Brief on Key Takeaways from 50th Board Meeting in Geneva

By Bryn Gay | December 14, 2023

Download 50th Board Meeting Key Takeaways Brief

 

Key Takeaways

This brief compiles the positions and reflections shared by the Developed Country NGO Delegation and does not represent the views held by the Global Fund Secretariat or the Global Fund Board.

 

Introduction

The Developed Country NGO Delegation (DevDel) attended the 50th Global Fund Board meeting from 14-16 November 2023 in Geneva, Switzerland.

The Global Fund met against the backdrop of intersecting crises – from intensifying effects of climate change to financial austerity to escalating conflicts to threats to gender equality, LGBTQIA+ and migrant communities, and shrinking civil society space – that could jeopardize the gains made in HIV, tuberculosis, and malaria, despite the service delivery interruptions during Covid-19. Prior to the board meeting, our delegation joined the civil society and community delegations in expressing concern over the deteriorating human rights for LGBTQIA+ communities in Uganda and other countries and the exclusion of men who have sex with men and transgender community representatives from the Kyrgyzstan Country Coordinating Mechanism (CCM), which we have flagged as violating Global Fund principles and CCM eligibility criteria.

The decision points taken at this meeting regarding increasing malaria program risk to ‘very high’; the updated blended finance approach; the updated quality assurance policy; and approval of the 2024 corporate work plan and operating expenses budget can be accessed by following this link.

Notably, Luxembourg announced a new contribution of €750,000, bringing their total pledge for the 2023-2025 period to €15.45 million, which is a 70% increase over their previous contribution. Following the 50th Board meeting, Ireland matched Luxembourg and pledged an additional €750,000, raising Ireland’s total contribution to €65.75 million for the three-year period.

 

The Board Agenda

The first day focused on the progress and observations of grant-making under the Global Fund Grant Cycle 7 and took a different approach by providing constituencies with thematic, guiding questions to frame the discussions. The board agenda across the three days included discussions on key themes arising from the Annual Report on Community, Rights and Gender; Resilient and Sustainable Systems for Health, Pandemic Preparedness and Response, and the Covid-19 Response Mechanism; Co-Financing; the implementation of the Global Fund’s market shaping strategy for rolling out new health products and technologies (such as dual active ingredient long-lasting bed nets and malaria vaccines); climate and health; CCM; and resource mobilization.

 

Key Issues Discussed

The Developed (DevDel), Developing Country NGO, and Communities Delegations fostered renewed collaborations during joint pre-meetings to align positions on four key areas, in no particular order, as they intersect and can be integrated in funding requests and during grant implementation:

  1. Human Rights

Key populations bear a double brunt of the global anti-rights movements attacks and increasing HIV burden. As we know, 95% of all new HIV cases in countries outside of non-Mediterranean Africa are among key populations and our sexual partners. Key populations have disproportionately low access to HIV treatment. We must continue working on stigma and discrimination as well as legal reforms – and ensure there are dedicated funds for human rights interventions. We asked how we can use investments to track anti-homosexuality laws before they are enacted, and to equip communities most at risk. Acting now in countries at risk of implementing these laws and investing in affected communities to prepare would go far in saving lives in the future.

We recommended a situation room to look more closely at if and how safety and security measures are being integrated into country allocations. We raised questions about the process related to flexibilities, grant waivers, and exceptions in emergencies, including emerging conflict settings.

While supporting the development and use of digital technologies in our programs, we are concerned with issues related to data, including the management of sensitive data and the misuse of community data which can and does lead to human rights violations. We called on the Global Fund to conduct a deep dive on digitalization, including advancing human rights, gender and equity, risk, and climate mitigation. 

  1. Malaria and Climate Change

There are currently humanitarian crises in 37 malaria-endemic countries and the situation is deteriorating in several countries. We need more flexibilities and innovative approaches in those challenging operating environments to ensure all populations, including migrants and displaced populations, have access to malaria interventions.

We urged the Secretariat and Partnership to:

    • Coordinate efforts to mobilize additional funds;
    • Ensure that communities and civil society are involved in prioritization of interventions and identification of malaria risk mitigation strategies;
    • Prioritize the role of community healthcare workers and strong community systems, to generate demand in the uptake and implementation of the latest tools and achieve the final stretch in malaria elimination; and
    • Accommodate funding flexibility and innovative approaches for challenging operating environments.
  1. Funding for Mobilization Efforts by Affected Communities

Multi-country funding for key populations and meeting the most vulnerable needs must be informed by affected communities and people with lived experience in that region. The allocation amount that is provided must respond to the needs of the region and go to countries facing the greatest funding gaps.

We are pleased to see community-led monitoring, or CLM, being rolled out in Global Fund programs. However, we expect that the essence of CLM is not ignored – those are activities designed, delivered, and analyzed by communities themselves, and not other players. We encouraged making distinctions between community-led organizations (CLOs) and community-based organizations (CBOs), and to understand the funding levels to CLOs. We recognized that strengthening the organizational capacities of Project Management Units to be able to contract and manage community-led organizations will be critical – but there’s also an urgent need to update policies, clarify flexibilities available, and to be fully transparent from the beginning of this grant cycle about the risk tradeoffs and regulatory flexibilities to be able to effectively move forward with the right implementation arrangements.

  1. Strengthening Country Coordination Mechanisms

DevDel generally supports a Communities’ delegation proposal for creating a CCM Advisory Group, which, in our view, could be linked to the Grants Management Division and CCM Hub. In addition, with the number and complexity of issues that come to the Strategy Committee, and as described in the Report of the Coordinating Group, our delegation supports additional discussions about the details of a CCM Advisory Group and continues to urge that the Ethics and Governance Committee (EGC) assume the full CCM mandate, which is to ensure the broad inclusion and quality participation of civil society and affected communities. We also supported the CCM Evolution Initiative to be mainstreamed into the operations of the Secretariat. We also joined the request to ensure and increase youth representation at CCMs across the Global Fund portfolio.

