A new report by Open Society Foundations on the Global Fund to fight AIDS, Tuberculosis and Malaria states that “Human rights principles in the Global Fund’s work merit the kind of oversight that the [Global Fund] secretariat brings to such questions as corruption and mismanagement”. The Fund, like most other aid donors, have very strict checks and balances and safeguards to detect and deal with financial irregularities. They take corruption seriously and so they should, since corruption means that money isn’t spent on what it should be, it compounds bad governance, and it seriously undermines the credibility of donor aid programmes. Indeed, the Global Fund itself has recently had funding withheld by a number of donor countries based on reports of financial mismanagement uncovered by the Fund’s own Inspector General.
Important as fighting corruption is, I sometimes can’t help thinking the safeguards are pushed too far. I remember a colleague calling me a few years ago to ask me if I really thought it made sense to go and buy project bananas* from a supermarket at ten times what they cost in the market, for the sole reason that the supermarket could provide a receipt with official VAT registration details. Around the same time a small sex worker association doing peer outreach had their funding suspended because on one of the 30 or so reporting sheets – designed to serve as proof that activities really happened – there was an inconsistency in the way the national ID card number of one of the participants had been written up. It’s bad enough taking down personal information from stigmatised and criminalised people – all the project was doing was giving them condoms and a talk on sexual health – but then interrupting services for reasons like that is really taking things too far. So you’ll understand why I’m a little bit sceptical about the value of some of the financial procedures we put in place in aid projects.
What to make of the recommendation in this new report to pay the same sort of attention to human rights? On the face of it, it is appealing: protecting human rights is surely far more important than protecting financial integrity. I wish people worried more about how effective programmes are and whether programmes are damaging to communities. But there’s a bit of a conceptual problem. Aid programmes are supposed to advance human rights anyway. The Global Fund was set up to help fulfil the right to health of hundreds of millions of people by helping them avoid getting ill and by helping them get access to good quality treatment. Isn’t that enough? Well, no, because advancing human rights is one thing, but protecting them is quite another. Once you get involved in national responses to problems as big as AIDS, TB and malaria you invariably also come up against these protection issues: arbitrary detention of people with TB; sterilisation of people living with HIV; the abject poverty of the people most affected by malaria. And when it comes to HIV there are all sorts of other issues such as the criminalisation of homosexuality, drug use and sex work, which aggravate vulnerability to HIV and which make providing services nearly impossible. It isn’t really possible to have an effective response to HIV in these contexts.
The report focusses on the ways in which the Global Fund might support the promotion of human rights of particularly marginalised and stigmatised groups – for instance by only agreeing to fund “human rights based” programmes or turning down requests to fund programmes which violate human rights; by funding legal support, law reform advocacy campaigns; and by using its good offices and considerable influence to advocate with authorities at the national level. Last year we saw an example of this when the Executive Director of the Fund raised the issue of criminalisation of homosexuality with the President of Malawi.
Like tracking financial management and corruption, monitoring human rights is easier said than done. One approach, discussed in the report and already adopted to an extent by the Global Fund, is to make the application process more sensitive to identifying the relevant issues: for instance by better labelling of human rights related activities for which funding is requested, and by asking applicants to outline how human rights problems which get in the way of programmes will be addressed. I think it is fine to do this but I also think it is a blunt instrument. I’ve reviewed dozens of Global Fund proposals, and I’ve written a few too. Even though the application form is very long and detailed, the level of information that it is possible to convey just isn’t deep enough to identify what we would need to know. The “Human rights” section of the application form is one of hundreds of questions, and doesn’t tend to be top of the list of things countries discuss when putting together their application – and yet they still get funded. There is also a “scale” issue – even if a proposal includes good human rights programming, it is not easy to know whether what has been included is really necessary or sufficient to resolve the problems.
Some of the money that gets given on the basis of these proposals ends up going through several subcontracts and intermediaries, so that there are hundred or thousands of small organisations using the money on the ground: describing what each of these is going to do (and the ways in which they will promote human rights or refrain from violating them) isn’t realistic. Moreover, what a funding proposal says is one thing, and the way the project is implemented is quite another. Refusing outright to fund proposals that contain some problematic components is itself fraught with difficulties since there may be other components that are absolutely fine and which, by themselves, can be considered to “advance” human rights. An example might be a proposal including, on the one hand, antiretroviral treatment for tens of thousands of people living with HIV – treatment they wouldn’t get otherwise – and on the other hand, repressive and coercive strategies for HIV prevention with sex workers. In situations like this surely the best outcome would be for the Global Fund to make clear its “red lines” and to try to convince applicants to rectify the problematic sections in order to be able to continue getting funding. Refusing funding, or interrupting funding for a whole programme has to be less attractive than simply trying to fix the bits that are unacceptable.
Another challenge is that, at country level at least, there isn’t always consensus on what human rights means. The Global Fund itself has progressive policies on issues such as sexual orientation and gender identity, but officials in ministries of health and other AIDS actors – including civil society organisations – can be more inclined to think that homosexuality and sex work are in and of themselves human rights violations, that need to be stopped. Moreover even if they are on the right side of the argument, the ability of ministries of health and other AIDS actors to influence decisions and policies of other ministries is limited.
The Fund requires countries to put in place governance structures (country coordinating mechanisms) that are aimed at ensuring different sectors and marginalised groups are represented. A key aim of this is to ensure country applications to the Fund are accountable to different groups and respectful of human rights; there have certainly been some “success stories”, but for the moment many of those representing marginalised populations are not that well equipped to effectively advocate in a formal meeting attended by government ministers and donors. As a process for assuring human rights protection, it is still rather hit and miss.
The Open Society Foundations report makes the point that, in the same way that financial controls are not considered to be a challenge to national sovereignty, human rights monitoring needn’t be. This underestimates the political sensitivities and controversies around what human rights are. Nonetheless, the Global Fund is entitled to introduce whatever controls it likes, providing its donors let it and providing countries will continue to take its money. This is just as well since, in my opinion, in order to really effectively embrace what is being proposed and to monitor human rights “compliance” it isn’t enough to check that the funding proposals look OK and to demand transparent processes for developing them. There also needs to be some form of in-depth, intensive, on-the-ground monitoring, and a mechanism for credibly identifying and responding to human-rights related challenges as they arise. It’s no small ask.
* What the hell is a project banana, you ask? They were being used as makeshift condom demonstrators.