Approval of the Global Fund Strategy Narrative
One of the most important decisions that took place at the 46th Board meeting was the decision to approve the new Global Fund Strategy Narrative. In a 75-minutes meeting held on Monday 8 November, the Board discussed and reached a consensus on a new and very different Strategy compared to previous ones, with the inclusion of ‘pandemic preparedness and response’ and an increasing focus on health financing as cross-cutting objectives.
Our article First look: the new Global Fund Strategy Narrative, published in September, went into the Strategy in some detail. It was appreciative of the immense level of effort that has gone into developing this narrative but at the same time was skeptical of whether efforts to cater to such a wide-ranging and diverse group of stakeholders would result in an indigestible and muddled Strategy. This article describes the changes made to the Narrative based on feedback received, it summarizes the gist of the Board discussions and notes the decision that the Board reached.
The Global Fund’s 2023-2028 Strategy was developed through a highly consultative two-year process. In July 2021, the Global Fund’s Board approved the 2023-2028 Strategy Framework. Based on extensive evidence, lessons learned, and several rounds of constituency feedback, a draft Strategy Framework was developed. This draft was reviewed by constituencies at the beginning of September 2021, and their input was then used to refine the Strategy Narrative that was sent to the Strategy Committee (SC).
In October 2021, the SC agreed on the final revisions to the Strategy Narrative based on additional constituency input and recommended the Strategy Narrative, reflecting final revisions, to the Board for approval at their 46th meeting in November 2021 (it can be found in Annex 1 to the Board paper). The approved Strategy Narrative will form the basis for a comprehensive and accountable M&E Framework, including key performance indicators (KPIs), to measure the success of the Global Fund partnership in achieving the Strategy’s primary goal and objectives. Its approval will also kickstart preparations for implementation, including for the next cycle of grants and relevant policy updates. Following approval, the Strategy Narrative will be formatted for external audiences, with attention to user-friendliness.
Overview of the Strategy Narrative contents
At almost 50 pages, it is still a long read. It is laid out as follows:
Box 1. New Strategy Narrative at a glance
Box 2 explains the difference between the current Strategy and the new one.
Box 2. What is different about this new Strategy?
First of all, it is important to stress what remains the same. The primary goal of the Global Fund is still to end AIDS, TB and malaria. That’s what the Global Fund partnership was created to do, and it is against this benchmark that our success will be judged. Our fundamental philosophy also remains the same: the Global Fund works as a partnership and achieves success by supporting implementer governments, affected communities, and other in-country stakeholders to have the tools that they themselves determine are needed to fight the three diseases. Our relentless focus on outcomes remains unchanged: our performance will ultimately be judged by lives saved and infections averted.
But there is also much that is different - so much, that providing an exhaustive list would require repeating much of what is set out in this Strategy Narrative. However illustratively, here are ten examples of aspects of the Global Fund partnership’s Strategy that will change our work to accelerate the pace of implementation.
Changes made to the draft originally presented to the Steering Committee
The pre-Board papers helpfully provided two versions of the Narrative, one a Courtesy Copy with Tracked Changes made by the Steering Committee when it met in October and based on feedback from the various constituencies, and a second clean copy with the changes incorporated.
The most notable changes were:
- Contribute to the Sustainable Development Goal (SDG) target of achieving universal health coverage (UHC): references to achieving UHC were included throughout the Strategy where relevant.
- The TB section additionally contains updates to TB data in line with the 2020 data released by the World Health Organization (WHO) on 14 October 2021.
- Close gaps in HIV prevention coverage: support to comprehensive sexuality education was added.
- Regarding Mobilizing Increased Resources, ‘as part of its commitment to this approach, the Global Fund is actively engaging in the sustainable financing work under the umbrella of the SDG 3 GAP.’
- Unsurprisingly, given the heated discussion and contention around this ‘objective’, the biggest changes were made to section 7, Evolving Objective: Contribute to Pandemic Preparedness and Response:
The paragraph starts: ‘Given the ongoing COVID-19 pandemic emergency and current wide-ranging discussions across multiple stakeholders about how best to address PPR within the global health architecture, this objective is described as “evolving” within our Strategy.’ The Strategy authors have added the following: ‘Uniquely, this objective is labeled as “evolving” to reflect both the need to respond to the ongoing immediate needs of the COVID-19 pandemic, and broader discussions on the global health architecture within the G7 and G20, and by expert groups like the Independent Panel on Pandemic Preparedness and Response. Any future response to a new pandemic would require additional and future Board decisions based upon the specific context.’ This text was originally in a footnote but has been moved up to the text to emphasize its importance.
