A W4GF webinar took place on Monday 28 May. W4GF global advocates engaged with the Global Fund Secretariat (GFS) on Challenging Operating Environments (COEs). The discussion was moderated by Maureen Murenga, W4GF Advisory Group member and Director of the Lean on Me Foundation.

As outlined in the EANNASO Community Guide to the Global Fund’s Challenging Operating Environments Policy, COEs are countries or regions facing a number of complicated circumstances and situations which make it difficult to implement programming and measure impact. For example, a challenging operating environment could include a country with:
• Weak or unstable political situations (i.e. War or terrorism)
• Poor access to health services (i.e. Severe shortages of doctors and nurses)
• Man-made or natural crises and disasters (i.e. Earthquakes or floods)
• Outbreaks of other diseases (i.e. Ebola)

Recent policy amendments to the Global Fund’s COE Policy were discussed. These changes make provisions for serious health crises that emerge from in-eligible non-high-income countries. In the past the Global Fund would not consider supporting in-eligible countries but now they will, especially if the crisis has an adverse impact on the global response to HIV, Tuberculosis, or malaria. The Global Fund Board further requested the Secretariat, and partners, to present potential investment cases meeting these criteria. These are to be directed to the Strategy Committee for review and recommendation to the Board with options on how the proposed investment should be funded. This policy remains applicable to this allocation cycle. 26.8% of the Global Fund allocation from 2017-2019 has been designated for COEs. Whilst 27% of the global disease burden of HIV, Malaria and TB is from COEs, the highest of these being in Malaria.

The Global Funds Strategy Investing to End Epidemics includes a key objective to Maximise impact against HIV, TB and malaria. 

Presentations and Speakers
The webinar presentation from the Global Fund Secretariat is accessible here and the presentation from Society for Women and Aids in Africa Sierra Leone Chapter (SWAASL) is accessible here. The webinar recording is accessible here.
• Heather Doyle, Gender Senior Coordinator in the Community Rights and Gender Department at the Global Fund
• Ana Baracaldo, Strategy Policy and Performance, COE Team
• Marie Benjamin – SWAASL (was not able to participate due to technology – A separate interview will follow).

Understanding Challenging operating environments – Ms Ana Baracaldo, Global Fund Analyst COE and Risk Analyst
The presentation provided insight into the development and operationalization of the Global Fund policy and displayed the realities of the application of policy in COEs this whilst addressing gender and human rights issues in COEs.

The Global Fund Challenging Operating Environments Policy
The recommendations developed by the Technical Evaluation Reference Group (TERG): Review on Fragile states 2014 informed policy on COEs through The Global Fund Strategy 2017-2022 under Strategic Objective 1. Sub Objective D is to “Improve effectiveness in challenging operating environments through innovation, increased flexibility and partnerships”. The operational policy note (OPN) on this was approved last year.

Key recommendations from the TERG guided policy development including:
• A classification framework for COEs.
• Establishing an approach for acute emergencies.
• Global Fund to improve its engagement with humanitarian partners.
• Placing an emphasis on flexibility on Global Fund policies to better adapt to different countries in different challenging environments taking into consideration varying developmental concerns or challenges that each context may be experiencing.

The operationalization of this policy took shape in 2017, based on principles of:
• Innovation – Refers to improving procurement and service delivery and multi donor approaches.
• Flexibilities – Involves a more coordinated approach and more flexibilities (29 more flexibilities which include making allowances for reprogramming and contingency planning.
• Partnerships -The creation of partnerships to bridge the divide and create a more coordinated response. Partnerships include Global Health Cluster and other various other humanitarian organisations like , International Committee of the Red Cross (ICRC), International Organisation for Migration (IOM) and United Nations High Commission for Refugees (UNHCR). These partnerships have strengthened access to and support for migrant and vulnerable populations in conflict settings.

Thus far, support to COEs has ranged from severe emergency environments such as Yemen or to more chronic settings in countries affected by Ebola.

The classification Process
The classification process of COEs is conducted through an internal measure known as the External Risk Index (ERI) The funding allocation is categorized according to high impact and non-high impact allocation. The ERI is a composite index that is derived by compiling data from 10 authoritative indices (e.g. Fragile States Index, UN’s Safety & Security Index). Ad-hoc adjustments can be made depending on emerging needs.

Applying 29 flexibilities is a key consideration in COE policy that the PRs can request. Examples of flexibilities include: contingency planning; requesting additional days for reporting; additional verification mechanisms. In 2018, GFS heads of departments and regional managers identified 5 different portfolios based in COEs for example, within the Central Africa Republic there are initiatives taking place with country teams to facilitate contingency planning with Country Coordinating Mechanisms (CCMs) and Principal Recipients (PR) to better respond to the country context with the cooperation of humanitarian partners.

