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

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 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

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