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ESPAÑOL ABAJO
Global Fund in CRISIS
1. Why do I dare speaking up?
My name is Gracia Violeta Ross. I am the National Chair of the Bolivian Network of people living with HV/AIDS (REDBOL). Bolivia is a middle income country with a concentrated HIV/AIDS epidemic. I am one of the founders of the Bolivian Country Coordination Mechanism and member of the Technical Committee that prepared and presented the Country Proposal for Round 9. I was a member of the Developing Countries NGO Delegation from 2007-2009 in the Global Fund to fight AIDS, Tuberculosis and Malaria Board.
Please forgive me if I dare to speak on this topic. The recent discussions on the Prioritization Criteria, and the way the issues are presented, force me to speak, it is my moral obligation to tell you what I think this is all about.
2. Prioritization: What does it officially means?
During the 20th Global Fund Board meeting (Addis Ababa- Ethiopia, November 2009), one of the topics was the decision of the so called Prioritization Criteria.
The Prioritization Criteria (officially means):
• Prioritizing countries with generalized epidemics (particularly HIV/AIDS) for grant eligibility.
• The context: the tension between the demand and supply in the global economic crisis.
3. Prioritization: What does it actually means?
Maybe the unintended consequences of this decision were not visible for everyone on the Board; maybe they were but have been ignored. Just to make sure we all know what is being decided here, I will continue the debate some activists opened in relation to this decision.
On my experience at country and global level, and with the advice of many colleagues across the world, what the Prioritization Criteria really means is:
• That the technical criteria of the proposal will be disregard as the key evaluation criteria for proposals. Therefore, money that is not sufficient will be given to any proposal, only if the epidemic is generalized and the levels of poverty are extreme. Therefore, I think the Technical Review Panel (a technical mechanism that evaluates the proposals in their technical solidity in an independent way) would no longer be needed.
• That the Global Fund will continue implementing the bad experiences of development practices: EMERGENCY RESPONSES ONLY. If the income level and the epidemic levels are the main criteria to have a proposal approved, the investment on prevention is not justifiable. This thinking is counterproductive, because it is possible that some countries will let the epidemic grow until the point in which they can qualify for the grants, almost “automatically”. This kind of practice in global epidemics will never bring results.
EMERGENCY RESPONSE ONLY
Focus on the immediate and evident impact of the epidemics, such as people dying, costs of hospitalization and medications.
LONG TERM RESPONSE
Focus on the underlying causes of the epidemic, not only to provide treatment for those already affected but also creating environments that stop producing more cases of HIV, TB and Malaria, such as poverty, lack of education, gender inequality.
• The Prioritization Criteria means that on the medium term, the Global Fund will be smaller. But this reality is not spoken as clearly. It would be better to know if the Global Fund does not have money and plans to run away, we rather know now. If the Prioritization Criteria are implemented, the “GLOBAL” Fund needs to begin changing its name, because it will no longer be global, but targeted to certain countries only.
• Can we trust the epidemiological data as one of the main criteria for grant approval? We know many countries will have different levels of quality of this information, either using the epidemics as a commodity in order to get more resources and international aid or denying the data at country level because of political, ideological, cultural and racial barriers. What we currently know, especially on the HIV/AIDS epidemic, does not present the complete picture, especially NOT in terms of prevention gaps.
• It might be the case that this decision is already implemented on the practice. Being a member of the Technical Committee that developed the proposal on HIV/AIDS for Round 9 in Bolivia, I happen to know that we were asked to reduce the budget in 10%, this ALREADY HAPPENED. What is astonishing here is the way the decisions are taken in practice, and formally adopted afterwards.
Who is driving the Global Fund? Who has so much power to do so? I always had the sense there was “a second Global Fund Board” operating extra officially, outside the actual Board meeting. I hope to be wrong.
4. The CRISIS of Ethics, Principles and Values in the Global Fund
The current discussions about the Prioritazation Criteria puts on evidence one of the topics that has been a major preoccupation of me and many: Has the Global Fund the ethics to deliver for us, those who actually live with the diseases?
