In 2012, a resolution by African Ministers of Health approved the establishment of the African Constituency Bureau to support and improve the level of representation of the two constituencies within the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Bureau was thus set up in 2017 and is funded mainly by the Global Fund, the Bill and Melinda Gates Foundation (BMGF) and L’ Initiative.
Today, the Bureau is five years old, which marks a key moment in the life of the institution, an opportunity to conduct an assessment of its work since its establishment. It was therefore time for evaluations to be carried out in order to analyse “the state of progress of advocacy and influence as well as the integration of Africa’s priorities/interests in the decisions of the Global Fund Board and committees through the work of the ACB”. Thus, the aim was to review the ACB’s achievements; its adaptability to the changing landscape; the strategic relevance and importance of the ACB; its capacity, effectiveness and sustainability; factors that may facilitate or limit the goal of extending the ACB platform beyond the Global Fund; and the key positive and negative lessons learned from funding a nascent organisation. These evaluations were jointly conducted by BMGF and L’Initiative.
The results revealed both strengths and weaknesses or challenges as can be expected of any institution, let alone a nascent organisation.
The ACB was described as a body which has succeeded, within a short period of time, in improving the level of representation of African constituencies in the Global Fund Board, through the relentless and effective efforts of a lean team consisting initially of the Executive Director, the Administrative and Financial Manager and the Communication Specialist, whose efforts deserve to be fully acknowledge. The ACB’s accountability in terms of relevance, consistency and effectiveness is excellent.
The strengths include the ACB’s strong governance with documents (strategic plan, operational plan and advocacy plan) that are well developed but which set the bar very high for ACB’s success, the adequate support to African representatives to carry out their duties and exercise their influence, the increased level of representation of African constituencies at the Global Fund through ACB involvement in the selection process, training and support to representatives, the operationalisation of human resources who are familiar with the portfolio and country priorities, the recognition of ACB staff and African representatives by the Global Fund Secretariat.
In addition, internal financial control and monitoring is effective thanks to quality resources; financial audits are no exception.
In terms of programming, the ACB is successfully conducting the activities as outlined in the 2022-2025 operational plan. The statements are considered to be of high quality. At the country level, there is a good level of satisfaction with ACB’s preparation of Global Fund pre-Board meetings with regard to the development of statements, with 94% of CCMs rating this preparation as very satisfactory or satisfactory. The statements are in line with the concerns raised by the countries during Annual Consultative Meetings (ACMs), Cluster-Based Learning Regional Network (CBLN) meetings and informal telephone calls, which makes them relevant and appreciated by the countries, who feel that they are being listened to.
To a large extent, the ACB has been successful in sustaining and galvanising the meaningful engagement and participation of constituencies and countries from African constituencies within the Global Fund Board and related committees. As a matter of fact, evaluations have shown that all countries were informed and made aware of the Board and committee election process, and all had the opportunity to nominate candidates; Board members are well prepared and provided with briefing notes and talking points; consensus building and commitment between African constituencies and constituent countries has enabled African delegates to share a common view, for example when they provided input into the Global Fund Strategy (2023-2028). The project is therefore considered effective.
Moreover, African constituencies are increasingly influential at Global Fund Board and Committee meetings. This is demonstrated by the commitment and active participation in key issues during meetings, such as the disease split during the strategizing sessions. The African representatives on the Board were able to mobilise support from other constituencies.
Other positive aspects that were noted included: the mentoring of new representatives by former ones and the overlap period which are good practices for a successful transition, the recruitment of staff from different regions which is a good existing practice that needs to be enhanced, the invitation of national and/or community NGOs in Cluster-Based Learning Regional Network (CBLN) meetings to strengthen the link with the civil society and communities, the preparation of bilingual documentation for the ACMs to enable participants to submit their ideas more easily; CBLN meetings are excellent channels for expressing needs from the field and disseminating new learning, the close relationship with AIDSPAN allows the GFO to be used as a medium of information even if it is not sufficient as a feedback channel from Board meetings.
With regard to weaknesses and challenges, what can be noted in particular is the lack of involvement of African health Ministers, yet, they are the founders of the organisation, the lack of management time and human resources to conduct more research but especially to capitalise on successful experiences, the insufficient external coherence regarding the African civil society and communication mechanisms which are more effective in some countries than in others as they depend on the effectiveness of the leadership and positioning of the Country Coordinating Mechanism (CCM).
Furthermore, although countries acknowledge that there is a gradual increase in the level of their representation in the Global Fund governance bodies, the immediate results are mixed. In fact, 53% of CCMs consider that their representation has only “moderately” enabled African constituencies to get the Board decisions they wanted.
The evaluation has equally made it possible to note that efforts to increase the visibility and awareness of the ACB beyond the usual Global Fund in-country structures (CCM) have had limited success and consequently, awareness of the ACB at higher political levels of Ministries of health and finance is limited. To date, the ACB has been focusing on programmatic issues and not on visibility and political influence.
Other difficulties mentioned concerned discussions and resolution of issues related to mobilising African resources for the ACB or expanding its agenda and scope beyond the Global Fund, as well as the ACB’s current funding mechanism which is highly donor dependent and does not ensure its sustainability or provide specific pathways to achieve it. So far, no funding has been obtained from African governments, even though the ACB was established by a resolution of African Ministers of health. According to the reviewers, this situation is likely to remain problematic given current global economic constraints.
Another issue highlighted was human rights and gender issues, which are still far from being considered as priority concerns for African countries. The ACB nevertheless insists that they be included as a priority in the constituencies’ statements and speeches.
It was further noted that there is no general monitoring and evaluation plan or results framework for the ACB that defines the overall objectives for the duration of the Strategic Plan. Indeed, the current monitoring and evaluation plan, though generally aligned with the Strategic Plan, was developed for L’Initiative’s two-year project.
In conclusion, the constituency countries, the ACB Board and other development partners, including the Africa Centers for Disease Control and Prevention (Africa CDC), the WHO Regional Office for Africa (AFRO) and UNAIDS, have all recognized the strategic importance and relevance of the ACB. The ACB is committed to and has started building partnerships with various regional partners, including the AU, UNAIDS, WHO/AFRO and Africa CDC. In addition, the ACB’s Executive Director has provided good leadership for Africa’s participation in the Global Fund and is highly respected by his colleagues, but the management team has not yet been able to establish tangible relationships with African regional entities and has not yet made significant progress in expanding to other health initiatives.
Efficiency is difficult to estimate because nothing compares to the ACB, but the team is doing the best it can with the financial resources available. The joint evaluation also noted that investment in brand building and visibility is a necessity/pre-requisite for diversifying the ACB’s funding base.
There is no doubt that domestic funding by stakeholders is much needed to gradually move away from dependence on external donors and to this end, the ACB’s goal within a decade is to be funded by African governments for a better sense of ownership of Africa’s health issues by Africans themselves.