Section: Trinidad & Tobago
Response to Latin American PLWA from Anandi Yuvaraj, Global Fund Civil Society Board member representing PLWA Communities
The response of Anandi Yuvaraj to the letter recently sent by PLWA from Latin America expressing their concerns regarding the Global Fund Process in the region is included below, although it was orginally sent as an attached file.
First, I would like to thank Ms. Yuvaraj for responding, and also clarify that this response to Ms. Yuvaraj's comments is my opinion which does not necessarily coincide with the response of those Latin American activists who drafted and signed the letter sent to Ms. Yuvaraj and Ms. Rita Arauz last January 28th in Lima, Peru. In fact, as I have clarified in a separate letter to Ms. Yuvaraj, since her response is in English, and most people in Latin America do not even speak English, we will have to wait for a Spanish translation of her response in order to distribute it to the various Latin American communities who wrote the original letter. She has addressed her letter to "Richard Stern and PLHAs/ networks/Activists of LAC," but our Agency, Agua Buena, did not actually write the original letter. It was an informal coalition of Latin American activists, including the Agua Buena staff, who did so. Specific questions posed by Ms. Yuvaraj should also be answered by the many other people who participated in writing the letter and signing it.
Second, I would like to recognize that it is an impossible task for one person, 'representing' the Communities of People Living with HIV/AIDS, Tuberculosis and Malaria, to be aware of all the factors affecting implementation of rapid "scaling up" and effective use of Global Fund resources as it impacts on the lives millions of people who need treatment in 80 or more Global Fund target countries.
But this also demonstrates the fundamental weakness of the Global Fund in responding to the needs of the Civil Society. One or two or three Civil Society representatives to the top level of decision making, being the Global Fund Board, is woefully inadequate in comparison to the havoc that the AIDS epidemic is causing in many countries. How can a few civil society representatives accurately represent the situation affecting millions of people in 80 countries to their fellow Board members?
At this point it is clear that the Global Fund Board is dramatically out of touch with the urgency of maximizing the Fund's ability to scale up the response to the epidemic rapidly and in a way that is congruent with Koffi Annan's original goal in calling for a worldwide "Global Fund" that would save as many lives as possible as soon as possible, this now almost four years ago. There is no excuse for this, considering that the Fund began functioning early in 2002.
Several Global Fund Secretariat members have told me that more community activism is needed because even people working at the Secretariat don't have meaningful access to these top level decision makers, most of whom are tragically unaware of what the GFATM situation in the field really is.
The whole structure of the Fund and its functioning should be reviewed, evaluated and revised at this point because in many countries, while dozens or hundreds of people are dying of AIDS each day, the money that would provide treatment for them is sitting in the bank in Geneva, or in some cases in accounts in the target countries themselves.
In my opinion, in seeking to maintain The GFATM as only a "financial instrument," as Ms. Yuvaraj puts it, the Fund has lost its way, and, in doing so, paradoxically has created a huge and inefficient world wide AIDS bureaucracy, divided among most of its target countries, that in many cases serves more as an obstacle to rapid scaling up, than as a conduit to efficient treatment access. These mini-bureaucracies, known as "Country Coordinating Mechanisms" and "Principal Recipients", have, in many cases, demonstrated dramatic inefficiency in delivering available resources to the community. In other cases it is the interaction between the CCM's and PR's and the Global Fund itself, that has proven to be lethal to the target communities. (There are of course, exceptions to my statement and in some cases the Global Fund process is working effectively, but in most cases in Latin America and the Caribbean that we are aware of, the projects seem to be in crisis).
With respect to Ms. Yurajav's point (#3) about " Low priority of antiretroviral treatment" this is perhaps the point that we in Agua Buena are most interested in, as our major focus is on Access to Treatment for People Living with HIV/AIDS. According to UNAIDS 300 people a day die of AIDS in Latin America and the Caribbean. In the 15 countries we work in, we estimate that about 60,000 PLWA who need treatment now do not have it, and there are Global Fund projects approved in 11 of these 15 countries, according to the latest information we have available. The Global Fund, in its three years of existence has provided treatment to only about 5,000 people in total in these 11 countries, but the potential amount of people who could be on treatment with already approved projects is well over 40,000, if the Fund had functioned as it should be functioning. The best we can do from our perspective is try to communicate the reality of those People who need treatment in the countries we work in (no ARV's, no meds for OI's, no blankets, no bus fare to get to clinics, no money for "co-payments," etc, etc.) to the powers that be at the Global Fund, those who might be able to make decisions that would help these people while they are still alive.
