December 10, 2019

Honorable Ministries and Secretaries of Health,

It is my honor to address you on the occasion of presenting the final progress report on the key actions undertaken during my managerial responsibilities as Global Fund Board Member for the Latin American and Caribbean constituency for the period 2017 -2019.

As already reported, the nomination process for the LAC Representation for the period 2019-2021 was launched in keeping with the Terms of Reference approved at the Latin America and Caribbean Constituency Meeting (Santo Domingo, Dominican Republic, 24-25 July, 2013) and subsequent amendment in the Parallel session during PAHO Directing Council, in Washington D.C., September, 2015. According to the rotation agreed between Sub-regions, the Latin America Sub-region becomes Alternate Board Member and the Caribbean Sub-region becomes Board Member. The call for Alternate Board member was issued with deadline on July 1th for Latin America and only one nomination was received in due form. Board Member Nomination Committee (BMNC) was established to review nominations following specific selection criteria, such as: 1) Demonstrated experience in chairing/leading decision-making process in GF governance bodies (CCMs/RCMs, project management and assessment, Board delegate, Board Member and/or Committee Member); 2) Demonstrated knowledge and experience of working with the three diseases (HIV/AIDS, Malaria and Tuberculosis) in the health area and/or development and financing at regional level; 3) Language: English advance level (additional languages relevant for the Region are considered an advantage) 4) Demonstrated experience and leading capacity with diverse stakeholders from public and private sectors, including United Nations agencies, governments, bilateral donors, civil society, NGOs, and people affected by three diseases (HIV/AIDS, Malaria and Tuberculosis); 5) Demonstrated experience being representative at Regional level in partnership, governmental organizations, public health institutions; with facilitator and consultative approach (politic and strategy diplomatic abilities) as well as capacities to stablish contacts broadly and effectively.

The Committee was integrated by well-recognized experts in the LAC Region with extended experience on Global Fund related issues, as follows:

• Kurt Frieder, Executive Director of Huésped Foundation in Argentina, Coordinator of C-20 CS Health Group during Argentinean Presidency.
• Carina Vance – Executive Director of ISAGS – UNASUR, Brazil; Former – Minister of Health, Ecuador
• Alejandra Acuña, Vice- Minister of Health, NATIONAL AIDS COMMISSION Member, Costa Rica, EMMIE member, RCM EMMIE Former – Chair.

The BMNC recommended Dr. Mirta Roses Periago and submitted officially to the LA MOH requesting no-objection with deadline on August 2, 2019; as established common practice, lack of response was deemed to be an approval. The Secretary of Health of Argentina was the presenter of the nomination.

In the Caribbean Sub-region, the call for nomination for Board Members was issued with deadline August 9, 2019. During the Council for Human and Social Development (COHSOD) and Caucus in Washington D.C. held on September 28, 2019 in Washington, DC, before the opening session of the 57th PAHO Directing Council, the Hon. Dr. Mary Isella Isaac, Senator, Minister of Health, Santa Lucia, was endorsed as the Board Member.

The Call for Nomination by Civil Society Organizations to have a representative in the LAC delegation was not issued this year since it was staggered with Board member and alternate to preserve institutional memory for effective continuity, good governance and following due process.

The LAC Delegation Composition for the period between November 2019 and October 2021 is structured as detailed bellow:

• Dr. Mary Isella Isaac, Board Member, Senator, Minister of Health, Saint Lucia
• Mirta Roses Periago, Alternate Board Member, Director Emeritus PAHO/WHO, Argentina
• Gabriela de la Iglesia, Communication Focal Point for Latin America, Argentina
• Dereck Springer, Former – PANCAP Director and Communication Focal Point, Guyana
• Dr. Alejandra Acuña, TCHG Chair, Vice- Minister of Health, Costa Rica
• M. Joan Didier, OECS RCM Representative, Saint Lucia
• Javier Luis Hourcade Bellocq, LA CSO Member, Argentina
• Edner Boucicaut, Caribbean CSO, CCM representative, Haiti
• Lucien Govaard, CariFLAGS Co- Chair, Youth Representative, Trinidad and Tobago
• Guillermo Birmingham, Audit/Finance, AFC member, Panama
• Eduardo Hage Carmo, Public Health Specialist, Former Senior Public Health Officer at ISAGS – UNASUR, Brazil

The LAC delegation attending the Forty Second Board Meeting on November 14-15, 2019, in Geneva, Switzerland, was headed by Hon. Dr. Mary Isella Isaac, Board Member, and myself as Alternate Board Member; Mr. Dereck Springer, Caribbean Communication Focal Point; Mr. Javier Luis Hourcade Bellocq, Alternate LA CSO Member; Mr. Edner Boucicaut, Caribbean CSO Member; Ms. Lucien Govaard Youth Representative; Hon. Dr. Alejandra Acuña, TCHG Chair; Ms. M. Joan Didier, OECS; Dr. Eduardo Hage Carmo, Public Health Specialist; and Mr. Guillermo Birmingham, AFC member.

