Joint input into the Global Fund Strategy Development from CEECA region

On September 1st the document named “Joint input into the Global Fund Strategy Development from key affected communities and civil society from CEECA region” was send to the Global Fund in a response to an earlier invitation from the Global Fund to join the Open Consultation to Inform the Development of its new Post-2022 StrategyStrategy.

Discussions were organized by the Eurasian Harm Reduction Association (EHRA) and involved key regional networks that unite key affected communities and civil society organizations working in the Central and Eastern Europe and Central Asia (CEECA) region. Initial focus-group discussion was held on June 25th during the Regional Partners’ coordination call organized by the Regional Civil Society and Community Support, Coordination and Communication Platform – Eastern Europe and Central Asia (EECA).

The resulting draft document was circulated for comments during August 2020 among the leaders of the following nine regional networks and organizations of civil society and key affected communities that unite hundreds of national community-based entities as well as civil society groups in 29 countries of the region:

  • Eurasian Harm Reduction Association (EHRA)
  • Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM)
  • TB Europe Coalition (TBEC)
  • Center for Health policies and Studies (Center PAS)
  • Alliance for Public Health (APH)
  • Eurasian Key Populations Health Network (EKHN)
  • AFEW International
  • Regional Expert Group on Migration and Health
  • Sex Workers’ Rights Advocacy Network (SWAN)
  • Eurasian union of adolescents and young people Teenergizer

 You may find the resulted document following this link: https://eecaplatform.org/en/joint-input/.

Addressing HIV and TB in Prisons, Pre-Trial Detention and Other Closed Settings

From EECA Regional Platform for Communication and Coordination

The new technical brief describes how HIV and TB interventions for people in prison and other closed settings can be incorporated into funding requests to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund supports evidence- and rights-based interventions aimed at ensuring access to HIV and TB prevention, treatment, care, and support for key populations, including people in prison.

Global Fund resources should be used to fund interventions that are in line with internationally agreed standards and technical guidance and have a significant impact on the HIV and TB epidemics in a country. Global Fund policy requires upper-middle income countries to focus 100% of their funding on programs benefiting key and vulnerable populations, lower middle income countries must demonstrate that 50% of funding is focused on the same. Low-income countries are also strongly encouraged to target resources to those at highest risk. Global Fund resources can also be used to advocate for laws and policies that enable an effective human-rights-based HIV and TB response and the removal of policies and laws that present obstacles to this.

  • Section 1 of this brief outlines the vulnerability of people in prison to HIV, TB, viral hepatitis and other infectious diseases. 1 UNAIDS (2015). UNAIDS Strategy 2016-2021. 2 WHO (2016). Global Health Sector Strategy on HIV, 2016-2021. 3 WHO (2015). WHO End TB Strategy. 4 Global Fund (2015) Global Fund Support for Co-morbidities and Co-Infections
  • Section 2 outlines guiding principles for designing and implementing programs.
  • Section 3 outlines the comprehensive package of interventions for HIV, TB, and other health issues recommended by WHO, UNODC, and other partners.
  • Section 4 describes approaches to incorporating prison harm reduction programs within funding proposals, and the health components and strategies for an enabling environment that should be included.
  • Section 5 offers examples of promising practices from around the world.
  • Section 6 lists further publications that may be of assistance in compiling proposals, as well as for technical support in programming. Publications on specific areas are also mentioned throughout this brief and referenced in the footnotes.

The technical brief is available following this link>>>.

Global Fund support for fighting COVID-19

The Global Fund, the largest multilateral funder of health systems worldwide, is providing immediate funding of up to US$1 billion to help countries fight COVID-19, mitigate the impacts on lifesaving HIV, TB and malaria programs, and prevent fragile health systems from being overwhelmed, through grant flexibilities and the COVID-19 Response Mechanism.

 

Grant flexibilities, announced on 4 March 2020, allow countries with current grants to: 1) use up to 5% of their current grant value if there are savings, and/or 2) reprogram up to 5% of the value of a grant to meet immediate COVID-19 response requirements. Repurposing equipment already purchased through a Global Fund grant is also an option to respond to COVID-19.

