URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

Udenrigsudvalget 2017-18
URU Alm.del Bilag 33
Offentligt

Danish Organisation Strategy

for

The Global Fund to Fight AIDS,

Tuberculosis and Malaria

2017-2022

October 2017

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

1. Objective

This organisation strategy for the cooperation between Denmark and The Global Fund to Fight

AIDS, Tuberculosis (TB) and Malaria (the Fund) forms the basis for the Danish contributions to the

Fund,

and it is the central platform for Denmark’s dialogue and partnership with the

organisation.

This version 2.0 follows the first Danish Organisation Strategy for the Fund and will to a large ex-

tend continue the strategic direction set therein. It determines the Danish priorities for the Fund’s

performance within the overall framework established by the Fund’s Strategy 2017-2022 (“Invest-

ing to End Epidemics”) and is aligned with its timeline. In addition, the organisation strategy out-

lines specific results that Denmark will pursue in its continued cooperation with the organisation.

Denmark will work closely with like-minded countries, and especially its Board constituency (Point

Seven) towards the achievements of results.

2. The Organisation

2.1 Basic Data and Management Structure

The Fund is the largest global public-private partnership dedicated to attracting and disbursing

resources for the fight against AIDS, TB and malaria. It was established at the initiative of then UN

Secretary-General Kofi Annan, as an international financing institution

–

outside the UN system, as

this was seen as increasing the potential of the Fund to

Established

2002

attract private funding.

Geneva

The Fund is governed by a

Board

including 20 voting

members with equal representation of implementers and

donors, which includes representatives of donor and

recipient governments, non-governmental organizations,

the private sector (including businesses and founda-

tions) and affected communities. Furthermore, the

Board has eight non-voting members, including the

Board leadership and representatives of key internation-

al development partners. Among these are, the WHO,

UNAIDS and the World Bank as well as a number of

public-private partnerships such as Roll Back Malaria,

Stop TB, and UNITAID. The Board meets at least twice

annually.

Executive director

Replenishment

2017-19

Division of funding

for the 3 diseases

Human Resources

(Geneva)

Country portfolio

Mark Dybul (until

May 2017)

USD 12.9 billion

50% for HIV, 32% for

malaria and 18% for

More than 700

417 active grants in

more than 100 coun-

tries

Board member:

April 2015-May 2017

Denmark member

of Board

Denmark has been a Board member from April 2015 to June 2017 representing Point Seven (Swe-

den, Norway, Netherlands, Ireland, Luxembourg and Denmark). The constituency is an important

channel for Danish contributions/influence to the current discussions at Board level. Norway serves

as alternate Board member and takes over the Board position in June 2017 with the Netherlands

as their alternate. The constituency members develop joint positions and to ensure an efficient

division of labour the individual members take the lead on different issues.

The day-to-day operations of the Fund, including resource mobilization, overseeing grant imple-

mentation and providing support to the Board are undertaken by the

Secretariat.

It is based in

Geneva and has no country offices. The Secretariat is complemented by the independent

Office of

the Inspector General (OIG),

which reports directly to the Board through its Audit and Ethics

Committee.

Grant proposals are reviewed by

The Technical Review Panel (TRP),

an independent and im-

partial panel of international experts in health and development, functioning as an advisory body.

TRP ensures inter alia that proposed interventions reflect latest scientific evidence, the newest

developments/technologies for the three diseases, up-to-date guidelines, and best practices.

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

Based on TRP’s

recommendations,

the

Grant Approvals Committee (GAC),

a committee of sen-

ior management, reviews final grant proposals before recommending them to the Board for ap-

proval.

The Technical Evaluation Review Group (TERG)

is another independent body advising

the Board. The TERG ensures independent evaluations and oversees evaluations performed by the

Secretariat. Furthermore, the TERG advises the Secretariat on methods and best practices of mon-

itoring and evaluation.

Operations in countries supported by the Fund are overseen by national

Country Coordinating

Mechanisms (CCMs).

The CCMs include representatives of all sectors involved in the response to

the diseases, government, multilateral or bilateral agencies, nongovernmental organisations, aca-

demic institutions, faith-based organization, the private sector and

–

especially

–

people living with

the diseases. The CCMs aim to ensure meaningful engagement of people living with or affected by

the three diseases as well as key and vulnerable populations

. The CCMs develop financing appli-

cations

–

funding requests. The CCMs also engage in periodic reviews of programmes financed by

the Fund and nominate the so-called Principal Recipients. It is important to reflect that the Fund

has no decision-making power over the CCMs which are national mechanisms established at coun-

try-level to facilitate country ownership.

