NGO REPORT 2019: Call for Case Studies on Universal Health Care

NGO Delegation to the UNAIDS Programme Coordinating Board

Call for Case Studies: Deadline for submission 9 August 2019 Extended!!! 23 August 2019


Each year, the NGO Delegation to the Programme Coordinating Board (PCB) of UNAIDS produces an NGO Report focused on a priority subject for communities and civil society. In 2019, the Report will address‘If It Is To Be Truly Universal: Why Universal Health Coverage Will Not Succeed Without Key and Vulnerable Populations’. This will focus on how the significant and incomparable experiences and lessons of key and vulnerable populations in the response to HIV can be broadened and adapted to make Universal Health Coverage a reality. The report will use evidence from countries around the world and will include recommendations for action by UNAIDS and its UN Co-sponsors.

To produce the 2019 NGO Report, we are looking for strong and interesting case studies that address:

  • Key and vulnerable populations, i.e. communities that are most affected by HIV, yet have least access to services. These include men who have sex with men, sex workers, trans people, people who use drugs, people living with HIV, adolescent girls and young women, prisoners and migrants.
  • Successful responses to HIV that can be adapted and broadenedfor a country’s plans, packages and programmes for Universal Health Coverage.We are especially interested in the following 6 types of responses:
    1. Targeting and reaching the most marginalized
    2. Addressing the social determinants of health (e.g. human rights, gender equity)
    3. Providing high quality, person centred services
    4. Developing cost effective, community-based models
    5. Securing access to affordable medicines
    6. Ensuring multi-sectoral governance and accountability

Outline of case study information

As a starting point, we need brief information (maximum 300 words) about suggested case studies. This should summarise:

  • Who the key and vulnerable population are
  • The context to the work (e.g. in terms of the HIV epidemic, socio-economic status of the country and legal and policy environment)
  • The response to HIV (i.e. 1. Targeting and reaching the most marginalized; 2. Addressing the social determinants of health; 3. Providing high quality, person centred services; 4. Developing cost effective, community-based models; 5. Securing access to affordable medicines; or 6. Ensuring multi-sectoral governance and accountability) – briefly describing what it involved.
  • The results of the response (e.g. in terms of improved quality of services, higher number of people reached or improved wellbeing of key and vulnerable population).

Based on this brief information, we will then select case studies to focus on – considering a balance across different populations, geographic areas, political and economic contexts, etc. – and follow-up with colleagues to gather further information, including through interviews.

Deadline of submission is August 9, 2019 August 23, 2019. Please send submissions to [email protected], cc [email protected] and [email protected]


You may download the PDF version of this Call for Case Studies here.

THE NGO DELEGATION’S COMMUNIQUE FOR THE 44th UNAIDS PCB MEETING

The NGO Delegation's Communique for the 44th UNAIDS PCB Meeting is already out. The Communique contains the following sections: Report of the Executive Director; Report of the Chair of the Committee of Cosponsoring Organisations; Report of the PCB working group to strengthen monitoring and evaluation role on zero tolerance against harassment, including sexual harassment, bullying and abuse of power at the UNAIDS secretariat; Update on strategic human resources issues; Unified Budget, Results, and Accountability Framework (UBRAF); Nomination of the next Executive Director of UNAIDS; Thematic Segment.

You may download a PDF version of the Communique (with photos from the PCB Meeting) here.

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CHAPEAU

Jules Kim, Asia and the Pacific Delegate

With the shadow of the challenging 43rd Programme Coordinating Board (PCB) meeting in December 2018 fresh in our minds, there were significant concerns about what we could expect at the 44th PCB, which took place on June 25-27, 2019, in Geneva, Switzerland. Chaired by Mr. Xia Gang,Deputy Director-General of the National Health Commission of China,the 44th PCB was held at Starling Hotel and not at our usual venue, the WHO Executive Boardroom. A heatwave across western Europe meant we were anticipating scorchingly hot temperatures for the whole PCB week - an apt backdrop for the heated discussions expected throughout the PCB.

The June PCB has traditionally been the ‘housekeeping’ meeting for the administrative and governance aspects of the Joint Programme. But this was also the PCB where the selection of the new Executive Director would be discussed, as well as the Management Action Plan and Report of the Working Group of the Programme Coordinating Board (PCB) to strengthen the PCB’s monitoring and evaluation role on zero tolerance against harassment, including sexual harassment, bullying and abuse of power at the UNAIDS Secretariat.

