1. Opportunities for SRH-HIV Linkages in AIDS Component Proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria
As of 17 February 2010

2. “The Global Fund will champion and fund… programs that empower women and girls so they can protect themselves, by having access to sexual and reproductive health care (SRH),
access to female-controlled prevention measures (female condom, negotiating condom-use etc.), and access to education. In this context the Global Fund will champion activities that strengthen SRH-HIV/AIDS service integration.”
Global Fund Gender Equality Strategy
Plan of Action

3. Status of SRH-HIV Linkages in Global Fund Proposals
Despite having always been willing to consider SRH interventions as part of a response to HIV/AIDS, country uptake of SRH-HIV linkages via Global Fund proposals has been slow and incomplete.

4. Percentage of HIV-related proposals approved by the Global Fund containing elements of sexual and reproductive health, by Global Fund round
Based upon research conducted by WHO Division of Reproductive Health and Research and published in the WHO Bulletin, referenced in slide 24, Resources for SRH-HIV Linkages

5. Opportunities for SRH-HIV Linkages: Global Fund Policy
The Global Fund’s Gender Decision Point
Dual-Track Financing
Health Systems Strengthening
Community Systems Strengthening
Changes to CCM guidelines and CCM funding
Preparing Your Proposal

6. Opportunities for SRH-HIV Linkages: The Gender Decision Point
Scaling Up a Gender-Sensitive Response to HIV/AIDS, Tuberculosis, and Malaria by the Global Fund:
“The Board recognizes the importance of addressing gender issues, with a particular focus on the vulnerabilities of women and girls and sexual minorities, in the fight against the three diseases, more substantially into the Global Fund’s policies and operations…”
Decision Point GF/B16/DP26: November 2007

7. Impacts of The Gender Decision Point
Modifications to proposal form and guidelines
Increased staffing capacity at the Secretariat: Senior Gender Advisor, Sexual Orientation and Gender Identity Advisor, and M&E expert
Development of a Gender Equality Strategy and Plan of Action
Development of a Sexual Orientation and Gender Identity Strategy and Plan of Action
Review of gender-related capacity in Global Fund structures (CCMs, the Technical Review Panel, etc.)
Review and modification of proposal form, guidelines and fact sheet to support more integration of gender-related activities in the proposal

8. Opportunities for SRH-HIV Linkages: Dual-Track Financing
• Non-government sector is infrequently used as a Principal Recipient (PR), and NGO PRs are often international orgs, not indigenous.
• From Round 8 onward, ‘routine inclusion’ of both government and non-government PRs for Global Fund grants (“dual-track financing”) recommended in proposal guidelines and considered in proposal review process.
An explanation is required if country applicants do not choose this implementation model—and the explanation may not be accepted if it is insufficient.

9. Dual-Track Financing: Expanding Civil Society’s Role
• Benefits of dual-track financing may include:
- increased absorption capacity
- accelerated implementation and performance of grants
- the strengthening of weaker sectors
- inclusion of CSOs that haven’t been well represented, like SRH or women’s orgs
Civil society has a demonstrated capacity for successful program implementation alongside government implementers: 83% of Global Fund civil society Principal Recipients (PRs) are A or B1-rated; only 2% C-rated
Reference AIDSpan study of PRs to highlight strong performance of civil society in comparison to governmental PRs.

10. Opportunities for SRH-HIV Linkages: Health Systems Strengthening
Strategic Approach to Health Systems Strengthening:
“The Global Fund should continue to support the strengthening of public, private and community health systems by investing in activities that help health systems overcome constraints to the achievement of improved outcomes in reducing the burden of HIV/AIDS, tuberculosis and malaria.”
Decision Point GF/B15/DP6, April 2007

11. Health Systems Strengthening: Building SRH-HIV Capacity
• WHO-defined “building blocks” for a well-functioning health system:
-Health Workforce
-Service Delivery
-Information
-Medical Products and Technologies
-Financing
-Leadership and Governance
From WHO’s “Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes”
Training for health care workers to be able to provide integrated services, procurement of SRH supplies such as female condoms or rape kits, IEC materials about how linkages and integration work, etc.
HSS can bridge the gap between the HIV world and the SRH world at the service delivery level.