Principal Recipients (PRs)

receive Global Fund financing directly, and then uses it to implement

prevention, care and treatment programmes or passes it on to other organizations (sub-recipients)

who provide those services. Many PRs both implement and make sub-grants. There can be multi-

ple PRs in one country. The PR also makes regular requests for annual disbursements from the

Fund based on demonstrated progress towards the intended results.

The Fund contracts

Local Fund Agents

(LFA) to provide independent, professional advice and

information relating to grants and recipients in the country. The LFA assesses PR capacity and

grant performance and plays a leading role in identifying risks, including risk of fraud. In the ab-

sence of country offices

they are often described as the “eyes and ears” of the

Fund. In some

high-risk countries, LFAs can be supported by

Fiscal Agents

as an additional control measure.

Countries use Global Fund financing to implement programmes based on their own needs

–

devel-

oped with input also from non-government partners in the country

–

and are responsible for the

results and impact achieved. Funding requests should be based on national strategies, involving

key population and civil society partners as well as government. Each country tailors its response

to the political, cultural and epidemiological context. Involvement of various partners is consistent

throughout the Fund, from the governing Board and its committees to the CCMs and implementers

on the ground.

2.2 Mandate and Mission

The Fund follows the key principles of; Country ownership; Performance-based funding; and

Transparency. It has a unique governance structure, operating as a partnership between govern-

ments, civil society, the private sector, foundations, donors, technical partners and affected com-

munities. The Funds vision is to achieve a world free from the burden of the three diseases, and

the strategy is to invest for impact. The mission of the Fund is to

“attract, leverage and invest

additional resources to end the epidemics of HIV, TB and malaria and to support attainment of the

Sustainable Development Goals”.

The Fund’s Strategy encompasses four strategic objectives;

Maximize impact against HIV, TB and malaria; Build Resilient and Sustainable Systems for Health;

Promote and Protect Human Rights and Gender Equality; and Mobilize Increased Resources.

Key population groups include but are not limited to men who have sex with men, transgender persons, peo-

ple who inject drugs, sex workers, and people living with HIV. Vulnerable populations refer to those who have

increased vulnerabilities in certain context, e.g. young women, adolescents and girls

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

2.3 Results so far

The Fund has contributed to

impressive results

in the fight against the three diseases. Approxi-

mately, 10 million people are now on antiretroviral AIDS treatment under programs funded by the

Fund. In the period 2002-2015 16.6 million people have received treatment for TB and 713 million

insecticide-treated bed nets have been distributed in countries receiving support from the Fund

The cumulative signed funding by disease from 2002 till now amounts to USD (in round figures)

19.5 billion for HIV/AIDS, 11 billion for malaria and 6 billion for TB. No other organisation working

in international health development can match these figures. Overall country allocations are based

on the specific disease burden and the economic capacity of a country. LICs with a high disease

burden receive comparatively higher grants. Around 80% of total funding goes to Sub-Saharan

Africa.

Furthermore, the Fund has made its investments more effective by optimising procurement of

drugs through pooled procurement, which ensures both increased value for money and more rapid

delivery. With its co-financing policy the Fund also catalyses increased domestic finance for sus-

tainability of health programs and gains made against the three diseases. Countries supported by

the Fund have so far increased their domestic financing commitments by USD 6 billion for 2015-

2017 compared to 2012-2014. This has in part been spurred by the Fund’s co-financing policy that

calls for additional domestic investments in programs. Over the next three years, the Fund expects

to catalyse USD 35 billion in domestic resources for health.

In 2015, there were 2.1 million new HIV infections globally, showing a 38% decline in the number

of new infections from 3.4 million in 2001. At the same time the number of AIDS related deaths is

also declining with 1.1 million AIDS related deaths in 2015, down from 2.3 million in 2005. Global-

ly, an estimated 36.7 million people were living with HIV in 2015. This represents an increase from

previous years as more people are receiving the life-saving antiretroviral therapy. In 2016, a rec-

ord high of 18.2 million people in low- and middle-income countries received antiretroviral therapy

as a result of both international and national investments.

TB incidence rates (number of new cases) are declining in most countries receiving funding, and

mortality rates have fallen by 31% between 2000 and 2015. Globally, TB has fallen by an average

of 1.5% per year since 2000 with a cumulative reduction of 18% until 2014.

Malaria incidence and mortality is declining in most countries receiving support from the Fund,

contributing to reductions in overall child mortality. The target set in 2005 by WHA of a 75% de-

cline in incidence rate and mortality rate has been met in many the countries receiving funds, and

between 2000 and 2015 there has been a 58% decline in mortality from malaria globally.

Despite impressive results,

challenges

remain. The three diseases continue to claim many lives

and healthy life years. More needs to be done before the SDG 3 target of ending the three epi-

demics by 2030 can be reached.