The agenda for the first two days was planned to run from 9 am to 9 pm with a third full day for the Thematic Segment on Delivering on SDG3: Strengthening and Integrating Comprehensive HIV Responses into Sustainable Health Systems for Universal Health Coverage.

Surprisingly, each day ended ahead of schedule, a likely result of China’s chairing, which included traffic lights to remind PCB members and observers when to wrap up and end their interventions. A clear set of decision points were agreed upon on the floor of the PCB often ahead of the time allotted in the agenda.

The NGO Delegation held numerous side meetings with civil society, cosponsors and member states to discuss issues of concern, hear and raise important perspectives and manage potential areas of conflict. Importantly, the regional and global civil society calls prior to the PCB and debrief sessions with CS observers throughout provided an important opportunity for us to maintain a community-centered perspective to the key issues being presented.

There was vocalisation of support for collective action to end AIDS as a public health threat by 2030 by all present at the meeting. There was firm support for the importance of maintaining a strong and independent UNAIDS. And there was a clear sense that delays could not be afforded and that we needed to move forward in the ‘housekeeping business’ to enable progress to meet these goals.


AGENDA 1.3: REPORT OF THE EXECUTIVE DIRECTOR

Aditia Taslim, Asia and the Pacific Delegate

UNAIDS is currently at an important chapter in its existence, with the upcoming selection of a new Executive Director, the development of a new five-year strategy, and setting of new targets for 2025 and beyond. As the previous ED, Michel Sidibe, has left the organization, Gunilla Carlsson has taken the role of Executive Director, ad interim. Her role is to not only ensure a smooth transition, but also to facilitate a stronger UNAIDS through its Management Action Plan implementation and to regain the trust and confidence from the communities, partners, and Member States, particularly donor countries.

Gunilla’s report delivered the message that AIDS is not yet over. Despite the achievements globally, progress remains uneven. Many countries are still lagging behind in reaching the 2020 targets. Low treatment coverage, rising new HIV infections, crisis in HIV prevention, stigma and discrimination continue becoming regular themes that are discussed at every meeting. It is clear that we are not doing enough and there is no room for complacency.

She further noted that in the era of shrinking space of civil society, the communities of people living with HIV and key populations continue to be attacked globally and at the country level. UNAIDS must continue to be the model through its Joint Programme, in putting people most affected at the center of the response, and remain relevant in transforming the HIV response, gaining the political support, and supporting community-led responses.


AGENDA 1.4: REPORT OF THE CHAIR OF THE COMMITTEE OF COSPONSORING ORGANIZATIONS

Lucy Wanjiku Njenga, Africa Delegate

The 44thPCB was a meeting that I was happy to be part of. Compared to my initiation meeting in December 2018, I found this to be a more progressive atmosphere as we look forward to changing and achieving the UNAIDS we need. What would be great to see is greater and meaningful involvement of People Living with HIV in the work of the Cosponsors especially in countries to keep the important community organisation work going and to see fruits from the collaborations. Community organisations in the response, especially young women-led, are important partners that cannot be overlooked, yet, many are still struggling to survive. With UNFPA as the Chair of the Committee of Cosponsoring Organizations (CCO) in the PCB for 2019, the ICPD 25 is also a pivotal arena for engagement. Taking place in November 2019 in Nairobi, Kenya, ICPD25 must take the voices of the community, especially young people, into consideration, and ensure that the next commitments made, and concrete actions taken, are with them, for them, and by them, and that accountability measures are in place.

What also struck me was when UNFPA Executive Director Ms. Natalia Kanem asked for a meeting with the NGO Delegation, to get our perspectives as representatives of civil society and communities. As the CCO is in process to recommend a candidate or candidates to the UN Secretary General for the UNAIDS Executive Director from among the five candidates identified, this was a reminder that our voices matter and why UNAIDS as a UN Joint Programme exists.


AGENDA 3: REPORT OF THE PCB WORKING GROUP TO STRENGTHEN MONITORING AND EVALUATION ROLE ON ZERO TOLERANCE AGAINST HARASSMENT, INCLUDING SEXUAL HARASSMENT, BULLYING AND ABUSE OF POWER AT THE UNAIDS SECRETARIAT

Alexander Pastoors, Europe Delegate

After the presentation of the Independent Expert Panel (IEP) report at the 43rd PCB meeting in December 2018, it was clear that both the working environment at the Secretariat in Geneva and the various regional and country offices of UNAIDS, as well as the public image and reputation of UNAIDS, were negatively impacted by the lack of appropriate senior management action to protect its staff from (sexual) harassment, bullying, and abuse of power. A working group was established to advise the PCB on how to strengthen its monitoring and evaluation role on all of the above-mentioned forms of misconduct at the Secretariat.

