Despite commitments from governments to “leave no one behind” across all health and development work, funding from donors for HIV and TB responses is decreasing and governments are not living up to their obligations to ensure the right to health of their citizens. The first and hardest hit are people living in middle-income countries (MICs), where donor governments and multilateral funding mechanisms are withdrawing financial support. HIV and TB primarily affect key populations in these countries—sex workers, men who have sex with men (MSM), people who use drugs, the incarcerated, migrants, and poor women and girls. Unless action is taken, millions will suffer and die.
Upper-middle-income countries (UMICs) and other MICs, especially those with low disease burdens but concentrated epidemics among key populations, fare the worst because most donors are shifting financing priorities to lower-income countries severe epidemics. The reasons given typically include the need to direct funds to countries and contexts with the most limited resources and capacity. That rationale sounds reasonable from a theoretical or conceptual level, but makes little logical sense from an epidemiological or practical standpoint. For one, countries are categorized as middle or lower or upper income, or one of various gradations in between, solely on the basis of per capita income. That factor is notoriously imprecise in terms of identifying where the most pressing needs are. MICs remain home to the majority of poor people in the world. Data published in 2012 identified that 80% of the world’s poorest people—those who live on less than $2 per day—are now living in MICs. The burden of the three diseases is concentrated in MICs, which currently are home to about 57% of all people living with HIV, 72% of those living with active TB, and 54% of malaria cases annually. MICs’ share of the world’s people living with HIV is projected to rise to 70% by 2020. About 60% of worldwide cases of multidrug-resistant TB (MDR-TB) are in just four countries, all of which are MICs: India, China, Russia and South Africa. In addition, focusing solely on countries that contribute the most to global disease burden means ignoring epidemiological realities—including countries with concentrated epidemics and/or countries with high national burden but smaller population size.
CSSN Preparatory Consultation
In October 2016, 35 activists and advocates from around the world met in the city of Amsterdam to discuss the need for coordinated advocacy, capacity building and communications efforts to address the funding crisis in middle income countries, in the light of the current rapid withdrawal of international donor funding for the HIV/TB and malaria responses. What followed was the development of an action plan and the birth of a solidarity movement in support to countries and populations that are being most affected. The concept of a Civil Society Sustainability Network (CSSN) was developed with the idea of having a CS-owned group of experts to advocate for and support a medium and long-term sustainability of HIV- and TB-related programming for civil society and key and vulnerable populations.
In order to progress the idea of CSSN forward, between March-June 2017, International Civil Society Support conducted a consultative process that reached out to participants that attended Amsterdam 2016 meeting and other civil society activists. This process asked for more detail feedback in order to determine profile, roles and tasks of the core team of CS advocates that will steer CSSN and ultimately identify ideal candidates for the core team. Furthermore, the consultation also aimed to gain more understanding of the type of communication and coordination platform or central internal communications mechanism that will be needed as part of an effective communications strategy for the CSSN. This strategic framework is a result of these series of consultation processes that ultimately form the identity, role and mandate of CSSN.
Civil Society Sustainability Network: Communicate, Coordinate and Support
CSSN is a global initiative that support communication between stakeholders that play crucial role in the response to HIV and Tuberculosis epidemic. This include:
- Support communication within civil society, including non-governmental organisations, communities and key population organisations/groups
- Initiating and supporting dialogues between donor governments, financing institutions, technical agencies and civil society, communities and key population organisations/groups
- Advocating for transparent, fair and constructive dialogue between financing institutions, donor and implementing countries, and technical partners
- Empower transitioning countries government on policies and issues related to sustainability, transition and investment on disease response
- Communicating alerts and red flags related to country level transition and sustainability to relevant technical and financing agencies such as The Global Fund, PEPFAR, etc
- Collecting, analysing, verifying and disseminating crucial evidence and strategic information related to sustainability and transition
In supporting transition preparedness and increasing quality of transition, CSSN will:
- Advocate and work with relevant technical agencies and financing institutions in developing policies, framework and implementing transition strategies
- Identify specific technical assistance needs and facilitate the provision of technical assistance for civil society, community and key populations
- Develop and support the development of tools related to sustainability and transition
- Foster the development of south-to-south technical assistance between civil society, communities and key population organisations/groups
The CSSN Global Working Group
CSSN operates through the guidance and strategic directions set by the global working group. The global working group held a face to face meeting twice a year and hold quarterly conference calls to discuss variety of issues, opportunities and the work of CSSN