More than 3.2 billion people remain at risk of malaria and every

second minute one child under five dies from the disease. In addition, some malaria parasites are

becoming immune to existing drugs making treatments more expensive or less effective. Poor

health information systems make monitoring of outbreaks challenging and preventive efforts more

difficult.

The decline in HIV incidence and mortality has been disproportionally distributed. In a number of

countries the HIV/AIDS epidemic is not yet under control and continues to be a challenge for the

international control efforts. This is especially the case in Africa, where the social and economic

consequences of HIV/AIDS remain considerable. Women and girls are more vulnerable to HIV in-

fection than men, mainly because of social, economic, legal and cultural factors such as en-

Based

on data from the first half of 2016.

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

trenched gender roles, unbalanced power relations, and violence against women, including sexual

coercion. Globally, women account for 51% of all people living with HIV, and in sub-Saharan Africa

young women between 15-24 years of age account for 66% of newly infected among young peo-

ple. Alarmingly, young people remain particularly vulnerable to HIV and much more needs to be

done to provide adolescents with comprehensive sexuality education and access to relevant ser-

vices.

The HIV/AIDS epidemic, and to some extent the epidemic of TB, which is being fed by HIV/AIDS,

is disproportionately hitting key populations. Female sex workers are estimated to be 14 times

more likely to be living with HIV than other women of reproductive age in low and middle-income

countries. The prevalence of HIV among men who have sex with men is 19 times higher than

among the general population. The HIV prevalence among people who inject drugs is estimated to

be around 28 times higher than in the population as a whole. Despite the need to give priority to

services for key populations, efforts to address the HIV-related needs of key populations remain

severely underfunded. The high prevalence among key populations represents a pool of infection

that spreads into the general population. Human Rights violations and discrimination of key popu-

lations in many countries hinders an effective response.

Moreover, Multi-Drug Resistant TB (MDR-TB) is a serious problem on the rise.

MDR-TB is far more

costly, time consuming and complicated to treat than non-resistant TB. There are more side-

effects and the infection is often more lethal. According to the Fund, in 2015 there were approxi-

mately 580,000 cases of MDR-TB and nearly half of those people died.

2.4 Effectiveness of the Organisation

During the initial years, the Fund concentrated on channelling funds to what was seen as a global

health emergency. Throughout the evolution of the Fund’s

business

model, more focus and efforts

have been put towards

increased efficiency of its investment,

focusing on countries with the

highest disease burden and lowest economic capacity as well as areas of concentrated epidemics

in key and vulnerable populations. The Fund has further deepened its approach to contribute to

Health System Strengthening.

In an effort to maximize its investment, and increased its

value for money,

the Fund is also

working to leverage its significant spending on commodities. The Fund’s

market-shaping

strategy

supports health outcomes and access to products by leveraging the

Fund’s

spending to facilitate

healthier global markets for health products. It does this by shaping markets to support innova-

tion, sustainability, quality, affordability and availability. The procurement of commodities current-

ly accounts for about 40% of grant expenditures. By 2016 the Fund had achieved three year sav-

ing worth more than USD 600 million through a more effective pooled procurement mechanism

(PPM) and by working with partners such as the United Nations Children’s Fund (UNICEF), the US

President’s Malaria Initiative and the UK’s Department for International Development (DFID) to

harmonize global forecasts and align strategies.

The Fund has recently been subject to an assessment by the

Multilateral Organisation Perfor-

mance Network (MOPAN).

The 2015-2016 MOPAN assessment of the Fund reflects the organi-

sation’s achievements related to results, practices, behaviours, and the organisational system it-

self. Overall the assessment concludes that the Fund provides strong global leadership and com-

pletely meets the requirements, rating the Fund with high scores on selected indicators.

MOPAN has also identified some areas of improvement, including the integration of disease specific

approaches in the overall efforts to strengthen systems for health, and of cross-cutting issues into

programmes, such as key populations, human rights and gender equality. Significant improve-

ments have been made in the analysis of these issues but challenges remain in terms of imple-

mentation across funding and programming. According to the assessment, although the Fund has

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

increased its efforts to align to national policies and cycles, there is a lack of efforts to align with

other developing partners. Respondents of the assessment emphasised that the sharing of infor-

mation by the CCMs was unsatisfactory.

