Global Fund and COVID-19: Implications for Key Populations

MPact is closely following developments regarding COVID-19, and particularly its impact on gay, bisexual and other men who have sex with men. MPact has provided short info notes with resources on a variety of topics, including: tips for LGBTI advocatessex and sexual healthstaying healthy under physical distancing and self-isolationtips for health professionals serving LGBTI communities during COVID-19; Human Rights Advocacy & COVID-19: Considerations for LGBTI Advocatesa joint statement with UNAIDS on discrimination in the age of COVID-19 and Inclusion of LGBTI People in COVID-19 Response Efforts. Stay tuned for updates and check out all our resources on COVID-19 here.


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The COVID-19 pandemic has changed every facet of our world. We are only just beginning to understand how this will impact the communities we serve, including the ability to receive funds from multilateral and bilateral institutions such as the United States President’s Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB and Malaria (the Global Fund or GF). MPact is committed to regularly informing partners during this rapidly evolving situation by providing up to date information about key decisions made by these two main funders in the global response to AIDS, Tuberculosis and Malaria.

Both PEPFAR and the Global Fund are aware of the extraordinary challenges that countries are facing due to the COVID-19 pandemic. The impact of the virus is widespread; however, individuals from marginalized or disadvantaged groups who already experience poorer outcomes in healthcare are often disproportionally affected by the wider implications of the pandemic. Prevention and rapid containment of COVID-19 is a priority in order to minimize the negative impact on health systems, as well as services for people living with HIV (PLHIV) and people who need HIV prevention services, especially key populations (KPs). As such, the COVID-19 pandemic has significant implications for programs that the Global Fund supports. This action alert summarizes how the Global Fund is responding to COVID-19 and advises KP on what they can do to access funding to ensure KP programming remain in focus and what to do if KP concerns are marginalized or if human rights violation take place.

COVID-19 and the Global Fund

In its weekly communication on COVID-19 and HIV, the Global Fund summarizes preliminary messages about the operation of HIV programs and services. It elaborates on how the Global Fund partnership is responding to HIV in the context of COVID-19 and supporting guidance from technical, implementation and advocacy partners. The Global Fund is also making flexible funding available to support countries as they respond to the COVID-19 pandemic. By helping countries to address COVID-19, the Global Fund believes it can mitigate the impact COVID-19 may have on AIDS, TB, and malaria programming.

The Global Fund has committed up to US$1 billion available to support countries to respond to COVID-19[1]. Eligible activities include:

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

Funds are being directed to countries through two channels:

Grant flexibility

Up to 10% of the total value of existing grants can be allocated to eligible COVID-19 activities. A maximum of 5% can come from savings and another 5% through the reprogramming of approved activities. Countries are encouraged to use savings first before seeking reprogramming or requesting funds through the C19RM option. KPs may wish to resist allocating savings to COVID 19 activities if that funding would be better allocated to under-funded KP focused activities.

In the flexibility option, funding requests are submitted by the countries’ principle recipients (PRs), and not the country coordinating mechanisms (CCMs), where civil society (CS) and KPs have seats.  PRs are encouraged to obtain CCM endorsement, however, given the quick turnaround time for this funding option this does not always happen. Funding decisions are made by the Global Fund Secretariat in around five working days.

Since being launched last March, 87 requests totaling US$129 million have been approved and integrated into grants. The majority of funds are from cost savings (US$113 million), not grant reprogramming. The focus has been on epidemic preparedness, including diagnostics and personal protective equipment (PPE).

Key populations advocates can influence choices made through the grant flexibility mechanism by lobbying their member at the CCM to reach out to PRs. They can also influence existing PRs to consider requesting programming relevant to KPs.  KPs should advocate to ensure programs relevant to their concerns are maintained, while ensuring the safety and security of CS staff and members of the community.

