Global Fund: Progress Report 2010 - unaids

2.6.2 Ensuring access for
all people
126. One way to ensure equitable access to necessary
services is to make them accessible to everyone
in need. To achieve universal access, programs need
to be accessible for everyone, including rural populations,
the poorest, prisoners and pre-trial detainees,
and other vulnerable and marginalized groups. The
Global Fund investments support interventions aimed
at these groups, including the provision of free or
highly subsidized services and products.
127. Subsidized and free ART has had a noticeable
effect in Rwanda, Zambia and Tanzania, where, between
2002 and 2006, differences in out-of-pocket spending
on health care between the general population and
people living with HIV have narrowed considerably. In
Zambia, out-of-pocket health expenses for people
living with HIV in 2002 were nearly five times higher
than for the general population, but only 23 percent
higher in 2006. Similarly, in Rwanda and Tanzania, the
difference in out-of-pocket spending between the
general population and people living with HIV declined
from 257 percent to 28 percent and from 136 percent
to 75 percent, respectively (70).
128. The Global Fund has been supporting the national
malaria strategy in Kenya, where a key intervention
was the free distribution of 3.4 million LLINs in 2006
to pregnant women and children. The proportion of
children sleeping under an ITN increased from 7 percent
in 2004–2005 to 67 percent in 2006–2007, with
about two-thirds of them using a net obtained during
the free distribution campaign. The campaign was
successful in reaching children from the poorest
households (71).
BOX 2.5 GENder-rESPONSIVE
prOGrammING OF GLOBAL
FUNd grANTS
Countries are required to provide epidemiological and behavioral data
in grant proposals and specify how the proposed interventions will reach
affected populations. However, the overall availability of disaggregated
data is currently limited and implementation strategies do not always address
inequities and barriers faced by women and key affected populations.
For example, a study of 211 Global Fund-financed proposals in sub-Saharan
Africa from Rounds 1 to 7 found that the majority of proposals included
targeted services for women and girls, such as malaria prevention for pregnant
women or ARV prophylaxis for HIV-positive pregnant women.
However, only a few proposals addressed underlying sociocultural barriers
to care (74). This shortcoming is well recognized and the Board of the
Global Fund has adopted a gender strategy, recognizing that a concerted,
long-term effort is required to address it (75, 76).
In Rounds 8 and 9, the grant proposal forms and guidelines were improved
to encourage applicants to address gender and equity issues. Around
67 percent of eligible proposals in Round 8 provided data disaggregated by
sex and age. Implementation of the gender strategy includes analysis of
disaggregated data by sex in order to improve gender responsive programming
in grant implementation (72). The Secretariat monitors the extent
to which programs include gender and social equity analyses as part of the
grant reviews.
130. In Rounds 8 and 9, nearly four out of five HIV
proposals submitted to the Global Fund included at
least one activity targeting men who have sex with
men, transgender persons or male, female and transgender
sex workers. Among proposals recommended
for funding by the Technical Review Panel, the percentage
of proposals including at least one element
related to sexual orientation and gender identity
increased from 74 percent in Round 8 to 87 percent
in Round 9.
51 THE GLOBAL FUND 2010: INNOVATION AND IMPACT results aND progress ON internatiONal targets
2.6.3 Strategies to address
the needs of the most
affected communities
129. The Global Fund is committed to ensuring that
its policies and grants prioritize the needs of the groups
who are most affected by – or vulnerable to – HIV,
TB and malaria. In 2008 and 2009 the Global Fund
adopted two complementary strategies – one promoting
gender equality in the response to HIV, TB and
malaria (72) (see Box 2.5) and one focusing on the
special needs of sexual minorities, including men who
have sex with men, transgender people and sex workers
(73). Both strategies promote inclusiveness and
diversity in Global Fund procedures and decisionmaking
structures, and both emphasize the importance
of linking funding decisions to evidence and measurable
results.
131. The number of proposals that address issues of
stigma and rights promotion is also increasing. Overall,
25 percent of all proposals received in Round 8 and
33 percent of all proposals received in Round 9
included at least one activity aimed at addressing
stigma or promoting rights, targeting any or all of the
key, at-risk population groups. Among funded proposals,
13 percent in Round 8 included at least one such
activity, compared to 42 percent in Round 9.
132. Table 2.13 presents examples of successful
Round 8 and 9 proposals addressing needs of key
affected populations. While some progress is being
made, in many countries greater political commitment
and sustained support from the Global Fund and
other partners will be needed to ensure that HIV services
are provided to those who need them most.