactively. That is, if they have included transition in the next three years, these could be the last ones. The Global Fund Secretariat is committed to be flexible in this regard and to openly discuss with the countries and the Governing Board, in each particular case.
The Fund is transitioning out of the region, which in many cases may be a fancy way to say that it is leaving. Transitioning should be a responsible and orderly way to leave, it is on us to oversee that this is the case. The next country on the list seems to be Peru, but other countries in the region will follow, as well as many in Eastern Europe.
The Fund will redirect to significantly fund fifteen countries, in a given region, nine of them on HIV/AIDS; in other words, the Global Fund has left or lost its global coverage attribute.
In a next article we will detail information on the new policy for funds allocation.
An exit with little responsibility
Finally, the Global Fund is leaving many of our countries, as for a decade we have been struggling for this not to happen. We have seen some progress in our countries taking the responsibility of domestic investment in the response, but (a big BUT), in the best case, it has been for the purchase (sometimes inefficient) of antiretroviral medication and other inputs. And what about civil society investment? Who will fund organizations on key populations, human rights and political advocacy? We doubt it will be the government, and the Global Fund will not be there either to do so.
Have we made the most of the 10 or 15 years of the Global Fund investment in our countries? Surely not. We have wasted time and money, fighting and becoming part of the waste and incorrect use of resources. This is not the cause for the exit of the Fund, but it is that we wasted valuable time for leveraging the investment in the response to the three diseases.
I come from a country that resigned to the Global Fund and returned money; where the National Program on HIV, STIs and hepatitis invests responsibly in the response. In the last grant from the Fund, a marginal sector of civil society spent hours arguing at the CCM, they took money over which they have not yet been held accountable and exercised an embarrassing conflict of interests, cutting the resources pie to benefit their organizations while they got contracts as consultants. This discussion does not involve all the countries in the region, but most of them.
But in other LAC and Eastern Europe countries, drug users, transgender, gays and other MSMs and sexual workers, are still getting HIV, getting sick and dying. Today the Fund is or will be leaving many countries and perhaps, if still open, in some years it will come back to an epidemic emergency in many of the countries. Leaving and coming back takes many lives. Many achievements will be lost. This is not only a failure of a funding mechanism, but the abandonment of a partnership agreement.
The difference between transition and a hasty departure?
Three years are not sufficient to transition from one situation to another. The Board and the stakeholders must closely follow these processes and the Global Fund should be transparent to the fullest and propose flexibilities, wherever necessary. With a deeply divided Board, the departure itinerary of the Fund was approved in many of our countries. There is a list of –more or less- ten countries that begin their transition in LAC and Eastern Europe, which seems to be the best kept secret and does not say much about transparency. But we ask our readers who participate at the CCMs where transition has been included; to kindly let us know about it.
It is fair to say that we all agree that Africa is the hardest hit region in the planet by the epidemic and which has very low levels or capacity to absorb resources. The reasons that make these countries vulnerable to the diseases are the same that reduce their abilities to manage the resources received. It is a vicious circle. But it is also real that between 75% and 85% of the money allocated by the Global Fund, will remain unspent; more than one billion that could be invested in our countries.
Money is not scarce in donor countries, neither in our countries. However it is not available to our people, to civil society organizations. There is money but priorities are wrong. And this will take lives.