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quinta-feira, 24 de outubro de 2013

Toward a legal framework that promotes and protects sex workers’ health and human rights

Cheryl Overs, Bebe Loff
Complex combinations of law, policy, and enforcement practices determine sex workers vulnerability to HIV and rights abuses. We identify “lack of recognition as a person before the law” as an important but undocumented barrier to accessing services and conclude that multi-faceted, setting-specific reform is needed—rather than a singular focus on decriminalization—if the health and human rights of sex workers are to be realized.
This paper attempts to bring clarity to the discussion concerning the regulation of commercial sex, the rights of sex workers, and reducing vulnerability to HIV among adult female sex workers. Varying combinations of law, policy, and enforcement practices are shown to come together along identifiable themes to determine how sex workers live and work.
Though there is a great deal of literature on the effects of criminalizing sex work, the ways in which other forms of law and practice contribute to shaping the working environments of sex workers in different places is less understood. The consequences of the lack of recognition of the sex worker as a person before the law in many countries are hardly discussed. The absence of recognized legal status—not confined to sex workers—may be the result of the lack of a birth certificate, identity card, voter card, or other means that societies create to recognize individual legal personality, which make it  possible to act and make claims in society. This can mean that the sex worker is deprived of the benefits of citizenship even though they are born the country in which they work. It is suggested that in some places this phenomenon may be as much to blame for many of the deprivations and violations of rights suffered by sex workers as are other more commonly recognized concerns. Health programs that focus solely on the sexual health of sex workers to the exclusion of this fundamental issue of status may inadvertently reinforce this problem.
In this paper, the singular focus on criminal law is extended to consider the many factors that create and reinforce sex worker marginalization and social exclusion. We set out and explain the issues that must be addressed in order to improve sex workers’ status and health. The range of regulatory mechanisms used to govern sex work, enforcement practices, lack of clarity in the language used to describe this, and the claims of sex workers are discussed, as well as the limited steps that have been taken towards seeing the sex worker as a person possessed of at least some rights. We draw particular attention to the failure, in many places, to recognize sex workers as persons before the law. This means they are unable to make enforceable claims against office holders, employers, and service providers who, as a consequence, are not held accountable to sex workers.
The International guidelines on HIV/AIDS and human rights, first issued in 1996 and reissued in 2006, include this language about sex work:
With regard to adult sex work that involves no victimization, criminal law should be reviewed with the aim to decriminalize, then legally regulate occupational health and safety conditions to protect sex workers and their clients, including support for safe sex during sex work. Criminal law should not impede provision of HIV/AIDS prevention and care services to sex workers and their clients…1
The UNAIDS Guidance Note on Sex Work, published in 2009, echoed these themes.2 After the release of this Guidance Note, the executive director of UNAIDS initiated the Joint Action for Results: UNAIDS Outcome Framework 2009-2011. Outcome Area Six specifically calls for the removal of punitive laws, policies, practices, stigma, and discrimination that block effective responses to AIDS.3
Both sex worker groups and United Nations agencies argue that the criminalization of sex work negatively impacts sex workers’ health and human rights.4 Sex workers throughout the world have consistently claimed they are adversely affected by laws, policies, and enforcement practices that result in their exposure to violence, other criminal acts, and human rights violations, and which frequently reduce their access to education and health services and contribute to their social and economic exclusion. In these circumstances, the vulnerability of sex workers to HIV is significantly heightened. Sex workers identify stigma as the core issue and the law as a powerful tool for either empowering sex workers or further victimizing them.5
Law reform advocates suggest that if commercial sex is legitimized, sex workers may seek protection from exploitation and violence by the same laws and mechanisms that protect citizens and workers. They claim that sex workers might then enjoy the protections that accompany recognition of their equality with others, including the ability to conduct their trade in the safest possible workplaces, form unions, and access health and other services.6 If they remain without recognized legal status, these outcomes will be difficult to achieve.
