A W4GF webinar on March 20 provided space for 35 W4GF advocates and partners to engage with the Global Fund Secretariat (GFS). The webinar provided an update on the Global Fund’s investments and strategy to reduce new infections amongst adolescent girls and young women (AGYW) in 13 countries. To listen to the entire webinar click here.

Introduction
This is the first of a series of W4GF webinars taking place throughout 2018. This is the third time W4GF is hosting a webinar that covers AGYW, which is indicative of the evolving initiatives accompanying AGYW within the Global Fund.

We know the challenges that women and girls in all our diversity face and the struggle that activists face to have a seat at the table so the Global Fund’s focus on gender and AGYW is appropriate and important especially given that, in some regions, girls account for more than 80% of all new infections among adolescents. This in itself demands a response grounded in gender transformative approaches.

Recently this year the Global Fund Secretariat launched HER which stands for HIV Epidemic Response. HER is a collaborative platform for a range of partners to support AGYW in 13 countries at high HIV risk: Botswana, Cameroon, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

Update from the Global Fund Secretariat

To view the slides presented by the Global Fund Secretariat click here

Summary from Rukia Mannikko, Technical Advisor, Gender, Community Rights and Gender Department (slides 1-8)

  • The Global Fund has a target to reduce HIV incidence by 58% over the next five years (2022).
  • Key components of this work include:
    • National AGYW HIV incidence targets and plans
    • Robust monitoring and evaluation with processes to track and improve investment responses
    • Quality design and implementation of AGYW programs
    • Adequate resources to fund quality, at-scale AGYW programs.
  • A five-fold investment increase has been recorded since the roll out of the new strategy on AGYW. From 11 countries the investment is approximately US$103 million – Botswana and South Africa are still to submit their funding requests so this figure will increase.
  • The funding deficit is >US$60 million, which will increase once Botswana and South Africa submit their funding requests.
  • A substantial investment has been made for voluntary medical male circumcision (VMMC) as a high impact intervention despite its focus on men.
  • Seven of eleven grants (Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia and Zimbabwe) have been signed countries that have submitted funding request. These are highlighted in blue on slides 7 and 8. Funding requests from Cameroon, Lesotho, Namibia and Swaziland have been submitted but have not yet been signed off.

Summary from Lize Aloo (Specialist, Data Use for Action, Gender, Monitoring Evaluation & Country Analysis Team) on the Strategic M&E priorities to support implementation of comprehensive and multi-sectoral quality AGYW programs (Slides 9-11):

  • The overall objective of the Global Fund M&E plan is to measure the reduction of new HIV infections in the 13 countries. This is performed at different levels, namely:
    • Output/coverage indicators for signed grants
    • Outcome indicators at individual and population levels. The Global Fund Secretariat is currently working to strengthen these
    • Impact: new infections among females aged 15-24 years. The Global Fund has different methods to track this but the most common is HIV country estimates.
  • Key highlights include:
    • The need for strong data systems that help programs monitor progress in a timely way
    • Countries need to know their own data needs to identify the appropriate systems for planning, program management and reporting
    • It is important to track individuals and identify the most vulnerable and marginalised AGYW in districts
    • Tracking service provision and referrals is important to avoid duplication given that many services are implemented in a multi-sectoral context.
  • Another key priority is to reinforce outcome measurements beyond output and coverage indicators. Countries are encouraged to develop innovative ideas to measure individual and population level outcomes. These include:
    • Tracking referrals to ensure clients receive services: tracking those who are diagnosed with HIV to ensure they received treatment and tracking those who test HIV-negative to ensure they receive the relevant support to remain HIV-free
    • Data quality is key as this is used to plan, inform program management and allocate resources. This includes performing spot checks, verifying reports and achieving a clear understanding of indicators and reporting requirements.
  • Countries need to use the data to learn from implementation and to strengthen programs and services and leverage the analysis to inform high levels of the Global Fund decision-making. Substantial quantities of data are generated but are not always interpreted or used effectively. More needs to be done to use and analyse the information received.
  • Updates on upcoming activities include:
    • Developing a measurement framework to streamline the M&E approach, building on existing systems and providing additional technical guidance on AGYW
    • Planned assessment of AGYW data systems to identify existing deficiencies that will provide M&E support to countries
    • M&E technical assistance (TA) pool to support countries in addition to existing TA support.

