STRATEGIC AREA 1: HUMAN RIGHTS
Anticipated Outcome: Human rights principles and approaches are more strongly reflected within Global Fund operations, policies, decisions, processes, and funded programmes.
Context: The Communities Delegation is committed to ensuring that Global Fund funded programmes and investments operate in, and contribute to, environments that respect and value human rights. Human rights abuses and violations continue to exacerbate the impact of the three diseases. The marginalisation and criminalisation of communities of drug users, sex workers, transgender people, and men who have sex with men remains a major structural driver of HIV and TB epidemics; often leaving these communities with limited or no access to appropriate and necessary HIV and TB services. Supportive legal environment, rights-based and evidence-informed approaches are critical to achieving sustainable public health outcomes and ensuring equitable access to prevention, treatment care and support to all who need them.
The Communities Delegation has played and active and critical role in achieving progress in this area. Since defining its strategy and workplan in early 2011, the Delegation has contributed to the successful inclusion of a specific Human Rights Objective within the Global Fund Strategy 2012 – 2016. It has also directly promoted and advocated for the operationalization of the Human Rights objective with the Secretariat and Board via interventions at the Board and Committee levels. Working with key partners – Open Society Foundation (OSF), UNDP and the Ford Foundation, the Delegation contributed to the conduct of two consultation meetings. The most recent of these consultations, held in June 2012, resulted in a range of clear recommendations for implementation of the Human Rights Objective. There have also been other key developments, such as the report and recommendations of the Global Commission on HIV and the Law. These recommendations are presented to the Strategy, Impact and Investment Committee (SIIC), which instruct the Secretariat to progress the implementation. The Communities Delegation’s primary task over the coming 18 months will be to ensure the adoption of these recommendations.
1. Ensure that Human Rights are operationalized in the Global Fund Strategy 2012 – 2016; and 2. Ensure that Community Systems Strengthening (CSS) is used as a means to support, protect and enable human rights.
STRATEGIC AREA 2: ACCESS TO PREVENTION, TREATMENT, CARE AND SUPPORT
Anticipated Outcome: Market-shaping approaches increase access to optimal treatment for HIV, TB and malaria for all who need it in Global Fund funded programmes.
Context: Advocating for the achievement of Millennium Development Goals (MDGs) 4, 5, and 6 is a Communities Delegation priority. The Delegation will with the Board, Committees and Secretariat to ensure that the focus of MDGs 4, 6, and 6 remain central to the work of the Global Fund, and that all communities living and affected by the three diseases who require access to prevention, treatment, care and support services have access to them. In recent years, considerable energy and money have been spent trying to achieve Universal Access to prevention, treatment, care and support for HIV, and equal efforts have been spent on reaching MDG 6 for malaria and TB. Although most targets for Universal Access by 2012 have not been met, the goal remains an important one for low- and middle-income countries around the world.
A review of the pilot of the Affordable Medicines Facility – malaria (AMFm) has been undertaken and it is now important to ensure that the evidence-based recommendations of this review are taken up by the Global Fund so as to secure optimal programmes to tackle malaria. In addition, and in line with the Stop TB Partnership targets for MDR-TB, the Communities Delegation identified scale up of access to MDR-TB treatment and diagnostics as a priority area. Of the 12 million prevalent TB cases, it is estimated that around 650,000 are multidrug-resistant, and globally only about 53,000 people are on treatment. Funding available for MDR-TB is much lower than the resource need set out in the Global Plan (US$0.9 billion in 2011 to US$1.9 billion in 2015).
To reach the planned targets, substantial resource mobilisation will be needed. The price of treating a patient averages at US$8,200 in the 27 high MDR-TB burden countries in 2009 – 2011, and could be brought down substantially through ambulatory models of care. The Communities Delegation will advocate for better and more efficient systems and processes that will be able to bring drug and commodities prices down to provide treatment for more people.
1. Ensure the Global Fund achieve the best possible process for procurement of drugs, diagnostics, and delivery systems; 2. To develop a Delegation position based on the recommendations from the results of the AMFm pilot; 3. To develop and promote a Communities Delegation position on the inclusion of malaria as part of the Continuity of Services (CoS) policy; and 4. Achieve funding and increased access to MDR-TB prevention, treatment, care and support, and diagnostics in Global Fund funded programmes.