Total available funding for flexibilities is up to US$500 million. As of 5 May 2020, funding has been approved for 73 countries and five regional grants for a total of US$109 million. Among them Albania got US$80,400 of support, Kosovo EUR 91,733 and Romania EUR 316,255. This information is updated regularly through the Situation Reports on the Global Fund website. Eligibility: Countries and multi-country grants with current grants from the 2017-2019 allocation period.

Application process: For the use of savings and reprogramming, the Principal Recipient issues a request to the Global Fund’s Fund Portfolio Manager. Preferably, it is endorsed by the CCM. The Global Fund responds within five working days.

The request should include a brief budget, describe the activities to be funded, how it will fit into the national response, and outline potential consequences to and mitigants for HIV, TB and malaria programming.

Implementation: Global Fund financed activities must be implemented by an existing Principal Recipient (and/or existing Sub-Recipients). The main investment categories are (a) protecting Global Fund disease program against negative impact of COVID, (b) direct responses against COVID, and (c) address immediate gaps in health and community support systems. Guidance on eligible activities is available on the Global Fund’s website.

Funding Source: Countries can use savings or reprogram current grants, up to 10% of the grant value.

More information is available here>>>.

 

The COVID-19 Response Mechanism (C19RM), approved in April 2020, authorizes US$500 million in funding in addition to grant flexibilities. C19RM can be used across the three diseases and the health system, even if a country only has a single Global Fund grant for one component. The CCM will assess the most urgent needs and direct activities through one or more of the principal recipients.

Total available funding: USD$500 million, initially. Public and private donors are able to direct additional resources to the Global Fund through C19RM to scale up the COVID-19 response and support systems for health across the grant portfolio.

Eligibility: Countries with a Global Fund allocation for the 2020-2022 period can access an amount equivalent to up to 10% of their allocation. This ceiling includes the use of savings and reprogramming under existing grants.

The immediate additional amount of funds available for each country is 3.25% of the 2020-2022 allocation period, provided the country has not yet used savings and reprogramming exceeding 6.75% of this allocation.  Application Process: The application is submitted through the CCM or the regional coordinating mechanism preferably by 31 May and no later than September 2020 so that emergency funding can reach countries as soon as possible.

The funding request is divided into two parts:

  • Priority 1 for the most urgent activities. This is capped at 3.25% of the 2020-2022 country allocation. The Global Fund will respond within 10 days to this request.
  • Priority 2 for supplementary interventions. This is capped at 10% of the 2020-2022 country allocation minus the amounts already requested for C19RM Priority 1 and approved grant flexibilities/reprogramming. These supplementary requests could be awarded later if more funds are made available.
  • All applications should demonstrate that an inclusive engagement with civil society and key affected populations took place to formulate the demand. C19RM funds are additional and will not be deducted from the 2020-2022 allocation. Funding must be fully utilized by June 2021.

Instructions to apply can be found here>>>.

Implementation: C19RM funds must be implemented through an existing country grant and principal recipient, regional and multi-country grants. It can be used for three areas, to:

  1. Mitigate the impact of COVID-19 on current HIV, TB and malaria programs.
  2. Reinforce the national COVID-19 response
  3. Invest in urgent improvements in health and community systems

 

Global Fund allocation of additional funding

The Global Fund Board has approved in February additional funding for portfolio optimization, funded from the Register of Unfunded Quality Demand (UQD), in the amounts of 135.666,553 USD and 25.693.664 €, for 28 grants in 23 countries. The funds come from 650 million USD approved by the Audit and Finance Committee for portfolio optimization to fund high-impact interventions from the Register of Unfunded Quality Demand, linked to grants in the 2017 – 2019 funding cycle. The additional amounts will be integrated into the 28 existing grants through grant revisions that increase each grant’s upper-ceiling amount.

Also, The Global Fund Board has approved the Secretariat’s recommendation to allocate 43,3 million USD in additional funding to several countries and grants including Kosovo (HIV/AIDS). These additional funds come mostly from unutilized funds within grants, often because of countries’ lower-than anticipated rate of funds’ absorption. In addition to previously approved program budget of 1.445.502 €, recommended additional funding is for 112.010 €.

