Joint Statement of Civil Society Organizations in advance of the Thirty-Ninth Meeting of the Global Fund Board

Eligibility Position Statement 2018 updated

Eligibility Position Statement 2018 updated_Page_1

 

5 May 2018

On the 9th – 10th of May 2018, the Global Fund’s Board will consider revisions to the Fund’s Eligibility Policy based upon recommendations from its Strategy Committee. While some of these recommendations are positive, others raise serious concerns. By this Statement we – the organizations representing civil society and including communities of people living with and affected by the three diseases and other key populations from different countries and regions – would like to share with Global Fund Board members our position on several critical issues that should be considered by the Board during its deliberations on the Eligibility Policy.

Ensure access to transition funding for countries moving to high Income status

Evidence demonstrates that in upper-middle income countries (UMICs) where the Global Fund has transitioned out abruptly, governments do not automatically step up and fund life-saving services for criminalized and marginalized populations who have elevated vulnerability to the three diseases and face barriers to accessing services. Experience shows that instead, people who inject drugs, men who have sex with men, transgender persons, sex workers, migrants, homeless and other key populations are being left behind, with limited to no access to health services and support.

GNI per capita – which is used by the Global Fund as one of the key eligibility criteria – is a poor measure of a country’s wealth, since it masks countries’ internal income inequality and sheds no light on how much of the income goes to health and responses to the three diseases in particular or social inequalities and injustice. It is important to have multiple–criteria framework for eligibility and take into account fiscal space and heath expenditures that are devoted to the three diseases.

Thus, restricting access of countries to transition funding because of a World Bank decision to change their income status without taking into account their readiness to sustain the response to three diseases is considered by us as an irrational and unfair punishment of people affected by the diseases, who already suffer as a result of their own government’s lack of political will.

The most recent example of the application of this irrational provision of the Eligibility Policy is in the Russian Federation, where the last HIV grant (the only one ever granted under the “NGO-rule”, developed and coordinated by communities themselves and which proved itself as effective) was finished in December 2017 without any transition funding being available. This closure could have serious implications for the lives of communities most affected.

Do not restrict access to funding for HIV, TB and malaria responses of UMIC G-20 countries with high disease burden

We consider the requirement that UMIC G-20 countries must have an ‘extreme’ disease burden in order to be eligible for the Global Fund’s funding is purely political, absent of any rational approach to eligibility. Thus, this requirement should be completely eliminated. It particularly would make sense considering the intention to simplify/remove the five disease burden categories and replace them with a single threshold for UMICs. All upper-middle income countries with at least ‘high’ disease burden that are members of the Group of 20 (including those not being on the OECD-DAC List of ODA recipients) should become eligible to receive an allocation for any disease component.

Do not restrict access to funding for HIV for countries not on the OECD DAC List of ODA

The OECD DAC ODA requirement for UMICs to be eligible for HIV funding has existed since 2007. For the 2017-2019 allocation period, there were two countries whose HIV components are not eligible because of this requirement – Romania and Bulgaria. These countries both have high HIV disease burden. Like in a number of other countries in transition, the main challenges in Romania and Bulgaria are to sustain HIV prevention programs among key populations.12 Romania, which ended the Global Fund HIV grant in 2011 with low epidemic and recorded concentrated epidemic after a closure of many services and since then systematically has lacked political will on behalf of its government to fund the HIV prevention among key populations. Bulgaria ended its HIV grant in 2017 and it is yet to be seen whether its new national HIV program will lead to sustaining the response, in particularly whether the government will deliver full-scale funding in line with the national program and establish a working mechanism to fund community and civil society groups to provide services the key populations. It is not the first time we advocate for the elimination of this provision in the Eligibility Policy and, in our opinion, by continuously preserving this requirement the Global Fund itself creates a political barrier that precludes the provision of evidence-informed interventions for key populations in these countries.

