How we engage Stories of effective community engagement on AIDS, tuberculosis and malaria
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How we engage Stories of effective community engagement on AIDS, tuberculosis and malaria
How We Engage 01
HOW WE ENGAGE
Stories of effective community
engagement on AIDS,
tuberculosis and malaria
Civil society and community-based organizations – especially those that represent
people living with or affected by disease – and key populations have a crucial role
to play in the design, delivery, monitoring, and governance of HIV, TB and malaria
programs. Since it was established in 2002, the Global Fund has been committed to
engaging communities, strengthening community-based responses and promoting
gender equality and human rights in the programs that it supports.
As the Global Fund increases the focus of its key populations. In Sierra Leone, a new consortium
investments on high-impact interventions and of community-based organizations emerged from
settings, closer engagement with communities the country dialogue on HIV/TB, malaria and health
is essential to achieving that goal. Wider and and community systems strengthening proposals as a
more inclusive processes of country dialogue are major voice for the rights of key populations and as an
determining national priorities for funding on health, implementer of effective programming.
and are making programs more effective.
Since 2014, these and other examples of community
As this series of eight case studies illustrates, organizations and networks strongly influencing the
expanded dialogue and participation in the content of Global Fund proposals have been replicated
development of grants are leading to more focused in dozens of countries. In all regions of the world, more
and responsive programming in many countries. extensive dialogue and participation in Global Fund
In Cambodia, the national process for developing processes are leading to HIV, TB and malaria programs
the country’s approach to TB involved a broad that are more responsive to community needs and
and innovative approach to consultation with that will ultimately have greater impact. In many
communities affected by TB and led to a Global Fund countries, stronger engagement of communities and
grant that strongly reflects their needs and concerns. key populations in grant governance and oversight
The Cambodian dialogue process has been adopted has been achieved, including through new minimum
as a model in other countries. In El Salvador, as a standards for the participation of key populations in
result of their participation in a national dialogue Country Coordinating Mechanisms.
for the first time, transgender communities have
begun to access better HIV services financed The experience of Kyrgyzstan illustrates how a
by the Global Fund. In Kyrgyzstan, community lengthy national dialogue for the development of a
participation in a challenging process of dialogue request for Global Fund support on HIV/TB can be
and grant development has helped to reshape harm accompanied by effective reforms to the process
reduction services and other HIV programming for of selecting key population representatives on the
02 How We Engage
Country Coordinating Mechanism. At a regional level, had been completed in more than 40 countries and for 15
stronger civil society engagement in governance of regional applications, highlighting both the tremendous
the Global Fund-supported Regional Artemisinin demand for such support and the still-unmet needs
Initiative in the Greater Mekong region is of many community organizations for longer-term
helping to ensure that malaria interventions assistance that extends through the period of
reach the most vulnerable people in the grant implementation.
most remote communities.
In addition to providing specific technical
The case studies also demonstrate support for communities to engage
how community engagement in Global Fund processes at the
can be greatly enhanced by country level, the Community,
the provision of targeted Rights and Gender
south-to-south, Special Initiative has
peer-led technical included two other
assistance and components.
support to Component
community 2 is providing
organizations up to
and networks US$5.3 million
at the national, to eight global
regional and global and regional key
levels. The need to population networks
provide support for closer to support the long-term
community engagement was capacity development of their
recognized by the Global Fund constituencies to engage with
Board in 2014 when it approved a the Global Fund at the country and
US$15 million Community, Rights and regional levels, in partnership with the
Gender Special Initiative to accompany Robert Carr Civil Society Networks Fund
the rollout of the new funding model. There (RCNF). The Global Fund/RCNF grantees
are three mutually reinforcing components of the are undertaking a wide range of capacity
Community, Rights and Gender Special Initiative. development activities in over 50 countries and
all regions in the Global Fund portfolio. The example
Most of the short-term technical assistance of the International Community of Women Living
assignments provided under Component 1 of the with HIV Eastern Africa shows how the partnership is
Special Initiative have involved a focus on key strengthening the ability of networks of women living
populations and many have had an expanded scope with HIV to engage in advocacy in support of the
of work on human rights, community responses, Global Fund at the global level, building the capacity
youth and gender. The type of technical assistance of regional networks and empowering women at
provided has varied widely, ranging from support the country level to better understand and engage
for community consultations to participation in in national processes related to the Global Fund,
country dialogues, development of funding requests, including priority setting, concept note development
program design, desk reviews of critical documents and participation in Country Coordinating Mechanisms.
such as national strategic plans, and mapping of legal
and human rights frameworks. In many In recent months, under Component 2, resources have
countries – highlighted in the cases of Benin, also been made available to support and expand the
Sierra Leone and Kyrgyzstan – technical assistance meaningful engagement of communities affected
provided through the Special Initiative has extended by TB through partnership with the Global Coalition
through to the grant-making phase and has helped of TB Activists (GCTA). A similar partnership is
to build the capacity of community organizations as underway with four organizations that will work
they prepare to implement activities or undertake collectively to reinforce engagement and capacity
community-based monitoring of Global Fund grants. of malaria-affected communities and civil society
groups, including how to better analyze and address
The case studies provide a snapshot of the technical human rights and gender-related barriers to access.
support that has been provided. By September 2016, the While we do not describe these efforts in detail in
Special Initiative had received more than 110 requests this publication, we look forward to sharing similar
for support and 80 short-term technical assistance success stories emerging from these investments in
assignments for community organizations and networks the future.
