July 20, 2023

 Subject: Semesterly Progress Report of Key Activities and Responsibilities undertaken by the Board Member of the Latin America and the Caribbean Constituency to the Global Fund

Honorable Ministries and Secretaries of Health,

It is my honour to present this progress report on the key actions undertaken during my managerial responsibilities as the Board Member for the Latin American and Caribbean Constituency of the Global Fund Board. I temporarily replaced Dr. Mirta Roses effective April 2022.

LAC’s participation and engagement in the 49th Board Meeting

The LAC Delegation participated in the Forty Ninth Meeting of the Board held in Hanoi, Vietnam on May 10-11, 2023, and was headed by Mr. Dereck Springer, Caribbean Communication Focal Point (Guyana), whom I designated as Board Member, due to my unavailability to attend. Dr. Lourdes Kusunoki, Coordinator of the “TB Laboratory Diagnostic Strengthening for the Americas Region», PR – ORAS/CONHU (Peru), was designated Alternate Board Member, by the Hon. Senator Jonathan La Crette, ABM, Minister for Health, Wellness and Religious Affairs, Grenada, due to his unavailability to attend. Ms. M. Joan Didier, OECS RCM Representative (Saint Lucia), was designated Communication Focal Point, by Dr. Gabriela de la Iglesia, Latin America Communication Focal Point (Argentina), due to her unavailability to attend. Mr. Lucien Govaard, CariFLAGS Co- Chair, Youth Representative (Suriname) also attended.

LAC Delegation commended the Executive Director (ED) for the progress towards 95-95-95 in some countries as well as for the advances in TB diagnostic and treatment to mitigate impact due to COVID-19; while expressing concern regarding the upsurge in malaria infections and deaths due to conflicts in some of the affected countries, and the deterioration in LGBTI rights in some countries.

The Board also considered the 2023-2028 KPI framework adjustments; amendments to the Risk Appetite Statements as well as the Pandemic Prevention, Preparedness and Response.

Key Performance Indicators

LAC recognized the efforts of the Global Fund Secretariat (GFS), Strategy Committee (SC) and Audit and Finance Committee (AFC) and supported the decision that material changes to a key performance indicators (KPI) will continue to be recommended by the Audit and Finance Committee (AFC) or the Strategy Committee (SC), within their respective responsibilities for Board approval, and the delegated authority to the  Secretariat, in consultation with the leadership of the relevant Committees, in making non-material KPI adjustments.

LAC Constituency commended the Global Fund Secretariat (GFS) and the Global Fund Modelling Guidance Group (MGG), for their work in guiding the target setting process for KPI 1 (mortality rate) and KPI2 (incidence rate), as well as for their commitment to craft further justification and explanation that enabled the Board to understand the rationale for those choices that were based on the assumption of a robust methodology. LAC also recognised that there has been significant efforts to improve and address concerns shared by several constituencies. However, while the targets are realistic and technically sound, LAC considered that they are still not aligned with the ambition of the Global Fund Strategy 2023-2025 and the investment case, and more so with the goals and targets of many other Frameworks, Strategies and Plans that all point to ending HIV, TB and Malaria as public health threats by 2030. LAC contended that both impact KPI (I1& I2), which are at the highest level of the KPI framework in terms of what the impact that the GF is expected to generate in relation to the three epidemics, should be considered as a responsibility of the GF partnership. Furthermore, LAC emphasised that the high target level (70%), defined for the range indicated by the modelling, includes the development of innovations that are essential to achieve disease elimination. In this regard, LAC welcomed the GFS and STOP TB joint collaboration to review the targets according to the funding available to show higher targets. With regards to the targets proposed for the human rights related barriers (BDB Cohort) for the three diseases (50%), LAC considered that this is a very conservative target while acknowledging the challenges related to the complexity of the methodology to assess country-by-country trajectory from baseline to show progress. LAC indicated our expectation that the Board will receive the details of the communication which will accompany the operationalization of the framework by the next Board meeting to better understand how the Global Fund will communicate these revised targets.

Malaria Programme Quality Risk

Once again, LAC underscored its previous concern that the Malaria Programme Quality risk is on the cusp of moving to Very High according to the Risk Appetite Statements. LAC welcomed the additional information which has been provided on the methodology and measures of the risk management framework. LAC expressed its satisfaction with the recommendation that the target timeframe be extended to enable the Malaria programme quality risk to achieve a ‘Moderate’ risk level.

Furthermore, LAC considered that the evolving drug and insecticide resistance patterns require ongoing monitoring to prevent a reversal of the achievements related to the disease elimination goal. LAC is cognisant the LAC Region has a unique and pioneering experience in Malaria elimination, and continues its progress towards Malaria elimination (Paraguay in 2018, Argentina in 2019, El Salvador in 2021, and Belize in 2023). However, LAC is concerned that a resurgence of cases is well underway, especially in South American countries. In this regard, LAC recommended the inclusion of the LAC Region in an emergency project for the prevention of emergence of resistant P. falciparum malaria, cognisant that the LAC Region has a very effective sentinel surveillance network for early detection of the emergence of resistance to malaria treatment. LAC welcomed the possibility of receiving additional funds to accelerate prevention programs that are being implemented in the region.