In a scenario where there is elimination of the “G-20 Rule” and “OECD DAC ODA Requirement”, a non- CCM option for directly financing non-governmental and civil society organizations should be ensured for countries which demonstrate human rights and gender barriers to accessing services among key populations.

In a scenario where the “G-20 Rule” and “OECD DAC ODA Requirement” are considered to be preserved in the new version of the Eligibility Policy – the so called “NGO Rule” should be expanded to cover to all ineligible upper-middle-income countries that have been excluded for political reasons under the OECD DAC rule and the G-20 requirement but meet the disease burden criteria. This would make Romania, Bulgaria and Russia eligible under the OECD DAC Rule and potentially China, Brazil, Argentina and Mexico eligible as G-20 countries. Also, the language of the “NGO Rule” on “political barriers” should be revised as this terminology has no clear definition, is inconsistent with international law and could be interpreted against the interests of key affected populations in countries. We suggest it to be replaced with “human rights and gender barriers” as a terminology being consistent with UN human rights standards.

The eligibility requirement of meeting eligibility criteria for two consecutive years should be modified if not removed. It is inhumane and ineffective from economic standpoint to wait for the second year for UMICs if new epidemiological data shows increased burden and they have been classified as UMIC for the last two years. Epidemics do not disappear over one year. Moreover, the epidemiological data arrives with a delay of one or more years after the burden increases due to data analysis and verification.

For the Eligibility Policy to be effective, it should be synchronized with other key policies, like the Sustainability, Transition and Co-Financing Policy and Allocation Methodology. There should be flexibility to find solutions for these––so far few––countries that become re-eligible in the middle of the Global Fund’s three-year allocation period; some re-eligible countries might find themselves in situations of zero allocation in spite of re-eligibility in the phase of epidemiological emergency and challenges to fund services among key and vulnerable groups. As the sustainability is an ongoing process that does not end with the Global Fund’s support transition and the Global Fund has committed strongly to the issue, the Global Fund should work with bilateral donors and private foundations to establish the ‘safety net‘ or sustainability bridging funding  to  address  the  transition and sustainability challenges faced in the countries that have phased out or are phasing out from the Global Fund, without waiting for the countries to become re-eligible due to emerging epidemics among vulnerable groups, as it was the case of Montenegro, Serbia and some other countries. That support could be given small time-bound grants to civil society and technical assistance to address the most challenging elements, like contracting and financing services for vulnerable groups that are delivered by community and civil society groups.

To conclude, we hope that when Global Fund Board members are making decisions on the afore- mentioned issues, they will take our position into account as it is in line with Global Fund’s mission, founding principles in the Framework Document, and strategy to end the three diseases. We share that commitment to ensuring the Global Fund can achieve high impact in responding to AIDS, TB and malaria in our regions and we strongly believe that our proposal helps us all advance that shared goal.

Yours sincerely,

 

Anna Dovbakh

 

Executive Director

 

Eurasian Harm Reduction Association

Dr. Rick Lines

 

Executive Director

 

Harm Reduction International

Christine Stegling

Executive Director International HIV/AIDS Alliance

Judy Chang

 

Executive Director

 

International Network of People who Use Drugs (INPUD)

George Ayala

 

Executive Director

 

MSMGF (the Global Forum on MSM & HIV)

Mona Drage

 

Director

 

LHL International Tuberculosis Foundation

Rodelyn M. Marte

Executive Director APCASO

Olive C. Mumba

 

Executive Director

 

Eastern Africa National Networks of AIDS Service Organisations (EANNASO)

Irene Keizer

Director/Manager Policy and Grants Aidsfonds (Netherlands)

Khadija EL Gabsi

Chair of the Board ITPC MENA

Koen Block

 

Executive Director

 

European AIDS Treatment Group (EATG)

Andriy Klepikov

 

Executive Director

 

Alliance for Public Health (Ukraine)

Richard Elliott

 

Executive Director

 

Canadian HIV/AIDS Legal Network

Vitaly Djuma

 

Executive Director

 