How We Engage 03
Component 3 of the Special Initiative has provided The experiences documented here show that the
up to US$4 million for the establishment of six funding model has been accompanied by important
regional civil society and community coordination and investments in time and resources to ensure that
communication platforms to enhance the knowledge the Global Fund remains a leader and innovator in
of civil society and community groups about the engaging communities in all facets of its work. Above
Global Fund, facilitate access to technical support and all, the case studies illustrate how the Global Fund’s
strengthen civil society and community knowledge vision of an inclusive funding model is being embraced
and awareness of how to effectively participate in and interpreted differently in the countries that the
national processes. As the case study on the Regional Global Fund serves. Whatever form community
Communication and Coordination Platforms shows, engagement takes, it should lead to better-designed
the platforms represent important investments in grants, more effective partnerships for governance
infrastructure that have enabled community-based and implementation, advances in human rights and
organizations in Francophone West Africa, Anglophone gender equality and greater impact against HIV, TB
Africa, the Middle East and North Africa, Eastern Europe and malaria.
and Central Asia, Latin America and the Caribbean, and
Asia Pacific to share knowledge and broker expertise KATE THOMSON
in a way that would not have been possible without Head, Community Rights and Gender Department
support from the Special Initiative. Global Fund Secretariat
It is hoped that – together with an independent
evaluation of the Community, Rights and Gender
Special Initiative to be completed by the end
November 2016 – these case studies will help to
inform decision-making about the future investments
that will be needed to sustain effective engagement
of community organizations and networks in Global
Fund-related processes.
© The Global Fund / John Rae
03 04 How We Engage The Global Fund thanks the organizations and the people represented in these case studies and thousands of others like them around the world, including our technical partners, whose commitment to the health of their communities is helping to make the Global Fund a more inclusive and effective funder of health programs.
How We Engage 04
05
© The Global Fund / John Rae
06 How We Engage
TA B L E O F C O N T E N T S
How we engage
Cambodia:
An inclusive national dialogue process for a stand-alone TB grant 08
El Salvador:
Empowering transgender communities for better HIV programming 10
Kyrgyzstan:
Strengthening community engagement in dialogue and
governance for an HIV/TB grant 12
Benin:
Strengthening civil society engagement in grant-making
and monitoring for the three diseases 16
Greater Mekong region:
Engaging communities in governance of a regional malaria grant 18
The Regional Communication and Coordination Platforms:
Supporting closer community engagement with the Global Fund
and its processes around the world 22
The Global Fund partnership with the Robert Carr
Civil Society Networks Fund:
Raising the voices of women living with HIV 26
Sierra Leone:
Building community capacity for the fight against HIV, TB and malaria,
and for a resilient health system 30
How We Engage 07
© The Global Fund / John Rae
08 How We Engage
CAMBODIA
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An inclusive
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national dialogue
process for a stand-
alone tuberculosis grant
Cambodia adopted a very innovative The consultation process was designed to be
inclusive, transparent and participatory. To solicit
and inclusive process of community participation in the two workstreams, the CCC issued
engagement in country dialogue and an open invitation in April 2014 to stakeholders,
experts, partner nongovernmental organizations,
Global Fund concept note development and communities. The CCC particularly sought to
for a stand-alone TB grant. engage people from communities affected by TB,
TB key populations and community structures such
Cambodia organized its consultations and community as Village Health Support Groups and Health Center
dialogue well in advance of the June 2014 deadline for Management Committees that are an important part
submitting the TB concept note. The process was led of the Cambodian health system.
by the country’s Global Fund governance mechanism,
known as the Country Coordinating Committee (CCC), The first workstream on technical issues consisted
in partnership with the Principal Recipient (CENAT – of ten half-day thematic working group discussions
the National Center for TB and Leprosy) and received based on the modules of the Global Fund TB concept
technical support from the World Health Organization note. Around 50 CCC members, non-CCC members,
(WHO), the U.S. government and the French 5% technical stakeholders and partners participated in
Initiative. these discussions around the country in April and May
2014 to develop the technical content of the Global
National consultations to prepare the TB concept Fund submission. Representatives of key populations
note consisted of two streams conducted in parallel. were involved in these technical discussions.
A first workstream provided technical inputs into the
concept note, while a second workstream involved The second workstream, community consultation,
consultations with communities, including key used a range of approaches, including surveys and
populations affected by TB. A WHO consultant was interviews, but placed strong emphasis on focus group
engaged to support the technical workstream, while a discussions that were held in four provincial locations
Cambodian-speaking consultant funded by the French and the capital, Phnom Penh, in April and May 2014,
5% Initiative supported the community consultations. engaging more than 100 people. Several of the focus
groups were designed especially to address issues of
Because Cambodia was updating its national strategic concern to members of Village Health Support Groups
plan for TB at the same time as it was developing its TB and Health Centre Management Committees. Other
concept note, the dialogue and consultation process for focus groups solicited input from key populations
the Global Fund application also fed into the process of affected by or at risk of TB, including people who had
developing the national TB plan, enabling the plan to be been cured of TB, families of TB patients, cured or
more informed by community input than ever before. at-risk diabetics, people with HIV, the elderly, peopleHow We Engage 09
who use drugs, former prisoners, migrant workers, a process of structured dialogue, all 180 participants
pregnant women, youth, transgender people, men in the technical working groups and the community
who have sex with men and indigenous communities. focus groups exchanged insights and consolidated
recommendations about what should be prioritized in
Importantly, each focus group was preceded by the funding request to the Global Fund. The bilingual
a session in which participants were provided discussions were structured around a preliminary draft
information and had opportunities to ask questions concept note and the extensive feedback provided at
about the Global Fund and its processes. This enabled the joint consultation was captured in the next version.
everyone to participate in the focus group discussions Prior to this meeting, key population participants
equipped with an understanding of the Global Fund received training to build their confidence to speak up
and how their inputs would contribute to the final and actively participate. The output from the meeting
concept note. also served as a major input into development of the
national strategic plan for TB.
