A webinar was organised and hosted by W4GF on July 27 2016 for W4GF advocates and partners for an update on the operationalisation of the Global Fund Strategy (2017 – 2022) and to provide further inputs. 8 participants, including 1 Global Fund Secretariat staff attended the webinar, which covered the following:

  • Global Fund update on operationalising the Global Fund Strategy (The slide deck presented is available here)
  • Key considerations from W4GF advocates
  • Questions and discussions from webinar participants
  • Next steps and actions

A. Global Fund Update on Operationalising the Global Fund Strategy
Presented by Ms Heather Doyle, Global Fund Secretariat

  1. Heather acknowledged and expressed appreciation for the community input so far received into the development and Board decision on  the Global Fund Strategy (2017 – 2022) and the Global Fund looks forward to continued input and support as this moves towards operalisation. The full slides presented on are available here.
  2. Findings from assessment of the Gender Equality Strategy (GES) and its action plan where combined with as assessment from the Global Fund Key Populations Action Plan and learning informs the new Global Fund Strategy. Some of the findings show:
    • The Global Fund is not yet able to investment in gender equality and key populations fast enough, at scale or high enough quality to fulfil its contribution to national and global commitments for the three diseases.
    • Increase in attention to key populations and gender issues but sometimes poorly translated into prioritized programs and investments in signed grants. Focus largely is on key populations in HIV, less so on vulnerable populations in the context of TB and malaria.
    • Struggles to secure meaningful engagement and attention (e.g. NSP development, grant-making, implementation and monitoring).
    • Concern about the sustainability of engagement and investments for key populations in countries that will transition from Global Fund support
    • As a financing institution without country presence, strategic partnerships are critical to ensure impactful investment. However, some partnerships would benefit from a stronger focus and transparent accountability framework – to maximise complementarity and ensure greater impact.
  3. Key Recommendations that the Global Fund is focusing on:
    • Operational plan and accountability framework: Ensure actions on gender equality and key populations are both: fully integrated into the operational plan for the new Strategy; and pulled-out in a specific plan against which the Secretariat reports annually. Transparency and accountability through regular internal and external monitoring is key.
    • Bottlenecks: Ensure cross-Secretariat analysis to better understand specific obstacles to progress on gender equality and key populations within the funding model and strengthen/adjust relevant processes such as addressing data gaps; strengthen support in areas least engaged (e.g. National Strategic Plan (NSP) development, grant-making, implementation and monitoring; and support key populations to engage in transition preparedness, planning and monitoring.
    • Capacity: Further strengthen gender equality and key population capacity building within the Secretariat, with emphasis on Grant Management Division e.g. develop staffing and developmental plans aligned with Global Fund priorities on gender and key populations, as well as consistent and ongoing learning opportunities.
  4. A re occurring theme at AIDS 2016 and from the assessment was the importance of Global Fund engagement with civil society and capacity in the secretariat to address and support work around gender equality, human right and key populations. This also speaks to how the Global Fund must strength the capacity of CCMs at the national level. The core objectives of the Global Fund 2017-2022 Strategy are to:
    • Maximise impact against HIV, TB and malaria
    • Build Resilient and Sustainable Systems for Health
    • Promote and Protect Human Rights and Gender Equality
    • Mobilize Increased Resources
  5. With in the objective on human right and gender equality there are five sub objectives which include and the two in bold are specific to women and girls:
    • Scale-up programs to support women and girls, including programs to advance sexual and reproductive health and rights
    • Invest to reduce health inequities including gender- and age-related disparities
    • Introduce and scale-up programs that remove human rights barriers to accessing HIV, TB and malaria services
    • Integrate human rights considerations throughout the grant cycle and in policies and policy-making processes
    • Support meaningful engagement of key and vulnerable populations and networks in Global Fund-related processes
    • In terms of strengthening work on community responses – for key populations the Global Fund will focus on the CCM eligibility criteria; support Secretariat-led periodic reviews; engage in NSP/Investment case development and grant implementation; support transition readiness and monitoring in priority countries; establish a feedback loop during grant implementation.
  6. For gender equality around the two sub objectives:
    • Scale-up programmes to support women and girls, including programmes to advance sexual and reproductive health and rights
      • Set indicators and baselines in 13-15 priority countries in sub Saharan and Eastern Africa where adolescent girls and young women (AGYW) face disproportionate HIV and TB burden – the Global Fund is working on these indicators now.
      • Develop and implement AGYW Programme quality assessment/monitoring plan (aligned with evaluation plan) this includes generating more evidence of what works from grants and understanding the quality of interventions being scaled up.
      • Support NSP development in selected countries
      • Develop grant management division (GMD) capacity to address gender-related barriers to services, incl. AGYW focus. This includes new positions that support the work and providing technical support and having the right people to support the work.
    • Invest to reduce health inequities including gender- and age-related disparities
      • Conduct TB gender assessments in 20-25 high TB burden countries – the Global Fund is now defining three operational indicators for 25 high burden TB countries
      • Support the inclusion of gender-related considerations into the grant rating system – how grants are ranked in the Global Fund
