Fragile states

ABSTRACT Côte d’Ivoire is known throughout West Africa as the most tolerant country, where gay, lesbian and transgender people from all backgrounds do not have to fear the same kind of systematic violence or opprobrium that plagues them elsewhere in the region. Yet for all this openness, the country is hardly an oasis: sex workers and men who have sex with men continue to encounter often violent stigmatization, the manifestation of a culture of ignorance and suspicion, particularly within the security and defense forces.

ABSTRACT Several institutions within francophone African countries, namely the Court of Accounts, the General Inspectorate of the State, and the Inspectorate of Health, have a mandate to control and audit resources related to health. Currently, none of them is involved with Global Fund grants. This is a missed opportunity as these in-country accountability institutions with their mandate, legal power, knowledge of local context can help improve the grants accountability, sustainability and country ownership.

ABSTRACT For the first time, in the Inspector General’s Advisory Report on Western and Central Africa, there is a transparent and multidisciplinary document available for further debate about new operational choices. In this region, 11 countries are classified as Challenging Operating Environments and should, under this category, benefit from flexibilities in their implementation to maximize impact. Two years after the policy was adopted by the Board, the OIG questions how it is being implemented, and calls for more country-by-country analysis.

ABSTRACT As the New Funding Model is rolled out, some upper middle income countries that no longer qualify for funding from the Global Fund, feel that the new mechanism ignores the refugee crisis and population movements in the MENA region.

ABSTRACT The Global Fund will respond to requests from Liberia, Sierra Leone and Guinea to be more flexible in reprogramming grants should this be needed to support the continued response to the Ebola epidemic. The countries may ask for a greater investment in health systems strengthening, as poor infrastructure, a shortage of trained health workers and weak systems are driving the spread of the outbreak.

ABSTRACT “The expectations for reporting, management and oversight placed on fragile states by the Global Fund have not been realistic,” the Office of the Inspector General said following an audit in Guinea-Bissau. Meanwhile, OIG investigations in Mali and Ghana revealed that some grant funds were misused.

ABSTRACT Ten years of armed conflict and perpetual insecurity have driven HIV prevalence in Côte d'Ivoire higher -- especially among women in the western zone on the Liberian border. Many of these women were infected as a result of sexual violence perpetuated by one or another of the marauding armed groups that terrorized the region for over a decade; others were infected after turning to prostitution to escape extreme poverty. Since 2012, the Global Fund has supported activities in the west to reach these women.

ABSTRACT An expression of interest for a $10.18 million regional initiative to develop a harmonized response to a TB crisis among Syrian refugees scattered across neighboring countries was rejected by the Global Fund.

ABSTRACT After more than 10 years of political instability and violent security crises, Côte d'Ivoire, supported in part by the Global Fund, is working to rebuild its battered supply chain, paying special attention to the once-restive west.

ABSTRACT The current political crisis in Ukraine could compromise a number of Global Fund-supported harm reduction activities in the annexed region of Crimea. Finding a solution will require a strong partnership between NGOs, government and the Global Fund.