1. Why Gender Matters? TB, Gender and the Global Fund Motoko Seko Technical Advisor, Gender Community, Rights and Gender Dept. The Global Fund January 2015

2. 2 Why gender matters to the Global Fund: Seizing the opportunities of NFM with the GES Gender-responsive programming for HIV, TB and malaria is solidly anchored in both human rights and scientific evidence, and essential to achieve impact. The Global Fund has Gender Equality Strategy (GES) designed to achieve strategic, high impact, gender- responsive investments that will save lives, prevent new infections and help provide care – operationalizing GES is the cooperate priority.

3. 3 The Global Fund Gender Equality Strategy (GES)  GES agreed by Board in 2008, Overall aims to: -Fund gender-responsive programmes -Support proposals to scale-up services that reduce gender-related risks and vulnerabilities -Decrease the burden of diseases and mitigate impact -Address structural inequalities and discrimination

4. 4 GES Action Plan 2014-2016  4 focus areas of the GES 1.Ensure that the Global Fund’s policies, procedures and structures effectively support programs that address gender inequalities 2.Establish and strengthen partnerships for effectively support development and implementation of programs addressing gender inequalities and reduce women’s and girls’ vulnerabilities 3.Robust communications and advocacy strategy to promote the GES 4.Provide leadership to support and advance the GES

5. 5 The Global Fund Expectation and requirement for Gender Integration Systematic inclusion of gender issues at all stages of the Global Fund grant cycle. Inclusive country dialogue: gender experts and representatives of women and girls have to be included in the concept note development and grant-making process CCM has to have “a balanced gender representation” (at least 30%) to be fully compliant with eligibility requirement. Achieving impact through programmatic prioritization based on epidemic: need using sex- and age-disaggregated epi- data to inform decision making Community, rights and gender (CRG) focused programming is encouraged by the Secretariat and TRP.

6. 6 Focal points training 130612 2300.pptx Engage more! Illustrative “women’s participation” Women’s limited participation in the Global Fund decision-making at country level: CCM participation (data as of end 2013) Female PLWD It is improving but too slowly!

7. 7 Recap: the new funding model process 2 nd GAC Concept Note Grant- Making Board TRP GAC Ongoing Country Dialogue NSP determined by country Grant Implemen- tation 3 years

8. Unpacking NFM process for maximizing opportunities for gender responsive programming 8 Illustrative 2 nd GAC Concept Note 2-3 months Grant Making 1.5-3 months Board TRP GAC Ongoing Country Dialogue NSP/ Investment Case Grant Implemen tation 3 years Ensure gender responsive programs are included and prioritized (and gaps identified) in NSPs Evidence-based advocacy for prioritizing gender- responsive interventions Inform GFS to further advocate for gender programming, if in- country efforts have “failed” Gender assessment report as TRP or GAC reference Gender assessment to inform programming decisions Monitor retention of proposed activities incl. gender-related TA Demonstrate strategic values of gender- responsive programs based on epidemics Continued community monitoring Women’s Caucus for consolidated inputs

9. 9 In the real world… We are not asking for token gender interventions to be implemented, at cost of other disease intervention. Delivery of disease interventions that take into account of special needs of women, men, boys and girls are our priority.  Thus, there is no “gender module” to tick and to forget implementing! No one need to address gender-related challenges alone – Partner with or link to existing gender-focused programs for maximum impact! i.e., HIV, TB and malaria interventions delivered with/through RMNCH; support/strengthen women’s organizations to deliver HIV, TB and malaria programs; link with clinical post-GBV care with social/legal support.

10. 10 Responding to the GF requirement… Findings of the first 20 concept notes review (Sept. 2014) Gender integration into TB or TB component of the TB/HIV concept notes was hardly seen TB concept notes have limited sex-disaggregated data (both epi- and program outcome data) but better linkages to interventions where exist Only a few included sex-disaggregated target for key interventions such as ACSM, TB diagnosis and treatment, etc. HIV concept notes with solid gender analysis rarely linked to concrete, related, evidence-based gender-responsive programming nor sufficient budgeting. CCM representation by TB community Countries struggle to ensure TB community representation in the CCM (re: new CCM requirement 4). Only 35 CCMs have TB-PLWD/KP representative as of October 2014. Additional 20 has NGO reps with TB expertise..

11. 11 Also beware of: Women’s share of CCM became a requirement, January 2015 (>30% or 15-29% with at least one member with expertise and constituencies) Great network of W4GF advocates in 34 countries: work with them! (Women4GF http://women4gf.org)http://women4gf.org Additional funding for CRG-related technical assistance is available – apply for a free TA to better integrate CRG issues into Global Fund grants http://www.theglobalfund.org/en/fundingmodel/technicalassistance/commun ityrightsgender/ http://www.theglobalfund.org/en/fundingmodel/technicalassistance/commun ityrightsgender/ Use UN and CS developed tools: UNDP Checklist for Integrating Gender into the NFM (http://on.undp.org/xOcqd )http://on.undp.org/xOcqd

12. 12 BACKUP SLIDES

13. 13 Gender responsive intervention doesn’t have to cost extra! http://www.mashpedia.com/player.php?q=92dT_1kbbek Example: Give instruction to women to produce deep sputum privately, or letting women returning with an early-morning specimen Quality of sputum improved dramatically, increased case detections among female population.

14. 14 One thing common about this world… Gender inequality exists in every country Women earn less than men (incl. female-headed households’ poverty)  Access barriers for services that require payment or transport  Impoverishment: Risk factors for TB infection  Difficult to leave abusive relationship for economic reasons Men and boys are not accessing health education / services as much as girls and women  Lower self-assessment of one’s vulnerabilities by men  Men accessing treatment too late  Less likeliness of forming communities, not peer-educating Women who are victims of gender-based violence are 50% more likely to have acquired HIV. Key affected women are facing more risk of violence.

15. 15 Focal points training 130612 2300.pptx Sample gender issues to be aware of and corresponding interventions IssueSample interventions Women do not have decision making power on when and how to access services Bring services closer to beneficiaries – provide mobile or community-based services instead of facility-based Community mobilization and advocacy for changing gender norms CSS for women’s organizations Integration of ATM and RMNCH services Gender based violence (GBV) making women and girls vulnerable to HIV, which can make them more susceptive of TB Linking GBV and HIV/TB and other health services (comprehensive package) Support initiatives to strengthen law enforcement on GBV Community mobilization and advocacy CSS of GBV survivors’ support groups Men do not seek health care because of gender norms for men Peer education / workplace programs Making health services accessible without being seen publicly, or out of working hours 1 2 3 Identifying appropriate interventions 6