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

A win-win situation: The role of the private sector

Through role-playing, the members of the Country Coordinating Mechanisms analysed the potential strategies to be developed by guaranteeing the inclusion of the private sector in the proposals.

Inform, raise awareness and avoid confrontation. These were some of the conclusions that were drawn from different work groups that participated in role-playing whose objective was to analyse the possibilities of including the private sector in the Country Coordinating Mechanisms.

In addition to demonstrating the most common mistakes made when looking at this sector, this role-playing helped to challenge certain stereotypes as each participant had to represent a sector other than the one they embodied on a daily basis.

These are some of the proposals that came out of this exercise:

- Businesses need to be informed about the work of the Global Fund, its operation, the role of the CCMs and how the projects are funded.

- It is also important to demonstrate to the representatives of the sector the advantages their business would obtain if it decides to participate in the mechanism.

- Train and raise awareness in the business but also train and raise awareness in the CCM members so that they do not approach the private sector with prejudices for the purpose of avoiding confrontation and acting with diplomacy.

- The proposals being looked at must be clear, concise and contain exact information.

- The exercise demonstrated that many times there are no clear proposals for the private sector and that, in many cases, proper communication does not exist with the representatives of the businesses. It is necessary to understand that the private sector can be added in different ways into the proposals whether through the donation of resources or as an executor of subsidies as well as a provider of goods and services and even as a CCM member.

Furthermore, technical assistance and promoting prevention and de-stigmatisation policies can be offered in the workplaces.

Therefore, it is important to work on the possibilities to incorporate this sector and to do it responsibly. Hence, it is necessary to select the CCM members who are the most capable of achieving this activity, demonstrate to them the impact that the Global Fund has on the HIV/AIDS epidemic and guide them through the positive techniques that many networks and organisation are already carrying out.

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

Can we see the forest for the trees?

Concluding the second day of the regional meeting, some participants felt the recommendations were advancing and promoted dialogue while others felt old ideas and rhetoric were being repeated that did not necessarily result in changes and improvement.

The Executive Director of the Global Fund, Michel Kazatchkine, held a series of meetings with the different sectors in which he shared a Global Fund analysis as well as the CCMs that were very interesting from a conceptual and policy-making perspective.

“The Global Fund and its governing mechanisms (national and world-wide) put forward a concept of “Health Democracy”. A new paradigm in public health that has a plan to overcome traditional hygienist policies which are authority-based and with a slanted viewpoint” maintained Kazatchkine.

“The actual response to HIV/AIDS, Tuberculosis and Malaria require optimistic plans that promote collective responsibility and true participation by all sectors involved in the problem” he affirmed.

For political and cultural change to occur, which requires great thought into the types of governmental programmes and the national responses, it appears to necessitate different deadlines according to the urgency of these diseases.

Some of the great challenges that have existed from the minute Global Fund was founded still subsist as the years go by accompanied by a sense of frustration in both the governmental public sector as well as in civil society.

There have been strides made in terms of participation and appropriation in the countries, but there are serious bottlenecks at the time progress needs to take place for questions related to the importance of harmonisation, the need for performance supervision and communicating the advances and the results.

This has particular relevance at this time in which there are trends that question the effectiveness of international support, the exceptionability of these diseases and the need to concentrate efforts in order to quickly prevent them and treat them.

Much energy has been invested in topics related to “power”, institutional power or economic power, losing the focus on the need to more effectively coordinate the forces so that “powerful” change and improvement can occur.

Eight years ago, the international community came to the conclusion that more technical and financial resources were required in order to respond to AIDS, TB and Malaria. Comparatively speaking, the countries currently have better access to these resources which has brought to light that covering these needs was only a part of the solution.

There are still many critical areas to expose with the majority being found within the national scope. The urgency to save lives and mitigate the impact of the diseases persist. However, pressure is now added to this in order to demonstrate that we still need a great commitment from the international community to revert the impact of the epidemics. In this way, funding the efforts can continue so that health-related millennium goals can be met.

Without getting caught up in metaphors related with climatic change, it appears that we could be lost in a forest of how to find a solution to effective multisectoral participation in the Global Fund's Country Coordinating Mechanism, losing sight that perhaps we are dealing with only one tree in another large forest in which it is much more difficult to find our way out.

