Our Global Fund programming aims to :
ICASO has developed a number of tools to help civil society and key populations understand and engage with the Global Fund. Scroll down to access our resources.
To see our work at a glance check this out:
ICASO works with global, regional and national partners to monitor and advocate for the effective implementation of the Global Fund’s Funding Model. ICASO does this by:
1) Supporting civil society to meaningfully engage and influence Global Fund processes at the country-level
2) Supporting civil society to build a system for ongoing monitoring of and advocacy on Global Fund processes at the country-level
3) Feeding back the experiences from the country-level to the global level to address barriers and influence policy-setting
Sustainability and Transitions:
In 2014, ICASO and the Global Forum on Men who have Sex with Men and HIV published a paper called Punishing Success, an explanation of Band 4 of the Global Fund and its implications for civil society and key populations. It found that with the Global Fund’s desire to invest more strategically in an effort to make a greater impact against the three diseases, what was effectively happening was that countries with low or relatively low disease prevalence were being penalized for their success. Reports from countries in Eastern Europe and Central Asia, where many upper middle income countries were either becoming ineligible or where governments were expected to provide significant counterpart financing (up to 60%), suggested this would be disastrous- particularly for key populations.
The data at the time showed that 90% of harm reduction programs were funded by international donors -of which the Global Fund was by far the largest. Advocates expressed concern that any abrupt withdrawal of Global Fund funding would be detrimental to countries with punitive laws and negative attitudes towards key populations.
As time progressed it became abundantly clear that countries would not spontaneously start funding programs for key populations without strong pressure -both internally and externally. ICASO supported EHRN to document the impact of transition on the region. This report was used in consultations organized on the topic of transition as well as during the Partnership Forum in Buenos Aires, Argentina. After sharing the report for CCMs and the Global Fund–there was a great deal of interest by civil society to repeat the exercise in the Baltic countries. It was also at this time that that it was becoming clear that a readiness assessment tool would be required to systematically measure, track, monitor and compare readiness of countries using the criteria that mattered to civil society and key population advocates.
EHRN developed a Transition Readiness Assessment Tool (TRAT) which is being shared across regions for e.g. with ICASO’s partners MENAHRA/RANAA which are implementing a regional grant in the Middle East and North Africa. The TRAT is based on four thematic areas of transition, as previously defined by the Global Fund Secretariat and the Eurasian Harm Reduction Network: policy, governance, finance and program. The TRAT was designed with the underlying assumption that in order for a country to be prepared for a sustainable transition, it must make progress on specific indicators in each of these thematic areas. Under each thematic area, three indicators help measure this progress.The tool was used to conduct case studies on the impact of Global Fund Withdrawal on the Sustainability of Harm Reduction Programs on 5 countries. The case studies can accessed by clicking on the links. EHRN is working on developing a manual to help civil society who want to conduct similar assessments in their countries.
ICASO supported the Caribbean Vulnerable Communities Coalition (CVC) to document and advocate on the potential impacts of Global Fund transition in Jamaica. The reclassification of Jamaica as an upper middle income country has positioned Jamaica for transition from Global Fund support for its HIV programs. The transition, which has already begun and was slated to be fully realized by the end of 2018, is expected to result in the government assuming greater financial and implementing responsibility of Jamaica’s current programs in HIV prevention, treatment, care and support. For example, the government has begun to honor its commitment to funding antiretrovirals in its public facilities.
However, there is significant concern by civil society groups and other stakeholders that such economic-focused indices seem to ignore the restrictive legislative environment that marginalizes key populations, the absence of a mature civil society with legislative and institutional support to maintain strong advocacy, widening income inequalities, and social inequities exacerbated by stigma and discrimination directed toward people living with and affected by HIV . The impending withdrawal of The Global Fund from Jamaica has heightened awareness among local stakeholders involved in the HIV response of the implications of such a funding transition. Assessing The Potential Impact and Implications of the Global Fund’s Transition on Civil Society, Key Populations, And People Living with HIV in Jamaica. The report has been shared with the Jamaica CCM and the Global Fund which has not identified Jamaica as one of the countries to being transition readiness assessments. Although there still has not been an official announcement, the fund portfolio manager responsible for Jamaica has indicated that Jamaica may in fact still be eligible beyond 2018.