      • Develop and launch comprehensive gender capacity strengthening plan for external bodies – CCMs; LFA; TRP; OIG
      • Improve guidance and grant making tools for countries on addressing gender-related barriers to services and gender equality – This is across the three diseases. The Global Fund in also working on an information note on gender quality and malaria and in TB they are focused on producing the right data so that by the end of this Strategy countries have the right sex and age desegregated data to analyse and drive the right programming.
  7. Regarding human rights – the last strategic framework focused on accountability of human rights and put in place mechanisms to enable people to report on human rights violations but this Strategy is scaling up investments in human rights and this is reflected in the sub objectives. The Global Fund will focus on the following:
    • Identify and support 15-20 countries to scale-up programmes to remove human rights barriers to health services
    • Revise Global Fund guidance and module concerning HIV, TB and Malaria-relevant programmes to remove human rights barriers to health services
    • Develop an M&E strategy and necessary tools for programmes to remove human rights barriers to health services
    • Strengthen GMD, as well as in-country and technical partner capacity.
  8. The next sub objective around human rights includes:
    • Propose amendments and support adherence by all new policies;
    • Strengthen human rights due diligence in risk assessments to further reduce the risk of human rights violations in grants;
    • Support the inclusion of human rights considerations in the grant rating system.
  9. Key Performance Indictors (KPIs) are set at different levels in the Global Fund. The work on young women is reducing incidence by 2022 and the Strategic target for this will be set August 31. In the next two weeks a presentation can be shared on how we are setting the target and baseline. In terms of the implementation KPIs (which refer directly to the Strategic KPIs these refer to how to track the work to be done on young women and adolescent girls in the 13 countries and what do the NSPs look like. TB and data is another KPI and their own capacity to monitor this. There will be thematic reports on gender equality; human rights and key populations to capture KPIs and not reduce work done to a number but trying to capture all the work done.
    • The KPI on key populations is still a work in progress “Coverage of key populations reached with evidence-informed package of treatment and prevention services appropriate to national epidemiological contexts” and it has been challenging to develop something meaningful.
    • The KPI on gender and age equality will measure HIV incidence in women aged 15 – 24.
    • The KPI on reducing human rights barriers to services is “# of priority countries with comprehensive programs aimed at reducing human rights barriers to services in operation”.
    • The programs for HIV will be aligned with the “7 key interventions to reduce stigma and discrimination and increase access to justice” of UNAIDS.
  10. There are other lower level KPIs that the Global Fund will be following specific to 13 countries:
    • Reducing the prevalence of intimate partner violence: Indicator: Proportion of ever-married or partnered women aged 15-49 who experienced physical or sexual violence from a male intimate partner within the past 12 months (Sources: WHO, UNAIDS, UNFPA, SDG 3.3)
    • Empowered decision-making regarding SRHR: Indicator: Proportion of women aged 15-49 who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (SDG 5.6.1)
  11. Process Indicators for HIV are:
    • Targeted national strategic planning – Women and Girls (subset of 13 countries)
    • Indicator: Number of Global Fund eligible countries (and/or %) with a specific plan and associated targets regarding HIV infection among women and girls included in the National Strategic Plan (or investment case) (New)
      • Targeted national strategic planning – Key populations (across portfolio)
    • Indicator: Number of Global Fund eligible countries (and/or %) with a comprehensive package of interventions for key populations in the National Strategic Plan (or investment case), disaggregated by populations group (particularly male SWs, TG and females who inject drugs) (New)
      • Ability to report on sex and age disaggregated results (across portfolio)
    • Indicator: Number of Global Fund eligible countries (and/or %) reporting on disaggregated results (New)
      • Gender assessments (GF Recommendation to remove)
    • Indicator: Number of Global Fund eligible countries (and/or %) that have conducted an HIV gender assessment in the last 5 years, either as a standalone activity or as part of programme reviews (New)
  12. Process indicators for TB (still being developed) are:
    • Targeting national strategic planning
      • Indicator – % of Global Fund eligible high TB burden countries with prevalence surveys in the past 5 years (assumption that age & sex disaggregated data available) that have an action plan (in NSP or other strategic document) to address inequity in access to TB services.
      • Indicator – % of Global Fund eligible high TB burden countries with prevalence surveys in the past 5 years (assumption that age & sex disaggregated data available) that have an action plan (in NSP or other strategic document) to address inequity in access to TB services.
    • Ability to report on sex and age disaggregated results
      • Indicator – % of GF eligible countries collecting and reporting on sex- and age-disaggregated TB treatment outcomes.
  13. Gender assessments
    • Indicator – % of Global Fund eligible countries with prevalence surveys where a gender assessment has been conducted, either as a standalone activity or as part of programme reviews
  14. The Community Rights Gender Special Initiative (CRG SI), (which does not continue past 2016, unless the Board approves otherwise) is to enable civil society to access some support. A limitation was that this is runs up until grant singing and does not cross over into grant making which is where a lot of the design happens and through grant implementation. WE are hoping this will be renewed and will be available through the entire grant cycle.
  15. There is a meeting on the KPIs next week which is organised through the HIV situation room managed by UNAIDS and WHO