The LAC delegation had an active role and strong voice to emphasize the relevance of Transition and Sustainability in our region, urging the GF to define better the specific characteristics and expectations of a successful transition so that accurate information to monitor and evaluate transition processes can be gathered and progress be more accurately assessed to reach goals and protect achievements and investments.

LAC Delegation Statement raised an overall concern about the fragmentation among policies, strategies and their implementation tools, identified in some of the issues presented to the Board, which was particularly but not exclusively reflected in the CCM and Wambo topics. The main recommendation to address this issue was is to present always an integrated vision among them i. e. Governance/ STC / CCM; Market Shaping Strategy /Pool procurement/ Wambo. Moreover, LAC Delegation recalled some concerns, highlighted in the 41st Board Meeting LAC Delegation Statement, in relation to the actions undertaken to achieve GF goal of ending the epidemics, defining Civil Society as a key essential player for achieving goals of saving lives and identifying the need to reach out to additional partners, share our common goals in Global Health, aligned with the GF mission and vision to strengthen information systems, contribute to HSS and UHC, and develop innovative interventions and creative approaches, such as, bridge funding for countries in eligibility transition or close to elimination goals.

Additionally, the Strategic Objective of building RSSH could incorporate an indicator related to Government´s capacity to implement social contracting with CSO´s.

The Board most relevant decisions were: 1) Sources and Uses of Funds for the 2020-2022 Allocation Period; 2) 2020 Work Plan and Budget Narrative and the 2020 Operating Expenses Budget; 3) Evolving the wambo.org pilot for non-Global Fund-financed orders; 4) Revisions to the selection process of the members of the Board Standing Committees and to the Charters of the Board Standing Committees.

Before the actual Board meeting, both the Implementers Group and the LAC Delegation held preparatory meetings on November 12 and 13, respectively in Geneva, Switzerland, to review key issues and agree on common positions particularly about the Sustainability, Transition and Co-financing; Sources and Uses of Funds for 2020-2022 allocation period; CCM Evolution, Supply Chain Management and other critical agenda items of shared interest. The Implementers Group worked actively in the amendment of the decision point on Revisions to the selection process of the members of the Board Standing Committees and to the Charters of the Board Standing Committees; and in the negotiation process with donors group before the Board approval. Photograph of LAC delegation is attached.

2019 was a replenishment year for the Global Fund, the process of advocacy and pledging was extremely successful and resulted in USD 14.2 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023. France hosted the Global Fund’s Sixth Replenishment pledging conference in Lyon on 10 October 2019, LAC delegation was headed by myself as Board Member and Hon. Dr. Marie Gréta Roy Clément, Alternate Board Member. We congratulate the Executive Director of the Global Fund, Peter Sands, and his very capable team for the great successful achievement of the 6th Replenishment target as well as we express our deep appreciation to the President of France, H.E. Emmanuel Macron, not only for hosting the Lyon meeting but also for leading the call for pledges. This replenishment was a clear milestone on our way towards the goals of the Agenda 2030.

Concerning the methods of work for LA Representation, I would like to recognize the ongoing support received from the Latin America Communication Focal point for the GF and the Area of Communication Platform support. The Latin American local support group for the Board Member continues functioning with additional members from NGO Networks, Civil Society, and technical partners such as PAHO/WHO and UNAIDS. Additionally, LAC Constituency extended support to the Technical Cooperation Horizontal Group, a Regional Coordination structure, providing technical support to the TCHG Permanent Secretary establishment during the first semester 2019, created to ensure continuity and preserve institutional memory through presidency rotations as well as the technical and financial support to the workplan development and the relaunch of TCHG communication tools (web page and Facebook). Furthermore, the LAC Constituency and the HTCG (Horizontal Technical Cooperation Group), with the intention of contributing to harmonize and optimize regional coordination structures, jointly conducted a survey on experiences and opinions regarding the processes and arrangements supported by the Global Fund in the LAC Region. The main purpose aimed to assess duplicity of efforts/value for money due to the multiple mechanisms GF funded in LAC Region (country proposals, multi-country proposals, CAR-LAC, LAC Platform, Portfolio Managers, CCMs, RCMs, Principal Recipients and LFAs. The survey was undertaken through a structured self-applied electronic questionnaire (between March and April 2019) and in depth interviews to 10 key selected reporters, considered to be relevant actors in the response to the three diseases in the LAC Region. The Executive Summary, was issued on November 4, 2019. Among the most relevant findings, Sustainability emerges as a critical issue in the agenda of the response to the three diseases in the Region according to both the questionnaire and the interviews. Although some responders affirm that countries are beginning to walk on the road of transitioning, most of them consider that there are gaps and pending commitments, and that sustainability is not guaranteed to ensure a full and integral response including prevention and the participation of civil society organizations. Main obstacles to guarantee sustainability are in the political and programmatic areas. On the first one, the concern is about lack of political will and the current scenario of a “conservative” wave among new governments in the Region as well as the economic/financial crisis. On the programmatic side the concern is about reduction or absence of support to civil society organizations as well as absence of an integrated and multisectoral response. This last element was mentioned from almost all the voices of those persons related to the response who belong to CSOs, NGOs and UN agencies. Another relevant finding is related to the fact that Universal health coverage is seen as a very much needed policy to guarantee sustainability. Nevertheless, taking into consideration the very low number of actions/discussions on this topic where the responders have participated, it seems the topic is not very seriously adopted and incorporated in the national agendas. We also note with concern that the GF Community is not participating in the UHC Debates and encouraging CCM participation in the UHC debates as expected (Please find attached the Executive Summary).

