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By: Javier Hourcade
LAC Key Correspondent Team and GFATM Board Member Communities Delegation.
Over the past 22 years, the Global Fund partnership has saved 59 million lives and halved the number of annual deaths from HIV, TB, and malaria. In 2022, the Global Fund approved its strategy for 2023 – 2028. This roadmap will determine the Global Fund’s contribution to the 2030 goals of ending the three most deadly infectious diseases. With the new strategy, the Global Fund renews its commitment to putting people and communities at the center of the response to end the three diseases and identifies mutually reinforcing objectives, namely: Maximize integrated, people-centered systems for health to achieve impact, resilience, and sustainability; Maximize the participation and leadership of the most affected communities to leave no one behind and Maximize health equity, gender equality, and human rights. The second objective follows the prioritization of the Global Fund’s investment in Community-Led Monitoring (CLM). Community-based organizations achieve results that other actors cannot. Their leadership is especially crucial in reaching people who are being left behind. The success of the Global Fund depends on community participation and in the CLM.
CLM is a logical outgrowth of community-led response, which is not new. Civil society and community-based organizations have for decades perform oversight and watchdog interventions over states to ensure a government response that is responsive to the needs of communities and people living with or affected by diseases. CLM is a central role and part of the nature of the so-called “third sector,” comprised of all non-governmental organizations, to observe, monitor, and balance the other sectors that hold power, namely the government and the private sector.
According to UNAIDS, community-led responses are those “actions and strategies that seek to improve the health and human rights of their members, which are specifically informed”. Community reports on national responses to HIV have provided insight into the other side of the data reported annually by governments. CLM reports on lack of transparency, corruption, shortages of medicines and supplies, stigmatizing and discriminatory practices, and other human rights abuses within and outside the health sector.
The CLM has provided evidence that has catalyzed changes and improvements in health services and has spotlighted the structural barriers that keep people away from services. As a result, many governments have intensified their efforts to limit and control community-led response, including CLM and watchdog. Organizations and leaders must have access to predictable and independent resources for safe and funded CLM. At a time when civil society space is shrinking and the criminalization of communities is increasing significantly, systematic community monitoring becomes more complex but more urgent.
Weaponize CLM
During the GC7, the introduction of interventions for surveillance and monitor CSO and CBOs, surveillance the communities by the state or other actors, under the title of CLM, has been noted with concern. This is not a play on words but a real attempt to use CLM as a weapon against communities.
At least the Global Fund has multiple tools to monitor performance, efficiency in resource investment, and adherence to planned outputs in each funding cycle. Without omitting the importance of accountability for all actors, it is highly dangerous to promote the monitoring of governments, agencies, and large NGOs over CBOs and Key Populations groups. Historically, these practices have only served to moderate and limit communities’ oversight and the watchdog role.
Monitoring behavior, practices, disease incidence and prevalence, and other ways of studying the progression of epidemics, even with the indispensable participation of communities, is different from CLM. On the other hand, the creation and maintenance of observatories can be considered CLM actions if they collect information from the community level.
We cannot say that CLM is new when NGOs and CBOs have been monitoring and watchdogging the state and its programs on health and related issues for decades. The Global Fund has not proposed anything new; it has only prioritized this role in line with the current strategy and recognized that some Global Fund grants still struggling to have people and communities at the center of the response and that many resources that should be for the response are still diverted in other directions.
Community systems are part of resilient and sustainable systems for health, if we provide them with sufficient resources. CLM is central to the credibility of the Fund. Many actors involved with the Fund have expressed concern about implementing the CLM, needing clarification on a new term for a traditional practice of community-based organizations. There are decades of experience and good practice of CLM, just under different names. This is not about reinventing anything but about recognizing that in the past, the Global Fund has had challenges in funding CLM and making sure that resources are directed to communities.
There is no need to commoditize and transform the CLM into innovative and magical products when it has been an essential part of the identity and contribution of communities. We cannot allow national dialogues, CCMs or the Global Fund secretariat to dictate what the CLM is, when the communities must remain in the “driving seat”. We need resources to ensure a horizontal and peer-to-peer transfer of knowledge on this and other community-based approaches. CLM is not part of a national strategy but a tool to monitor its implementation.
The needs of CLM must be externalized by communities, even if it seems obvious. In any case, there is an urgent need for the Global Fund to improve the incorporation of CLM findings into the strategic Monitoring by the CCM and by the Fund secretariat. For many countries in LAC, the Global Fund’s transition is a clear threat to the continuity of any CLM effort. We face a future with fewer resources for civil society and communities and an extinction of Country Coordinating Mechanisms. It is unforgivable that after 22 years of the Global Fund’s existence, we are still talking about of the relevance of the CLM, which is something that pre-exists the Fund itself.