The focus group discussions explored the
current level of understanding about TB Following the national meeting, a concept
key populations and people who have note writing team was convened with the
been cured of TB, as well as people’s support of the United States Agency for
perceptions and experience of International Development (USAID)
TB care, including factors that and the Centers for Disease
promote or act as barriers to Control (CDC). The draft concept
care. Focus group members note was then presented to
were also asked to make the CCC (many of whose
recommendations for members had been
improving access to closely involved in
and improving the consultation
the quality of process)
TB care, and along with a
their inputs budget, which
were synthesized was important in
in a situational enabling community
analysis report. members to see how
their recommendations had
Focus group participants translated into funded
emphasized the particular activities. For example, the
vulnerability to TB of the elderly, budget showed how more rapid
current and released prisoners, the poor, delivery of TB test results would
migrants (especially those working in mills, be achieved with the procurement of
factories and other crowded environments), GeneXpert machines and a new system of
people living with HIV, soldiers, men who have sending test results by SMS.
sex with men, sex workers and other marginalized
women, indigenous communities and people in remote Cambodia’s successful engagement of communities
areas who lack access to health information. They in the development of its 2014 Global Fund TB
recommended approaches for increasing awareness concept note was made possible by strong and
about TB among these populations, strengthening effective leadership of the CCC; the government’s
and promoting community participation and removing commitment to inclusivity and transparency; advance
barriers to services. They specifically noted the need for planning; effective support from partners and an open,
more attention to key enablers such as food, transport innovative, well-facilitated, well-designed and well-
and assistance for the poor, the need for more rapid documented consultation process that was aligned
delivery of test results, the need for clarification of with the process of national strategic planning.
the role of private health clinics, and measures to
more effectively engage communities in case finding, The national dialogue process for the Global Fund
particularly Buddhist monks. TB concept note in Cambodia has since served as
a model for the development of the country’s HIV,
After the parallel workstreams had concluded, a joint malaria and health systems strengthening concept
event was held to consolidate their findings. This was notes. The process and materials used to facilitate the
achieved through a two-day national consultation community consultations have also been adopted in
held at the end of May 2014 during which, through other countries.10 How We Engage
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Empowering
transgender communities
for better HIV services
El Salvador was among the first six Despite these advances, people living with HIV and key
populations most at risk of HIV in El Salvador frequently
countries to apply for funding under experience high levels of stigma, discrimination,
the Global Fund funding model in violence and hate crimes, including assault and murder.
Many of these crimes are committed with impunity by
2013 and it was the first country to police and gangs and go unreported.
sign an HIV grant agreement under
the new model. At the time that El Salvador was invited by the Global
Fund to participate as an early applicant under the
Because the HIV epidemic in El Salvador is highly funding model in 2013, the country had recently revised
concentrated in key populations at higher risk – its National Strategic Plan for HIV. It had also begun
specifically, female sex workers, men who have sex initial national consultations in anticipation of the next
with men and transgender women – these groups round of Global Fund funding, including holding a series
were closely involved in the country dialogue and of thematic roundtable meetings with key stakeholder
development of the HIV concept note. groups. The major component of the country dialogue
convened by the Country Coordinating Mechanism
El Salvador has taken important steps to protect the consisted of two “intersectoral meetings” of around
human rights of key populations most at risk of HIV. 120 people, 80 percent of whom were from civil
National law establishes the right of people living with society organizations, including organizations that
HIV to be treated in a dignified manner without stigma represent men who have sex with men (EntreAmigos),
or discrimination. An HIV Unit has been established in sex workers (Flor de Piedra and others) trans
the Office of the Ombudsman for Human Rights with women (COMCAVIS, ASPIDH Arco Iris and Colectivo
a mandate to investigate and prosecute HIV-related Alexandria) and people living with HIV (Associacón
human rights violations in the country, particularly Visión Propositiva, ICW-Personas Viviendo con
those committed against key populations. In 2009, SIDA and others). The Global Fund Secretariat also
the Public Health and Social Welfare Ministry passed a supported field visits to key population organizations
directive to eliminate all forms of discrimination based by the Country Coordinating Mechanism, the Ministry
on sexual orientation in public health services, and in of Health and technical partners to understand their
2010, a presidential decree prohibited discrimination concerns and needs.
in public administration on the basis of gender identity
or sexual preference. In the same year, the government Transgender organizations played an important
created a Department for Sexual Diversity to promote role throughout the country dialogue process. HIV
public policies that are inclusive of lesbians, gay, prevalence among transgender women is alarmingly
bisexual and transgender persons. high in El Salvador at more than 25 percent, andHow We Engage 11
trans people are highly marginalized, subject to The experience of El Salvador shows how the close
discrimination and violence. They also face significant engagement of marginalized communities in dialogue
barriers in accessing health services. Because of – with strong support from the Country Coordinating
prejudice, many trans women cannot find work and Mechanism and the Ministry of Health – can help to
lack family support, pushing them into sex work. ensure that Global Fund-supported programs cater
The experience of participating in a large country more effectively to the needs of marginalized and
dialogue meeting to directly influence the content neglected communities. As a member of the trans
of a Global Fund funding proposal was new for community in San Salvador reported in 2015:
many civil society participants, particularly those
from trans communities. To help them prepare, trans
groups held their own “mini-dialogue” that provided
them with an initial, separate space to develop their We need to address the underlying
ideas and inputs before participating in the larger
reasons that trans people are vulnerable
intersectoral dialogue meetings.
