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Less global funds, more problems
Gonzalez, Open Society Initiative of Southern Africa (OSISA)
May 10, 2012
Fund medicines or fund the programmes that support uptake and adherence?
That's the choice countries are now facing amid Global Fund shortfalls.
With money tight, countries are slashing civil society-led HIV and
TB programmes - treatment supporters, community-based volunteers,
support for people living with HIV - to safeguard essential
services, according to preliminary research being conducted by the
Open Society Foundations.
In November 2011, the Global Fund to Fight AIDS, TB and Malaria
faced US$2.2 billion in unpaid donor pledges and cancelled its Round
11 of funding. This was the most dramatic manifestation of years
of broken donor promises.
Two years earlier, Global Fund donors reneged on almost 15 percent
of pledges - a figure that rose to almost a quarter of donor
pledges in 2010, according to former Global Fund Executive Director,
Michel Kazatchkine's November 2011 report to the board.
To ascertain the impact on civil society of these Global Fund shortfalls,
OSF undertook research in three countries that had planned to apply
for Round 11 funding - Swaziland, Malawi and Zimbabwe.
Through interviews with nearly 45 representatives from civil society,
Global Fund Country Coordinating Mechanisms (CCMs), HIV and TB programmes,
and UN agencies, OSF found that these countries are facing funding
gaps for essential services such as HIV and TB testing and treatment,
prevention of mother-to-child transmission services (PMTCT), and
support for orphaned and vulnerable children (OVC).
The research found that to free up funding for these initiatives,
all three countries are cutting the kinds of complementary, civil
society-led activities identified as 'critical enablers'
in the UNAIDS Strategic Framework.
Swaziland has now halted HIV prevention programmes with the exception
of PMTCT and medical male circumcision and may re-programme phase
II of its current Global Fund money to shift more money towards
buffer ARV stocks, according to Vusi Nxumalo, CCM member and Vice
Chairperson of the Swaziland National Network of People Living with
HIV and AIDS.
Swaziland's Round 11 application - like that of Namibia
- would also have been the first to include HIV prevention
programming aimed at criminalised, most-at-risk populations, such
as sex workers and men-who-have-sex-with-men. In addition, the country
would have addressed the needs of its small population of injecting
Malawi and Zimbabwe have already cut CSO activities under their
Phase II renewals to shift money towards medicines, HIV testing
kits and PMTCT.
For example, Zimbabwe's recently approved Round 8, Phase II renewal
has slashed funding for behaviour change communication in communities
and schools by 54 percent; institutional capacity building and strengthening
of PLWH networks by more than a quarter (27 percent); and OVC support
by almost a fifth (17%) - all without consulting CSO implementers.
"The removal of behaviour change communication is not justified,"
said Joyce Siveregi, deputy director for programmes at the Zimbabwe
It's not the first time that countries have had to cut CSO programming
to preserve drug stocks and diagnostics.
In 2009, the Global Fund mandated a 10 percent 'efficiency
gain' in Round 8. Unpublished OSF research found that during
grant negotiations, most countries felt resources for commodities
such as medicines, lab equipment and infrastructure could not be
reduced. Instead, gains were achieved by decreasing resources devoted
to programmatic components primarily implemented by CSOs, such as
information, education, and communication materials and campaigns,
prevention activities, and outreach services targeting marginalised
and vulnerable groups.
Under OSF's current research, about 80 percent of CSOs said organisational
funding had declined in the past two years, with several, longstanding
organisations citing funding cuts of up to 30 percent.
To cope, CSOs have scaled back or cut both staff and the kinds of
programmes they were forced to cut in 2009 - most prominently,
community systems strengthening, human rights and/or community mobilisation
Ironically, respondents reported that community-based organisations,
including those comprised of PLWH, were among the types of CSOs
"These are not organisations that are going to be supported
under the Transitional Funding Mechanism," Vusi Nxumalo told
OSF. "We are losing the community structures that we've built
up. If there comes a time when there is more money for HIV, we're
going to have to go back into communities and build these structure
all over again."
Now that the Global Fund has announced that it has US$1.6 billion
available to begin investing in new programmes, it needs to prioritize
investments in the communities it was set up to serve.
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