COVID-19 Response Mechanism (C19RM)

Launched in late April, the C19RM will allow countries to request funding up to 10% over and above the funding levels indicated for their 2020-2022 funding allocation. The funds can be used for:

  • interventions to mitigate the impact of COVID-19 on HIV, TB and malaria disease programs;
  • actions to reinforce the response to COVID-19;
  • initiatives to make urgent improvements in health and community systems – including laboratory networks and supply chains; and
  • engaging with vulnerable communities.

Applications are to be submitted by CCMs, which means community and KP engagement is required in the development of C19RM requests. C19RM activities can be carried out by current Global Fund grant recipients. Be sure to have your say!

Application materials and guidance notes are available at: https://www.theglobalfund.org/en/covid-19/response-mechanism/. The Secretariat will review and provide approval within 10 working days from the date of submission.

Examples of KP and community programming includes:
  • Programs to address gender-based violence;
  • Strengthening/adapting community-led HIV service delivery models for sex workers, gay and other men who have sex with men, people who use drugs, and trans people (eg: OST access, community-led ARV delivery);
  • Community-led and based monitoring of HIV, TB, malaria, and/or COVID-19 responses;
  • Community mobilization and advocacy;
  • Integration of COVID-19 prevention and support into community-led and based HIV, TB, and malaria responses; and
  • Human rights related monitoring, access to justice, legal literacy, addressing stigma and discrimination, and training for health providers and police on rights and medical ethics.
What if communities and civil society are being excluded?

Contact your representatives to the Global Fund Board. They have indicated that are very interested in tracking KP engagement in the COVID-19 response.

Delegation Focal point Email address
Communities Bruna Martinez bmartinez@gnpplus.net
Developing countries NGOs Lesley Odendal l.odendal@developingngo.org
Developed countries NGOs Kataisee Richardson kataisee@yournextconsultant.com

You can also request technical assistance from the Global Fund CRG. CRG technical assistance can be requested for a broad range of initiatives. In the context of COVID-19, TA could include program design, data gathering related to impact of COVID-19 on KPs.

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Meaningful engagement of communities and civil society in Global Fund processes during COVID-19

The Global Fund has developed a substantial volume of guidance material relevant to CCMs applying for COVID-19 funding, country teams supporting their requests, and other partners. Links to these materials are found in the resource section below. The most relevant document is prepared by the CRG department and summarizes the guidance relevant to KPs. Highlights of the recommendations relevant to KPs and communities are as follows:

CCMs are encouraged to:
  • Protect essential HIV services and assess the likelihood of interruption of HIV-related services including testing, treatment and opiate substitution treatment (OST) for people who inject drugs (PWID).
  • Analyze service barriers with a human rights, gender and key and vulnerable population lens and introduce mitigation strategies including hotlines, community support groups training for health care providers.
  • Ensure communities are part of decision-making, governance and the design, implementation and monitoring of COIVD-19 responses. The CCM eligibility requirement regarding transparency must be followed.
  • Ensure an inclusive and transparent country dialogue process and that communities have an opportunity to meaningfully participate remotely using different technologies. See tips and tools for virtual country dialogues, case studies on virtual consultations and guidance to CCMs on how to repurpose funds to support virtual consultations.
  • Ensure safety and security: prioritize the need for data privacy and protection when considering new virtual platforms to engage with communities and civil society. Platforms with end-to-end encryption, such as Signal, should be favored given the risk of criminalization, discrimination, and persecution many communities face. See the Guidance on ensuring safety and security of key populations.
Principal Recipients are encouraged to
  • Protect and fund community systems and responses and health systems more broadly, and to encourage flexibly and shifting to interventions to reduce barriers to effective rollout of COVID-19 responses for all.
  • Continue to adhere to the five minimum human rights standards that are part of every grant agreement and ensure they do not discriminate against anyone while providing services and maintain the confidentiality of service users.
  • Continue to pay all salaries, including for community outreach workers/peer educators. See  Global Fund Q&A for other eligible costs.
  • Offer phone or data credits to community outreach workers, community treatment supporters, and peer educators to be able to provide remote support.
Timing flexibilities for Global Fund funding requests

Given the pandemic and shelter-in-place orders in many countries, the Global Fund is introducing timing flexibilities for funding request submissions for Windows 2 and 3. This will allow applicants to submit their funding requests as soon as they are ready and then quickly move to grant-making. The GF plans to deliver the Technical Review Panel Review and Recommendation Form within 8 weeks from each submission date.