By Javier Hourcade Bellocq
Key Correspondent Team – Asuncion, 9/12/09

Recommendations for multisectoral participation

Representatives from all over the region debated and drafted proposals to guarantee maximum participation and representation for all sectors in the CCMs.

The participants in the South American Regional Meeting of the Country Coordinating Mechanisms and the Regional Coordinating Mechanisms participated in an exercise in which a debate took place on the need for inclusion, participation and representation of all the sectors in the CCMs. The groups prepared proposals and action plans to achieve advances against these obstacles.

Selection of CCM members from the non-governmental sector

The CCM members acknowledged three common problems: A lack of rotation, a lack of representation and the existence of necessary but poorly organised sectors. To resolve these problems, they proposed to apply existing policies and they comply with the election process every two years and with only one mandate extension.

They also suggested that the balance between Civil Society and Government be maintained and that it works in response to the agendas of the sectors and not according to persons or institutions. Lastly, they recognised that s common effort needs to be made in order to guarantee the participation of the less-organised sectors with the support of international cooperation.

Roles and responsibilities of the different sectors in CCM operations

The participants concluded there was a need for capacity building in order to fulfil the roles of the participants. Hence, a greater commitment is needed from the members, the policy-making role of the CCM needs to be boosted and dialogue and advocacy needs to be put into writing in order to prepare national strategies.

They also considered it important to ensure that all sectors participate from the beginning of the proposal preparation and to avoid fragmentation.

Active representation by the CCM members of the interests of the sector they represent

In this last point, the participants identified three precise challenges: Capacity building, achieving effective communication and including baselines in the preparation of the proposals. In the presentation of their conclusions, the group stated that it is fundamental to “strengthen the capacities of each member so that they can effectively participate and represent their sectors”.

To achieve this, they suggested, amongst other action plans, preparing a Web page which includes all the information about the CCM.

The conclusions of all the teams demonstrated that the theory was clear. The problems are identified and there are effective proposals to resolve them. Now, all that remains is to put them into practice to see if they can successfully overcome the conflicts and the differences so that these ideas can truly come into fruition.

By Alejandra Ruffo
Key Correspondent Team – Asuncion, 9/12/09

Contribution of regional networks in CCM

Representatives from different regional networks gave their opinion on the participation of key populations in the CCMs.

The Latin American and Caribbean Network of Women Sex Workers (Redtrasex), the International Community of Positive Women (ICW), the Latin American and Caribbean Network of Transgender Persons (Redlactrans), the Association of Men Having Sex with Men (ASICAL) and the Latin American and Caribbean Network of Organisations with HIV/AIDS Services (LACCASO); noted a greater participation and inclusion of diverse populations within the Country Coordinating Mechanisms.

“There are prejudices surrounding women sex workers for managing large sums of money”, complained Elena Reynaga of Redtrasex who stated that if there were actually women sex workers in the CCMs, it was because Redtrasex trained women so they could participate.

In turn, Arely Cano, Secretary General of the Latin ICW, maintained: The CCM must allow women to participate and not just by sitting quietly in a chair, but rather by allowing their voices to be heard. In addition he added that one of the challenges is also “to allow the voices of women living with HIV/AIDS to be heard in the different venues".

Marcela Romero, Regional Coordinator of the RedLacTrans, mentioned that the inclusion of the trans populations in the CCMs was an important milestone as their needs and problems are very different from the other populations. “We would like to take our rightful place in order to have access to prevention, universal access and human rights” demanded Romero.

Finally, Orlando Montoya, General Coordinator of ASICAL stated that it was “very difficult to ensure that all the needs are represented" and acknowledged that the networks are part of a very important tool".

All these testimonies are a sample of the work carried out by the networks in order to have a place in the different CCMs, although they also demonstrate that though the participation has increase, there is still not sufficient numbers to provide an effective and organised regional response to the problem of HIV/AIDS.

By Mirta Ruiz
Key Correspondent Team – Asuncion, 9/12/09

Global Fund ED visits Paraguay

Michel Kazatchkine, Executive Director of the Global Fund, travelled to Paraguay to attend the regional meeting and sign a new agreement for €3.5 million in order to fund HIV/AIDS programmes.

