Le Rendez-vous de l’OFM: Webinar on the challenges of global health

Introduction

On September 17, 2024, Aidspan hosted a webinar dedicated to current global health challenges. Part of a series of regular events, the guests were Isabel Hotellart and Sarah Respaut, Partnership Coordinator and Head of the Accélérateur modality at L’Initiative, respectively. This interactive exchange addressed L’Initiative’s strategic priorities in the fight against pandemics, with particular emphasis on reducing gender inequalities, respect for human rights, inclusion, and the central role of community players.

The webinar took place in two parts. First, Isabel Hotellart and Sarah Respaut gave a 30-minute presentation outlining the main thrusts of their work. The second part was devoted to discussion, with plenty of room for questions from participants. This moment of interaction, deliberately prolonged, encouraged a rich and constructive dialogue.

Before offering you a review of this webinar, albeit not an exhaustive one, let’s take a brief look at what L’Initiative is all about.

Launched at the end of 2011, L’Initiative is a complementary mechanism to the Global Fund to Fight AIDS, Tuberculosis and Malaria, implemented by Expertise-France. With a three-year budget of €319 million (2023-2025), representing 20% of France’s contribution to the Global Fund, it targets 40 countries, mainly in West and Central Africa, and focuses on regions with a low Human Development Index.

The aim of L’Initiative is to optimize the effectiveness of Global Fund grants and strengthen the impact of health programs. L’Initiative plays a catalytic role, building the capacity of health actors, improving institutional frameworks and supporting innovative approaches to pandemics.

L’Initiative is governed by a multi-disciplinary Steering Committee chaired by the French Ministry of Europe and Foreign Affairs, and includes representatives from civil society, the French Development Agency, the French Ministry of Health and Prevention, the research community, and permanent guests such as the Global Fund Secretariat.

During the webinar, Isabel Hotellart and Sarah Respaut presented L’Initiative’s three pillars of action: Expertise Channel, Projects Channel and the Accélérateur.

The Expertise Channel

The Expertise Channel is L’Initiative’s technical assistance system, deployed throughout the year. The duration of its missions varies according to needs, with the main objective of supporting those involved in the fight against pandemics. This support aims to facilitate access to and implementation of Global Fund grants, by adopting a capacity-building approach.

During the webinar, it was emphasized that the Expertise Channel is a technical assistance scheme on demand. It was able to mobilize €16.9 million in 2023 to support missions in 37 countries. By way of example, the Expertise Channel provided support for the launch of the seventh funding cycle of the Global Fund (CS7), with a commitment of €12.5 million.

The Expertise Channel offers short- to medium-term technical expertise in three modalities. The first involves technical support for all key stages of the Global Fund’s funding cycle, with a simplified application review process lasting up to six months.

The second modality offers enhanced support to priority countries in the implementation and monitoring of grants, based on strategic planning of their needs, with a maximum duration of three years, re-evaluated annually.

Finally, the Expertise Channel offers ad hoc “on-demand” support for technical needs not covered by the other modalities, for a maximum duration of one year. The main objective of the Expertise Channel is to strengthen the capacities of players involved in the fight against pandemics and the improvement of healthcare systems, by facilitating access to and use of Global Fund grants. Particular attention is paid to local and regional expertise, with the establishment of partnerships between national and international experts, as was the case during the Covid-19 crisis.

The Projects Channel

L’Initiative’s Projects Channel supports medium-term programs aimed at changing healthcare practices and policies. L’Initiative supports the ecosystem of the Global Fund and the fight against pandemics, with a particular focus on local and national players.

3 calls for projects are launched by L’initiative each year through the Projects Channel.  These calls particularly target :

• – Vulnerable populations
• – Strengthening health systems, including community health systems, with a focus on human resources for health
• – Operational research (theme defined each year)

These calls for projects are designed to address priority issues that complement programs supported by the Global Fund. Selected projects are the result of relevant partnerships, bringing together international and/or local organizations.

These collaborations are developed in a way that encourages stakeholders to take ownership of the project, thus fostering lasting commitment.