For a long time, it seemed like the ethics were there. For example with the policy of “no intrusion” which led countries to decide on our own what to present in a proposal. The Global Fund also brought in the same table (the Country Coordination Mechanism) people with the diseases, governments, NGO, technical agencies, etc.
Good for the good, but…
• The current discussion/implementation of the Prioritization Criteria puts on evidence the lack of INTEGRITY of the Global Fund, with its self as a cooperation organism, with the poor of the world (because there are also poor people in the middle income countries), with the development agenda and with the commitments made.
The Global Fund said one thing (Universal Access), thought and designed a different one (for ever changing eligibility criteria), and did a different one (actually already implemented the idea of prioritization for Round 9 approved proposals). THIS IS NOT INTEGRITY AT ALL.
5. Equality and/or Equity: Why now?
The Global Fund has a terrible crisis, not only on the bank accounts in Switzerland but also in its ability to align with the principles and values that gave birth to it.
Does the Global Fund understand the difference between the principles of Equality and Equity?
Just to make sure we do not forget:
EQUALITY
Helping first those in greatest need
For example, in the case of the Global Fund:
Helping the poorest countries first but without abandoning the others
EQUITY
Equal for every one
For example, in the case of the Global Fund:
Equal reduction of budgets for every proposal regardless of their need.
Technical solidity as the main basis of all proposals regardless of the situation of poverty at country level.
It is very interesting to notice the discussion on the Prioritization Criteria, just comes on board now, precisely when the donors are facing the greatest hit of the economic crisis.
Therefore, my question is: Why now?
6. “I love you but will not marry you and I can’t take care of your baby” Approach
The way the Global Fund is treating people with the diseases reminds me of the experience of my young friend in Guatemala. This was a teenager who fell in love with an older man from Spain. She trusted him whenever he said “I love you and will be here for you”.
After all she got pregnant, when she told him, he left. He called her by phone to let her know that he was married and had a wife and kids to take care of in Spain. He argued he had to pay the bills at home and could not help her raising the kid.
When the conversation came to an end, he dared to say: “I love you but will not marry you and I can’t take care of your baby”.
Like the girl on the story, how can we trust the Global Fund anymore? “We” the middle income countries, [the pregnant girl in the metaphor], we have been abandoned on the first proof of love. We were left pregnant with a baby we did not create alone, now we have to raise this baby on our own.
Not only have the values been abandoned but the global Leadership the Global Fund had on the epidemics was damaged, we lost trust because of the forever changing eligibility criteria.
7. Forever Changing Eligibility Criteria
I always felt the Global Fund wanted to find ways to reduce the number of countries supported by any possible criteria, call it National Strategies or any names. Many times I felt the long term response did not matter as much as the numbers of the emergency response to the epidemics.
For this reason, in every board meeting I attended, the topic of eligibility criteria was on the agenda. This phenomenon of not being able to agree on something for 6 months and actually do it is something close to insanity, I call this phenomenon: FOREVER CHAGINNG ELIGIBILITY CRITERIA.
Can we agree to something and do it?
8. What if the Global Fund helped us preparing for a crisis instead of running away from it?
What if, since the begging of the Global Fund, 20% of the proposal was mandatory allocated for actions that will ensure the sustainable response at country level? Nobody suggested this.
In Bolivia, for Round 9, we added a groundbreaking objective: Political Incidence, which aim is to ensure national responses for the long term. This initiative, I am proud to say, did not come from the Technical Review Panel or the Global Fund, it came from people living with HIV because we know what it takes to live with a disease for a life time.
I am sure, if we sat together, Global Fund Board, people with the diseases, donor and implementing countries, we will find ways to overcome the crisis.
On my view, the most terrible crisis we are facing is not the financial one, which somehow will come to an end as the economy revitalizes. My main worry is about the crisis on the values, ethics and principles, those are very important to sustain a healthy world in the next 5 years and after.
Can we agree on values, principles and ethics and deliver on them?
I would like to know what everyone think of these ideas, but especially what the Board of the Global Fund thinks. A response from them would be terrific!