Although continued eligibility would represent a major win, it is abundantly clear that the Global Fund will eventually stop its grantmaking in the region and civil society needs to be prepared for this. ICASO is supporting CVC to pilot its own transition readiness assessment tool with key civil society and community stakeholders to help the sector understand and plan for the imminent transition ahead. After the piloting, the tool will be refined and shared with widely in four languages.
ICASO also produced a discussion paper Handing Over Health: Experiences with Global Fund Transitions and Sustainability Planning in Serbia, Thailand and South Africa which presents a brief review of some of the current transition literature, paired with interview data from three country case studies. It examines Global Fund transitions in three different regions and at varying stages of progress. Serbia is presented as a country in the post- transition phase, after the Global Fund announced the country would no longer be eligible for support. The case of Thailand is shared as a mid-transition country, currently in the middle of a two-year handover, which ends after its current grant. Case study three offers a close-up of South Africa, a country in the pre-transition phase, not yet exiting the Global Fund system, but experiencing allocation reductions, while exploring sustainable financing mechanisms for the future.
Community Systems Strengthening:
ICASO’s work on community systems and responses focuses on making an explicit case for scaled up investment in this area. In addition to financial support to community responses, there also needs to be a commitment to providing adequate technical support to communities and developing markers of success beyond the typical reductionist indicators currently in use. ICASO has been working with partners to help define and make accessible the concept of community systems/responses and to build a strong evidence base for why they are invaluable to ending the AIDS epidemic.
In the Global Fund’s current funding model, as with the previous one. Uptake of Community Systems Strengthening (CSS) interventions remains pitifully low in concept notes. One reason for this is that that there is a lack of clarity around what qualifies as CSS and what does not. In order to address this confusion, ICASO and the International HIV/AIDS Alliance produced a civil society Q&A that helps to civil society and key population groups gain insight on how to position their interests in CSS during the country dialogues and proposal development processes.
ICASO and ICSS, supported the Free Space Process partnership and the Global Fund Advocates Network, to examine the evidence of the role key and vulnerable communities play in ending the epidemics and the unique role they play in advancing results through investments in the Global Fund. The paper, entitled Key Populations and the Global Fund: Delivering Key Results states that Investment in key and vulnerable populations is not an ‘optional extra’, but rather a fundamental factor to ending AIDS, TB and malaria. Without scaled-up, evidence-based programs for those most marginalized and vulnerable it will not be possible to meet the United Nations Sustainable Development Goals (SDG), nor the goals set out in the UNAIDS Strategy 2016- 2021. Key and vulnerable populations are present in all continents (despite continuing ‘official’ denials of their existence) and addressing their needs is not only a human rights obligation: science has taught us that this is a critical requirement from an epidemiological and public health point of view. Strategic investments in groups focusing on gender equality, women and girls, and human rights are equally vital. Anything less than a fully funded Global Fund replenishment will therefore undermine the scale-up needed.
ICASO is also producing a paper on the investment case for community responses set to be published in November.
Regional Concept notes provide a unique entry point for key population programming. Regional Concept Note Development in the Global Fund’s (New) Funding Model Observations from the first round of regional concept notes.This discussion paper offers observations and lessons learned through three case studies of regional concept note (RCN) development: in Eastern Africa, Southern Africa, and the Middle East and North Africa (MENA). All three concept notes focus on improving the engagement and access to HIV services of key populations in the respective regions. As regional programs provide a unique and critical space for Global Fund-supported advocacy for key populations, this paper details some of the challenges and opportunities presented in the processes and offers recommendations for how various stakeholders can manage such processes moving forward. The case studies and recommendations draw on document reviews and interviews with stakeholders involved in each of the three regions. Each process was unique, and therefore there are different lessons to be learned from each experience.
ICASO also commissioned a second paper on this theme looking at regional concept notes in the second window. It will be published soon.