Eurasian Coalition on Male Health

Benjamin Collins

 

Director

 

International HIV Partnerships

Wojciech J. Tomczyński

 

Co-Chairman

 

East Europe & Central Asia Union of PLWHIV (ECUO)

Dragos Rosca

 

Executive Director

 

Romanian Harm Reduction Network

Dr. Dan Werb

 

Director

 

International Centre for Science in Drug Policy

Catalina Constantin

 

President

 

MDR-TB Patients Support (Romania)

Iulian Petre

 

Executive Director

 

The Federation of PLHIV Organizations (Romania)

Anton Basenko

 

Chair of the Board

 

Ukrainian Network of People who Use Drugs

Maria Georgescu

 

Executive Director

 

ARAS – the Romanian Association Against AIDS

Adina Manea

 

Director

 

Youth for Youth (Romania)

Silvia Asandi

 

General Manager

 

Romanian Angel Appeal Foundation

Anya Sarang

 

President

 

Andrey Rylkov Foundation for Health and Social Justice (Russia)

Samir Ibišević

 

President

 

Association PROI (Bosnia and Herzegovina)

Evgeny Pisemskiy

 

Сhair

 

NGO Phoenix PLUS (Russia)

Lilian Severin

 

Director

 

NGO AFI (Act For Involvement), Republic of Moldova

David Otiashvili

 

Director

 

Addiction Research Center – Alternative Georgia

Dr. Karen Badalyan

 

Executive Director

 

Eurasian Key Populations Health Network

Vanessa López

 

Executive Director

 

Salud por Derecho (Spain)

Oswaldo Adolfo Rada L.

 

Regional Spokesman

 

Mecanismo social de apoyo y control en VIH de Colombia – MSACV

Andrey Chernyshov

 

Director

 

Public association “Supporting people living with HIV” Kuat” (Kazakhstan)

Yuliya Georgieva

 

Chair

 

NGO “Center for humane policy” (Bulgaria)

Graciela Touzé

 

President

 

Intercambios Civil Association (Argentina)

David Borden

Executive Director StoptheDrugWar.org (USA)

Maria Stagnitta

 

President

 

Forum Droghe (Italy)

Mariela Hernández

 

President

 

Latinoamérica Reforma (Chile)

Nicky Saunter

 

Chief Executive

 

Transform Drug Policy Foundation

Martin Leschhorn Strebel

 

Director

 

Network Medicus Mundi Switzerland

Nebojša Djurasovic

 

President

 

Association “Prevent” (Serbia)

Nalwanga Resty

Head of the organization Tendo’s World (Arts & Health)

Zeeshan Ayyaz

 

Executive Director

 

Amitiel Welfare Society (Pakistan)

Karyn Kaplan

Executive Director Asia Catalyst

Irma Kirtadze

 

Head of organization

 

NGO Women for Health (Georgia)

Anke van Dam

Executive Director AFEW International

Ahmed Douraidi

 

Coordinator

 

Association de lutte contre le sida (Morocco)

 

Open Letter to the National Antidrug Agency

We, the undersigned organisations, some of Romania’s most representative NGO’s in the field of drug prevention, treatment and harm reduction, are hereby notifying with regard to our decision to begin a boycott in working with the Romanian National Antidrug Agency (NAA) which we consider to be mostly responsible for the deplorable state of the Romanian system for drug prevention, treatment and rehabilitation. The institutions of the Romanian State and specifically the NAA should be reminded of their responsibilities towards drug users, communities affected by addiction and the Romanian civil society that has been for the last five years, struggling to survive and still build services for the population.

As stated in the official documents, the Romanian National Antidrug Agency (NAA) “elaborates, creates, implements, finances, monitors and evaluates the National Program and the Program of National Interest of prevention and medical, psychological and social assistance of the people who use drugs” and “collaborates with the non-governmental organizations in order to achieve the goals in the National Antidrug Strategy”. Recent history shows though that the “financing of the Program of National Interest of prevention and medical, psychological and social assistance of the people who use drugs” and the “collaboration with the non-governmental organizations in order to achieve the goals in the National Antidrug Strategy” have been hindered by the slow rate of implementing the Program of National Interest (PNI 2015-2018) and by the very hard to achieve conditions imposed in the guidelines of the subprograms opened for calls in this Program..