Gracia Violeta Ross, National Chair, Bolivian Network of People Living with HIV/AIDS. March 30, 2010
ESPAÑOL ABAJO
Global Fund in CRISIS
1. Why do I dare speaking up?
My name is Gracia Violeta Ross. I am the National Chair of the Bolivian Network of people living with HV/AIDS (REDBOL). Bolivia is a middle income country with a concentrated HIV/AIDS epidemic. I am one of the founders of the Bolivian Country Coordination Mechanism and member of the Technical Committee that prepared and presented the Country Proposal for Round 9. I was a member of the Developing Countries NGO Delegation from 2007-2009 in the Global Fund to fight AIDS, Tuberculosis and Malaria Board.
Please forgive me if I dare to speak on this topic. The recent discussions on the Prioritization Criteria, and the way the issues are presented, force me to speak, it is my moral obligation to tell you what I think this is all about.
2. Prioritization: What does it officially means?
During the 20th Global Fund Board meeting (Addis Ababa- Ethiopia, November 2009), one of the topics was the decision of the so called Prioritization Criteria.
The Prioritization Criteria (officially means):
• Prioritizing countries with generalized epidemics (particularly HIV/AIDS) for grant eligibility.
• The context: the tension between the demand and supply in the global economic crisis.
3. Prioritization: What does it actually means?
Maybe the unintended consequences of this decision were not visible for everyone on the Board; maybe they were but have been ignored. Just to make sure we all know what is being decided here, I will continue the debate some activists opened in relation to this decision.
On my experience at country and global level, and with the advice of many colleagues across the world, what the Prioritization Criteria really means is:
• That the technical criteria of the proposal will be disregard as the key evaluation criteria for proposals. Therefore, money that is not sufficient will be given to any proposal, only if the epidemic is generalized and the levels of poverty are extreme. Therefore, I think the Technical Review Panel (a technical mechanism that evaluates the proposals in their technical solidity in an independent way) would no longer be needed.
• That the Global Fund will continue implementing the bad experiences of development practices: EMERGENCY RESPONSES ONLY. If the income level and the epidemic levels are the main criteria to have a proposal approved, the investment on prevention is not justifiable. This thinking is counterproductive, because it is possible that some countries will let the epidemic grow until the point in which they can qualify for the grants, almost “automatically”. This kind of practice in global epidemics will never bring results.
EMERGENCY RESPONSE ONLY
Focus on the immediate and evident impact of the epidemics, such as people dying, costs of hospitalization and medications.
LONG TERM RESPONSE
Focus on the underlying causes of the epidemic, not only to provide treatment for those already affected but also creating environments that stop producing more cases of HIV, TB and Malaria, such as poverty, lack of education, gender inequality.
• The Prioritization Criteria means that on the medium term, the Global Fund will be smaller. But this reality is not spoken as clearly. It would be better to know if the Global Fund does not have money and plans to run away, we rather know now. If the Prioritization Criteria are implemented, the “GLOBAL” Fund needs to begin changing its name, because it will no longer be global, but targeted to certain countries only.
• Can we trust the epidemiological data as one of the main criteria for grant approval? We know many countries will have different levels of quality of this information, either using the epidemics as a commodity in order to get more resources and international aid or denying the data at country level because of political, ideological, cultural and racial barriers. What we currently know, especially on the HIV/AIDS epidemic, does not present the complete picture, especially NOT in terms of prevention gaps.
• It might be the case that this decision is already implemented on the practice. Being a member of the Technical Committee that developed the proposal on HIV/AIDS for Round 9 in Bolivia, I happen to know that we were asked to reduce the budget in 10%, this ALREADY HAPPENED. What is astonishing here is the way the decisions are taken in practice, and formally adopted afterwards.
Who is driving the Global Fund? Who has so much power to do so? I always had the sense there was “a second Global Fund Board” operating extra officially, outside the actual Board meeting. I hope to be wrong.
4. The CRISIS of Ethics, Principles and Values in the Global Fund
The current discussions about the Prioritazation Criteria puts on evidence one of the topics that has been a major preoccupation of me and many: Has the Global Fund the ethics to deliver for us, those who actually live with the diseases?