to HIV. One of them is that we have few
During the intersectoral meetings, trans communities options to make a living other than sex
emphasized that, while the national HIV strategy
work and beauty salons. That is why
recognized trans people as a key population
vulnerable to HIV, it contained no targets relating to training in things like computer skills at
trans people. Trans communities also lacked empirical the community center is so important,
data with which to effectively make the case for
programming specifically targeted to their needs, and in addition to HIV testing, referral
noted that previous Global Fund grants had tended and support.
to group trans people together with men who have
sex with men. Although earlier programming for
men who have sex with men and sex workers had
indirectly benefited trans people, it had not addressed
a range of trans-specific issues, including the impact
of hormone therapy, stigma, low self-esteem and lack
of employment opportunities. Trans people in prisons
and young trans people were identified as particularly
vulnerable to HIV and in need of attention. Trans people
noted the need for more comprehensive attention to
drug and alcohol use and vocational training, and
identified the adoption of a national gender identity
law as a high priority for advocacy.
After significant debate among stakeholders, it was
agreed that – in addition to interventions for men who
have sex with men, sex workers and prisoners – the
concept note should include specific programming
for trans people, including strengthening the capacity
of transgender groups, advocacy for a gender identity
law and a tailored package of services to be provided
at “comprehensive prevention community centers”
(centros comunitarios de prevencion integral). These
centers offer a basic package of services – such as
testing for HIV and other sexually transmitted
infections and referral to treatment – to everyone,
as well as complementary services for specific
key population groups. For centers catering
to trans people, complementary services
include vocational training, referral to
social and employment services
and support in cases of human © The Global Fund / John Rae
rights violations.12 How We Engage
K Y R G Y Z S TA N
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Strengthening
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community engagement
in dialogue and governance
for an HIV/TB grant
The experience of the Kyrgyz Republic in Russian or Kyrgyz, poor accountability mechanisms,
perceptions of conflicts of interest and the dominance
in developing and reiterating its TB/ of other stakeholders on the Country Coordinating
HIV concept note in 2014 and 2015 Mechanism.
involved many challenges for civil society Following the rejection of the HIV concept note in June
organizations seeking to understand 2014, Kyrgyzstan decided to develop a joint HIV/TB
proposal, consistent with the Global Fund’s approach
and engage with the Global Fund’s of aligning funding for HIV and TB programs. The
funding model and ensure that the needs development of a new HIV/TB concept note provided
an important opportunity for civil society groups
of key populations were adequately
to mobilize and engage more closely in the national
reflected in the concept note and grant. dialogue process and to advocate for more effective
programming for key populations, and, in particular, for
These challenges were tackled successfully with harm reduction.
the help of technical assistance provided through
the Global Fund’s Community, Rights and Gender AIDS Strategy, Advocacy and Policy (ASAP) undertook
Special Initiative that involved extensive an initial consultation with key population groups and
consultations on programming and led to an people living with HIV in September and October
innovative approach to communication among civil 2014. The consultation identified a number of gaps
society groups. As a secondary effect, it also led and challenges in programming for key populations, as
to a more effective and representative process to well as barriers to effective community engagement.
select civil society representatives for the Country These included: poor surveillance data; poor quality of
Coordinating Mechanism. services; inadequate laboratory capacity and unreliable
test results for people on ARV therapy; stigma and
An initial HIV concept note submitted by Kyrgyzstan discrimination in health care settings; police harassment
in June 2014 was rejected by the Global Fund due of sex workers and people who inject drugs; and poor
to the country’s failure to comply with Country coordination and communication among civil society
Coordinating Mechanism eligibility criteria. At the organizations. In the area of harm reduction, the
time, the Country Coordinating Mechanism included national HIV response had neglected changes in drug
representatives of people living with HIV and key use patterns that require larger quantities of needles
populations, but these members had experienced and syringes, as well as the sexual and reproductive
many challenges, including limited knowledge and health needs of women who inject drugs. More attention
expertise, lack of documentation and information was also needed to strengthening the links betweenHow We Engage 13
prison and other health services and to providing legal In December 2014 and January 2015, additional
support to key populations, including drug users, sex technical assistance was provided by the Canadian
workers and men who have sex with men. HIV/AIDS Legal Network with funding from the
Community, Rights and Gender Special Initiative to
With financial support provided by the Community, develop recommendations for the content of the
Rights and Gender Special Initiative, the International community systems strengthening and removing
HIV/AIDS Alliance’s Eastern Europe and Central Asia legal barriers modules of the new concept note.
Technical Support Hub (EECA Hub) undertook a The community systems strengthening component
comprehensive review of Kyrgyzstan’s existing harm focused on capacity building for key populations
reduction program in late 2014. The EECA Hub and other community organizations, particularly
also facilitated “pre-dialogue” and “country with regard to engaging in dialogue with the
dialogue” meetings with key population and government through national networks, and
other civil society organizations and held was designed to complement requirements
numerous focus groups and individual for inclusion of civil society in the design,
meetings with service providers delivery and evaluation of services
and government officials, as well in the service components of
as undertaking site visits. This the proposal. The removing
process closely engaged TB legal barriers component
communities in the focused on increasing
national dialogue legal literacy among
around a Global key populations
Fund proposal and establishing
for the first time a network of
in the country. “street lawyers”
to provide legal
With the support of the assistance. These
EECA Hub, civil society recommendations were
organizations identified largely included in the concept
six major priorities for harm note by the committee tasked by
reduction programming in the new the Country Coordinating Mechanism
concept note: with writing the proposal.