It was emphasized during the webinar that each project benefits from rigorous monitoring at every stage of its lifecycle, from the planning phase through to closure. This includes regular audits, impact assessments and, where relevant, the capitalization and validation of the results obtained. These processes are carried out in strict compliance with the quality criteria established by L’Initiative, guaranteeing the effectiveness and sustainability of the actions carried out in the field.

How do the calls for projects work?

The proposals financed by L’Initiative are the result of calls for projects, and aim to reinforce the effectiveness of actions against pandemics. These projects contribute to improving public policy and healthcare practices including strengthening of resilient and sustainable systems (RSS) for health .

The Accélérateur

The Accélérateur is a mixed intervention modality that aims to respond to neglected challenges in the fight against the 3 diseases and strengthen human resources in health.

The Accélérateur’s first priority is human resources for health, with the aim of promoting sustainable advances in access to healthcare services and the fight against pandemics, by strengthening both the number and skills of healthcare personnel.

The second priority is to tackle challenges that are often neglected in a limited number of countries, focusing on strengthening community health systems, improving pediatric health, developing tools to combat pandemics, and optimizing health data and its use.

It was emphasized during the webinar that L’Initiative has observed that certain challenges, described as “neglected”, remain without project proposals. These themes are often complex or little addressed, and are essential to strengthening healthcare services and improving the fight against pandemics. It is in this context that the Accélérateur has set up the SOFIA support fund.

The SOFIA program, set up by the Accélérateur, supports the development of mid-sized civil society organizations in the response to pandemics, with customized financial and technical support.

Partnerships with players such as StopTB, Unitaid and UNAIDS for specific projects have also been developed. Among the challenges identified are pediatric HIV (a call for expressions of interest has been launched on integrated child health, covering cross-cutting issues such as malnutrition and mental health), community response and integrated malaria surveillance.

The Accélérateur launched an Emergency Fund for Ukraine shortly after the outbreak of war in the country. To date, five projects worth over €5 million in Ukraine have been launched. As an example, there is a project that has been adapted and targeted at vulnerable and key populations to help them maintain care and health services more generally during the current crisis in Ukraine.

Currently, the Accélérateur plans to invest in human resources for health through six flagship projects in Chad, Rwanda, Madagascar, Togo, Congo and Guinea-Bissau. These initiatives include training in advanced field epidemiology, developed in collaboration with the University of Lomé, ISPED and the University of Bordeaux. Finally, a masterclass on tuberculosis was held in Cameroon in December 2023, to stimulate research in this field. In addition, a training course on climate change and malaria will be held in December 2024 in Rwanda, in partnership with the WHO and the Global Malaria Program, aimed at strengthening integrated disease surveillance.

The Accélérateur‘s Current Projects

Partnerships and Strategy

The guests at the webinar explained that L’Initiative has positioned itself as a key partner of the Global Fund, offering France and its stakeholders a strategic position in the fight against the three major diseases. L’Initiative’s commitments are systematically submitted to the Global Fund Secretariat for approval, guaranteeing close coordination in the implementation of projects and requests for technical assistance. L’Initiative has also added new permanent Observer Members to its Steering Committee, including a representative of the Global Fund Secretariat, African constituencies and Global Fund Board communities, thus reinforcing the inclusiveness of its governance.

Human rights, gender equality and communities

One of the highlights of the webinar was highlighting the importance of gender equality in healthcare projects. Since 2020, L’Initiative has integrated gender indicators into its projects, with 43% of them having the explicit aim of combating gender inequalities. In 2024, these efforts were stepped up, in line with France’s gender equality strategy.

Strategic priorities for France :

• Equality between women and men is a priority for France. Through feminist diplomacy, the Ministry of Europe and Foreign Affairs (MEAE) is taking this commitment to the international stage. France has also drawn up an international strategy on sexual and reproductive health and rights (2023-2027).
• In France’s global health strategy, human rights and gender equality are fundamental guiding principles. The role of communities and civil society players is also central to the strategy. L’Initiative has aligned its strategy with these principles.
• In line with the MEAE’s “human rights and development” strategy, in which France is committed to: (i) ensure that all projects and programs financed do not undermine human rights, and (ii) that these projects and programs, in all sectors, aim to produce a maximum of positive effects for the realization of human rights.

