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Since the 1990s, Latin America and the Caribbean has been at the frontline and a leading region in terms of programs, as well as, in the advancement of the realization of more and new civil rights. We had countries whose effective responses have been exported through technical-programmatic capacity bilaterally and horizontally; where Brazil is one of the examples, within Latin America and the Lusophones -speaking countries.

We benefited from a broad spectrum of regional networks and initiatives, both from civil society, key populations, as well as scientific, academia and governments; an example of this is the model of the Horizontal Technical Cooperation Group (GCTH). We successfully organized regional forums and conferences, which nurtured an agenda within our region and the world. We had consultations and workshops in both sub-regions of the Global Fund and other multilateral mechanisms, on critical issues of the responses. Even at the General Assembly of the United Nations, we had the emblematic and influential Rio Group.

In the last decade, still, with the decrease in investments in HIV, with changes in the Global Fund and PEPFAR eligibility policies, and with the beginning of the involuntary transition process from all middle-income countries, which has been proven harmful in some cases in other regions, gains of the last decades have been lost or are at risk of being lost in countries who graduated from ODA. The stagnation of national and regional responses andthe weakening of strategic spaces for participation have a clear correlation with the strategic and epidemiological information that countries report or omit in recent years showing nosignificant progress. Decades ago, we could argue that we were victims of our own success. Is that still the case?

It is a fact that many countries in the region are going through political, economic, and even humanitarian crises and that the policies have changed, through government positions that are anti-rights. Some administrations of the recent past in countries that enable the processes of inclusion and expansion of human rights are no longer at the forefront of those governments. Despite this scenario, identify a obvious causal relationship, between the start of stagnation or setbacks and these changes in the political trends of the region.

“Despite the proven benefits of engaging communities and civil society, many barriers limit their effectiveness and influence, including lack of resources, capacity and support and challenging legal, social, and policy environments. Inequitable access to resources, policy dialogue and decision-making nationally and internationally particularly affects marginalized communities, including women and girls, young people, ethnic, racial and religious minorities, indigenous populations, lesbian, gay, bisexual, trans-gender and intersex (LGBTI) people, (Female Sex Worker) migrants and people with disabilities”. (1)

We believe that the process of the High-Level Meeting on Universal Health Coverage and the limited involvement of civil society in LAC in its preparatory phase and HLM debates is a clear symptom of the state of affairs. A great missed opportunity, where Civil Society was absent or banned from national delegations (for various reasons); and where many countries have not had local consultations. Those are clear setbacks. The target 2030 is very close, and much must be done to rebuild the necessary capacity for structures, spaces, and mechanisms. We must significantly improve the participation of civil society, but also of other stakeholders, in the planning, implementation, and monitoring of actions and initiatives related to the UHC at all levels.

We welcome that twelve agencies within and outside the UN system have worked for 18 months in an collaborative manner to develop the Global Action Plan for Healthy Lives and Well-being for All (GAP), and then during their recent launch they have renewed the commitment to joint work and the impressive potential that this synergy will have in all regions so that 2030 goals are not a utopia. How did Civil Society participate in the development of the Global Action Plan?

The participation of the region in the GAP consultation process was very limited and conditioned by having been organized: 1) in person, around the UNGA Multi-stakeholders Hearing on UHC in April, with a very low registered participation of society civil society in general and from Latin America and the Caribbean and 2) the second consultation, online, was conducted in English and the participation of civil society, for obvious reasons, was mainly possible for International NGOs in developed countries. As a result, not only our voices – from the LAC region and as a global south- have not been heard in development, without or that the knowledge that our sector has about GAP is practically nil.

“The agencies have an important role to play in optimizing opportunities for communities and civil society to contribute to achieving the health-related SDG targets, including through their participation in local, country, regional and global processes”. (2)

Reading the document, we can find the mention of seven accelerators, and we could put the lens on the number three: “Participation of communities and civil society” and the fourth: “Determinants of health.” The seven are relevant to our sector, but these two directly affect us, if you continue to have low participation and consultation within the region.

How have the twelve agencies thought to implement these accelerators globally and regionally? How will they apply civil society participation without talking to us?