The Caribbean subgroup continues to be supported through the PANCAP/CARICOM platform and there is a fluid and constant communication and consultation among the two sets of countries. PANCAP/CARICOM is also the very capable administrator of the funds received to support the LAC operations and PAHO /WHO provides administrative support to the Latin America representative for the operation and maintenance of a communication platform in Spanish to ensure a continuous flow of information within the Constituency and with other stakeholders in the Latin America sub-region, as well as to provide the technical expertise in analyzing and compiling policy and strategy documents and comments from all stakeholders including PAHO, UNAIDS, CCMs and RCMs, and presenting and /or negotiating the regional position at the Board level.

Beyond my duties as GF Board member, I have been a member of WHO Strategic advisory group (SAGeM) on malaria eradication (2016-2019), as well as a Roll Back malaria RBM Board member (2017-2020). In these groups, I have the responsibility of contributing with the individual and collective experiences of disease elimination from the LAC Region, while I keep reminding all parties about the need of protecting the countries achievements, particularly in UMICs and LMICs in the response to the three diseases. As a member of the WHO/MEOC (Malaria elimination Oversight Committee 2017-2022), I have been particularly engaged in supporting the Secretary of Health of Argentina to attain elimination status. Argentina was certified malaria-free by the World Health Organization (WHO) on May 21, 2019. Argentina is the second country to be certified in the last 45 years (after Paraguay) and the ninth country to be certified in the Americas region since 1962. Cross-border collaboration with Bolivia was a key factor to Argentina’s achievement suggesting that other neighboring countries in the region should strengthen cross-border initiatives to control the disease. Following the successful certification of Paraguay and Argentina, six other countries (Belize, Costa Rica, Ecuador, El Salvador, Mexico and Suriname) reduced the incidence of autochthonous cases and are in good track to eliminate the disease by 2020. Nowadays, with some countries in Latin America recording a resurgence in malaria cases, a robust surveillance system and the continuous retraining of health workers which enabled Argentina and Paraguay to maintain zero malaria cases must continue to be prioritized in the long-term.

I am pleased to inform that Guillermo A. Birmingham, LAC Constituency expert and Audit and Finance Committee (AFC) member (2018-2020), attended the 10th and 11th AFC meetings held in Geneva, Switzerland on July 16-17 and October 15-16, respectively. Relevant issues were addressed, and substantial contributions were made on Financial Oversight on Sources and Uses of Funds and OPEX budget, Resource Mobilization, Human Resource Management, Strategic Performance Assessment, Risk Management Overview, Sourcing and Supply Chain.

With reference to the LAC Constituency outreach efforts, I would like to mention the availability of Board Member six-month reports; the regular briefings to Permanent Missions of LAC Member states based in Geneva and during the COHSOD and PAHO Directing Council; and regular meetings with LAC Regional Manager and country teams responsible for country and regional grants to improve relationships between GF Secretariat and LAC countries.

I would like to express my gratitude to the health authorities for the confidence and responsibility bestowed upon me as Global Fund Board Member for the Latin American and Caribbean constituency for the period 2017-2019, as well as my deep appreciation to the Alternate Board Member, Hon. Dr. Marie Gréta Roy Clément from Haití, and all the LAC delegation members, Local Working Group and Local Support Group.

I will continue my duties as Alternate Board Member, supporting the Hon. Dr. Mary Isella Isaac in her new role as Board Member and with the LAC Constituency members.

The monthly newsletter in Spanish is being published and you can subscribe to it as well as visit the website www.lacfondomundial.org, and/or use communication channel through Facebook facebook.com/lacfondomundial and Twitter at @FondoLac.

Please do not hesitate to contact me for any enquiry or further information; I am opened to your guidance, proposals, suggestions for improvement and consultations through my personal e-mail rosesperiago@hotmail.com and at the institutional e-mail grupolafm@gmail.com

I take this opportunity to wish you, your families and all your co-citizens a Prosperous, Happy and Healthy 2020.

Sincerely,

Dr. Mirta Roses Periago
Global Fund Alternate Board Member
Latin America and the Caribbean Representation