“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

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

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

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