Since 2020, 43% of L’Initiative’s projects have been classified as “CAD1” for gender mainstreaming in operations, meaning that gender equality is an important and deliberate objective. Moreover, in 31% of projects, equality is the main objective, corresponding to “CAD2”, which indicates projects dedicated to gender equality.

To reinforce this dynamic, L’Initiative has drawn up a gender roadmap aimed at integrating the fight against gender inequality into all aspects of its activities. Within the framework of the Expertise Channel, this translates into 4 areas of work corresponding to L’Initiative’s main working methods:

• Mobilize skills by helping to integrate the gender dimension into each expertise assignment (Expertise Channel);
• Support catalytic projects by promoting gender mainstreaming in all projects (Project Channel and the Accélérateur);
• Produce and share knowledge on gender issues;
• Support the influence of French and Francophone players by committing to the promotion and respect of gender equality among its partners.

As far as projects are concerned, gender mainstreaming is now systematic, with the aim of ensuring that every project is classified in CAD 1 or 2.

In terms of human rights and inclusion, several emblematic projects were highlighted, including the UNAIDS project supported by L’Initiative via the Accélérateur to combat stigma and discrimination in Western and Central Africa, with a legislative reform component.

Between 2017 and 2023, L’Initiative supported 37 projects directly targeting LGBTQIA+ communities, part of whose beneficiaries include people from this community, for €43.7 million committed (provision of health services, prevention, screening and treatment issues, the right to health and patient rights, and HIV prevention activities). Further, 41 technical support projects for €2.8 million committed and 34 local NGOs or community-based organizations working with LGBTQIA+ populations benefited from this technical support.

With regard to sexual and reproductive health and rights (SRHR), €8.5M committed in 2024 for Technical Assistance and projects with at least one SRHR component.

With regard to the inclusion of people with disabilities, €2.8 million has been invested in projects and Technical Assistance is being implemented or developed in 2024.

Following a brainstorming session with the Global Fund’s Strategic Initiative of Community, rights and gender (CRG) in June 2024, L’Initiative has strengthened the protection of human rights in its projects and technical assistance missions and now include a security component in certain diagnostics and strategic plans for civil society organizations.

Mapping the challenges facing L’Initiative and prospects for 2025

After taking stock of the actions and projects undertaken by L’Initiative, Isabel Hotellart and Sarah Respaut presented a map of the challenges facing L’Initiative and the outlook for 2025.

Mapping the challenges for L’Initiative

The priorities of the Three Diseases Initiative are:

Malaria:

• Investment and epidemiological urgency;
• Evolution of the pandemic: climate change, ACT resistance, new vectors; and
• Pediatric malaria.

Tuberculosis:

• Pediatric TB;
• Search for missing cases;
• TB resistant;
• Diagnostic capabilities; and
• Malnutrition/TB link.

HIV:

• HIV Pediatrics;
• Delayed coverage among children;
• PMTCT / Triple elimination;
• Key populations; and
• Advanced HIV.

The cross-cutting priorities cited are:

• Health data;
• Resistance monitoring;
• Mobile populations (TB/Palu/HIV);
• Crisis/emergency situations;
• Malnutrition;
• Mental health;
• Pediatrics; and
• Decentralization of services.

Prospects for 2025

With regard to the prospects for 2025, a number of resource replenishments were highlighted, including:

• A need to optimize the use of available resources to maximize program impact. Operational research, technical assistance and the scaling-up of interventions supported by L’Initiative contribute to this objective.
• A need to mobilize alternative resources to finance interventions and players: building advocacy capacities for resource mobilization, costing plans for strategies to combat pandemics, etc.
• The need to guarantee the resilience of healthcare systems: to ensure that interventions to strengthen healthcare systems are long-term, or to support community players who can guarantee the continuity of the response. DATPs, support from the SOFIA Fund and the StopTB partnership, for example, contribute to this objective.

The webinar underlined L’Initiative’s ongoing commitment to fighting the three diseases, improving global health systems and promoting equality and human rights, while highlighting the challenges ahead in global health. The webinar concluded with a series of interactive exchanges between participants and L’Initiative team, reinforcing the collective commitment to tackling global health challenges.