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Published: 14 March 2024

Community Responses and Systems

The Challenge

In many countries, vulnerable and marginalized people cannot access prevention, treatment and care services because of barriers such as stigma or discrimination, violence (including gender-based violence), or punitive laws, policies and practices. These groups can also face persistent and growing barriers to equal engagement in decision-making, including around how financial resources are allocated and how health services are prioritized and delivered.

As epidemics become increasingly concentrated among those who are not well served by the formal health sector, it is essential to strengthen the leadership, engagement and capacity of the communities affected by and responding to HIV, tuberculosis (TB) and malaria. Community-based and community-led organizations and networks have a unique ability to interact with affected communities, react quickly to community needs and issues, and engage with affected and vulnerable groups.

These organizations and networks can provide direct services to their communities and advocate for improved health programming and policy environments. They are often best placed to guide and implement health programs that respond to their communities’ diverse needs, and to identify and contribute to addressing structural and social barriers that impede access to quality health care services.

Our Response

Communities are at the heart of everything we do. By empowering the communities most at risk we ensure that lifesaving services reach the most vulnerable, including those marginalized by poverty, stigma, discrimination or criminalization. Putting people and communities at the center of our model helps build the trust that is the vital foundation for achieving our mission and ensuring no one is left behind.

The Global Fund invested US$16 million during the 2020-2022 allocation period to support civil society and communities most affected by the three diseases in participating and engaging in Global Fund and related processes across the grant cycle. Our investments also support countries to better integrate community systems and responses into long-term national health plans, with a focus on ensuring that they are sustainable and complementary to public health responses.

Our Community Engagement Strategic Initiative works with civil society and communities most affected by the three diseases to strengthen their engagement and participation with Global Fund programs and related national processes. We support short-term, peer-to-peer technical assistance to civil society and community organizations on human rights, gender, community responses, community systems strengthening and other related areas.

The Global Fund Strategy 2023-2028 prioritizes investments in long-term, tailored capacity building of community-led and community-based organizations, networks and groups, in order to strengthen links and improve service continuity between community-led activities and formal health care provision. Our Strategy also supports community-led monitoring, where communities monitor the effectiveness, quality, accessibility and acceptability of the health programs and services they receive. This support aims to strengthen the uptake and implementation of community-led monitoring mechanisms across HIV, TB and malaria, and generate evidence that will inform programmatic and financial decision-making for better health outcomes. Community-led monitoring is proven to be effective in improving services for marginalized and vulnerable people, as well as addressing related health and human rights concerns.

Community health workers are at the heart of community systems. Increasingly relied upon to deliver health programs in remote areas and with marginalized populations, community health workers deserve to be treated as professionals – paid, trained and supervised. Their jobs should be integrated in the primary healthcare system of countries. That is why the Global Fund has partnered with the Africa Frontline First Initiative, launching a catalytic fund in 2022 to finance community health in Africa.

We support the Monrovia Call for Action for community health workers, advocating for increased professionalization. As the majority of community health workers are women, we are also committed to supporting their status and employment on an equal basis with men, and to advocating for their protection against gender-based violence.

The Breaking Down Barriers initiative is a groundbreaking effort to confront the injustices that make some people especially vulnerable to diseases and unable to access the health services they need. The initiative provides the knowledge and the skills that are essential for people affected by HIV, TB and malaria to understand, demand and secure their health-related human rights. It works to enable health care providers, police, prison officials, judges, and parliamentarians to provide supportive and effective services to all those most vulnerable to disease.

Find out more about the Breaking Down Barriers Initiative

At 16, it was daunting for Justin to tell his parents that he was gay. His parents were supportive, but they worried how their son would be treated. He saw how young people who identify as LGBTQI+ are stigmatized and scapegoated, which motivated him to fight to protect the human rights of other young people. Justin co-founded the Iloilo Pride Team, which established the Iloilo City’s first, and now yearly, Pride parade. He later became the Executive Director of Youth Voices Count, a network and advocacy organization for LGBTQI+ adolescents and youth in the Asia-Pacific region. Justin is now a member of the Global Fund Youth Council, a group of young leaders who advise Global Fund leadership.

Learn more about Justin’s Story

Community-led monitoring of treatment access barriers faced by HIV service users has contributed significantly to an increase in viral load suppression (when the amount of HIV in a person’s blood becomes so low that it is undetectable). Results from 11 countries participating in a Global Fund-supported program by the Regional Treatment Observatory in West and Central Africa highlight how, through community-led monitoring, the rate of viral load suppression at monitored clinics increased from 48% to 77% in two semesters.

Stronger Than TB is a community-led organization in Ukraine, established by people affected by TB. The organization brings together people affected by the disease to provide trainings in advocacy to encourage a shift to patient-centered TB care, methods for protecting the rights of community members, and monitoring to evaluate the responsiveness of outpatient services to the needs of patients at all stages of care. Stronger Than TB’s work has helped influence the reform of the TB care system in Ukraine, successful cooperation with regional authorities to develop regional TB response programs, implementation of a social procurement system, and it has increased the effectiveness of communications with key stakeholders.

The Networking HIV and AIDS Community of Southern Africa (NACOSA) is a network of over 1,800 civil society organizations working to turn the tide on HIV, AIDS and TB in South Africa. NACOSA supported programs on strengthening community systems for 134 civil society organizations, including Sisonke Sex Worker Movement of South Africa. As a community-led and human rights-based organization, Sisonke received funding to strengthen its governance and oversight mechanisms, to develop a constitution and code of conduct, and to implement technical and programmatic trainings on human rights, equity, empowerment and community linkage, and networking.

Photo: Photo: The Global Fund/Vincent Becker

Through NACOSA support, additional sex workers, dedicated site coordinators, and competent and skilled peer educators were also mobilized and trained on how to contribute to the Sisonke movement. Sisonke was instrumental in developing the first ever National Sex Worker HIV Plan for South Africa, which focuses on reducing HIV, sexually transmitted infection (STI) and TB incidence among sex workers, reducing HIV, STI and TB-related mortality among sex workers, and reducing human rights violations experienced by sex workers.

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