The Strategy Committee met at its 4th Strategy Committee Meeting on the 21st – 23rd June 2017 in Geneva, Switzerland. As part of the Strategy Committee Meeting, the Strategy Committee discussed over the course of 4 hours over two days to provide clear guidance to the Global Fund Secretariat in providing the scope of the revision to the Eligibility Policy to inform Secretariat analysis.

As part of the discussions of the Strategy Committee, the following areas were discussed:

Part I: Technical Considerations
1. Economic capacity
2. Small Island Economy Exception
3. G-20 Rule for Upper-Middle Income Countries
4. Disease burden thresholds
5. UMIC OECD-DAC Requirement for HIV/AIDS
Part 2: Other Considerations
1. NGO Rule for HIV/AIDS
2. Multi-country Requirements – 51% Rule
3. Funding for ineligible components – GF/B37/DP11
4. Other

A summary of key concerns and positions of the Communities Delegation expressed at the Strategy Committee Meeting are as follows:

Process in discussing Eligibility over the next 18 months

  • The different components in the Eligibility Policy is interrelated, and that the revised Eligibility Policy needs to work as a whole and not in parts
  • The challenge with the current Eligibility Policy is that allocations are decided upfront every three years, and little flexibility as no additional monies is available should a country/component be made eligible or requires emergency access to funding
  • Although the Eligibility primarily a technical discussion, there are political dimensions that need to be managed in parallel at the Global Fund Board level. The Communities Delegation requested that there needs to be a parallel process to manage these discussions in a transparent manner with the spirit of identifying common grounds in supporting the Global Fund in achieving its mission and strategy.

Areas of focus in the Eligibility Policy for discussion

  • Economic Capacity and Disease Burden: GNI per capita should not be the sole economic capacity indicator that is used even if it is the “best” economic capacity indicator that is relied upon frequently. However, replying on it is not good enough in economic realities in Upper Middle Income Countries (UMICs). We wish to see an improvement of the eligibility criteria beyond the sole use of GNI and disease burden, and requests for the Secretariat to explore fiscal space analysis and health expenditure in conjunction, especially when countries transition into the UMICs category. This analysis should provide realistic practicalities around how these types of processes can be conducted practically.
  • G20 countries: An eligibility projection should be provided if the G20 groupings are removed. In practise, the Delegation does not support political groupings of countries in the Eligibility Policy as this might not be relevant to what the Global Fund Strategy is trying to achieve, we would not support replacing it with any clause that could potentially be politically charged in restricting other components to keep them ineligible. The Communities Delegation does not believe that G20 countries should not receive transition funding, and we believe that transition funding should be accessible for any country that becomes ineligible.
  • Disease Burden Thresholds: To fully align with the ambitions of the Global Fund Strategic sub objective 1a1)Scale-up evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and vulnerable populations disproportionately affected by the three diseases., it is important that key population prevalence is represented across all disease burden categories as well reflected in severe and extreme disease burden categories so that the Global Fund is consistent in its response in both generalised and concentrated disease settings. We note that the current cutoff point for KP prevalence might provide a skewed picture in terms of the level of severeness of HIV among KPs. Therefore, we would like to see an analysis with the support of Technical Partners and especially KPs and communities, on the cutoff point in KP prevalence refined.
  • NGO RuleThe Communities Delegation wants to see a mechanism that can enable communities and civil society to access grants, especially in cases where transition(s) have deviated significantly from their initial plans and where transitions have basically failed due to the lack of political commitments. We believe that these mechanisms are extremely important to ensure that the Global Fund protects investments that have basically failed due to the lack of political commitments. These mechanisms will be extremely important to make sure that the Global Fund protects investments that have been made to countries, and to prevent countries from coming back to the Global Fund with even larger gaps and resources needs. In the context of transition(s) and sustainability, in country, communities and civil society are the only actors in countries, and will always be there.
  • Multi-Country Requirements: We believe that this requirement has not caused any issues to the Global Fund, and that it has encouraged dialogues and become one of the critical options in addressing transitioning countries. We do not believe that it is a priority to change this requirement at this point. In addition, the Communities Delegation supports the proposed revision by the Global Fund Secretariat to include “ineligible” countries that are currently receiving transition funding to be an “eligible” country as part of multi-country programmes.
  •  Transitioning Countries: The Secretariat currently has the flexibility to determine the transition period and if necessary, an additional period. The Communities Delegation requests for the Secretariat to come up with an analysis, taking into account funding requests from countries that have become ineligible in the allocation period 2014 – 2016 (and therefore entitled to transition funding) on how the Secretariat has determined the transition period, whether there is a deviation/gap from the transition and sustainability plan, and whether there are needs for a 2nd transition period. We would also like to see further analysis on the 2nd transition period that focuses on supporting some scale of KP services and community advocacy, as documented widely by Curacio and other communities documenting on countries that have transitioned out.

For more information, please refer to the joint statement submitted by the Communities Delegation, Developed Country NGO Delegation and Developing Country NGO Delegation on the Eligibility discussion at the 4th Strategy Committee Meeting.

The timelines leading up to the Global Fund Board endorsing the new Eligibility Policy is as follows:

  • March 2017 – Initial Strategy Committee discussion (3rd Strategy Committee Meeting)
  • June 2017 – 2nd Strategy Committee discussion: scope of review defined (4th Strategy Committee Meeting)
  • October 2017 – Options/analysis presented: Further refinement of options (as needed) (5th Strategy Committee Meeting)
  • November 2017 – 38th Global Fund Board Meeting discussion
  • March 2018 – Revised policy/options presented for Strategy recommendation to the Board for decision (6th Strategy Committee Meeting)
  • May 2018: Revised policy for Board approval (39th Global Fund Board Meeting)

References   [ + ]

1. Scale-up evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and vulnerable populations disproportionately affected by the three diseases.