If the Civil Society representatives to the Board can hear our perception regarding the reality of those who are dying of AIDS, and take this reality into account and convey it to the Board, than that is our specific goal in this reply to Anandi Yuvaraj.
Agua Buena Human Rights Association
To: Richard Stern and PLHAs/ networks/Activists of LAC
Global Fund Board Member for the Communities Living with AIDS, TB and Malaria.
From the outset, I really appreciate all the comments and observations you have made on behalf of civil society organisations/PLHA movements from Latin American region. Whole heartedly, I would like to thank everyone who has put in the effort to bring these issues to my notice and the hope that you have invested in me to take these pertinent issues with Fellow Board members, Secretariat and TRP at appropriate forum to ensure that they get addressed.
I would like to first acknowledge the absolute importance of the need to communicate and consult with people living with HIV, TB and Malaria. As a delegation we have been privileged to have had a strong and committed representation from the LAC region in Rodrigo Pascal. However, as a Board member for this constituency the challenge is to ensure that I and the delegation are fully aware of the issues that the communities are facing. Recognising the existing difficulties in communicating, partly given our limited resources and diversity of languages as a community, I have just initiated a review of the Delegation to identify how we can best achieve this and what structures and processes need to be in place. Your advice on this would be greatly appreciated.
I will now try and address your specific points.
- Priority to people living with AIDS, TB and Malaria: As representative of community, I understand the importance that must be placed on the individual and the community. The Global Fund must continue to work to ensure that the needs of individuals are heard and met. At every Board meeting the delegation ensures that this message is heard and we push for policies that meet these needs. We will continue to do this, but need your support to make sure that all other delegations, including governments, hear this message loud and clear.
- Funding agency: One of the key challenges for the Global Fund has been to ensure that it is additional to existing mechanisms and does not just become another massive organisation with country offices everywhere. Consequently, from the beginning it has always maintained that it would remain a financing instrument, keeping its own size to a minimum, relying on partnerships with existing agencies to provide the technical support at the country level. This has clearly been challenging to say the least. Initially there was a lack of coordination and capacity of existing technical organisations, lack of clarity of funding for this support from grants and also a lack of utilisation of local experience and capacity, including networks of people living with HIV. Recent attempts at the Board level to address this problem have included providing the Secretariat with a mandate to assist in the identification of support needs, including the introduction of an Early Warning System, and to facilitate technical support. Is this enough? We need to know where this is not working. We will be asking the Secretariat to provide the Board with a review of how these mechanisms are performing. Please can you provide specific information of what is happening in your countries and provide suggestions on how you think this can be resolved.
- Low priority of antiretroviral treatment: I do not have the relevant information to comment on at this point, whether it was the result of proposals with treatment focus not being submitted from your region or because of proposals with treatment focus are not getting through the proposal review process. I do not understand on what basis these priorities have been determined and by whom. Are the CCM/Countries that submitted the proposals not setting this priority? I will try to clarify with Secretariat and TRP what were the reasons and what their role is on this issue. As far as I know the Secretariat does not have any role to decide on what the countries should focus and what they should address. But again any evidence you can provide on specifics would really help.
- Divisions in civil society: Though I have not met you personally, I have heard so much about the Latin American PLHA movements and the power of their voices in demanding and leading the civil society movement to realise their right to treatment and other social rights. Up to now I was under the impression that PLHA movements and civil society’s participation and representation from Latin American region in Global Fund processes were the better examples and something we should all replicate in our countries. The sources are reports and studies produced by the Secretariat and other institutions in assessing the involvement of NGO/PLHA in proposal development and monitoring and implementation of Global fund programmes in-county. Your comments contradict this impression which is worrying. Could you please help me to understand what exactly you mean by the divisions in civil society caused by funding from the Global Fund, with relevant examples at country levels? Without adequate information, it may not be possible for me to seek explanations.
