‘AIDS Is Not Over’: Irish Civil Society meets with the Global Fund

Brynne Gilmore, IFGH Key Correspondent

On September 6^th at Iveagh House, Dublin, around 20 representatives from Irish Civil Society met with The Global Fund for AIDS, TB and Malaria (GFATM) representatives Mark Dybul, Executive Director, and Graham McNeill, Donor Relations. Organised by the Irish Forum for Global Health (IFGH) and the Dóchas HIV &AIDS Working Group, the meeting participants, including members from Concern, Childfund, Centre for Global Health, Trócaire and Oxfam, were able to engage in an open discussion on Ireland’s involvement in the international response to HIV, TB and Malaria and the future directions of the Global Fund.

Chaired by Nadine Ferris France, Operations Director of IFGH, the meeting was opened by Noreen Gumbo, Chair of the Dóchas’ HIV &AIDS Working Group, who commended the Global Fund for its commitment to health systems strengthening, policy inclusivity and for placing national stakeholders at the forefront of decision making – but not before providing some background on the new Dóchas’ policy on HIV & AIDS in response to Ireland’s recently released international development strategy, “One World, One Future” [http://www.dochas.ie/Shared/Files/4/HIV_and_AIDS_policy.pdf]. Firstly acknowledging Ireland as a leading international donor, Ms. Gumbo raised concerns over a decrease in investment in the response to HIV &AIDS stating, “we are so close to a point where we can manage the HIV epidemic, yet we see from where we are standing, a turning away [from a focus on HIV &AIDS]”. The Dóchas report, ‘AIDS Is Not Over’, highlights a deprioritisation of HIV & AIDS in the new development policy  coupled with a 48% decrease in  funding spent on HIV by Irish Agencies from 2006 to 2011 and a , while recommending strategies to increase momentum and political leadership.

Following the many optimistic statistics from GFATM’s recent Needs Assessment^⁠1 on antiretroviral (ARV) coverage, decreased AIDS and malaria related mortality, and TB detection rates, Dr Dybul reiterated Ms. Gumbo’s concerns over donors losing steam in relation to HIV investment by reaffirming that AIDS is not over, as we are already seeing an increase of HIV rates in some areas, especially within the most marginalised and vulnerable populations.  While again acknowledging Ireland’s commitment to international development, tracing it back as a core part of Ireland’s history, Dr. Dybul stated that the donor environment has changed, and is often no longer based on purely humanitarian interests, but on what he termed, ‘enlightened self-interest’: International donors are working in an integrated world and should recognise the benefits of globalisation in creating economic and relationship possibilities, enhancing capacity and opportunities for all parties.

Not only is how we think about donating changing, but also how we practice and implement funding in donor countries, which is something GFATM is currently reconstructing in their organisation. Civil society and country health systems must work in partnership, especially to reach the most vulnerable populations, with domestic financial commitment featuring prominently. Dr. Dybul made it clear that the old methods of vertical funding reminiscent of the 1980s are impractical and don’t address key health systems failures. Instead, GFATM is working within new more visible models of one funding pool going directly to countries that can prioritise local needs that should ultimately strengthen health systems.

As well as how we provide funding, how we measure its impact needs to improve. Many current output-based evaluations don’t measure real change, highlight populations or groups who are most vulnerable, or consider human rights in their reporting. GFATM is focusing more on a result-based framework that shows disaggregated data, by gender and age for example, and also highlights marganised groups, such as men who have sex with men. When examining results through this lens, as Mark Dybul noted, we are ensuing that gaps in programmes and the most vulnerable groups are being highlighted. Reducing their usual 150 markers for evaluation, GFATM is changing to approximately 30 complete indicators, such as coverage rates, that examine the effects on communities and households more strongly, instead of just focusing on an individual disease – recognising the inextricability of the multiple determinants of health, facing individuals.

Bringing health funding and evaluation reporting closer to communities and more in line with country priorities and identified needs is essential to continue success in GFTAM related programmes, especially in a donor climate that is currently facing resource restriction and a deprioritisation of certain health topics. Recognising health as a human right, and aligning funding policies and reporting within this discourse needs to remain adamant on political leaderships agendas, because as Dr. Dybul stated, “[there is] no disconnect between a result based framework and human rights”.

Brynne Gilmore

[email protected]

Further reading

Dochas HIV/AIDS Policy Paper:AIDS in not over: Ireland’s Responsibility to help finish the job

Why we need to act now

Global Fund Needs Assessment

¹ http://www.theglobalfund.org/en/replenishment/fourth/