Partnership Forum 2015
More than 130 partners in global health gathered in Addis Ababa, Ethiopia, on 7-8 May to participate in consultations about developing the next strategy for the Global Fund partnership. The Partnership Forum was lively and energetic, with many concerns and suggestions brought forward, in English and French, reflecting a broad range of topics.
"The new strategy needs to keep human rights at the core,” said Nana Gleeson (pictured above), member of the Country Coordinating Mechanism in Botswana, who was one voice of many who spoke effectively. “We need to see how we can bring this to the ground, in countries and communities."
There were working groups on strengthening health and community systems, on how to be effective in fragile states and challenging operating environments, on sustainability and transition, on gender, on human rights and on other topics. The goal of the Forum was to get input for the next five-year strategy for the Global Fund, and the quality and quantity of contributions was rich.
The Partnership Forum will continue with a gathering in Southeast Asia in late June, and another in Latin America in early September. At the same time, there is an e-Forum for ongoing online participation. Many additional consultation opportunities alongside meetings hosted by technical and other partners.
With One Voice
Just before the Partnership Forum in Addis Ababa last week, more than 100 people from 46 implementing countries in Africa met to discuss how to strengthen their engagement on the Global Fund Board and contribute to making grants more effective in efforts to end HIV, TB and malaria as epidemics. The meeting focused on contributing to the strategy of the Global Fund, and making sure that the priorities, needs, obligations and contributions of African nations toward solving health problems are fully involved.
Many participants at the meeting of the Africa Constituencies Bureau of the Global Fund shared perspectives and lessons learned over the past year in the process of application for funding and during implementation. They talked about finding ways to strengthen health systems and to boost domestic financing for health. They discussed the importance of placing women and girls at the center of health efforts, and the need for flexibility and for tailoring programs to specific circumstances including challenging operating environments.
“We worked together,” said Assetina Singo-Tokofai, the coordinator of National Aids and STIs Program in the Ministry of Health in Togo. “There was no Anglophone Africa or Francophone Africa, we were one Africa Group.” She said the goal of improving the effectiveness of the two African constituencies on the Global Fund Board – West & Central Africa and Eastern and Southern Africa – is to increase overall impact on people affected by the diseases in the region.
One step toward achieving better impact is the establishment of an Africa Constituencies Bureau – an entity to improve the effectiveness of Board members who represent the Africa constituency at the Global Fund Board. With a focus on better service for the people affected by the diseases in the region, the Africa Bureau will work as a technical advisory unit for members of Board representing the Africa constituencies.
Anita Asiimwe, the Board member for Eastern and Southern Africa, said the Africa Bureau is a culmination of years of hard work aimed at boosting the impact of investments made by the Global Fund partnership. Nele Djalo, the President of the Country Coordinating Mechanism in Niger, said the bureau will provide an opportunity for African countries to engage with the Global Fund more strategically. It will also allow countries to share valuable experience on implementation of health programs.
The global health landscape is constantly changing, and it is sometimes a challenge to keep up-to-date. The complexity of preparing and implementing grants also means proactively working to remove obstacles and bottlenecks. The meeting demonstrated the determination of participants to work together to get it done.
The Best Investment
On the same day that participants gathered in Addis Ababa for the Partnership Forum, a U.S. Senate Sub-committee convened a hearing in Washington D.C. to consider spending on global health. It was one step in a legislative process, the kind that occurs in governments all over the world. Yet this hearing captured the spirit and sense of possibility that motivates funders to commit to global health.
Senator Lindsey Graham, who chairs the Appropriations subcommittee, could not have framed it better, in our view. “What I want the American taxpayer to know is that from my point of view, being a conservative Republican from South Carolina, I have never seen a better return on investment,” Senator Graham said. “In terms of future commitment of money, now is not the time to back off. We are literally inside the ten yard line when it comes to some of these diseases like AIDS and malaria and there are thousands if not millions of young people alive today because of America’s intervention and the taxpayer’s generosity.”
Senator Patrick Leahy of Vermont, the subcommittee’s ranking Democrat, echoed the view that national security and economic development are well served by investing in health. He added another reason for commitment as well: “When you’re in the wealthiest country in the world, you have some moral responsibilities.”
Elton John, who set up an AIDS Foundation, testified to the tremendous difference that U.S. involvement has had on the epidemic. “Congress’ leadership has been transformational,” he said. “What we once invested in hospices to treat the dying, has been repurposed to treat the living.” Rick Warren, Pastor of the Saddleback Church, testified that bolstered investment can make the world more secure and prosperous. “Medicines costs less than tanks,” he said.
Deborah Birx, U.S. Global AIDS Coordinator, spoke about the impact being achieved by PEPFAR, the President’s Emergency Plan for AIDS Relief, with its focus on young girls. Dr. Birx described DREAMS, with its goal helping girls develop into Determined, Resilient, AIDS-free, Mentored, and Safe women, though evidence-based interventions.