Amongst many acknowledgements of gratitude and providing a balance of the Global Fund in the region, its Executive Director, Professor Michel Kazatchkine, participated in a round of questions and answers with the participants at the Regional Meeting.

Following the presentation he met with Paraguay’s Minster of Health, Esperanza Martinez, to sign a new agreement for €3.5 million that is designated to fund programmes for prevention, diagnosing and treatment of HIV/AIDS.

“We have seen an extraordinary change in terms of health world-wide. The key factor was understanding the unacceptable gaps between the North and South countries”, stated Kazatchkine at the beginning of his presentation, in which he gave an analysis of the panorama in the region related to HIV/AIDS, tuberculosis and malaria.

In his analysis he said that 2010 “will be an absolutely critical year” as in addition to presenting the new structure, it will be a year of transition in which the Global Fund will become an autonomous institution. In reference to these changes Kazatchkine assured that the CCMs will occupy a very important place in advocacy.

“Five of the eight Millennium Development Goals are directly or indirectly related to health”, he maintained and assured that currently the Global Fund "has become the most important global funder" in terms of health.

“The model is very attractive because of its pillars and you are the ones who implement your proposals”, he explained. Thus, he persistently asked the representatives from the CCMs to make a commitment to successfully achieve the goals. “Keep working, manifesting, expressing your needs and be an advocate. The Global Fund is making a difference and this saves lives. And the Global Fund is you”, he expressed.

In the signing of the agreement with Paraguay, Kazatchkine insisted on a request for greater commitment from the regional CCMs in order to successfully reach the millennium goals linked to health: “With this signing, I have no doubts that the millennium objectives will be achieved by Paraguay. And they must be achieved for all countries in all of Latin America because they have potential”.

By Alejandra Ruffo
Key Correspondents Team – Asuncion, 9/12/09

The Global Fund and Paraguay sign a new agreement

The Global Fund pledges €3.5 million for the prevention, diagnosis and treatment of HIV and AIDS in Paraguay.

The Global Fund to fight AIDS, Tuberculosis and Malaria and the Centre for Information and Resource Development signed an agreement today for €3.5 million over two years to support HIV and AIDS programmes.

This grant will allow Paraguay to increase its care and treatment interventions for persons living with HIV in six of its health regions.

“I am pleased to be joined by Dr. Agustin Carrizosa, Executive Director of the CIRD to sign Paraguay’s Round 8 agreement with the Global Fund,” said Professor Michel Kazatchkine, Executive Director of the Global Fund, who travelled to Asuncion to attend the Regional Meeting of the Global Fund and to sign the agreement with Paraguay.

“This agreement reflects the strengths of Paraguay to expand access to HIV and AIDS prevention and treatment and their continued efforts to fight against this epidemic,” he added.

Paraguay is a country of 6 million inhabitants, in which 21,000 are living with HIV/AIDS. Its HIV prevalence rate is 0.6 percent. Paraguay has another grant from the Global Fund that began in 2007 and that successfully provided ARV treatment to 1,857 persons.

The grant that was signed today is for a total of €12 million over five years and will be implemented by the CIRD Foundation. The programmes supported by the Global Fund and covered by this grant will include treatment services for HIV and AIDS, treatment for Sexually Transmitted Infections, Information on Behaviour Changes, an increase in community-based participation in the national response, amongst others.

Currently, the Global Fund has approved grants for $16.1 million world-wide in 140 countries since its creation in 2002. The Global Fund actually provides one fourth of all international funding for AIDS as well as two-thirds of the funding for tuberculosis and malaria.

The Global Fund supports programmes that provide services to hundreds of millions of people. As a result, more than 4 million lives have been saved to date all over the world. 3,000 deaths have been prevented every day. The general results of the programmes supported by the Global Fund world-wide include:

· 2.3 million people currently under antiretroviral treatment (ARV)
· 5.4 million people currently under effective treatment against tuberculosis
· 88 insecticide treated nets distributed to protect families against malaria
· 79 million people who were provided with HIV counselling and who underwent HIV testing
· 537,000 seropositive pregnant women who were provided prophylaxis treatment to prevent Mother-to-Child Transmission of HIV
· 110 million people who were provided with community-based information services
· 3.7 million orphans who received basic support

Global Fund press release
Key Correspondents Team – Asuncion, 9/12/09

The new structure of the Global Fund

David Kim, of the Global Fund’s Strategy Team, gave a presentation on the new organisational structure that will be implemented from 2010.

