Rising to the challenges of civil society

After the South American Regional Meeting was concluded, representatives from the different sectors that make up the Country Coordinating Mechanisms evaluated the meeting and put forward their challenges for the next Round.

The Regional Meeting for the Country Coordinating Mechanisms and the South American Regional Country Coordinating Mechanisms concluded and set forward numerous challenges for the participants.

With 2010, which is expected to be a critical key year, looming on the horizon and in light of the new structure presented by the Global Fund, representatives of civil society drew their own conclusions from the meeting.

The positive outcome is to be able to view the opportunities that the mechanisms have to optimise both their organic and operational structure. “The Global Fund is insisting on establishing a better balance within the CCMs between the civil sector, the private sector and the government", explained Orlando Montoya, General Coordinator of ASICAL.

Arely Cano, Regional Secretary of the International Community of Women Living with HIV/AIDS, pointed out that the meeting was enlightening in terms of “gaining more in-depth knowledge about how Global Fund operates and being able to see how civil society, organisations and networks can participate and strive for their proper place.

Rising to the Challenges

“The challenge is empowerment, as with all information that we provide, to prepare our regional proposal in the best way possible and to have it approved in Round 10. This is one of our major challenges”, acknowledges Elena Reynaga, Executive Secretary of RedTraSex.

Marcela Romero, Regional Coordinator of RedLacTrans, agreed that the big challenge is Round 10: “We are going to have to work with the CCMs and present the project. And this presentation has to make them a partner that has the required capacity, the necessary strengthening and information in order to hold their own in a debate”.

Another key challenge will be to achieve the participation and representation of all the sectors within each CCM. “We ask that the CCM statutes in Latin America be reviewed and revised so that the partners in the Trans population can occupy their own place as a specific vulnerable population and not within a collective group”, insisted Romero.

Montoya, in turn, maintained that the main goal will be that the CCMs can ensure its agreement document with the prevalence of the epidemic in these sectors and in each country. “If not, there are going to be many sectors within the mechanisms that therefore, are less affected by the epidemic and are relegated to priority sectors which are the voices that really need to be heard within the CCMs” he commented.

Lastly, Arely Cano referred to the women’s’ situation which according to a report presented by the Observatorio Latino has little representation. “This does not deal with specifying an agenda because we already have one. It deals with being able to see how as women we can have our proper place", she clarifies and concluded:

The exercise will be to see how we can achieve activities between the different actors so that the voices of all populations can be heard”.

Hence, the challenges are the same for everyone. We need to see what happens at the time we put them into practice.

By Alejandra Ruffo and Mirta Ruiz
Key Correspondent Team – Asuncion, 10/12/09

“It is important to understand how donors feel”

“It is important to listen and understand the feelings of the donor community” said Ambassador Fidel Lopez Alvarez speaking at the Global Fund’s South America CCMs/RCMs Regional Meeting.

The Ambassador was representing the Spanish International Development Cooperation Agency (AECID) at the conference which took place in Asuncion, Paraguay, during December 2009.

"There is a dual concern between the donors, on one hand, the global financial situation and on the other hand, the approach that the Global Fund has taken” he said.

He also explained that the Global Fund has undertaken commitments of $7million up to Round 9. In the actual cycle of procuring resources of the Fund, which is about to conclude, the donors raised the sum of $10billion.

If during the next cycle - which begins in 2010 - a similar sum can be achieved, then that would be a great success considering the global crisis he said.

However, this result would leave less than $3billion for future funding rounds, a little over what was required for any of the recent rounds by itself (Round 9 had a total sum of $2.2billion).

Aside from the economic crisis, the donor community is concerned about the impact the Global Fund could have on the national health systems by continuing in the trend of a vertical approach where more resources are invested in some countries, in only one disease, than all other programmes in Public Health.

However, they take a favourable view of the progress achieved in the application of strengthening policies of the health systems and the horizons that will be opened regarding the requests of Global Fund National Strategies.

Concerning the region, he adds: “The admonishment is so that they put political pressure on governments in Latin America to provide us with common criteria that could favour the Fund and the region.

