Global Fund Advocates Network (GFAN) Global Strategy Meeting 2017 - 22-23 February 2017 Amsterdam, the Netherlands
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Global Fund Advocates Network (GFAN)
Global Strategy Meeting 2017
22-23 February 2017
Amsterdam, the Netherlands
www.globalfundadvocatesnetwork.org 1Introduction and Overview
On 22 and 23 February, the Global Fund Advocates Network (GFAN) came together
in the Lloyd Hotel in Amsterdam for their annual global strategy meeting. Few, if any,
seemed under the impression that 2017 will be an easy year to advance the Global
Fund (GF) agenda and mobilize the resources crucial to do so. On the contrary, many
expressed concern about the growing nationalist discourses and upcoming election
outcomes in a number of traditional donor countries and the current and future
impact of this tense political climate on Official Development Aid (ODA)
commitments. In response to these uncertainties and the changing discourse around
ODA and global solidarity, the key objective of the GFAN meeting was to collectively
unpack these challenges, concerns and obstacles, reflect on the efficacy of past and
current strategies and to brainstorm about what kind of advocacy approaches are
best attuned to the current context and most effective in promoting and
strengthening GF structures. The central goal of the meeting was to formulate
concrete opportunities and action plans to more effectively collaborate, as a
network, on innovative advocacy and fundraising strategies, using both existing and
new platforms, forums and tools.
Joanne Carter, the chair of the GFAN Steering Committee, captured the urgency of
this meeting during her opening remarks on Tuesday morning. In her comments, she
underscored that the dual priority for GFAN is to not only to develop concrete action
plans to make the implementation of replenishment a reality and identify new
opportunities for resource mobilization, but also to ensure that past gains are, in fact,
sustained. Her opening remarks were followed by a number of presentations that
illuminated how these priorities are affecting various GFAN topics, providing insight
into the impact of funding trends and GF policies on the three diseases, HIV/AIDS,
malaria and TB, in a variety of settings and locations. The topics varied widely,
ranging from the relevance of Universal Health Coverage (UHC) in relation to the GF;
new findings and opportunities in TB; the challenges of transitioning in Sustainability,
Transitioning and Co-Financing (STC) in Middle-Income Countries; innovative
financing and funding approaches to replenishment; the future of ODA and the
potential of investment discourses in resource mobilization; sexual and reproductive
health and rights; and new strategies to take GFAN advocacy to a next level through
a people-powered movement for health. During the Q&A sessions that followed the
presentations, GFAN members exchanged perspectives around these topics and
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2asked questions. These conversations continued on Wednesday afternoon, where
break-out groups took a selected presentation topic to a more practical level by
identifying major challenges and opportunities in that domain and formulating
specific action plans and opportunities to adequately respond to them.
Seeking a closer understanding of how different regions and countries deal with
current challenges, what kind of themes, goals and directions they prioritize in their
daily work and how GFAN can further improve its function as a support network,
participants had been asked, prior to the conference, to share their perspectives on
these issues in a country-survey. To stimulate regional collaboration, Tuesday's
break-out groups were organized per region. They offered GFAN members the
opportunity to reflect, as a region, on the state of their work and to formulate
opportunities, synergies, support needs and actions for 2017.
This report summarizes the key points of the presentations and presents an overview
of the outcomes of these discussions. It provides links to the full presentations,
located in an online Dropbox folder, and encloses copies of the break-out notes as
annexes. Given the non-permanent nature of the Dropbox folder, those interested in
keeping presentations for future reference are advised to download the documents.
Break-out notes are attached as annexes to this report.
At the closing of the meeting, Peter van Rooijen, the Director of ICSS, remarked that
the high engagement levels of GFAN members throughout the discussions and
presentations showcased the network's creativity, energy and dedication to health,
equality and global solidarity more broadly. At the same time, he said, the meeting
made clear that the network has a lot of work on its plate in 2017. The goal of the
meeting, as well as this report, is to help getting the job done. This paper is divided
into four sections. The first section offers a summary of the presentations and a link
to the full presentations. Highlights of the discussions, that followed these
presentations, are captured in the second section. Drawing on the break-out groups
and annual survey outcomes, the third section maps GFAN challenges and
opportunities for various regions and countries. The final section captures the
outcomes of Wednesday's topical break out groups, providing perspectives,
initiatives and commitments made by different groups on how to take GFAN
advocacy to the next level in 2017.
