Increased investments and enhanced capacity to address gender inequality
As part of its new strategy for 2017-2022, the Global Fund has placed increased emphasis on rights and gender. One of the four strategic objectives focuses directly on promoting and protecting human rights and gender equality, aiming to scale up programs to support women and girls (including programs to advance sexual and reproductive health and rights) and invest to reduce health inequities (including gender and age-related disparities). See GFO article.
For the Fund, this is a fairly radical shift. It is the first time that gender has featured in a top-line strategic objective in the Global Fund's organizational strategy. Previously, there had been a parallel Gender Equality Strategy (2008) and a related Action Plan (2014).
"Having a separate and unequal strategy had to change," said Heather Doyle, Senior Coordinator for Gender at the Global Fund. A consultation on gender in 2015 in New York alongside a session of the Commission on the Status of Women (CSW) highlighted the Global Fund's failings on gender equality in terms of investments and approaches. "We needed fundamental changes at the Secretariat level," Doyle said.
Recognizing past challenges and preparing for its new strategic focus on gender equality, the Global Fund Secretariat is pursuing an initiative called Strategic Actions for Gender Equality (SAGE). The main goal of SAGE is to ensure that strategic objectives on gender equality translate to quality investments on the ground, removing gender-related barriers to critical health services. SAGE is a time-bound project which began in February 2016 and is slated to end in March 2017. Once the project ends, the key objectives should be integrated and embedded in how the Global Fund does business.
SAGE has three main work streams:
Replenishment. This work stream speaks to how effectively the Global Fund communicates what it is doing on key issues related to gender, and especially related to engaging civil society in this area. There is clear recognition that this communication matters for how successful the Fifth Replenishment conference will be in September. For the Fund, this has meant prioritizing a strategic presence in global forums such as Women Deliver and the Women in Development conference.
Data and systems. Transforming the way the Global Fund collects sex- and age- disaggregated data is a key priority for SAGE. This work steam is connected to a separate project called AIM (covering 83 grants), which is a way to improve how the Fund collects and uses data. The 83 grants that are part of AIM will be required to report sex- and age- disaggregated data. This may include data on how many men and women are currently supported on treatment through Global Fund investments. Doyle notes that "Currently, we can't do this, and this is particularly important for TB." There is no single indicator to capture progress in gender-TB work across the continuum of care.
Processes. While the initiative is mainly focused on the first two work streams, there is a third and longer-term work stream which examines policies and structures, training, support programs, leadership, and institutional culture, among other things. This work stream focuses on ensuring that the Global Fund Secretariat has the structures in place to successfully implement its strategic objective on gender equality.
Through these work streams, SAGE has five key aims:
quality investments across the three diseases that address gender equality, gender and age related disparities, and the health needs of women and girls;
scaled-up, quality investments for adolescent girls and young women in sub-Saharan Africa that will reduce this population's HIV incidence;
data systems that are able to respond to sex and age disaggregation data needs;
strong partnerships with national governments, civil society, communities, technical partners, and the private sector and
increased Secretariat and CCM capacity to address gender inequality.
To achieve these aims, SAGE will prioritize several countries for intensified efforts to introduce and scale up programs for adolescent girls and young women to reduce HIV incidence. The Global Fund anticipates doing this in the following countries: Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.
"If you look at HIV incidence in those countries, it's both high and stagnant for the last 3-5 years," Doyle explained. "Then you have the youth bulge. Even if we maintain what we are doing, you will see a rise [in new infections]."
In a recent interview, U.S. global AIDS coordinator Ambassador Deborah Birx spoke to the youth bulge issues, saying, "If you look at South Africa, itself, about the demographics of the young women in the age category of 15 to 30 at the beginning of the epidemic in 1985 and you look again now of how many young women, there's about 25 to 30 percent additional young women in that age group." With so many more young women placed at risk, prevention efforts will have to be enhanced to keep in step. Changes to the Global Fund's allocation methodology for 2017-2019 will make up some ground, as there will be a 30% increase in allocations for sub-Saharan African countries with the highest HIV infection rates in women and girls (see GFO article).
Doyle told Aidspan that the discussion on how to reduce these extremely high levels of HIV incidence among young women has been too narrow at times. "For example, do cash transfers work? Does comprehensive sexuality education work? Whom do you target?" she asked. She noted that PEPFAR's DREAMS package - which goes beyond health interventions to include poverty, gender inequality, sexual violence, and lack of education - really opened up this space, both politically and programmatically.
As a complementary process to SAGE, the Global Fund's Community, Rights and Gender (CRG) Special Initiative has been deploying technical assistance to enhance gender components in country dialogues and concept notes. Gender-related technical assistance (TA) has been in high demand, featuring in 18 assignments over 2014-2015 (see figure). Nearly 25% of all short-term TA deployed through the CRG Special Initiative has been to support the inclusion of sound gender-responsive interventions in concept note development.
"We can't take a passive approach," Doyle concluded. "Isolated interventions will not get us there. We need comprehensive packages for young to reduce incidence in this population."