Background:

  • Timeline of the activities in the PNI 2015-2018
19.08.2015 The Governmental Decision no. 659/2015 is adopted (the approval of the Program of National Interest of prevention and medical, psychological and social assistance of the people who use drugs 2015-2018)
15.07.2016 Public debate on the financing methodology (though in the GD no. 659/2015 this methodology should have finished in 30 days from the law’s publication)
26.10.2016 The guidelines’ drafts for applicants in the subprograms IV, VII and VIII of the PNI 2015-2018 are published
12.12.2016 Open call for applications (with the necessary documentation), dead-line: 31.01.2017
07.02.2017 A new call for applications (with the necessary documentation), dead-line: 06.03.2017, time-frame for projects’ assessment: 13.03.2017-24.04.2017
21.03.2017 Invitation from the NAA to the NOS’s to a public debate in order to modify GD no. 650/2015 and to prolong the period of the PNI till 2020
15.11.2018 Dead-line for finishing the projects funded by PNI 2015-2018
  • The indefinite delay on the implementation of the PNI 2015-2018 that should have started in 2015 and are necessary to the communities of people who use drugs,
  • The conscious delay policy of making public the documentation for PNI 2015-2018 all through the year 2016, a policy belongings to the National Antidrug Agency and the Ministry of Interior,
  • The launch of the open call at the end of 2016 and a relaunch at the beginning of 2017 even if there was no budget allocated for 2017,
  • Romania can not fulfil the obligations assumed under the national strategies and action plans,
  • There is no public funding (from the government) for private providers of services for people who use drugs,
  • There are no services (public or private) for underage PWUDs and the legislation is lacking in this area,
  • There are no guidelines yet for the subprograms I, II, III, V and VI in PNI 2015-2018,
  • The guidelines published contain conditions quite hard to achieve, such as the one holding that the salaries of the people hired in the project must be 10% of the total budget,
  • The increase in the levels of new cases of HIV, Hepatitis, TB, STDs, unwanted pregnancies, newborns with chronic diseases or various incapacities, deaths, high criminality in communities, in the absence of any real, coherent and focused relationship of the NAA with the NGOs.

Considering all these arguments, the organizations in the Romanian Harm Reduction Network have decided to indefinitely suspend all communication with the National Antidrug Agency, seeing that the NAA does not fulfill and has no will to fulfill its mission (always assumed in theory, never in practice), consequently the meeting called by the NAA will not be honored.

Romanian Harm Reduction Network – Mihai Tănăsescu (president), Dragoș Roșca (executive director)

ARAS (The Romanian Anti-AIDS Association) – Maria Georgescu (president)

ALIAT (The Alliance to Fight Alcoholism and Addictions) – Bogdan Glodeanu (executive director)

PARADA Foundation– Ionuț Jugureanu (executive director)

Sens Pozitiv Association – Alina Dumitriu (executive director)

Joint Statement of Romanian Civil Society Organizations in advance to the Thirty Sixth Meeting of the Global Fund Board

08 November 2016

 

Successful Replenishment and the Risk of Zero Allocations for a resurgent epidemic

 

At the 5th Global Fund Replenishment Conference in September, US$12.9 billion was raised for the 2017 – 2019 Allocation Period — the largest replenishment amount ever in the Global Fund’s history. At the end of October, the Global Fund published its 2017 Eligibility List identifying which country components are eligible for funding during the during the 2017-2019 funding cycle, noting that eligibility does not guarantee an allocation. According to this list, Romania’s HIV/AIDS program is only eligible for funding for HIV/AIDS under the NGO rule, the criteria for which is detailed in the Global Fund Eligibility Policy.

