In the first half of 2024, a baseline survey was conducted to document the key learning needs of communities of Latin America and the Caribbean (LAC) to enhance their engagement in Global Fund (GF) grant processes and national responses to the three diseases. Limitations of the survey include the lack of participation of community leaders from Caribbean countries and the low response rates from leaders in the malaria and TB sectors. For each category analyzed, a descriptive frequency and percentage analysis was performed on the information collected on each variable (univariate). Data were disaggregated by disease (HIV, TB, and malaria), country, gender, and disease (bivariate).  

107 individuals from 12 countries in the region responded to the survey. Of these, 56.1% were male, 33.6% were female, and 8.4% identified as transgender.  

This report presents the findings, conclusions, and recommendations for addressing the key learning needs identified. The report is expected to serve as a baseline for planning, monitoring and evaluating the activities of the LAC Learning Hub for the 2024-2026 period.  

The results made it possible to identify and describe the learning needs of civil society organizations (CSO) and community representatives from 12 Latin American countries.   

This learning needs assessment was carried out by the Latin America and the Caribbean Learning Hub, with support from the Community Engagement Strategic Initiative (CE SI) of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Similar assessments were conducted by other Regional Learning Hubs, including those in Anglophone Africa; Asia Pacific; Eastern Europe and Central Asia; Francophone Africa; and the Middle East and North Africa.  

The primary goal of these assessment was: 

To identify the learning needs and gaps among communities and civil society who are living with, affected by, or vulnerable to HIV, TB, and malaria in terms of their effective engagement in national Global Fund and related processes.  

Methodology  

A documentary review of issues related to the learning needs of communities working on HIV, tuberculosis (TB) and malaria in Latin America and the Caribbean was conducted. The review identified seven relevant learning need categories to enhance the engagement of leaders of civil society organizations (CSOs) and communities in the region.  

To identify the subject population, the following inclusion criteria were established:  

• Individuals should reside and work in one of the 17 eligible countries for GF grants in LAC.  

• Engage in the response to one of the diseases (HIV, TB, and malaria or TB/HIV co-infection).  

• Provide services to key populations (KPs) according to national criteria.  

• Either currently participate or have previously participated in the Country Coordinating Mechanism (CCM).  

A database was created with data from the target population, in line with the inclusion criteria. The following media were used to disseminate the survey:  

• Six alerts in Mailchimp.  

• CCM Secretariats.  

• The list available at the Interactive Map: Tool to Improve Knowledge of CSO Engagement in GF Processes in LAC.  

• Weekly email reminders sent to constituencies, regions, and countries with the lowest response rates.  

The data was collected between April and May 2024. Despite the strategies employed, no responses were received from Honduras and countries in the Caribbean, therefore they were excluded from the analysis.  

Findings  

Documentary review  

TB situation in the Americas  

• In the Americas, in 2022, 325,000 new TB cases were estimated and 239,987 (74%) were notified, which was 4% more than in 2021 

• The End TB Strategy aims to end the global TB epidemic and is linked to the Sustainable Development Goals (SDGs)  

• In LAC, funding for the TB response relies heavily on domestic funding in countries, while the most important funding sources in the region are USAID and the Global Fund 

HIV / AIDS situation in the Americas  

• The number of new HIV infections in Latin America is estimated to have increased 9% from 2010 to 2023, with approximately 120,000 new infections in 2023. The Caribbean had a reduction of 22% from 2010 to 2023, down from an estimated 19.000 new cases to 15.000 per year  

• The HIV epidemic in the Region disproportionally affects certain sub-population (key populations), including men who have sex with men (MSM) transgender women, and female sex workers  

• In LAC, funding for the HIV and AIDS response relies heavily on domestic funding in countries, while the most important complementary funding sources in the region are the Global Fund (except for ineligible countries) and the USAID  

Malaria situation in the Americas 

• In the Americas, 481,788 cases of malaria and around 92 deaths were reported in 2022  

• Eighteen countries including one territory in the Region of the Americas are currently at risk of malaria  

• Paraguay, Argentina, El Salvador, and Belize were certified malaria free by WHO in 2018, 2019, 2021, and 2023, respectively  

