03 Dec 2019

Communities Delegation at the 33rd Executive Board of Unitaid

The Communities Delegation (CD) to the Unitaid Board, representing people living with the diseases, actively participated in the Executive Board of Unitaid at its semi-annual meeting held in Geneva, on 20 and 21 November 2019.  The Communities Delegation was represented by the Board Member, Liaison Officer and four delegation members. This brief report summarises the key issues discussed at the Board meeting, the Communities Delegation’s positions, and the resulting outcomes and decisions.

Communities Delegation at the 33rd Executive Board of Unitaid

Executive Director steps down

Mr Lelio Marmora has announced to the Unitaid Executive Board that after five years of service, he has decided to step down as Executive Director of Unitaid within the next few months. The Board has thanked Mr Marmora for his leadership and recognized his pivotal role in transforming Unitaid into a leading global health organization. Deputy Executive Director Dr. Philippe Duneton will assume the role of acting Executive Director as of March 2020 until a successor is appointed. Dr. Duneton is a seasoned member of the Unitaid executive team, and the Board has expressed complete confidence in his ability to lead the Unitaid secretariat at this time.

Agility mechanism and Chagas disease

While Unitaid has managed to support significant innovations in HIV, TB and malaria, the midterm review of the 2017-2021 strategy also showed that the operating model may not be nimble enough to catch smaller innovations with potential at an early stage in their gestation. Such investments also tend to be riskier by nature and may not have the same maturity in terms of path to scale-up. In that context, the Secretariat has developed a framework for an “Agility mechanism” that is intended to complement the operating model, and that can empower Unitaid to support innovation to the full while protecting the integrity of its mandate.

Following the September Board Seminar and the recent PSC meeting in October, the Board approved the framework to pilot an ‘agility mechanism’ which will allow Unitaid to invest in new opportunities of up to $20 million in 2020, approximately 10% of its annual funding pipeline. This agility mechanism will stay within the current mandate to support innovations in HIV/co-infections, TB, malaria, RMNCAH (reproductive, maternal, newborn, child and adolescent health) and Antimicrobial Resistance (AMR) and will be piloted during one year, with a view to informing the next strategy (2021-2016).

Scalability of Unitaid’s investments is key in areas that are especially dependent on domestic financing, such as RMNCAH. A timely example, relevant for maternal and child health, has been identified: new diagnostics and treatments for Chagas disease to contribute to the elimination of congenital disease, with technical breakthroughs to stimulate a country-led response. A call for proposals for Chagas disease was launched this week.

The agility mechanism will differ from the current operating model in two ways. First, the Executive Board delegates the administration of the agility mechanism to the Unitaid Executive Director, with the Secretariat determining which projects to source and select and taking responsibility for supporting projects and assessing progress. Second, the Executive Board does not seek to use the Board endorsements that are required in the current operating model, but instead requests that the Secretariat report annually on any projects supported by the agility mechanism. The Secretariat will, however, seek endorsement by the Board for projects over $5 million.

The Communities Delegation broadly agreed with the new mechanism and governance model in order to quickly respond to new opportunities and emphasised the need to include communities as key players in order to turn Unitaid’s investments into long-lasting in-country adoption and policy changes.

Expanded Area for Intervention (AfI): malaria chemoprevention, focus on intermittent preventive treatment in infants (ITPi)

The Board confirmed the expansion of the current AfI on malaria which already includes Seasonal Malaria Chemoprevention and chemotherapy in pregnant women to the renamed AfI “Malaria chemoprevention” by including the opportunities presented by Intermittent Preventive Treatment in infants (IPTi), for children under 12 months.

IPTi is considered a high-impact and cost-effective intervention for preventing malaria-related mortality in infants. Unitaid will look at tackling key barriers to scale up, such as determining the right dosing and formulations for infants, as well as identifying complementary opportunities for delivery by including IPTi in existing immunization programmes and weighing visits.

The Communities Delegation supported the expanded AfI and underlined the importance of community health promotion for the uptake and sustainability of these preventive interventions. “We strongly encourage that any IPTi project has a framework and clear budget for inclusive community engagement and that Ministries of Health will be involved so that the outcomes of these interventions will be integrated into the National Health Systems,” said Communities Board member, Kenly Sikwese. “Specifically, we want to ensure that communities can play a critical role in the advocacy for the long-term sustainability of the project.”

The delegation also advocated for a more comprehensive approach to reduce infant mortality from malaria. Severe anaemia continues to be a significant challenge in mortality for children under five years, hence a holistic approach of the social determinants, including nutrition, should be part of the Call for Proposals to be launched in the coming months.

Governance updates

The Executive Board appointed a new Chair and Vice-Chair for the Policy and Strategy Committee (PSC) and welcomed Sarah Boulton on behalf of the UK and Precious Matsoso on behalf of African Countries respectively. The Communities Delegation received Observer status on the PSC and became a full member of the Finance and Accountability Committee (FAC). The Board appointed Jamie Morris (Gates Foundation) on behalf of the Foundations and Leonard Abrantes on behalf of Brazil, as Chair and Vice-Chair of the FAC. Communities Board member, Kenly Sikwese, will continue serving as a member on the increasingly important Governance Working Group to overlook the development of a Code of Conduct for the organization.

The next Board meeting will take place in Geneva on 17-18 June 2020.

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The Communities Delegation to the Unitaid Board represents people living with and affected by HIV, TB and Malaria and those co-infected with HIV and HCV. The Communities Delegation has the goal of representing the views, voices, needs and interests of Communities living with the Diseases at Unitaid Board and Committee level. It aims to be transparent, accountable and to prepare communities to engage in Unitaid’s work areas that directly affect those living with the diseases at grassroots and country level, especially in the global south. The Communities Delegation to the Unitaid Board is hosted by the Cape Town office of the Global Network for and by People Living with HIV (GNP+). For more information, please contact Wim Vandevelde, Liaison Officer, Communities Delegation, wvandevelde@gnpplus.net

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