Human Rights

The movement to end epidemics calls us to build more just and equal societies. Too often, the people most vulnerable to disease are the same people who don’t have access to health care because of stigma, gender inequality or discrimination. The Global Fund Strategy 2017-2022 recognizes the need for greater investment to include and expand programs to remove such barriers in national responses to the three diseases, so everyone can access the health services they need.

The Global Fund is taking a pragmatic and programmatic approach to reducing human rights-related barriers to health services. This human rights work increases the effectiveness of Global Fund grants by helping them to reach the most people and maximize uptake of services and retention in services, particularly for the most vulnerable.

Addressing human rights-related barriers to health

Human rights and gender-related barriers to health have long blocked national responses to HIV, TB and malaria, including: stigma and discrimination; gender inequality and violence; punitive practices, policies and laws; and social and economic inequality. The Global Fund’s Sustainability, Transition and Co-financing Policy now requires all countries, regardless of income level, to include programs to address these barriers in their proposals.

Seven key program areas that are effective in reducing human rights-related barriers to HIV and TB services include:

• Stigma and discrimination reduction
• Training for health care providers on human rights and medical ethics
• Sensitization of lawmakers and law enforcement agents
• Reducing discrimination against women in the context of HIV and TB
• Legal literacy
• Legal services
• Monitoring and reforming relevant laws, regulations and policies

In addition, for TB there is a need to ensure confidentiality and privacy, mobilize and empower patients and community groups, address policies regarding involuntary isolation or detention for failure to adhere to TB treatment, and make efforts to remove barriers to TB services in prisons. For malaria, among other things, the Malaria Matchbox Tool should be used to assess inequities in access to malaria services as well as human rights- and gender-related risks and vulnerabilities, meaningful participation of affected populations should be ensured, and access to malaria services for refugees and others affected by emergencies improved.

To assist implementers in rolling out these programs, the Global Fund developed and issued technical briefs on HIV, human rights and gender equality; TB, gender and human rights; malaria, gender and human rights; human rights and gender programming in challenging operating environments – countries or regions affected by natural disaster, conflict or poor governance; and human rights in the times of COVID-19.

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Many lessons have been learned in recent years as programs to reduce human rights-related barriers to services have been implemented and scaled up.

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Breaking Down Barriers initiative

Through our Breaking Down Barriers initiative, we are providing intensive support, including US$45 million in additional funds in 2017-2019 and another US$41 million in 2020-2022, to 20 countries to vastly scale up evidence-based programming to reduce human rights-related barriers to HIV, TB and malaria services. Countries include: Benin, Botswana, Cameroon, Democratic Republic of Congo (province level), Cote d’Ivoire, Ghana, Honduras, Indonesia (selected cities), Jamaica, Kenya, Kyrgyzstan, Nepal, Mozambique, Philippines, Senegal, Sierra Leone, South Africa, Tunisia, Uganda and Ukraine. Baseline assessments of human rights-related barriers to services have been completed in each of these countries, and many have already adopted country-owned, budgeted strategic plans to reduce the barriers identified.

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Isaura Mula (right), a community health worker in Mozambique locally known as “activista”, engages girls and young women in her community to talk about symptoms of HIV, the importance of testing, and the health services available to prevent of mother-to-child transmission of HIV. The Global Fund / John Rae

Integrating human rights throughout our work

The Global Fund’s approach to human rights is established by the Global Fund Board and based on consultations with governments, affected populations, human rights experts, civil society organizations and technical partners. The Global Fund has committed to integrate human rights principles – participation, equity, accountability and transparency – throughout the grant cycle, and increasingly into the policy-making process. Global Fund staff receive training on human rights, gender and key and vulnerable populations. Beginning with the country dialogue, the Global Fund works with countries to ensure that key and vulnerable populations most affected by the diseases are represented and have a voice in the process.