“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

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

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

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