The working group, which included two representatives from the NGO Delegation, was very positive in its opinion about the revised management action plan (MAP) that the Secretariat made in order to eliminate all of these forms of misconduct. The PCB adopted the report and its recommendations to implement the MAP fully. Subsequently, the PCB decided to establish an independent evaluation office that reports directly to the PCB.

It could not, however, reach consensus on a number of issues that related directly to the oversight role of the PCB on human resources (HR) related issues. Although this agenda item seemed very internally focused for many civil society observers and very distant to the actual work of UNAIDS, at the core of this discussion lay very fundamental discussions among member states on how UNAIDS should function as a Joint Programme.

On the one hand, you have a number of member states who believe that better oversight by the PCB of human resources and the full implementation of the MAP is needed to avoid any of the recent crises from reoccurring. On the other hand, a number of member states believe that a new ED and fresh focus by the PCB will be sufficient. Member states also differed as to whether changing the PCB’s oversight role in human resources requires going back to ECOSOC for a new resolution on UNAIDS.

The NGO Delegation has a strong position that going back to ECOSOC in this current global climate, where not only UNAIDS, but the United Nations as a whole is under threat, will weaken the Joint Programme and potentially lead to the loss of community and civil society space on the PCB. We believe that current governance mechanisms under the ECOSOC resolution are sufficient for the future, and that a middle way is possible where a better focus by PCB members and better HR reporting by the Secretariat can ensure the workplace staff’s need to thrive and deliver.


AGENDA 4: UPDATE ON STRATEGIC HUMAN RESOURCES MANAGEMENT ISSUES

Millie Milton, Latin America and the Caribbean Delegate

A fit-for-all work-force is the ideal workplace that UNAIDS Secretariat is aiming to achieve. Human resource management involves both strategic and comprehensive approaches to managing people, as well as workplace culture and environment.The 25% reduction of staff not only negatively impacted on the smooth operation of the Secretariat, but also on the delivery of its programmes.

The NGO Delegation noted issues in the report such as the time for filling vacancies was too long and that the annual mobility exercise needed to be more specific in the reason or criteria used to promote staff. We also noted that there is no gender balance in staff employment, for instance, there was no mention of a transgender person being employed.

In terms of training, it is important for training needs to be identified and training in leadership to be increased. Face-to-face trainings are more impactful and should be explored more.


AGENDA 7: UNIFIED BUDGET, RESULTS AND ACCOUNTABILITY FRAMEWORK (UBRAF)

Andrew Spieldenner, North America Delegate

The Unified Budget, Results and Accountability Framework (UBRAF) is a cornerstone to the June PCB meeting, as it involves the performance and financial reporting for UNAIDS and the UN Cosponsors. The UBRAF reports were organized around three agenda items: performance, finances and budgeting. In each area, some member states were selected to highlight. The UBRAF was accepted with particular note of coordinating country-level work across UN agencies, encouraging donor governments to make multi-year contributions and to fulfill their 2018-19 commitments, and to look ahead to the next budgeting process.

The NGO Delegation delivered three interventions on UBRAF: 1) insisting that UNAIDS be more transparent with where the money is for civil society; 2) pay closer attention to the disparities between policy acceptance and policy implementation in policy indicators; and, 3) encourage country-level programs to focus on harm reduction and human rights approaches.

Across these interventions, we noted that country envelopes were not developed with meaningful input from key population networks, as well as advocates for women and girls. We cautioned UNAIDS to take into account political landscapes in country envelopes and country transition plans, as those of us who are marginalized and criminalized are most likely to be overlooked. Furthermore, it is also equally important for the communities to reach out to their respective UNAIDS country office and demand the space in decision-making process. A detailed-list of countries receiving country envelope allocation can be found here (p.7-8).


AGENDA 8: NOMINATION OF THE NEXT EXECUTIVE DIRECTOR OF UNAIDS

Jonathan Gunthorp, Africa Delegate

At a critical time in the HIV response, when the future of the Joint Programme is being debated in global health architecture, who leads UNAIDS is crucial to the success of the global AIDS response.