Some feminists have advocated abolition of sex work by women, suggesting that it is indivisible from human trafficking as no person would voluntarily agree to prostitute themselves. They advocate stronger criminal laws against people who sell sex, clients, and sex business operators. Others suggest that liberalization of sex work laws increases demand for commercial sex and therefore also exacerbates human trafficking and other forms of exploitation or abuse.7
Regulation of commercial sex

The primary mechanism for controlling sex work is criminal law, which may make all or some activities related to commercial sex illegal. These laws vary greatly from country to country.8 In some countries, all aspects of commercial sexual transactions are criminal for all involved. More frequently, criminal laws are directed at those who sell sex or profit from it. The most common form of legal regulation is prohibition of specific activities associated with commercial sex, such as public soliciting for prostitution and procurement of minors. Recently, laws aimed at preventing trafficking and sexual exploitation have proliferated, with many jurisdictions extending the coverage of laws against trafficking to include clients and consenting adults who are deemed to be sexually exploited.9
Sex workers are referred to in laws that are enforced against them by a variety of terms including “prostitute,” “entertainment worker,” “trafficking victim,” and “victim of sexual exploitation.”10 Sex work is also regulated by laws drafted to address concerns unrelated to sex work. Examples include laws dealing with vagrancy, obscenity, nuisance, drugs, public order, sodomy, and alcohol consumption. Executive orders aimed at reducing antisocial behavior by restricting access to an area or evicting people from public housing are also used against sex workers.11
In almost all countries, there are laws against third parties involved in prostitution. These include laws against procuring adult women for prostitution, brothel keeping, advertising transactional sex, human trafficking, transporting or controlling prostitutes, or living on immoral earnings. Police will frequently confiscate condoms as evidence of sex work. All such laws can target managers, drivers, launderers, bartenders, receptionists, and landlords, as well as sex workers and their partners and families. Criminalization of sex business operators and clients alike is increasingly underpinned by an ostensibly humane redefinition of the female sex worker as a victim in need of rescue, rather than a criminal to be punished. Despite this characterization, the sex worker herself continues to be punished in both formal and informal ways. In some cases, sex workers are charged with trafficking and brothel keeping offenses (particularly if they share a workplace with another sex worker) or must agree to be detained for rehabilitation.12
Commercial sex may also be regulated and licensed. Some schemes permit commercial sex in certain streets or brothels; others permit commercial sex that accords with prescribed standards, such as the licensing of managers and the registration of workers. In Germany, for example, sex workers have limited access to indoor premises, but in Berlin, they are allowed to work on streets if they pay tax by purchasing a ticket from a machine.13 In the Philippines, sex workers must produce a “health card” to avoid arrest.14
Public health law plays an important part in the regulation of sex workers. In New Zealand, it is an offense to buy or sell unprotected sex.15 Medical examination of female sex workers and testing for HIV and other STIs is required in many jurisdictions, and steps are taken to prevent sex workers operating if they are HIV-positive or have an STI. In Turkey and Senegal, for example, it is an offense for a person to sell sex if they have not submitted to a medical examination.16 In other places, such as legal brothels in the state of Victoria in Australia, sex workers cannot work if they have an STI.17 The US state of Nevada has a similar regime.18 Under Chapter 441A of the Nevada Administrative Code, sex workers must be medically examined prior to commencing work, then on a weekly basis for certain diseases. Forced HIV and STI testing of arrested sex workers is lawful in some countries, including the United States where police publish pictures of arrested sex workers and their tests on official websites.19 Similar official “naming and shaming” of sex workers also occurs in the UK and was routine in China until it was banned.20
Forced medical examination of sex workers has been documented in many other countries, including Macedonia, where it led to several women being charged with serious public health offenses when they were found to have Hepatitis C antibodies.21 In Malawi, a newspaper reported that sex workers were taking legal action against the government for forcing them to be tested for HIV.22
HIV-positive sex workers are also likely to be affected by criminalization of HIV transmission.23 Several cases have been documented of HIV-positive sex workers being charged with criminal offenses, or being subject to orders that limit movement to prevent them infecting others.24 In a number of American states, a person who engages in sex work—or patronizes someone selling sex—knowing the sex worker is HIV-positive, is charged with a felony as opposed to a misdemeanor.25
A commission investigating sex work and HIV in South Africa said of legalized sex work with health controls:
[It] represents the same difficulties that criminalization does, especially since criminalization is the inevitable ‘default’ position where prostitutes do not comply with the conditions for working within the parameters of the legal sector.  The inclusion of mandatory HIV testing as one of the conditions for legalization compounds the difficulties created by criminalization.26
Policy making and law reform are difficult when patterns of enforcement bear little or no relationship to formal law. Enforcement practices that are substantially based on discretion are unreliable and prone to corruption. In most cases, especially in poor countries, few arrested sex workers are formally charged with an offense, taken to court, and jailed. It is common, particularly in countries where the rule of law is weak, for sex workers and sex business operators to pay fines or bribes or to be incarcerated in police stations, detention centers, and even jails without formal charges and an opportunity to appear in court.27 Indeed, some sex worker activists have alleged that this process can be so entrenched that only military police or retired officers are able to operate sex venues safely.28 Conversely, in some places, laws against commercial sex are not enforced because there are insufficient resources to do so, or because there is a deliberate policy of tolerance.
