A moment for radical change

By Sophie Hobbs, NACOSA Communications, published in the Independent Philanthropy Association of South Africa March newsletter

On Monday 26th of January, we were due to work on our proposal for the next round of the US President’s Emergency Fund for AIDS Relief (PEPFAR) funding as part of the DREAMS initiative – a global partnership aimed at ensuring adolescent girls and young women are Determined, Resilient, Empowered, AIDS-free, Mentored and Safe. Instead, we were convening an emergency management meeting to figure out how to deal with the news that our flagship gender-based violence and HIV prevention and response programme was being suspended with immediate effect. Despite the various waivers and court rulings that have occurred since the initial suspension order, our programme was terminated a month later.

NACOSA has been a PEPFAR implementing partner since 2014. We had been through President Trump’s first administration and expected that some major changes would be coming. But nothing could have prepared us for the end of PEPFAR funding – the widely admired, bi-partisan mechanism started by Republican President George W. Bush in 2003 that has saved millions of lives. The impact was immediate and profound. NACOSA, along with over 100 other local PEPFAR implementing partners, suspended services, withdrew from facilities and began laying off staff. NACOSA had to suspend funding to the 15 smaller, local implementing organisations that were an integral part of our programme. At least one of these organisations was receiving all of their funding through the grant with others ranging from 10- 54% of their funding.

Our community-based programme served an average of 100,000 adolescent girls and young women annually with prevention services, 32,000 survivors of violence in 89 post-violence care facilities nationwide, 5,200 children living with HIV and 15,000 other vulnerable children and households. All of this work was terminated. We have to say goodbye to 160 of our colleagues, the majority of whom were working as community facilitators – young women from the very communities we serve. Across the country thousands of health, community and social care workers are losing their jobs at the same time. These passionate and dedicated people are now not able to do the vital community work they were doing before and are worrying about how they are going to provide for their families.

Long-term sector-wide impact

Over the longer term, with HIV testing, treatment, and prevention efforts dramatically cut, we expect to see higher infection rates, more drug-resistant TB cases, and increased AIDS-related deaths. Critical services to survivors of sexual violence are disrupted, including support to access HIV testing, post-exposure prophylaxis (medication to prevent HIV in the case of rape), trauma containment, linkage to treatment, child protection and other social services. These cuts will impact most heavily on the vulnerable in our society – children, young women, and other people on the margins. Around 90% of violence cases in the facilities where our programme was operating were women and 43% were under the age of 18.

The scale of this is hard to comprehend. An entire sector has been hit and although we were initially hopeful that the waiver for life-saving services would provide some respite, we have had to come to terms with the fact that foreign aid as we knew it is dead.

Although PEPFAR funded just 17% of South Africa’s HIV and GBV response, a significant amount of this funding went directly to independent, community-based organisations. Community organisations are the connective tissue in the HIV response, linking people to services and smoothing referral pathways. The concern is that it is the community response that will be lost in this crisis, with facility-based medical services prioritized.

Weathering the storm

Those of us working in the public health development space are used to quickly pivoting in the face of a crisis. With the Covid-19 pandemic only just in the rear-view mirror, we immediately swung into action with emergency fundraising campaigns and getting together with other affected organisations to share information and present a united front. A group of PEPFAR implementing partners has connected with government at all levels to assess the impact and cost a minimum package of services. Other groups are more focused on campaigning and advocacy, working with the media to bring this story to global decision-makers.

South Africa’s government is confident it can mitigate the impact on facility services and there may be other bilateral agreements that can step in to bridge the gap – the European Union announced a multi-million Rand package of support to South Africa just last week. But the worry is that independent organisations do not have the reserves to survive the substantial scaling back of foreign aid funding over the long term.

Independent philanthropists can play a critical role in this crisis, with the provision of emergency funding to help organisations keep the lights on and continue to deliver services to the most vulnerable.

Innovation for sustainability

The time has come for us to grapple with the sustainability paradox of independent civil society. Almost every fundraising proposal or application for grant funding has a sustainability section in it but donors seem reluctant to fund the very things that will make organisations more self-reliant: endowment funds, infrastructure, the costs of salaries for fundraisers, networking activities, capacity building or other core costs that can build organisational reserves and resilience.

We need to use this moment of crisis as an opportunity to develop indigenous South African models of philanthropy and self-reliance. NACOSA is currently working on the creation of a Stokvel-type fund that organisations can themselves contribute to, with matched funding from the donor community, which can be drawn on in emergencies such as the one we find ourselves in now. By pooling our resources, and accessing the expertise of our asset management community, we can create a new model that is locally built and owned.

“You can’t drink from an empty cup,” says Colin Van Wyk, the Director of Phambili, a NACOSA network organisation based in the Strand. Phambili is one of the many community organisations that stepped up successfully to support the country’s Covid-19 response. They were able to deploy quickly and were trusted by communities to bring services, particularly among hard-to-reach groups of people. What these organisations found most helpful during the Covid crisis was the agile funding they received that was not linked to targets, capacity support (including vehicles, centrally procured PPE, training and mentoring), and being able to network with other organisations doing similar work.

Philanthropists should put trust in community organisations and the work they are already doing by funding core costs, contributing to endowment funds and working together to reduce the administrative burden on organisations. For example, by using common monitoring, evaluation and reporting frameworks like the Sustainable Development Goals – a globally recognised and agreed set of indicators for development.

Stepping up for sustainable progress

South Africa has made incredible progress in its response to HIV and AIDS, reducing mother-to-child HIV transmission and increasing life expectancy with the help of the global community. With new developments like long-acting injectable prevention options, we were hopeful that we had the end of AIDS within our sights. The funding disruption will set us back considerably – not just in South Africa but across the world. We cannot let this happen. We cannot go back to the days of thousands of people dying of AIDS and children being left orphaned.

This is the moment for radical and innovative local solutions co-created by organisations, philanthropy and government to respond to a rapidly shifting and uncertain global environment. It is up to us to seize this once in a generation opportunity to change the face of South African community development funding.