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3Table of Contents
Introduction and Overview .............................................................................................. 2
Presentations ....................................................................................................................... 6
Universal Health Coverage and the Global Fund ................................................................. 6
TB: New Findings, New Advocacy Opportunities and Potential Synergies ................... 7
Sustainability Transitions and Co-Financing in Middle-Income Countries ..................... 8
Replenishing the Global Fund: Looking Back, Looking Forward ....................................... 8
The Future of ODA: International Public Investment and the Future of the Global
Fund ............................................................................................................................................... 9
Taking GFAN to a Next Level? .............................................................................................. 10
SRHR and Global Fund Resource Mobilization ................................................................. 10
Discussion Highlights ....................................................................................................... 11
Mapping GFAN Challenges and Opportunities .......................................................... 14
Global ......................................................................................................................................... 14
Regional & National ................................................................................................................. 16
Africa....................................................................................................................................... 16
Asia-Pacific............................................................................................................................. 18
Australia ................................................................................................................................. 19
Nordic Countries .................................................................................................................... 21
U.S.A........................................................................................................................................ 24
Canada.................................................................................................................................... 25
Latin American and Jamaica ................................................................................................ 26
Taking GFAN Advocacy to The Next Level: Ideas, Actions and Commitments .. 27
G20 / G7 (Including FTT) Advocacy..................................................................................... 28
UHC Advocacy ......................................................................................................................... 29
Sustainability, Transition, and Co-Financing (STC) Advocacy ........................................ 31
HIV-TB Advocacy .................................................................................................................... 34
Action Items ....................................................................................................................... 36
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4Annexes .............................................................................................................................. 39
Annex 1. List of Participants .................................................................................................. 39
Annex 2. Break-out notes Africa .......................................................................................... 42
Annex 3. Break-out notes Asia Pacific ................................................................................ 45
Annex 4. Break-out notes Nordic Countries ...................................................................... 49
Annex 5. Break-out notes U.S.A ........................................................................................... 52
Annex 6. Break-out notes Canada........................................................................................ 53
Annex 7. Break-out notes Latin America and the Caribbean ......................................... 54
Annex 8. Break-out notes G20 / G7 Advocacy ................................................................. 55
Annex 9. Break-out notes Universal Health Care ............................................................. 58
Annex 10. Break-out notes STC Advocacy ........................................................................ 61
Annex 11. Break-out notes on HIV / TB............................................................................. 67
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5Presentations
Universal Health Coverage and the Global Fund
Bruno Rivalan, from the French Office of Global Health Advocates, discussed the
relevance of Universal Health Coverage (UHC) in relation to GFAN. In his
presentation, Bruno:
✓ Identified key factors that drive the momentum of UHC: 100 million pushed
into poverty because seeking care; 400 million still lack basic health services;
growing evidence about the need to support health systems, manifested by
Ebola and Zika.
✓ Identified key initiatives, trends and institutions around UHC, including 1)
pledges made by more than 100 countries since 2012 on UHC, 2) the launch
of the UHC2030 process, a multi-stakeholder platform to strengthen
collaboration to achieve UHC, 3) growing discussions on measuring UHC, 4)
the Framework to Accelerate Universal Health Coverage in Africa ($24 billion
commitment by WB and GF), 5) the UHC Monitoring Portal
✓ Gave the following examples of recent UHC-related CSO advocacy: 1)
national level coalitions, regional work -GFAN AP, 2) advocacy on SDG
indicators 3.8, 2.4, and 3) ensuring a strong CSO constituency in UHC2030.
✓ Pointed out that GFAN has to be opportunistic about this trend, because
UHC resonates with both donors and citizens and offers opportunities for
coalitions at different levels and, by emphasizing quality of care, can
strengthen GFAN's role in identifying where people are not receiving care.
✓ Argued that the relevance for GFAN in this area lies mostly in policy shaping
of UHC design; domestic resource mobilization; accountability to ensure
delivery of pledges; and, adequate framework for sustainability and
transition.
✓ Responded to a question on coalition case studies (and the wish for useful
examples) by suggesting that, while country particularities always differ,
Ghana may serve as an interesting case, because of the success of Ghanaian
civil society groups - from tax justice to maternal and child health groups - to
exert pressure on the government for a more progressive domestic resource
mobilization system.
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6✓ Watch and download the full presentation on Engaging in the UHC
discussion - Relevant for GFAN? Presentation and the background paper on
the topic here.
TB: New Findings, New Advocacy Opportunities and Potential
Synergies
Greg Paton and Colleen Daniels from the Stop TB Partnership provided a timely
picture of the state of TB research and advocacy, linking recent trends and
developments in the field with challenges and opportunities for advocacy. As part of
their key insights, they:
✓ Argued that major challenges include 1) the increase in missing TB patients,
2) old diagnostics, 3) long toxic treatment regimes, 4) the fact that vaccines
don't work for everyone, 5) the shortcomings of one-size-fits-all approaches,
6) a lack of community engagement, 7) slow roll-out of new tools, 8) human
rights abuses and a lack of understanding of the disease, 9) the need to shift
from medicalized framing of TB toward a community-driven and community-
engaged approach, 10) the need to move away from pilots to scaling up, and
11) the need for more data for targeted action on the ground
✓ Noted that success requires novel drug combinations as well as community
awareness and a focused approach to find, prevent and treat TB better:
Strengthen, Find, Prevent.
✓ Discussed The Paradigm Shift – Stop TB’s Global Plan to End TB 2016-2020,
which focuses on people-centered targets around human rights, gender
based, inclusive leadership and community driven approaches.
✓ Explained that, driven by this shift toward human rights, key and vulnerable
populations, the Stop TB Partnership is developing various guides that help
countries find TB suffering populations, including prisoners, mobile people,
drug users and are also working to develop gender-focused assessment
resources.
✓ Expressed the desire to learn from HIV people on how to use major meetings
and conferences for action on the ground.
✓ Noted that GFAN is particularly interesting to the partnership as an
opportunity to learn lessons and experiences from HIV movement.
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7✓ Watch and download the full presentation on Bending the Curve - Stop TB
Partnership Presentation here and read more about the Step Up for TB
campaign here.
Sustainability Transitions and Co-Financing in Middle-Income
Countries
Sustainability, Transitions and Co-Financing (STC) was the topic addressed by Mike
Podmore from STOPAIDS UK, or as he put it, “how not to abandon poor and
marginalized people affected by the three diseases in MICs and sustain and build on
the gains instead”. In his presentation, Mike:
✓ Noted that, despite the fact that GNI and official diseases are widely seen as
insufficient criteria to assess the state of a country's health systems, the GF
still determines eligibility based on these measures, creating service gaps and
challenges for transitioning countries
✓ Highlighted STC policy challenges in the area of 1) eligibility, 2) short
transition plan funding, 3) insufficient use of the flexibilities provided in policy
for renewed transition funding, 4) insufficient use of the NGO rule, and 5)
dire funding realties.