Sexual assault by police also plays a routine part in the global commercial sex landscape. Lack of accountable law enforcement processes means that sex workers who are victims of crime often have little incentive to report the crimes committed against them because they know they are highly likely to be ignored, or arrested and further abused.29
As noted above, offenses, whether or not they are designed to respond to sex work, may be routinely enforced against sex workers, their families, and associates, irrespective of whether there are grounds to do so. The presence of condoms as evidence of sex work is often relied upon to harass or prosecute, and is an example of a widely used enforcement practice that both activists and academics have criticized strongly.30,31
Arbitrary (and non-arbitrary) detention, sometimes for the purposes of rehabilitation and “protective” custody, are frequently reported in the literature on sex work. Sex worker activists have dubbed it “raid and rescue.”32 UN Special Rapporteur Anand Grover recommended compulsory detention and rehabilitation centers be closed as they are “ineffective and counterproductive.”33
Irrespective of whether incarceration is arbitrary or not, it carries additional health risks and has the potential to lead to further human rights abuses. The risks of detention often include assault and sexual violence, exposure to TB, and deprivation of medication, including anti-retroviral medicine for HIV, which has serious health consequences. In Cambodia, Human Rights Watch identified enforcement of the law on the suppression of human trafficking and sexual exploitation as causing arbitrary detention of sex workers in government rehabilitation centers, resulting in human rights violations and adverse health effects. According to Human Rights Watch, detainees reported rape and missed medication among the consequences of their detention, as well as loss of jobs or homes, and the forced abandonment of children and other family members for whom they were responsible.34
Limited rights

Undocumented migrants and refugees are the most instantly recognized categories of people lacking the rights that accrue to citizens of a country. However the benefits of citizenship are not automatic to all born in the country in which they reside, in particular those whose births are not registered.35 Sex workers appear to be disproportionately affected by lack of citizenship rights, or “recognition as persons before the law.”36 The combination of the legal status of sex work, the lack of legal status of the person who is the sex worker, and social stigma plays a significant role in driving social and economic vulnerability. Sex workers and their children are deprived of all ordinary civil entitlements. Sex workers without documents  such as birth certificates or identity cards have limited access to services and are unable to enter into formal agreements, such as leases or contracts, or to interact with government departments. This means they are unable to own, rent, or inherit property, vote, register the births of their children, or access education, justice, health care, loans or banking services, utilities, or work in the formal economy. In some cases, the inability to produce proof of identity will be associated with disrespectful and hostile attitudes in clinics, schools, and government offices. This may lead HIV-positive sex workers to avoid treatment that could both save their own lives and prevent transmission. It can also mean being held in detention centers or police custody longer, as they must be released into the care of someone who is legally recognized as a person.
Negotiating access to goods and services from this disadvantaged position clearly increases susceptibility to exploitation and abuse. Those who cannot access accommodation lawfully are prey for unscrupulous “slum lords,” those who cannot obtain legitimate health services are vulnerable to “quacks,” and “loan sharks” are the only option for those without access to legal finance services. There is little data addressing the health consequences that result from the fundamental denial of sex worker legal subjectivity.
Swaziland provides a poignant example of law that denies the humanity of the prostitute. Section 3(1) of the Swaziland Girl’s and Women’s Protection Act is as follows:
Every male person who has unlawful carnal connection with a girl under the age of sixteen years or who commits with a girl under that age immoral or indecent acts or who solicits or entices a girl under such age to the commission of such acts shall be guilty of an offense and liable on conviction to imprisonment not exceeding 6 years with or without whipping not exceeding 24 lashes and with or without a fine not exceeding one thousand Emalangeni in addition to such imprisonment and lashes.37
Section 3 (3) of the Act provides the following defense to the charge of carnal knowledge of a girl child under 16, “that at the time of the commission of the offense the girl was a prostitute.”38 According to this law, a girl under the age of 16 cannot consent to sex – however if she is under 16 and a prostitute, she can neither consent to sex, nor can she claim protection from the law if someone has sex with her. By granting her neither agency nor security, the law offers her no protection.