In terms of key strengths of the Fund, MOPAN highlights the clear strategic direction, the organi-

sational restructuring, and the improved risk and human resources management as well as result-

based budgeting. Further, MOPAN positively notes the vibrant and effective partnerships, the

commitment to practical implementation of result-based management, and the work towards gain-

ing data of high quality

In addition,

DFID updated a Multilateral Development Review

in December 2016 evaluating

the overall success of the Fund. Together with World Bank and GAVI, the Fund achieves the high-

est score “very good” in organisational strength out of a total of 38 assessed agencies. The report

highlights that the Fund is especially capable of providing economies of scale, which is described

as a key benefit. Moreover, the Fund is also acknowledged for its ability to mobilise resources from

diverse sources

The

Mid-term review of the Danish Organisation Strategy 2014-2016

of April 2016 con-

cluded that the Fund continues to be an important partner for Denmark in the efforts against

AIDS, TB and Malaria as well as in global health, and has achieved great results during its lifetime.

Overall the Fund is doing well and has improved its governance and allocation methodology re-

markably during the past couple of years. The review recommends that Denmark continue to work

with the Fund to maintain focus on; poverty reduction; Human Rights, young women and adoles-

cents; and a more comprehensive approach to strengthening systems for health, as well as a con-

tinued improvement of the Funds monitoring framework to measure the overall impact of the

Fund.

Globally, there is growing recognition of the evidence showing that human rights approaches in-

crease the effectiveness, efficiency and sustainability of HIV/AIDS, TB and malaria programming.

Yet in many countries, poor and inequitable targeting of interventions, discriminatory social and

legal requirements, unsupportive policy settings, and sometimes severe and persistent human

rights violations continue to undermine programmes and reduce impact. There has been a broad

consensus that the Fund should do more to explicitly promote human rights-based approaches.

Thus, the Fund’s

commitment to invest

in programmes that address human rights barriers has

been strengthened in the 2017-2022 strategy. Moreover, the Fund recognises gender inequalities

as a strong driver of the HIV/AIDS, TB and malaria epidemics and therefore commits to ensuring

that its grants support equal access to prevention, treatment, care and support.

As mentioned previously, the CCMs should comprise representatives of people living with HIV and

of people affected by TB or malaria. There is room for improvement on this issue, and the Fund

now requires all CCMs to show evidence that the requirement is being followed. It is also a re-

quirement that key populations are engaged in the development of funding applications; the Fund

requires that this is documented in the funding applications. Nonetheless, stronger efforts from

partners and governments with the support of the Fund are required to ensure that CCMs are ef-

fective, inclusive and transparent.

3. Key Strategic Challenges and Opportunities

3.1 Relevance and Justification of Future Danish Support

http://www.mopanonline.org/assessments/globalfund2015-16/index.htm

https://www.gov.uk/government/publications/raising-the-standard-the-multilateral-development-review-

2016

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

The Fund continues to be an important stakeholder for Denmark in the fight against the three dis-

eases. Support to the Fund is directly in line with the strategy

“The

World 2030,

Denmark’s strate-

gy for development

policy and humanitarian action”,

and its aim to place Denmark at the forefront

of international efforts to promote sexual and reproductive health and rights, including the fight

against HIV/AIDS.

The strategy underlines that Denmark’s overriding aim in international devel-

opment cooperation is to

fight poverty, enhance sustainable growth and development, economic

freedom, peace, stability, equality and rules-based international order.

According to the World 2030, Denmark will apply human rights as a core value in partnerships and

use principles of non-discrimination, participation, transparency and accountability in all phases of

development cooperation. These priorities are reflected in the Fund’s own strategy, including ef-

forts to promote and protect human rights and gender equality, and reduce human rights barriers

to services and increase programing for key populations. Furthermore, the Fund’s

interaction with

civil society at country level and civil society involvement at Board level

concurs with Denmark’s

human rights-based approach to development.

Denmark remains committed to the SDGs, and the Fund is one of the biggest multilateral funders

of the health-related SDG 3

“Ensure healthy lives and promote wellbeing for all at all ages”.

particular, it is a key organisation in the efforts to achieve the sub-target 3.3 to end the AIDS, TB

and malaria epidemics by 2030. According to predictions for the three diseases there is risk of

resurgence of the epidemics and loss of the results obtained if strong investments to scale up ef-

forts are not made in the next four to five years.

The Fund’s

work

is also expected to have a notable impact on SDG 3.8 (universal health-

coverage), SDG 3.1 (on maternal mortality) and SDG 3.2 (on child mortality); malaria is especially

dangerous for small children and pregnant women, and vertical transmission

of HIV still accounts

for a large share of new infections.

Multilateral organisations often have an advantage over bilateral development organisations in

fragile states where Denmark does not have a permanent presence. The Fund is increasingly fo-

cusing on fragile countries and situations and has developed a new policy for challenging operating

environments (COEs).