12. Opportunities for SRH-HIV Linkages: Community Systems Strengthening
Community Systems Strengthening is:
Capacity building at the local level to increase the ability of civil society organizations to respond to the health needs of their communities, in particular those communities not currently reached by prevention, care and treatment programs.
See the Global Fund’s fact sheet on Community Systems Strengthening.
CSS can be part of Health Systems Strengthening but can also stand alone, as long as positive outcomes for HIV can be demonstrated in context of local epidemiology.

13. Community Systems Strengthening: Programme Examples
Improving physical infrastructure, such as providing confidential consultation rooms at local clinics.
Organizational Development, including financial and programme management, planning, and M&E.
Technical capacity building, such as partnership building and technical assistance.
Operations Research to identify successful community-based SRH-HIV interventions and advocacy.
Advocacy to improve policies that support linkages.
The range of interventions may be funded to support CSS, but they must be consistent with the gap analysis, the gender analysis, and the local epidemiology, and show clearly-defined positive outcomes on HIV to be relevant for GF proposals.
Community-based needs of key populations should also be considered and addressed with particular interventions where this is called for by local epidemiology and gap analysis.

14. Community Systems Strengthening: Why Is It Important for the Linkages Agenda?
Civil society (CBOs/FBOs/PWA networks/NGOs) has a strong track record in implementation, but capacity overall is still weak.
Dual-Track Financing and Health Systems Strengthening require increased capacity of communities to deliver essential services.
Increased attention to gender-related vulnerabilities in proposals requires participation of greater variety of CSOs to implement.

15. Opportunities for SRH/HIV Linkages: Changes to CCM Guidelines and CCM Funding
• Vulnerable and marginalized groups: “The Global Fund strongly encourages CCMs to consider how to improve the representation and participation of [vulnerable groups] on the CCM…”
• Vulnerable and marginalized groups, as well as women’s groups, are also included in list of recommended CCM representatives
• CCMs can request funding from the Secretariat to improve CCM functioning
-explicitly includes funding for civil society sector to strengthen performance of its representation
- explicitly includes funding for CCMs to build capacity to better integrate the Gender Equality and Sexual Orientation and Gender Identity Strategies
See Guidelines on the Purpose, Structure, Composition and Funding of Country Coordinating Mechanisms and Requirements for Grant Eligibility

16. Accessing Global Fund
LGBTI, MSM and sex workers face serious challenges accessing decision-making or control in CCMs, PRs and SRs
Funds not being allocated to appropriate interventions; lack of services related to health and rights
Addressing political, social and cultural issues difficult but crucial at country level
Global Fund has modified CCM and proposal guidelines to include references to key affected populations, and funding qualified multi-country proposals thereby providing a potential pathway to programs that reach MSM, transgender people, and sex workers
There are many barriers to getting Global Fund money for good SRH-HIV linkages and service integration, including for marginalised groups like MSM and sex workers. Changes to language in proposal guidelines help make it easier for countries to include these activities.

17. Opportunities for SRH/HIV Linkages: Preparing Your Proposal
Overarching principles: country-owned, technically-sound, positive outcomes for HIV/AIDS.
Know Your Epidemic: link understanding of vulnerable populations (and why they are vulnerable) to needed policies and services people can access.
Gender Gap Analysis: space to seriously consider any SRH gaps and link identified gaps with activities proposed.
Epidemiological Background: indicators like unmet need for contraception help identify important SRH activities to address in proposal. Sex and age disaggregation.
Build Capacity: Up to 10% of proposal budgets can be used for technical assistance.
Country ownership often includes demand creation—highlighting for stakeholders the many opportunities the Global Fund provides for SRH-HIV linkages.
Part of knowing the epidemic through gap analysis and epidemiological background is to identify why people are vulnerable, why people can’t access services. Then propose activities that will fill these gaps!
Proposal forms are undergoing significant revisions for Round 10 to reflect new and improved emphasis on women, girls, and SOGI. Fact sheets and other materials to support proposal development will be updated accordingly.

18. What Linkages Will the Global Fund Fund
Beginning with Round 8, an example of areas the Global Fund will support:
Interventions related to interactions between the three diseases, including providing access to prevention services through integrated health services, especially for women and adolescents through reproductive health care
From Round 8 Proposal Guidelines

19. What Linkages Will the Global Fund Fund: A Few Examples
Family planning services and commodities, including non-condom contraceptives.
Gender-based violence prevention and response, such as one-stop clinics with multisectoral programmes.
Interventions with men and boys to address gender norms.
Expanding clinics to provide confidential consultation rooms for co-location of services.
This is nowhere near a complete list. If it can be demonstrated to have a positive impact on HIV/AIDS and it is being done in a technically sound way that matches the needs in the country, the Global Fund will probably fund it. Main message: be innovative and bold!