 MDG 4: Reduce C hild Mortality  MDG 5: Improv e Maternal Health  MDG 6: C ombat HIV /A IDS, Malaria and other Diseases
STRATEGIC AREA 3: EFFECTIVENESS AND EFFICIENCY
Anticipated Outcome: A more transparent, accountable, effective, and efficient Global Fund that demonstrates positive, rights-based impact for communities.
Context: Since its establishment in 2002, the Global Fund has evolved and matured alongside the changing landscape of global health and development. Processes and reforms have been implemented to cope with the changing environment, but many of these have not proven adequate and adaptable to epidemiological profiles with regards to populations, persons at highest risk, and the number of persons affected by the three diseases.
Inefficiencies have arisen as the Global Fund became increasingly complex and thus there are a number of issues at the Secretariat and Board level that need to improve to ensure more effective processes at the Secretariat and for countries.
The concepts of Community Systems Strengthening (CSS) and Dual-Track Financing (DTF) assist civil society to strengthen their own structures in country, especially for marginalised communities, allowing them to be implementers of programmes. As we move towards the Global Fund new architecture, increased pressure is being placed on civil society organisations and their Structures.
The ultimate goal of efficiency and effectiveness is to provide services to those who need them, and to create faster, better and quality impact on the three diseases.
1. Secure a community responsive funding model that contributes to the achievement of the Global Fund Strategy 2012 – 2016; 2. Contribute to an effective, accountable, and transparent Global Fund governance structure; and 3. Ensure that the Global Fund Secretariat effectively addresses and integrates civil society issues and concerns.
STRATEGIC AREA 4: REPLENISHMENT AND RESOURCE MOBILISATION
Anticipated Outcome: A financially sustainable fully funded Global Fund that maintains its demand-driven model.
Context: The Communities Delegation recognises that for an effective and sustainable response to HIV, TB and malaria, countries require both domestic and international investments and commitments to reach MDGs 4, 5, and 6. As an instrumental funding mechanism for HIV, TB and malaria commodities, responses and services, the Global Fund has played a unique role in meeting country needs through a demand-driven model that funds all Technical Review Panel (TRP) recommended proposals. To ensure predictable and sustainable resources, the Global Fund needs to be fully replenished. The Communities Delegation plays a vital role in advocating for a financially sustainable Global Fund.
Specific principles we follow:
Keep It Global – bearing in mind that the populations we serve transcends all geographical boundaries and exist in both concentrated and generalised epidemics;
The engagement of all implementing governments to advocate for the Global Fund, as well as to contribute (co-finance) to their domestic health budgets; Joint civil society efforts and collaborations, and mobilisation of civil society and communities support at all levels; and The need for continuing work on replenishment for the Global Fund, and not just during the pledging cycle.
1. Implementing countries increase and continue meeting their pledges and contributions to Global Fund funded programmes. 2. Donors increase and continue meeting their pledges and contributions to the Global Fund. CLICK HERE FOR MORE INFORMATION ON THE ACTIVITIES OF THE COMMUNITIES DELEGATION ON RESOURCE MOBILISATION FOR THE GLOBAL FUND.
STRATEGIC AREA 5: DELEGATION PROCESSES
Anticipated Outcome: An effective, efficient, and accountable Communities Delegation, with stronger capacity, greater institutional memory and functional internal processes.
Context: In order to make a significant contribution to the Global Fund, the Communities Delegation recognises the need to strengthen its own capacity and systems. The Delegation aims to develop its strength and professionalism with effective communication mechanisms that allow for consultation among its wider constituencies. Many skills are needed to function effectively and strengthen the capacity of its members for its continued success. Feedback from Delegation Members and the leadership, including responses to structured questionnaires, highlighted a range of needs and opportunities to unleash greater potential and achieve a strong Communities Delegation. The Communities Delegation has a unique and complex role to give voice to the diverse experiences of communities, and to secure two-way feedback between the Global Fund structures and the Communities most affected by the three diseases. No other Global Fund Delegation has such a complex mandate, and this requires highly efficient systems, as well as the need for resources to sustain the Delegation so it can continue to participate fully within the Board and Committees of the Global Fund.
In addition, there is a need to ensure that to support the work of the Delegation, that it has the resources to do so.
1. Assess and strengthen the capacity of Delegation Members; 2. Identify and strengthen internal processes and systems; 3. Mobilise resources to support the Communities Delegation; 4. Develop, maintain and strengthen strategic partnerships; and 5. Monitor and evaluate the performance and effectiveness of the Delegation.