On International Women’s Day we should reflect on the wider implications of this extraordinary headline-grabbing case. There is a hidden story here that is just as telling: the excitement of scientific discovery, the pragmatism of public health, and the urgency of raising more money.

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Tomorrow is World AIDS Day and this year all the talk is of tipping points and “ending AIDS.” On both sides of the Atlantic lobby groups are calling on their governments to create blueprints to achieving an HIV free generation. So why, after 26 years of working in the sector, do these cries make me feel a little queasy?

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The Global Fund’s New Funding Model – Some steps to secure gender transformative responses to AIDS through the new Strategic Investments Frameworks

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ASAP is very concerned that the current Global Fund model does not appear to be delivering clear outcomes for women and girls and to secure gender transformative responses to the epidemic that are required for a quality response.

The Zambia case study is the first in a sequence of four which will deliver an in-depth analysis designed to support the Global Fund, UN Women and other technical agencies to enhance their support to countries to deliver gender-transformative HIV programming.

To date, the review has found limited implementation of activities scaling up responses to HIV that address the needs of women and girls in a way that would transform local responses to HIV and better the lives of women, their families and communities.

The review indicates that countries have a weak understanding of the most strategic gender-transformative programs required to maximise impact on women and girls. Most immediately it has identified a number of structural barriers within the Global Fund processes that limit strategic investments. It is hoped that these barriers, as well as the recommendations emerging from the review, will be addressed by the new funding model as it seeks to implement the Global Fund’s strategy.

Earlier reviews have considered the gender aspects of proposals made to the Global Fund, but have not captured the state and level of implementation of gender-responsive programming undertaken by countries with Global Fund grants.

ASAP’s goal is to provide the basis for the Global Fund and UN Women to support countries with guidance and recommendations that will enhance gender-responsive and gender-transformative programming.

Key areas of analysis include gender norms and harmful practices, gender-based violence against women, scaling up PMTCT efforts to keep mothers and babies healthy and HIV free, the leadership and meaningful involvement of women, especially women living with HIV in the response, programming to meet the needs and rights of women and girls from key populations, and to engage men and boys in efforts to address gender equality.

Client

Global Fund to Fight AIDS, TB and Malaria; UN Women

Process

The ASAP team, led by Hanke Nubé with Sophie Dilmitis, with Robin Gorna and Natalie Fisher-Spalton, is conducting a detailed desk analysis of nine HIV Global Fund active grants from Rounds 7 (phase 2) to 9. This looks at the commitments made in the Gender Equality strategy with proposals made by countries and programmatic achievements. This review analyses the implementation of gender activities, documenting budgeted activities, and capturing key implementation successes and challenges.

The desk review will inform the in-depth enquiry that will be undertaken through in-country analyses. The review will suggest three to five countries for analysis, as well as supplying criteria and methodology for these in-country case studies.

The final report will be designed to provide an in-depth analysis that will support the Global Fund, UN Women and other technical agencies to enhance their support to countries to deliver gender-transformative HIV programming.

Robin Gorna, who has spent 26 years working globally to combat AIDS, fears that at a time when we know how to deal with the problem, we are losing the political will to tackle it. She sees finances drying up, and stigma, prejudice and an unwillingness to engage with social and sexual aspects of the illness preventing millions from getting access to the treatment and care they need. Robin Gorna believes there is a real opportunity to end the epidemic, and she blames short attention spans and the wrong actions for the fact that it is still on the increase.

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Who are the current Global Fund Board Members?
[English]

The purpose of the Global Fund’s Partnership Forum
[English]

What is a Country Coordinating Mechanism?
[English]

What is the Technical Review Panel?
[English]

What is the Office of the Inspector General?
[English]

Performance Based Funding at the Global Fund
[English]

Global Fund Strategy Framework
[English] [Français] [Русский] [Español]

Summary of consultations to develop the Global Fund Strategy
[English] [Français] [Русский] [Español]

Report of the consultations to develop the Global Fund Strategy
[English]

Global Fund to Fight AIDS, Tuberculosis and Malaria: Framework Document, 2001
[English]

Global Fund, Partnership Forum 2011 , Sao Paulo, Brazil 28 – 30 June 2011
[English] [Français] [Русский] [Español]

World Bank’s Global Program Review: The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank’s Engagement with the Global Fund
[English]

Summary background paper on country ownership
[English] [Français] [Русский] [Español]

Global Fund presentation on Country Ownership, made by Michel Kazatchkine, Accra, November 2011
[English]

Global Fund Implementers Meeting April 2011_Dakar Outcome Document
[English] [Français] [Русский] [Español]

Global Fund Implementers Meeting Nov 2011_Nairobi Outcome Document
[English] [Français] [Русский] [Español]

Monterrey Consensus of the International Conference on Financing for Development, 2002
[English]