✓ Suggested various initiatives and opportunities that civil society could
respond with, some of which had been developed during meetings in
Amsterdam, Durban and Montreal in 2016, such as the forming of a civil
society sustainability network, a global solidarity campaign and a safety net
mechanism to fill emergency gaps in transitioning countries.
✓ Watch and download the full presentation on Sustainability, Transitions and
Co-Financing in Middle-Income Countries and a draft paper on the topic
here.
Replenishing the Global Fund: Looking Back, Looking Forward
Christoph Benn, Director for External Relations at the Global Fund, devoted his
presentation to learned lessons around replenishing, in which he:
✓ Observed with concern that with the rise of nationalist and protectionist
government, the solidarity values on which the GF is built are under threat
and require strong responses.
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8✓ Stressed that the expansion of networks and strengthening of key actor
engagement, particularly young people, has gained in importance.
✓ Argued that the independent structure of the GF and its intrinsic linkages
with other development problems provide strong advocacy hooks.
✓ Argued that an action plan is needed to mobilize more resources, noting that
his team considers $285 million of public and $250 million of private sector
funds feasible.
✓ Sees new funding opportunities in active involvement with smaller donor
countries, the Middle East, philanthropic engagement platforms and Lottery
Models.
✓ Emphasized that, while the private sector offers a lot of potential, this must
not undermine public commitments.
✓ Recommended as advocacy message: the GF is a good investment because of
its interlinkages, synergies with other problems
✓ Watch and download the full presentation on Ambitious Resource
Mobilization in the Context of Global Uncertainties here.
The Future of ODA: International Public Investment and the
Future of the Global Fund
Guest speaker Jonathan Glennie from Ipsos MORI, used his presentation to rethink
development narratives and to argue for a narrative shift from aid to International
Public Investments. More specifically, he:
✓ Argued that the GF needs reinventing, mostly in its rhetoric, to adapt to a
changing development discourse, where resource mobilization will gain in
urgency.
✓ Argued that development discourse is slowly moving from outdated charity
and development continuum models to a new International Public Investment
narrative that refrains from the static and paternalistic charity narrative.
✓ Expressed concern about GF country classifications that shape transitioning
policies, as these processes send an inaccurate signal that no higher level can
or should be expected from these countries.
✓ Read and download the Paper on International Public Investment and the
Future of the Global Fund and the presentation on the topic here.
www.globalfundadvocatesnetwork.org
9Taking GFAN to a Next Level?
In 'Taking GFAN Advocacy to a next level?' Peter van Rooijen, from ICSS, made the
case for an innovative funding approach and a 'people-powered movement for
health' that create new opportunities from individual citizens to donate and support
GF goals. His key objective was to propose some ideas to gauge the position of the
GFAN network toward such an approach and their enthusiasm for developing them
further. In his presentation, Peter:
✓ Asserted that the ceiling of donor funding may have been reached, and that
increased funding may require an advocacy approach that goes beyond the
current advocacy base and target the public. (Increased funding requires
increased demand).
✓ Suggested that a people-powered movement for health, focused on
grassroots engagement and public awareness, could create such demand and
that GFAN - with its unique North-South collaborative model for mobilization
and its transparent, accountable structures - may be uniquely positioned to
convene such a movement.
✓ Proposed that such a movement could focus on, but not be limited to, young
people through the use of digital platforms and digital tools and with targeted
messaging that highlight the narrative of the Sustainable Development Goals
(SDGs) and focus on inequality, social justice and human rights.
✓ Suggested it could be earmarked to specific goals, allowing direct links
between donations and programs, and between community4community,
CS4CS, H4H, etc.
✓ Suggested that a partnership with the Narrative Project, a initiative that seeks
to increase public support for global development, could be explored
✓ Watch and download the paper on Taking Global Fund Advocacy to the Next
Level and the presentation here.
SRHR and Global Fund Resource Mobilization
Concentrating on the role of sexual and reproductive rights and health (SRHR),
Mikaela Hildebrand from RFSU spoke about the GF strategic objectives that deal
with these issues, namely support for reproductive, women’s, children’s, and
adolescent health, and platforms for integrated service delivery (2b); strengthening
global and in-country procurement and supply chain systems (2c); leveraging critical
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10investments in human resources for health (2d); scale-up programs to support
women and girls, including programs to advance sexual and reproductive health and
rights (3a); invest to reduce health inequities including gender- and age-related
disparities (3b); introduce and scale-up programs that remove human rights barriers
to accessing HIV, TB and malaria services (3c) and support countries to use existing
resources more efficiently and to increase domestic resource mobilization (4b). All
these issues, Mikaela stressed, are interlinked. Mikaela used the presentation to
✓ Note that the Nordic policy context continues to strongly focus on gender
equality and SRHR
✓ Note that at the GF Replenishment Conference 2016-2017, Nordic countries
represented 5.44% of the total, but that Nordic countries will want to see
results for them to keep investing
✓ Argue that an integrated approach will likely appeal to many Western
countries
✓ Suggest ideas for areas of collaboration and movement building, namely
Agenda 2030 reporting (health, education, inequality, inclusive societies and
follow up); Right to Health, Health in All Policies, UHC and Health Systems
Strengthening; Development effectiveness and quality of ODA; Shrinking
space for civil society/social accountability; Lessons from AIDS response on
pricing for contraceptives and medical abortion; HIV & SRHR integration
including for key populations; Increased domestic spending in social sector
✓ Note that if, in response to the U.S global gag rule, Nordic countries will step
up their efforts, this money will come from somewhere else.