For the last few months, a process has been underway to select the next UNAIDS Executive Director. Following the precedent of the last ED selection in 2008, a Search Committee was constituted by the PCB made up of five member states, four co-sponsors, and the two NGO Delegation members who sit in the PCB Bureau. A world-wide search was held focusing on all regions and involving both applications, as well as head-hunting. Because of the confidentiality of a high-profile recruitment such as this, the whole Search Committee had to sign non-disclosure agreements. That meant the two NGO delegates had to operate in an unusual way for civil society; without any ability to consult or report back, even within the NGO Delegation. Nevertheless, they took the values and principles of civil society into PCB discussions that ended with the search criteria and the search process, itself.

After a rigorous process involving short-listing, interviews by the Committee, and discussion at the PCB, the Committee recommended five candidates to the Co-sponsors in the last week of June. Co-sponsors will interview all five candidates in July and recommend one or more names to the UN Secretary General who will then appoint a new ED.

As mentioned during the PCB Special Session in March 2019, the NGO Delegation re-emphasized the value of having someone from the global South to lead such an important movement, given that this is where majority of people living with and affected by HIV come from. We look forward to working with a new ED who will strengthen UNAIDS and steer the global response with and for key populations and all those affected by HIV.


AGENDA 9: THEMATIC SEGMENT

Wangari Tharao, North America Delegate

Held on June 27th, 2019, the 44thThematic Segment aimed to examine ways in which the HIV response could leverage the potential benefits of UHC, while avoiding any potential pitfalls and optimizing on the successes and lessons learnt through the HIV and AIDS response. Keynote speeches were delivered by Rico Gustav, Executive Director of GNP+ and Ambassador Cleopa Mailu of Kenya. They provided insights on opportunities and challenges that have to be navigated and possible ways forward to ensure UHC incorporates relevant SDGs and comprehensive approaches to HIV. This was followed by three panels focusing on: HIV focused programmes which have evolved into integrated platforms for comprehensive health services; achievements and challenges in providing comprehensive, inclusive and non-discriminatory services, including HIV services integrated within broader health services including those targeted to key populations; and financing mechanisms and governance issues in the move to UHC.

In the discussion, it became clear that there was an uneven inclusion of HIV key populations and holistic HIV wraparound services. In terms of key populations, the meaningful inclusion of sex workers, people who use drugs, trans communities, gay and bisexual men and other men who have sex with men, and people living with HIV has been a key part and unique to the HIV response, including shaping policies. Beyond HIV treatment, HIV services have included HIV prevention, sexual and reproductive health and rights, harm reduction, mental health and legal advocacy. The NGO Delegation is concerned with UHC moving forward without including both key populations and holistic HIV wraparound services.

Throughout the day, tough questions were raised ranging from: How universal will UHC be? What will be the essential packages, how and who will design them? How will social enablers be integrated? What about sexual and reproductive health and rights? How accessible will these services be for key populations? What mechanisms will be instituted to ensure the right to access for all? What mechanisms will be used to ensure civil society and key populations are part of the UHC governance? Specific proposals and solutions were discussed and interventions from the floor highlighted gaps and other solutions that needed to be considered.

The NGO Delegation, along with civil society speakers and Thematic Civil Society Advisory Group (CSAG) developed the following key messages:

  • Attention is focused on putting "the last mile first" to facilitate inclusion of all key populations, particularly those that are criminalized and supporting translation of “leaving no one behind” into reality.
  • Proposed actions protect the gains already made in the HIV response through support of comprehensive, people-centered and expanded health systems that are inclusive of community-led responses with allocated financial resources to support them.
  • Any actions on UHC utilizes a rights-based approached, is grounded in equity, determinants of health and sexual and reproductive health and rights, particularly in relation to key populations.
  • Affected communities play a vital leadership role in the move to UHC, with opportunities to shape plans, packages and fiscal mechanisms leading to and in the rollout of UHC.

The NGO Delegation plans to continue pushing these messages to influence any discussions prior and during the High Level Meeting (HLM) on UHC to be held in New York in September 2019. Mindful that negotiations on the draft Declaration is in progress, we have also adopted the UHC Statement by Civil Society released in April 2019 as part of the preparatory advocacy activities for the HLM.

A report of the Thematic will be tabled at the December PCB meeting and Decision Points (DPs) will be negotiated and adapted.


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