The Pandemic Fund

LAC strongly supported the joint Implementer Group Statement on the Pandemic Prevention, Preparedness and Response Fund which was shared with the board. LAC acknowledged the Secretariat´s efforts to ensure coordination and complementarity between the Pandemic Fund and C19RM investments in countries to maximise the available resources for country responses and impact. However, LAC is of the view that the Secretariat should continue working to develop clear terms of communication regarding the submission of proposals to avoid mixed messages to beneficiary countries. LAC also highlighted documented challenges that countries have been experiencing with regard to the implementation of C19RM funds. These challenges are due mainly to protracted delays in procurements and limited in-country absorption capacity. Therefore, LAC called upon the GF to aggressively seek to overcome these issues before assuming additional commitments, vis-a-vis the pandemic fund.

Additional Safeguard Policy

LAC welcomed the Secretariat’s proposed review of countries under Additional Safeguard Policy (ASP). LAC called on the Board to prioritise a meaningful discussion on the crisis that is occurring in Haiti. LAC stressed the critical situation faced at the country level to deliver services; particularly highlighting the humanitarian crisis which is currently occurring in Haiti and which is hindering access to prevention, treatment and care services for persons living with and affected by the three diseases. The Global Fund’s contribution in the fight against the three diseases is significant and is helping to save lives, however, the volatile socio-political situation on the ground in Haiti is seriously impeding the impact of the three programmes. LAC urged the Secretariat to continue improving flexibility in relation to administrative requirements to ensure timely disbursements.

Outgoing Board Leadership

Finally, LAC Delegation extended its gratitude for the Board Leadership stewardship and excellent leadership during the last three years, a time of turbulence, a time of great uncertainty in the midst of the COVID-19 pandemic. LAC acknowledged that the Board Chair and Vice chair have demonstrated stellar leadership in piloting Board decisions during a very difficult time for the Global Fund and the world. LAC also wished the outgoing Chair, Dr. Donald Kaberuka, success in his future endeavours. LAC welcomed the outgoing Vice-Chair, Lady Roslyn Morauta, as new chair of the Board; and Ms. Bience Gawanas, appointed as new vice-chair. LAC Delegation also extended its gratitude to the Committees’ leadership and members for their dedication and commitment to the work of the Global Fund during their tenure.

Key Decision Points

The Board most relevant decisions were: i) 2023-2028 KPI Framework adjustments and ii) Amendments to the Risk Appetite Statements unanimously approved.

Implementer Group Engagement

Key issues discussed

Prior to the Board meeting and as part of Implementers Engagement, the Implementers Group (ImG) held a preparatory meeting in Hanoi, Vietnam, on May 7, 2023. The meeting was co-chaired by Dr. Miso Pejkovic, ImG Chair, and Ms. Yolanda Paul, Vice chair. The IMG also reviewed key issues and agreed on common positions particularly about the Challenging Operating Environment; Pandemic Fund (PF) and Pandemic Prevention, Preparedness and Response; Communities, Rights and Gender; Risk Management; and other critical agenda items of shared interest.

Joint Implementer Statement

Following consensus, the Implementer Group leadership issued a Joint Statement, on behalf of its 10 Constituencies, requesting timely and consistent implementation of flexibilities provided for under the Challenging Operating Environment (COE) policy as well as updating the definition of COE, and urge the Secretariat to provide a clearer strategy, including a realistic timeline, for moving countries from under the Additional Safeguard Policy (ASP). The Joint Statement also requested the Global Fund to continue the engagement with the Pandemic Fund to seek alignment and coordination to reduce cost burdens and duplication efforts; increase programmatic efficiency; build stronger and more resilient health systems; and achieve faster reduction in incidence of diseases. Finally, the IMG called upon the Global Fund Partnership to collectively stay the course on comprehensive programming and service delivery using evidence-based interventions, community-led and key population-led service delivery, and multi-country approaches to drive down barriers.

LAC Preparatory Meeting

Prior to the Board meeting, LAC convened a preparatory meeting virtually on April 27, 2023, for LAC Delegation Members, to enable the delegation to review key issues and agree on common positions, particularly in relation to Challenging Operating Environments, the Regional Artemisinin-resistance Initiative (RAI) and Malaria Program Risk – Malaria Drug and Insecticide Resistance Risk Update, the Approval of Adjustments to the 2023-2028 KPI Framework, the Engagement with the Pandemic Fund’s First Call for Proposals and other critical agenda items of shared interest.

LAC Representation on the Strategy Committee

Dr. Massimo Ghidinelli, LAC Constituency expert and Former Unit Chief HIV/STI, TB and Viral Hepatitis – PAHO and Former Director, CDE PAHO Washington, was appointed to the Strategy Committee (SC) for the period May 2022-2025. He attended the 21th SC meeting held in-person, on March 13th – 14th, and the 22nd SC meeting held virtually on July 10th-11th. Relevant issues were addressed, and substantial contributions were made on the Catalytic Investment; Independent Evaluation Function; Thematic discussion on Human Rights; Pandemic Fund; Strategic Performance Report and Adjustments to 2023-2028 KPI Framework and other critical agenda items.