✓ Affirm that, as was suggested during the Q&A, gender-based violence (GBV),
in particular sexual violence, must feature in health responses, given the
connections between HIV and such violence.
Discussion Highlights
Narrative emerged as a central theme throughout advocacy and financing
conversation, from discussions around the power dynamics that underlie historical
and current aid discourses to the importance of messaging in advocacy campaigns.
Some argued for a global discursive shift away from top-down narratives of 'aid,'
'donors', and 'development continuums-concepts that, as was observed by various
commenters, has irked many in the Global South for decades - toward a narrative of
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11'health as a good investment' and a matter of International Public Investment. The
three main North-South narratives that were identified were 1) a pay-back narrative,
which could seek to appeal to a sense of justice for historical exploitation, 2) the
charity narrative that currently characterizes ODA, and 3) the global good narrative
that paints ODA more as an investment, rather than a hand-out. While here was
broad agreement around the 'aid' development being outdated at best and neo-
colonial and imperialistic at worst, not everyone seemed convinced that investing is
such a discursive shift would substantially help the GF reach its funding needs on the
ground, in part because the top-down narrative is a product from geo-political forces
that are too politicized and entrenched to tackle discursively. Some expressed
doubts about the unintended side effects of relying too heavily on investment
rhetoric, noting that loan providers or other agendas can easily hijack investment
vocabularies for their own ends. Others pointed to the often-deliberately silenced
elephant in the North-South investment room -illicit financial flows from South to
North and tax evasion practices- arguing that these are essential aspects of North-
South development -investment relations.
Overall, however, the impact of development vocabularies on GF policies and
broader health impacts, and the relevance of advancing GFAN's understanding of
these dynamics, was widely acknowledged and illustrated in a variety of ways: from
discussions around the limitations of GNI or GDP in capturing capture inequalities in
health care services, to the limited efforts to collect data on the interlinkages
between out-of-pocket payments, structural adjustment policies and inequality. The
discussions around transitioning countries and eligibility criteria policies aptly
illustrated the extent to which outdated development concepts are reflected in GF
policies, to the detriment of transitioning countries, who -due to these
classifications- risk a disruption of services and a set-back in access.
The collective unpacking of the role of discourse proved fruitful in the domains of
advocacy messaging and fundraising strategies as well. Those confident about the
potential of large philanthropy engagement platforms in bringing about new funding
opportunities argued that language around 'investment returns' could be effective in
tapping into the private wealth of the growing class of millionaires and billionaires.
Key advantages of the GF, some argued, is that it has a uniquely independent
organizational structure and that its focus, health, is indispensable to wider
development goals.
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12Those keen to explore new narrative opportunities to reach, mobilize and engage the
public on a new and deeper level sparked lively debates on what kind of narrative
could create a 'people-powered movement for health', able and willing to both
bolster political support for the GF and contribute financially themselves as well.
Using smart narratives, some suggested, that emphasize independence, partnership,
shared values and progress as key GF values, such campaigns could foster more
grassroots support in donor countries. Such a 'people-powered movement for health'
could take the form of a citizen-focused campaign, it was suggested, aiming to
mobilize and engage targeted groups of the publics in direct forms of support, both
in political advocacy campaigns as well as in financial support opportunities.
Those in support of developing such a campaign structure suggested that:
1) it is important that those in charge of, for example, digital and social media do
in fact possess these skills,
2) that young people and faith-based organizations could fit in such a campaign,
3) this strategy could seek to create event-specific platforms which -rather than
asking ongoing support from citizens- engages them at specific moments,
such as replenishment sessions, and use these moments to create platforms
for citizens’ engagement.
Those more skeptical of the idea expressed concern about the about
1) the extent to which such a shift would contribute to a shifting responsibility
to citizens,
2) how such an approach fails to challenge, or even entrenches, the charity
dynamic, and
3) might find that the online space for such actions that it would seek to
penetrate, is quite crowded already.
With stronger collaboration on advocacy as a central goal of the meeting, a number
of upcoming events and processes were identified as key opportunities, including:
World TB Day; the G20 Summit; the G7 Summit; the High-level Political Forum on
sustainable development (HLPF); the UHC Conference; The Geneva Initiative; World
TB Day; the Stop TB Partnership Board; Russia Ministerial Conference on TB; the
UN High-Level Meeting on TB 2018; the World Conference on Lung Health; the
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13Rome Summit (for RM); the UNGA (for RM); the AIDS 2018 Conference (for RM); the
Regional Lung Conference in Ghana; the A/P Union Conference.
The desire to join forces and learn from each other's successes and disappointments
was expressed throughout the conversations, as were the concerns about resource
mobilization and political climates, hostile to ODA and global solidarity. Yet, as the
regional and country-level discussions will demonstrate, opportunities do exist and
can be seized most effectively through coordination and cooperation.
Mapping GFAN Challenges and Opportunities
Global
Prior to the meeting, GFAN conducted two surveys: the annual GFAN survey
circulated to the full membership, as well as a survey for meeting attendees to gauge
opportunities for ongoing resource mobilization in their regions. Thirty-one GFAN
members from twenty-three countries and regions filled in the annual survey,
thereby providing country and regional information about both the challenges and
opportunities they experience and anticipate in their advocacy work. This section is
based on the presentation by Meaghan Derynck from the GFAN Secretariat. It first
provides a broad summary overview on opportunities, challenges and needs,
followed by regional and country-specific overviews. These regional and country
overviews, which vary in detail, emphasis and length, are drawn from survey
responses, presentations and the results of the regional break-out groups. The full
break-out group reports are added as annexes and the country-survey responses can
be downloaded through the Dropbox links provided.