The Paris Declaration on Aid Effectiveness, Organization for Economic Co-Operation and Development, 2005
[English]

Accra Agenda for Action, 3rd High Level Forum on Aid Effectiveness, Accra, Ghana, 2008
[English]

Busan Partnership for Effective Development cooperation: Fourth High Level Forum on Aid Effectiveness, Busan, Republic of Korea, 29 November – 1 December 2011
[English] [Français] [Español]

Oxfam: Ownership in practice: The key to smart development
[English]

Oxfam: The politics of partnership: How donors manage risk while letting recipients lead their own development
[English]

Oxfam: Saving lives through country ownership
[English]

As a result, m2m was able to play a central role in the Global Task Team that crafted Countdown to Zero: Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (The Global Plan).

The Global Plan is a landmark event in efforts to build greater support and resources for women’s and children’s health globally.

With ASAP’s help, m2m’s participation has meant that the Global Plan includes a strong policy statement that Mentor Mothers – recent mothers who are trained and paid to support pregnant women and other mothers living with HIV — are a central force to achieve the goal of the virtual elimination of pediatric AIDS by 2015, and to keep mothers living with HIV alive.

m2m now plays a key role on the Global Steering Group that oversees the delivery of the Global Plan, as well as the Inter-Agency Task Team for PMTCT (IATT) that secures technical support to deliver the Plan in the 22 priority countries where action must escalate in order to achieve its goals.

With Presidents Bill Clinton and Goodluck Jonathan, UN Secretary-General Ban Ki-Moon and UNICEF and UNAIDS Directors Tony Lake and Michel Sidibe at her side, an HIV-positive mother working with m2m, Babalwa Mbono, launched the Global Plan at the UN in New York in June 2011.

This is a milestone for the engagement of mothers and pregnant women with HIV into the worldwide and national policy processes that can their lives.

In 2012, ASAP will further support m2m to develop a diversified resource mobilization strategy, linked to their increased advocacy. ASAP is also supporting m2m to secure stronger peer review of their work and to intensify the progression of HIV-positive women within the structure of m2m.

Client

mothers2mothers

Process

Since late 2010, ASAP’s Director has worked closely with the three co-founders of m2m, their leadership team and Board to undertake a substantial, systematic, scale-up of advocacy activities. Work included development of a strategic plan and identifying key intervention points. Most notable of these, the “right tables” to be at, so that m2m can maximise the impact of their time and efforts to leverage the best results with limited burden on staff whose principle responsibility is service delivery.

Links

mothers2mothers Feature in BMJ

This series of meetings was designed to support Implementers to engage effectively with the Global Fund Board and Committees, by ensuring that, as a bloc, Implementers’ voices were informed, coherent and strong, and better able to influence the Global Fund’s future direction and achievements.

The consultations were convened and sponsored by UNAIDS together with WHO and the Stop TB Partnership. They were held in three locations: Geneva (December 2010 and March 2011), Dakar (April 2011) and Nairobi (November 2011).

Each meeting brought together up to 80 people for up to three days. Participants included Global Fund Board members, alternates and members of the committees and delegations, with a broad range of implementers, among them chairs of Country Coordinating Mechanisms and representatives from principal recipients and sub-recipients.

Implementers from more than 70 countries took part in the consultations, and a significant proportion of participants came from civil society sector and communities affected by the three diseases.

The goal was to strengthen the work and achievements of the Global Fund, and to ensure that implementers’ voices were strong and central to the organisation as it evolves, including through greater engagement in the governance structures.

The meetings were designed to provide a neutral platform for Global Fund implementers to meet and engage with each other in order to develop their thinking and approach to upcoming debates, discussions and decisions in the Global Fund Board and committee meetings. The consultations were timed immediately before key events in the governance calendar and focused on emerging issues (eg policies on prioritisation and eligibility, the comprehensive transformation plan, the new strategy). The approach was to introduce and discuss new and proposed Global Fund policies, strategies and programming revisions, and then to solicit feedback and input from implementers. The discussions focused on specific policies undergoing change of development, and drew upon Implementer experiences with and expectations of the Global Fund more generally.

Client

UNAIDS, with WHO and the Stop TB Partnership

Process

ASAP’s Director worked closely with the sponsors – UNAIDS, WHO and Stop TB Partnership – and with implementer participants to devise and facilitate an approach that maximised participation and results. This included preparing the context, background reading and participation at the meeting, devising a highly interactive agenda, in advance of the meeting. At the meetings, ASAP’s Director was the lead (and on two occasions the sole) facilitator.  In addition to facilitating the consultation, she worked closely with the meeting coordinators to modify the agenda to adapt and respond to emerging needs. The consultations were conducted in English and French.

