osf first to go - presented at asshh 2013

7/28/2019 OSF First to Go - Presented at ASSHH 2013

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The First to Go: How Communities are

being affected by the Global Fund

Crisis

Laura Lopez Gonzalez, Open Society Foundation

Research Consultant

[email protected]


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Methods

Between March and April 2012, OSF contacted 35 CSOsin Swaziland, Malawi and Zimbabwe

32 were interviewed An additional 12 interviews were conducted with high-

level contacts representatives from the CountryCoordinating Mechanisms (CCMs), national HIV and TBcoordinating bodies, and United Nations agencies to

provide a broad overview of civil society dynamics andRound 11 cancellation's impact.

Draft was fed back to participants for fact checking


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Country wish lists

Swaziland: buffer stocks of antiretrovirals (ARVs) and the labreagents for CD4 count and toxicity testing; OVC and PLWHsupport

Malawi and Zimbabwe: TB drugs, TB diagnostic support,HW salary support, additional Microscopists and health HealthSurveillance Assistants, who are responsible for a broad rangeof activities that includes HIV counselling and testing, infantHIV testing and condom distribution

Zimbabwe: Expanded GeneXpert roll out, and support toimprove lab culture capacity; advocacy component on

paediatric TB aimed at health workers

Malawi: OVC, PLWHA support; support for communitysputum collectors

Malawi and Swaziland: First apps to include MARPs


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Zimbabwe

Community-based care workers, who have beensupported with kits and incentives such as stipends or

foodstuffs, may also be hard hit by the loss of Global

Fund money

Treatment shortages have already been reported in someprovinces

With the TB programme almost wholly funded by theGlobal Fund, impacts expected


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Zimbabwe

Year Projected Treatment Gap

2012 66,500

2013 About 71,000

2014 87,000

2015 361,000


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Swaziland

Scaled down school feeding programmes. Programmes atneighbourhood care points were in danger of running out of

funding in the next two years

HIV prevention programmes, with the exception of (PMTCT)of mother-to-child HIV transmission and medical male

circumcision, were halted until 2013

Hoping to shift condom procurement to development partnerssuch as Population Services International or the UN PopulationFund (UNFPA)

Some clinics have been operating without treatmentsupporters, data clerks since 2008. These clinics also reported

being unable to implement TB infection control practices


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Malawi

Country saw periodic shortages of HIV testing kits thisyear; treatment rationing

As of early June 2012, the national AIDS committee hasproposed including salary support for affected healthworkers under the countrys Rolling Continuation

Channel but no decision had been taken. These top-ups,

important to retaining the countrys scarce healthworkers, may therefore come to an end.

Forecasted a gap of about US$ 12 million in healthworker salary support between June 2012 and June 2014

NAC introduced caps on CSO asks


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Civil society impacts

Half were most likely dependent on GF funding Two-thirds reported that their work in community

programme design and delivery had been impacted.

Halfsaid work with MARPs had been affected


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Hardest hit

Associations, support groups of people living with HIV Organizations operating at the district and community level

In Swaziland, SWAPOL closed its legal aid unit, which focusedon defending women's rights to property, for example, in acountry where women are legally still minors

Two-thirds of the CBOs that originally comprised the TsabangoHIV/AIDS network of 30 organisations in Malawi closed

The Swaziland National Network of People Living with HIV andAIDS (SWANNEPHA) was facing closure, as are some of its

local affiliates that provide adherence support and defaulter

tracing to local clinics


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Civil society impacts

When asked about their budget forecasts, about 40 %of respondents said their budgets would decrease

between now and 2014; an equal proportion responded

that their budget forecast for the next two years wasuncertain. No CSO said they expected their budget toincrease.

Without access to additional funding, or a new fundingwindow, almost 90 % of CSOs said they would haveto scale back programming; about a quarter said thatthey would also have to retrench staff.


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"We are losing the community structuresthat we've built up. If there comes a time

when there is money for HIV, we're going

to have to go back into communities and

build these structure all over again. -

Vusi Nxumalo, Vice chairperson of the Swaziland

National Network of People Living with HIV and

AIDS and CCM member


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Domestic funding

UNAIDS Zimbabwe working with government toincrease private sector contributions to HIV response but

anticipates that, if successful, that would take years to get

off the ground

Swaziland was lauded for taking the decision todomestically fund treatment in 2012 but continues to

source this funding from inconsistent customs revenues,which led to HIV treatment and lab reagent stock outs

throughout 2011

Local NGOs reported nonpayment of some staff atgovernment hospitals in 2012


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Implications

In 2009, the Fund mandated a 10% efficiency gain. OSF research found that in 9 countries, this efficiencygain was achieved by cutting civil society-led

programming, much like the countries under review didin the wake of Round 11s cancellation.

This pattern suggests that when countries are under-funded, civil society-led programming is likely the first to

go in order to assure access to essential medicalcommodities


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Recommendations - 2012

The Board should affirm CSOs importance in health responses bycalling on the Secretariat to develop a strategy outlining how CSOs

will be supported throughout the implementation of the Global Fund

strategic plan (2012-2016) and secretariat restructuring

Fund Portfolio Managers, Country Teams should ensure fundingfor community-based service delivery and systems strengthening is

protected and grant processes are transparent

Technical partners should provide guidance and technical support toensure support is retained for critical enablers, including community-

based service design and delivery, and programmes to address human

rights and barriers to access


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Today - The new funding model

In late April, OSF commissioned a rapid assessment ofcivil society participation in the new funding model

among the HIV applications of three early applicants Burma, El Salvador and Zimbabwe. This remains

ongoing

Preliminary results garnered largely from Zimbabweand to a lesser extent Burma found:

Country dialogues have included a wide range of civilsociety actors, including MARPs;

Newly revamped/ introduced GF mechanisms fosteredlandmark moves among MARPs in both countries; and

The need to support civil society in advocating for CSS


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To download a copy of the First to

Go report, go to osisa.org

For copies of the preliminary results

of OSFs latest rapid assessment or

to participate, please contact me at:

[email protected]

osf first to go - presented at asshh 2013

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