At the 48^th meeting of the Global Fund Board, members were treated to two Thematic Discussions, one on gender and the other on communities. The gender thematic presentation was based on the Gender Thematic Report. This article summarizes the important points of the Board presentation and the subsequent discussion. The Fund’s ambition regarding gender The 2023–2028 Global Fund Strategy commits the Global Fund and its partners to initiating a “partnership-wide focus on gender transformative programming to advance gender equality and reduce gender-related barriers to HIV, TB and malaria (HTM) services,” by:

• Scaling up comprehensive programs and approaches to remove gender-related barriers and inequalities across the portfolio.
• Advancing youth-responsive programming, including for adolescent girls and young women (AGYW) and young key and vulnerable populations (KVPs) and their partners.
• Supporting comprehensive sexual and reproductive health and rights (SRHR) programs and their strengthened integration with HIV services.
• Supporting targeted sexual and gender-based violence (SGBV) prevention and response interventions and systems.
• Promoting the role of community-based and community-led organizations (including women and LGBTQI-led organizations) in the design and implementation of programs dedicated to challenging harmful gender norms, prejudices and stereotypes.
• Supporting the integration of national gender-responsiveness action plans into multisectoral health and HTM strategies.
• More proactively engaging ministries of gender and social protection in Global Fund processes.
• Establishing innovative partnerships with development partners, national government agencies and community-based, community-led and civil society organizations working on advancing gender equality.
• Deploying quantitative and qualitative data to identify drivers of HTM inequity and inform targeted responses, including by gender.

The Global Fund has high hopes that in three years’ time, the end of the forthcoming funding cycle 2023-2025, it will see:

1. Gender equality as a key consideration in the design, delivery and evaluation of all Global Fund-supported programs, not only in standalone initiatives.
2. Sex and gender-disaggregated data routinely used for program design, delivery, adaptation and evaluation.
3. Clear roles, responsibilities and accountability within the Secretariat and across the whole Global Fund partnership.

The presentation went on to define gender and what this means in the Global Fund context and then discussed how gender as a topic has been addressed in the Global Fund over the years.

Figure 1. The evolution of gender in the Global Fund

For the Fund to deliver its Strategy commitments and reach the HTM objectives, a dual approach will be used to integrate a gender-equality focus across the portfolio as well as investing in dedicated gender-specific interventions in key areas. The principles of this approach will be applied consistently across all portfolios, with implementation tailored in line with a differentiated approach.

Dual approach is based on lessons learned The findings of various reviews have led to the development of this approach:

• The 2020 Technical Evaluation Reference Group (TERG) Strategic Review said that progress against gender objectives was “muted and inconsistent”. Global Fund grants were often designed without sufficient focus on gender issues to attain results.
• The 2020-2022 Technical Review Panel (TRP) Observations Report noted that interventions to address inequalities were “insufficient to meet the scale of need and were siloed”. Gender assessments rarely translated into well-targeted services and interventions with metrics to monitor outcomes
• The 2022 Community Engagement and Community-led Response Evaluation found that the gender focus was under-developed. The AGYW Strategic Initiative was described as “laudable but limited” to HIV in Southern and Eastern Africa. The approach was deemed to be “insufficient to ensure that gender is fully considered and addressed across all Global Fund investments”.
• 2022’s MOPAN Assessment found that cross-cutting objectives such as gender were given less priority in resourcing. Gender was not adequately integrated, e.g., into the key performance indicator (KPI) framework.
• The 2022 UN University International Institute for Global Health Gender Scan of United Nations Development Programme programs funded by the Global Fund said that “Funding requests were largely gender blind”, and, where funding requests include gender analyses, the “barriers and needs identified are often not addressed through program activities or budgets”.
• The 2022–2027 Strategy consultations said that the Global Fund should double-down its efforts on equity, human rights and gender, including by “more deeply embedding this focus throughout the Global Fund’s work” and the grant lifecycle.

These findings emphasize the need for a dual approach, preventing a siloed and inconsistent focus by integrating a gender-equality lens across the entire portfolio and better meeting the scale of need by combining integration with targeted, gender-specific interventions. The following diagram shows how the Fund envisages gender to be embedded across the grant life cycle in order to deliver its new Strategy.