Window 2 submission dates Window 3 submission dates
Window 2b: 31 May

 

Window 3a: 31 July

 

Window 2c: 30 June

 

Window 3b: 31 Aug

 

See https://www.theglobalfund.org/en/funding-model/applying/submissions/ to find your country submission dates for Windows 2 and 3.

Human rights and gender

The recommendations below, while relevant during all circumstances, are especially critical during the COVID-19 response. Prioritization should happen with input from communities most affected by the three diseases. For additional recommendations, see the Guidance Note on Human Rights in Times of COVID-19.

  • Implementer safety: In contexts of strict lockdown, ensure program implementers, including community workers, have written authorization to deliver goods/services, to deter police harassment, as well as the necessary personal protection equipment following WHO guidance.
  • If law enforcement agents violate rights—such as harassment of LGBTI people, sex workers, people who use drugs—ensure there is access to legal aid.
  • Community-led monitoring: Support communities to monitor and report human rights violations, including heightened stigma, discrimination and violence against key and vulnerable populations who seek services (HIV, COVID-19 or otherwise).
  • Ensure programs to reduce human rights-related barriers, including interventions to end discrimination and other barriers to HIV, TB, and malaria services.
  • Ensure access to essential sexual and reproductive health and rights services packages.
  • Intimate partner violence/gender-based violence: People, including key and vulnerable populations, may experience elevated risks of interpersonal violence linked to quarantine or “stay at home” policies, so ensure that gender-based violence programs and resources are available to communities

Community-based organizations and individuals facing Human Rights violations can also report cases online directly to MPact using our Incident Assessment and Documentation Tool.

Learn more here: https://bit.ly/2YDYHwv

MPact Recommendations for KP Advocates

Key population communities should address the COVID-19 crisis proactively by:

  • Developing safe ways to continue engaging with your community, including virtual consultation to determine the support they need.
  • Documenting adverse experiences of community members, including delayed access to prevention, care, treatment interventions and products, such as OST, condoms and lube.
  • Documenting any human rights violations, including police abuse, denial or delay of access to services.
  • Sharing information about adverse experiences and human rights abused broadly, including with MPact, Delegations to the Global Fund Board and social media.
  • Reaching out to KP representatives on your CCM, to ensure that they are requesting funding for interventions that are relevant to KP concerns.
  • Monitoring programming supported by the Global Fund and reporting any problematic deviation of services caused by COVID-19.

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Resources

Global Fund Funding Request Instructions and Documents
Global Fund COVID-19 Guidance
Technical Partner Guidance

Links to a full range of partner guidance can be found at:

Community Guidance

The Global Key Populations Networks — MPact, the International Network of People who Use Drugs (INPUD), the Global Network of Sex Work Projects (NSWP), and Global Action for Trans Equality (GATE) — post regular updates about COVID-19 information on their websites.  The regional GF platforms have also developed a special COVID-19 section in their website ; ie EANNASO and APCASO.

Please feel free to report to us (MPact Director of Policy Nadia Rafif at nrafif@mpactglobal.org) any problems or obstacles you may experience, which we can document and report to the Global Fund.


[1] See overview:  https://www.theglobalfund.org/en/covid-19/

[2] To contact a Country Coordinating Mechanism or see its leadership, use the Coordinating Mechanism Contacts tool

[3] Use the Data Explorer tool to access the FPM’s name and contact information

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