 

In advance to the upcoming 36th Meeting of the Global Fund Board on the 16th and 17th of November, we – representatives of Romanian civil society organizations, including people living with HIV and TB and key populations – would like to express our deep concern about the potential disconnect between a successful replenishment and the small or non-existent allocations that will be made available for countries like Romania and upper middle income countries with HIV epidemics that are still not controlled. We believe that there is a high risk that the allocation for the HIV component for Romania for the next three years could be zero – the same as it was the previous allocation period. In this circumstance, even if we, as civil society, work hard to show that we meet the criteria of the NGO rule, there will be no funding available for us to apply for.  

 

Some unfortunate history

 

The last Global Fund HIV grant for Romania came to an end on 30 June 2010. In 2011 the Romanian CCM developed an HIV proposal for submission to the Global Fund for Round 11, which we all know, was cancelled. At the same time, the 23rd meeting of the Global Fund Board adopted new country eligibility criteria that resulted in Romania becoming ineligible to apply for another grant owing to its classification as an ‘Upper Middle Income’ (UMI) country with a ‘moderate’ HIV disease burden.

 

However, in 2013, Romania’s HIV disease burden was increased to ‘high’, making it again eligible for an HIV grant under the New Funding Model (NFM) through the ‘NGO rule’. A targeted concept note was developed and submitted, but was not supported by the Global Fund. The Fund’s ‘Eligibility and Counterpart Financing Policy’ states that one of the conditions necessary to receive an allocation for HIV under the NGO rule is that the applicants must provide confirmation that the “allocation will be used to fund interventions that are not being provided due to political barriers and are supported by the country’s epidemiology”.

 

At that time, Romanian NGOs working on HIV, harm reduction and human rights, tried to prove that indeed, there were serious and insurmountable political barriers to the delivery of HIV prevention services for key populations that take the form of:

 

  1. the lack of a strategic HIV framework since 2007;
  2. the lack of national human rights strategy focused on vulnerable groups;
  3. the lack of targeting by the National HIV Program on prevention measures for people who inject drugs (PWID) and men who have sex with men (MSM) even though official data indicates that these are the most affected key populations;
  4. the ongoing lack of government funding for harm reduction interventions even after the government made a commitment to provide such public funds;
  5. the lack of political will to publicly address the steady increase of HIV among MSM;
  6. the lack of sexual and reproductive health education strategy and legal attempts to criminalise sex education in the public school system; and
  7. the lack of capacity of Romanian Government to address and implement the recommendations issued by the UPR in 2013 and the recommendations issued by the Committee on Economic, Social and Cultural Rights[1].

 

However, such issues were viewed by the Global Fund Secretariat as a ‘lack of funding or political will rather than political barriers’, per se[2]. Unfortunately the same barriers still remain, and this sad history is resulting in catastrophe for people living with HIV in our country:

 

  • HIV prevalence among PWID in Romania rose from 1.1 to 4.2 percent between 2008 (when we still had a Global Fund grant) and 2010;
  • The prevalence among PWIDs then shot up to an estimated 49.2% in 2013 before falling back somewhat to 27.5% in 2014[3] due to the efforts of NGOs including mobilization of some support from the EU (structural funds), Norway and a few private foundations;
  • It was noted in a January 2016 article in the International Journal of Drug Policy that “a specific HIV outbreak among drug users (around 2011) has been directly linked to the significant decline in harm reduction services following the Global Fund transition out of the country[4]“;
  • While estimated 18% MSM in the capital city had HIV in 2014[5], even country’s UNGASS report acknowledges lack of any HIV prevention among MSM with exception of volunteer sporadic actions;[6]
  • Although the Romanian government is supporting HIV treatment and partially funds someopioid substitution therapy, almost zero governmental funding has been allocated on HIV prevention activities among key affected populations in recent years;
  • People from key populations remain highly stigmatized and marginalized, for example, criminal law punishes possession of ‘high risk’ drugs with up to 3 years of imprisonment. While the legislative and policy environment in Romania does provide for harm reduction and other services targeted to key populations to maintain some services, the Government has shown little commitment to fund such interventions, especially needle and syringe programs;
  • At the same time HIV prevention services are still being partly funded in Romania by the Global Fund through its current TB grant, which while extremely helpful, only funds a small part of our population affected by both TB and HIV.