20. What SRH-HIV Linkages Will the Global Fund Fund: More Examples
Operations research to identify best practices, such as implementation of the Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages.
Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages, published by UNFPA, International Planned Parenthood Federation, WHO, UNAIDS and Global Network of People Living With HIV/AIDS.

21. Opportunities for SRH-HIV Linkages in Global Fund Proposals
Create demand for SRH-HIV linkages in your country.
Gain understanding of Global Fund principles.
Ensure representation of gender and SRH experts on CCM.
Identify opportunities to strengthen health and community systems to meet goals.
Write a bold, technically-sound proposal. Think big.

22. Example: Creating Demand for SRH-HIV Linkages
Organise civil society workshops that bring together SRH organisations that have never worked with the Global Fund
Provide “Global Fund literacy” trainings to help organisations learn how the Fund works
Educate key HIV/AIDS organisations and CCM members about why SRH can improve HIV/AIDS outcomes and encourage SRH orgs to join CCM
Seek support from representatives of bilaterals or UN agencies in your country who also support SRH

23. Example: Writing a Bold, Technically-Sound Proposal
Ensure CCM understands the need for SRH to improve HIV/AIDS outcomes
Identify gaps in programming early in the process and choose which interventions to propose
Respond to the CCM call for sub-proposals by submitting a proposal that addresses what you think needs to happen
Request technical assistance when needed in a timely manner, including for a civil society sub-proposal
Seek support from representatives of bilaterals or UN agencies in your country

24. Resources: SRH-HIV Linkages
Sexual and reproductive health in HIV-related proposals supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria
Making the Case for Interventions Linking Sexual and Reproductive Health and HIV in Proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria forthcoming from WHO
Sexual and Reproductive Health and HIV Linkages: Evidence Review and Recommendations (WHO, UNFPA, IPPF, USCF)

25. More Resources: SRH-HIV Linkages
A Practical Guide to Integrating Reproductive Health and HIV/AIDS into Grant Proposals to the Global Fund (Population Action International)
Advancing the Sexual and Reproductive Health Needs of People Living with HIV (Global Network of People Living with HIV)
Shadow Report: Review of Country Coordinated Proposals with SRH-HIV/AIDS Integration Submitted to the Global Fund Round 8 (Mobilizing for RH/HIV Integration Initiative)
This is just a sample of six documents; there are many more!

26. Resources: Proposal Development
A Beginner’s Guide to the Global Fund, AIDSPAN
The AIDSPAN Guide to Round 10 forthcoming, at
WHO and UNAIDS resource kit for writing Global Fund HIV proposals for round 9
Guidance Paper: WHO Support to Countries in Accessing and Utilizing Resources from the Global Fund to Fight AIDS, TB and Malaria
Supporting Community Based Responses to AIDS: A guidance tool for including Community Systems Strengthening in Global Fund proposals, The Global Fund
Fact Sheets and FAQs, Available for Round 10 following launch of Round (anticipated May 2010), The Global Fund

27. Resources: Technical Assistance
Civil Society Action Team (CSAT) supports civil society in finding TA
UNAIDS Country Coordinator can link requests for support to the TSF and other TA providers
Technical Support Facilities (TSF) can also receive direct requests for TA
Bilateral donors may also offer Global Fund TA, such as the GTZ BACKUP Initiative
Important to remember that SRH-HIV integration and linkages are very specific technical areas; ensure that the consultants selected to respond to these TA requests have the required expertise. If a TA provider suggests a consultant that doesn’t have enough expertise, say no and ask for someone who does!
CSAT only provides TA for civil society organisations, but its primary role is to link requests for TA to providers and funders of TA. CSAT is not itself a hub for technical assistance provision.
The TSFs and UN family prefer for official requests for TA, especially those from the CCM, to go through the UNAIDS UCC first, rather than going directly to the TSF.
Many UN agencies other than UNAIDS may also be able to help with TA, especially for SRH