The 2016 Annual Survey Results found that 51.7% indicated that their organization’s
main disease focus is HIV; that GFAN Info Notes, calls, and in-person meetings
ranked as the most useful GFAN resources; that 100% of respondents said they
would continue working on Global Fund resource mobilization in the short- and
medium-term, from now until the next pledging meeting in 2019; that 92.3% of
respondents said that they see opportunities for ongoing Global Fund resource
mobilization in their country/region, and that 100% of respondents said that they
felt the GFAN Secretariat’s work, as well as their own work, on resource mobilization
for the 5th replenishment was a success.
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14In response to the survey circulated to meeting attendees regarding ongoing
resource mobilization in their regions, participants identified the following
challenges: political instability; lack of political will; lack of coordination among
regional civil society groups in general; lack of coordination among regional civil
society groups working on the 3 diseases; overlapping replenishment periods
between Global Fund and Gavi; the potential lack of a midterm pledging opportunity;
and “advocacy overload”, which seems to cause some fatigue for Parliamentary
champions.
A majority of partners responded that their resource mobilization efforts for the
coming year are focused on ensuring that current pledges are being delivered in full
and on time (Australia, Canada, Denmark, Japan, UK, US, Zambia). Many also
expressed that they do not foresee an increase in ODA in their countries in the near
future, with some even facing cuts. Other dominant challenges include the lack of
knowledge of the Global Fund amongst the general public; challenging political
environments; elections; cuts to ODA; broad SDG agenda and competition for scarce
resources; global health not being prioritized; focus on bilateral versus multilateral;
national debt level and economic crises; and the need for stronger ties between the
Global Fund and R&D for the 3 diseases.
At the same time, there is space for opportunity, for example in 1) France, where
there seems to be space to ask for an increase, 2) The Netherlands, provided that the
outcome of the election on March 15th are favorable, 3) Spain, where non- binding
proposals were accepted by all parties in December 2016, but where ongoing
pressure is needed to ensure that the pledges actually happen, 4) Jamaica, where
there is potential to leverage the government’s commitment to financing the HIV
response into a domestic contribution, although the high debt ratio doesn’t leave
much room, 5) The U.K, where DfID has shown a strong interest to mobilize
resources for R&D and where private sector contributions could be 'unlocked', and 6)
Italy, where -depending on the outcomes of the next elections- the 5 % Initiative
offers potential for other opportunities.
Support in many forms, the survey showed, is appreciated and needed by the entire
network. Support needs include financial support to continue and build on work
currently being done; knowledge sharing and development of joint strategies across
GFAN, regionally and across diseases; communications support and skills training,
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15including reports showing tangible results for making a strong investment case,
shared resources and communications materials; leveraging the Speakers Bureau;
stronger language from the GF Secretariat on funding gaps; messaging that link the
GF to broader health goals and political priorities; more accountable mechanisms and
opportunities for funding middle-income countries; closer relationship between
CSOs and the GF Secretariat; general networking among GFAN members for
connecting with affected communities and coordinating advocacy efforts.
• Read and download the full presentations with summary results from the GFAN
Annual Survey 2016 Responses and Resource Mobilization Opportunities here.
Regional & National
Africa
Supported largely by the New Venture Fund, the African group has created many
new collaboration avenues recently. The group currently prioritizes domestic
resource mobilization for health, delivering on the replenishment pledges and
ensuring that the three diseases remain priorities for African governments. In their
current funding submission, the African group ensures that gender lenses and human
rights are prioritized. CSO engagement is one of their entry points for UHC 2030
with the goal of making engagement less ad hoc. Another objective going forward, is
to more effectively use data in financing advocacy efforts and to make domestic
resource mobilization more dynamic and impactful, including through citizen
engagement and tapping into demographic trends, particularly the large number of
youth on the continent.
The group listed a number of key needs, such as the need to 1) build their knowledge
and advocacy on health financing so that they possess the up to date information
needed to marshal, generate and account for funds, 2) implement strategies for
influencing national budgeting processes, 3) organize themselves to follow up on
accountability, 4) give greater visibility and profile to those that contribute and give
them greater incentives to give, 5) twin the message on increased domestic financing
with messages of global solidarity.
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16Key questions for the group are:
• how to get politicians to understand the figures?
• how to build the DRM literacy of communities and of parliamentarian?
• how to involve and bring in Northern colleagues so that they broaden their
advocacy beyond ODA? and
• how to ensure continuity from the U.K?
The group finds it challenging to sustain momentum throughout elections, when
relationships and parliamentarians lose seats. Furthermore, they find it difficult to
balance the messaging on global solidarity, while at the same time asking for
governments to fund the national response.
The following opportunities were identified:
• World TB Day
• Regional Lung Conference in Ghana
• The Africa TB Caucus, which is seen as a valuable tool for both domestic
resource mobilization and GF championing
• The chance to use the conference in Ghana and the existing national caucus
to build political will of African Parliamentarians. Some countries did not
pledge because they are unaware of the extent of the TB problem – Zambia
started late.
• Domestic financing is seen as the biggest challenge and the greatest
opportunity.