It is not clear whether the new strategy how regional programs will look under the new strategy. ICASO continues to use advocate for an expansion of regional programs, with some tweaks, as a key mechanism to reach key and vulnerable populations.
Country Coordinating Mechanisms:
Coordinating Mechanisms (CCMs) are the most important country-level decision-making bodies with regard to Global Fund grants. CCMs are expected to be inclusive of diverse constituencies within their respective countries. However, despite widespread acknowledgement that civil society involvement is a prerequisite for optimally functioning CCMs, civil society is still too often constrained in its ability to influence decision-making within them. ICASO has worked extensively with civil society and key population representatives on CCMs to ensure their meaningful involvement in grant design and oversight. Through this work, ICASO has also systematically documented lessons learned and recommendations to inform the Global Fund’s support of CCMs under the current funding model.
In response to these issues, the Global Fund piloted a project called “Strengthening and Systematizing Civil Society Engagement in the New Funding Model”. provided top-up funding to Country Coordinating Mechanism (CCM) secretariats in ten countries. The funding, limited to between $25,000 and $50,000 USD, was meant as support for the greater engagement of key population networks and people living with HIV, malaria and/or tuberculosis in the New Funding Model (NFM) processes in 2013 and 2014. The funds were to enable and incentivize CCMs to ensure meaningful involvement of communities in country dialogue and concept note development, as well as in program planning and implementation, and to provide them with support from a third-party organization to advise and monitor the pilot program’s progress.
ICASO felt that this approach may fall short in guaranteeing the meaningful engagement of these groups and sought to document the process and generate lessons to be used by the Global Fund Secretariat. ICASO was tasked with carrying out an evaluation of the process.
The evaluation of the Pilot began in November 2013, after some initial steps had been taken in most participating countries, but before any engagement activities started. The evaluation concluded in September 2014, with six of the 10 participating countries having embarked on Year 1 activities, although none had completed the activities in their work plans, where these existed. ICASO partnered with the USAID- funded Health Policy Project (HPP) to conduct the evaluation. HPP provided in-kind support to the evaluation through in-country consultants, review of evaluation materials, including interview guides, technical advice and ongoing review of project process, as well as offered direct support through in person key informant interviews in each of the countries visited. Rather than seeking to examine impact, the evaluation sought to gain an understanding of the most efficient and effective steps needed in launching the program, and to some degree, how to sustain such a program in its early stages. Focused on the initiation process, the evaluation did not assess progress made towards achieving program objectives, which was considered beyond the remit of the assessment.
The general approach used for the Pilot were found to be appropriate and to hold substantial potential for enhancing engagement of key populations in the funding model, however the lack of preparation, guidance and strategic approach hindered the proces significantly. ICASO has recommended the pilot be located within the Key Population Action Plan 2014-2017 but to date, it seems the pilot has not be picked up or expanded.
Through this process, ICASO determined that civil society and key population representatives could benefit from a simple induction guide that helps them to understand the Global Fund as well as their oversight function and that provides real life case studies and tips from community representatives from around the world. This CCM Toolkit More than A Seat at the Table: A toolkit on how to engage meaningfully as HIV civil society representatives. Is a valuable companion to anyone newly elected to a CCM asking themselves: ‘what do I do now’? or to civil society wanting to support and hold their representatives accountable
Global Fund Strategy 2017-2022:
ICASO began the process of informing and influencing the Global Fund Strategy 2017-2022 in 2015. ICASO and ICSS, in partnership with the Free Space Process, organized a kick off meeting in Amsterdam in April 2015, bringing together civil society and key population stakeholders to have a discussion about gaps in the current strategy, as well as elements that should be retained. A meeting report was generated and used by the board delegations in their advocacy.
Throughout 2015 and 2016, the Global Fund initiated an extensive consultation process that ICASO encouraged civil society to participate in through several alerts highlighting key entry points and opportunities for input around the narrative, the objectives and the key performance indicators.