Figure 2. Strategy delivery: embedding gender across the grant lifecycle

In the GC7 cycle, the ‘gender readiness’ of all countries will be evaluated through a new tool, the Gender Assessment Marker (GEM). The countries will submit their funding requests (FRs) as usual, in line with the requirements in the FR application documentation. The TRP will then assess the FR against the GEM criteria in Figure 3 below and assign scores. The scores and budgets combined will give the percentage of all gender equality-focused spend, and, through identifying the strengths, weaknesses and trends, the GEM score will be used to mobilize technical assistance and  support in collaboration with partners

Figure 3. Gender Equality Marker (GEM)

The discussion also wanted to highlight risk. Aggregated Gender Risk remains high, and the direction of travel is “steady”, as the diagram below shows.

Figure 4. Risk rating

  The challenges are:

• The disconnect between the bottom-up risk rating  (moderate )and the assessment of the aggregated organizational risk (high).
• Gaps in the availability and use of gender-disaggregated data.
• Gender equality is routinely acknowledged for HIV, but the approach to gender risk is less mature for malaria and TB

The solution lies in strengthening systems, tools and processes:

• Strengthening the second line: the Fund’s Community, Rights and Gender (CRG) Department will lead in collaboration with other technical teams and the first line Country team.
• Both first- and second-line team capacity in gender risk management will be built in the Secretariat.
• Gender risk assessment guidance will be updated as part of the integrated risk management module (IRM) 2.0 update.
• There will be a clearer definition of gender risk to better understand the drivers and elaborate mitigation.
• The Fund will support the collection and use of disaggregated data to make data-driven decisions on program design and monitoring.

The presentation then went on to discuss the delivery challenges and their drivers, of which some could be addressed by the Secretariat but others were the responsibility of the Board and the Partnership to consider.

Finally, the presentation concluded by requesting the Board to consider six questions:

1. How can we better incentivize grants that attack longer-term, complex issues such as gender equality?
2. Are we willing to accept fewer quantitative results in the short-term to focus resources on longer-term but more transformative issues such as gender equality in the context of health?
3. Do we need to rethink and redefine what success looks like to the Partnership, including accountability to donors, not to mention holding ourselves to account?
4. How can we better articulate roles and responsibilities across the Partnership and hold partners to account for their role in delivering on gender equality?
5. How can we most effectively engage our partners and governments to make gender equality a top priority?
6. What practical steps can we take to mobilize the whole Partnership to deliver our commitments on gender equality?

Board discussion

Although this discussion was held at the end of day , it still generated full attendance and support from Board members, a measure of how the topic’s importance was viewed.

Many were at pains to point out the difference between ‘equity’ and ‘equality’ since both are often (incorrectly) used interchangeably.

Several noted that the World Health Organization is also in process of developing a related policy and are well aware of the challenges of the trade-offs between short-term and long-term results.

The Board spent some time in discussion on the GEM, with several members commenting that collecting the information as all very well but that it is only as good as what we do with it – low scores will trigger a “tailored to country context” offer of support and so it was important that data are not only collected properly but used properly. The discussion paper and the GEM were felt to be a big step in the right direction and members welcomed the dual track gender transformative approach while also noting that “one size doesn’t fit all and we are not all on the same page”.

Others emphasized their support of the transformative agenda, pushing the level of ambition to what’s within scope and what is feasible. However, while the level of ambition should remain, big problems take time to address. We need to manage our own expectations as to when they can be met.

Several highlighted the need to make tools and guidance easy to use and that gender equality and equity should be used as a lever to achieve health outcomes.

Peter Sands was asked to provide assurance: Will the Secretariat have the capabilities needed in grant management to deliver on this? If not, the Board would be open to discussion on what should be deprioritised in OpEx to drive this ambition, including a Board steer that having insufficient numbers of gender staff is unacceptable.

The Board documents GF/B48/9B Gender Thematic Discussion will be available soon on the Global Fund website.