The participation was vital and strategic, considering that Africa remains the epicenter of HIV and malaria epidemics and is home to more than half of the 30 high TB burden countries worldwide. With support from the African Constituency Bureau (ACB), the East and Southern Africa (ESA) and the West and Central Africa (WCA) constituencies supported governance decisions that include Sources and Uses of Funds, the Global Fund 2023 work plan, Extension of the utilization of the COVID-19 Response Mechanism (C19RM) funds to end 2025, Extension of wambo.org for non-Global Fund resources, Monitoring and Evaluation Framework, and the Multi-year evaluation calendar. Africa’s participation culminated in developing and submitting 12 constituency statements to the Global Fund governance bodies.
The ACB continued implementing its project amid several moving pieces within the Global Fund ecosystem. With the adoption of the 2023-2028 Strategy, there needed to be revisions and alignments of systems to enhance coordination in preparation for the rollout of the new strategy. In line with the many documents received from the Secretariat, the ACB provided support to ESA and WCA leaderships on decisions points that include revisions to the Terms of Reference for the Technical Review Panel, the change from a 2- to a 3-year tenure for Board and Committee Operating Procedures, the Governance Performance Assessment Framework, and the changes to the honorarium framework—the period of all these high-level reviews also coincided with ACB organizing ESA and WCA countries to participate in the nomination and selection of the next cohort of Global Fund board chair and vice chair positions.
Global Fund grants in several WCA countries continue to be implemented under challenging environments characterized by political instability, security tensions, and displacements. These all call for inter-country collaboration to ensure the continuity of HIV, TB, and malaria (HTM) services among migrant populations. Long-running conflicts have spillover effects on millions of people in the affected region, with children, girls, and women bearing the most consequences. Internal disputes and displacements affect grant absorption, including the supply chain, finding of TB missing cases, distribution of mosquito nets, and the provision of diagnostics services. To this end, ACB and its partner, AIDSPAN, arranged a cluster-based learning network (CBLN) in Lomé, Togo, to tackle information asymmetry in challenging operating environments (COE). A Lomé ‘declaration’ was produced and shared with the participants and the Global Fund. Five strategic priorities for WCA identified from the meeting
were capacity building, COE, alleviation of financial procedures and exit from ASP, risk management, and co-financing.
Given the impact of COVID-19 on HTM services, ACB supported ESA and WCA committee and board leadership to push for local manufacturing as a risk mitigation measure and ensure affordable commodities are manufactured closer to the consumers. Experiences learned at the height of the pandemic showed that many African countries struggled to access lifesaving medicines and other consumables. Africa, therefore, needs to move towards self-dependence in the manufacturing, supply, and distribution of these esential commodities so that at the climax of any pandemic, commodities reach out to communities at the right time and with good quality.
Organizational risk registers are essential for countries to determine areas requiring attention. However, after the Lomé meeting, few countries/principal recipients (PRs) were aware of their risk profiles. The organizational risk register for Quarter 2 of 2022 showed mixed residual risks and their directions of travel, with some risks either being high, steady, or declining. Through the ACB-organised CBLN, the Global Fund country teams were requested to ensure risk matrices were shared timely and systematically without having to be requested.
Meaningful and collaborative partnerships are essential in the fight against the three diseases. Thus, during the year, ACB jointly organized separate regional meetings with UNAIDS, the Stop TB Partnership, and the African Union (AU). ACB also participated in three regional conferences organized by Roll Back Malaria. These meetings touched on better ways to accelerate progress in the fight against HTM and to sensitize countries in their Grant Cycle 7 (GC7) application.
In Lomé, Togo, the ACB held a meeting with representatives of the ministries of health on the margins of the 72nd WHO Regional Africa Ministerial meeting. This side event culminated in advocacy for African countries to increase their pledges at the 7th replenishment conference and to work towards raising health resources domestically.
During the year, BMGF and L’Initiative conducted two independent evaluations to assess the capacity of ACB to discharge its mandate. The findings from both evaluations pointed towards some areas for improvement. In the coming year, ACB will develop a work plan to address the critical areas identified for optimal representation of the two constituencies.
The ACB work remains a journey whose accomplishment is possible through the commitment and effective representation by committee and board members in Global Fund governance platforms. These accomplishments result from long conversations, passion, impassive explanations in committee or board meetings, consensual approval, and resounding no or abstention votes.