Summary

of Key Civil Society Recommendations Concerning the

Development of the Global Fund to Fight AIDS, TB and Malaria
Strategic Plan 2017-22
Introduction
In April 2015, ICSS and ICASO in collaboration with the Free Space Process1 hosted a
consultation involving regional and key population networks working in HIV, TB, and
malaria to begin defining the priorities civil society wanted to see in the new Global
Fund strategic plan 2017-2022.2 The meeting built on work done by other groups
including the Open Society Foundations (OSF), Women for the Global Fund (W4GF), and
the Eurasian Harm Reduction Network (EHRN). As follow-up to the initial meeting,
ICASO and ICSS participated in three partnership forums (Addis May 5-8, Bangkok June
22-25, Buenos Aires September 1-4) to further refine the key asks. The rich and
diverse comments from the consultations were summarized in a matrix3 and shared
with the Communities and NGO delegations to the Global Fund Board for their
deliberations in board and committee meetings. The matrix highlights the similarities
between regions about priority asks and the way certain themes were strengthened and
clarified over the course of the partnership forums and other consultations.
The Global Fund Strategy, Investment and Impact Committee (SIIC) coordinates the
strategy development process and prepares recommendations for board approval
based on input from the secretariat, technical working groups, consultations and the
partnership forums. The board will review and approve the vision, mission, guiding
principles strategic objectives and sub-objectives at its meeting in November. The
secretariat and relevant committees will continue to work to operationalize the new
strategy throughout 2016. At the April 2016 board meeting, the Global Fund will
approve the full 2017-2022 strategy, which should include the detailed implementation
plan. The corporate key performance indicators (KPIs) including baselines and targets
will be reviewed and approved at the November 2016 board meeting.
This paper recaps civil society priority asks and notes the areas that are not yet
reflected in the strategic framework. It also documents recommendations concerning
developing the implementation plan and defining KPIs to measure the success of the
strategy. Comments are grouped into six themes:

Human rights
Vulnerable and key populations
Women and girls and gender equity

Community Response and Community Systems

Strengthening (CSS)
Financing the Response
Middle Income Counties, Graduations and Transitions

The free space process (FSP) brings together 11 international organizations with a focus on key populations to enhance the quality,
cohesion and impact of advocacy and leadership on HIV. Based on their unique perspectives FSP partners presented a brief to the
Global Fund Board outlining seven strategic priorities concerning the new strategy. The letter is attached here (Annex 2).
2 Meeting report is available at: http://www.icaso.org/media/files/24010-SummaryCSAsksGFStrategyV60922.pdf
3 The summary matrix is available at: http://www.icaso.org/media/files/24010-SummaryCSAsksGFStrategyV60922.pdf and at
http://www.globalfundadvocatesnetwork.org/wp-content/uploads/2015/10/Summary_CS_Asks_GF_Strategy_V6_09.22.pdf.

1

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Human Rights

Over the course of the consultations, participants were in agreement that human rights
should continue to be a priority in the new strategy. They recommended, however, that
funding levels for human rights-focused programming increase, including through
programs targeting vulnerable and key populations4. In situations where legal barriers
exist to supporting key populations, participants advised the Global Fund to encourage
non-country coordinating mechanism proposals, regional grants, or the direct funding
of non-governmental organizations (NGO) working with key populations, as is done in
Russia. 5
Participants recommended the Global Fund develop additional guidance on how to
incorporate human rights analysis into the grant cycle and policy-making processes.
They also recommended capacity building on human rights analysis for the Secretariat,
the technical review panel (TRP), country coordinating mechanisms (CCMs), and local
fund agents (LFA). Promoting the rights of people living with disabilities was identified
as a human rights concern that needs to be embedded into Global Fund guidance.
The consultations noted that, while there is a KPI in the current strategy relating to
human rights, it would be better to have a KPI that specifically measures progress in
achieving the strategic objectives with respect to human rights and key and vulnerable
populations. This KPI should track and report on the actual investments made in these
areas.
The Buenos Aires partnership forum made specific recommendations to clarify the
wording in the strategic framework concerning human rights. See Annex 1 for the
August 2015 version of the strategic framework with recommended revisions. The
suggested changes concerning human rights are shown in sub-objective 3e.

