Can we have “Community at the center” with despite underfunding Catalytic Investments?
As a complement to this blog, you can read our Catalytic Investments 101 brief.
“Communities at the centre” became the oft-repeated catch-phrase of the development of the Global Funds’ 2023-2027 strategy. The stated primary goal of the new strategy, as detailed in the Strategy Framework is to work with and to serve the health needs of people and communities to end AIDS, TB and Malaria. It aims to do so by maximizing people centred systems, the engagement and leadership of most affected communities and promote health equity, gender equality and human rights. Underpinning these objectives is the mobilization of increased resources.
The Global Fund did mobilize increased resources at its 7th Replenishment, raising by the time of the critical November 2022 Board Meeting a total of US$15.7 billion, compared to US$14 billion in 2019. The increase in pledges however did not translate directly into significantly more funding available for programs. In total, US$13.9 billion could be used as sources of funds for country allocations and Catalytic Investments because of donor “set-asides” and conditions attached to the U.S. pledge of $6 billion. And so while the Global Fund raised a record-setting amount of pledges – US$15.7 billion!!! – country allocations have only increased by a meagre 3.3%, from US$12.7 to US$13.1 billion, and Catalytic Investments have been nearly halved from US$890 to US$400 million
A few months before the 7th Replenishment, our report “Still Dying: the Global Fund & Key and Vulnerable Populations” pointed out that key and vulnerable populations bear the burden of unequal resource allocations and access to services in every country and that gaps in resource mobilization will disproportionately affect those populations. That is exactly what we are seeing with Catalytic Investments.
The reality that we document in this report is that key and vulnerable populations for the three diseases are not prioritized by government-led programs funded through the country allocations, because of a wide array of barriers to access. Catalytic Investments were envisioned as a mechanism to remedy this issue, by targeting directly the most vulnerable groups and removing barriers to access. This is why the cuts in Catalytic Investments are so concerning.
Figures from aidspan
We had called for a scale-up of support for human rights initiatives: we’re getting a 23% reduction in matching funds for human rights. There are now fewer incentives for countries to include counterpart financing for human rights programming in their country allocation. Alongside increasingly challenging fiscal conditions, this is a significant challenge.
We asked for increased funding for prevention, treatment, care and support for key and vulnerable populations affected by HIV, TB and malaria: for GC7, Matching Funds for Key Populations have been cut 68%, and catalytic initiatives targeting adolescent girls and young women (AGYW), which received US$56 million in the last cycle, has been cut down to US$24 million (see table 1 and figure 5) in a category alongside prevention for key populations and sexual partners.
There are, absolutely, some important and positive developments in this cycle – a new North Africa multi-country grant, some new countries eligible for human rights and key populations matching funds, a new community systems and responses alongside a strategic initiative for community engagement. Many grant recipients use Global Fund grants and other sources of financing to support innovative, community, key populations and civil society oriented programming – but generally speaking, Catalytic Investments are what drives change towards innovation and funds those initiatives that countries are not funding through allocations.
Another promising initiative was the introduction of a new mandatory Community Annex in Grant Cycle 7 (GC7) funding requests. In it, CSO representatives on CCMs must report on up to 20 programmatic priorities which should include not only the programs and priorities that were included in the Funding Request, but also those that were rejected. Though promising, the Community Annex will not be reviewed by the Technical Review Panel (TRP) and will only be used “to assess the effectiveness of country dialogue and to give a fuller picture of community needs”. Is this “maximizing leadership and engagement”? How does this help communities and CSOs bring expertise to inform technical discussions and advance program quality if there is no technical review of communities and CSOs proposals?
We recognize that the Global Fund Secretariat, its donors and implementers at the Board likely did not get the outcome they hoped for in terms of Catalytic Investments: the question now is, what will they do about it?
A key question is whether additional resources can be mobilized to “top-up” Catalytic Investments. There is essentially US$500 million missing to bring it back up to a stable level from last cycle. This is not a fanciful number – if the UK alone increased its funding to 6th Replenishment levels, it would make an additional US$470 million available to the Global Fund. But would the Secretariat and the Board be willing to allocate additional resources, if raised, to Catalytic Investments?
Funding gaps are critical but so are the gaps in political will – we need a pathway forward that ensures continued and sustained progress against the three diseases and recognizes human rights, gender and other barriers for all, but particularly key and vulnerable populations from accessing health services. Catalytic Investments aren’t the solution to all of these problems: but it has been successful in innovating and significantly increasing our knowledge and tools to address them.
Fully funded Catalytic Investments would mean the Global Fund could continue to be a leading partner in the work to scale-up TB prevention, improve country readiness for innovation (shorter treatment regimens anyone?) and quality TB programming, address vector control threats and biologic threats in malaria case management in Africa and invest significantly more funding in HIV incidence reductions by focusing on those who – while they are marginalized economically, socially and legally – are not at the margins of the epidemics. It would also allow for increased funding for better data, supporting regional reference laboratories and national diagnostic networks.
The Global Fund Secretariat seems willing to do it – having presented ambitious plans for up to US$1.1 billion of Catalytic Investments adopted by the donors, implementers and other constituencies of the Global Fund Board. What remains to be seen is how they intend to bring that vision to life. “We did our best under difficult circumstances” isn’t enough: we have to find the institutional and political will to raise additional resources to get closer to the minimum investment target and fully-funding Catalytic Investments need to be the priority for any additional funds.
You can also read our Catalytic Investments 101 brief here.