Mark Dybul, Executive Director of the Global Fund, pointed to the 55 countries on track to cut malaria by 75 per cent by the end of next year, as well as the 26 that are on the path to elimination. He also reminded the committee that this progress could not be taken for granted. “We can accelerate work towards ending these epidemics or we can risk their resurgence,” Dr. Dybul said.
Phelister’s River of Life
Credit: The Global Fund / Zacharias Abubeker
Phelister Abdallah spoke at the opening session of the Partnership Forum in Addis, aiming to voice the concerns of sex workers and other people most affected by HIV, TB and malaria. She did so by mentioning her personal story.
“I am a mother and a sex worker. I have two kids. I am living with HIV and I represent the Kenya Sex Workers Alliance,” she said.
That was just the headline. She told her full story in an interview, and it turned out to be quite a story.
Growing up on the Kenyan coast, Phelister was the daughter of a poor but hard-working single mother. When Phelister was 14, her mother fell ill with a mental disorder. Phelister dropped out of school and moved in with an aunt. Her uncle raped her. She had to gather a lot of courage tell her aunt, but the response was not good. “If I ever hear you say that again, I will kill you,” her aunt told Phelister. Her uncle raped her again, repeatedly, until she ran away months later.
She fell in with a pimp. At 15, she was selling sex to men in Malindi, a tourist resort. For an underage girl, it was a hard life. But she considered it much better than getting sexually abused by her uncle. “At least I was earning some money,” she said. Before long, she got pregnant. She went to a back-street abortion clinic, and then to another. None would operate, saying she was too young and undernourished. They did not want her to die in their hands.
One of the women at an abortion clinic said there was another option, selling her baby. She took Phelister into her home, caring for her until the baby arrived. The delivery was tough. “I was tiny,” said Phelister. “It was hard to push. Finally the baby came but I only heard the cry before it was whisked away from me,” she said. “I will never know whether it was a boy or girl.”
She was quickly kicked out of the woman’s home. She went back to the community of sex workers who took care of her until she was ready to hit the streets again. Months after resuming work, she met a client who helped her go to school. She took private classes and sat for primary school exams and did two years of high school, until she ran out of school fees. She tried sex work during the holidays, but she could not make enough to pay for her education so she dropped out again to do sex work full time.
At 19, she got involved with one of her clients and got pregnant with his baby. This time she wanted to raise her child. She was in love and her life was looking up. Then she went to a health clinic and learned that she was HIV positive. When she told her boyfriend, he left.
But she wanted to protect her baby. With treatment for the prevention of mother-to-child transmission, she delivered a healthy boy. She joined a sex-workers association, and was soon nominated as leader. When her son was three years, the father of her child showed up one evening. They talked, and he agreed to test for HIV. “Could you take me to the testing center?” he asked. She was happy to do it, and even happier when the test came negative, assuaging her guilt that she might have infected him. She had long suspected that she had gotten infected by her uncle. She and her boyfriend planned for another child. With HIV treatment, they could avoid infecting her boyfriend and baby. A baby girl arrived, HIV negative.
Phelister gradually grew in her advocacy work for sex workers. She went back to school, and graduated from secondary education with high grades. She has become the national coordinator of KESWA, a job that takes her around the world to represent Kenyan sex workers.
She mentors sex workers, a great way to keep learning herself. Her organisation coordinated the Sex Worker Academy for Africa, where sex workers meet. One session on sharing violence experiences asked each participant to follow “the river” of his or her life, coming to terms with its rapids and rocky parts as well as its smoother bits. It was a life-changing experience. “We cried together, for three months,” she said. “When the three months were over, the pain was gone. We learned to let go, and to speak to people, not to shout at them.”
Phelister’s relationship with her boyfriend is on and off. There is still a part of him that hasn’t accepted her life’s predicament. But she has. She still does sex work part-time. “I love my job,” she said. “I had to love it, to make it the career I never had.” Her message to the world is to let sex workers be. “Sex workers don’t need rescue. What we need is a safe space for us to do what we do, so that we can protect ourselves and protect our clients.”
By the Numbers
Value for money: The Procurement for Impact initiative is reducing costs through more efficient and effective purchasing and supply chain management. The initiative has saved $500 million since 2013 - money that is being reinvested by countries for greater impact. It has also improved monthly on-time delivery of commodities from 38 to 68 percent over the same time period.
Mobilizing domestic resources: A Domestic Financing for Health Strategy requires countries to match 15 percent of every grant with an increase in domestic resources for health investments – of any kind. It is catalyzing investment: Additional domestic funding is up 51 percent for the 2014 to 2016 period, accounting for nearly US$3.9 billion in additional funding.