1. Increasing program coverage, especially After the HIV/TB concept note was submitted to
of harm reduction services run by community the Global Fund in January 2015, some civil society
organizations using peer-led approaches organizations remained concerned that the writing
instead of abstinence and drug rehabilitation; process had lacked transparency, particularly with regard
to how the activities and approaches proposed by civil
2.
Improving access to HIV and TB screening and society had been reflected and prioritized and who was
strengthening linkages to treatment and care for responsible for finalizing the concept note. Access to
key populations, including through the use of peer- the final form of the full concept note was limited and
driven case management; the document was prepared in English, which many civil
society members did not speak or read.
3. Ensuring that a standard package of harm reduction
services be available across the country; The Global Fund and Canadian HIV/AIDS Legal Network
both recommended that further steps be taken to
4. Improving program quality and validating contested increase transparency and involvement of civil society
service coverage figures in government-run needle in the process. To promote wider understanding
and syringe exchange services; of the specific content of the community systems
strengthening/removing legal barriers modules and
5.
Measures to mitigate human rights violations by to anticipate potential comments from the Technical
police, such as police targeting of sites offering harm Review Panel, the Canadian HIV/AIDS Legal Network
reduction services, along with appropriate legal consultant, Country Coordinating Mechanism
support services, and Secretariat and the Principal Recipient, the United
Nations Development Programme (UNDP), hosted
6. T
he need for adequate budgets for key population a workshop in April 2015 at which 30 civil society
programming. participants drafted their own “concept note” for14 How We Engage
the two modules and made appropriate budget for technical assistance through the Community,
allocations. The programs proposed by the group Rights and Gender Special Initiative. The forum also
bore a close resemblance to what had been submitted provided an opportunity to improve communication
in the actual concept note. This “retroactive” process and coordination among civil society groups and
helped to build understanding about Global Fund to promote reform of the Country Coordinating
processes and community systems strengthening/ Mechanism, which had become dysfunctional as a
removing legal barriers activities in an environment result of longstanding conflicts between government
where civil society engagement on these issues had and civil society members that led to the resignation
previously been suboptimal. of several civil society members in April.
However, participants in the workshop agreed that the The Global Fund Country team and the Community,
budget submitted in the concept note for activities Rights and Gender department worked with the EECA
under the two modules had been inadequate. Hub and local civil society groups to ensure that the
Accordingly, the Canadian HIV/AIDS Legal Network planning process for the forum was inclusive, paying
and key population groups made requests to the closer attention to wider participation of key population
Country Coordinating Mechanism and other partners networks and TB communities than in the past. At the
for additional funds for technical assistance to same time, prospective participants were invited to
ensure that there would be appropriate civil society join a Google Group as a platform for discussions prior
participation in program implementation. They to the forum and to enable ongoing communications
also agreed to form a working group to oversee a after the event.
legal environment assessment by the Canadian HIV/
AIDS Legal Network that would identify the legal The two-day NGO Forum took place at the end of
instruments available in the country to support and June 2015 and attracted more than 120 participants.
implementation of the removing legal barriers module, A full session was devoted to interaction with the
including for the “street lawyers” program. The legal consultant who had been engaged by WHO to redraft
environment assessment was undertaken between the concept note in light of the comments received
May and August 2015. from the Technical Review Panel. Following the
forum, the Google Group enabled ongoing dialogue
In late April 2015, the Technical Review Panel requested among civil society groups on the redrafting process.
that Kyrgyzstan revise the HIV/TB concept note with A facilitator provided summaries and translations of
attention to four major issues: Global Fund documents to members of the Google
Group using a DropBox, including key elements of
1.
Ensuring adequate service coverage among key the concept note and the Technical Review Panel
populations; comments. In early July, the group’s members
provided consolidated inputs to the WHO consultant.
2. Making improvements in monitoring and retention The Google Group was particularly useful in enabling
in the HIV treatment cascade; civil society members to keep track of how their inputs
were being addressed as the concept note evolved. The
3.
Increasing government support for prevention Google Group was also used to share information and
among key populations; and results from the legal environment assessment being
undertaken by the Canadian HIV/AIDS Legal Network.
4. Improving case management for people leaving It remains an active forum for ongoing dialogue among
prison. civil society groups on grant implementation.
The submission date for the revised concept note was The NGO Forum also played an important role in
August 2015. The Technical Review Panel specifically helping to resolve challenges that civil society had
noted the appropriateness of the “street lawyers” experienced with Country Coordinating Mechanism
component of the removing legal barriers module. representation. Information was provided to forum
participants about the role of the Country Coordinating
To ensure a transparent and inclusive process Mechanism and Global Fund Country Coordinating
of responding to the Technical Review Panel’s Mechanism minimum standards and eligibility criteria.