Uliane Appolinario, Program Officer, Strategic Initiative, Community Rights and Gender Department (Slides 14-15) on community engagement within the Community Rights Gender (CRG) Strategic Initiative (SI).

The short-term TA (demand driven) addresses specific needs of AGYW in the 13 countries. The Global Fund Secretariat is working with Kelin and ASAP. Key areas of support include the following:

  • Designing AGYW Meaningful Engagement Plans
  • Overall training and mentoring of AGYW-led groups and networks in interventions of the Global Funded grants and supported processes.
  • Short-term mentoring of youth Country Coordinating Mechanism (CCM) representatives
  • AGYW coalition building with a view to influencing national policy and advocacy
  • AGYW-led ad hoc working groups/committees/accountability frameworks to follow up on grant implementation/other relevant processes.

Target: At least one TA delivered in each of the 13 AGYW countries with concrete outcomes to AGYW groups.
Time frame: July 2019. Key areas for development:

  • Disseminate information on the TA and raise community awareness in the 13 countries
  • Provide examples of successful TA that created concrete community engagement models for AGYW/Youth
  • Obtain national stakeholders support (including Principle Recipients (PRs and CCMs)) to open spaces in which AGYW can engage.

HER Voice Fund

Objective: Support AGYW groups in overcoming logistic, administrative and language barriers to participation in relevant national policy and programming processes that affect their rights and health. Implementers: Southern Africa AIDS Trust (SAT) and Eastern Africa National Networks of AIDS Service Organisations (EANNASO).

Key areas: Participation, community consultation, communication and outreach, policy and advocacy.
Target: USD500,000 disbursed to support AGYW groups to engage in relevant national processes linked to or supported by the Global Fund. Timeframe: December 2018. Key areas for development:

  • Identify country opportunities for AGYW/Youth to engage, i.e. what are the upcoming processes in each of the 13 countries
  • Identify AGYW Ambassadors and focal points
  • Communication, communication and communication.

Update from W4GF Advocates and Her Voice Fund

Summary from Maureen Murenga (Lean On Me) shared her experience from Kenya. (38 minutes into the recording) – For the full story please click here

HER Voice Fund is managed jointly by SAT and EANNASO – for more information on this fund click here. Yvonne Kahimbura (EANNASO) and Glory Chagama (Her Voice Fund Grants Manager) share their experience with the Her Voice Fund:

  • Focal point organisations from the 13 countries have been identified
  • A call for Ambassadors is circulating. Ambassadors play a leading role in obtaining knowledge and mobilising AGYW groups within their countries to apply for the Fund, as well as in supporting HER Voice Team in accessing the relevant country-specific information required for successful implementation of the project. Ambassadors will have first-hand access to a wide range of policy-makers and be seen and recognised globally as young advocates who are pushing AGYW response to HIV and other pressing issues, including TB.
  • The Fund has written to CCMs in the 13 countries introducing this fund and has met young CCM representatives.
  • The HER Voice Fund will convene a meeting in April utilising the Anglophone Coordination Community Rights Gender Platform and are inviting only Ambassadors and fund implementers.
  • In Jan (11), Feb (14), March (17) applications were approved. A total of 42 applications out of 230 have been accepted since the inception of the Fund. A total of 1 application was received from Cameroon, 9 from Kenya, 9 from Malawi, 1 from South Africa, 8 from Tanzania, 8 from Uganda, 1 from Zambia and 4 from Zimbabwe. No application has been received from Botswana, Lesotho or Swaziland. There appears to be a lack of understanding about what this Fund represents.

