Sustaining Civil Society’s Role in the HIV Response

1. Sustaining Civil Society’s Role in the HIV Response Farley R. Cleghorn, MD, MPH Chief Technical Officer Futures Group July 23, 2014 Photo: Pierre Holtz, UNICEF

2. Critical role of CSOs • Photo: West Cape News, Treatment Action Campaign • Source: UNAIDS and WHO, “Expanding Access to HIV Treatment through Community-Based Organizations,” accessed at data.unaids.org/publications/irc-pub06/jc1102-expandaccesstohivtreatm_en.pdf in July 2014. • In many countries, laid foundation for national response to HIV • In Burkina Faso and Mali, community-based organizations brought first HIV medicines into country • Powerful advocates for improved access to health care and more affordable treatment • Instrumental in helping reduce HIV-related stigma and discrimination • Key research partners • Pioneers in reaching vulnerable and hard-to-reach populations

3. Changing aid landscape • Emphasis on transitioning country programs to different levels and types of funding • PEPFAR categories for country recipients • Long-Term Strategy • Targeted Assistance • Technical Collaboration • Co-finance • New category: Country Health Partnerships • Countries have decision-making role in allocation of PEPFAR resources • In the midst of these changes, how do we ensure a strong, sustained role for CSOs? • Source: FY2014 PEPFAR Guidance for Sustainability Planning

4. Case of Guyana • Illustrates some of the challenges and opportunities in transition • An original PEPFAR focus country that began receiving support in FY2004 • From 2013-2017, PEPFAR Guyana will transition to targeted technical assistance support • Direct funding for service delivery will shift • US government-supported programs will transition to local partners • Anita Datar, Health Policy Project

5. Sustaining NGOs in Guyana • In Guyana, NGOs deliver: • 25%-50% of programming for people living with HIV • 75%+ for programming for men who have sex with men, sex workers, home-based care, reducing stigma and discrimination, and orphans and vulnerable children • Strong reliance on PEPFAR funds for HIV programming • PEPFAR supported at least 80% of HIV expenditures for 10 out of 15 NGOs profiled by the Health Policy Project • Transition plan will support major needs identified by NGOs • Priority: Capacity strengthening to increase financial, institutional, and programmatic sustainability • Sources: National Composite Policy Index (NCPI); Datar, A., Iyer, P., and Shipley, S. 2013. Supporting PEPFAR Guyana Transition Planning for HIV Prevention, Care, and Support Services in the NGO Sector. Washington, DC: Futures Group, Health Policy Project.

6. Global issues for CSOs • Sources: Sriskandarajah, Danny, “Why Restricting Foreign Funding of NGOs is Wrongheaded,” retrieved from http://philanthropynews.alliancemagazine.org/2014/04/28/why-restricting-foreign-funding-of-ngos-is-wrongheaded/ in July 2014. Statement by the Government of Uganda on the Anti Homosexuality Act, 2014, issued July 7, 2014 • Restrictions on foreign funding • More than 20 attempts in past two years to restrict foreign funding for NGOs • Stigma, discrimination, and criminalization • CSOs and donors key advocates against harmful laws and actions • New capacity needs and demands among both CSOs and governments Except from recent Ugandan Government statement: “…the Republic of Uganda enacted the Anti Homosexuality Act…with a view to curbing open promotion of homosexuality…However, its enactment has been misinterpreted as a piece of legislation intended to punish and discriminate against people of a “homosexual orientation”, especially among our development partners…The Government…reaffirms that no activities of individuals, groups, companies or organisations will be affected by the Act…”

7. Promising work: South Africa • Challenge: Health facilities inadequate for meeting demand for condoms and reaching key populations in country’s three highest prevalence provinces • Response: CBOs work with government partners to learn and apply innovative mapping technology to target and expand condom availability • In GertSibande district, CBO and government stakeholders identified and activated more than 1,600 new condom distribution outlets • USAID- and PEPFAR-funded Sexual HIV Prevention Project • Strengthen capacity of CBOs to address programmatic gaps • CBOs forge stronger relationships with government partners • USAID- and PEPFAR-funded Sexual HIV Prevention Project

8. Honduras: Sustaining NGOs that serve key populations • Technical assistance and performance-based funding provided to NGOs that serve key population groups through USAID- and PEPFAR-funded AIDSTAR-Two project • From 2009 to 2012, the NGOs expanded the reach of their prevention services and met or exceeded their targets • In 2013, the project transferred its know-how, tools, and lessons to the Honduran Health Secretariat • The Health Secretariat has assumed responsibility for contracting non-public providers for delivery of prevention services to key populations • Source: AIDSTAR-Two: Building Civil Society and Other Organizational Capacity for Country-led HIV and AIDS Programs,” Accessed July 2014 from www.msh.org/news-events/stories/aidstar-two-building-civil-society-and-other-organizational-capacity-for-country

9. Local Capacity Initiative • New effort to increase CSO capacity for policy and advocacy • Reduce legal and policy structural barriers • Reduce stigma and discrimination • Engage key populations in helping plan and implement programs • Sustain their efforts beyond donor funding • Includes at least 17 countries across Africa, Central Asian Republics, Asia, Latin America, and the Caribbean • CSOs directly funded by OGAC/PEPFAR through local USAID missions and CDC offices • Technical assistance for CSO advocacy and organizational development from USAID- and PEPFAR-funded Health Policy Project and Advancing Partners & Communities Project

10. Final words • Political and legal environment remains challenging • Multiple levels of advocacy important • CSOs as well as donors • Some maneuvering may be possible despite laws • Ghana: Homosexual acts illegal, but advocacy working group helped convince government to initiate Key Populations Desk to document and respond to rights violations against MSM and other groups • Planned and supported transition processes for CSOs critical • Guyana and Honduras promising models • Capacity needs exist among both CSOs and government • CSOs as research partners for assessing needs and results • New Health Policy Project activity: supporting ethical transitions for key population programming