May 29th, 2021

Honorable Ministries and Secretaries of Health,

It is my honor to address you on presenting the progress report on the key actions undertaken during my managerial responsibilities as Global Fund Alternate Board Member for the Latin American and Caribbean constituency for the period 2019-2021.

The LAC delegation participating in the Forty Fifth Board Meeting and the third one held virtually on May 11-12, 2021, was headed by myself, as Acting Board Member, with ad interim delegation of authority from Hon. Dr. Mary Isella Isaac, Senator, Minister of Health and Wellness (Saint Lucia), due to her non availability to attend the meeting; Dr. Rosmond Adams, Director of PANCAP, CARICOM Secretariat and Caribbean Communication Focal Point (Guyana) as Acting Board Member, with ad-interim delegation of authority; Dr. Gabriela de la Iglesia, LA Communication Focal Point (Argentina); Mr. Edner Boucicaut, Caribbean CSO Member, Former Chair of CCM Haiti (Haiti); Mr. Lucien Govaard, CariFLAGS Co- Chair, Youth Representative (Suriname); Ms. M. Joan Didier, OECS RCM Representative (Saint Lucia); Hon. Dr. Alejandra Acuña, Technical Cooperation Horizontal Group (TCHG) Chair, Vice- Minister of Health (Costa Rica); Mr. Dereck Springer, Former PANCAP Director (Guyana) and Mr. Guillermo Birmingham, Audit/Finance, AFC member (Panama).

LAC Delegation highly appreciated the ED´s six priorities identified and his report on the actions taken, the strategic decisions made with agility, flexibility, and creativity to position the GF in the challenging pandemic scenario. LAC also congratulated the Global Fund ongoing actions under the innovative COVID-19 Response Mechanism and the Grant Flexibilities, to protect Global Fund’s core mandate of ensuring adequate response and program continuity. At the same time, the LAC Delegation acknowledged the extraordinary efforts and dedication of the GF leadership and all staff.

On the resource mobilization current and future scenario, LAC stressed the hard impact of COVID-19 on the fiscal situation of our implementing countries and the urgent need to consider the increasing challenges in committing even agreed domestic financing in the current grant cycle. Moreover, LAC urged the ED to give priority attention to this issue for the much-needed fast approval of 2021-2022 grants.

After more than a year, we know that the COVID-19 Pandemic not only put a halt to the progress made on the three diseases response, but also rolled back most of the achievements. In this regard, LAC made an urgent call of attention on the unfinished agenda and how to work to address the set back and move forward to strengthen Pandemic Preparedness and Response (PPR).

In addition, LAC highly commended the OIG hard work to maintain active its workplan adjusting with innovative and expanded partnership at country level to accomplish its role. LAC also thanked the Risk Management Officer and his team on the report and on the sharp analysis, and proposed, as well, a review of the frameworks in lieu of the dynamics of the new scenario generated by COVID-19 and the threat on achieving our resource mobilization and programmatic goals.

At its meeting, the Board also discussed development of the next Global Fund Strategy and the need to adapt to the new challenges posed by COVID-19 on top of those created by climate change. On Global Health Security (GHS), the LAC Constituency GF Strategy statement stressed the need to avoid presenting only the negative side of the impact of COVID-19 on HIV/AIDS,
TB and Malaria when addressing GHS matters. We also need to demonstrate the potential leverage on the investments made, the capacity built and the lessons learned by the GF over the last 20 years (i.e.: community systems, surveillance, contact tracing, behavioral communication, acceptance and proper use of condoms and bed nets to inform communities about risks and use of protective measures, adherence to treatment and measures, supply chain), instead of only protecting from the epidemics impact. The Global Fund (GF) has become one of the most powerful and well-resourced organizations in global health and the largest multilateral investor in grants for health systems strengthening and this has to be highlighted and recognized. The GF’s future contributions to GHS should primarily build on the GF’s current mandate and deliver its mission against HIV, TB and malaria in a way that supports and strengthens countries “capacities for prevention, preparedness and response”.

The LAC Delegation flagged a key message: “According to psychosocial approaches, the best way to address invisible and potential risks is to work on the current and present risks, i.e. by working every day with every community and with innovation to eliminate the three diseases, we can develop the capacities, skills set, tools and experiences, enthusiasm and will, to address GHS, not as an abstract goal but as a tangible real threat”.

LAC Delegation supported Donor Group Consensus Statement on GF Strategy Framework 2023-2025 and Pandemic Preparedness and Response, which emphasizes that Ending AIDS, TB and Malaria should continue being the core goal and mandate of the Global Fund, and the contribution to PPR should be focused on how to build resilience and strengthen systems to deliver a suitable response to the three disease. The LAC positioning stressed the need to continue supporting the approach that prevents HTM service disruption in case of upsurge of pandemics, climate change, political instability and health threats. Furthermore, LAC shared some reflections: i) the obstacles and challenges are the same that weakened the global and local ability to prevent a new pandemic; ii) the history of humanity shows that three disease started (decades, centuries and millenniums ago) as pandemics and then become endemics; iii) the new strategy should recognize clearly the lessons learned from the failures in achieving and sustaining the primary goal of ending the three diseases, identifying what we need to do better and do differently, in order to change and include these findings. In this way, achieving success in our goal of ending three diseases, will be strengthening PPR to future health threats; and iv) the GF partnership model should urgently move to articulate partners ́ committees or alliances at each level (not only global, but also at regional, sub regional, country and local level) to ensure aid alignment, efficiency and effective and sustainable investments and results. In that sense, the Strategy narrative should describe with further detail those aspects related to complementarity, responsibilities, accountability and technical support competences of all actors engaged.