 

Additional DevDel Priorities 

  1. Communities Annex

We advocated for enforcing and instilling further levers, oversight mechanisms, and follow up of the Communities Annex and minimum standards on community engagement. The Communities Annex is a new requirement for Grant Cycle 7 funding requests that captures civil society and affected communities’ priorities during country consultation processes led by the CCM.  We recommended greater use and full access by the Technical Review Panel to use the Community Annex. We called for community engagement processes to be strengthened by front-loading the necessary funding in GC7 for better community involvement and advocacy.

  1. Blended Financing

We supported the proposed operational Framework for blended financing, which could help embed HIV, tuberculosis, and malaria and resilient and sustainable systems for health interventions in broader health sector investments and under Universal Health Coverage. Success on blended finance requires a structured approach with policy clarity for all teams involved; agile decision-making process at the Secretariat level; and oversight by the Board through the Audit and Finance Committee.

  1. Sustainability, Transition and Co-Financing (STC) Policy Review

We co-signed to review the Global Fund STC policy in 2024 for its aims to enhance domestic funding for key and vulnerable populations and human rights interventions to increase the sustainability of services, and to enhance the domestic budgets to remunerate community health workers and volunteers and financially sustain outreach interventions. We supported a review of the STC policy, which we advocate as requiring oversight by all three Global Fund Committees, and which we view as separate from other reforms to global health initiatives.

  1. Meaningful Participation and Inclusion in Any Future of Global Health Initiatives (FGHI)

We strongly encouraged all delegations who would convene or participate in the ongoing work of FGHI, reforms to the Global Fund or other global health initiatives, projects or conversations to ensure that there is meaningful participation and inclusion of communities and civil society from the outset.

 

Follow Up Actions To:

 Global Fund Partnership

  • Regarding the updated Quality Assurance policy, in support of countries transitioning to WHO Listing Authority (WLA), engage communities and civil society in monitoring national procurement processes for transparency and equitable access. We requested follow up technical sessions on the updates to WHO prequalification and WLA.
  • Conduct a deep dive on the collection, management, and storage of community data by other stakeholders, which poses threats to key and vulnerable populations and affected communities.
  • The poor pediatric HIV and TB indicators require stronger approaches for children across the three diseases. We call for targeted interventions and improved coordination to address the alarming shortfall in prevention-of-mother-to-child transmission coverage and people living with HIV who started TB Preventive Treatment (TPT), while noting that TPT coverage for children under 5 and their household contacts remains a cause for concern in TB programs.

Secretariat

  • Greater use of the Communities Annex and minimum standards on community engagement by the Technical Review Panel.
  • Create a CCM Advisory Group, which could be linked to the Grants Management Division and CCM Hub.
  • Fund the implementation of the Advocacy Roadmap to ensure that affected communities and civil society are engaged with the replenishment process in-between cycles and adequately supported for mobilizing domestic resources.
  • Review the Global Fund STC policy in 2024, with oversight by all three Global Fund Committees.
  • Considering the range of underfunded Global Fund priorities, provide additional clarity on (1) which sources of funds are being used when blended finance opportunities arise, and (2) how blended finance opportunities are weighed against other priorities that would value from additional resources.
  • Obtain further details on the 15% of total in-country budget allocations for Country Coordinating Mechanisms in order to understand how to integrate direct funding for affected communities, including community-led and community-based organizations.
  • DevDel joined other delegations’ observations regarding the 40% increase in set-asides between the 6th and 7th funding replenishments and requested more information about the analysis that the Secretariat had done on the impact of set-asides on potential future replenishment outcomes.

Both the Secretariat and Broader Partnership

  • Accommodate funding flexibility and innovative approaches for malaria interventions in humanitarian crises and other challenging operating environments.
  • Convene a situation room to look more closely at if and how safety and security measures are being integrated into country allocations.
  • Emphasizing the importance of staff health and wellness, we supported the Staff Council to talk directly to the Board and its Audit and Finance Committee, rather than only submitting written reports.
  • Provide additional information on the specific actions to raise new resources to maximize the United States’ matching pledge.
  • With the approval of the updated Quality Assurance policy, share the plan and timeline to ensure that principal grant recipients, supported by national regulatory authorities, have the capacity for implementing market surveillance activities for all pharmaceuticals and medical devices. Request follow up discussions to talk through the decision and its implications for the wider international community and relevant stakeholders.

 

Next Steps

  • Further discussion on whether to add Board representation;
  • Continued monitoring and engagement of FGHI dialogues;
  • 51st Board Meeting to be held 22-24 April 2024 in Geneva, Switzerland.

 

Outgoing Leadership

The Global Fund acknowledged the outgoing leadership of Kate Thomson, and welcomed Vuyiseka Dubula, as incoming Head of the Community, Rights and Gender Department.

 

About the Developed Country NGO Delegation

The Developed Country NGO Delegation is one of twenty voting delegations to the Global Fund Board. It plays a critical role in the development and evolution of organizational strategy, the funding model, the work of the Secretariat and policy. Delegation members are representatives of civil society organizations based in countries not eligible for the Global Fund grants. For more details on the Delegation, please visit our website, www.developedngo.org and on the Global Fund, please visit www.theglobalfund.org.

For more information, please contact Ms. Bryn Gay, DevDel Constituency Focal Point.

 

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