For a long time, it seemed like the ethics were there. For example with the policy of “no intrusion” which led countries to decide on our own what to present in a proposal. The Global Fund also brought in the same table (the Country Coordination Mechanism) people with the diseases, governments, NGO, technical agencies, etc.
Good for the good, but…
• The current discussion/implementation of the Prioritization Criteria puts on evidence the lack of INTEGRITY of the Global Fund, with its self as a cooperation organism, with the poor of the world (because there are also poor people in the middle income countries), with the development agenda and with the commitments made.
The Global Fund said one thing (Universal Access), thought and designed a different one (for ever changing eligibility criteria), and did a different one (actually already implemented the idea of prioritization for Round 9 approved proposals). THIS IS NOT INTEGRITY AT ALL.
5. Equality and/or Equity: Why now?
The Global Fund has a terrible crisis, not only on the bank accounts in Switzerland but also in its ability to align with the principles and values that gave birth to it.
Does the Global Fund understand the difference between the principles of Equality and Equity?
Just to make sure we do not forget:
EQUALITY
Helping first those in greatest need
For example, in the case of the Global Fund:
Helping the poorest countries first but without abandoning the others
EQUITY
Equal for every one
For example, in the case of the Global Fund:
Equal reduction of budgets for every proposal regardless of their need.
Technical solidity as the main basis of all proposals regardless of the situation of poverty at country level.
It is very interesting to notice the discussion on the Prioritization Criteria, just comes on board now, precisely when the donors are facing the greatest hit of the economic crisis.
Therefore, my question is: Why now?
6. “I love you but will not marry you and I can’t take care of your baby” Approach
The way the Global Fund is treating people with the diseases reminds me of the experience of my young friend in Guatemala. This was a teenager who fell in love with an older man from Spain. She trusted him whenever he said “I love you and will be here for you”.
After all she got pregnant, when she told him, he left. He called her by phone to let her know that he was married and had a wife and kids to take care of in Spain. He argued he had to pay the bills at home and could not help her raising the kid.
When the conversation came to an end, he dared to say: “I love you but will not marry you and I can’t take care of your baby”.
Like the girl on the story, how can we trust the Global Fund anymore? “We” the middle income countries, [the pregnant girl in the metaphor], we have been abandoned on the first proof of love. We were left pregnant with a baby we did not create alone, now we have to raise this baby on our own.
Not only have the values been abandoned but the global Leadership the Global Fund had on the epidemics was damaged, we lost trust because of the forever changing eligibility criteria.
7. Forever Changing Eligibility Criteria
I always felt the Global Fund wanted to find ways to reduce the number of countries supported by any possible criteria, call it National Strategies or any names. Many times I felt the long term response did not matter as much as the numbers of the emergency response to the epidemics.
For this reason, in every board meeting I attended, the topic of eligibility criteria was on the agenda. This phenomenon of not being able to agree on something for 6 months and actually do it is something close to insanity, I call this phenomenon: FOREVER CHAGINNG ELIGIBILITY CRITERIA.
Can we agree to something and do it?
8. What if the Global Fund helped us preparing for a crisis instead of running away from it?
What if, since the begging of the Global Fund, 20% of the proposal was mandatory allocated for actions that will ensure the sustainable response at country level? Nobody suggested this.
In Bolivia, for Round 9, we added a groundbreaking objective: Political Incidence, which aim is to ensure national responses for the long term. This initiative, I am proud to say, did not come from the Technical Review Panel or the Global Fund, it came from people living with HIV because we know what it takes to live with a disease for a life time.
I am sure, if we sat together, Global Fund Board, people with the diseases, donor and implementing countries, we will find ways to overcome the crisis.
On my view, the most terrible crisis we are facing is not the financial one, which somehow will come to an end as the economy revitalizes. My main worry is about the crisis on the values, ethics and principles, those are very important to sustain a healthy world in the next 5 years and after.
Can we agree on values, principles and ethics and deliver on them?
I would like to know what everyone think of these ideas, but especially what the Board of the Global Fund thinks. A response from them would be terrific!
Gracia Violeta Ross, National Chair, Bolivian Network of People Living with HIV/AIDS. March 30, 2010
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