In line with SDG 17 the Fund is also working to ensure the sustainability of its programmes. The

Fund has developed a policy for Sustainability, Transition and Co-financing, which aims to ensure

that programmes are co-financed by national governments, that projects are planned and imple-

mented in a sustainable manner so that countries are prepared when they transition from receiv-

ing financing from the Fund. The Fund implements counterpart financing policies to support coun-

tries to increase domestic funding for the three diseases and the health sector

The

Fund’s

strategy reflects the criticism raised by Denmark and by recipient countries, civil socie-

ty as well as governments, that the organisation must provide more flexible funding opportunities,

be more attentive to the needs of countries, be more predictable in its funding, use national strat-

egies and national systems, be more transparent and efficient, and integrate human rights consid-

erations in the whole funding cycle. The organisation has heeded the criticism and undertaken

major initiatives to change policies, strategies and organisational set-up. The updated allocation

model now assures more stable, predictable and aligned funding based on indicative funding

frames at national level, linked to country specific circumstances, including the scope of the dis-

ease burden. Moreover, the funding has been made more flexible to allow for better alignment

with national budgeting cycles and country-specific demands.

mother-to-child transmission

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

3. 2 Major Challenges and Risks

Most risks of the Fund remain the same as in the previous strategy, although some risks such as

the shrinking donor contribution until now have proven smaller than initially expected.

Risk no. 1. Maintaining the high level of funding

As for any specialised organisation, changing international priorities and a declining trend in ODA

and especially in health ODA are continued risks for the Fund. With the direct inclusion of

HIV/AIDS, TB, malaria in the SDGs the Fund has a continued mandate directly related to the

broader development priorities. However, the broader scope of the new goal (and targets) will

make it even more obvious that horizontal, integrated health services are key to achieving results,

and the Fund will have to do even more on health systems strengthening.

Both as a consequence of changes in international priorities and following the global financial cri-

ses shrinking donor contributions continue to be a risk for the Fund. However, the Fund has taken

a smaller “hit” compared to many other organisations in recent years

and the impressive result of

USD 12.9 billion pledged at the Funds 5th replenishment in December 2016 underlines this. The

United States provides around 1/3 of the total support for the Fund, and early indications are that

the level for 2017-2019 will be maintained as pledged in Montreal in September 2016. With UK

and France both providing around 1/10 of the total support, the Fund continues to have a fairly

high dependence on a few donors.

At the same time, the number of global health partnerships and international health initiatives

keeps growing, thereby increasing the demands for funding. It is therefore uncertain whether the

current level of contributions can be sustained. A reduced turnover may not be a risk for the Fund

as an organisation if the Fund is able to prioritise and gradually reduce commitments in a predict-

able way, but the pressure on the organisation to make the structures leaner and adapt to less

generous funding will grow.

Risk no. 2. Programmatic impact and systems strengthening

The disease specific focus of the organisation risks distorting national priorities in developing coun-

tries with weak administrative systems. The Fund is increasingly focusing on strengthening health

systems and the flexibility that allows countries to improve the integration of the efforts and work

across diseases, but the risk of distortion of priorities persists in organisations with a strong dis-

ease specific focus. This alongside the structure of the Fund, with no country presence, constitutes

inherent challenges. The CCMs, which are intended to be integrated into and work in close collabo-

ration the national health systems sometimes creates semi-parallel systems. In addition the coor-

dination and dialogue with other development partners on the ground is at times limited.

The Global Fund recognises that strong health systems which integrate robust community re-

sponses are needed to end HIV, TB and malaria as threats to public health. Resilient and sustaina-

ble systems for health (RSSH) are a core pillar of the Global Fund Strategy. The

Global Fund’s

RSSH investments contribute to addressing system-wide constrains that not only affect the three

diseases but other health programs as well. Moreover, the investments help strengthen the level

of integration of national HIV, TB and malaria programs into national systems for health.

Risk no. 3. Misuse of funds and maturity of risk systems

It is acknowledged that channelling huge amounts of funds to health interventions in some of the

world’s poorest countries carries risks

of misuse of funds, both in terms of technical effectiveness

and financial management. The significant amount of investments spent on commodities adds to

this risk. Misuse of funds became a problem for the Fund in 2011 due to heavy media exposure of

some specific cases. This initiated an intensive investigation and the set-up of the High Level Re-

view Panel which has led to the creation of a new Funding Model as well as creation of specific unit

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

focusing on risk, led by a Chief Risk Officer. Moreover, the Office of the Inspector General (OIG)

thoroughly investigates and audits any inappropriate use of grants.

The Fund has introduced a risk management system that looks systematically at four risk areas;

programmatic and performance risks; financial and fiduciary risks; health services and product

risks; and governance, oversight and management risks. This system aims to allow for a compre-

hensive overview of the risk associated with the different grants and tailored mitigating measures.