The Global Fund presented its new structure for 2010 on the first day of the Latin American Regional Meeting of the Country Coordinating Mechanisms.

“The new structure will work on harmonisation, alignment and the secretariat. This will give the CCMs a major role, strengthening and helping them in their governance and management” explained David Kim, of the Global Fund’s Strategy Team.

The Global Fund structure currently in force was designed at the time of its creation and has continued improving over time. “This structure has favoured the achievement of impressive results”, acknowledged Kim.

The new structure is going to introduce simpler formats for the purpose of encouraging and facilitating information that the preceding rounds already had in the approved proposals. In addition, there will be two calls for proposals per year and each country can choose when they would like to present their proposal.

“We are hopeful that there will be more money for the Country Coordinating Mechanisms", mentioned Kim, who also added, in reference to performance management, that there needs to be more programmatic supervision in each country.

The new structure will be launched in May 2010 with new requests and in 2011 periodic supervision is going to be introduced.

By Mirta Ruiz
Key Correspondents Team – Asuncion, 8/12/09

The challenges of multisectoral coordination

At the Regional CCM Meeting of the Global Fund, work groups were created to prepare a series of recommendations for the purpose of successfully meeting challenges that the CCMs are confronting. We present a few of them.

Conflict of interest

Conflict of Interest is defined as a conflict a CCM/RCM member must face when he has a personal or institutional interest resulting in a discussion or decision on this mechanism. For example, when the CCMs select the Principal Recipients and Sub-Recipients who implement the programmes or the supervision or the development of the programmes, amongst others.

The specific recommendations of the work group are to create an external ethics committee (selected and assigned by the CCM) or a mixed committee (with members also from this same mechanism).

In any coordinating mechanism or governing board, it is inevitable that at one time or another a conflict of interest will arise, however, this decision-making area must have active policies and concrete measures to resolve these conflicts.

It would be difficult in many of our countries to have a CCM without the membership of key organisations that are also potential Sub-Recipients. For this reason, it is fundamental to strive for practical solutions to these central ethical issues.

Harmonisation and Alignment

Since its creation, the Global Fund is an organisation that provides additional resources for national responses to the three diseases. However, in practice many Global Fund programmes become projects that are not aligned with the already existing programmes.

The group determined the need to leave rhetoric behind and move forward with implementation, thus the national response must be only one response and it must be multisectoral.

The Global Fund is now involved in the implementation of a new structure which includes, as a policy, that the countries may only request resources to fund National Strategies. This measure is, in some way, a reflection of the attempts at harmonisation that were not successful enough, not only in the countries but amongst the community of the donor countries.

The concerns of civil society are the validity and relevance of the National Strategic Programmes (those that require an in-depth review) and the participation of the NGOs, the most vulnerable populations and the communities in this new structure.

The Global Fund has existed for many years now and some countries in the region have been funded since the first round. However, there is still confusion and incertitude about the role of the CCMs accompanied by few practical responses to the challenges of communication and conflict of interest which, in many cases, cast a doubt on the legitimacy of these mechanisms.

Hopefully, this regional meeting whose focus is to strengthen the mechanisms, will be an opportunity to overcome some of these challenges and improve the effectiveness and efficacy of the resources that Global Fund invests.

By Alejandra Ruffo and Javier Hourcade Bellocq
Key Correspondents Team – Asuncion, 8/12/09

Presentation of the Friends of the Global Fund LAC

On 8 December 2009, the new phase of the Friends of the Global Fund Latin America and the Caribbean was presented within the scope of the Regional Meeting of CCMs and RCMs of the Global Fund’s fight against AIDS, Tuberculosis and Malaria.

Friends of the Global Fund Latin American and the Caribbean (LAC) are part of the network of 8 organisations, which in regions and countries that are developed or currently being develop, fulfil the role of being ambassadors of the Fund.

These independent entities have been created to increase knowledge, visibility and awareness about the three diseases and the Global Fund, and to carry out policy advocacy with the decision-makers in the public and private sector so that they can lend their political and financial support.

