Six-monthly progress report on responsibilities as Global Fund Board Member of the Latin American and the Caribbean Constituency: July 2019

July 3, 2019

Honourable Ministries and Secretaries of Health,

It is my honour to address you when presenting the 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.

The LAC delegation attending the Forty-First Board Meeting on May 15-16, 2019, in Geneva, Switzerland, was headed by myself as Board Member; Mr. Dereck Springer, Acting AB Member, with an ad-interim delegation of authority from Hon. Dr. Marie Gréta Roy Clément, Minister of Public Health and Population, Haiti, due to her non-availability to attend the meeting; Mr. Javier Luis Hourcade Bellocq, Alternate LA CSO Member (Argentina), acting Communication Focal Point, delegation of authority from Mr. Dereck Springer, Caribbean Communication Focal Point (Guyana); Mr. Edner Boucicaut, Caribbean CSO Member, CCM Representative (Haiti); Dr. Aurelio Nuñez, RCM EMMIE Chair (Panama); Ms. Carina Vance – ISAGS – UNASUR (Ecuador); Ms. M. Joan Didier, OECS RCM Representative(Saint Lucia); Mr. Pablo Montoya, Technical Cooperation Horizontal Group (TCHG) Chair (Costa Rica) and Mr. Guillermo Birmingham, Audit/Finance, AFC member (Panama).

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 concerns 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 the Government´s capacity to implement social contracting with CSOs.

The Board most relevant decisions were: 1) Allocation Methodology for 2020-2022; 2) Catalytic Investments for the 2020-2022 Allocation Period; 3) Approval of the Amended and Restated Policy on Restricted Financial Contributions; 4) 2018 Annual Financial Report; 5) 2018 Statutory Financial Statements; 6) Appointment of the External Auditor; and 7) Appreciation of Outgoing Board Leadership Authorities, Ms. Aida Kurtovic – Chair (Bosnia and Herzegovina) and Amb. John Simon – Vice-Chair (United States).

The Board welcomed the new Board Leadership Authorities appointed on May 2, 2019; Dr. Donald Kaberuka as Chair of the Board (Rwanda) and Lady Roslyn Morauta as Vice-Chair of the Board (Papua New Guinea) to each serve two-year terms, or until the appointment of their respective successors, starting from the adjournment of the 41st Board Meeting on 16 May 2019.

Before the actual Board meeting, both the Implementers Group and the LAC Delegation held preparatory meetings on May 13 and 14, respectively in Geneva, Switzerland, to review key issues and agree on common positions particularly about the Allocation Methodology 2020-2022; Catalytic
Investment and other critical agenda items of shared interest. Photograph of LAC delegation is attached.

The process for selecting the new Implementers Group leadership was approved and will be launched in the second semester.

2019 is a replenishment year for the Global Fund, the process of advocacy and pledging was launched. The full Global Fund Sixth Replenishment Investment Case was presented and discussed by global health leaders at the Preparatory Meeting of the Global Fund Sixth Replenishment, hosted by the government of India in New Delhi on 8 February 2019. The Global Fund fundraising target seeks to raise at least US$14 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 will host the Global Fund’s Sixth Replenishment pledging conference in Lyon 10 October 2019. In Early Pledge, Portugal announced a pledge of €750,000 to the Global Fund’s Sixth Replenishment, which is more than triple its previous commitment. In addition, Prime Minister Shinzo Abe announced Japan’s commitment to the Global Fund’s Sixth Replenishment at the meeting of the Sustainable Development Goals Promotion Headquarters on 21 June 2019, Japan’s commitment will be achieved through a contribution of US$840 million to the Global Fund’s Sixth Replenishment and this pledge represents a 5 percent increase when compared with the previous three-year period.

I am pleased to inform that Guillermo A. Birmingham, LAC Constituency expert and Audit and Finance Committee (AFC) member (2018-2020), attended virtually the 9th AFC meeting on March 26-27, in Geneva, Switzerland. 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.

Another relevant achievement for LAC Region was the GF/PAHO agreement on the development of a monitoring framework for HIV services for Key populations pool which seeks to improve HIV/STI services for key populations across the Region.

Regarding the financial contribution to the Region, more than $2.2B has been invested, since its inception, by the GF in the LAC region for HIV/AIDS, HIV/TB, Malaria and TB components. Currently, there are 42 active grants in 18 countries and 6 multi-country projects, with the following relation between signed and disbursed amounts by diseases component: HIV/AIDS USD $ 146.9/USD $ 68.1; Tuberculosis USD $ 60.3/ USD $ 34.8; Malaria USD $ 48.1 / USD $ 20.9; HIV/TB USD $ 96.0 / USD $ 34.2. The distribution by the implementer of grants signed is the following: CSOs 57%, Government 25%, Multilateral 16%, and Others 3%. In addition, the LAC Region has twelve grants in the grant-making pipeline in 6 countries and 3 multi-country projects (HIV-LA, HIV-CAR, TB LAC). Considering unspent funds, as per new rules, resources no longer go to the next grant cycle, and still some countries are confronting difficulties in this aspect. Concerning the Transition process, fifteen countries in LAC conducted Transition Readiness Assessments in various forms and developed sustainability or transition strategies and work-plans. There was a strong collaboration with partners for the development and support to the implementation of these plans. Some relevant advances were identified in the following cases: a) the Dominican Republic and Cuba integrated the HIV sustainability strategy/transition work-plan in the new HIV NSP 2019-2024; b) Jamaica is working under the same approach for the development of its costed NSP 2020-2025; c) El Salvador integrated TB sustainability strategy in the TB NSP 2019-2024; d) Guyana set up Sustainability Steering Committee, chaired by the Vice-Minister of Health, to guide the development and conduct the oversight of the Sustainability Strategy.

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 / Technical Secretary for TCHG 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 newly established TCHG Permanent Secretary, 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).
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 the WHO Strategic advisory group (SAGeM) on malaria eradication (2016-2019), the last meeting took place in June and the final report was delivered to Dr. Tedros DG WHO., 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 neighbouring 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.

The Declaration of the Rights of People Affected by TB was historically launched on May 13, 2019, by TB people, in partnership with the Stop TB Partnership and together with the three civil society delegations (Communities, Developing Country NGO and Developed Country) to the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria at an event in Geneva. The launch of the Declaration is a significant step in recognizing the urgent need to adopt a human rights-based approach to TB and fund human rights-based interventions that overcome barriers to universal access.

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.

As already reported, the nomination process for the LAC Representation for the period 2019-2021 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. 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 a deadline of July 1th for Latin America. 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 the 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 is composed by well-recognized experts in the LAC Region with extended experience on Global Fund related issues, as follows:

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

The BMNC will present their recommendation officially to the LA MOHs requesting no-objection with a deadline on August 2, 2019; as established common practice, lack of response will be deemed as approval.

The call for nomination for Board Member from the Caribbean countries was issued with deadline August 9, 2019.

The Call for Nomination by Civil Society Organizations to have a representative in the LAC delegation will not be issued this year since it is 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 will be announced by the end of 2019.

I will continue my duties as Board Member during the second semester of 2019, in collaboration with Hon. Dr. Marie Gréta Roy Clément as Alternate Board Member and other LAC Constituency members, providing regular progress updates of the achievements within the Region.

The monthly newsletter in Spanish is being published and you can subscribe to it as well as visit the website, and/or use communication channel through Facebook and Twitter.
Please do not hesitate to contact me for any enquiry or further information; I am open to your guidance, proposals, suggestions for improvement and consultations through my personal e-mail and at the institutional e-mail



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