In 2013 the OIG assessed that internal control, governance and risk management processes where

only utilised on an ad hoc basis. Today the OIG considers the Fund to have matured and it has

already achieved an “initiated” level and is moving towards an “embedded”

level in its organisation

maturity rate.

4. Priority Results of Danish Support

The priority results chosen for this strategy are aligned with

“The World 2030”.

Denmark will continue to work towards ensuring focus on the poorest countries with the highest

disease burden, which is also central to the Fund’s allocation model. Funding to middle income

countries should be limited and targeted key or vulnerable populations and should furthermore

also normally depend on financial contributions from local counterparts.

The priority results areas of the Danish organisation strategy are based on the Funds own monitor-

ing framework and targets are chosen from the

Fund’s

Key Performance Indicators (KPI)

adopted

for the 2017-2022 strategy. Denmark will concentrate efforts with the Fund in the following focus

areas which

provide the best fit with Denmark’s strategic priorities:

A. Ensuring that the Fund maintains and strengthens its focus on human rights, includ-

ing equity and gender equality

Despite the need to address the disproportionate distribution of especially HIV, targeting of key

populations generally remains underfunded and politically highly challenging in some countries.

Thus, inequitable targeting of efforts, discriminatory social and legal restrictions as well as other

human rights violations continues to obstruct progress and undermine programmes.

“The World

2030”,

emphasises that human rights are the basis for partnerships in development. This concurs

with the strategic plan of the Fund as expressed in its Strategic objective 3:

Promote and protect

human rights & gender equality,

and includes promoting efforts to overcome behavioural and

structural barriers, i.e. addressing Sexual and Reproductive Health and Rights and gender ine-

quality.

A human rights based approach implies ensuring that all legal and social barriers to reaching key

populations are identified and reduced if not removed. This pertains most specifically to the re-

sponse to HIV/AIDS. The Fund is working actively to address gender inequality, among other initi-

atives through a commitment to ensure that its grants support equal access to prevention, treat-

ment, care and support. Moreover the Fund has launched intensified efforts to remove human

rights barriers, especially for key populations and vulnerable groups in a sub-set of countries to

build on lessons learned as well as building new experience in the field. In the Fund’s strategy

indicators have been defined for both gender and age equality and human rights barriers (GF KPI

8 and GF KPI 9, cf. Annex 2) that enables follow-up on these engagements.

Denmark will work to ensure that the Fund maintains a continued, evidence-based, specific and

comprehensive disease response that is inclusive of marginalised populations and addresses all

barriers to access, including through coordination with technical partners such as UNAIDS. Special

attention will be given to countries, primarily in Sub-Saharan Africa, where women and girls are

particularly at risk of HIV-infection. Empowerment of young girls and adolescents, including

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

through initiatives to avoid girls dropping out of school, though access to comprehensive sexuality

education and to services, will be a key factor in reducing prevalence in these countries.

Denmark will follow the Fund’s

efforts in

reaching its strategic objective 3 and in particular GF KPI

Gender & age equality

(Percentage reduction in HIV incidence in women aged 15-24) and 9

Reduce human rights barriers to services

(Number of priority countries with comprehensive pro-

grammes aimed at reducing human rights barriers to services in operation) (see annex 1).

B. Maximising the Fund’s Impact on Strengthening Health Systems

Rights, including Sexual and Reproductive Health and Rights, have little meaning if the national

health systems are unable to deliver services. Building resilient and sustainable systems for health

is central in the Fund’s

strategy

with one out of four strategic targets being dedicated to this; Stra-

tegic objective 2

Build Resilient and Sustainable Systems for Health.

The underlying indicator (GF

KPI 6) intends to measure various aspects of health systems such as procurement; supply chain;

financial management; Health Information Management Systems (HMIS) coverage; disaggregated

results; and alignment with National Strategic Plans. Denmark considers Health Systems

Strengthening the best way to improve health for the poor in a sustainable way, and will support

the Fund’s

efforts in this area.

Alignment with national strategic plans and planning processes still proves challenging in some

countries. Work in this area is moving in the right direction and the Fund is working towards better

alignment as well as more flexible and diversified approaches to be able to adjust to different con-

texts and level of development. Thus, work has gone into the adjustment and improvement of the

Fund’s allocation methodology to ensure the most efficient investments possible.

Going forward, Denmark will support a continued and strengthened prioritisation on Health Sys-

tems Strengthening to avoid that a too vertical approach creates inefficiency and disintegration of

efforts.

Denmark will follow the Fund’s

efforts in

reaching its strategic objective 2 and in particular GF KPI

b) Supply chain

(i. Percentage of health facilities with tracer medicines available on the day of

the visit; ii. Percentage of health facilities providing diagnostic services with tracer items on the

day of the visit) as well as and

f) Alignment with National Strategic Plans

(see annex 1).