comments and redrafting the concept note, the EECA A new election process for civil society members of the
Hub provided support for planning and facilitation Country Coordinating Mechanism was agreed to, based
of Kyrgyzstan’s 7th National Forum of AIDS Service on the principles of universality (everyone has a right to
Organizations, a key objective of which was to elect and be elected); free participation in the election
develop civil society responses to the Technical process; equity (equal conditions for all participants
Review Panel comments, thereby making it eligible in the election); equality (all electors have one voiceHow We Engage 15
evaluated equally); and confidentiality of votes. The In June 2016, the Alliance EECA Technical Support
election then took place based on representation Hub also provided additional technical assistance by
by key population constituency (people who inject supporting trainers in the delivery of peer-driven harm
drugs, sex workers, men who have sex with men and reduction services under the grant, with an emphasis
prisoners), instead of the previous process of selecting on reaching underserved people and linking them
representatives by region. The election resulted in more effectively to HIV testing and treatment.
two-thirds of society civil members on the Country
Coordinating Mechanism being replaced by new Kyrgyzstan’s experience strongly illustrates how
representatives. strategic investments in a wide range of technical
assistance can greatly enhance civil society
The final HIV/TB concept note for Kyrgyzstan was engagement in Global Fund processes, including
submitted in August 2015. Following a further round dialogue on concept note development,
of clarifications as requested by the Technical Review Country Coordinating Mechanism
Panel, the Global Fund Board approved the HIV/TB representation, grant implementation
grant for Kyrgyzstan in May 2016. and innovative peer-led approaches
to service delivery.
In November 2015, the Canadian HIV/AIDS Legal
Network provided additional technical assistance
through the Community, Rights and Gender Special
Initiative to prepare civil society organizations
for implementation of the community systems
strengthening/removing legal barriers modules, based
on the findings of the legal environment assessment.
The investments in
technical assistance have
been vital for us, absolutely
precious. It was very important
to invest in the dialogue process.
Even though it was painful at times,
the wounds are now healing so that we
can work together better than we did before.
Another big achievement is that the technical
assistance helped us to take our experience as
HIV activists and transfer some of that knowledge
to the TB community, which really lacked a voice. The
challenge for us now is ensuring that the Principal Recipient
implements the community systems strengthening/removing
legal barriers module as it appeared in the concept note, not
however they choose to do it. Further technical assistance would
really allow us to monitor and have more effective dialogue about how
the grant is actually implemented.
A leading community member in the country16 How We Engage
BENIN
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society engagement in
grant-making and monitoring
for the three diseases
Civil society organizations in Benin have and what it can fund remained somewhat limited.
Several organizations expressed the need for more
faced a wide range of challenges in targeted support in order to constructively influence
engaging with the Global Fund on areas the grant-making process and to play a more effective
role in grant monitoring and implementation.
relating to human rights and gender, in
part due to inadequate representation To address these challenges, after the concept note
was submitted, five nongovernmental organizations
on the Country Coordinating Mechanism in Benin submitted a joint request to the Global Fund
prior to 2015. Community, Rights and Gender Special Initiative
seeking technical assistance in two key areas. First,
Civil society organizations have also lacked capacity the organizations requested support for strengthening
to organize, advocate for and effectively implement attention to key populations, gender and human rights in
strategies at the local and national levels, especially with the implementation of new Global Fund grants. Second,
regard to overcoming legal barriers to HIV prevention they requested support for the further development of
and treatment services. Support provided through an alliance of stakeholders involved in the fight against
the Community, Rights and Gender Special Initiative the three diseases in Benin – the “National Health
in 2015 helped civil society organizations in Benin to Alliance” – that had been established in May 2015. The
address these challenges in the process of concept note aim of the alliance was to improve the visibility and
submission, as well as during the grant-making process. participation of civil society in the country’s HIV, TB and
malaria programs generally, and particularly to advocate
Benin submitted concept notes for HIV, malaria and for the needs of key populations.
TB in April 2015. Comments from the Technical Review
Panel were shared with the Benin Country Coordinating The technical assistance was provided by the Canadian
Mechanism in July 2015. While the Technical Review HIV/AIDS Legal Network and an independent consultant
Panel generally approved the concept notes and the knowledgeable about Benin who had expertise in
prioritized strategic investments, it noted that the community strengthening and organizing. The provision
country needed to place greater emphasis on key of technical assistance began in late June 2015 and
populations – including people who use drugs and was completed at the end of September 2015. In the
prisoners – and develop strategies to address gender- course of the technical assistance assignment more
based violence. than 30 organizations and individuals were consulted,
including people living with HIV, sex workers, people
Although civil society had participated in country who use drugs, prisoners, men who have sex with
dialogues prior to the development of the concept men, organizations working on gender-based violence,
notes, knowledge about the Global Fund, its processes youth organizations, lawyers, health professionals,How We Engage 17
organizations involved in governance and monitoring Both the government Principal Recipient and the
of public affairs, organizations working in health and nongovernmental Principal Recipient (Plan Benin) have
development, mutual health insurance organizations, advocated with the relevant authorities for prisoners to
UN organizations and several Global Fund Principal have access to condoms and for wider access to needle
Recipients in Benin, including Plan International and and syringe exchange and opioid substitution therapy. As
the National TB Control Program. In-depth reviews part of the technical assistance provided, the Canadian
of the original concept notes, Technical Review HIV/AIDS Legal Network produced a report summarizing
Panel comments, national strategic plans and legal outstanding key legal challenges and barriers to accessing
frameworks affecting access to prevention, treatment health care among people living with HIV, people who
and care for key populations were also conducted. inject drugs and people at risk of sexual and gender-
based violence in Benin, which serves as a reference for
As noted by the Technical Review Panel, the original future advocacy.