Vulnerable and Key Populations

The August version of the strategic framework uses wording that explicitly calls for
evidence-based interventions for key and vulnerable populations disproportionately
affected by the three diseases. It makes this assertion in the same sub-objective which
calls for a focus on supporting countries with the highest burden and the least ability to
pay. (See sub-objective 1a in Annex 1). There is no indication which of these foci has
priority, but this issue will, no doubt, be a central concern when the board considers
changes to the funding allocation model.
Vulnerable and key population issues and concerns were highlighted throughout the
consultations. Many of the recommendations around KP are reflected under the
graduations and transitions and human rights headings. A few specific
recommendations not mentioned elsewhere include:

Key and vulnerable populations include sex workers, people who use drugs, men who have sex with men, transgender people,
women and youth and people living with HIV (See: The Global Fund Key Populations Action Plan 2014-2017 , p 5),
5 As a high-income country Russia is not eligible to receive funding from the Global Fund however the country is experiencing a
concentrated HIV epidemic in key populations, which are not able to access services through the state. To address this challenge the
Global Fund supports programming for vulnerable and key populations through a local NGO, Open Health Institute.

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 using and gathering disaggregated data (across the diseases and by key
population, age, gender and gender identity, acknowledging transgender people
as separate from men who have sex with men )
exploring non-traditional funding mechanisms for human rights and key
populations programming including a specific funding window with lower
bureaucratic overhead
addressing criminalization and other barriers used as excuses to not provide
services to KPs in some countries
making it mandatory for CCMs to monitor human rights violations and
discrimination of KPs in the context of Global Fund programs
confirming a desire to improve access to HIV services for transgender people
who are not acknowledged as a priority key population in many countries

Women and Girls, Gender Equity

The wording in the August version of the strategic framework has incorporated
recommendations concerning scaling up support for women and girls and making
investments to reduce gender- and age-related disparities in health. (See sub-objectives
3a and 3b in Annex 1). The consultation also called for stronger links to sexual and
reproductive health and rights (SRHR) to be included in the strategy, although this has
not yet been reflected in the framework.
Other longer-term recommendations provided by participants in the consultations
include:
developing institutional and Global Fund staff-level performance indicators on
gender equality
increasing the visibility of gender equality and women and girls issues in Global
Fund communications and advocacy materials
ensuring that gender- and age-disaggregated data is collected through the right
indicators to monitor the effectiveness of program outcomes for women and
girls
increasing investments in programs that address barriers women and girls face
in accessing information, education, support services
investing in programs that transform harmful gender norms and address
unequal power relationships
supporting the meaningful participation of womens groups in country-level
mechanisms and processes through sustained funding and technical assistance
These recommendations will need to be tracked in the implementation plan and KPI
development phases.

Community Response and CSS

Early versions of the strategic framework appeared to have community systems

strengthening (CSS) subsumed under health systems strengthening (HSS). Fortunately,
feedback from the Addis partnership forum and other consultations resulted in CSS and
the community response becoming a stand-alone sub-objective (2a). Having a specific

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reference to strengthening community responses and systems provides a window for

action on strengthening the role of the community response and CSS in the same way
that the three sub-objectives on human rights in the 2012-16 strategy provided impetus
for tools, policies, technical assistance, and KPIs on human rights.
Whether the same headway will be made on CSS and the community response remains
to be seen. The consultations made several recommendations on this topic including:
setting a specific funding target in each country for community and key
population lead activities including advocacy and watchdogging activities
developing better resources and tools to deepen country level expertise in the
community response and CSS
building the evidence to justify funding community responses and CSS and
provide focused capacity-building with governments to help them appreciate the
importance of a comprehensive, inclusive response
developing a KPI to measure improved community engagement in the responses
to the three diseases and a tool to quantify cross-cutting matters such as
meaningful engagement and investing in communities
developing KPIs that track scale-up of support to vulnerable and key populations
Participants in the consultations also noted that ongoing support is required to
strengthen the community response to the three epidemics. In particular, they noted
that investments in capacity-building for key populations through mechanisms such as
the Robert Carr civil society Networks Fund have proven to be invaluable in increasing
key population, gender equity and human rights programming and should be
maintained and expanded. Participants also noted the need for the Global Fund to
support the Community, Rights, and Gender team (CRG) and other key teams in the
secretariat they play an important role in enabling community engagement and
facilitating participation in country dialogue and program development processes.