- Minor changes were made to ‘Improve coordination, alignment and complementarity of efforts.’
- Under Development Partners, Unitaid was added ‘to continue the strategic partnership with the Global Fund on equitable access to health products; identify high potential health innovations; and accelerate the development, introduction and adoption of these innovations through targeted investments and coordinated market shaping efforts.’
- Implementer governments also received some amendments, most notably:
- The inclusion of ‘providing access to equitable, quality UHC’;
- ‘By ensuring HTM remain high on the agenda, and by building partnerships at country-level to support HTM program sustainability’;
- Inclusion of the private sector by ‘promote the integration of community systems and services provided by the private sector';
- Private Sector: Two new objectives were added: ‘4) support the long-term sustainability of health product markets; 5) contribute to strengthening national and regional capabilities in procurement, supply chain, product supply and related regulatory systems for health products and services’;
- Technical partners: To UNAIDS, the addition of ‘to promote human rights, gender equality, the empowerment of women and girls, communities and key populations and champion community-led responses.’
The stakeholders commended the SC and Secretariat’s work in the highly consultative process undertaken to determine the Global Fund’s next Strategy and were pleased to see important inputs reflected in the narrative that have been made by the various delegations as well as other leading civil society and community groups and networks in the Global Fund Partnership.
Most constituencies echoed the importance of moving from discussions on the narrative to the implementation of the Strategy, ensuring that the highlighted components on what must be done differently are fully operationalized and that the new Independent Evaluation Function will be critical for the monitoring and evaluation of the Strategy.
The new Strategy is a landmark document in the global health arena and will allow the Global Fund Partnership to lead by example in new and deepened areas of work. To that end, and recognizing the important coordination and influencing role of the Global Fund, stakeholders wanted to see a timeline outlining when specific important will come to the Committees and Board for discussion/decision as critical strategic enablers/directions that will facilitate the successful realization of the collective goals. These issues include but are not limited to: the NextGen Market Shaping strategy; Digital Health Transformation; Private Sector Engagement; Resilient and Sustainable Systems for Health (RSSH); and Pandemic Preparedness and Response (PPR).
In particular, regarding PPR, delegations requested clear timelines from the Secretariat and SC that will allow the concretization of this ‘evolving objective’. While this issue continues as a rapidly developing area of work and coordination with respect to the global Covid-19 response, an agreed timeline to define the Global Fund’s role in PPR more broadly is critical to guide and support planning across the Partnership, managing (internal and external) expectations, and clearly defining and communicating the areas of focused contribution, and the resources required to do so. Equally crucial will be clarity should there be the undesirable reality of flatlined funding and the potential adverse implications for HTM investments.
Some delegations highlighted three areas of consistent interest which, they felt, did not receive clear operational guidance in the final Strategy Narrative. These are: (1) Resourcing and measuring the commitment to ‘people’ and ‘communities at the center’; (2) Bolder ambition for TB, including a greater recognition and support of the critical role of communities and civil society in finding missing cases, providing psycho-social support and other services; and (3) A responsible approach to transition, particularly as the evolving response to the C19 pandemic has a disproportionate impact on vulnerable populations and economies. They hoped that the operationalization of these priorities will become clearer and more definitive in the coming months.
Work with communities cannot solely be the mandate of the Community, Rights, and Gender (CRG) thematic area, stakeholders insisted: all parts of the Global Fund’s architecture and funding model must reflect the priorities of the new Strategy. In brief, accountability for ‘community-centered results must be balanced with the authority granted to all divisions to achieve them.
Decision point with amendments
The following decision point was presented for approval.
Decision Point: GF/B46/DPXX: Approval of Strategy Narrative for the 2023-2028 Global Fund Strategy
Based on the recommendation of the Strategy Committee, as presented in GF/B46/03_rev1, the Board:
Budgetary implications: The Secretariat will work with the Audit and Finance Committee on anticipated costing and operating expenses related to the Strategy once the Final Strategy is approved.
There were 19 votes in support and one friendly abstention. Accordingly, the Decision Point was carried overwhelmingly.
The Board Document GF/B46/03, Approval of the Global Fund Strategy Narrative, should be available shortly at https://www.theglobalfund.org/en/board/meetings/46