HIV concept note provided for only limited coverage
of harm reduction interventions for people who use The second component of technical assistance provided
drugs and a lack of comprehensive programming, for by the Canadian HIV/AIDS Legal Network focused on
example, in areas such as needle and syringe exchange, increasing key population and civil society participation
opioid substitution therapy, legal support, addiction in Global Fund processes through the development of
treatment, treatment and other services in prisons the National Health Alliance. The technical asssistance
and the involvement of drug users in programming. providers identified opportunities to expand
Limited attention had also been paid to rights- the alliance’s membership and expertise by
based approaches for people living with HIV, including key population groups, human
law reform, stigma and discrimination rights organizations, prison groups, health
and gender-based violence against service user groups and social science
key populations. Support from the and health research organizations
technical assistance providers that monitor access to
and discussions between prevention, treatment and
civil society groups, the care in the country. They
Country Coordinating also worked with alliance
Mechanism and the members to identify
Global Fund Country team priority activities, including
during the refinement of the acting as a watchdog to monitor
approved concept note and the implementation of Global Fund-
grant-making process resulted in a supported programs and undertaking
number of recommendations in the final advocacy to improve the quality of
technical assistance report, including the care and patient monitoring, address
need for further national dialogue on HIV and discrimination, promote law reform, increase
the law to address issues such as criminalization TB case detection and net use among vulnerable
of disclosure, legal aid, sensitization of health care and key population groups and tackle gender-based
providers and police. The technical assistance report violence. Capacity-building priorities for the alliance
recommended that provisions already in the concept and its members were also identified to increase
note – such as those relating to research on target understanding about issues related to harm reduction
groups, training of peer educators and advocacy with and human rights and to build skills in health policy
prison authorities for law reform – could be used to dialogue with government. Recommendations emerging
support such a dialogue. from the technical assistance assignment were shared
with local and international partner organizations that are
Acting on these recommendations, the government positioned to help the National Health Alliance grow and
Principal Recipient (Ministry of Health Programme move its agenda forward.
National de Lutte contre le SIDA) developed an entirely
new module during the grant-making process, focusing Benin illustrates how targeted technical assistance
on removing legal barriers. The module includes and support for civil society can have an impact on
activities such as legal assessments, trainings, dialogue programming for key populations at the grant-making
and support services benefiting people living with HIV, stage, well after an initial concept note has been
people who inject drugs and people at risk of sexual submitted to the Global Fund. Technical assistance has
and gender-based violence. The module is being also enabled civil society groups to organize themselves
implemented through two national nongovernmental to play a more effective and ongoing role in monitoring
organizations with prior experience in gender and the grant’s implementation.
human rights programming.18 How We Engage
G R E AT E R
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Engaging communities in
governance of a regional
malaria grant
The emergence of resistance to assist in case detection. Accessing populations who
live and work in remote areas is one of the major
artemisinin-based drugs in the Greater challenges for the initiative, and is increasingly seen
Mekong sub-region is regarded as a as vital to its success. These populations include
mobile and migrant communities, military groups
serious threat to malaria control and and workers in forestry, farming and mining whose
elimination efforts globally. livelihoods are often seasonal. They are often located
in difficult, forested terrain with extreme weather
Recognizing the need for an accelerated and well- conditions. Mapping these communities, assessing
coordinated regional approach to this challenge their needs and providing targeted and culturally
and following the lead of other partner efforts in appropriate services in their own languages has been
the region, the Global Fund awarded US$100 million an ongoing challenge throughout the course of grant
in 2013 for the Regional Artemisinin-resistance implementation.
Initiative (RAI), an unprecedented level of support
for a regional grant. Oversight of the RAI grant is provided by a Regional
Steering Committee that complements the work
The RAI covers five counties – Thailand, Cambodia, of Country Coordinating Mechanisms in the five
Viet Nam, Laos (People’s Democratic Republic) countries. The Regional Steering Committee focuses
and Myanmar – and involves collaboration between particularly on the “inter-country component” of the
ministries of health as well as many other partners. grant that supports activities in cross-border areas,
The funding supports national malaria control as well as surveillance, mapping, data sharing and
programs in expanding access to insecticide-treated coordination at the regional level. The committee’s
nets, malaria diagnosis, treatment, case detection membership includes representatives from the five
and surveillance, with a strong focus on eliminating participating countries’ ministries of health and other
malaria in areas where resistance is known to be stakeholders, including multilateral and bilateral
emerging, as well as surrounding areas at risk. The development partners, academia, the private sector
grant is supporting a number of innovative approaches, and civil society.
including cross-border malaria diagnosis and treatment
posts and targeted mass treatment campaigns. At the time the regional concept note was developed
in 2013, several country dialogue consultations were
Many of the interventions supported by the grant held in the participating countries, with a broad
depend upon the effective engagement and range of stakeholders, including implementing
mobilization of community-based networks of nongovernmental organizations, and the grant has
village health workers and health volunteers to been very focused from the outset on community-
distribute nets, perform community education and based approaches. Nevertheless, apart from civilHow We Engage 19
society representation on the Regional Steering Three formal meetings of the platform have been held
Committee, the initiative has not had a systematic since 2014. At its meeting in May 2016, participants
mechanism to engage with a broad civil society discussed strategies for stronger involvement with
constituency within the RAI countries and at the APLMA to promote the response to malaria as an
regional level. Strengthening the participation of opportunity to strengthen health care more generally
civil society groups in both the implementation and in RAI countries. They also discussed collaboration
governance of the RAI grant and in malaria control with the Asia Pacific Global Fund Advocacy Network
efforts in the Greater Mekong Sub-region more on campaigns related to the 2016 Global Fund
generally has therefore become a high priority. replenishment; explored opportunities for technical
To this end, the Regional Steering Committee assistance under the Community, Rights and
and the Global Fund Secretariat have supported Gender Special Initiative; agreed on a draft
the creation of a network (or platform) of civil funding proposal to the French 5% Initiative
society organizations involved in malaria in the to strengthen the platform’s work and
five countries participating in the RAI grant. The recommended increased civil society
platform is hosted by the Raks Thai Foundation, participation in the Regional Steering
which is based in Bangkok and which is engaged in Committee, a proposal that the
community-based health promotion, education and committee has approved.
other development activities.