Constituency Outreach

With reference to the LAC Constituency outreach efforts, I would like to highlight the monthly LAC Newsletter, the Board Member six-month reports 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.

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 the communication channel through Facebook facebook.com/lacfondomundial and Twitter @FondoLac

Launch of Nomination Process for New LAC Leadership

 As already reported, the nomination process for the LAC Representation for the period 2023-2025 was recently launched in keeping with the Terms of Reference approved at the Latin America and Caribbean Constituency Meeting in 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, these Terms of Reference entered into force based on endorsement by the Ministers of Health of the Latin America and Caribbean region. According to the rotation agreed, the Board Member will be from the Caribbean Sub-region and the Alternate from Latin America Sub-region.

The call for Board Member was issued by PANCAP on June 23, 2023, with a deadline of August 18th for submission of nomination. The call for Alternate Board member was issued with a deadline on July 31st for Latin America. Alternate Board Member Nomination Committee (ABMNC) 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 advanced 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 establish contacts broadly and effectively.

The Committee for selection of the Alternate Board Member is composed by well-recognized experts in the LAC Region with extensive experience on Global Fund related issues, as follows:

• Dr. Rosmond Adams, Advisor, Health Systems and Services PAHO/WHO Office (Suriname), Former PANCAP Director and Former Communication Focal Point for the Caribbean, LAC Representation.
• Dr. Lourdes Kusunoki Fuero, Program Coordinator “Strengthening TB laboratory diagnostic in the Region of Americas” regional grant of the Global Fund, ORAS/CONHU (Peru) and LAC Delegation member.
• Mrs. Erika Castellanos, Executive Director, Global Action for Trans Equality Civil Society Leader, Communities Delegation Member and Former Communities Delegation Member for the GF Board.

The ABMNC will present their recommendation officially to the LA MOHs requesting no-objection with a deadline on September 1, 2023. As established common practice, lack of response will be deemed as an approval. The selection of the Board Member will be made at the Meeting of the Council of Human and Social Development-Ministers of Health in September ahead of the PAHO Directing Council Meeting. The LAC Delegation Composition for the period November 2023 and October 2025 will be announced by the end of 2023.

I will continue my duties as Board Member, in collaboration with the Hon. Senator Jonathan La Crette in his role as Alternate Board Member and with the LAC Constituency members until the end of October 2023.

Board Member´s Representation beyond the Global Fund

Beyond my duties as GF Board member, I continue as Executive Secretary of the Ministry of Health Council from Central American and Dominican Republic (COMISCA) since August 1st, 2021, for a four-year period. In this group, I have the responsibility of contributing with my individual and collective professional experience in Public Health to support technically the political and strategic coordination. I have also participated in the LVIII COMISCA ordinary meeting that was held in – person in San Pedro, Belize on June 22-23, chaired by Hon. Kevin Bernard, pro tempore COMISCA Chair for the period between January and June of the current period. During this Regional Forum, Dr. María del Carmen Calle – ORAS CONHU, Executive Secretary – presented the outcomes of the regional grant of the Global Fund “Strengthening TB laboratory diagnostic in the Region of Americas”. Therefore, the Ministers of Health recommended the SE-COMISCA and the Regional Coordination Mechanism (RCM), in collaboration with PAHO/WHO and National TB Programs of the MoH or Secretaries of Health which are State Members of SICA, to develop a Regional Strategic Plan for TB, including TB-HIV co-infection as well as comorbidities including diabetes, hypertension and chronic renal disease.

Furthermore, during a specific session with HIV partners, such as USAID, PEPFAR and CDC; the COMISCA agreed to convene a High-Level Regional Forum on HIV in El Salvador in December. The main objective of the meeting will be to review the COMISCA agenda to address gaps in the HIV response to achieve 95-95-95 targets. During the meeting, the COMISCA congratulated El Salvador for receiving the certification by the World Health Organization (WHO) on June 21, 2023, following Argentina in 2019 and Paraguay in 2018. Eleven countries in the region of the Americas were certified as malaria-free by WHO. Globally, a total of 42 countries and one territory have reached this milestone.

Recognition

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 which significantly enhances Latin America’s representation within the constituency and the Board and committees.

The Caribbean subgroup continues to be supported through the PANCAP/CARICOM platform. PANCAP/CARICOM is also the administrator of the constituency funding funds that supports the LAC’s operations and provides administrative support to the Latin America representative for the operation and maintenance of the communication platform in Spanish to ensure a continuous flow of information within the Constituency and with other stakeholders in the Latin America sub-region. Funding also supports the provision of 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.

Mr. Dereck Springer is currently serving as the Interim Communications Focal Point for the Caribbean and serves as a bridge between Latin America and the Caribbean, particularly in advancing the work of the constituency workplan which is usually undertaken by the Director of PANCAP.

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 aacuna@sica.int and at the institutional e-mail grupolafm@gmail.com.

Sincerely,

Dr. Alejandra Acuña Navarro

Global Fund Board Member

Latin America and the Caribbean Representation