Addressing the criminal status of sex workers will not fully resolve the abuses suffered, however this debate dominates discussion about commercial sex. This is an interesting phenomenon given that in many countries sex work itself is not prohibited. Yet this discussion is beset by confusion. Terms such as “trafficking,” “sexual exploitation,” “abolition,” “toleration,” “semi-legal,” and “decriminalization” have no uniformly agreed meanings and are, as a consequence, applied inconsistently. Advocates who use this language cannot be confident about what has been communicated to others. Terms such as “legalization,” “decriminalization,” and “regulation” are often used interchangeably, which limits the possibilities for coherent discussion about reform of the law and policy governing commercial sex. For example, decriminalization has many meanings: no law should apply to commercial sex; or no criminal law should apply; or that commercial sex should be permitted in certain forms and not others; or that commercial sex should be regulated like physiotherapy, for example, or some other occupation sharing similar features. Even if something called decriminalization was possible, this is unlikely to be a complete solution in view of the broad range of problems faced by sex workers. Similar issues emerge for sex workers where police practice is delinked from law, where sex work is legally indivisible from trafficking, or where criminal laws not originally intended to be used to regulate commercial sex are misapplied, and whether the criminal law is silent or unenforced.
The language of rights also contributes to confusion. This is in part because treaties also use phrases such as “traffic in women” and “exploitation of prostitution of women,” which can be interpreted in many ways, including in justification of the punishment of sex workers. For example, Article 6 of the Convention on the Elimination of All Forms of Discrimination Against Women states:
States Parties shall take all appropriate measures, including legislation, to suppress all forms of traffic in women and exploitation of prostitution of women.39
Laws that penalize all aspects of commercial sex may be interpreted as being consistent with international treaties that treat sex work as sexual exploitation and indivisible from trafficking, making sex work itself inherently an abuse of rights. Moreover, policies, such as the anti-prostitution pledge contained within the US President’s Emergency Plan for AIDS Relief, that aim to eliminate sex work are constructed as being consistent with a reduction in vulnerability to HIV and therefore in accordance with the right to health.
Where the law prohibits or limits access to commercial sex in venues, sex workers will find alternative ways and places to work. In rich and poor countries alike, this means soliciting in the street, contacting clients by phone and the Internet, meeting clients in secret places, obtaining employment in clandestine brothels, or using a guise such as hairdressing, karaoke, or massage services. In these circumstances, sex is likely to take place in hidden rooms, streets, parks, cars, and roadsides where there is limited access to water and other physical conditions required for health and safety. Where sex work is bar- or entertainment venue-based, sex workers’ exposure to alcohol and tobacco can also pose a health threat. Where commercial sex is disguised as another business, such as massage or entertainment, condoms may not be present lest they are discovered by police and used as evidence of sex work, sexual exploitation, or human trafficking.  In areas where the laws against commercial sex are strongly enforced, brothels operated by criminals frequently have the worst possible conditions for sex workers; abuse, violence, and unprotected sex are more likely.40
Existing circumstances greatly increase vulnerability to HIV, to violence, and to other human rights abuses. This could be remedied by the establishment of legal and suitably regulated workplaces in which labor rights are recognized and occupational health and safety standards apply. Such standards do not include mandatory testing for HIV and STIs. Laws that criminalize sex business operators, or define them as traffickers and procurers deny sex workers the benefit of working as employees in lawful businesses, even where sex work itself is not criminalized. At present, sex business operators may be penalized for “exploiting prostitution,” “living on the earnings of prostitution” or “trafficking,” irrespective of how well they treat their staff. Sex workers are generally unable to rely upon employment contracts, which are unenforceable in most jurisdictions because they relate to an unlawful or immoral purpose, and because the sex worker may not have the legal status needed to enter into a contract.
