May 14, 2019
In early May, AVAC joined Zambian civil society organizations (CSOs) in Lusaka for a kick-off meeting to plan the country’s Key Population Investment Fund (KPIF) activities. The lessons learned there are highly relevant to civil society in every country where KPIF will be introduced. This is time sensitive and urgent for all of us who want to see this investment have a meaningful impact.
Two years ago, at the United Nations’ 2016 High-Level Meeting on Ending AIDS, the world came together to plan how to achieve the Fast Track goals aimed at radically reducing AIDS deaths and new infections. A few member states, like Iran, pushed back against the bold new initiatives needed to reach and serve key populations in order to achieve those goals. Civil society raised its voice in the halls and in rain-soaked protests to call for approaches that placed services for and led by key populations at the center of the response. Responding to this call, PEPFAR’s Ambassador Debbi Birx announced a new $100 million investment in the KPIF. This investment, modeled on the DREAMS Innovation Challenge, hit a number of delays in its implementation. Now that it has finally been launched, some of the details about its structure are clearer: these PEPFAR grants will be made through USAID and CDC to implementing partners in each country, who then should be directing resources to local key population (KP)-led organizations.
As our experience in Zambia shows, this investment in actual KP-led organizations that have the trust and faith of the community needs to be tracked and made a non-negotiable in every country. The program’s impact will be measured via the Monitoring, Evaluation, and Reporting Indicators that PEPFAR uses to monitor all partners’ performance. Since these have been largely focused on large service delivery programs – testing, linkage to treatment, PrEP enrollment – it can look like a barrier to eligibility if the local KP-led groups do not provide services. However, direct service delivery is not a requirement for receiving KPIF funds. This is another point to emphasize and track as KPIF rolls out.
What happened in Zambia?
AVAC, MPact, Health GAP and many other international groups have worked alongside African KP organizations to demand that the KPIF money flow to groups that know what needs to be done and have the trust of the community. At AIDS 2018, these groups called upon PEPFAR to create an independent KP advisory group for the fund, and they continued to question the funds structure, timelines and purpose at the PEPFAR Regional Planning Meetings in early 2019.
In May, AVAC joined Zambian KP groups and the CDC for the national KPIF planning process. AVAC and these CSOs met separately the day before the meeting to plan demands and review CDC’s proposed approach for implementation, which had been developed without engaging civil society.
Faced with this information, the CSOs decided it was strategic that they speak in one voice and this led to one of the most inspiring moments of the week. A new and entirely unprecedented consortium of Zambian KP CSOs was formed. The Zambian Key Population Consortium (Zam-KPC) aims to push forward an advocacy agenda focused on human rights and HIV prevention, treatment and care, and preventing discrimination and abuses faced by key populations. For far too long, Zambia’s key populations have been left behind in terms of direct engagement on issues that affect them. With this coalition, Zam-KPC intends to not only have a seat at the table but to monitor and implement programs that target KP communities.
Zambian CSOs came up with their own demands for how the KPIF funds should be invested and how civil society should be engaged moving forward:
- No implementation to begin without an identified KP CSO sub-award partner.
- Work with KP groups to develop sub-awards and build technical capacity of KP CSOs.
- Work with CDC Zambia to support the structural development of the KP Consortium.
- Use available funds from PEPFAR’s Zambia-focused country operational plans (COPs) to build capacity in CSOs so they can provide prevention services including PrEP, distribute HIV self-test kits, and understand PEPFAR’s requirements for monitoring, evaluation and reporting (MER indicators).
CDC and their lead implementation partner, Centre for Infectious Disease Research in Zambia (CIDRZ), agreed to all of these demands, and further committed that this work would happen in the next five months before any sub-grants are made to KP organizations.
The next five months are critical to the Zambian KPIF investment. AVAC will continue to provide support to the Zambia KP Consortium in making sure they are holding themselves, CDC and CIDRZ accountable. We will be actively monitoring the same process in other countries and supporting activists in those countries to get involved.
We all have to pay attention to how these KPIF funds are moving in country. Here are some of our emerging lessons learned:
- Meet with the funding agencies (CDC and USAID) and their KPIF implementing partner (IP) as soon as possible—ask for updates on the IPs plans for geography, KP partners and roles. No decision is set until KPs sign off. Now is the time to engage. If you don’t know who your agency is or what the schedule is, email firstname.lastname@example.org.
- Build a bold, shared agenda. PEPFAR has, in the past, critiqued CSOs for being divided or in competition. Now is the time to work in solidarity—the biggest wins will come from a strong coalition of groups. If there is no KP coalition, you may want to build one; in most countries, KPIF funds can support the work building coalition.
- Consortiums do not have to apply for KPIF funds but member organizations should apply based on needs and strengths. For example, consortiums can work to identify which member is best placed to deliver particular services and decide that they should be the one applying for that portion of the programming.
- Advocacy and activism improve uptake and service delivery. KP groups do not need to be service providers to get these resources, but they do need to understand how the results will be evaluated based on MER indicators.