Financing the Response Funding Model

The consultations were clear in their assertion that the Global Fund resource
mobilization targets for the next replenishment need to be ambitious. During the
Buenos Aires partnership forum, participants recommended an additional sub-objective
(4e), which makes it explicit that the Global Fund needs to mobilize and invest sufficient
resources to enable countries to transition successfully. This speaks to the principle that
leaving no one behind and supporting key populations in middle-income countries
should continue to be a priority for the Global Fund.
Most of the issues related to financing the response and the funding model were
captured in strategic objective 4: Mobilize increased resources and public goods for
health. The consultations noted that, while some of the sub-objectives are good, they
lack details and civil society continues to have concerns. For example, 4c: implementing
market shaping efforts to increase access to affordable quality assured key medicines and
technologies, is a good idea and should result in the Global Fund encouraging countries
to take advantage of TRIPS flexibilities. The implementation plan for the strategy will
need to be monitored to see how the Global Fund will actually implement the market
shaping sub-objective.

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The consultation generated several recommendations relevant to the review of the

funding model, which will be taking place at the board and committee level during the
coming months. Participants argue that the review of the funding model needs to done
transparently and based on a thorough assessment of the lessons learned from the
allocations model in place at the moment. The bottom line is that any changes should
improve access to service for key populations not diminish them.

Middle Income Counties (MICs), Graduations and Transitions

All of the consultations argued that the Global Fund should have an approach that
leaves no one behind. The focus on funding based on the World Banks gross national
income (GNI) classification was roundly rejected and the Global Fund was asked to
come up with another mechanism to determine eligibility. Participants in the
consultations called on the Global Fund to develop a transition methodology that
includes the following elements:
a transparent and thorough dialogue with all stakeholders to develop a country-
specific transition plan
a mechanism to monitor transitions to ensure compliance with agreed steps,
particularly concerning continuing support to key populations
a provision to reestablish funding in the event of changes in income, disease
burden, or human rights violations
The consultations also called on the Global Fund to put in place direct support to NGOs
so that they will be able to participate in country level policy dialogue throughout the
transition, develop the skills to access alternate funding sources, and monitor country
performance in the post transition phase. CSS is seen as central to ethical transitions.
The next version of the strategic framework will probably reflect strong messaging
concerning ethical transitions from Global Fund support, particularly given the input
from the Buenos Aires partnership forum. It will be important to monitor the
implementation plan to ensure that the recommendations concerning sustainable
transitions called for by civil society are included and put into operation.

Conclusion
Once the strategic framework gets adopted at the November board meeting, the
strategy development process enters a new phase. The partnership forums and multiple
consultation process have provided rich input into the high level framework and many
of the recommendations by civil society have already been adopted. The next phase,
during which the implementation plan and KPIs are developed, will be led by the Global
Fund Secretariat, with final approvals by the board in 2016. This paper has outlined
some of the recommendations that should find their way into the implementation plan
for the new Global Fund strategy and ultimately into KPIs. Strong advocacy on these
concerns will be carried out by the Communities and NGO Delegations to the board with
support as requested from the broader community. Both ICASO and ICSS are committed
to working throughout the next phase to ensure that civil societys inputs are reflected
in the final strategy.