At the conclusion of the two major consultations – in Dakar and Nairobi – ASAP supported small drafting committees of the implementers to produce an Outcome Document that issued at the close of the meeting.  These outputs played a central role in supporting further development of  implementer inputs to the Global Fund Board meetings and related formal processes.

Reports

ASAP’s concise reports on the meeting were produced within days.

Global Fund Implementers Meeting April 2011_Dakar Outcome Document
[English] [Français] [Русский] [Español]

Global Fund Implementers Meeting Nov 2011_Nairobi Outcome Document
[English] [Français] [Русский] [Español]

The goal was to develop better mechanisms for dialogue between transgender people from developing nations and the UN and the Global Fund. Discussion centred on the health and human rights challenges that transgender people face, and how and why multilateral agencies should seek to engage more effectively with them as part of their development mandates.

The main outcome was the articulation of a set of “wants” from the Global Fund and UNAIDS, in particular UNAIDS Co-sponsor WHO, the World Health Organization. The activists made specific requests of the UN and the Global Fund, relating to the health and rights-related needs of trans communities. One of the “wants” was a preference for the use of the term “trans”, while recognising that preferred terminology varies between countries and contexts. Overall these “wants” are expected to form a crucial part in the development of improved efforts by multilateral entities to recognize and respond to trans needs in the future.

ASAP’s facilitation allowed a project plan to emerge, to establish a new global platform for developing country trans activists to engage in advocacy and peer support. The plan articulates a range of national, regional and global activities that activists would undertake to maintain the momentum of their deliberations, under the guidance of an expanded and inclusive steering group.

Client

UNAIDS, UNDP, UNFPA and the Global Fund to Fight AIDS, Tuberculosis and Malaria

Process

The meeting was the first of its kind ever held, a fact which itself underscores the continued isolation of much of the worldwide trans community.

The trans steering group approached ASAP’s director to facilitate the meeting after the original facilitator – a trans woman – was unable to take the project forward for personal reasons. Short notice meant the bulk of the work was on site, requiring a flexible and creative approach.

At the request of trans participants, attendance was restricted to the participants themselves, the facilitator and interpreters. Representatives from the Global Fund and UN agencies were only invited to attend two sessions – one to inform trans participants of their work, the second to hear the “wants” of participants for future dialogue.

ASAP’s approach here built trust and openness, and can be considered a model of good practice that the UN should consider for future engagement with key populations and vulnerable groups.

The consultation brought together 11 representatives and activists from the broad trans community, including people who self-identify differently and uniquely. Participants came from Africa, Asia, Central Asia, Latin America and the Pacific.

The consultation process took place in Geneva, convened jointly by the Global Fund and the UNAIDS co-sponsors responsible for trans issues, UNDP and UNFPA, as well as the UNAIDS secretariat. Preparation was guided by a steering group of trans activists and representatives of the UN and the Global Fund. Language and time zone barriers complicated the preparatory phase, and a virtual meeting of the full steering group was never possible.

Despite these logistical issues, with ASAP’s help this pioneering meeting has laid new groundwork in the inclusion of trans communities in global AIDS, health and human rights initiatives.

ASAP designed The Robert Carr Civil Society Networks Fund to secure stronger funding flows for civil society networks. The design process also assisted networks to help define and focus their work so as to create tangible benefits for the communities that they serve.

The project marked a critical point in a lengthy effort to identify sustainable funding for more than 10 civil society networks that had agreed to work jointly to overcome persistent shortfalls.

Robert Carr was a leading Jamaican AIDS activist who died in 2011. He was internationally known for his work on human rights, stigma and HIV. The Carr Fund is expected to raise $21-million in its first three years to support global and regional civil society networks.

ASAP’s goal with the project was not only to help civil society networks to secure sufficient, predictable resources, but also to enhance their capacity to support the quality, effectiveness and gender equity of AIDS responses to inadequately-served local populations.

As a result, The Carr Fund has been designed to respond not only to the fact that there is insufficient, irregular funding, but that at country level there is inadequate attention paid to those communities and populations most in need of effective HIV prevention, treatment, care and support.

The funding mechanism is evidence-informed, result-focused and strategic. It was developed so that national responses should become more effective in meeting local needs.

Client

International Civil Society Support (ICSS), UNAIDS

Process

ASAP rapidly mobilised a small, talented and diverse team from Europe, Asia and Africa to support the design of a new funding mechanism.

The initiative was successfully completed in just three months to meet donor requirements for a new fund to be designed before the end of 2011. It was a complex initiative, working with multiple stakeholders and requiring a careful exploration of the dynamics which had led to funding changes, and to understand opportunities to find novel ways ahead.

ASAP’s extensive research and consultation used eSurveys, key informant interviews, stakeholder workshops and literature reviews. The ASAP team working on The Carr Fund brought expertise in grant management, monitoring and evaluation, social research skills, strategic and organisational awareness, as well as a deep knowledge of the environment and challenges that now face both donors and civil society networks.