The Friends of the Global Fund Latin America and the Caribbean will be particularly centred on:

· Mobilising political, strategic and financial support for the fight against the three diseases in the region.
· Increasing understanding and support for the Global Fund.
· The main activities will be political advocacy, raising awareness campaigns, working with mass media, education about the Global Fund and research in terms of searching for more and better evidence about the three diseases.

Javier Hourcade Bellocq, Director of the Friends of Global Fund explained: "We would like to promote more significant participation by the governments, the private sector, educational institutions and civil society in all structures of the Global Fund. For example, within national, regional and international frameworks”.

He also went into detail about one of the great challenges in the region: “A higher profile of the region is needed on a world-wide basis and on the agenda of the donors. Hence, we must provide better evidence about the concentrated epidemics and demonstrate that if in one of our countries, we have a prevalence of 20 or 35% in a specific population, we are being severely battered by the epidemic”.

In terms of the role of civil society, he added: “There is a lot of work to be done by organised Civil Society on the response to HIV/AIDS, we still need to successfully mobilise the communities around the response to Tuberculosis and Malaria. It is difficult but it can be achieved”.

Javier Hourcade Bellocq recently left the Global Fund’s Governing Board where he represented the Communities of Persons living with HIV, TB and affected by Malaria and he is currently a regional representative for Latin American and the Caribbean in the International Alliance. The International Alliance shelters the Friends of the Global Fund.

The Friends of the Global Fund was formed in the International Conference on AIDS in Mexico in 2008 and was based in Columbia. This year, it was transferred to a new group of people who formed a team based in the city of Buenos Aires.

For more information: jhourcade@aidsalliance.org

Key Correspondents Team – Asuncion, 8/12/09

Principles of the CCMs: Advancements and challenges

Representatives of the Global Fund gave a presentation on the general concepts of the CCMs where they spoke about the achievements and the points that need to be improved upon in order to work more effectively.

In the second session of the Latin American Regional Meeting for the Country Coordinating Mechanisms and the Regional Coordinating Mechanisms, David Winters and Katherine Owen, from the CCM Team of the Secretariat, gave a presentation on the general concept and principles of these elements. Both of them were in agreement about one recommendation: “There must be more transparency in activities”.

“There is a need for greater transparency in the selection of the CCM members so that their representation will be more meaningful. People should represent sectors and not organisations”, affirmed Owen in his presentation. Along the same line, David Winters added: “Those closer to the problem need to be participating in the solution”.

During the session, the orators explained how the CCM works and gave actual statistics on its composition. Some populations, such as women and transgenders, have successfully obtained a greater presence, although statistics show that men represent the majority of the percentage and occupy more presidential posts.

“With our collective efforts and funding, resources are being mobilised, lives are being saved and the prevalence rate for AIDS, tuberculosis and malaria are decreasing. The challenge for our Board of Directors is that people are not presenting projects as opposed to national programmes", explained Winters.

For his part, Owens emphasised the importance of fulfilling the role of supervision: “If proper supervision is not carried out, an opportunity to find solutions, to improve the implementation of the proposals and to have effective Principal Recipients is lost”, he pointed out.

Finally, they mentioned the importance of not converting the CCMs into private closed groups: “Those who are not members should be invited. This is good for transparency so that the work we are doing can be seen. CCMs are not private, exclusive clubs or groups that make decisions for others", advised Williams.

“We have to leave our comfort zone where we are accustomed to working with members and certain areas of government. We need to broaden our horizons”, added Owen.

After the presentations, work groups were formed to analyse the role of the CCMs, the issues of Conflict of Interest, Harmonisation, Coordination and the work between the Secretariats. Further information on the basic structures of the Fund can be found here.

By Mirta Ruiz and Alejandra Ruffo
Key Correspondents Team – Asuncion, 8/12/09

LAC Regional Meeting of the Global Fund begins

Esperanza Martinez, Paraguay’s Minister of Health, and Lelio Marmora, Head of the Global Fund’s Regional Team for Latin America and the Caribbean, participated in the call to order of the meeting, which took place in Asuncion.

