Background

UNDP’s work in health and development – elaborated in UNDP’s HIV and Health 2022-2025 Strategy – is guided by respect for and promotion of human rights and gender equality as set out in the United Nations Charter, the Universal Declaration of Human Rights and other international treaties. In the context of HIV, tuberculosis and malaria, there is strong recognition of the need for greater attention to key and other vulnerable populations in all epidemic settings, including action to address social, legal and cultural barriers to access HIV and other health services, promotion of human rights and rights-based approaches, and support for engagement of key and other vulnerable populations in policy development, health governance and programming.

Likewise, the Global Fund’s 2023-2028 Strategy includes the imperative to maximize health equity, gender equality and human rights by deepening the integration of these dimensions into HIV, TB and malaria interventions, including through expanding the use of data to identify and respond to inequities, scaling up comprehensive programs to remove human rights and gender-related barriers, and leveraging the Global Fund’s voice to challenge harmful laws, policies and practices. Furthermore, growing inequalities and pervasive human rights, gender-related and other structural barriers continue to exacerbate vulnerability to HTM infection and limit access to services. The failure to put communities at the centre of the design, implementation and oversight of programs has resulted in suboptimal programming and health outcomes.

A growing body of evidence suggests that human rights barriers can drive people – in particular, key populations¹ – away from health-seeking behaviour, thereby fuelling the spread of the three diseases. These barriers can include, among others, stigma and discrimination, punitive legal and policy frameworks (e.g. but not only criminalization), lack of informed consent, mandatory or coerced testing, and gender-based violence. As a result of gender-based discrimination, women and girls are disadvantaged when it comes to negotiating safer sex and accessing HIV prevention information and services. However, despite recognition of this reality and substantive guidance on the importance of programmes to combat human rights and gender-related barriers, a Global Fund analysis found that many grants do not include this programming, or, if they do, it is included at very low levels.

In light of the above, in the Global Fund’s New Funding Model for applications, applicants are expected to include:

(1) an assessment of the human rights related barriers in their country, including stigma, discrimination, and violence against key and vulnerable populations. They are also asked to consider existing legal and policy settings and contexts, as well as age-specific barriers, including lack of independent access to HIV and/or sexual productive services.

(2) an assessment of gender related barriers which considers gender inequalities and barriers, why they exist, and their impact on health outcomes. Applicants should consider how gender intersects with other barriers, such as age, place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status and social capital.

For both assessments, applicants are asked to include which barriers will be addressed with GF financing and expected outcomes. If an existing assessment is available (such as one completed as part of a National Strategic Plan review), it should be attached. If not, applicants are requested to complete one.

Objectives of this section

This section of the Manual includes links to the existing and substantial policy and programming guidance, as well as practice pointers to implement programmes to address human right barriers and promote gender equality at various points in the grant life cycle. It is not meant to be an exhaustive section of the guidance and resources available, but rather a guide to help programme and policy staff to develop, implement and evaluate programmes that seek to promote an enabling environment with a focus on key populations.

A key goal of this section is to facilitate an understanding of human rights, the needs and vulnerabilities of key populations and women and girls, and the interrelatedness of these areas in the context of achieving positive health outcomes for HIV, TB and malaria, and to prepare Country Offices (COs) to advocate for, and effectively implement and evaluate, programmes to promote and protect human rights and gender equality. Recognizing that these are issues which can often be misunderstood or deprioritized in funding request and in grant budgets, it is strongly recommended that relevant Project Management Unit (PMU) staff closely consult with their contact in the UNDP Global Fund Partnership and Health Systems Team (GFPHST) to answer any questions, provide guidance, and to ensure that they have access to the most up to date policies and resources. To support the introduction of this work, the HIV and Health Group (HHG) has developed a vetted roster of qualified consultants who can help with policy and programme work to support design, implementation or evaluation of human rights, key populations and gender interventions.

¹In the context of HIV, gay men and other men who have sex with men, sex workers and their clients, transgender people, prisoners and people who inject drugs are the main key population groups. These populations often suffer from punitive laws or stigmatizing policies and are among the most likely to be exposed to HIV. For TB, KPs include people living with TB/HIV co-infection, migrants, refugees and displaced people, miners, prisoners, children in contact with TB cases, and people who inject drugs. The concept of “key populations” in the context of malaria is relatively new and not yet as well defined as for HIV and TB. However, there are groups that meet the criteria for key populations. Refugees, migrants, internally displaced people and indigenous populations in malaria-endemic areas are often at greater risk of transmission.