A notable exception to this is a decision of the South African Labour Appeal Court in 2010 that held that although sex work was illegal, sex workers were still entitled to procedural fairness and protection against unfair dismissal.41 However, while the court held that the illegality of prostitution does not negate the constitutional protections that may be enjoyed by sex workers, it also noted that although sex workers would, as employees, be entitled to form and join trade unions, they would not be entitled to participate in any activities, including collective bargaining, that amounted to the furthering of the commission of crime.42
Criminal records, the inability to obtain goods and services, stigma, and the ensuing erosion of confidence, combine to ensure that many sex workers remain socially excluded; this makes them likely to stay in the sex industry into old age. There are reports of rehabilitation programs that offer lessons in sewing, hairdressing, or cooking, and some that offer small loans to start small businesses. These are aimed at enabling female and sometimes transgender sex workers to earn money to leave sex work. However, such programs reach a very small proportion of sex workers, and there is no evidence that they have, or could, significantly reduce the number of persons selling sex or form a cost-effective strategy for reducing HIV. It may be that recognition of legal personhood, enabling more equal access to employment opportunities, holds greater potential for enabling sex workers to exercise control over their livelihood choices than “rehabilitation”.
Principles

According to the UN Advisory Group on Sex Work, efforts to empower sex workers have resulted in measurable improvements in sex workers’ quality of life, self-confidence, and agency. Studies have documented good social and economic outcomes, increased social capital, and high rates of condom use.43 Creating regulatory frameworks that enable these improvements is crucial.
Although national regulatory regimes will consist of different mixes of laws and policies, the principle that should govern and inform reform efforts is that sex workers should enjoy the same protections and benefits as other citizens and workers. Sex workers must be understood as persons endowed with rights in a meaningful fashion, not merely as a rhetorical claim. To achieve this, the following should form the basis of a reform framework:
Recognition of sex work as an occupationA commitment to the application of human rights standards and norms, including recognition of sex workers as legal persons capable of holding and exercising all human rights, the right to work, freedom of association, and a recognition of the right of consenting adults to form sexual relationships, paid and unpaidA commitment to ensuring that commercial sex can take place under healthy and safe conditions that are understood to exclude oppressive testing regimesGuaranteed access for sex workers to health and social servicesJustice, including but not limited to, protection from violence, abuse, and discrimination.
For this to happen, it will be necessary to adopt consistent use of precise language to describe the regulatory environments for commercial sex, the consequences of possible regulatory options, and the potential solutions. It will also be essential to collect accurate local data about the laws, policies, and enforcement practices to be remedied, and their impact, intended and unintended, on the health of male, female, and transgender sex workers.
Law reform

In most countries, it will be necessary to repeal and reform criminal and other types of law (whether applied as intended or misapplied) that unnecessarily limit sex workers’   access to safe workplaces, services, and economic opportunities.  To be successful, this must be done in a manner that acknowledges the variety of forms that commercial sex takes, and the range of individuals who perform roles associated with commercial sex other than the physical provision of sexual services. As noted, there may be owners, employers, cleaners, drivers, cooks, and other support staff. Sex work can be arranged around entertainment venues such as hotels and bars, in formal brothels, as a home-based occupation or linked to personal services such as massage and escorts. Sex workers can be employees, sole traders, or independent contractors.  Examples of suitable regulatory responses to all of these circumstances may be found by examining comparable health and safety and labor regulations for other occupations providing personal services.
At an international level, the ILO has begun this process by incorporating sex work into international labor standards through a recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200). In 2010, during the 99th Session of the International Labour Conference, delegates stated sex workers were implicitly covered in the category of:
all workers working under all forms or arrangements, and at all workplaces, including…persons in any employment or occupation.44
Bringing sex workers within the scope of this recommendation may be an important first step toward an international policy and legal framework, within which sex workers may benefit from the same protections as other workers.
At a national level, the New Zealand Prostitution Reform Act 2003 is often cited as an example of decriminalization of sex work. This Act recognizes various forms of commercial sex and provides that contracts for commercial services are not void. It enables sex workers to refuse service, while allowing for the rescission or cancellation of a contract for a sexual service that is not performed. The Act also creates advertising restrictions, and stipulates that a permit to immigrate to New Zealand will not be granted on the basis that a person intends to operate or invest in commercial sexual business. A 2008 government report found that as a result of this act, many sex workers felt more able to report violent crimes and felt that the police respected their rights.45
Court decisions

Courts have made decisions consistent with respect for sex workers’ rights, including in countries where sex work is the subject of criminal law.46 A case of importance in this regard is the “Tanbazar” case (Bangladesh Society for the Enforcement of Human Rights v Bangladesh, 2001). In 1999, police evicted Bangladeshi sex workers in Tanbazar and Nimtali from their workplaces and confined them in a vagrant center for the ostensible purposes of rehabilitation. The judgement describes a night raid where, “the policemen suddenly dragged them, abused and beat them and pushed them and their children into the waiting buses using filthy language.”47
The court found that upon their eviction from their brothels, the sex workers were deprived of their livelihood and that this amounted to a deprivation of the right to life. The court concluded that the police action was unconstitutional and illegal.