- Misappropriation of resources: If Global Fund money is being misappropriated this is clearly unacceptable. This should be raised with the appropriate Fund Portfolio Manager at the Global Fund Secretariat. You can get the contact details from the Global Fund website (www.theglobalfund.org). I would press you to do this and please copy me into any correspondence so that I can make attempts to ensure this is dealt with appropriately.
- Representation of Civil Society on CCMs: This lack of representation and government dominance is reflected in many of our countries. This is why the Communities Delegation has pushed hard for more prescriptive requirements on CCMs to ensure full and effective representation on the CCMs. While we agree the policies do not go far enough, the recent Board decisions for a number of new requirements (such as civil society electing their own representatives) are a step in the right direction. The Secretariat has also initiated an assessment of all CCMs which will be used to evaluate proposals and Phase II renewals – hopefully becoming an incentive for improvements in the CCMS. However, again we need to be kept informed of where this is failing and I would appreciate any suggestions on how to improve this situation. We will continue to press for improvements within the CCMs at the Board level.
- Phase 2 in jeopardy: Your concerns about the possibility of countries losing funds are our concerns as well. Every effort possible needs to be made by all, including the country stakeholders and the Secretariat to ensure that Phase 2 gets funded. But it would be unacceptable to just accept some grants will fail. The performance-based system is meant to help lead to more effective implementation. But there are numerous options available to the Secretariat, including changing the Principal Recipient to one that can deliver more effectively. This should be considered before considering stopping funds. I will be raising this with the Secretariat to ask for explanations – but please send me specific information that I can use in my discussions.
- Global Fund providing technical support: As discussed in point 2 above, the Global Fund is committed to remaining a financial mechanism and relying on technical partners to support in-county needs. Funds are available through grants for technical support. But we agree that so much more needs to be done in ensuring that this happens and greater support from the Secretariat and other partners to facilitate this is essential. This problem is not unique to the Global Fund, but we need to find better ways of ensuring this support reaching those that need it most.
- Delays in disbursement: The Global Fund is sensitive to this issue and is taking all measures not to repeat this and proactively engaging the countries to stick to the timeline with regard to reporting.
- Sustainability of funding: This will be raised with TRP to ensure that this is built into the proposal from Global Fund end and also strongly advocate that civil society should ensure that these are addressed in the proposal when the proposal is being developed at country level.
- Information sharing on processes and decisions: As I stated at the beginning of this I am fully committed to trying to improve our communication with the communities’ constituencies. This has been challenging due to our limited resources. However, the review we are currently undertaken of how the delegation communicates and operates will hopefully identify ways to improve this capacity. We will also work with the Secretariat to ensure they share relevant information with CCMs, and with the Mick Matthews (email@example.com), the Civil Society Relations person at the Secretariat. Your active participation in sharing information will be important and please let me know how you think we could improve this through existing networks.
I would again like to thank you for raising these issues with me and to reiterate that I am committed to ensuring that people living with HIV, TB and Malaria remain at the centre of the Global Funds activities. The Global Fund has provided hope for many that they will access treatment, that they will have the resources to protect themselves and care for those already living with AIDS, TB and Malaria. This is such a massive opportunity to ensure continued funding for responses to AIDS, TB and Malaria, so we must work together to get it right.
I hope this is a satisfactory response to your letter. There is clearly a lot of work to be done to ensure people living with HIV, TB and Malaria are united in our response to the epidemics.
Please do not hesitate to contact me.
Global Fund Board Member for the Communities Living with AIDS, TB and Malaria.
Dear Richard Stern
Please find attached my response to your open letter addressed to me, as Board representative for Communities living with AIDS,TB and Malaria on Global Fund Board.
I would appreciate ,if you could share this response with PLHA groups and networks in LAC region.
With warm regards