The most substantial opportunities for input were the Global Fund organized Partnership Forums, in Addis Ababa, Bangkok and Buenos Aires. ICASO was present at each of them, bringing the input from civil society gathered over the course of preceding consultations to ensure that civil society was well prepared and was building on the contributions and suggestions brought by others. These contributions were documented and shared widely.In fact, ICASO developed a matrix that helped track input by theme–thus highlighting key areas that were deemed important by civil society across multiple consultations-both areas of convergence and divergence.
Key themes were⋅ Human Rights ⋅ Community Response and Community Systems Strengthening (CSS) ⋅ Vulnerable and Key Populations ⋅ Financing the Response ⋅ Women and Girls and Gender Equity ⋅ Middle Income Countries, Graduations and Transitions
Engaging in the Grant Cycle:
Since the Global Fund ushered in its current funding model, ICASO has been helping civil society and key populations to engage and be involved in all the steps of the grant cycle, from national strategic planning through to grant making.
ICASO has produced a series of alerts and guidance notes aimed at engaging community members in the various aspects of the Global Fund’s complex concept note development, review and approval cycle.
In particular, ICASO produced a grant-making guidance note in response to a critical gap identified in the engagement of civil society after a concept note is drafted. Following the submission of a concept note to the Global Fund, communities and civil society should continue to play a critical role. The guidance note highlights the opportunities community and civil society have to ensure that the good ideas included in concept notes make it into programming. The alert documents the steps involved in getting from concept note development to grant implementation, and recommends entry points, resources, and other technical support available to community and civil society.It will be interest to community and civil society representatives on Country Coordinating Mechanisms (CCM), as well as disease-specific NGOs, vulnerable and key population networks, gender and human right activists, and any other group that participated in the concept note development process.
ICASO also developed guidance for civil society around the country dialogue (needs hyperlink). Although the Global Fund emphasizes the continuity of country dialogue, in many cases the country dialogue represents a finite moment in time where multi- stakeholder consultation took place outside of the CCM. This guidance document is intended to be a tool for civil society organizations which are engaged in, leading, or monitoring country dialogues. An explanation of the key features and expected outcomes of the country dialogue process is followed by a discussion of country dialogues in practice over the past year. A review of existing analyses and interviews with civil society participants in country dialogues inform a discussion of the principles of effective country dialogues. For the purposes of this document, “effective” country dialogues are those which include significant and meaningful civil society and key population participation and inform a concept note which reflects the true nature of a country’s epidemics and an inclusive strategy for combating them.
ICASO has also been supporting work that shows that greater involvement by civil society and key populations in concept note development leads to better concept notes and responses to HIV. To this end, ICASO partnered with the Regional Platform for Anglophone Africa, hosted by EANNASO and AIDS Accountability International (AAI) to produce a toolkit to equip civil society and community groups with new skills to influence decision-making processes about health. This toolkit can be applied to a wide range of health decision-making processes, including influencing Global Fund concept notes, national strategic plans, PEPFAR country operational plans, among others. The toolkit called: How to Influence Decision-Making Processes about Health is a video which can be played via YouTube. (Click on the modules below)
Fully Funding the Fund:
ICASO worked behind the scenes for several months with a coalition of civil society organizations led by the Interagency Coalition for AIDS and Development (ICAD) to ensure that the 5th Replenishment Conference would be held in Canada and we were absolutely delighted to be present when the announcement was made in May 2016 that Montreal would in fact play host to the Replenishment Conference and that the government would increase its pledge to CAD 785 Million and later to CAD 805 Million.
ICASO also played a role in ensuring that civil society from around the world were present to attend the official event and the various side events that took place over the days preceding the conference. ICASO, ICAD, the Global Fund Advocates Network, the Canadian Partnership for Maternal, Newborn and Child Health and Results Canada organized 2 events around the replenishment including a public panel to discuss key populations and human rights in the context of the AIDS response with a keynote address by Stephen Lewis as well as an advocates workshop that brought together Canadian and international advocates from the 3 diseases to strategize around the issues of resource mobilization, key populations and sustainability. A workshop report is forthcoming.
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