On the final day of the FORO, the Alliance Caribbean Alliance Alliance
Joana Godinho, Senior Health Specialist from the World Bank, presented the mechanisms available to involve civil society in the World Bank’s HIV/AIDS projects. The World Bank takes the position that the HIV epidemic cannot be controlled without the participation and involvement of civil society, and requires governments to disburse at least 50% of the funds received from the World Bank to civil society organisations. However, grants and loans from the World Bank are always provided to the government, who then is responsible for their distribution and the implementation of the project. In cases where funds are not disbursed to civil society, she emphasised the fact that the World Bank can exert only limited pressure on the government. Joana described several challenges the Bank has experienced in working with civil society, including low capacity for implementation, financial management accountability, and in monitoring and evaluation systems, and highlighted the need for extensive capacity building of civil society to enable more effective engagement with the World Bank.
Malcolm McNeil, DfID Senior Health Advisor for the LAC region, outlined DfID’s main approaches to increasing civil society and international financing institutions. He identified lack of political will at the national level as a key obstacle to an effective response to the needs of key populations, as well as the shift in the international arena which has undermined investments and commitments to reproductive health rights. Malcolm emphasised the need for strategic partnerships between donors and civil society that enable open and constructive dialogue that result in strong collaborations. Further, consortia and partnerships between civil society organisations enable the disbursement of funds from donors to intermediate civil society organisations – this limits the administrative resources from donors, and can therefore facilitate increased funding for civil society. Malcolm briefly addressed the importance of DfID’s fast response funding.
Patricia Perez, Regional Coordinator of ICW Latina, highlighted key obstacles that are preventing effective engagement of civil society with the World Bank. Civil society organisations are lacking information, which prevents civil society from entering into dialogue. Patricia questioned how it was possible to meet the needs of key populations without direct dialogue and engagement by the World Bank with those most in need. Political will was needed to overcome this lack of communication and engagement. Further, Patricia highlighted that political requirements by donors were imposed on civil society in detriment of the quality of programmes and comprising the extent to which needs were being met. She called on the World Bank representatives present to take this message back with them, and to create a political forum that would enable this dialogue between the World Bank and civil society. Only in this way are available funds going to be used in ways that best address the needs in the region.
At several occasions, the Alliance Alliance
In conclusion, the World Bank emphasised that the messages from this breakfast would be taken communicated within the institution, and that it hopes to increase the number of similar opportunities for direct dialogue.
Today a very successful and well attended session was held in which the Code of Good Practice was introduced and presentations were heard from two organisations who have been actively working with the Code and who shared their experiences to date. Stephen Lewis introduced the session and briefly introduced the Code, looking at how it came about. Alvaro Bermejo expanded on the history of the Code and said that it had come about following the pressure on donors to contribute to HIV/AIDS work and that more actors were sought in the fight against AIDS. More money was coming from the donors to implement the projects and civil society needed a clear voice. Many organisations working in HIV/AIDS had not necessarily worked in this area before and as donors requested that recipients of funding deliver. Alvaro clarified that the meeting was not to discuss what we should take out or change from the Code but to talk about how we can use it so that the civil society voice can be heard and that all actors are held to account.
Esperanza Delgada from IIPF, Mexfan presented how they had made use of the Code. She described that it was being applied in 17 organisations and that 6-7 of the guiding principles had been used to:
1. Make a general analysis of the organisation
2. look at the different services available
3. look at the level of understanding by medical staff
4. What the actual situation was in terms of stigma and discrimination
5. check the internal policies of the organisations
The Code made clear to Mexfan that it could work together with other HIV networks and to take advantage of their expertise. This led to Mexfan receiving funding to enable them to put together a more integrated plan.
The Code is in its first phase, and they are looking forward to working with Key Populations. Mexfan is very satisfied with the work done so far with the Code.
Jose Maria di Bello, Red Cross, Argentina, also presented their experiences of using the Code. The Red Cross is currently holding the second phase of the Code. He mentioned that often organisation don’t like to be told what to do, but that the Code is very inclusive and summarizes the ideology of most organisations. He added that civil society was a difficult group to work with, but that the Code invites civil society to be united in its diversity.
In introducing Amira Herdoiza from Kimirina in Ecuador, Steve mentioned that the Code had been adapted and used in Ecuador Ecuador
Amira presented what had been done with the Code in Ecuador
- express and uphold the principles of the Code
- strengthen NGO work
- create strong collaborations with the different actors
- give a stronger voice to PLHA
So far, the activities undertaken are:
1. the formal launch of the initiative
2. Active search of new members
3. the creation of steering team including: Kimirina, Care Ecusdor, CEEPVS, Equidad y Famivida
4. Productions of the user-friendly version Code documents
Forthcoming work includes:
1. a national consultation meeting for the role-out. Three big workshops are planned
2. Implement a communication and distribution plan
3. develop capacity plan to strengthen capacity (and reach minimum standards).
4. create a Technical Secretariat for the follow-up and communication
Amira closed by saying that the Code should not be seen as anything additional, but as a tool which can assist organisations to move forward.
Health is not for Commerce
Anton Kerr, Senior Policy Advisor at the Alliance
The panellists gave an overview of key barriers that prevent countries from accessing affordable medicines such as the intellectual property system maintained by the WTO and international trade. The presentations explained how the WTO international trade regulations protect intellectual property for the benefit of pharmaceutical companies. Countries are bound to these regulations, regardless of the product purchased. The mobilisation of civil society and DOHA agreements led to the agreement that public health public health should be the primary consideration, with the protection of intellectual property being of secondary importance. This allows countries to use TRIPS flexibilities in order to prioritise the public health of their population. However, in reality, due to existing free trade and bilateral agreements, countries are not fully able to use TRIPS flexibilities, and in some cases legal action is taken against them by the relevant pharmaceutical companies.
The panel moved on to discuss key questions facing civil society’s role in overcoming barriers to access to essential medicines. These questions included whether access to ARVs should be considered separately from access to essential medicines in general. Participants discussed the two mechanisms available to drive down the prices of drugs: increased and improved use of TRIPS flexibilities or a review of the international intellectual property regime within the WTO. Alternatively, messages of advocacy efforts could push for a focus on mechanisms that drive down prices by focusing on competition.
Anton Kerr showed the important role of civil society in the region for ensuring access to affordable medicines. He provided background on the UNITAID initiative, launched and supported by Brazil Peru France UK Norway UK
Participants of the discussion forum agreed that national, regional and international civil society organisations need to work together to identify the needs for advocacy and to work jointly with those active in issues relating to trade negotiations and general development to maximise the impact. The lack of many countries’ ability to locally produce medicines highlights the need for a regional approach to procurement and trade negotiations related to essential medicines.


