The Case for CSO Representation on the Financial Intermediary Fund for PPR

Working with Global Fund, FIND, and others, it was CSOs that introduced a sense of urgency and increased pressure to speed up guidelines, including through this op-ed that precipitated a meeting with the WHO DG and the subsequent approval of self-tests guidelines. In other words, it was CSOs that increased agility in this regard. CSOs also took the lead in advocating for community-based outpatient test-and-treat strategies and greater collaboration between ACT-A Tx and Dx Pillars and authored a White Paper and Advocacy Brief on this topic. 

It is also well established that in response to the HIV pandemic, communities and civil society acted as multipliers and incubators of critical innovations which drove the HIV response; this agility was also demonstrated in the initial responses to covid-19 with networks of people living with and affected by HIV regularly gathering evidence to better understand problems identified by members of their communities. These networks understand how to frame and deliver prevention messages and work with governments to ensure that policies and services are put in place to address these challenges. Agility and efficiency of CSOs were also acknowledged by the Independent Panel for Pandemic Preparedness and Response, who emphasised that ‘For the best results, communities and civil societies should be partners early on in the design, planning, implementation, and assessment of such efforts on the international, national, and local levels.’ 

While we should all value agility, agility should not be prioritised at the expense of a deliberative decision-making process that ensures all key stakeholder perspectives are both heard and addressed. It is always possible for a few actors of similar mind or background to make quick decisions together but the decisions they make seldom if ever enjoy legitimacy, buy-in or long-term effectiveness because they can easily ignore the realities of those most affected. Decisions made through the exchange of views and priorities of all key stakeholders mean that everyone has a better understanding, appreciation and support for the ultimate decision reached, particularly if achieved through negotiated consensus. 

It seems almost incredible that it would be necessary to include a refutation of this here but hopefully it will be of little surprise to most that CSO representatives across global health institution governance bodies can bring decades of academic, technical and policy expertise on all relevant global health subjects. 

The ACT-Accelerator was a very recent example of where highly experienced, qualified and technically skilled civil society and community representatives were identified through open selection processes managed by the civil society platforms for the broad range of pillar technical working groups and for the Facilitation Council. The expertise civil society representatives have brought to ACT-A most recently and to the Boards of all the ACT-A co-lead agencies over the last two decades is well documented and understood by secretariats and other board members alike.

In addition, CSOs bring lived and historical experiences addressing epidemics and monitoring disease trends in different countries – and this qualitative expertise is essential towards ensuring that efficiency and impact are achieved. 

In linking point one and point two, CSO networks work together to discuss the key technical elements of policy; from this base, CSO networks are able to push back when weak technical arguments are used to delay or block advances on important policy initiatives.

An example is the return of doses from the DRC to the COVAX in April 2021. As news broke, CSOs on the ACT-Accelerator reached out the DRC CSO colleagues, who informed us that there was widespread distrust in government that translated into distrust in public health services, that there had been insufficient engagement of community health workers who had been mobilised in the Ebola response, and that provincial health leadership had not been engaged. 

The COVID Vaccines Delivery Partnership (CoVDP) was established in March 2022. While they are doing important work to address aforesaid barriers, prior to the CoVDP being established, effective CSO engagement could have expedited the necessity of increased health systems emphasis, community worker engagement, and other interventions informed by expertise on local contexts that is brought by civil society networks.

The Global Fund explicitly acknowledges that community and civil society organisations “play an important role in influencing how government budgets address health and in delivering messages that hold governments accountable and transparent. In both donor and implementing countries, communities and civil society are an important partner in advocating for increased government health spending and resource mobilisation…on a more political level, community and civil society play a crucial role in advocating on behalf of the Global Fund, both in raising awareness in implementing countries and as part of larger fundraising efforts with donor governments.”