“When communities and civil society are engaged, they bring their lived experience, perspectives and expertise to knowledge generation, policy making and health responses that are informed, effective and sustainable We recognize the commendable work of community agencies, networks and regional leaders, and we make a clear recognition that there are fewer financial and in-kind resources.” (3)

In the following years many of the most relevant regional networks of LAC will devote much attention and energy to the efficient implementation of a sophisticated multi-country program on sustainability of the Global Fund, which did not include the GAP and the accelerators on time, when its was developed. We are still concerned about the evidence of a risky lack of synchrony of the interventions financed in the countries (e.g. Transitioning and Sustainability) and those that will have to do with the work of the UHC implementation in the Member States in LAC, even though they will directly affect response to HIV, the associated comorbidities and other diseases.

It must be recognized that Universal Health Coverage is not the same as Universal Access to Health, as is guaranteed in many Constitutions of countries in our region. We required the sustainability of services in most countries and that’s will happens through programs, models, systems and services funded by domestic resources. The health coverage should be efficient, effective, transparent and participatory and this requires a strong civil society. In addition, we will continue needing the support of the international cooperation, that do remain relevant, especially in the face of inequality indicators (SDG 10) in Latin America, which indicate a significant gap within their own countries.

Thus, we have a possible scenario of relevant intergovernmental organizations, with the capacity to influence by carrying out actions in a different dimension, and sharpening the effect of “silos”, which isolates us even more from civil society working on other health and development issues. Never it’s too late. We understand that civil society must once again be part of these joint efforts in a process that includes the commitment of all and results in a enabling process meaningfully involving CSO and networks in the implementation of programs. But inclusion must be in all processes and at all levels.

We don’t have an apocalyptic or pessimistic view. We believe that we are at the right time, a potential turning point, to initiate a sequence of dialogues on how we can improve the current situation in the region, while we find a way to partner in the implementation of the UHC that our people requires, Global Action Plan which will be global, in all the regions and countries.

In this regard, we promptly request a virtual meeting with all the representatives of the agencies, the twelve, as well as those that participate or will participate in the GAP in the region, to discuss the issues mentioned in this document.

Respectfully,

Regional and international networks and initiatives of and with work in Latin America and the Caribbean:

(In alphabetical order)

1. Alianza Liderazgo en Positivo

2. Coalición de Activista de las América – Alberto Colorado – Coordinador

3. Consejo Latinoamericano y del Caribe de organizaciones no gubernamentales con servicios en VIH/SIDA (LACCASO) – Alessandra Nilo – Directora Regional

4. Comunidad Internacional de Mujeres que viven con VIH (ICW Latina) – Mariana Iacono–Coordinadora Suplente

5. Corresponsales Clave, Equipo de América Latina y el Caribe – Javier L. Hourcade Bellocq – Editor y Lidie López Tocón – Coordinadora.

6. Fundación Huésped – Leandro Cahn – Director Ejecutivo

7. Gay Latino – Simón Cazál – Secretario General

8. Gestos, Brasil – Alessandra Nilo

9. International Treatment Preparedness Coalition ITPC – LATCA

10. International Consortium of AIDS Service Organizations (ICASO) – Mary Ann Torres – Directora Ejecutiva

11. Movimiento Latinoamericano de Mujeres que viven con VIH (MLM+) – Mirta Ruíz – Secretaría Regional MLCM+

12. Plataforma Regional Coalition Plus – Amira Herdoiza – Coordinadora

13. Red Centroamericana de Personas con VIH (RedCA+) – Otoniel Ramírez Hernández – Secretario

14. Red de Jóvenes Positivos de América Latina y el Caribe (J+LAC) – Miguel Subero, Horacio Barreda y Aarón Zea.

15. Red Latinoamericana de Personas que viven con VIH (Redla+) – Estela Carrizo, Guiselly Flores y Luis Adrián Quiroz (Comisión Normalizadora)

16. Red Latinoamericana y del Caribe de Personas Trans (RedLACTrans) – Marcela Romero – Coordinadora Regional

17. Red de Mujeres Trabajadoras Sexuales de Latinoamérica y del Caribe (RedTraSex) – Secretaria Ejecutiva – Elena Eva Reynaga

Notes

1. Stronger collaboration, better health: global action plan for healthy lives and well-being for all, p. 62 link
2. IDEM
3. IDEM

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