"One must be creative, positive and proactive. I think that the following areas need to be explored: the high-technical quality of the proposals, explore in-depth the mechanisms of co-funding, given that there are no contradictions between being a donor and being a recipient of the resources; continue to strengthen political advocacy in order to increase understanding about concentrated epidemics and there is a need to redouble the efforts on prevention and lastly, the trend towards requesting resources through national strategies”.

Lopez Alvarez also recommended working strategically with other delegations in the governing board of the Global Fund, working with countries that have both similar epidemics and similar national incomes, and also working with civil society, the private sector and foundations.

He also announced the significant contribution made by the Spanish government to UNAIDS for the provision of Technical Assistance affiliated with the Global Fund.

“I regret having to share with you this warning, but it is time for all the actors in the region to put forth strategies that maintain Latin America within the portfolio of the Global Fund.

“The Government of Spain has been and always will be supporting Latin America within the Global Fund, as we have been doing in other international institutions”, concluded the Ambassador.

The words of the representative of the Spanish Government, far from being negative or foreboding, merely added to other voices at the conference. Therefore the region as a whole can embark on a series of activities that follow the agenda of the donors.

We will soon find out if the warnings generate positive actions within an international context where it is no longer enough to just ask for donations from international financial mechanisms.

By Alejandra Ruffo and Javier Hourcade Bellocq
Key Correspondent Team – Asuncion, 10/12/09

The importance of costs per unit for Civil Society

In more than two decades of the National Response to HIV/AIDS, we have not made great inroads into defining the costs per unit of the interventions of civil society. The World Bank (with its ASAP Programme) UNAIDS, the Global Fund and the International Alliance began a process to increase the knowledge of civil society organisations by active participation in the development of the National Strategic Plans (through ASAP) and the determination of costs per unit.

But why is it important to know the specific costs per unit? For the last few years, national strategic plans have begun to develop that are costly. However, these plans lack the calculation of the costs of the interventions of civil society. Hence, the national accounts are exclusively governmental.

The important of having and applying tools to define these costs can by summarised in: The opportunity to group together the interventions into service packages so that civil society organisations can know the specific actual costs and by this route they can develop projects and adjusted proposals to implement programmes in their role as sub-recipients of the Global Fund.

It is also a resource for political advocacy, it can demonstrate the economic contribution in this sector and it can reclaim a higher investment, based on evidence, in these proven programmes and better access to the vulnerable population.

For example, when a Gay/MSM organisation through a peer intervention deliver a condom to a person on the ground, normally the error lies in financing the cost of only the condom, a leaflet and the time spent by the person who did the peer work.

Behind this activity exists a variety of direct costs (travel expenses, snacks or administration and stock management for the condoms) and indirect costs (expenditures for maintenance of the organisation, training the peer workers and fees for other officials of the organisation.

As a consequence, many times the organisation underestimates the actual final costs in their budget and therefore may confront serious difficulties in meeting the goals set by the Principal Recipient which include covering the budgetary differences from their own coffers.

Starting next year, the first workshop will be organised to adjust and validate a tool which will be distributed to national workshops in a limited number of countries in 2010.

The civil society organisations cannot continue working in situations of semi-exploitation with precarious working conditions and ending up looking for resources from their limited reserves to cover budgetary gaps. This is a topic of greater effectiveness, efficacy and equity which has nothing to do with the commitment of this sector to the national responses.

By Javier Hourcade Bellocq
Key Correspondent Team – Asuncion, 11/12/09

Key points in the World Bank’s AIDS Strategy Action Plan

Representatives of the World Bank’s AIDS Strategy Action Plan presented the objectives of the programme and developed some key points to strengthen the participation of civil society in the preparation of proposals and in defining the costs per unit.

Rosalia Rodriguez Garcia, Manager of the AIDS Strategy Action Plan (ASAP) together with Eric Gallard, who works on the planning of this strategy for Haiti, presented the advantages of this programme, promoted by UNAIDS and managed by the World Bank.

They want to make the training and necessary tools available to civil society so that the strategies are based on actual results of the work carried out by each sector.

“As Soon As Possible” is the meaning of the acronym of this programme and that is exactly the timeframe it hopes to achieve. “It was created to respond strategically to the epidemic and to make sure the resources were utilised effectively", explained Rodriguez Garcia.

