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Source: corresponsalesclave.org

By: Constanza Armas

On January 27, 2022, six regional platforms gathered at a roundtable meeting to reflect on the community participation in the Global Fund’s COVID-19 Response Mechanism (C19RM) last year, assess the challenges and lessons learned, and prepare for the future, as part of the Community, Rights and Gender Strategic Initiative.

By way of context, the COVID-19 pandemic has had a global negative impact on health services in general and on tuberculosis (TB), malaria, and HIV services in particular, especially in low- and middle-income countries. According to data from the Global Fund to Fight AIDS, TB and Malaria (the Global Fund), between 2019 and 2020, there was an 18% reduction in TB diagnoses, which decreased access to treatment and led to a 7% increase in TB deaths. Regarding HIV, 80% of the countries reported a reduction in testing and treatment. There was also evidence of a 12% increase in deaths from malaria in 2020.

Against this backdrop, in April 2020, the Global Fund established a COVID-19 Response Mechanism (C19RM) that made available US$759 million in funding to 88 countries and 5 multi-country grants, in addition to the US$4.2 billion provided annually to more than 100 nations. These funds helped ensure that resources and commodities were available in countries to respond to COVID-19 and mitigate its impact on HIV, TB and malaria.

Likewise, in April 2021, the Fund launched a second round of C19RM funding, this time providing US$3.1 billion to 107 countries and 14 multi-country grants through December 2023. Furthermore, as a lesson learned, the C19RM Investment Committee awarded an additional $2.1 million to support meaningful community participation in the development of funding requests, advancing the Community, Rights and Gender Strategic Initiative (CRG SI).

Last week, the six regional platforms –which include civil society coalitions and communities from Anglo and Francophone Africa, Eastern Europe and Central Asia, Middle East and North Africa (MENA), and Latin America and the Caribbean– gathered at a roundtable meeting to reflect on community participation in the C19RM during 2021. This is the second encounter of this type that has brought together civil society and community groups from the various countries in which the Global Fund invests.

The meeting was attended by Kate Thomson, Head of the Community, Rights and Gender Department at the Global Fund, and moderated by Gemma Oberth, Global Platforms Coordinator.

During the gathering, participants noted that the updates to the C19RM from 2020 to 2021 have been positively evaluated. However, more work still needs to be done regarding the work process, access to information, and community participation. This is particularly true in the engagement and effective participation of human rights and grassroots organizations, key populations, communities, and youth, among others, as some of them expressed that their priorities and demands were not included.

The meeting took into consideration experiences from various populations and different geographic areas. Among other topics further developed below, it focused on the enhancement of the delivery of technical assistance consultancies, timeline adjustment and clear definition of lines of work by the Fund, the inclusion of communities and key populations, and improvement to data collection methodologies.

Technical assistance

In most cases, technical assistance consultancies were effective as long as the people involved were familiar with the communities they were working with and, in turn, were recognized by them. Knowledge of the environment and the political-social dynamics in the country of implementation was also essential in the experiences presented.

Likewise, as a lesson learned, people evaluated less positively the exclusive use of virtual media as a link between communities and consultants and occasional or one-time consultancies. Regarding the latter, there was a proposal to increase the available resources to ensure ongoing and flexible technical assistance capable of accompanying the communities during the intended work processes.

Time adjustment and definition of lines of work

In most of the presentations and during the discussion, speakers questioned the work timeframe imposed by the Global Fund. They considered that these times were limited for mobilizing resources, seeking and evaluating technical assistance, preparing key actors, and including and training some populations and communities.

In the words of Johnny Tohme, M-PACT’s Senior Community Mobilization Manager, there are “too many demands for such limited time and resources,” especially in the context of the pandemic. Because of this, some suggested the possibility of modifying and making work times more flexible. This change would provide, above all, better preparation conditions for the design and implementation of the proposed plans, ensure the participation of key populations, and allow consultations between communities.

Communities

Communities were the focus of both presentations and comments during this event. The speakers emphasized that communities need to be supported with factual information, periodic reviews, and occasional interventions to resolve conflicts. It is also necessary to ensure their participation in all stages of the projects, including the diagnosis and implementation phases. A simplified application process for funds, especially in times of emergency, is also essential.

Although there was evidence of more significant commitment from the communities and an improvement in the consultation and work mechanisms, other groups –such as migrants, persons deprived of liberty, transgender persons, sex workers, drug users, and youth, among others– were not represented in all the dialogues. In some cases, this was due to the absence of grassroots organizations to represent them; in others, it arose from time limitations, insufficient technical experience, difficulties inherent to the pandemic response, or connectivity problems.

As a result, there was a proposal to increase the resources available to communities at the country level to support them in their ability to set priorities and build capacities for more effective participation in the online sessions of the Global Fund processes. As Samia Mahmoudi of the Middle East and North Africa (MENA) Platform pointed out, “attendance at events does not necessarily imply effective participation in the discussions. Not all the representatives of key populations have the same capacity to express themselves and represent their group in their interventions.” Additionally, as mentioned above, the tight deadlines did not facilitate the preparation of applications for resource mobilization and assessment of needs.

There were other views on this last point, however. One civil society person from Kenya commented that “community participation should no longer be a mere formality. You have been told that communities lack experience, but that is no longer true at this point. Communities have experience and expertise, and we should be at the center of the implementation.”

These discussions prove to be central because, as one participant stated, “it is crucial to have a definition of community, as some of our donors are confused when we make a request. We believe that community means people representing vulnerable groups, but this is a definition that needs a revision.“

It is necessary to open these paths of dialogue so that responses and work can reach the most vulnerable populations and build links of listening and trust from existing networks.

Finally, participants emphasized that investing in community linking should be an ongoing, long-term agenda meant to ensure meaningful participation, legitimize their contributions, and establish follow-up and monitoring mechanisms through formal and informal networks.

Communication channels and community consultation

Engaging as many key populations as possible with the proposed projects is one of the most significant challenges of community work—even more so considering the constraints imposed as a result of COVID-19. Because of this, the initiatives that employed a range of information dissemination sources –such as telephone calls, emails, WhatsApp, Facebook groups, webinars, and some face-to-face meetings– were evaluated as successful.

Several presentations discussed the importance of having an organized work methodology that included clear objectives and captured the most significant number and diversity of voices within the target communities. In this regard, Lídice López pointed out that “designing a critical path plan that included all the process steps and used various tools and methodologies for gathering information (such as surveys, interviews, and focus groups) would increase participation and obtain more robust information on priority needs.”

Such measures would be essential during all parts of the process, as it would allow to know and evaluate the progress of each initiative while adjusting the work timeframes.

Other topics discussed

Among the other issues discussed at the meeting, participants pointed out the need for the Global Fund to disclose its position concerning grants intended to strengthen community actions. Likewise, there was a proposal to place resilience among the priorities that key actors should discuss when new allocations were made, as this type of action becomes visible in communities facing multiple and complex needs and deprivations.

Finally, there was an emphasis on the need to improve communication channels within and between countries. This concern included a large amount of information and tools for sharing and dissemination that would place vulnerable communities and would provide a more effective contribution to the proposed projects.

Roundtable meetings such as this are spaces essential for key populations to express in their own voice their ideas, needs, observations, and proposals directly to the Global Fund. They want to and should be the protagonists of the projects, both in the diagnosis and implementation: only in this way will health services in response to malaria, TB and HIV be truly strengthened.