Health advocates from across Africa share experiences, build capacity, and strategize on how to respond to HIV, TB and malaria
A two-day meeting attended by civil society and community advocates, the Global Fund, technical partners and state representatives has equipped participants to more meaningfully engage in the implementation of Global Fund grants in the African region.
The Third Annual Anglophone Africa Regional Platform Meeting, which took place on April 26th and 27th 2018 in Accra, Ghana, was one of a series of meetings held in Accra and co-organized by The Eastern African National Networks of AIDS Service Organizations (EANNASO), Hope for Future Generations (HFFG), and the Non-State Actors of Ghana. EANNASO hosts the Anglophone Africa Regional Communication and Coordination Platform, which is a component of the Global Fund's Community, Rights and Gender Strategic Initiative. Participants included health advocates working on HIV, TB and malaria, and CCM members representing civil society and communities of people living with and affected by the three diseases, from 24 English and Portuguese-speaking countries in East, West, Southern and Central Africa.
According to Nooliet Kabanyana, the Technical Support Center Program Manager for the Anglophone Africa Platform, the meeting provided an opportunity to build on the lessons from the [Anglophone Africa Regional Platform] meeting in Kigali, Rwanda in 2017. "In Kigali, we were just being introduced to the Global Fund's New Strategy 2017-2022 and to key features of the new architecture, and many countries in the region were in the initial process of developing their fund requests to the Global Fund," Kabanya said. "This year, we were able take stock of the lessons learned from the first phase of the Community, Rights and Gender Special Initiative (2014-2016) and really build the capacity of civil society and community-based groups to identify and adequately access technical support at various stages of the funding cycle, particularly to support program implementation".
Uliane Appolinario from the CRG department talked about the progress made in driving a human rights- and gender-responsive agenda across the entire portfolio. She described the Global Fund's ongoing work to define the full range of community systems and responses and community interventions within Global Fund investments. She also discussed efforts to document and promote approaches to community-based monitoring to improve services and program impact. A recurring theme shared by the various Global Fund representatives over the course of the meeting was that it is critical for civil society to remain engaged throughout the grant cycle but particularly during the implementation stage, highlighting the tremendous opportunity presented by the fact that for the first-time ever, the CRG is now providing technical assistance for oversight and community monitoring of grants.
Cases studies on innovative Global Fund programming
The meeting also provided an opportunity to showcase examples of innovative Global Fund programming from across the continent through case studies. The presenters tackled various themes: civil society engagement in challenging operating environments (COEs) such as South Sudan, where despite conflict and insecurity, a national platform of civil society and community groups is being formalized; programming for adolescent girls and young women (AGYW) in Kenya, community monitoring in Sierra Leone to deliver feedback on service quality in DOTS centers, and finding "the missing TB people" (those who have not been diagnosed and/or need treatment) through peer educators, referral systems and community mobilization for adherence in Mozambique.
Lucy Wanjiku Njenga, from Young Women Voices in Kenya, presented on how coalitions of young women and girls managed to influence Global Fund programming. "We were not going to get a seat at the table so we demanded for it, took a seat, and ensured our wants were addressed. AGYW representation in the Global Fund writing team was one young woman who programmers overwhelmed and kept out of the conversation," Njenga said.
"With support from Lean on Me, two more AGYW representatives were able to attend the writing process. A lot of lobbying of other members and CCM members was needed to ensure our priorities were not taken out". Acknowledging a tendency to dismiss young women in spaces where doctors, academics, and older and more experienced advocates are present, she reminded the room that young women are experts at understanding their own issues and designing solutions for them, and should be consulted from the beginning.
Sustainability, transition, counterpart financing and domestic resource mobilization
Sustainability, transition, and counterpart financing - issues that don't receive as much airtime in the region as elsewhere - were addressed during a panel. Olayide Akanni from Journalists Against AIDS (JAAIDS) discussed the experience of Nigeria, where the 2014-2016 Global Fund allocation was cut by 15% - $170.61 million - for failing to meet the counterpart financing commitment (see GFO 333). She recommended a broad-based, country-wide domestic resource mobilization strategy which clearly articulates how federal- and state-level financial contributions are regularly captured. Akanni also suggested that it was critical to "promote a shared understanding among the various stakeholders of the various clauses and conditionalities in each grant agreement".
Nana Gleeson from the Botswana Network on Ethics, Law and HIV (Bonela) described Botswana's experience of preparing to implement the country's final malaria grant, and cautioned that key populations were particularly vulnerable to transitions; African advocates should be looking at case studies from Latin America and the Caribbean and Eastern Europe, she suggested, as examples of good practices and potential pitfalls.
Many in the room were shocked to find out that the Global Fund would no longer be funding some countries - especially in Africa. Linda Mafu, the head of Civil Society and Political Advocacy at the Global Fund talked about domestic resource mobilization. In her presentation, she shared some key achievements for 2017. Namely, national dialogues on health financing held in Togo, Benin and Senegal, and the finalization of sustainability plans in Kenya and Tanzania. She also identified countries that have been identified as high-priority countries for domestic resource mobilization in 2018: Ethiopia, Kenya, Tanzania, Zambia, Zimbabwe, Uganda, Benin, Togo, Burkina Faso, Senegal, Cote D'Ivoire, Cameroon, Niger, Nigeria, Malawi and Liberia.
From knowledge to practice
The meeting included presentations on how civil society can use epidemiological data and evidence to influence programs, how technical partners are equipping communities to respond to the three epidemics, and lessons learned from technical assistance provision in the region. For example, participants were introduced to the different forms of technical assistance available through the Community Rights and Gender Department, the International HIV/AIDS Alliance, UNAIDS, and the Stop TB Partnership. Through group work, participants were able to practice identifying and articulating technical assistance needs.
Gaps in Malaria representation
Despite the fact that 91% of malaria deaths occur in Sub-Saharan Africa (according to the WHO) there were few malaria representatives attending the meeting, which reflects an ongoing challenge faced by the Regional Platform in engaging malaria constituencies. Increased investment in malaria and a push to consolidate a message around the importance of human rights and gender-responsive approaches have stimulated more requests for technical assistance on malaria grants but there is still much work to be done. Stephen McGill, Executive Director of Stop AIDS in Liberia (SAIL), who is a person living with HIV and is a long-standing AIDS advocate, urged those in the room to break the silos and "take up the fight against malaria". The room stood silent as he recounted the story of his own son contracting malaria and dying the next day.
The second lady of Ghana, her excellency Samira Bawumia closed the meeting with a call for greater engagement of civil society including community and faith-based organizations and an ambitious vision. "The time is right for us to push towards achieving a Universal Health Coverage as envisaged in the UN Sustainable Development Goals so all can have access to quality affordable health care."
For their part, many participants committed to submitting technical assistance requests to support community monitoring initiatives to identify and address implementation bottlenecks. Participants also worked together to develop country roadmaps cataloguing all the key country processes relevant to the Global Fund for the 3 diseases happening over the course of the next year. EANNASO will use this information to anticipate support needs and develop strategies to ensure the communities prepared to engage.
EANNASO, as host of the Regional Platform, reiterated its mandate to support the development of technical assistance requests and to share strategic information about the Global Fund and case studies highlighting relevant country experiences.
Overall, the participants felt the meeting was a success and appreciated the opportunity to learn from their peers and bring concrete strategies back to their countries.
Caoimhe Smyth, from Stop TB Partnership said: "The expertise and commitment in the room was mind-blowing at times and I kept wishing that other people were in the room to witness it. I also felt that the presence of the [TB] community, the availability of tools, and experiences being shared was a lot stronger this year, which reminded me of how far we've come".