The additional 112,010 will support Kosovo’s HIV grant, specifically activities to reduce human rights-related barriers to HIV services, community responses, and systems for social mobilization, building community linkages, collaboration, and coordination. These funds will also pay for capacity building for community health workers.

The Principal Recipient for Kosovo is the Community Development Fund.

Global Fund response to COVID-19

Extract from the Global Fund Note on COVID-19

The escalating COVID-19 coronavirus pandemic is changing the way that we live and work. The Global Fund is adapting to the rapidly changing circumstances, to remain focused on:

  1. Maximizing impact from the current grant cycle, and
  2. Working with partners for the timely submission of high-quality grant applications, along with strong Prioritized Above Allocation Requests.

In the Guidance Note on Responding to COVID-19, the Global Fund underlined that

The Global Fund strongly encourages countries to consider and take prompt action to mitigate the potential negative consequences of COVID-19 on existing programs supported by Global Fund grants. Particular attention should be given to health worker protection, communication to affected communities, maintenance of essential services, supply chain coordination, early replenishment of stocks, disinfection of assets, waste management. Related costs may be approved by the Global Fund as eligible expenditure.

To give countries further flexibility in responding to COVID-19, the Global Fund will consider, subject to prior approval:

  • Timebound reprogramming of savings under existing grants (up to a limit of 5% of total grant value) and/or;
  • Redeployment of resources procured through existing grants, particularly infrastructure and capacities that become under-utilized because of COVID-19.

 Eligible activities include, but are not limited to:

  • Epidemic preparedness assessment;
  • Laboratory testing;
  • Sample transportation;
  • Use of surveillance infrastructure;
  • Infection control in health facilities;
  • Information campaigns.

 Where there are no savings possible in existing grants or in other exceptional circumstances, an existing grant may be re-programmed up to an additional limit of another 5% of its total value.

The Global Fund constantly monitors COVID-19 developments and is working to adapt its guidelines accordingly. Further updates will be issued in the coming weeks. Visit their website for the latest information following this link>>>.

 

Strategic planning to improve sustainability of HIV prevention services

The Alliance for Public Health engaged a group of experts to perform a brief assessment of the latest experiences in the Serbia on financing civil society organisations with national funds, including the Global Fund national grant, and to plan on the national level for the sustainability strategy and concrete steps.

The experts visited Serbia from 16 to 20 December and held a serial of meetings with the Ministry of Health, Ministry of Youth and Sports, Health Insurance Fund, CSOs and other stakeholders. At the last day of the mission, the concluding stakeholder consultation with presentation of preliminary findings was conducted.

The visit was organized by DPNSEE member organization Timočki omladinski centar, who is the national lead of the multi-country project implemented by the consortium led by the Alliance. Representatives of DPNSEE and our other member organisations Prevent and Duga also contributed at the meetings.

Global Fund 2020 Eligibility List

The Global Fund have just published their 2020 Eligibility List and the updated Projected Transitions List. Some of the changes are related to South East European countries.

Since Bulgaria and Romania are not on the OECD DAC list of ODA recipients, they may be eligible for an allocation for HIV for non-governmental or civil society organizations under Paragraph 9b of the Eligibility Policy only if they have demonstrated barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology. As 2020 is an allocation year, the Secretariat has conducted an assessment and has determined that Bulgaria and Romania don’t meet the requirements under Paragraph 9b of the Eligibility Policy. Therefore, they have been determined not to be eligible for an HIV allocation for the 2020-2022 allocation period.

Kosovo* was classified as an Upper-Middle Income country in the 2019 Eligibility List based on the latest three-year average of GNI per capita data (Atlas method). As a result, the HIV and TB components may be eligible for an allocation of Transition Funding in the 2020-2022 allocation period.

North Macedonia‘s HIV component is now classified as eligible in the 2020 Eligibility List after meeting eligibility criteria for two consecutive eligibility determinations, noting that eligibility does not guarantee an allocation.

Montenegro and Serbia remain eligible for HIV and Romania for Tuberculosis.