We are not talking about a funding programme since there are no direct subsidies granted. What it does offer is technical service, measures to increase capacities and the development of tools.

“Many times, activities in the community sector do not appear in the budgets. We do not know what is an actual expense so there are many estimates” affirms Rodriguez Garcia.

“The international organisations do not know how much is spent on community interventions. You have this information”, he added, “Therefore, the objective of this strategy is to provide civil society with the opportunity to participate in the process at all times".

In turn, Eric Gallard explained in detail how to estimate the costs per unit of the community interventions carried out by the members of the networks and organisations, including the direct and indirect costs.

In many cases, this work is not accurately reflected in the budgets so the purpose of this strategy is to train each sector in calculating the actual costs that the sectors incur and not estimates that generally end up penalising them.

The representatives of civil society who attended the workshop acknowledged this weakness so they asked the persons in charge of the strategy to inform the networks and the organisations of the steps of the process and that this information reaches beyond the national programmes of each country and is shared with others.

By Mirta Ruiz and Alejandra Ruffo
Key Correspondent Team – Asuncion, 11/12/09

UNAIDS: The Fund's programmes must be fully aligned

The Regional Director of UNAIDS, Dr Cesar Nuñez, gave a presentation highlighting the achievements and advances made by the LAC region in Round 9.

According to Dr Cesar Nunez, the recent successful results are owing to a concerted effort between UNAIDS, other agencies in the United Nations system and regional initiatives of Civil Society. The countries and their CCMs also merit these achievements because they were able to better coordinate their needs in proposals of higher technical quality.

“Latin America has a 55% coverage of access to antiretroviral treatment”, stated Doctor Nunez.

However, he clarified that these data are distorted by better coverage in some countries versus others that have less coverage. It is important to point out that these data are based on the number of people who require treatment in the health system.

Showing a series of graphics on access to diverse services, he clarified: “Access to the majority of services is improving and access for the most vulnerable populations as well. The important pending subject is prevention and in the immediate short-term, we must dramatically increase our efforts to reduce the exposure to HIV”.

In the sense of recent discussions in the regional meeting, Nunez reminded everyone of the importance of alignment and harmonisation and introduced the concept of 3-1 (three ones) to provide further details.

The three ones promote the concept that countries have:
· An agreed-upon AIDS action framework that proposes a baseline to coordinate the work of all those involved
· A national AIDS coordination authority with a broad multisectoral mandate
· A monitoring and evaluation system.

The policy of the three ones recognises the fundamental role of the national health authority, which has a defined role and clear leadership to coordinate, however it promotes the formation of multisectoral consultation locations to design national plans and strategies.

Hence, Cesar Nunez considered the approach of the formation of CONASIDAs (National Committee Against AIDS) as an interesting model that should fulfil the role of supervising the programme funded by the Global Fund.

He explained: “The Fund's programmes must be fully aligned and based on national strategies. In countries where a CONASIDA and a CCM exist, there is going to come a time when there will be only one mechanism; it is impossible to maintain both. It deals with making the money work for those who need it most” concluded Cesar Nunez.

Finally, the guest speaker said that UNAIDS will continue providing technical support to countries in order to present innovative and eligible proposals for Round 10.

In this meeting, the Spanish Agency for International Development Cooperation (AECID) announced by their Ambassador, who recently signed an agreement for financial support with UNAIDS in order to provide Technical Assistance associated with the Global Fund.

By Mirta Ruiz
Key Correspondent Team – Asuncion, 10/12/09

Interview with Lelio Marmora, head of Global Fund LAC

The Head of the Global Fund’s Regional Team for Latin America and the Caribbean carried out an evaluation of the meeting held in Asunción and weighed the panorama for the region with an outlook for next year.

What is your evaluation of this meeting and what do you think its short-term results will be?

"I think that it left us with a quite positive result because it is the first time that we have held a meeting that dealt with specific cross-cutting topics of the Country Coordinating Mechanisms (CCMs). It discussed extremely important topics such as the question of funding the CCMs, defining the supervision role of the CCMs in a very concise manner, the positioning of the private sector and what are the possibilities of increasing its participation.