In addition to the COE policy, the Emergency Fund (launched in 2014) is an innovative approach which allows in-country teams to have quick access to funds in emergency situations when reprogramming was not an option. It is a time bound fixed approach to accessing funds. From 2014- 2017, $30 million was available in the Emergency Fund while $20 million has been made available for the 2017-2019 allocation period. Under the new allocation cycle only one request has been received from Uganda to respond (to the influx of refugees from South Sudan.

The relationship between gender and COE (slide13)
The UNFPA Adolescent and Youth Dashboard is a resource which highlights indicators that track progress around young women in Sub Saharan Africa, which range from gender equality, sexual and reproductive health, access to education and intimate partner violence. There is a high correlation between indicators and gender inequalities in COE settings. This presents a challenge to the GFS as the GF is (by and large) a gap donor with a focus on treatment. There is a real need to strengthen programming to ensure more integrated health services and racking these indications in CoEs to effectively address HIV, TB and malaria.

The Global Fund will host an implementation workshop later in 2018 on gender based violence in COE settings with Francophone and West and Central Africa. The objective is to ensure the Global Fund’s resources are maximizing impact and integration of services across HIV, TB and malaria to improve prevention and treatment and minimize gender related barriers in COE settings. This will lead to a broader conversation around what the Global Fund should be funding related to integrated services in these contexts.

 Discussions and Questions
Q. How does the GFS ensure that communities, particularly women and girls engage in Global Fund processes in COEs especially when proposals are often developed in emergency situations?
A. When we look at the CCM sex disaggregation in COEs and other Global Fund processes we tend to see more males represented and women have a harder time participating in COEs. There has been some experience with the Community Rights and Gender (CRG) Strategic Initiative and how this can support COEs. Technical assistance has largely focused on Key Populations and more needs to be done to address the gender related barriers that women face to engagement which requires further attention.

Q. Key populations continue to experience human rights violation and are generally more at risk and vulnerable in COEs. Can provisions in this policy lend to reprogramming to best respond to the needs of key populations particularly in areas where they are criminalized? Has this discussion happened? And using the resources in the country? Are there additional measures to protect key affected populations in these environments?
A. Flexibilities are used in such instances. Reprogramming is possible and is dependent upon country teams and if there are savings that allow for that reprogramming. Niger is one example where the TB grant was reprogrammed to provide services to migrants in transition centres. There have also been some experiences with the CRG around providing sustained short and long-term support for key populations in COEs and what we are able to do is always changing. Country teams try to address the needs of key populations in creating ways. This takes good will and both sides and the GFS should be documenting where support has been provided to key populations without risking their safety.

Q. Sometimes a country is in a challenging environment, but governments do not admit this. At the same time the country may not fall under the Global Fund ERI. Would the Global Fund act on alarms raised by civil society? Venezuela is one example of a country where the government failed to admit that a crisis existed.
A. All countries eligible for funds fall under the Global Fund ERI. Venezuela was ineligible for Global Fund financing based on the data submitted by their government. At the recent Board meeting it opened up opportunities to make an investment case for such countries to the Global Fund for support. Civil society should always raise these issues directly with the Global Fund, especially if there are rapidly deteriorating human rights issues. The Emergency Fund is another option open to countries or contexts in crisis that do not fall under the classification of COEs (COE Index is updated annually). The Philippines policy on drugs was given as an example – the Global Fund did not categories this as a COE but support was provided to ensure access to service continued for key populations.

Q. What about actions around the massive displacement of populations specifically Rohingya in Bangladesh. Bangladesh has to use its country allocations for immigrants. You mentioned the Uganda example where reprogramming was implemented for refugees from South Sudan – was this considered in Bangladesh?
A. These are similar situations but it is important to note that before we use the Emergency Fund the country team is encouraged to liaise with country stakeholders. In the case of Uganda this was not possible to reprogramme the entire grant so the team requested additional funds. In the case of Bangladesh, the Emergency Fund has been discussed as an option but the country teams do not think this is necessary yet.

Q. My understanding is that COEs are determined at the beginning of the funding cycle and they remain on that list for the three years…not so?
A. The COE list is approved at the beginning of each cycle for three years and each year the ERI is published along with the post adjustment process to see if any other countries should be included into the COE list.

This meeting was attended by 23 participants including: Erika Castellanos, Maureen Murenga, Ann Ithibu, Chapman Msowoya, Gemma Oberth, Ida Hakizinaka, Carol, Emily Carson, Francis, Nalwanga Resty, Kemoh, ITPC Global, Emily Carson, Marie Benjamin, Ida Savadogo, Nooliet, Martin-Mary Falana, Yuki Takemoto. Three representatives of the Global Fund Secretariat: Ulliane Appolonario, Heather Doyle and Ana Baracaldo and the W4GF Secretariat was represented by Sophie Dilmitis and Matipa Ndoro.

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