Concerning the post-2023 KPI Framework development, LAC Constituency agreed with the set of principles identified to guide the selection of indicators: Importance, Integration, Accountability and Actionability. With regards to the proposed options for models for the structure for the evaluation function at the Global Fund, LAC Constituency supports model 3, an evaluation unit that reports directly to the Strategy Committee and the Board; in addition, the unit manages all strategic evaluation and determines the workplan in consultation with SC/Board. However, LAC expressed its willingness to assess model 2 more in depth, which considers reporting administratively directly to the Executive Director Office. In this model an Evaluation Committee provides an oversight function on the evaluation workplan; evaluation terms of reference and quality of evaluation reports requesting to the SC/Board and oversight over the evaluation unit and the evaluation unit is accountable programmatically to the committee.

The Board most relevant decision was the approval of the increase of forecasted aggregate operating expenses available for the 2020-2022 allocation period by US$ 30 million, to facilitate the implementation of critical activities in 2022 topping OPEX at US$ 930 million. There was an Executive Session of the Board to review the Executive Director´s Performance Assessment.

Before the actual Board meeting, both the Implementers Group and the LAC Delegation held preparatory meetings on May 6 and 10, respectively, to review key issues and agree on common positions particularly about the New Global Fund Strategy Development; COVID-19 and Business Continuity other critical agenda items of shared interest.

Regarding the LAC grant portfolio update, a total amount of 381 million for the HIV/AIDS, HIV/TB, Malaria, RSSH, TB and Multi-components has been allocated for the 2020-2022 cycle. Additionally, as of March 2021, GF provided US$ 29M (C19RM and grant flexibilities) to the COVID-19 response in LAC, including bolstering health systems and mitigating the impacts on lifesaving HIV, TB and malaria programs. Haiti and Guatemala have benefited the most from grant flexibilities, while Venezuela and Peru have benefited the most from the C19 Response Mechanism; several requests are in process for C19RM 2021.

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 to the Alternate Board Member continues functioning through virtual communication with additional members from NGO Networks, Civil Society, and technical partners such as PAHO/WHO and UNAIDS.

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 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, 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 Alternate Board member, I continue as Member of the WHO MEOC (Malaria eradication oversight committee) since 2018, as well as a Roll Back malaria RBM Board member (2017-2022). 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. Nowadays, with some countries in Latin America recording a resurgence in malaria cases and with the outbreak of COVID-19 Pandemic, 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. On the 25th of February, El Salvador was certified as malaria-free. We congratulate El Salvador for becoming the first country in Central America to receive the certification by the World Health Organization (WHO) and the third country to have achieved malaria-free status in recent years in the WHO Region of the Americas, following Argentina in 2019 and Paraguay in 2018. Seven countries in the region were certified from 1962 to 1973. Globally, a total of 38 countries and territories have reached this milestone.

On the 21st of February 2020, Dr. Tedros Adhanom, the WHO Director-General appointed me as one of the six Special Envoys on COVID-19 (2020-2022), to provide strategic advice and high-
level political advocacy and engagement in the LAC Region and to work in close collaboration with WHO Regional Directors and country offices to coordinate the global response to COVID-19. My main functions as Special Envoys on COVID-19 are to: i) Amplify the messages of the Director General; ii) Disseminate WHO guidance on COVID-19 readiness and response; iii) Partake in high-level advocacy and political engagement; iv) Provide strategic advice on preparedness, readiness and response to COVID – 19 outbreaks; v) Engage with regional bodies and national governments; and vi) Report regularly to the Director-General on my work and the situation in countries.

Guillermo A. Birmingham, LAC Constituency expert and Audit and Finance Committee (AFC) member (2018-2020), was appointed to the AFC for a second term (2020-2022). He also attended the 15th AFC meeting held virtually, on March 22nd & 23rd. Relevant issues were addressed, and substantial contributions were made on OPEX Evolution 2020-2022 Budget Ceiling Revision, OIG 2020 Annual Report and Risk Assessment, Recoveries for the period ended 31 march 2020, and Strategic Performance and KPI Framework.

Dereck Springer was appointed as chair of the ImG Strategy Development Group to contribute with his expertise in governance areas.

With reference to the LAC Constituency outreach efforts, I would like to mention the monthly LAC Newsletter, the Alternate 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.

As already reported, the nomination process for the LAC Representation for the period 2021-2023 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, the Board Member will be from Latin America Sub-region and the Alternate from the Caribbean Sub-region.

The call for Board member was issued with a deadline on June 28th 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 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 is composed by well-recognized experts in the LAC Region with extensive experience on Global Fund related issues, as follows:

• Dr. Lucrecia Ramirez de Castellanos, Ministry of Health Advisor, Former Vice-Minister and Former National TB Program Manager, Ministry of Health, Guatemala.
• Dr. Lourdes Kusunoki Fuero, Program Coordinator “Strengthening TB laboratory diagnostic in the Region of Americas” regional grant of the Global Fund, ORAS/CONHU.
• Lic. Javier Hourcade Bellocq, Civil Society Leader, Communities Delegation Member and Former LAC Delegation Member for the GF Board.

The BMNC will present their recommendation officially to the LA MOHs requesting no-objection with a deadline on August 2, 2021. As established common practice, lack of response will be deemed as an approval.

The call for nomination for Alternate Board Member from the Caribbean countries will be launched subsequently.

The LAC Delegation Composition for the period November 2021 and October 2023 will be announced by the end of 2021.

I will continue my duties as Alternate Board Member, supporting the Hon. Dr. Mary Isella Isaac in her 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.

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.

Sincerely,

Dr. Mirta Roses Periago
Global Fund Alternate Board Member
Latin America