 

The key barrier to a sustainable HIV prevention program and HIV/AIDS sector in Romania is the lack of political will to fund the program by the Government.

 

We hope that members of the Global Fund Board understand the decision before you at your November meeting to apply your new allocation methodology may result in allocations of zero in communities facing a re-emerging HIV crisis. This stands in contradiction to commitments to keep the Global Fund global by introducing a differentiated investment approach in which funding decisions are guided by considerations of need and impact. As we fight against government inaction on HIV, the Global Fund must also live up to this commitment. Our live and the lives of the people we work with depend upon it.

 

Yours sincerely,

 

ACCEPT Association (LGBT, SW), Romanita Iordache – Vice President

ALIAT Association  (IDUs),  Bogdan Glodeanu – Executive Director

ARAS – Romanian Anti AIDS Association (PLHIV, IDUs, SW, MSM, other), Monica Dan – Project Coordinator

CARUSEL Association (IDUs, Roma, homeless people, SW, PLHIV), Marian Ursan – Executive Director

COPAC – Coalition of Organizations of Patients with Chronic Diseases (18 NGOs), Radu Ganescu – President

CRJ – Centre for Legal Resources (Human Rights), Georgiana Iorgulescu – Executive Director

ECPI – Euro-regional Center for Public Initiative, Florin Buhuceanu – Executive President

FONPC – Federation of Non-governmental Organizations for Children (82 NGOs), Bogdan Simion – President

PARADA Foundation (Homeless and other vulnerable groups), Ionut Jugureanu – Executive Director

Romanian Angel Appeal Foundation (PLHIV), Silvia Asandi – General Director

RHRN – Romanian Harm Reduction Network (IDUs) Dragos Rosca – Executive Director

Save the Children Romania (Homeless people, other vulnerable groups), Liliana Bibac – Project Coordinator

SECS – Romanian Society for Sexual and Contraceptive Education, Iustina Ionescu – President

Sens Pozitiv Association (PLHIV, IDU, SW, MSM), Alina Dumitriu – Executive Director

UNOPA – National Union of Organizations of People Living with HIV (22 NGOs) Iulian Petre – Executive Director

Youth for Youth Foundation (young people),  Adina Manea – Executive Director

PSI Romania (MSM/LGBT), Patricia Mihaescu – Operations Manager

 

 

 

[1] „Concluding observations on the combined third to fifth periodic reports of Romania”, 9 December 2014, pct. 22, Sexual and reproductive rights,available at http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=E/C.12/ROU/CO/3-5&Lang=En

[2] The Impact of Transition from Global Fund support to Governmental Funding on the Sustainability of Harm Reduction Programs. A Case Study from Romania. Eurasian Harm Reduction Network. 2016.

[3] EMCDDA (2016). Statistical Bulletin. Table on HIV Prevalence accessed at: www.emcdda.europa.eu/data/stats2016#displayTable:INF-108

[4] http://www.ijdp.org/article/S0955-3959(15)00236-4/fulltext

[5] EU-funded project Sialon II. Report on a Bio-Behavioural Survey among MSM in 13 European Cities. Accessed at:http://www.sialon.eu/data2/file/133_Sialon%20II_Report%20on%20a%20Bio-behavioural%20Survey%20among%20MSM%20in%2013%20European%20cities.pdf

[6] Romania: Country Progress Report on AIDS Reporting period January 2015 – December 2015. Bucharest, April 2016. Available at:http://www.unaids.org/sites/default/files/country/documents/ROU_narrative_report_2016.pdf