• In LAC, funding for the malaria response is coordinated and partly funded by a Regional Initiative for Malaria Elimination (IREM), as well as national governments and the Global Fund. Other relevant donors include the Inter-American Development Bank (IDB), the Gates Foundation and the Carlos Slim Foundation 

Situation of communities and civil society in the region and the Global Fund (GF) processes 

While engagement of civil society, communities, and key populations has been strengthened in recent years, in the previous phases of implementation the Latin America and the Caribbean Learning Hub has identified key challenges that simulta- neously need to be addressed:  

• Community organizations and leaders need to renew political agendas according to the new context of pandemics  

• Communities need to renew their leadership by including and training young leaders and other key popu- lations, such as people using drugs  

• There needs to be a focus on strengthening the understanding of the Global Fund architecture, processes, and policies, particularly the Sustainability Transition and Co-financing (STC) Policy, CCM Evolution, and community-led monitoring, as disinformation and limitations in accessing information are barriers to effective participation  

• The Caribbean sub-region requires a focused approach, to ensure its political, cultural, and economic context is taken into consideration  

• Greater collaboration and coordination are required between civil society organizations, networks and organizations led by or working with key populations, and other key regional stakeholders 

• Community-led Monitoring is an excellent opportunity to strengthen and improve community capacity on data-driven advocacy in LAC  

• As the CCM Evolution Strategic Initiative has come to an end, there is a gap to ensure the continued meaningful involvement of communities in CCMs (e.g., CCM elections, strong feedback-mechanisms) 

Conclusions  

An average level of knowledge and skills is observed among participants in all the areas analyzed; however, the greatest learning needs were found in relation to national GF processes; programmatic and sustainability issues; and climate change, environmental sustainability, and health. 

Below are the most relevant conclusions:  

• The results made it possible to identify and describe the learning needs of CSO and community representatives from 12 Latin American countries to better engage in the GF processes at the national level, as well as in the response to the three diseases 

• The participation of community representatives from the Caribbean region remains a challenge: no leaders from this region participated in the process, despite the different strategies implemented, so the present re- sults do not reflect the learning needs of the sub-region. The Caribbean presents cultural and social differences with Latin American countries. Geographical characteristics (mainly islands in the Caribbean Sea, and some countries in Central America and South America) may also can influence in creating a very different context and realities; those issues can influence in the level of participation 

• Limited participation also was observed in malaria and TB, this situation can be explained, given the disease burning. Data from GC7 shows the type of grants by disease component in LAC: HIV (15 grants), TB (9 grants), and malaria (7 grants), this data also can explain the differences in the participation levels  

• An average level of knowledge and skills is observed among participants in all the areas analyzed; however, the greatest learning needs are in the components of national GF processes, programmatic and sustainability issues, and climate change, environmental sustainability, and health. The highest levels of knowledge and skills are observed in the community engagement and HIV response components  

• In the community engagement component, the main learning needs are related to community led monitoring and knowledge of the regulatory frameworks related to the diseases they work with. These needs are greater for females and for those working in the malaria, TB and TB/HIV co-infection constituencies, as well as for those based in Colombia, Peru and Venezuela  

• In the component on knowledge of GF processes in national contexts, needs are related to technical review panel recommendations, grant negotiations, reprogramming and reallocation of funds, funding requests, and grant monitoring and evaluation. By country, the greatest learning needs are found in Colombia, Peru, Bolivia, and Ecuador  

• Needs related to the use of strategic information are greater in the interpretation and use of epidemiological information, community-led research, and community-led monitoring. The countries with the greatest learning needs in the use of strategic information are Peru, Bolivia, Venezuela, and El Salvador  

• Participants need to strengthen their knowledge and skills in all areas of the communications component, but with greater emphasis on the development of communications plans and media management. The needs are greater for female participants and those living in Peru and El Salvador  

• On programmatic and sustainability issues, there is a need to improve knowledge and skills related to public financing of community responses, costing of community interventions, and the safety and security of organiza- tions working with KPs. By country, the greatest needs in these areas are found in Bolivia, Colombia, Costa Rica, Ecuador, El Salvador, Peru, and Venezuela  

• Finally, given the novelty of the topic and the importance of climate change, environmental sustainability and health, it is necessary to include it in the learning strategies for the communities in the countries of the region