• National budgeting cycles are more clearly articulated at a sub-regional level
– through the regional sectoral working group. Health financing commitments
are made here. There is a need to leverage the sub-regional processes
through the RECs and follow up on the commitments.
• Growing momentum about tapping into high net-worth individuals – for
Africa’s social challenges.
• Goi goi, harmabee, Ubuntu – giving is engrained in African cultures
• The initiative 'Kenyans for Kenya' raised millions raised through safaricom
mobile money technology (Mpesa), current campaign for the drought
• Growing middle-class in Africa and growing economies
• Opportunities to leverage technology for crowd funding
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17• Opportunity to learn from what has come before – not allow DRM push to
signal transition.
• Widening advocacy agenda that aims to increase government revenue and
ways of raising domestic revenue
• Growing attention by African governments and advocates to fair trading
terms, illicit financial flows – publish what you pay, tax holidays for foreign
companies
• The break out-group notes can be found in Annex 2.
• See GFAN Africa Updates Presentation by Rosemary Mburu, WACI Health
23 Feb
Asia-Pacific
GFAN Asia-Pacific has been formulating its project mainly working on transition,
domestic financing, capacity building and sustainability, focusing on two countries of
Asia-Pacific region. Civil society in South Korea and Japan also started their work for
advocacy for the Global Fund. The group plans to look at the next NVF proposal
including activities such as organizing study tours for journalists and other activities
targeting media in the region. The group expressed the intention to work more
closely with parliamentarians, particularly on training. New Zealand, it was noted, is
slated to get a new government in September 2017, which could lead to an increase
in ODA of £5-10 million.
On a national level, Japan identified the following opportunities and challenges
• A-P Union Conference (late March 2017) – side events and bringing together
TB issues of Asia-Pacific region, Japanese TB civil society and Global Fund
issues to the table. GFAN AP and South Korean groups commit to work with
Africa Japan Forum on statement at Union Conference and communities
representative
• G7 in May – health is prioritized agenda and Italians want to discuss "climate
change and health". Japan pushing for UHC, and AJF working to push for
AIDS/TB/Malaria
• HLPF is usually picked to announce Japan contribution to GF
• UHC Conference in November 2017. Following up on "UHC in Africa"
initiative launched in TICAD Vi.
www.globalfundadvocatesnetwork.org
18• International conference on UHC: commitment next steps: In July will start
preparing for the UHC Conference. Need understanding on next tranche of
NVF grant.
• Because of the direct influence of the US government on Japan, the Trump
administration presents a challenge
• Concerned with the suggestions of some parliamentarians in the ruling
coalition to evaluate international organizations by the numbers of their
Japanese staffs.
• Japan's national debts present another challenge
South Korea listed the following opportunities and challenges:
• Policy Analysis for recommendation to decision makers on the Global Fund
for advocacy efforts
• Impeachment process is still going on, and ODA policies or related policies
may be restructured by the new administration. A major challenge is whether
the impeachment on the final decision will be delayed or rejected and the
timeline.
• Global TB Caucus is working with South Korea Parliamentarians; there is a
need to link with NVF grantee for work this year
• Planning for study tour this year after the new government is in place
• June/July airline levy fund will be planned for 2018 budget distribution:
Journalism pressure, support letters to government - commitment on next
steps Timeline – September 2017
• Need to leverage the air levy fund to encourage other countries
• Small workshop held after the policy analysis for key stakeholders, media, etc.
(Timeline – June/July 2017)
Australia
The likelihood of the Australian government increasing overall ODA funding -beyond
present levels on the present or forthcoming financial years and within the present
term of government ending in 2019- seems low. Without an increase in ODA
funding, there is very little room to move to increase the Global Fund contribution by
a very large factor, although increases can be secured with effective advocacy and
lobbying. Pacific Friends of the Global Fund noted:
www.globalfundadvocatesnetwork.org
19"The political environment to support increased ODA funding is becoming
tougher and more complex. It cannot be assumed that current levels of ODA
will remain as they are, although the Global Fund is in a relatively good
position within the present ODA envelope. Recent Australian campaigns to
raise ODA levels have been largely without result. Only efforts concentrating
on specific agencies like the Global Fund have led to increases. Therefore,
more efforts in support of the Global Fund will return dividends. There is a
need for financial support to pursue these medium-term strategies for GF
support leading up to 2019. However, Pacific Friends should continue to
work closely with those agencies advocating for higher levels of ODA. If the
FTT concept is to be placed in public debate in Australia, a communications
and partnership strategy would have to be developed with local NGO and
others. It is a very worthwhile objective to raise the FTT in the Australian
context. However, there is no prospect that an FTT proposal would be
adopted by either major party before the next federal election, and this
should not be pursued as a short-term objective."
Opportunities:
• Support for both Gavi and the GF is high within Parliament, with several
champions in the major parties. In addition, both the Ministers and shadow
Ministers for Foreign Affairs and for International Development are well-
disposed to both funds as well. This goodwill creates an opportunity for
advocacy to lay a strong foundation for replenishment in 2019.
• The present government has shown an interest in specific initiatives around
regional health security, and will fund these initiatives so there may well be an
opportunity for lateral support for the Global Fund and partners to work with
the Australian government on such initiatives. Some type of additional
specific-purpose funding may therefore become available for the Global
Fund.
• With regards to FTT, the present Australian government will not be well-
disposed to an FTT, but there is ample scope to pursue this idea provided a
connection can be made with the right local Australian NGO partner(s). At the
very least, the merits of the FTT should be placed into public debate and
discussion in Australia and New Zealand and raised with appropriate political
leaders, parties and advocates.
www.globalfundadvocatesnetwork.org
20• UHC may be of interest to the Australian government if it is pursued by the
Japanese government at Ministerial level. The Australian government is open
to advice and ideas around Regional Health Security, and UHC may be seen
in this context.
