Human Rights and the Global Fund to Fight AIDS, Tuberculosis and Malaria: How Does a Large Funder of Basic Health Services Meet the Challenge of Rights-Based Programs?
Ralf Jürgens, Joanne Csete, Hyeyoung Lim, Susan Timberlake, and Matthew Smith
Abstract
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to greatly expand access to basic services to address the three diseases in its name. From its beginnings, its governance embodied some human rights principles: civil society is represented on its board, and the country coordination mechanisms that oversee funding requests to the Global Fund include representatives of people affected by the diseases. The Global Fund’s core strategies recognize that the health services it supports would not be effective or cost-effective without efforts to reduce human rights-related barriers to access and utilization of health services, particularly those faced by socially marginalized and criminalized persons. Basic human rights elements were written into Global Fund grant agreements, and various technical support measures encouraged the inclusion in funding requests of programs to reduce human rights-related barriers. A five-year initiative to provide intensive technical and financial support for the scaling up of programs to reduce these barriers in 20 countries is ongoing.
Introduction
The Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter the Global Fund), which began its operations in 2002, emerged during a period in which the nexus between health and human rights had established itself as a distinct area of public health practice and an intellectual discipline. By 2002, the United Nations (UN) entities brought together to form the Joint United Nations Programme on HIV/AIDS (UNAIDS) had a strong commitment to rights-centered approaches to HIV, as seen, for instance, in UNAIDS’s inclusion of nongovernmental organizations (NGOs) in its governance body and its work on discrimination and other human rights abuses related to HIV. As explained below, the Global Fund was born out of the idea that a different kind of institution might be needed to expand financing to HIV programs. As a financial institution without field staff, the Global Fund would operate very differently from a direct service provider or UN agency. But it would operate in accordance with agreed-on norms contained in HIV programs and policies, including the meaningful participation of people living with HIV, the prohibition of discrimination based on HIV status, and the inclusion of often criminalized persons—such as sex workers, people who use drugs, and LGBT persons—in HIV programs. It was also challenged to bring lessons from HIV efforts to bear on programs to address tuberculosis (TB) and malaria.
This article describes the strategies and initiatives undertaken by the Global Fund in its effort to support human rights-based programs to address HIV, TB, and malaria. It suggests that within institutional constraints specific to its foundational values and processes, the Global Fund has found progressively more active ways to assist grantees in designing, implementing, and evaluating rights-centered health programs.