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Annex 1: PF3 Suggested revisions to Draft Strategic Objectives August 2015

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Annex 2: Free Space Process Key Population Statement on the Global Fund Strategy

Observations, concerns and recommendations for the Global Fund Board considerations in the new Global
Fund Strategy development process
Dear Global Fund Board members,
With this letter the undersigned 11 global civil society and key populations networks would like to share some
observations, concerns and recommendations for your consideration in the new Global Funds Strategy
Framework development process. These recommendations are based on our participation in the Partnership
Forums and consultations that have been organized by some of our members and partners.
We commend the fact that key and vulnerable populations are now recognized in the objectives of the draft
Global Fund Strategy Framework as a focus for investments because it is clear that without a full and equal
partnership with these populations, we will never be able to move closer towards ending the AIDS and TB
epidemics.
It is important to note that key populations are called as such for a reason. Not because of any inherent
characteristic in their behavior or the way they earn a living, etc. but because they are vulnerable due to
pathologization, stigmatization, discrimination and criminalization. A substantial number of governments do
not even acknowledge the existence of key populations and deny the importance of protecting their rights and
addressing their needs in the response to the epidemics.
The Global Fund, in collaboration with key and vulnerable communities and technical partners, has a unique
role to play in addressing enforced punitive and criminalization laws as they represent a disabling environment
and a clear indicator of a countrys limited willingness to properly response to HIV, TB, and Malaria and the
needs of key and vulnerable populations in particular.
We note with great concern that while key and vulnerable populations are recognized at the highest strategic
level in the draft Global Fund Strategic Framework, we face at the same time pressure to limit the Global
Funds investments in Middle Income Countries where the majority of the people living with and affected by
the diseases live, where most poor people live and where concentrated epidemics among key and vulnerable
populations exist. The Global Fund must resist this pressure and protect its investments and the gains it has
achieved in the past decade.
In the last three years, we have seen increased engagement of key and vulnerable populations in Global Fund
processes at country level, which has often resulted in better representation of their needs in Concept Notes.
However, increased engagement at country level processes is not the same as increased recognition by
governments and did not prove to be a guarantee for funding allocations to these populations. This illustrates
the need for a continued effort, and sustained prioritization to achieve increased investments that actually
reaches key and vulnerable populations. In this context we also note the importance of building on existing
policy frameworks such as the Global Funds Key Populations Action Plan, its SOGI strategy and its Gender
Equality Strategy, and support of systematic use of the available range of key population implementation tools
(eg. SWIT, TRANSIT, DUIT and MSMIT).
Over the last couple of years we have seen a trend towards (re-)medicalization of the HIV response, which
falsely suggests that there are quick solutions to the complex and multilayered problems that require
addressing social determinants and inequalities fueling the epidemics. We believe that the Global Fund is
uniquely positioned to mobilize the multi-disciplinary partnerships needed at the global and country level in
developing comprehensive and inclusive responses in which evidence based, human rights based and
community based programming are core.

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Given what is at stake and the challenges we have identified, we believe that the Global Funds new strategy is
an essential tool in optimizing opportunities and moving towards ending the three diseases. We therefore
recommend the following:
1. Scale up is essential

We believe that the current draft Strategy Framework has the right elements but lacks ambition. We support
the Global Funds mission - Attracting, leveraging and investing additional resources to end HIV, tuberculosis
and malaria as epidemics and to support attainment of the SDGs - but it should be unequivocally clear that
this mission cannot be achieved without scale up in terms of investments, quality services and reach into the
communities. Wisely spent funds on the right, proven interventions for the most impacted populations will
help us in achieving greater impact. The ambition to scale up must be reflected in all Strategic Objectives of
the Strategic Framework.
2. The Global Fund urgently needs a Sustainability& Transition Policy

There is sufficient evidence by now that demonstrates how challenging if not outright harmful Global Fund
transitioning out of countries to date has been, especially for work that serves the needs of key and vulnerable
populations.
The Global Fund urgently needs to develop a Sustainability and Transitions Policy that clarifies the Funds
responsibilities regarding sustainability of programming, how the Fund protects gains made and prevents
waste of investments made in the last decade. In this context the Fund must assess the willingness of
governments to address the needs of key and vulnerable populations. Lack of such willingness will undermine
the sustainability of any response as well as successful transitioning. The principles and criteria of this policy
should guide the Global Funds future deliberations on the outcomes of the Equitable Access Initiative and
discussion on allocation approaches (and not vice versa).
Where transition out of countries needs to be planned for and supported, civil society and key and vulnerable
populations networks at global, regional and country level have a unique role to play in ensuring inclusion of
the interests of these populations through sharing of lessons learned, advocacy and watch dogging.
3. Strategic objectives must lead to increased funding

