08 May 2018

Civil Society Sneak Peek: What’s Happening this week at the Global Fund Board Meeting?

The Global Fund will hold its 39th board meeting this week in Skopje, Macedonia. During these biannual meetings, the Board makes a number of critical decisions that are legally binding and determine the future direction of the Fund. This Board meeting will be the first for newly appointed Executive Director, Peter Sands. As such, the Communities Delegation will be keen to understand Mr. Sand’s commitment to defending responsible policies around eligibility criteria for middle income countries. Incidentally, Skopje in the former Yugoslav Republic of Macedonia, makes for a paradoxical venue for this week’s intense round of Global Fund deliberations and negotiations, as Macedonia is a upper middle income country that recently transitioned out of Global Fund support.

What should people living with HIV expect from the Global Fund Board Meetings this week?  

1) Eligibility Criteria: The Board is expected to make a number of technically complicated and highly contentious decisions related to the eligibility of countries to apply for and receive Global Fund grants in the future. A country’s eligibility to receive Global Fund grants is based on an equation that takes into account its disease burden and economic capacity. Of significant controversy is the reliance on the World Bank’s Gross National Income (GNI) per capita indicator that determines whether a country is classified as a lower, middle or high income country. According to current Global Fund regulations, upper-middle-income countries will only remain eligible for funds if they can demonstrate a high disease burden, with some exceptions.

The use of GNI to establish country eligibility is being challenged by communities and activists because it paints an incomplete picture of the country’s social, economic, and political stability and obscures economic disparities and the widening inequalities that key populations face. Youth, MSM, sex workers, transgender people and people who use drugs around the world continue to experience the burden of  late diagnosis, high HIV related mortality, significant ongoing gaps in access to quality HIV prevention, treatment, care and support services, as well as high levels of poverty, widespread stigma, discrimination and violence and a dismal lack of social and legal protections.

Over the years, the Communities and Civil Society Delegations of the Global Fund have fought for and gained some critical concessions on eligibility policy that have lessened the blunt trauma of transition. Some of these policies include increased flexibility to extend transition out plans, on a case by case basis, beyond the currently allocated 3 year period. Additionally, the Communities and Civil Society Delegation has continued to raise the complex issue of chronic underreporting of HIV prevalence data disaggregated by key populations, especially in middle income countries.

We should expect that the Communities and Civil Society Delegations will continue to exert pressure on Board members for further eligibility criteria flexibilities and concessions to ensure that the Global Fund remains global.

2) CCM Differentiation: This week the Global Board will also make additional decisions related to the possible adoption of a tripartite differentiated Country Coordinating Mechanism (CCM) model that includes 1) retaining the standard CCM model and/or 2) the creation of a new CCM model for transitioning countries and/or 3) the creation of a specific CCM model for challenging operational environments (i.e. Iran and Ukraine). The communities delegation would like to see a strong commitment and plan to strengthen, invest and rollout this differentiated CCM model.

3) Partnership Model: Not on the official agenda, but an issue that will likely come up in the corridors of this week’s meeting is the Global Fund’s policy on partnerships with corporate sponsors. This conversation is driven by the revelation that the Global Fund has suspended their partnership with the Heineken Brewing Company due to issues related to “the company’s use of female beer promoters in ways that expose them to sexual exploitation and health risks. Community members and Delegation members remain divided on the Heineken issue, but we should expect the Board to field questions related to the Global Fund’s criteria for determining what type of corporate partnerships the Fund wants to enter into in the future.

 

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