A recent decision of the Supreme Court of India has recognized the impact of lack of legal personality, noting:
We are of the opinion that the authorities should see to it that sex workers do not face these difficulties as they are also citizens of India and have the same fundamental rights as others. 48
It ordered that sex workers be issued ration cards, voter cards, and identity cards that do not mention their occupation, and that address verification requirements be relaxed. The court also ordered that the children of sex workers be admitted to appropriate classes in a government school.49
In 2010, Justice Himel of the Ontario Supreme Court in Canada recognized the difficulties created by a legislative scheme that allows sex work but criminalizes most aspects of its conduct. She stated:
Three provisions of the Criminal Code that seek to address facets of prostitution (living on the avails of prostitution, keeping a common bawdy-house and communicating in a public place for the purpose of engaging in prostitution) are not in accord with the principles of fundamental justice and must be struck down.  These laws, individually and together, force prostitutes to choose between their liberty interest and their right to security of the person as protected under the Canadian Charter of Rights and Freedoms. I have found that these laws infringe the core values protected by section 7 and that this infringement is not saved by section 1 as a reasonable limit demonstrably justified in a free and democratic society.50
Other initiatives and activities

In addition to law reform, there are other initiatives worthy of consideration. Primary among these is supporting sex workers to organize so that they are able to spread information about legal rights and contribute to policy development. Better use of existing law is also a strategy that has been taken up to challenge violent, corrupt, and discriminatory treatment.  Humanitarian Action in Saint Petersburg, Russia, provides legal services and trains paralegals to accompany female sex workers to court or detention facilities if they are charged with crimes.51 The Healthy Options Project Skopje (HOPS) in Macedonia provides legal services to female sex workers.52  The Asociación de Mujeres Meretrices de la Argentina (AMMAR) provides legal aid to female sex workers and has challenged police harassment and restrictions on where sex workers can work, partly through an alliance with labor unions. As has been pointed out, the provision of legal services is of value irrespective of the legal status of commercial sex.53
While themes may be suggested to guide law reform, no single legal model can provide a blueprint for the regulation of sex work because of the variation between laws, policies, and practices. In addition, as Ahmed states, “decriminalization [of sex work] will not eliminate issues that exist for sex workers, such as harassment from state agents.”54 The way forward is grounded in addressing the variety of issues raised by sex workers and in accurately identifying the aspects of local legal environments that drive sex workers’ social exclusion and limits their access to services.
We began by looking at the factors that create and reinforce sex worker social exclusion, and the consequent lack of access to health services. These outcomes flow from poverty, violence, poor law enforcement, laws that conflate sex work with human trafficking, and lack of legal personality. Associated with this are criminalization of drug use, gender transgression, and HIV transmission. We particularly emphasized the impact of the failure to recognize sex workers as persons before the law, which prevents them making the same claims as others on office holders, employers, and service providers. This is a critical omission in discussions around health and sex work, particularly in relation to access to services.
In seeking to identify progress, we have observed that while “decriminalization” or other legislative reform is at the forefront of advocacy efforts, many actual improvements to sex workers’ lives and to the governance of commercial sex have resulted from improved enforcement procedures, progressive court decisions, and through changes to laws and policies that are not ostensibly about sex work. This includes laws such as those governing citizenship, public health, drugs or gender rights.
It is commonly asserted that sex workers are unable to realize rights because sex work is illegal. While acknowledging that criminal laws limit sex workers’ rights, we question the notion that these offenses form an insurmountable barrier to sex workers exercising rights. This idea has been unhelpful because it suggests that nothing can improve unless the sex work-related offenses are repealed. This is clearly not the case in countries where there is no law on sex work, where it is unenforced, or where laws that are used to harass sex workers do not specifically mention sex work and may otherwise serve a useful purpose.
Governments have agreed to ensure the legal protection of the rights of people vulnerable to HIV and to overcome the legal barriers that block their access to prevention, treatment, care, and support. To meet these commitments for sex workers, international and national law reform is needed, as are policy changes and enforcement practices. These must occur alongside judicial recognition of sex workers’ legal entitlements and increased resources for sex workers’ social initiatives. Advocacy around human rights standards and norms and domestic law is more likely to succeed if more tools are used than the singular demand for removal of sex work offenses from the books.