• The Australian government has substantially increased funding for R&D
across the health spectrum including tuberculosis, malaria and, to a degree,
HIV/AIDS. The Global Fund has never presented itself as a partner in, or
recipient of, such funding from Australia. Perhaps there is scope if the Global
Fund wishes to do so.
• The media could be utilized better for advocacy purposes, for example
through human interest stories that highlight the personal dimensions of GF
work.
• Download the country survey on Australia from Pacific Friends of the Global
Fund here.
• See the break-out group notes for the Asia-Pacific region in Annex 3.
Nordic Countries
It is expected that, in response to the U.S Global Gag rule, the Nordics will seek to fill
that gap. Consequently, it is important for the GF to position itself as a relevant
partner in this domain. Amongst the challenges faced by GFAN groups in this region
is the dominant perception that “AIDS is no longer a problem”, the uncertainty
around the outcomes of upcoming elections and the costs associated with refugee
reception, which are taken from ODA budgets. GFAN members see ample
opportunities, however, to sustain and expand support for the GF, including:
• Work with GFATM to showcase GF investments and impact in SRHR
• Organize Nordic donor dialogue on overarching global health financing – aid
efficiency agenda (GFF and GF links)
• Leverage the AMR agenda; research and treatment issues (related to
transitions)
• Invest in champions in Parliaments – organize site visits with the GFATM
and/or working with Foreign Affairs Committees
• Commonality in Nordic policies reinforced under Trump/Gag Rule (e.g. She
Decides). Nordic council is gaining momentum and should be explored
further. Build lobby moment for GFATM (also if PEPFAR is cut)
www.globalfundadvocatesnetwork.org
21• GF to engage Nordic science/research community – include scientists in GF
technical advisory/working groups, secondments, etc. and make connections
to in-country advocates to leverage knowledge of the GFATM in national
policy dialogues
• Sensitize/educate other CS organizations in the region
• Invest in journalists, site visits, targeted collaboration with media
To seize these opportunities and maximize their impact, GFAN groups committed to
connecting people (Kerstin); convening and connecting Nordic partners, working to
organize policy dialogue spaces on health system architecture and MP site visits
(Laura); keeping GF as part of RFSU work portfolio (Mikaela); Nordic Council
presidency, considering level of commitment (Tor).
At the country level, the following challenges and opportunities emerged:
In Norway, the implications of the Global Gag rule is expected to lessen attention for
HIV/AIDS, which could represent an indirect threat to GF funding. In terms of their
poverty focus, Norway supports the need to transition quickly and focuses its
development aid largely on education, health and the private sector. In Sweden, the
Global Gag rule is also expected to affect HIV /AIDS programs. Therefore, any
additional Swedish funding to the GF is expected to cover those losses. Moreover, as
was noted during the break-out group, Sweden will want to see the GF to step up
the game – illustrate how new strategy takes into account the challenges of the Gag
rule. To maintain the current levels of funding is seen as a challenge (it was tough 5th
replenishment and the selling point was SRHR), and it is important that the GF
adapts its messages in a way that it relates to current discourses. Funding is further
undermined by the fact that the cost of refugee reception is covered by the aid
budget.
Denmark faces similar challenges in the area of shrinking overall ODA, hostile
environments for CS and refugee reception costs. Other challenges that emerged
from the survey and the break-out group include:
• Task division used as excuse to de-fund global health – lack of overall
analysis and expertise on global health
• The GFATM is not well known among key Danish stakeholders (or the
general public)
www.globalfundadvocatesnetwork.org
22• There is a very broad SDG agenda in place and huge competition for
resources among thematic areas and organizations.
• HIV/AIDS has become more invisible, TB and malaria not on the radar, global
health less prioritized
• The popular conception that Denmark does not need to invest in global
health because others (including Gates) have that covered.
Ensuring that Denmark does not break its pledge to the GFATM, as has happened
before, was prioritized, an issue that will require close monitoring of the budget
negotiations. AIDS-Fondet described the context for action as follows:
"In the current political situation/government (elections in 2019), there is very
little room to argue for a top-up on the contribution from ODA budgets – in the
absence of global events that provide lobby moments such as the current
mobilization around the She Decides campaign as a result of the Mexico City
Policy. Another moment could arise if speculations that the PEPFAR KPIF
program is cancelled or altered due to the new administration; providing
arguments that additional investments in the GFATM are needed to support key
population led civil society organizations ....[...]...The present Danish government
is opposed to Danish participation in an FTT. Supporting party Danish People’s
Party has not formed an official position and might be swayed into supporting it,
not least as a result of their recent approximation to the Social Democrats (new
line of collaboration, possible future government coalition) The former Social
Democrat-led government was against Denmark’s participation in the European
FTT, but after the news that a FTT agreement between 10 European countries is
close to being adopted, the new Social Democratic leadership has announced
that the party supports Denmark’s participation in the FTT. Other left wing
parties also support Denmark’s participation in the FTT; in November 2016 SF
(Socialist People’s Party) put forward a motion that Denmark participates in the
FTT."
In order to tackle these challenges, GFAN support is greatly welcomed, particularly
on 1) knowledge sharing and strategy development on the FTT during GFAN calls
and 2) through a joint overview of how the new US administration/Mexico City
Policy affects the GFATM programs and funding.
www.globalfundadvocatesnetwork.org
23• Find the country survey of Denmark - AIDS- Fondet here, and the Nordic
Group's break out notes in Annex 4.
