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the Global Fund to fight AIDS, Tuberculosis and Malaria
Issue 43 - 20 June 2014

Global Fund News Flash


Challenges in the New Funding Model

At a regional workshop for South and East Asia, convened this week in Phnom Penh, Cambodia, more than 280 people gathered to learn about the new funding model and discuss implementation. Gender and human rights issues were repeatedly raised. The words “commitment” and “impact” came up a lot, as participants spoke of determination to make a difference for millions of people affected by HIV, TB and malaria. Yet many participants in the workshop also pointed to obstacles and challenges. The harder parts of implementing effective programs often have to do with discrimination and stigma faced by men who have sex with men (MSM), sex workers, transgender people, people who inject drugs and other particularly vulnerable groups. We asked a few participants to speak frankly about what needs to be done. Here are excerpts from their remarks:

 

Midnight Poonkasetwattana
Executive Director, the Asia Pacific Coalition on Male Sexual Health (APCOM)

The new funding model can change things, by bringing in voices of the communities. My main concern is whether or not people from the communities will really be allowed a seat at the table, during country dialogue. The communities need to be involved from the beginning, in order to really change the programming.

If information is not accessible, it will be a top-down approach. Communities are the service providers. They rely on volunteers. They need to be empowered, and they need to know what is going on.


 

Pisey Ly
Activist in Phnom Penh
Cambodia

I hear the words “empowerment” and “gender equality.” But if you ask the people on the ground what that means, they don’t know. It is not our language. We see gaps all the time.

We hear about the new funding model, and we are scared that coordination at the country level will not be sufficient to make any real change. Change is happening, but not enough.

The government here talks about challenges. But what are they doing about it? There are so many NGOs in Cambodia, it’s like an NGO heaven. But after 30 years, the community is still not strong. Why is that? People should acknowledge their weaknesses. If you really want to create change, pay it forward.

I believe there is a challenge within the Global Fund. I want to ask why you invest in this program, or that one? There is talk about supporting human rights, but we don’t see it in action. You have to challenge people to do better. Each individual should ask themselves: Do you dare challenge your colleagues? Do you dare challenge your boss? Everything is intertwined. If you are not challenging yourselves to do better, how can you ask people in the field?

Why don’t you talk in simple language? When people make things complicated, it slows everything down.

Look at community systems strengthening. You talk about it, but it’s not real. I see it this way: You are giving us a pizza. You design the pizza. You pick the ingredients. We can smell it, but we can’t taste it.

I am trying to address the political situation. The key players here, the international funders, usually have their own agenda. You come to us and address false issues. You talk about getting to universal coverage, but when we go to the clinic, we still have to pay. You teach us how to distribute condoms, but then we get arrested for having them.

You tell us to analyze the context, but you never allow us to understand it. We are not stupid. We wonder what is happening. Who is responsible for the poverty?


 

Joselyn Pang
Director of the Global Fund Project
at the Malaysian AIDS Council

We need to be very strong in our interventions and the participation of communities is critical. They need to be involved at all levels, on the ground, in policy-making, in programmatic planning.

Stigma and discrimination is still very challenging for us. When people have good reason to be afraid to come forward, we can’t even determine how big the population is. We are just guessing at the size and the locations of the populations. That makes it very hard to address the issues effectively.

In Malaysia, we set up a national task force. When we operated needle exchange, we involved the police, and got their buy-in. It made a tremendous difference. With the police accepting and understanding the idea and the process, it removed a lot of obstacles we faced in the past. But we still face a lot of resistance, socially and culturally, to sex workers and MSM. Socially, many people in Malaysia see drug users as victims of addiction. But they see sex work and MSM as voluntary behavior.

The Global Fund helped us significantly with capacity building. The Global Fund was very strict with requirements, and we had to do a lot of improving. It showed the government how we needed to do more outreach.


 

Madu Dissannayake
Director of Advocacy for HIV/AIDS,
Sri Lanka Family Planning Association  

I am very concerned about representation by the community. What if there is no community? How do we make sure these groups are included in country dialogue? How do we call MSM a community? What does that really mean?  

Do we think country implementers are really capable of addressing gender bias? It is not easy work. We need to identify entry points within the legal framework.

One important aspect is to communicate clearly. We have to talk about our work in a way that is easy to remember. So I came up with three Cs: Clear Commitment to the Cause, Communicating with Conviction and Confidence, and Continuous Collaboration and Care. What do you think?


 

Roslyn Moruata
Chair of the Country Coordinating Mechanism, Papua New Guinea

There is a lot of work to be done in the transition. In Papua New Guinea, we have two grants that are ending and another that needs to be extended. So we have three concept notes that we have to prepare at virtually the same time. That’s quite a challenge.

The concept of the new funding model is very good. There is more flexibility on timing. In practice, it will be difficult to monitor implementation objectively. We’re quite overwhelmed.

I’m very concerned about the willingness-to-pay provision. Papua New Guinea is already making significant investment in health. If we are starting from a high level, compared with other countries, is that taken into account? At the CCM, we can’t direct what the government spends. It worries me, how that is going to work. It complicates things. 

But we need the money. We need the grants. So we’re going to work on it.

Making country dialogue inclusive is a great concept, in theory. Making it work in practice is harder. Identifying communities can be hard. What’s the malaria community? Practically everyone in PNG has had malaria. I’ve had it. How do you make a community out of that? Maybe we need to re-brand ourselves.

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