Emerging Issues of HIV, TB, and Malaria Affected Communities and Civil Society In asia-pacific during the COVID-19 Pandemic

The COVID-19 pandemic has tilted the world into an unprecedented situation. With most countries paralysed, its impact has put key and vulnerable populations disproportionately affected not only in terms of accessing the necessary services on HIV, TB, and malaria; it has also exposed populations to further stigma and discrimination, abuse, and inequalities, to name a few. To respond to this, the Global Fund has allocated an immediate funding of up to USD1 billion to help countries fight COVID-19 and to mitigate its impact towards HIV, TB, and malaria programs. However, it is imperative to understand how affected communities and civil society have advocated their governments or have utilised these funding to respond to the pandemic and at the same time reduce its impact in the fight against the three diseases.

APCASO, as the host of the Asia Pacific Community, Rights, and Gender (APCRG) Platform together with the Global Fund Advocates Network Asia-Pacific (GFAN AP) conducted a rapid assessment among CS and KP-led organizational partners in the Asia Pacific region envisaged to provide information for the Global Fund and its partners on the coping and mitigating mechanisms that CS and KP-led organisations have put in place in light of the COVID-19 pandemic and its measures, particularly with regards to engaging in the Global Fund processes at country level. This rapid assessment aims to  (1) assess the impact of COVID-19 related measures to HIV, TB, and malaria community access to treatment and other medical and health-related services and information; and the undertaking of robust and community-inclusive country dialogue processes for the development of new Global Fund funding requests; (2) document the engagements and impact of HIV, TB, and malaria communities and civil society in country-level COVID-19 responses; (3) understand community and civil society uptake of, and any challenges in observing  Global Fund-issued guidelines to mitigating the impact of COVID-19 in the implementation of Global Fund grants; and (4) seek perspectives on necessary further Global Fund COVID-19 related guidance and policy to mitigate negative impacts of the pandemic to HIV, TB, and malaria communities.

From the results of the rapid assessment survey conducted along with an online focus group discussion, it was found that existing HIV, TB, and malaria service delivery has been disrupted by these COVID-19 measures in varying levels. Services that provide prevention and treatment have either closed down or have enabled shorter operating hours since the beginning of the lockdown measures, which many clients find difficult to access. Key and vulnerable populations have experienced varying degrees of difficulty coping with this difficult situation brought about by the pandemic in terms of access to lifesaving services. At the same time, it was also observed that there has been an increase in gender-based violence (GBV) among key population groups, especially among sex workers. Specific vulnerable populations, such as migrant workers, have also experienced increased vulnerability due to their economic loss and impact of travel restrictions, making it difficult for them to access health services in their places of origin.

Results also show that the daily programmatic operations of civil society (CS) and key population (KP)-led organizations have also been severely affected by the COVID-19 pandemic. Some have reprogrammed their activities towards COVID-19 related activity. With the information from the Global Fund with regards to the COVID-19 Response Mechanism and grant flexibilities, CS and KP-led organizations were quick to mobilise and intervene in making sure that their needs and concerns will be addressed through these funds. However, many CCM members and technical working group partners were hesitant to implement these communications without direct instructions from the Global Fund Secretariat, making it difficult for communities to engage meaningfully in the design and utilization of these grant flexibilities. 

With these findings, this report recommends the following:

1.     Global Fund and funding partners to provide specific allocations to support civil society and key populations to augment immediate, medium, and long-term COVID-19 community-led responses. This is particularly applicable in responding to CRG-related issues that have emerged or intensified due to the COVID-19 pandemic. Such funding allocations should be provided on top of COVID-19 flexibilities and C19RM, either through a similar Matching Fund or a clearer guidance coming out of the C19RM Priority 2 support.

2.     CCMs and Global Fund Country Teams to immediately rollout Global Fund Funding Request, grant implementation, and grant flexibilities guidance and policies in coordination with civil society and KP-led organizations.

3.     Technical partners to develop further modelling exercises and situation reports on the regional and country-level impact of COVID-19 across the three diseases and disease responses and propose immediate and long-term recommendations to lessen the impact of the COVID-19 across the three disease responses.

4.     Civil society and KP-led communities to be supported to work closely with CCM, national disease programs, and similar multisectoral bodies such as national coordinating committees or AIDS councils to fast-track the immediate delivery of life-saving HIV, TB, and malaria drugs across levels in the countries and to avoid further infections and deaths due to HIV, TB, and malaria as may have been possibly intensified by the COVID-19 pandemic.

5.     All stakeholders, particularly civil society and KP-led communities to develop risk mitigation measures that would help sustain ongoing work around the health response especially in time of health and other emergencies. This includes support in policy and guidance development around reprogramming and other flexibility measures, establishment of digital platforms of working, and stakeholder partnership that would allow civil society and key population organisations to work in exceptional circumstances, especially when the work involves task-shifting or task-sharing roles with the government. 

6.     With the COVID-19 introducing a new normal in regional health advocacy and response, governments should be encouraged to explore inclusion of COVID-19 as well as possible future pandemics within the UHC framework. This includes strengthening and sustainability of health systems, improving strategic information sharing and data utilization, frontloading budgetary allocations on critical service delivery and vaccine and treatment research and development (R&D), and setting up systematic health emergency response that would involve health and non-health agencies and sectors.