 

The 2020 Eligibility List is now available on the Global Fund’s website>>>

The projected transitions list is available following this link>>>

 

Our initiative presented at the Global Fund Board meeting

The Developing Country NGO Delegation at the Global Fund published a statement with the 42nd Board Meeting highlights, including 8 important matters they pushed for at the meeting, with ways that civil society can move them forward. The statement is available following this link>>>

The initiative of the three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe to respond to the critical situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania was among the issues that the Delegation raised at the Global Fund Board meeting. It is mentioned in the point 4 of the statement:

Addressing civil society concerns: The Developing Country NGO brought to the Board and bilateral meetings concerns raised by civil society organisations including those by nearly 100 NGOs about the ending of multi-country grants in West Africa; cases of the failed transitions and interruption of services for key populations, including the lack of funding for harm reduction programs in Albania, Bosnia and Herzegovina , Romania and Bulgaria; and exploring next steps to ensure access to health services, treatment and care in Venezuela.

We hope that the Global Fund will make some concrete steps in helping us find a quick response to the urgent needs and building a sustainable solution in these countries.

 

Emergency situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania

The three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe were informed by our members organisations about the situation with sustainability of  harm reduction services in Bosnia Herzegovina which is characterised by lack of strategy, policy and funding caused by the delay in establishing national Government for more than a year after the elections, withdrawal of international donors and misunderstandings and low level of cooperation between the governmental institutions and civil society, but also inside the civil society sector providing harm reduction services. The national Strategy for prevention and control of HIV and AIDS has ended (2016) and the Transition plan, developed by the Country Coordinating Mechanism during implementation of The Global Fund funded programme has not been implemented. As a result, the harm reduction services are closed in Sarajevo, Mostar, Bihać and Banja Luka and exist only in Zenica and Tuzla relaying on voluntary work of unpaid Staff and with all supplies already on minimum.

The three Networks expressed our deep concern about the situation and willingness to give contribution to finding solution and ensuring both quick response to the urgent needs and building a sustainable solution. We are ready to provide non-partisan support in identification and advocacy for the best possible approaches to urgently start provision of services to the populations of people who use drugs, sex workers and prisoners and other affected populations and to properly advocate for the sustainability of governmental funding.

The urgent action we are taking is to explore opportunities for emergency bridging funding to ensure survival of existing harm reduction services in the country. The situation is alarming and requires direct action and mobilisation of the international community. The three network have limited resources, so we are now contacting some of our partners and donors, explaining the situation and calling for immediate and urgent support. This could include short-term funding and technical support to ensure a minimum of harm reduction services. So far, we have a promise from the Open Society Foundations for a small grant which would cover basic need for the month of November.

We plan to develop and implement a comprehensive process to achieve sustainable long-term solutions. The activities for long-term solutions target local governments and policy-makers with the aim to ensure sustainable funding for harm reduction services. We already offered our expertise and support in this process, In addition, we would like to engage and involve other relevant stakeholders, such as donors and funders.

As the first concrete long term action we decide to send an appeal to the Global Fund to review their eligibility model of supporting middle income countries, besides Bosnia Herzegovina also Albania, Bulgaria and Romania.

In advance of the upcoming 42nd meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) as well as the Global Fund Regional Meeting for Eastern Europe and Central Asia to take place in Istanbul on 26-27 November, 2019, we – civil society and community organisations and networks working in the Eastern Europe and Central Asia (EECA) region for the benefit of key affected populations, including people who use drugs – would like to express our profound concern as to the current lack of sustainable harm reduction services in the South East European countries of Albania, Bosnia and Herzegovina, Bulgaria and Romania, respectively. Taking into consideration the successful results of the recent Sixth Replenishment Conference, we would like to invite the Global Fund to safeguard a part of the catalytic investment funds available for the 2020-2022, including multi-country grants, matching funds and strategic initiatives, in order to sustain life-saving services for people who inject drugs and other vulnerable groups and to incentivise domestic investment in harm reduction in each of these post-transition countries.

41 civil society organisations from Eastern Europe and Central Asia supported the letter. We hope that the Global Fund shall understand the situation and support our proposal.

The letter to the Global Fund is available following this link>>>

 

Transition from Global Fund support to national funding: role, opportunities and priorities for civil society in Albania

Source:

The workshop “Transition from Global Fund support of HIV and TB programs to national funding: role, opportunities and priorities for civil society in Albania” took place in Tirana, the capital city of Albania, on 23 – 24 of October and gathered 29 participants including civil society representatives, CCM members, representatives of the Global Fund CRG Team and CCM Hub (online), experts from neighbouring countries and representatives of the governmental structures.