B. Questions and answers

  • How will Global Fund coordinate with national efforts related to PEPFAR/DREAMS, which are only being addressed in certain areas within particular countries? In 2015 the country operational plan (COP) in Kenya reduced USG funding for prevention in non-DREAMS counties.

The Global Fund is aligned to NSP (sometimes this works well and sometimes something is not so included so lobbying is required). The Global Fund and PEPFAR work in very different ways but they are in close collaboration at the national and global level. In countries where Global Fund has scaled up programmes for adolescent girls and young women girls (prior to UNAIDS launching their guidance) there was not one guidance on how the GF was prioritising with CCM programmes so the Global Fund aligned with DREAMS guidance. The Global Fund is often aligned with PEPFAR and compliments the work and is trying to cover other areas that DREAMS is not covering. This plays out in different countries in different ways.

Comments from participants: At this year’s Africa CoP – contribution and coverage of the Government, Global Fund and PEPFAR were visible; women and girls has always been a focus however not in a scaled approach and with impact evaluation, data is needed to demonstrate impact.

  • The biggest issue we should be aware of in relations to gender and gender equality is analysis of quality services and impact

The Community Rights Gender Division pushed hard to have a gender specific data specialist and they hope that this person will be recruited this year or early next and will be looking at how the Global Fund report on sex and age desegregated data and looking at qualitative research and producing data – it is a lost opportunity if we don’t. We have done a lot of smaller programmes that are great but these have not been scaled and included in the national strategic plans and taking this to scale nationally or even in a district. DREAMS is doing this to some extent in what they have funded. The vision is that in 5 years we have more data to feed programming. This person will be following the indicators we have discussed.

  • Will the three thematic reports be done within transitioning countries or will there be one transitioning thematic report that speaks to the three areas in transitioning countries?

There is a transition team at the Global Fund looking at transition preparedness planning. Countries in transition will be included in the thematic reporting and also included in the KPIs related to human rights.

  • PEPFAR has announced a 100 million key population fund – how do you link and ensure synergies with ho catalytic funding intends to work on gender quality?

Catalytic funding is dependant on how the Global Fund replenishment goes and this could between zero to 800 million. There is discussion around priority and thinking about what this might look like but it is a conversation at play and its impossible to be concrete until we know how the replenishment goes.

  • You mentioned the need to support NSP development in selected countries? – Is there a timetable that can be shared about which countries will need support?

The Global Fund has mapped out NSPs in 13 countries and the anticipated next submission date of the NSP and the submission date of the next concept note (which can flux). The Global Fund is happy to share this when it is more solid. The long-term goal for NSPs is around community engagement. The sec will have a working group on modelling and a key deliverables is improving existing models used by countries to inform budgets and planning around gender related interventions where we know we have data on what works, as right now they are not included. The Global Fund hopes to do piloting around this next year.