The objectives of the platform include increasing
the national-level engagement of civil society
organizations around malaria in RAI-implementing
countries and strengthening civil society participation
in regional governance and dialogue mechanisms,
including the Regional Steering Committee and the
Asia Pacific Malaria Leaders Alliance (APMLA), which
engages heads of government in the fight against
malaria. The platform is also an important forum
for sharing experiences and lessons learned in the
implementation of community-based malaria
programs targeting hard-to-reach populations,
and serves as an accountability and
constituency engagement mechanism
for civil society representatives on the
Regional Steering Mechanism.
© The Global Fund / John Rae20 How We Engage
The civil society platform has identified a number of Discussions will begin in late 2016 about the future
successes and best practices in implementation of of the RAI malaria grant after the end of its current
the RAI grant, such as: improved coordination and term in 2017. If the regional approach is maintained,
communication between the government and other the civil society platform will hold consultations with
sectors; increased capacity of mobile health workers civil society organizations at the regional level to
to provide malaria services to forestry workers and ensure that they are closely engaged in the dialogue
miners; and effective integration of malaria and other process for the development of the next regional
health interventions in mobile clinics in some settings. concept note. The platform also aims to have strong
The grant is also effectively engaging migrant health civil society representation on the concept note
volunteers to provide health information in languages writing committee.
accessible to migrants and is helping to strengthen
health care networks at the village level. The RAI grant in the Greater Mekong sub-region is
making important contributions to malaria elimination
However, platform members have also identified some efforts and is implementing innovative approaches to
significant ongoing challenges. These include: lack expand interventions to high-risk and hard-to-reach
of data and mapping of at-risk populations; further populations.
sensitizing health centers to the needs of migrant
and mobile populations; improving community-
level health and treatment literacy; longer-term
follow-up of patients over the course of malaria
treatment; restrictions on civil society activities
in some countries; and increasing the capacity of
community-based outreach to provide testing and
treatment rather than just referral to health centers,
especially in cross-border areas. More attention is also
needed regarding integration of services, which will
require strengthening the capacity of village health
workers. The civil society platform and community
representatives on the Regional Steering Committee
also wish to see more attention paid to human rights
and gender issues, including structural barriers
for high-risk populations, such as the inability of
undocumented migrants to access health care, and is
advocating for more attention to these issues.
The civil society platform is a very
positive development for malaria programs
in the region. We are pursuing an increasingly
effective civil society-focused approach and
trying to strengthen the role of civil society
organizations in malaria implementation, recognizing
that they have a key role to play in community-level
service delivery. In parallel, the platform is enabling civil
society to increase its participation in the governance of the
grant at the regional level.
Amelie Joubert,
RAI Regional Steering Committee Executive SecretaryHow We Engage 21
© The Global Fund / John Rae22 How We Engage
THE REGIONAL
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P L AT F O R M S
Supporting closer
community engagement
with the Global Fund and its
processes around the world
The six Regional Communication and 4.
To support the development of strategic capacity
development initiatives.
Coordination Platforms established in
2015 and 2016 with funding provided
Each of the regional platforms is hosted by an organization
by the Community, Rights and Gender with extensive experience and deep networks among
Special Initiative are playing a valuable civil society organizations and communities in its region.*
Situation analyses or needs assessments conducted by
role in supporting closer community each platform have helped to ascertain knowledge gaps
engagement with the Global Fund and among civil society organizations and communities with
regard to the Global Fund, determine local technical
its processes around the world. assistance needs and further map the capacities of
regional partner organizations to provide technical
The regional platforms are tasked with a specific assistance. Results of the survey conducted by the
mandate within the Community, Rights and Gender regional platform in Eastern Europe and Central Asia,
Special Initiative and have four key objectives: for example, found that one of the biggest barriers for
civil society and communities seeking to access technical
1. To enhance knowledge of the Global Fund among assistance was the lack of capacity to develop technical
civil society and community groups in each region; assistance requests, highlighting the importance of long-
term capacity building beyond the process of Global
2. T
o coordinate with other technical assistance Fund concept note development. The survey undertaken
initiatives; by the regional platform for Anglophone Africa, hosted
through the regional organization EANNASO, found that
3.
To improve understanding of and help address key populations require extensive support to participate
technical assistance and capacity development gaps in Global Fund-related country dialogues and to
among civil society organizations and community undertake community monitoring of Global Fund grant
groups, and implementation.
* The six platform hosts are Eastern Africa National Networks of AIDS Service Organizations – EANASSO (Anglophone Africa); the International Treatment Preparedness
Coalition – ITPC-MENA) (Middle East and North Africa); APCASO (Asia Pacific); the EECA Consortium (Eastern Europe and Central Asia); Réseau Accès aux Médicaments
– RAME (Francophone Africa), and Centro Regional de Asistencia Técnica para Latinoamérica y el Caribe – CRAT (Latin America and the Caribbean).You can also read