“Health policies cannot be made starting with guidelines given by a Minister. Permanent on-going interaction is necessary”, stated Paraguay’s Minister of Health, Esperanza Martinez, in the call to order of the Latin American Regional Meeting for the Country Coordinating Mechanisms and the Regional Coordinating Mechanisms. In addition, Lelio Marmora, Head of the Global Fund’s Regional Team of Latin America and the Caribbean, was in charge of the call to order.

Esperanza Martinez took the opportunity at the call to order to congratulate the Global Fund on implementing the Country Coordinating Mechanism in Latin American countries where they have already been operating for six years in the region. “We have six years of arduous work, lessons learned and political and technical maturity. We have learned by trial and error”, acknowledged Lelio Marmora.

“This meeting allows us to reassess in a favourable light international cooperation” affirmed the Minister of Health who is also the President of the CCM Paraguay. In turn, Marmora referred to the importance of organisation to fight against the current global economic crisis. “The international community is re-evaluating its investment in development, whether or not they should continue investing in AIDS, tuberculosis and malaria and whether or not they should continue investing at a multilateral level". In terms of this situation, she stated that Latin America is one of the regions that “suffers the most from this cutback”.


In the Meeting’s call to order the obstacles that must be overcome were also outlined in order to successfully achieve better performance by the CCMs. “We need strong systems, not strong people. Strong people who assume leadership are not sustainable”, maintained the representative of the Global Fund. And added: “Nowadays, the CCMs are an established reality and have earned their place. The day that we are no longer a part of the mechanism, the mechanism must continue functioning".


By Alejandra Ruffo
Key Correspondents Team – Asuncion, 8/12/09

The Corresponsales Clave Team in Asunción, Paraguay

Between 8 and 11 December, the City of Asunción in Paraguay hosted the Global Fund’s Regional Meeting of the Country Coordinating Mechanisms (CCMs) and the Regional Country Coordinating Mechanisms (RCMs) for the fight against AIDS, Tuberculosis and Malaria. The objective of the meeting is to strengthen these governing mechanisms of the national framework that are key cornerstones in the proper functioning of Global Fund grants.

The Global Fund is an organisation that collects and distributes additional resources for the fight against AIDS, Tuberculosis and Malaria in developing countries. Since its creation in 2002, it has signed subventions for 16.1 million dollars in 140 countries. The Global Fund grants funding based on performance and up to the funded date, all requests that are technically sound with interventions based on evidence.

One of its most relevant characteristics is its governing structure that faithfully responds to the approach of public and private association, recreating venues where decisions are made between government, civil society (particularly the most affected populations), agencies of the United Nations System, educational institutions and the private sector. This structure exists within the national framework (CCMs) and within the regional framework with a regional subvention (RCMs) whilst the highest governing body of the Global Fund is the World Board.

This initiative promotes programmes that will be developed, implemented and monitored by the countries. It is the CCMs that approve requests and monitor their programmes so they will be successful. It is for this reason that there are no Global Fund employees whatsoever in any country. The Fund is only responsible for channelling resources. The technical aspects fall on the shoulders of the Global Fund partners and in particular the Agencies of the United Nation System as well as the World Health Organisation and UNAIDS. There are also other strategic partners in the central countries such as the German Government’s Backup Initiative (GTZ) and a countless number of NGOs and initiatives.

There is a wide gap between theory and actual experience so since the creation of the CCMs, this has been more than one cause for concern. There is a wide-range of challenges in the CCMs mainly related to participation, good government, transparency and conflict of interest, amongst others. This event’s purpose is to unblock some of these bottlenecks pursuing the result of the stronger CCMs.

Amongst the different values that the Global Fund put forward when it was established, the three fundamental pillars are: significant multisectoral participation, local appropriation and alignment with national programmes. To achieve this, there must be consolidated CCMs where dialogue flows and where each sector can bring the perspective of its representatives in order to achieve effective and efficient programmes that will save more lives.

This meeting will cover CCMs/RCMs in Latin America. In 2010, similar events will be held in Central America and in the Caribbean. For more information on the Global Fund, visit its website at: www.theglobalfund.org/es/

Through this Blog, we can share with you the topics and the voices that will be heard in Asuncion.

By Javier Hourcade Bellocq
Key Correspondent Team – Buenos Aires, 5/12/09