Albanian HIV and TB components became ineligible for regular funding after the 2014–2016 allocations were announced and therefore Albania became eligible to receive transition funding. It will receive a three-year transition grant within the 2017-2019 allocation period. This transition grant is expected to start in January 2020 and will be a significantly lower level of investment—about one third the value of current Global Fund grants. The implementation of the current Global Fund HIV and TB grant is ending in December 2019.

According to the estimated annual needs to sustain HIV and TB responses prior to submitting the transition grant request, Albania’s needs approximately US $3 million to address its two epidemics effectively. Hence US $9 million is required over 2020-2022, the three-year period of the transition grant. With an allocation of just under US $6 million within the current HIV and TB grants, roughly 60% of the funding need is currently being met. Without significant increases in domestic funding, the funding gap is expected to grow in the coming years. Moreover, the services for key affected populations (KAPs) are largely implemented by civil society. Their scale, quality and delivery models are to be improved under the new transition grant. So far, these services have not been funded from domestic resources, though there is an office for civil society and general funding for civil society groups in the country. The national strategies on HIV and TB are expiring in 2019. The Global Fund, under its pilot ‘CCM Evolution Project,’ supports Albania’s HIV and TB governance reforms although with no clear outcome so far.

Community and civil society advocacy is critical at this conjunction of processes to ensure sustainability of the response. But at the same time the transition Funding Request 2020- 2022 poses a direct challenge to the services provided by NGOs being sub-recipients of the Global Fund grant. It is expected that starting from 2020 the number of NGOs supported by Global Fund will become twice lower, decreasing from 12 to 5. It is not clear what happens with the activities implemented by those 7 NGOs left behind and which exactly NGOs this will be.

Taking this context into account, the Eurasian Harm Reduction Association (EHRA) in coordination with the Global Fund Secretariat, decided to organize a workshop for civil society and community representatives in Albania. The workshop aimed to help improve the understanding of local civil society representatives involved in the country’s HIV and TB responses, of the Global Fund transition-related processes currently taking place in country and also to stimulate ideas, plans and opportunities for their meaningful engagement into such processes to ensure the sustainability of HIV and TB response among key affected populations in Albania.

The participants first heard the information about the steps being taken by the government to prepare for transition of HIV/TB prevention interventions from the Global Fund’s support and also about the transition-related risks for HIV response and civil society services. Representatives of the Ministry of Finance and Ministry of Health updated the participants on the work being done to secure funding and social contracting from national and local authorities including on the public budget cycles, possibilities to advocate and influence the budget at central and local level. Guest activists from North Macedonia and Montenegro shared their lessons learnt from the transition experiences of their countries with regard to budget advocacy efforts being taken by civil society in these countries to sustain HIV response among KAPs. The representative of the Agency for Support of Civil Society informed the participants about the opportunities of funding available for NGOs, including those related to public health. On the second day of the event the participants also had the opportunity to discuss and plan the advocacy steps need to be taken by civil society in nearest future to ensure the sustainability of services for KAPs as well as to discuss their Global Fund related TA needs and plan the possible content of the potential requests for the support within the Global Fund CRG TA Program.

DPNSEE President Vlatko Dekov presenting lessons learnt from North Macedonia

Genci Muçollari, Executive Director at DPNSEE member organisation Aksion Plus who participated in the workshop, thinks that “It was an interesting workshop though we were expecting high level presentation from the GF and the Ministry of Health and Social Protection (MHSP). World Health Organisation representatives were attending, other NGOs as well. Above all discussions among partners, the role of the MHSP and the Albanian government is very important to ensure a gradual transition from Global Fund to state funds through social contracting and other ways of contribution both in money and in kind to programs and activities covered before by GF. The workshop organizers presented some of the funding opportunities from other regional donors and call for proposals in order to support activities after the GF.

The event was organized by the Regional Platform for Communication and Coordination for the EECA Region, hosted by Eurasian Harm Reduction Association (EHRA).