Exclusion of Key Populations and People Living with HIV from implementation of programmes 10 June To: CC:

Transcription

1 Exclusin f Key Ppulatins and Peple Living with HIV frm implementatin f prgrammes 10 June 2016 T: CC: Mr. Nrbert Hauser, Chair f the Bard f the Glbal Fund t fight AIDS, TB and Malaria Ms. Aida Kurtvic, Vice Chair f the Bard f the Glbal Fund t fight AIDS, TB and Malaria Dr. Mark Dybul, Executive Directr f the Glbal Fund t fight AIDS, TB and Malaria t fight AIDS, TB and Malaria Ambassadr Debrah Birx, Ambassadr-at-Large and Crdinatr f the United States President's Emergency Plan fr AIDS Relief (PEPFAR) Cuntry Crdinating Mechanisms (CCM) Secretariats in Btswana, Malawi and Tanzania Cuntry Crdinating Mechanisms in Btswana, Malawi and Tanzania Mark Edingtn, Head, Grant Management Divisin, Glbal Fund Ms. Kate Thmsn, Head, Cmmunity, Rights and Gender Divisin, Glbal Fund Mr. Michel Sidibé, Executive Directr, UNAIDS Dr Lucica Ditiu, Executive Directr, Stp TB Partnership Glbal Fund Human Rights Reference Grup UNAIDS Human Rights Reference Grup Cmmunities Cnstituency f the Glbal Fund Bard Develping Cuntry NGO Cnstituency f the Glbal Fund Bard PEPFAR Crdinatrs in Btswana, Malawi and Tanzania We, the undersigned rganizatins f peple living with HIV, key ppulatins and human rights activists are supprted by the Rbert Carr civil sciety Netwrks Fund t implement a prgramme entitled Strengthening Key Ppulatin Advcacy fr the Best Use f Glbal Fund Resurces and Sustainable Funding fr HIV & TB in Btswana, Malawi and Tanzania. Over the last year we made significant prgress influencing the natinal HIV respnse strategies in ur cuntries. Please see ur shrt film highlighting ur persnal stries and achievements. We are writing t yu t express ur grave cncern abut the lack f meaningful invlvement f rganisatins f peple living with HIV and key ppulatins, in particular sex wrkers, peple wh use drugs, men wh have sex with men and transgender peple in the implementatin f grants frm the Glbal Fund t fight AIDS, TB and Malaria (the Glbal Fund) and the United States President's Emergency Plan fr AIDS Relief (PEPFAR) in ur respective cuntries. We cmmend the Glbal Fund and PEPFAR fr yur cmmitment t fund the AIDS and tuberculsis respnses glbally and investing in human rights prgramming and interventins targeting key

2 ppulatins, which are gravely under-resurced. We appreciate the prgress made in integrating gender, human rights and key ppulatin needs int the funding cycles and supprting rganisatins and representatives f key ppulatins t engage in prcesses and platfrms in their respective cuntries, in an effrt t ensure that interventins that blster their human rights and imprve their HIV and TB health utcmes are funded. We are particularly encuraged by the annuncement f a new $100 Millin Investment Fund t expand access t prven HIV preventin and treatment services fr key ppulatins by PEPFAR during the 2016 United Natins High-Level Meeting n Ending AIDS. We are hpeful that this supprt will make a difference in addressing challenges in identifying, measuring and addressing stigma and discriminatin. In the past year, we cnsistently engaged in cuntry dialgues, which included the review f Natinal HIV and AIDS Strategic Plans and Framewrks as well as participatin in cncept nte and Cuntry Operatinal Plan develpment and grant making prcesses. We invested unprecedented resurces and effrt t ensure that the experiences f peple living with HIV and key ppulatins were captured in these prcesses. We were inspired when we learned that the grant applicatins were apprved and even mre s that, amngst thers, the interventins under, amngst thers, the Glbal Fund mdules fr Remving Legal Barriers, Preventin prgrams fr men wh have sex fr men and transgender peple, Preventin prgrams fr sex wrkers and their clients, Preventin prgrams fr peple wh inject drugs (PWID) and their partners, as well as Preventin prgrams fr ther vulnerable ppulatins wuld be tailred specifically t address the needs f ur cmmunities. Hwever, fllwing the develpment, negtiatin and start-up prcesses, we are gravely disappinted and cncerned by the trend in exclusin and side-lining f peple living with HIV and key ppulatins and in particular, the institutins led by and fcused n the needs f peple living with HIV and key ppulatins in the implementatin f the apprved grants. We are particularly cncerned abut the fllwing: I. Lack f pprtunities fr natinal and cmmunity-based rganisatins f peple living with HIV and key ppulatins t access Glbal Fund and PEPFAR funding: The eligibility criteria t becme an implementing partner are unfavurable t rganisatins f peple living with HIV and key ppulatins: We have fund that the criteria t becme implementing partners, including Principal Recipient r Sub-Recipient, are slanted t favur well-established natinal rganisatins and/r natinally registered rganisatins with internatinal backing and netwrks, which have a track-recrd f having managed cmplex develpment peratins and/r strng financial and prgramme management systems. Fr example, in Tanzania, it was required fr the Glbal Fund grant Sub-Recipient t have previusly managed an annual budget f US$500, in rder qualify t becme a Sub-Recipient. This clearly disqualifies even thse natinally established rganisatins f peple living with HIV r key ppulatins which, due t many factrs, including the repressive scial, plitical and legal cntext in ur cuntries, have nly recently been able t frmalise their structures and/r are nly nw establishing systems required fr the implementatin f Glbal Fund r PEPFAR grants. It is well knwn that the vast majrity f rganisatins f peple living with HIV r key ppulatins at higher risk f HIV are significantly under resurced and d nt have the financial r human resurce capacity required t establish systems, which will meet the criteria required t bid fr Principal r Sub-Recipient status.