C. Continued institutional Reform and strengthened Risk Management

The Fund has continued to improve its governance and organisational efficiency. During the initial

reform process, the Fund addressed risk management; resource allocation; investments and eval-

uations; as well as organisation of the secretariat. Although the Fund has made immense progress

in the reform of its governance, including grant management and the allocation of funds, some

areas are still being improved to increase the efficiency of

the Fund’s

investments.

The Fund takes seriously any misuse of funding and has zero tolerance for corruption and misuse

of funding. All cases are referred to the OIG which is also undertaking regular audits. If any mis-

spent funds are identified, the Global Fund pursues recoveries, so that no donor money is lost to

fraud or ineligible expenses. Additionally, action is taken to address underlying weaknesses so that

countries can prevent future risks.

The OIG

has also launch some awareness campaign including “I Speak Out Now!” launched in

December 2015 to encourage staff and grant implementers to denounce any kind of violations

under the following categories; coercion, collusion, corruption, fraud, human rights violations and

product issues. The Fund has also put in place the whistle-blowing mechanism which is a confiden-

tial reporting system, allowing them to intervene earlier and thereby increase the quality of its

response.

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

The Risk Department, the second line of defence, acts as a bridge between the OIG and the Secre-

tariat. Working closely with the different teams it lends rigor to the risk identification, prioritization

and mitigating measures across key priority portfolios. The department also led the development

of an enterprise risk register with 29 priority risks spanning across the GF strategy, addressing

them are critical to achieving the GF mission of impact against the three diseases.

To fight against corruption, a wide range of measures prevails to mitigate the risk including the

appointment of external procurement advisors; procedures to avoid conflict of interest; increased

oversight by the Fund; investigation of the possibility of sanctioning enterprises on basis of the

Fund’s code of conduct; the introduction of new risk mitigation plans; and steps to ensure due

diligence of all collaborating partners and enterprises.

Risk management including determining the right level of risk appetite will remain a critical sub-

ject, not least due to the large investments in countries with challenging operating environments

(COEs). Denmark will follow developments in the risk index as well as the further development

and use of this system.

From a Danish perspective, the Fund should also continue efforts to improve governance and to be

innovative. The Fund needs to continue its evolvement and adjustment to a changed reality with

new challenges. As an example is the Board, which is working in two blocks that underline a divide

between implementers and donors that no longer reflects reality and the aspiration of the shared

responsibility agenda. Moreover, there are on-going discussions in the Fund on how to accommo-

date potential new bilateral donors that may not be likeminded with the existing constituencies.

Failure to address this may constitute a risk for the Fund in and inhibit the attraction of new do-

nors.

Denmark will follow the Fund’s

efforts in continued

institutional reform and strengthened risk

management through the Annual OIG report, and more precisely the progress in Key Components

of Risk Management Architecture. There is currently no dedicated indicator (KPI) on risk manage-

ment in the Funds monitoring framework. The previous (2014-2016) GF KPI related to risk (The

Portfolio Risk Index) has now been discontinued due to its significant flaws and unreliability, an

alternative has not yet been developed.

5. Preliminary budget overview

The Fund receives the vast majority of total funding from public donors as core contribution, with

USA, France and United Kingdom being the largest contributors (calculated on a total paid to date

basis). The Fund only accepts un-earmarked contribution from public donors. During its 5

replen-

ishment, and as was the case in previous replenishments, national governments pledged most of

the funds; donations from the private sector constitute around 6.4% of the total (4.6% from the

Gates Foundation, 1.8% from private companies).

Table 1

Indicative budget for Denmark’s engagement with

the Fund

Contributions in DKK millions

Core funds

Earmarked funds

Totals

150

2017

2018

150

2019

150

The numbers for 2017-2019 are preliminary and subject to parliamentary approval

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

In 2016, the Danish contribution to the Fund was DKK 50 million. End 2015

Denmark’s

cumulative

contribution to the Fund ranked as no. 14. The Point Seven-countries together constitutes the

fourth largest donor constituency (after US, UK and France). Decision on the Danish contributions

beyond 2019 is expected to be taken before the sixth replenishment conference.

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

Annex 1. Summary Results Matrix:

The matrix below shows the chosen Danish priority results (cf. chapter 4) and the related set of

indicators and targets from the Funds Key Performance Indicator (KPI) framework.

Danish Priority Result area A: Ensuring that the Fund maintain and strengthen its focus

on human rights, including equity and gender equality

GF Strategic objective 3: Promote and protect human rights & gender equality

GF Key Per-

formance

Indicator

Measure

Target

Comments

GF KPI 8:

Gender & age

equality

Percentage reduc-

tion in HIV inci-

dence in women

aged 15-24

58% (47-64%)

over the 2015-

2022 period

HIV infection rates among young women

are twice as high as among young men in

some regions in sub-Saharan Africa. The

indicator will track the extent to which an

enhanced programmatic focus on women

and adolescent girls results in a reduction

in new infections in selected countries

with large disparities in incident infec-

tions.

