The Global Fund Board passed its new Strategy for the period 2017-2022 - unanimously and to the sound of applause - during its 35th Board Meeting in Abidjan, Côte d'Ivoire. The Africa constituencies of West and Central Africa, and East and Southern Africa, were pleased to see the long process of developing the new Global Fund Strategy reach a successful conclusion.
Through an extensive consultation process, the resounding message was for The Global Fund to "stay the course" and refine priorities rather than make major strategic shifts. The strategy development process was led by Strategy, Investment, and Impact Committee chair David Stevenson and vice-chair Anita Asiimwe, the out-going board member representing the East and Southern Africa constituency.
It was gratifying to note that three of the priorities of the Strategy align very closely to what was identified at the May 2015 meeting of the Africa constituencies in Addis Ababa, Ethiopia as the most critical issues for Africa:
resilient and sustainable systems for health
women and girls
challenging operating environments
Resilient and sustainable systems for health
Building resilient and sustainable systems for health is the top priority for the Africa constituencies. The Africa constituencies strongly believe that such investments will yield not only the maximum impact for disease-specific programming but will also enable countries to better respond to both predictable and emergency public health issues across the board. The constituencies hope this will not only help to achieve Global Fund goals, but also lift the overall health status of Africans across the continent through improved national systems.
Specifically, it was good to see attention to human resources for health, including pre-service training for community health workers. This is a major victory since this has been an area most funders have resisted supporting. The constituencies were also pleased to note support for countries to develop M&E plans and investments in data systems to improve the quality of data that populate these plans - another huge step in the right direction. The constituencies hope to see alignment between Global Fund goals and targets and other global agendas to maximize the impact of data investments.
Women and girls
As Global Fund Executive Director Mark Dybul said during the board meeting, the battle will be won or lost based on how well we address the epidemic in women and girls in sub-Saharan Africa. In some places in Africa, the rate of HIV infection is two girls for every one boy; in others, infection rates are as high as 10 to one.
Structural and societal barriers compound the disparity and prevent access to life-saving interventions. The Global Fund's focus on women and girls in its 2017-2022 Strategy is therefore critical to achieve its global goals. This includes, for example, interventions that support girls to improve health as well as education, an unprecedented move by The Global Fund. As the strategy explains:
"... [Th]e evidence is growing that keeping adolescent girls and young women in school reduces their vulnerability to HIV infection and other health risks, and ultimately enables girls to become healthy, educated and financially independent women who make well-informed choices about their lives. By working together with organizations such as the Global Partnership for Education, the World Bank, and bi-lateral partners, investments made by the Global Fund may be leveraged or vice versa to enable adolescent girls and young women to have access to both better health and better education."
The Africa constituencies hope that sharpened focus on women and girls leads to swift improvements in capturing age and sex-disaggregated data at the country level.
Challenging Operating Environments (COE)
Challenging environments may result from enduring political, social and/or environmental issues or from emergency situations. Africa is home to a number of countries classified as COE. Such environments compromise a country's ability to achieve the intended impact or, worse, derail progress of Global Fund investments. Effective, efficient, tailored responses to COE, whether chronic or acute, will help ensure that ground is not lost in disease response.
The Africa constituencies congratulate The Global Fund Board for delivering an ambitious Strategy that responds to the current realities in global health. The Strategy demonstrates deliberate efforts to harmonize with other global initiatives to tackle the three diseases (specifically with the End TB Strategy, and the UNAIDS Fast Track, and the Global Technical Strategy for Malaria) as well as the Sustainable Development Goals.
The Strategy allows The Global Fund to maintain its role as a transformative force and a global agent of change that will spearhead efforts to rethink health system investments. There is a real opportunity to demonstrate that investments can be made in the foundations of strong and resilient health systems on which successful disease-specific interventions can be built, while staying true to its core mandate of fighting the three diseases.
Now comes the hard part: implementing the Strategy. But with strong support from donors and implementers around the world, there is little doubt that the next phase of Global Fund activities will take us further in global health than we could have imagined at the inauguration of The Global Fund back in 2002. Africa holds the greatest disease burden and so strongly appreciates the support from The Global Fund and its donors.
Together with its country partners, The Global Fund has saved some 22 million lives. The Africa Constituencies believe we - all of us involved in the work of The Global Fund at all levels around the world - are at a critical juncture as we move into the next replenishment cycle to ensure that The Global Fund is able to invest strategically and ambitiously to support countries in meeting their goals of eradicating the epidemics through strong and resilient health systems.
The author is policy outreach manager for Nairobi-based African Population and Health Research Center (APHRC), which provides technical support to the Africa constituencies to The Global Fund Board. The comments and opinions contained herein are her own and do not imply endorsement from the members of the Africa constituencies. This commentary is based on a blog the author published on 27 April on the website of the APHRC.