U.S.A
The Trump administration and the growing sense of nationalism in the public
dialogue, has led to a lot of uncertainty when it comes to U.S support for the GF.
Major challenges, as identified by Friends US, include overall cuts to ODA; attacks on
funding for multilateral organizations; concerns with the new ED not being a US
citizen; concerns with "mission creep" at the GF; issues with policy, such as SRHR. At
the same time, there is a lot of pushback against nationalist forces and within
Congress, there's continued strong support for the GF. As Friends US noted in the
country survey, there appears to be support for PEPFAR within the Administration,
but the Global Fund may be in a more vulnerable position than bilateral U.S
programs. Maintaining support in Congress for the annual appropriation if US$1.35
billion - leading to the $4.3 billion pledge for three years - is a key priority right now.
During the break-out group, the following opportunities and entry points were
identified:
• Celebrities to speak out
• Private sector, mobilize advocates, get Trump to own the ending it agenda
• Bankers are liked by Trump: BofA, McKinsey
• Faith based to Pence. Evangelicals to Pence. Jews to Ivanka.
• Re-energize PEPFAR coalition
• Op ed about ability of bilateral/multilateral together to end disease
• Retired members, in addition to Frist, who could support
• Post Brexit, Tory MPs went to new PM; US Republican Senators to WH
• Canada, UK, Japan, Australia encourages Trump (Friends and RESULTS
groups push) – to Tillerson.
• Canada feels they own replenishment, so US withdraw looks bad on them.
• UK minister to Tillerson on why we kept our investment
• Others push for G7 communique language that speaks to GF results,
transparency, accountability
• Use bad budget proposals (March, May) to mobilize other governments to
weigh in with Congress
• Quantify human impact of cuts
www.globalfundadvocatesnetwork.org
24• Tim Ziemer, formerly of PMI, and others to point you need both bilateral and
multilateral
• Heritage Foundation review of foreign assistance like UK, especially if they
issue Executive Order creating foreign assistance review commission
• Make list of Trump supporters who have been allies and/or on Co-Dels
• Share list of allies in Congress with GFAN
• Differentiate messages – faith, business, mothers and children, revise
messages for return on investment
• The type of support needed from GFAN includes ongoing work on Capitol
Hill, particularly with Republican appropriators and champions;
communications that help make the case for investment using themes that
resonate in the current environment; grass roots and grass tops work in
target states and districts.
• See the break-out group notes in Annex 5 and the country survey response
from Friends US here.
Canada
Canadian ODA has reached historically low levels, but the Trudeau government has
demonstrated strong commitment to the Global Fund through its political leadership,
fiscal commitment and hosting of the 5th Replenishment Conference in 2016, where
the country made a pledge of $804 million. In light of these contributions, and given
the signs that the government is unlikely to increase its ODA by any significant
amount for 2017, a top-up to its 2016 pledge is seen as unlikely. As RESULTS
Canada noted in their survey response, the commitment Canada made to host the
Fifth Replenishment Conference and their current pledge makes it difficult to build
an argument to invest further during this replenishment period. The release of the
government's new international assistance policy will shed a light on what advocacy
approaches and focus points could reap the most benefits. Early indications point to
support for UHC but a potential de-prioritization of R&D. For ICAD resource
mobilization remains a priority, while RESULTS Canada will focus primarily on
building support for R&D for diseases of poverty in Canada. Additionally, RESULTS
Canada will be working on developing a transition policy, with regard to the Global
Fund as well as Gavi. Against this backdrop, R&D focused research mobilization is
www.globalfundadvocatesnetwork.org
25seen as an opportunity. To leverage these opportunities successfully, the following
support is welcomed from GFAN:
• Support in ensuring that pledges are fulfilled (RESULTS)
• Support in R&D focused advocacy, particularly in ensuring we are connected
to affected communities and that our advocacy is in line with their needs
(RESULTS)
• Continue to strategically engage Prime Minister Trudeau beyond the 5th
Replenishment Conference as an important political voice and ambassador of
the Global Fund (ICAD)
• Engage the Canadian government as potential co-hosts of high-level events
(e.g., the WHA, the UN Commission on the Status of Women (March 2017),
the coming UN SDG review (July 2017)
• Advocacy tools for civil society organizations (general briefing notes, talking
points, awareness of and lessons drawn from successful campaigns in other
countries) (ICAD)
• See the survey results from RESULTS Canada here, ICAD here and the break
out group sheet in Annex 6.
Latin American and Jamaica
During the break-out group, there was wide agreement that there is a great need for
GFAN's work in the region. The main focus, it was agreed, should not be about
resource mobilization for the Global Fund and GF replenishment but for increased
domestic financing for health and/or increased financing for "global public goods for
health" or a UHC narrative. LA and the Caribbean were recognized as requiring very
different strategies. Rather than creating a new mechanism, existing networks can be
used, e.g. CVC for the Caribbean. The upcoming regional forum on sustainability is
seen as an opportunity, because it will gather stakeholders around the three
diseases. As the exact date will be released in the coming weeks, it is critical that
advocates are engaged and preparations are made. In order to launch new initiatives,
LAC hopes to land funding from the New Venture Fund. During the Q&A on TB
advocacy, it was suggested that -while the region of Latin America has not
(meaningfully) contributed to the GF yet, the region's number of billionaires -
including billionaires who made their fortunes through mining- is growing, presenting
new opportunities for TB fundraising efforts.
www.globalfundadvocatesnetwork.org
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