Lessons from the inclusion of human rights in the current Global Funds strategic objectives teach us that
although this represented a great opportunity for making progress in human rights based programming, it did
not translate into appropriate levels of funding at country level. The lack of clear Key Performance Indicators
(KPIs) that could measure the human rights strategic objective has proven to be a huge weakness in the
current Strategy. This mistake should not be repeated in the new Strategy.
We need KPIs that specifically measure progress in achieving the strategic objectives with regards to human
rights and key and vulnerable populations as well as the corresponding actual investments. In this context it
would also be helpful to link the strategic objectives that are related to human rights and key and vulnerable
populations with the grant management KPIs.
Where we have seen funds being allocated, we have often seen suboptimal levels of funding. Insufficient
funding leads to limited results, while there are at the same time high expectations. This undermines
outcomes and impact, and damages the fragile partnerships with key and vulnerable populations at both the
global and country level. We would like to show results, but for this we need adequate funding!

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4. Capacity needs to be strengthened

Increased funding must result in increased investments in capacity needs via grant agreements that include
community capacity to support ongoing key population engagement, addressing of human rights abuses and
violence, as well as community driven delivery of HIV, harm reduction, and related sexual health services.
To make this happen sustained investments are needed in the CRG team and their support to other Secretariat
divisions (including Country Teams and Fund Portfolio Managers). We have seen that Global Fund strategic
investments in CRG related Technical Support and civil society and key populations have paid off and strongly
recommend continuation of this targeted and focused funding in the future.
5. Better and safe data collection

To successfully implement the Global Funds new Strategy we need to strengthen the use of better,
disaggregated data (across the diseases and by key population, age, gender and gender identity,
acknowledging transgender people as separate from MSM) that are collected in a safe way e.g. that respects
human rights and confidentiality. Better data, in particular on key and vulnerable populations (through
capacitated engagement or even leadership of these populations), are essential in setting and monitoring
service targets and achieving better health outcomes.
6. Access to medicine and diagnostics

Access to quality, affordable medicines and diagnostics in general and for key and vulnerable populations in
particular, remains a key hurdle in achieving the desired health outcomes in many countries. Given the buying
power of the Global Fund, its central role in market shaping and influence on global procurement, the Fund
in close collaboration with UNITAID - must strengthen its support to countries to exercise full use of TRIPS
flexibilities.
7. A call on Technical Partners

The Global Fund will soon engage in the process of setting concrete targets and KPIs to concretize the
implementation of its new Strategy. We call on the Global Funds technical partners to support the Fund in
setting ambitious targets. In relation to key and vulnerable populations, the Fund and Partners should include
concrete and ambitious targets that encourage engagement of these populations in Global Fund processes at
country level, that drive enhanced investments in Community Systems Strengthening as well as scale up of,
and increased access to prevention and treatment services (including community based services) that actually
reach the communities.

Yours sincerely,
The Free Space Process partnership:
Ecumenical Advocacy Alliance (EAA)

International Community of Women Living with HIV/AIDS (ICW)

Global Action for Trans Equality (GATE)

International Council of AIDS Service Organisations (ICASO)

Global Forum on MSM & HIV (MSMGF)

International HIV/AIDS Alliance (the Alliance)

Global Network of People Living with HIV/AIDS (GNP+)

International Network of People who Use Drugs (INPUD)

Global Network for Sex Work Projects (NSWP)

International Treatment Preparedness Coalition (ITPC)

HIV Young Leaders Fund (HYLF)

International Civil Society Support (ICSS) FSP Secretariat

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