This objective is closely linked to other

strategic objectives focused on scale-up

of programmes supporting women and

girls; advancing sexual and reproductive

health and

rights; support to women’s,

children’s, and adolescent

health; and

removing barriers to access.

With a focus on 15-20 priority countries

this indicator will measure the extent to

which comprehensive programmes to

reduce human rights-related barriers to

access are established.

The programmes will be designed around

the “7 key interventions

to reduce stigma

and discrimination and increase access to

justice” of UNAIDS.

Where available, established WHO indica-

tors for assessing enabling environments

will be used to track progress in opera-

tionalizing the interventions.

The aim is that these programmes will

contribute to a meaningful reduction in

human rights barriers to services and

that increased access will lead to in-

creased impact. This will be measured

through in-depth evaluations as baseline

in 2017, at mid-term in 2019 and at the

end of the strategy period in 2022.

Note that while 8 countries are the target

for comprehensive programmes, all 20

countries will have active work.

a) Reduce human

rights barriers to

services

Number of priority

countries with

comprehensive

programmes aimed

at reducing human

rights barriers to

services in opera-

tion

GF KPI 9:

Human rights

4 for HIV & 4

for TB by 2022

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

Danish Priority Result area B. Maximising the Fund Impact on Strengthening Health Sys-

tems

GF Strategic Objective 2: Build Resilient & Sustainable Systems for Health,

aims to im-

prove the performance of strategically important components of national systems for health.

GF Key Per- Measure

Target

Comments

formance

Indicator

Share of the port-

folio that meet

expected stand-

ards for:

The aim is to measure the extent to

which investments in strengthening the

b) Supply chain

different components of health product

management systems contribute to the

i. Percentage of

uninterrupted availability of essential

health facilities

health products at service delivery

points.

with tracer medi-

cines available on

To be set in 2017

the day of the visit

based on baseline This is based on the mean availability

score for 10 -15 tracer items, and

and new Supply

ii. Percentage of

Chain Strategy

aligned with the recommendations of

the health product interagency task

health facilities

force.

providing diagnos-

tic services with

Diagnostic services readiness (i.e. the

tracer items on the

capacity of the health facility to provide

day of the visit

laboratory diagnostic services) is based

on a defined list of tracer lab items.

GF KPI 6:

National health strategies and disease

Strengthen

specific strategic plans will remain cen-

systems for

tral going forward into the Fund’s

health

application for funding process. Indica-

tor proposes to use this process to

monitor and ensure alignment between

funding requests and National Strategic

Plans.

f) Alignment

with National

During the current funding cycle the

Strategic Plans

vast majority of concept notes were

90% over the

rated by the Fund’s

independent Tech-

Percentage of

2017-2019 peri-

nical

funding requests

Review Panel as being well aligned with

rated by the TRP to

national strategic plan priorities. This

be aligned with

indicator will track whether this strong

National Strategic

performance is maintained in the next

Plans

replenishment period.

It was noted by the TRP that the indica-

tor be complemented by a wider set of

management information as part of

thematic reporting to draw out key

issues observed from TRP review of

funding requests

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

iii

Danish Priority Result area C: Continued institutional Reform and Risk Management

No Strategic Objective exists in the Fund Strategy for this priority results area

GF Key Per- Measure

Target

Comments

formance

Indicator

The Secretariat has acknowledged the

limitations related to the current main

metric, the Portfolio Risk Index, and

work is underway to develop it. Like-

wise, whilst the previous Key Perfor-

mance Indicator (2014-2016) related to

risk has now been discontinued due to

its significant flaws and unreliability, an

alternative has not yet been developed.

Until a new and more reliable GF KPI

has been developed, the assessment of

the Fund’s advancement in risk man-

agement and assurance will be based

the Annual OIG report (progress in Key

Components of Risk Management Archi-

tecture).

URU, Alm.del - 2017-18 - Bilag 33: Forlæggelse af organisationsstrategi for Den Globale Fond til bekæmpelse af AIDS, Tuberkulose og Malaria, fra udenrigsministeren

Annex 2. Global Fund Strategy and Key Performance Indicator (KPI)

framework 2017-2022:

Figure 1 Summary of the Fund Strategy 2017-2022: Investing to End Epidemics

Figure 2 Strategic Key Performance Indicator (KPI) Framework for the Fund Strategy 2017-2022: Investing to end epi-

demics.