One comment was the importance of domesticating the gender equality strategy of Global Fund given that south Africa will start in the next month with the new NSP, TA will be required.

  • The review and approach seems to conflate key populations and gender equality and could allow for gender quality to be lost. What mechanisms are being put in place to ensure that gender equality receives equal recognition?

Gender equality has gotten lost in the secretariat for various reasons. Whilst there are certain issues that are distinct to gender equality, human rights and key populations – there is also overlap and the Global Fund wanted to capitalise on discussions. Measures such as the thematic reporting (fed by the KPIs) and capacity building should avoid this happening.

  • Would it be possible to explain what type of interventions would be funded under Global Fund to address the HIV vulnerability among adolescent girls and young women? For example, in Durban we heard a lot about the links between HIV and child marriage; HIV and GBV especially for girls and women in all their diversity. Would the Global Fund be addressing these risk factors as a means to prevent new HIV infections?

Mark Dybal sat on the panel in Durban organised by Girls not Brides and spoke to these connections. Given the context of transition and the funding portfolio in terms of the allocation model what happens in Latin America will look very different to South Africa. For the countries were we will be measuring HIV incidence the Global Fund will be having discussion around comprehensive programming such as keeping girls in schools – intimate partner violence which has not had enough attention; child marriage.

PEPFAR (which sits on each CCM) have a role – In the 10 dreams countries where the Global Fund will also be working there will be heavy coordination on the package of interventions and the district prioritisations and how incidence is measured. PEPFAR and the Global Fund are discussing how to do this and do it together – ultimately countries should be able to measure incidence and follow this with their own response.

  • There is a huge gap around adolescents – no data plus no WHO guidance (only technical briefs) for adolescents who are part of key populations – how we will make progress here?

On key populations and adolescents – the Global Fund is not a norm setting body and follow the guidance that are set. They now have a new information note on adolescents. They did an assessment looking at 6 countries on how they were responding to adolescents and it came out strongly that they are not addressing key populations in adolescents. Under the principle of doing no harm they don’t want to put in policies that can hurt and drive adolescents out of services. This assessment is not a public document but Heather can send a summary.

  • Olena Stryzhak shared an update of our meeting in Durban with ladies from EECA region

Women from EECA met with Heather in Durban and discussed provision on a place in CCM in every country from EECA region to have a strong voice from women. They are preparing letters from ICW and Eurasian women on AIDS about their activities in the countries and what they would like to see in countries that preparing concept and they would like to be part of the CCM.

C. Next Steps

  • The operationalisation plan nor its KPIs do not need to be approved by the Board. The Global Fund Secretariat is putting together a draft implementation plan, which reflects key priorities. The Global Fund secretariat welcomed additional inputs on key interventions that the and informed that they will have a cross secretariat consultation as much of the work that needs to happen will not only be done by the CRG but across the Global Fund secretariat which will happen on August 31st and then have a solid implementation plan by mid fall when it will be good to check in again.
  • Partnerships with civil society will be critical – so that people know what the opportunities are and how people can access the support that they need.
  • Have this solidified and approved by the end of the fall and go into full implementation by 2017.
  • Any input should be received in the next two weeks – anything to be put forward as strategic actions should go into that consultation.
  • W4GF to organise another conversation around mid October.

The webinar was hosted by the W4GF Secretariat – Ms Rachel Ong (Global Coordinator) and Ms Sophie Dilmitis (Programme Coordinator); and attended by 8 participants: Jill Gay, What Works For Women; Mmapaseka Steve Letsike, the ATHENA Network, South Africa; Constance Njoru; Claire Mathonsi, International HIV/AIDS Alliance, UK; Carol Nawina, Community Initiative for TB, HIV/AIDS & Malaria; Sakunthala Mapa, IPPF; Tumainiel Mangi, Hope foundation for social entrepreneurship; Olena Stryzhak, All-Ukrainian Network of people living with HIV/ Eurasian Women’s Network on AIDS; and from the Community, Rights and Gender (CRG) department from the Global Fund Secretariat included Heather Doyle, Senior Coordinator, Gender.