3 The reluctance t directly grant t Sub-Sub-Recipients: In sme cuntries, including Btswana and Tanzania, there has been a blatant refusal by mst Sub-Recipients t subgrant at sub-sub-recipient level due t the effrt required and perceived risk invlved in ding s. This clearly undermines the ability f ur rganisatins t access funding at a level where they might have std a chance at benefitting frm the grant t implement interventin directly affecting us. Cnsidering that, due t currently weak institutinal structures, we are unable t access funds at Principal Recipient r Sub-Recipient levels, we see the refusal t grant at Sub-Sub-Recipient level as a barrier t grups f peple living with HIV and key ppulatins at HIV accessing financial resurces t implement interventins that will benefit their cmmunities. The lack f transparency in the selectin f implementing partners, including Sub- Recipients and Sub-Sub Recipients: In mst cuntries, there has been a lack f feedback n why rganisatins f peple living with HIV r key ppulatins, wh are well established, with strng institutinal systems and a track recrd f implementing the relevant prgrammes, are nt qualifying as Sub-Recipients f Glbal Fund Prgrammes. Fr example, in Malawi, the Centre fr the Develpment f Peple (CEDEP), a wellestablished rganisatin addressing the needs f lesbian, gay, bi-sexual, transgender and intersex peple (LGBTI), applied t be a Sub-Recipient fr the implementatin f the Preventin prgrams fr men wh have sex fr men and transgender peple mdule. Tw ther rganisatins (Dignitas and Pakachere) with n prven recrd in implementing preventin interventins fr men wh have sex with men r transgender peple were awarded the grant. CEDEP is yet t hear why they were unsuccessful in their bid t implement this mdule. Recently, the Principal Recipient reprted that they will nce again embark n a prcess t select Sub-Recipients t implement this mdule as the initial decisin that were made by rganizatins such as Dignitas and Pakachere n the prpsal t implement the mdule was reversed by their respective bards 1. Likewise, in Btswana, the Preventin prgrams fr sex wrkers and their clients mdule is t be implemented by a Sub-Recipient with n track recrd f implementing rights-based interventins with sex wrkers, while the lcal sex wrker s rganisatin has n pprtunity t access these funds t implement interventins fr their cmmunity. There is a lack f cmmunicatin regarding changes in interventins and crrespnding budgets in apprved grants fr peple living with HIV and key ppulatins: In mst cuntries, including Tanzania and Btswana, rganisatins f peple living with HIV and key ppulatins have nt been infrmed f changes made t interventins and resurces allcated t interventins during the grant-making prcess. This has resulted in a lack f trust between these grups and the Cuntry Crdinating Mechanism and Principal Recipients as it appears that interventins that were nt seen as a pririty were randmly remved r funds allcated elsewhere withut cnsultatin with the affected grups. II. Building resilient and sustainable systems fr health: There are limited pprtunities fr natinal and cmmunity-based rganisatins f peple living with HIV and key ppulatins (wh truly need this supprt), t access financial and technical resurces under the Cmmunity Systems Strengthening mdule, as these funds are 1 ActinAid Jint TB/HIV Prgram Prgress Reprt Quarter 1 (January-March 2016)