Discussion and questions

Q – It is encouraging to see the Global Fund exploring M&E. A year ago the ALIV(H)E Framework was developed by Salamander Trust, together with the ATHENA Network, the AIDS Legal Network, Project Empower and HEARD at the University of Kwa-Zulu Natal. This was commissioned by UNAIDS to develop a programme to strengthen and expand the evidence base in relation to initiatives to address violence against women in the context of HIV. This Framework examines SPICED indicators, which are developed by women themselves. This is available here and might be useful to the GFS and civil society. Another initiative was a global review of HIV Treatment Access for Women commissioned by UN Women. The report is accessible here. This review seeks to address the barriers that women face in accessing treatment as well as the structural violence they experience in health care settings. It would be valuable to understand the experience is of AGYW as they access health care services. Please also consult this article published in the Health and Human Rights Journal In Women’s Eyes: Key Barriers to Women’s Access to HIV Treatment and a Rights-Based Approach to their Sustained Well-Being.
A – This is a great comment – This is a work in progress for the GFS. Please share the ALIV(H)E Framework to view the indicators and see how this can be aligned.

Q – Can anyone become a TA provider or is this limited to certain identified providers?
A – A total of 26 TA providers were selected in 2017 through a call process. This call will not be opened again for another two years. If your organisation is active and reliable in specific countries, there are opportunities to engage with upcoming TAs at the national level.

Q – For how much longer will we continue to invest in VMMC when clearly this is not focused on adolescent girls and young women specifically?
A – VMMC has proved to be a high impact biomedical intervention but the countries did not use catalytic funding but we are seeing it included in that slide as this is part of the analysis of service delivery and biomedical interventions. The USD103 million does not include funds being attributed to VMMC. 

Q – Re PEPFAR DREAMS – admission to their programme has involved having an HIV test. Anyone who tests HIV-positive is not admitted to the programme and this raises many human rights concerns. I hope that the Global Fund is not causing the same issues around confidentiality?
A – The GFS can follow up on this with PEPFAR colleagues but there is no such requirement in Global Fund-supported programmes that the GFS is aware of.

Q – Regarding key areas on TA – I do not see an area on monitoring AGYW grants?
A – The GFS hopes to develop accountability mechanisms and monitoring mechanisms for use by the AGYW. This will be included in the TA moving forward and needs to be agreed with the PRs to be effective. Zambia is currently in the process of accessing TA to do just this.

Q – I have a question on M&E systems, especially at national level. How do we ensure we have quality data that is not duplicated since we have other donors who are supporting AGYW in the 13 countries like PEPFER; how do synchronise national data on AGYW groups obtained at the national level.
A – This is an important question. The GFS is still grappling with how to synchronise data and the quality of data to avoid duplication. The challenge is compounded by unique country identifiers. We are examining how best we can strengthen collaboration with government and community partners to lead on this issue and support countries to utilise a single harmonised system.

Q – Can we access funds to conduct webinars like this from the HER Voice Fund?
A – Yes. Requirements to access the HER Voice fund are accessible here.

Unanswered questions due to time constraints

  • How can we actively participate in these processes in different countries?
  • What is the difference between Global Fund supported programmes and PEPFAR Dreams projects?
  • How can the GF team work with the country partners to ensure that catalytic funding resources address the needs and priorities of AGYW so that what happened in Kenya does not happen again?
  • One of the areas for which we have seen a great need for capacity and support in Global Fund proposal developing and programming is dealing with critical enablers for AGYW… issues around dealing with harmful gender norms, gender-based violence, legal barriers around age of consent etc. Do we have enough funding and technical support for these areas?
  • I want to hear more on the requirements of the HER Voice Fund. The person who presented the challenges indicated that most applications were on service delivery, what then are we expected to focus on?

Closure
The next W4GF webinar is on 17 April 2018 and will cover TB gender assessments – more information on this will be available soon. Other webinars planed for this year include:

  • TB Gender Assessments: 17 April 2018
  • Gender and Challenging Operating Environments (COEs): May (date to be confirmed)
  • Community Monitoring: June (date to be confirmed)
  • Gender in the context of Sustainability and Transition: October (date to be confirmed)
  • Youth Strategy. Focus on adolescent key populations – November (date to be confirmed)
  • Malaria Matchbox: September (date to be confirmed)
  • HER Voice: December (date to be confirmed).