“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

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

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