This case study has been prepared by MPact to analyze community approaches used to increase meaningful engagement in Global Fund processes to ensure access for key populations.
Being implemented in 23 countries and across 6 regions, the Global Fund (GF) technical assistance program aims to increase meaningful engagement of Key Populations communities in GF processes through a series of community meetings and consultations/training workshops; peer-to-peer coaching; tools development; watch-dogging HIV program implementation; facilitating partnerships between community actors and national decision makers; and integrating human rights-based strategies into national AIDS plans.
This program aims to achieve:
- Well-supported key population membership on County-Coordinating Mechanisms (CCMs);
- Stronger community engagement in concept note development;
- Development and implementation of HIV-related programs tailored to the needs of gay men and other men who have sex with men, transgender people and other key populations;
- Ongoing monitoring of Global Fund-funded program implementation to ensure alignment with normative guidance issued by UN agencies, including the WHO; and
- Transition and sustainability readiness.
The following summary was the result of in-depth questionnaires, interviews, and reviews with our partners at APCOM in the Asia-Pacific region.
In April of 2019, APCOM hosted an Inter-regional Dialogue on the Global Fund’s Sustainability, Transition, and Co-financing (STC) Policy. Prior to the meeting, they developed a Factsheet on Global Fund STC Policy and the World Bank Transition Checklist. Both aimed to increase gay, bisexual, other men who have sex with men (MSM), and transgender people’s knowledge of and preparation for STC.
The Factsheet breaks down the salient information from the Global Fund STC Policy including defining sustainability, transition, and co-financing, key population challenges, and targeted actions for civil society engagement in STC processes to ensure they are not left out or behind. Several mini-case studies complement materials. Prior to this document, there was no distilled information available on STC for many grassroots community activists in the Asia Pacific region. The Factsheet has proven a useful tool for APCOM during workshops and meetings, and in discussions around STC, and has been disseminated widely on Facebook, the APCOM website, through their newsletter, and by demand from partners. It was originally developed in English but, recognizing the need for community members to break the language barrier and ensure widespread access and understanding, it is translated into Khmer, Bahasa, Nepalese, Vietnamese, and Burmese. Community networks in these countries have used it as a tool to engage with their CCMs and identify new STC activities.
The 2-day Inter-regional Dialogue was held in Bangkok, Thailand, to discuss more specifically what STC means in relation to Global Fund grants in respective countries. Participants from Cambodia, Nepal, Indonesia, and Viet Nam attended, including one community partner, one principal recipient (PR) representatives, and one CCM member from each country. Fifteen other global and regional stakeholders (from EECA and MENA) and key population network representatives, CRG department representatives, and MPact staff attended to lend support, answer questions, and hear more about community concerns. The event’s purpose was to review community HIV financing and provide a space to discuss the current state of key population and CCM understanding of and engagement with STC, towards next steps.
Materials used during the workshop included presentations, the Factsheet, and the Global Fund STC Policy – the latter two circulated to participants prior to the meeting. It became increasingly clear during the first day of the workshop, however, that participants all had different interpretations of STC depending upon their position and the stage of their country’s transition process. At the community level, some had no knowledge of STC at all, limiting their ability to engage in workshop discussions as well as disqualifying them from managing sub-grants under their national programs. Therefore, the first day of the workshop was mostly presentation and panel discussion to explore the concepts of STC as defined by the Global Fund and used in policy. Of importance was explaining that sustainability alone is not STC, but that all three concepts are intimately interlinked. This segued into a further discussion raised by participants about the technicality of Global Fund terminology, which challenges translation into local languages for greater comprehension.
The second day entailed mostly in group work, divided by, and responding to the three S-T-C components. During the last session of the workshop, participants produced a minimum standard requirements checklist to help during discussions around STC in the region and at the national level. All participant perspectives were included, and the final checklist was provided to the Global Fund CRG and respective Fund Portfolio Managers (FPM). Unfortunately, there has been little response from within the Global Fund.
One of the lessons learned in developing the Factsheet was that the involvement of key stakeholders is important for local buy-in and application of recommendations. Engagement can come through interviews (key populations, partner organizations, CCM members), mini-case studies and stories, and other methods. In this way, information on good practices and lessons learned can better inform complementary peer processes in other countries. Further, developing documents such as this one must be viewed as a piece of the process, not an end result. Based on Factsheet recommendations, APCOM is working with their members to map risks, challenges, and strengths towards improved STC responses.
At the workshop, while participant selection seemed logical and ensured diverse perspectives, it proved challenging to balance the power dynamics between the three national cohorts (community, CCM, PR) to ensure that community had a voice. In the end, despite the challenges, and with good facilitation, it proved beneficial. It was clear that different perspectives enable greater comprehension and empathy for discrete roles, greater mutual understanding of how the Global Fund works, and networking between country stakeholders for future collaboration and communication. Further, having other regional network representatives participate and share their experiences was beneficial to create opportunities to build relationships, collaborations, and broader cross-learning.
A further lesson is to anticipate that STC is an emotionally charged issue. During this workshop, the CCM representatives expressed the most concern about STC. This stemmed from confusion over the transition timeline, and fear over implications if transition failed. “Questions raised included whether there was an emergency fund if failure occurred to help pick up the pieces and start again,” notes Inad Rendon, Program Manager for APCOM and workshop facilitator. Of note, in Asia, CCMs form in many ways, and composition, selection criteria, and functionality are diverse. It is an acknowledged difficulty for stakeholders, especially community members, to look for suggestions from other countries because they often do not apply to their CCM processes, even though the purpose of CCMs in relation to national grants is the same.
A key takeaway from the workshop was that everyone should be “treated as a blank slate,” says Inad. In other words, it is advisable to not assume that “people know everything, or even anything.” A good practice is to simplify all information presented “as much as possible to ensure a common baseline understanding. This is the first step towards effective community engagement.” Later, information can always be augmented. It is further necessary to ensure that “communities are aware of key population networks in their countries and regions, and how to access information and resources on happenings related to STC within the Global Fund, PEPFAR, and the World Bank.”
During the workshop, it was noted that organizations needed to be more strategic about identifying and engaging with national organizations working in TB and malaria, as HIV is not a disease in isolation. The joint efforts of communities representing the three diseases is a more powerful voice for change.