"All of these are tactical topics. A tactic, which is circumstantial and a very specific action, is not the only important issue. Strategy is important as well. We must not confuse tactics with a strategy and it is a mistake which we are all tempted to make: the CCMs, the Secretariat of the Global Fund, the Board of Directors and the agencies."

And what would be the strategic topics to take into consideration?

"In strategic terms, I think that there are two very clear issues: The first is that you cannot build a coordinating mechanism, whether at a country or regional level, which is not based on the consensus. We will tirelessly repeat that one has to get out of the mode of conflict dynamics in order to go into a consensus dynamics. Intelligent, respectful consensus without imposing other points of view.

"A negotiation consensus but not a negotiation in which one sector reaps all the benefits because that is not negotiation either. The second strategic point is the positioning of Latin America versus the real world which is undeniable."

In terms of this point, how would you evaluate the region on a short-term basis?

"I think the coming year is going to be a critical year. I don't know if there will be enough time to prepare a strong positioning strategy at the moment, but Latin America can indeed be a protagonist in the discussion and deserves a leading role. However, to play a leading role there has to be a policy agenda that involves several key elements.

"We need to be innovative in what we propose to the international community. A region with an epidemic concentration like ours, with the level of income per capita that the countries have – despite the social inequalities – we have to be innovative."

And how could you be innovative?

"Innovative in the sense that we have to stop spending money and really invest it. Strong conceptual changes must be made in the way we conceive the projects going from the logic of the project to the logic of the programme. One cannot structure the response based on multiplying the fragmented projects where each one is on his own.

"Another element that seems to be critical from a policy agenda perspective is to continue utilising the ability of local technical assistance the way it is used in Round 9. I think it has been proven that Latin America can produce clear and concise proposals."

What are the exact recommendations when faced with this panorama?

Mainly to abandon the fragmented concept of permanent negotiation in the CCMs so that it can become an environment of constructive debate and not a setting where some policies are determined. Policy-making for the sake of policy-making is not very positive in this case.

"All the sectors have to reverse its way of interacting and try to imagine a scenario in which the national programme would be a State project and not a Government project or one sole sector project; it should be one sole project that contemplates the different variables of the distinct human groups of people."

Interview by Alejandra Ruffo and Mirta Ruiz
Key Correspondent Team – Asuncion, 11/12/09

Little participation by women in the Global Fund

The Observatorio Latino presented a study on the participation of women, sex workers and trans workers in the Latin American and Caribbean CCMs. According to the results, in spite of strides that were made, there is still a lack of representation.

The national agenda in the women's sector, in the sectors of women living with HIV, sexual workers and transgender workers have little visibility in regional proposals of the Country Coordinating Mechanisms. This is the conclusion that was reached by the study conducted by the Observatorio Latino with the support of the International Alliance and UNAIDS.

The report was carried out in 15 countries in Latin American and the Caribbean and it revealed that only the Honduras and Suriname have representation of the female population specifically as the rest of the countries are represented by collective groups, Non-Governmental Organisations, networks of affected persons or sectors.

As a consequence, it does not reflect the specific needs of women who are mainly linked to sexual and reproductive health, gender-based violence and human rights.

In the case of sexual and transgender workers, the study demonstrated that in the last two years there has been a significant increase in participation although it is still not sufficient enough.

This increase is due, in part, to the recommendations of the Global Fund to include vulnerable populations in the CCMs and primarily the strengthening of organisations at a national level and joint advocacy carried out by the regional networks.

Amongst the barriers identified by the study, the lack of epidemiological data was highlighted as well as the difficulty in understanding how the Global Fund and its mechanisms operate and the lack of an agenda that represents the specific needs of the sector. The demand of legal entities to form a part of some CCMs is usually an obstacle as well.

Creating flexibility in the statutes of the CCMs and opening the assemblies, ensuring effective participation of all sectors, developing participative processes, maintaining the leadership of the networks and facilitating understanding of the mechanisms were some of the recommendations that were outlined in the study.

In conclusion, the capacities of the movements must be strengthened and national and regional networks need to succeed in establishing the specific needs and actual situations that affect women on the agendas on the CCMs. This is an important challenge that the CCMs in all regions will face.

By Alejandra Ruffo and Mirta Ruiz
Key Correspondent Team – Asuncion, 10/12/09