Reaching the Most Vulnerable in Viet Nam
The Global Fund is committed to promoting and protecting human rights. It’s not just sound ethics, it’s also sound health policy. To really defeat HIV, TB and malaria, we have to focus on protecting the basic human rights of the vulnerable, making scientific advances available to everybody. In line with this approach, the Global Fund recently integrated a condition into its HIV grant with Viet Nam that requires the government to identify an international organization to monitor compulsory drug detention centers. The Global Fund has been closely working with its Vietnamese counterparts to ensure a sensible timeframe for their closure, as well as providing direct support to domestic networks of key populations. These compulsory drug detention centers in Viet Nam have been an issue of serious concern among human rights organizations, and the Global Fund has repeatedly raised human rights concerns with the Vietnamese authorities and has taken programmatic steps to address these.
Under a US$85 million grant signed in May 2013 between the Global Fund and the Ministry of Health of Viet Nam, the Vietnamese government agreed to identify an international, independent non-governmental organization to monitor conditions in all drug treatment centers where the Global Fund supports interventions. This international organization will be required to have extensive experience in monitoring and providing emergency medical relief in treatment facilities and closed settings, cannot be directly involved in the daily operations of the centers, must enjoy unimpeded access and be empowered to make recommendations to the Viet Nam government based on any findings. This additional safeguard will help to ensure that the services provided in the centers through Global Fund resources are provided on a voluntary basis, and that medical treatment is provided in accordance with international human rights standards. As of 1 January 2014, all Global Fund support for services in these centers will be conditional on this monitoring. The Global Fund remains committed to strengthening the essential contribution of civil society to the fight against HIV and AIDS. The grant to Viet Nam also provides seed funding to the domestic networks of sex workers, people who inject drugs, and people living with HIV – the groups most vulnerable to the pandemic. This funding is expected to strengthen the networks’ sustainability, their involvement in the national response, and their ability to advocate the human rights of their community members.
Engaging with Key Affected Populations
As part of the Global Fund’s new funding model, a pilot initiative is being launched aimed at increasing the participation in the grant process of people living with or affected by the three diseases and with key affected populations including girls and women. The pilot initiative, which will be tested in 10 countries during the rest of 2013, will provide additional funding to Country Coordinating Mechanisms that are proactively engaged during country dialogue and concept note development with people living with or affected by the three diseases and with key affected populations. The approach is also intended to strengthen the ability to identify programmatic gaps and intervention needs and create “safe spaces” for key affected populations, especially those who are criminalized and marginalized, to engage in the process. Each country will select a regional or global organization to support the CCM and give feedback to the Secretariat on how the pilot is working. The 10 countries selected for the pilot initiative are DRC, Lesotho, Sri Lanka, Swaziland, Uganda, Moldova, Thailand, Guyana, Nigeria and the Philippines. Countries were selected because they were interim applicants to the new funding model in 2013, because their CCM is applying for the CCM funding in 2013; or applying for funding with a large grant. CCMs will receive between $10,000 to $50,000 depending on the size of the country and the disease burden in the country. The Secretariat will evaluate the initiative and decide whether to roll out the initiative to CCMs in 2014.
Getting the Right Data
The Global Fund is adopting a new approach to funding, and getting the right data from countries who want to apply for grants is paramount. Ensuring good data is important not only to monitor the success of programs but it is also an essential factor to provide access to treatment and a reliable supply of medicines, especially for populations most at need. Technical specialists are currently gathering data in countries and the new funding model allocations in early 2014 will rely on this data. It is important that Country Coordinating Mechanisms start planning now to prepare for the new funding model before the final country funding allocations are known. Engaging now with WHO and UNAIDS will ensure that the disease burden data is up-to-date and is reflected in partner reports. The Global Fund will only use data provided by WHO and UNAIDS, so any changes must be agreed beforehand with technical partners. The new funding model allows countries to upwardly adjust their indicative funding amount through a “willingness to pay” qualitative factor adjustment mechanism. Countries that meet the established counterpart financing thresholds will be eligible for an increase to their allocation based on additional government investments. It is therefore important that data on government health spending is also up-to-date. Strong epidemiological information, especially at regional levels and for key affected populations, will allow funding applications to better target limited resources for strategic impact on the three diseases and cross-cutting Health Systems Strengthening.
Profile: Marijke Wijnroks
Marijke Wijnroks grew up in a small village in the eastern part of the Netherlands, with little awareness of the outside world. Her father was a factory worker. Life’s possibilities, she remembers now, did not seem to go much beyond the boundaries of the village. But one day, at age 9, Marijke saw the haunting faces of war, famine and disease from a place somewhere in Africa she had never heard of. “I remember seeing the images of Biafra on the television and it made such an impact on me that I told my parents: ‘When I grow up I am going to be a doctor and I am going to Africa to help those children’,” she recalled. “The idea of going to university or going abroad was something unrealistic, not part of my family’s background, but I was so clear with what I wanted to do with my life.” Marijke went on to earn a medical degree from Maastricht University in the Netherlands and a degree in tropical health and medicine from the Institute for Tropical Medicine in Antwerp, Belgium, before joining Médecins Sans Frontières as a young field doctor in war-torn South Sudan. And so began a remarkable career in global health and development work, spanning missions in civil society, the United Nations and in the government for more than 25 years in Africa, Asia, Latin America and Europe.
This month, Marijke became Chief of Staff of the Global Fund, with a particular focus on gender and human rights, bringing in the same enthusiasm of her youth. “The Global Fund is a model for the future: a learning organization that works with partners and adapts to the context of countries.” Marijke was Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS and also Deputy Director of the Social Development Department in the Ministry of Foreign Affairs in the Netherlands. She is not a newcomer to the Global Fund. She served as a Board member for several terms, and also for two years as Vice-Chair of the Board’s Ethics Committee. She feels the Global Fund can make an even greater difference than before, and she is eager to be part of it. “We have much more understanding of the epidemics. Prevention and treatment options have improved massively and we know much better how to implement programs. We can make history, both in defeating the diseases and in tackling the underlying factors that determine the diseases.” Marijke passionately believes that better integrating human rights into the Global Fund’s portfolio is essential to winning the fight. “Gender and human rights are factors that determine vulnerability to a disease. If you do not consider the position of women and girls when fighting HIV in Africa, for example, it is really difficult to have impact on the epidemic. The same applies with key populations such as LGBT groups, who suffer from stigma and discrimination.” A defining moment in her understanding of the vital importance of linking human rights to health came in South Sudan. “As a student I was involved with Amnesty International, but in South Sudan I saw real human rights atrocities happening all around me. That was a defining moment. I also saw the power of ordinary but amazing people: nurses, assistants, refugees.” In El Salvador, where she spent five years as a technical adviser for PAHO/WHO developing local health systems, Marijke witnessed first-hand how health can bring people together and help achieve reconciliation. Central America was still reeling from the civil wars that traumatized its populations and left deeply polarized nations where government and civil society did not work together. “Health is an entry point to change societies and rebuild communities.” From the windows of her ninth floor office at the Global Fund in Geneva, Marijke can see the mountains. Yet she never loses sight of the people she met as a field doctor in places such as Karamoja, Uganda, or in the Rohingya refugee camps in Bangladesh, where she focused on maternal and child health. “I have faces and names and memories of real people in my head. To me that is very important in this job,” she said. “But on the other hand you have to think broadly. A doctor in the field can offer primary health care, but to improve people’s conditions you need to be able to make structural changes and make difficult decisions.”