4 allcated t Principal Recipients and Sub-Recipients wh are funded t implement ther elements f the grant. If the Cmmunity Systems Strengthening effrts f the Glbal Fund are t make a difference fr cmmunities living with HIV and key ppulatins, their rganisatins, even thse wh are nt being funded t implement interventins funded the Glbal Fund, shuld als be ffered this supprt, particularly if the intentin is t strengthen their systems in rder t eventually qualify t be Sub-Recipient r Sub-Sub Recipients; There is a grwing disinterest by dnrs t cntinue supprting capacity building initiatives within grants. Rather, emphasis has been placed n selecting implementatin ready rganizatins, wh can meet targets quickly. In mst instances, this impedes the inclusin f a variety f rganizatins, predminantly thse f peple living with HIV and key ppulatins, t implement prjects (due t lack f capacity), and assumes an element f readiness that des nt exist amng rganizatins made fragile by the ever-changing ecnmic landscapes. We are particularly cncerned abut this as PEPFAR and Glbal Fund supprt t strengthen cmmunity systems is critical t building the capacity f rganisatins t becme Glbal Fund recipients; and There is a trend by implementing partners, including Principal and Sub-Recipients, t recruit/ pach the strngest candidates within the rganisatins f peple living with HIV and key ppulatins t jin their rganisatins t directly implement activities such as peer educatin interventins instead f investing in rganisatins f peple living with HIV and key ppulatins. This cnsequently fragments and weakens these institutins and their capacity t directly lead and implement interventins t imprve the rights and health f their cmmunities. It is critical t nte that financing fr key ppulatins-prgramming is heavily reliant n internatinal dnr supprt. The significance f this indicates that any changes in the cmmitment r willingness by dnrs t finance KP-prgrams, culd greatly impact the sustainability f key ppulatins-prgramming, as gvernments are still reluctant t supprt such initiatives with dmestic resurces. Accrdingly, t effect gd use f available resurces, dnrs and civil sciety rganisatins must wrk in tandem t ensure that funds are directed where significant prgramming gaps still prevail, and cst-efficient service delivery mdels are adpted by cuntries t achieve greater value-add with available resurces. Dnrs must stabilize their cmmitment t fund health systems strengthening (HSS) initiatives and advcate fr better investment f their resurces, twards imprving service delivery fr key ppulatins. T achieve true universal cverage, emphasis must be made t fund initiatives that mitigate existing service gaps that cntinue t inhibit access t and mnitring f ptimal treatment fr key ppulatins. Funding fr HSS gaps such as capacity building f healthcare wrkers and public health facilities twards building key ppulatins-cmpetent sites that render services sensitive t the needs f KPs, shuld be priritized with existing resurces. III. Limited capacity and understanding f human rights-based appraches and human rights prgramming within Principal Recipients and Sub-Recipients: We are gravely cncerned that Principal Recipients and Sub-Recipients selected t implement the Remving Legal Barriers mdule have a limited understanding and/r track recrd in rights-based appraches and in particular in implementing interventins t refrm laws and plicies, in rder t remve barriers t accessing health services. We are als cncerned that very few f them have the knwledge and capacity t implement human rights prgrammes that are included in the mdule and that this will have a negative impact n the lives f peple living with HIV and key. Recmmendatins:

5 In rder t cntribute t ending AIDS in ur respective cuntries by 2030 and ensure the ability f the Glbal Fund Strategy t maximize impact, strengthen systems fr health, prmte and prtect human rights and gender equality, the fllwing recmmendatins shuld be taken int accunt: The criteria fr selecting Principal Recipients and/r Sub-Recipients t implement the mdules fr Remving Legal Barriers, Preventin prgrams fr MSM and TGs, Preventin prgrams fr sex wrkers and their clients, Preventin prgrams fr peple wh inject drugs (PWID) and their partners, as well as Preventin prgrams fr ther vulnerable ppulatins, shuld include criteria t shw prven track recrd and capacity t implement interventins related t human rights, remving legal barriers and interventins fr key ppulatins; CCMs and Principal Recipients shuld put in place mechanisms t strengthen transparency and cmmunicatin, particularly with netwrks f peple living with HIV and key ppulatins. This shuld include cmmunicatin in regards t selectin f Sub-Recipients and changes in interventins and budgets related t interventins that affect them; A prtin f the Cmmunity Systems Strengthening funds be allcated t effrts t strengthen the capacity f rganisatins f peple living with HIV and key ppulatins t be able t establish rganisatinal systems and ther measures t be able t qualify fr Sub-Recipient r Sub-Sub-Recipient grants; A prtin f the Glbal Fund Cmmunity Systems Strengthening funds be used t strengthen the capacity f Principal Recipients and Sub-Recipients in human rights, sexual rientatin and gender identity issues, the law and HIV; and PEPFAR shuld recnsider the requirement f rganisatins being implementatin ready and a prtin f the new PEPFAR Investment Fund fr key ppulatins shuld be cmmitted t directly investing in the capacity f rganisatins f key ppulatins t be able t establish rganisatinal systems and ther measures t cntribute t sustainable HIV respnses. Signed: Btswana Netwrk n Ethics, Law and HIV / AIDS Men fr Health and Gender Justice Organisatin, Btswana Sisnke Btswana Silence Kills Supprt Grup, Btswana Centre fr the Develpment f Peple, Malawi Malawi Sex Wrker s Frum Malawi Netwrk f Religius Leaders living with and Persnally Affected by HIV and AIDS Tanzania Netwrk f Peple wh Use Drugs Tanzania Netwrk f Wmen living with HIV and AIDS Waremb Frum, Tanzania AIDS and Rights Alliance fr Suthern Africa Internatinal Treatment Preparedness Calitin East Africa Internatinal Treatment Preparedness Calitin - Glbal