Whilst at a meeting called by the Communities Delegation of the Global Fund to Fight AIDS, TB and Malaria in Amsterdam last month to discuss the proposed New Funding Model, I was sharply reminded why it is that communities and civil society – and not just governments and donor bureaucrats – must be part of decision-making processes that affect their health.
We live in a world where millions of people are still not getting the life-saving treatment they need. Key populations remain stigmatised, discriminated against and criminalised. Much HIV funding continues to be misdirected to programming and prevention activities for low-risk populations. All this needs to change if we are to grasp one of the greatest opportunities of our times – the potential to end AIDS.
Bureaucrats cannot decide health policies for all
We must fight for the policies of global, regional and national bodies around HIV to be informed by the experience of the communities most affected by HIV – including by those that are criminalised. This is vital if we are going to improve health outcomes; improve health systems to make them more accessible for people living with HIV and key populations at higher risk of HIV infection; provide livelihood opportunities and tackle human rights violations.
Participation has always been part of the spirit and global architecture of the Global Fund. This was behind the decision to create the multi-stakeholder Country Coordination Mechanisms (CCMs). To an extent, CCMs have been an ‘artificial space’, an incubator, where we have tried and tested a collaborative model in which governments, affected communities and (to a limited extent) the private sector are working together to govern a country’s response to AIDS, tuberculosis and malaria.
We’ve seen good and bad examples of CCMs: some where there was true community participation, others where it was just tokenistic. Some that only met to rubber stamp proposals and reports, others that have really taken on the oversight and coordination of the response. In all cases they have contributed to legitimising community voices, even in environments where governments have traditionally crowded out those voices that could challenge their perspectives.
As the Global Fund completes its move to a New Funding Model, we will discover whether the collaborative seeds sown in the ‘CCM nursery’ are able to take hold in the broader health-related country dialogue. In too many countries this dialogue is still held in ivory towers where only health bureaucrats are allowed in. To what extent will the CCM experience be able to change this? It’s a key question, one that will determine whether the Global Fund is able to leave a lasting legacy beyond its impact on the three diseases.
Participatory development: don’t take it for granted
In the Alliance’s new global strategy, HIV, health and rights: sustaining community action (2013-2020) we* too are focused on creating lasting solutions – through our own model of community-led programming and South-to-South cooperation.
As we prepare for a post-MDG world, it is more important than ever that civil society owns the development process and its goals. There will be a need for even greater collaboration with national governments in order to deliver health services for all but, at the same time, we will need to ensure that we join with other civil society organisations to hold governments to account for their actions and remain a critical voice.
For the Alliance, and for the Global Fund, an inclusive model for country-ownership of health (and wider development) priorities, where the role of civil society is seen is vital, is still something that we are going to have to continue to work towards rather than something that we can sit back and take for granted.
We will continue to fight for a seat at the table – to ensure that resources and support reach the people most affected by HIV, and to secure their health and human rights.
* The wide range of community leaders, activists, programme managers and civil society advocates who make up the Alliance.
- Read this statement from the Communities Delegation about the New Funding Model.
- Read more about the external challenges of the HIV epidemic, health, development and human rights on pages 8-9 of our new strategy, and our four strategic responses which unite our efforts to bring about a world in which communities have brought an end to HIV transmission.