The ASAP team identified priorities and needs, and then reviewed these against donor stipulations and restrictions, and presented options to the Working Group for consideration and final approval. The final product was a comprehensive design document that proposed a structure for the new fund with a monitoring framework to assess impact, and to enable the development of prioritised criteria for disbursement. The team explored a range of management arrangements and produced a final model with accompanying documentation to establish the new structure.

This project demonstrates ASAP’s ability to turn around an innovative project swiftly and effectively.

It built on an earlier project, undertaken by ASAP Director Robin Gorna with Karen Michael-Cox, on behalf of the same group of stakeholders, that brought together the funding needs of eleven global networks in one aligned, joint proposal to mobilise “emergency” short-term resources in 2011.

Both of these projects built on a substantial history of work which have involved ASAP associates. The projects were guided by and reported monthly to a joint steering group of donors and civil society networks, co-chaired by ICSS and UNAIDS. This group is now translating the design into a new structure.

The goal was to support PMNCH and its key partners, among them the Executive Office of the UN Secretary-General and the UN Foundation, to identify new and enhanced financial, policy and service delivery pledges from the global donor community.

A strategic plan was prepared in advance of the UN General Assembly session of September 2011, the first anniversary of the launch of the Global Strategy, which is focused on achieving Millennium Development Goals (MDGs) Four and Five, which have specific targets for reducing child mortality and improving maternal health.

ASAP supported PMNCH (and others) to secure a broad range of new financial, policy and service commitments to the Global Strategy, and helped to set new directions and a strategy for future action.

Client

Partnership for Maternal, Newborn and Child Health (PMNCH)

Process

A small ASAP team undertook an extensive desk review of the existing commitments, development policies and priorities of more than four dozen donor countries. The team focused on existing policies, funding history and potential for pledges to numerous multilateral and bilateral sources that could count as a contribution towards the Global Strategy.

ASAP’s review allowed for the identification of target sources for new and enhanced commitments that could be achieved prior to the Strategy’s first anniversary.

In addition, ASAP gathered strategic intelligence to review the likely success rate of various approaches, and maintained regular review, through informal sources as well as published materials, to assess likely interest.

This proved a demanding task, as government donors had shown substantial interest in the Global Strategy on launch in 2010 making it hard to mobilise additional interest.

ASAP’s approach was to prepare and submit fact sheets on each donor country, with overviews of recent and projected development assistance trends and commitments. These fact sheets were organized by suggested priority to help PMNCH and its allies identify the most likely sources for new and enhanced funding over a constrained time period.

Together, these fact sheets informed a comprehensive strategy document, which included proposed approaches that PMNCH could take.

ASAP also provided regular ad hoc advice to PMNCH and its partners on ideal approaches, and supported the engagement of PMNCH in activities designed to enhance commitment to the Global Strategy.

ASAP’s work supported the drafting and completion of elements of the report presented at a special event at the UN General Assembly listing new commitments pledged.

Report

2011 Commitments to advance the Global Strategy for Women’s & Children’s Health

Hilary lives in Gauteng Province, South Africa, where she works at the southern Africa office of the UK Department of International Development.

Hilary is a highly skilled manager in the development sector working particularly on gender-based violence, HIV and other public health issues. She brings to ASAP a decade’s experience on the ground in the southern African region, with a strong focus on designing, implementing and monitoring programmes as well as grant management.

For ASAP, Hilary led the management component of the project that created the Robert Carr Civil Society Networks Fund.

There is nothing more fulfilling than working with a team that is passion driven, it’s a team that firmly believes in human and social justice, particularly for the most vulnerable members of society.

Jeff is a U.S.-based writer, editor and researcher with extensive experience on the international response to AIDS and global development health priorities more generally. Among his other areas of work in recent years are projects regarding election monitoring, tobacco control and anti-corruption programming and policies.

He has worked in more than 40 countries, and has particular experience in Russia and Eastern Europe, including in regards to human rights associated with HIV, hepatitis and drug use. He has been living with HIV for more than two decades.

Jeff has high-level research and analytical skills, with the experience and ability to synthesise large amounts of complex information and to deliver high quality, accessible written products on time.

Jeff has worked regularly with and for community groups, including networks of people living with HIV and treatment activists. His work includes research and reports for donor organisations and multilateral agencies as well as leading civil society groups.

He has worked on many projects for ASAP, including the Global Fund Country Ownership consultation, support to PMNCH, and research for the private sector initiative with a major international bank; he also produced the reports for the two main Global Fund Implementers meetings in 2011, hosted by UNAIDS in Dakar and Nairobi.

I always enjoy ASAP projects because they provide an opportunity to directly engage across a range of different activities and priority areas. Though often challenging, the work is always satisfying as I am regularly interacting with smart, driven and brave people who continue to inspire me.