Report of GFATM - Civil Society meeting on Sept. 16, 2004, New Delhi

[Guest guest]

Minutes of meeting between Dr. Feacham and civil society representatives

New Delhi, Sept. 16, 2004. INP+, vice-chair of the Global Fund's Country

Coordination Mechanism (CCM), together with UNAIDS, organized a meeting of Dr.

Feacham, Executive Director of the Global Fund, with members of civil

society on September 16, 2004 in New Delhi. The purpose of the meeting was for

civil society organizations to have an interaction with Dr. Feacham about

priorities for India, and the functioning and future of the Global Fund.

The event began with Dr. Wind-, Country Coordinator of UNAIDS

India, welcoming the attendees. He noted that UNAIDS had, in alliance with

the Global Fund, organized three meetings with civil society in the last year,

to facilitate dialogue and raise additional funds from civil society sources.

While the new Project Director of NACO Dr. S.Y. Qureshi was unable to be

present, Dr. Wind- conveyed NACO's support of the Global Fund process.

He commended the quality of India's proposal, which had been approved in the 4th

round of funding.

A round of introductions followed Dr. Wind-'s welcome. Participating

individuals represented such organizations as

UNAIDS (N. Delhi),

INP+ (Chennai),

Sahas (Surat),

Christian Medical Association of India (N. Delhi),

Voluntary Health Association of India (N. Delhi),

Humana-India People to People (N. Delhi),

Humsafar Trust (Mumbai),

Massive Effort Campaign India (Pune),

MAMATA Health Institute for Mother and Child (N.Delhi),

Child Survival India (Delhi),

Catholic Health Association of India (Secunderabad),

Child in Need Institute (Calcutta),

Positive Women's Network of South India PWN+(Chennai),

Salaam Balak Trust (N. Delhi),

ARCON (Mumbai),

Swami Vivekananda Youth Movement (Mysore),

Durbar Mahila Samanwaya Committee (Sonagachi Project, Calcutta),

Society for Promotion of Youth and Masses (N. Delhi),

NIPASHA+ (Mumbai),

India HIV/AIDS Alliance (N.Delhi),

Population Foundation of India (N. Delhi),

YRG Care (Chennai) and

SAATHII (Chennai, Calcutta).

(Any omissions inadvertent)

Speaking of the GFATM and India, Dr. Feacham said that the Indian CCM had taken

a significant step forward in terms of its membership, but still had some

distance to travel - it was " not the best or worst in the world. " He expressed

his pessimism with regard to national prevalence estimates and said they were

quite likely underestimates. He said though prevention activity was increasing,

India still had a long way to go with respect to testing and treatment.

He explained the role of the GFATM, and said he was aware the government was not

the solution to the problem of HIV/AIDS in India. According to him, the

GFATM was designed to maximize and facilitate involvement of non-governmental

sectors. He noted that though the CCM started out being government-dominated,

at the present time there is more pluralism and representation of other voices.

Until Round 4, the government was the principal recipient of GFATM funding.

Despite that, Round 2 did have non-governmental organizations as sub-recipients,

and ARCON (AIDS Research and Control Centre, Mumbai) was a key player in Round

2.

Dr. Feacham said that in Round 4, GFATM funding to India had become separate

from Ministry of Finance processes. This pattern was increasingly common in the

129 other countries that are recipients of GFATM monies. With regard to

functioning of the CCM he said that the GFATM is not part of the CCM and its

degrees of leverage are small. While GFATM can and does give feedback on good

and bad practice, it cannot solve country-specific problems.

Several participants spoke about their experiences with the GFATM. Dr. Anand

from YRG Care described the objectives of the ARCON - YRGCare -Freedom

Foundation grant covering 4 states. Dr. Lanjewar from ARCON raised concerns

about the duration of funding and its impact on drug supply beyond the five

years of GFATM funding.

In response, Dr. Feacham observed that this issue of " what after GFATM? " faced

every country scaling up ART around the world relying on funds from foreign

sources. In low/rising per-capita income countries such as India - the shift

needed to be made from foreign to local sources. He called for political

advocacy towards increasing national resources for health.

Mr. Mrinal Kanti Dutta, from the Sonagachi project, raised several concerns

such as the needs for (i) more representation from vulnerable populations (ii)

support to both low- and high- burden states and (iii) lowering taxes on ARV

medication.

Dr. Feacham pointed out that differences between 'high' and 'low' burden states'

data may have arisen from various factors such as duration, nature and

(in)adequacies of data collection. He expressed GFATM's full support of the CCM

focus on non-high-burden states within the country, and also observed that GFATM

also welcomed applications from countries with a relatively small HIV problem.

Fr. Ouesepparampil from the Catholic Health Association of India drew attention

to the risks of basing major policy decisions on missing, incomplete

or poor-quality data. Seconding his point, Dr. Feacham called for prioritizing

collection of good data, supported by mathematical modeling of the epidemic by

researchers based in India.

Responding to this issue later in the meeting, Dr. Ramakrishnan of SAATHII said

the biggest challenge to mathematical modeling was going to be obtaining good

parameter estimates and mentioned the SAATHII-DharaniTrust initiative for

building the data collection/analysis capacities of HIV/AIDS NGOs.

Another participant, who was an ex-member of the CCM criticized the GFATM

application process, especially the single-proposal requirement, lack of support

for NGOs in preparing proposals, and rejection of non-ART proposals and

proposals from low-prevalence states.

Responding to these points, Dr. Feacham remarked that having the current CCM

vice-chair be from an NGO was a positive step. He said that while Round 5 would

also require a single proposal per country, there were ways to overcome the

challenges that this posed. He cited the example of Zambia, which had developed

a good proposal by bringing all the players (multiple PRs) to the table and

drafting a comprehensive and cohesive proposal. He also noted that countries

such as Russia had chosen to have sub-national CCMs and suggested this could

be emulated by India.

Dr. Wind- encouraged civil society representatives to forward further

comments to GFATM. He proposed an interactive channel on UNAIDS website

for interaction with civil society.

Mr. K.K. Abraham, giving his vote of thanks, noted that INP+ was elected as

vice-chair of the CCM, and the Secretariat Sub-Committee discussions were going

well. He suggested that in the 5th round, we can think of sub-national CCM.

Many attendees called for transparency in the GFATM process. Some of the

additional suggestions made were (i) 5th round dates should be announced well in

advance (ii) CCM should facilitate the process of NGO application (iii) drugs

and alcohol-addiction issues needed to be flagged (iv) More emphasis and

resource allocation to youth issues. (v) systematic, rather than ad-hoc,

setting of priorities by CCM and (vi) need for regular interactions among CCM,

NACO, and civil society organizations.

L Ramakrishnan,

SAATHII: Solidarity and Action Against the HIV Infection in India,

Chennai