Challenging Operating Environments (COEs) are countries or regions characterised by weak governance, poor access to health services, and man- made or natural crises. COEs present complex and challenging settings to programming and measuring for impact due to shifting needs, limited capacity, and accessibility constraints.
Currently 8 of the 22 countries in which UNDP acts as the Principal Recipient are classified by the Global Fund as Challenging Operating Environments. Operational challenges and risks in COEs are significantly higher than in non-COEs and require different approaches to increase health impact. COEs tend to be confined to low-income countries, yet middle-income countries can also experience sustained crises. Disease outbreaks, natural disasters and armed conflicts cross borders and cause fragility at national, subnational and regional levels, thus requiring interventions both within and across national borders. Crises in COEs may involve large numbers of refugees and displaced persons and can become protracted. The nature of these crises often calls for long term interventions that blend humanitarian and development approaches.
Investments in COEs aim to increase coverage of HIV, TB and malaria preventive and therapeutic services, to reach key and vulnerable populations, and to save lives. Investments in COEs also aim to build resilience through stronger community and health systems; and to address gender-related and human rights barriers to services. During emergencies, the scope of investments may be more limited, aiming to provide continuity of treatment and essential services, as well as to prevent and contain outbreaks.
COEs are particularly critical to the Global Fund mission and objectives: they account for a third of the global disease burden for HIV, TB and malaria, and for a third of Global Fund investments.
The new Global Fund Strategy Framework 2017-2022 reflects this importance by including a specific sub-objective on COEs, which has the goal of ‘Improving effectiveness in challenging operating environments through innovation, increased flexibility and partnerships’.
To support this the Global Fund and its partners including UNDP developed a policy paper ‘The Challenging Operating Environments Policy’ which outlines the principles that guides the approach and engagement in Challenging Operating Environments. From this an Operational Policy Note on COEs was developed to provide operational on managing COE portfolios in an agile and timely manner, within the principles defined in the policy.
The policy illustrates three principles that should govern Global Fund investments in COEs: flexibility, partnerships and innovation. These aim to enhance the responsiveness and timeliness of Global Fund investments, reduce the administrative burden for implementing partners, and facilitate more effective service delivery to populations in need.
Flexibility: Areas of flexibility include:
Partnerships: The policy recognizes the centrality of partnerships in COEs and the need to optimise the types of partners in COEs to strengthen in-country governance, enhance service delivery, and improve technical assistance.
Innovation: Both the GF secretariat and implementing partners will be encouraged to apply new approaches throughout the grant cycle, in order to maximise results in COEs.