In December of 2019, AMSHeR hosted a 2-day Regional Workshop on Sustainability of Key Populations Programming in the Context of the Global Fund Transition and Domestic Funding for Health in Kigali, Rwanda. The workshop occurred on the margins of the 20th International AIDS Conference on AIDS and STIs in Africa (ICASA) for time and cost efficiencies. The need for both information and skills to navigate STC was voiced by community constituents in several countries classified by the Global Fund as Upper Middle-Income Countries, or those that have already begun their transition processes. In attendance were representatives from Angola, Burundi, Cameroon, Ghana, Kenya, Madagascar, Malawi, Mozambique, Nigeria, Senegal, Tanzania, Togo, Rwanda, Uganda, Zambia, and Zimbabwe. Of the 19 participants, all were either AMSHeR members or partners from amongst key populations and included seven current and two former CCM members. Most participants worked in HIV, with links to TB. Additionally, three national AIDS council representatives from Madagascar, Zimbabwe, and Ghana.
The Regional Workshop sought to strengthen the capacity of partners in Sub-Saharan Africa to meaningfully engage in Global Fund processes towards successful transition and sustainability readiness, and to undertake effective advocacy to remove barriers impeding access to quality and equitable healthcare and services for key populations (e.g., stigma, discrimination, and criminalization). Prior to the workshop, AMSHeR reviewed similar activities hosted by other regional networks, and circulated materials to gauge participant knowledge. Despite this forethought, facilitators realized only during the workshop the extent of the information gaps, including even knowledge of the existence of the Global Fund STC Policy. To accommodate these gaps, communities and developing country NGO delegations agreed to host additional sessions in the ICASA community village for some workshop participants.
The workshop format included a mix of presentations, group work and breakout sessions, storytelling and experience sharing for peer learning, and ‘homework’ in the evening. Translation was provided for those not comfortable conversing in French or Swahili. Discussions revolved around the Global Fund and national funding request processes, the Country Coordinating Mechanism (CCM) function and representation, Office of the Inspector General (OIG) audits, human rights abuses, domestic health investment, and preparation for transition. “For these types of conversations and feedback the amount of time allocated is never enough,” notes Berry Nibogora, Director of Programs. After the first day session closed, participants were tasked with identifying which window their country had chosen for this next funding cycle, and what this meant for their communities in terms of preparing, caucusing, and holding consultations to advise the national application process. Additionally, they were to determine what the nature of funding in their country was (e.g., standard, transitional, etc.).
During the second day of the workshop, after reporting on homework findings (most countries had chosen window 1 and 2; only Kenya chose window 3), the discussion shifted to what sustainability beyond the Global Fund meant for communities and key population programming. Participants brainstormed and shared ways to maximize key population engagement in application processes to ensure their priority needs were met with remaining funds. Facilitators posed tough questions including: how will programs survive without Global Fund funding? How will community organizations and key population programs be institutionalized with domestic funds? And, how will the national health system address services? There were also conversations with CCM and National AIDS Commission members on tips to share or get information to the CCM and writing committee. Participants began mapping out roadmaps of engagement for finalization post-workshop. In future workshops, AMSHeR will schedule greater time for group work so that clear action items guide follow-up plans and roadmaps.
Following the workshop, several countries sought complementary AMSHeR support.
- Botswana, which is already in transition, was looking to support young emerging leaders to take programming and activism to the next level. “Part of sustainability is to ensure there is a leadership transition and some preparation so that people can easily take over even when the [current] leader falls ill or steps aside,” notes Berry.
- Cameroon was supported to apply for specific funds (ultimately from the French 5% Initiative) to help disseminate information from the Regional Workshop, and strengthen a national taskforce to build relationships and best position themselves with responsive stakeholders for the most promising grant-related outcomes. The CCM representative (who was a workshop participant) felt a strong need to educate and build the capacity of taskforce members on Global Fund processes and health funding in general.
- In Kenya, following the Regional Workshop, the key population consortium requested help setting up a consultation to look at advocacy for sustained investment in key populations across most counties. The consultation prioritized needs for the funding application to consider. The consortium further profiled CCM members by position and issue and are working to ensure Global Fund financial support to appeal a case at the supreme court (e.g., grant funds to support human rights advocacy and litigation).
- The partner in Namibia requested support to update their strategy, conduct audits and financial procedures, and start activities afresh following a major leadership turnover. They are now organizing a consortium of key population organizations to increase their voice and level of influence on Global Fund processes, and beyond.
- Nigeria asked for support to submit a technical assistance request to the CRG Strategic Initiative, which is currently under review, to support young key populations.
- The Zimbabwean participant, a member of the writing team and key population coordinator at the National AIDS Council, requested permission to use presentation and other workshop materials to enhance community understanding and Global Fund competencies. These resources are helping replicate conversations and jumpstart community planning. Guidance was also requested on making a case for transgender programming—a gap under the current grant. “We were able to share the modular framework that the Global Fund uses in terms of interventions, and that could be customized to the Zimbabwean context,” says Berry. Zimbabwe is already applying this framework.
One of the lessons learned was that the timing of STC-related workshops is important. “Being just after replenishment and when allocation letters were being sent meant that the workshop linked with ongoing processes at the country level, and participants were more attentive and interested. They immediately made the link between what was being discussed and the process they were going through. Rather than waiting to begin, they were able to clearly see the need to start conversations early. In other words, the needs were immediately felt, and the information is being applied,” notes Berry.
Another lesson was that all workshop materials (handouts, PowerPoint slides, video clips, discussion notes and conclusions) should be made available to all participants. In this way, they can co-opt them while the information and momentum are fresh, to raise knowledge and skills amongst other local key population leaders, CCM representatives, and key stakeholders—as in the Zimbabwean example.
Participants noted that, in one way or another, they are and will continue to be affected by CCM decisions. Another take-away lesson was that establishing efficient and effective channels for timely communications is important to get and keep stakeholders engaged. WhatsApp groups, for example, are important tools for communication and to solicit responses. Because community members and key stakeholders are often busy, communicating ‘save the date’ requests even three months in advance of important events will ensure a greater chance of engagement from the right mix of participants. In the case of the Regional Workshop, a WhatsApp group was established prior to meeting in December, and participants asked to keep it active to further capitalize on networking, momentum, and cross-learning.
Of note, having the workshop occur concurrently with ICASA was both a challenge and an opportunity. While it allowed for significant time- and cost-savings that resulted in a diverse number of participants attending without having to pay for travel expenses, some participants had conflicts due to competing sessions. Of further note it was critical that the facilitator had deep experience and knowledge of Global Fund processes from both theoretical and practical perspectives.
 Roadmaps include engagement categories and details on structure (who), specific actions and rationale, responsible party, and timeline, as well as specific actions regarding proposal development, grant making, and grant implementation, with short-, medium-, and long-term timelines around opportunities for engagement.