IFGH 2012: Increasing Country & Community Involvement in Global Health Policy Processes? The Case of the Global Fund to Fight AIDS, Tuberculosis and Malaria

January 29, 2012

Authors:Bruen C., Brugha R.

Author Affiliations: Dept. of Epidemiology and Public Health Medicine, Division of Population Health Sciences,Royal College of Surgeons in Ireland

Option 1 – Scientific / Empirical Research Findings

Presented as – Oral Presentation


In the context of the Global Fund to Fight AIDS, Tuberculosis and Malaria, to

a)  examine how non-governmental and other civil society organisations (CSOs) have engaged in global level 
policy and decision-making processes that affect country and community responses, including health 
systems and workforce challenges

b)  highlight the impact CSOs have had on the Global Fund, and the impact on them of engaging in the Global 


In-depth telephone interviews (2009-10) of purposively selected individuals (n=36) from: Global Health Initiatives (GHIs); developing country governments; bilateral donors; multilateral agencies; academic/research institutions; NGOs/CSOs; philanthropic foundations; and the private sector. Interviews were recorded, transcribed and thematically analysed.


Prior to establishment of the Fund, discussions on global HIV financing were shaped by donor priorities. Northern AIDS treatment CSOs became directly involved in 2001 through the Global Fund Transitional Working Group. Consultation was initially limited to Northern individuals and organisations connected to dominant Southern CSO networks. Over time, new technology enabled wider consultation with affected communities.

Early challenges included: perception of undemocratic and anti-participatory processes at global level; divisions and rivalries between CSOs; slow release of information; resource constraints. CSOs established mechanisms to enhance representativeness, communication and community engagement. Wider representation of CSOs ensued; however, tensions persisted around roles (advocacy versus service delivery); were divided along a Northern/Southern axis and shaped by competition for finances; and around fears of donor co-option.

Discussion/conclusions/ implications:

The Global Fund enabled CSOs and representatives of communities participate in global health policy processes. Contesting stakeholder views emerged on: i) who CSOs are accountable to; ii) meanings of country ownership; iii) and relationships between global and local level. Lessons learned from CSO engagement in Global Fund processes provide valuable examples to stakeholders on how to incorporate community perspectives, interests and needs into global HIV and health policy making.



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