The authors would like to thank Anatoli Shapiro and Cassandra Van for their assistance.
Cheryl Overs, BLS, is Senior Research Fellow at the Michael Kirby Centre for Public Health and Human Rights, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
Bebe Loff, BA, LLB, MA, PhD, is Associate Professor and Director of the Michael Kirby Centre for Public Health and Human Rights, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
Please address correspondence to the authors c/o Bebe Loff, Michael Kirby Centre for Public Health and Human Rights, Department of Epidemiology and Preventive Medicine, Level 6, Alfred Centre, Commercial Road, Melbourne, Australia, email: bebe.loff@monash.edu.
1. Office of the United Nations High Commissioner for Human Rights (OHCHR) and Joint United Nations Programme on HIV/AIDS (UNAIDS), UN Doc. No. HR/PUB/06-9 (2006). Available at http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.
2. UNAIDS, UNAIDS Guidance Note on HIV and Sex Work (Geneva: UNAIDS, 2009, Last updated April 2012). Available at http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2009/JC2306_UNAIDS-guidance-note-HIV-sex-work_en.pdf.
3. UNAIDS, Joint action for results: UNAIDS outcome framework, 2009-2011, (Geneva: UNAIDS, 2009). Available at http://data.unaids.org/pub/Report/2010/jc1713_joint_action_en.pdf.
4. UNAIDS Advisory Group on HIV and Sex Work, The report of the UNAIDS Advisory Group on HIV and Sex Work,(Geneva: UNAIDS, 2011). Available at http://www.uknswp.org/wp-content/uploads/unaidsadvisorygrouponsexworkandHIVDec2011.pdf.
5. I. Vanwesenbeeck, “Another decade of social scientific work on sex work: A review of research 1990-2000,” Annual Review of Sex Research
12 (2001), pp. 242–289.
6. UNAIDS (2009, see note 3).
7. M. M. Dempsey, “Sex trafficking and criminalization: In defence of feminist abolitionism,” University of Pennsylvania Law Review 158/6 (2010), pp. 1729–1778; R. Weitzer, “Sex trafficking and the sex industry: The need for evidence-based theory and legislation,” The Journal of Criminal Law and Criminology
101/4 (2012), pp. 1337–1369. For articles defending the Oppression Paradigm, see K. Barry, The prostitution of sexuality (New York/London: New York University Press, 1995); S. Dworkin, Pornography: Men possessing women (London: Women’s Press, 1981); S. Jeffreys, The idea of prostitution (North Melbourne, Australia: Spinifex Press, 1997), C. Pateman, The sexual contract (Cambridge: Polity Press, 1988).
8. For specific examples of each approach see ProCon.org, 100 Countries and their prostitution policies (Last updated, December 2011). Available at http://prostitution.procon.org/view.resource.php?resourceID=000772. See also European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers (TAMPEP), Sex work in Europe: a mapping of the prostitution scene in 25 European countries (Amsterdam: TAMPEP International Foundation, 2009). Available at http://tampep.eu/documents/TAMPEP%202009%20European%20Mapping%20Report.pdf.
9. C. Overs, Caught between the tiger and the crocodile: The campaign to suppress human trafficking and sexual exploitation in Cambodia
, draft (Cambodia: Asia-Pacific Network of Sex Workers (APNSW), 2009). Available at http://www.aidslex.org/site_documents/SX-0046E.pdf; D. Kulick, “Swedish model” (presentation at Beijing Plus Ten meetings, New York USA, February 28–March 11, 2005). Available at http://www.globalrights.org/site/DocServer/Don_Kulick_on_the_Swedish_Model.pdf; S. Dodillet and P. Östergren, “The Swedish Sex Purchase Act: Claimed success and documented effects,” (presentation at the Decriminalizing Prostitution and Beyond: Practical Experiences and Challenges international workshop, the Hague, March 3–4, 2011). Available at http://www.plri.org/sites/plri.org/files/Impact%20of%20Swedish%20law_0.pdf.
10. Overs (see note 10).
11. E. Ellington, “Prostitutes in Ilford to be forced off streets under ‘dispersal order’ plan” The Ilford Recorder (February 2, 2012). Available at http://oldestprof.com/index.php/crimewatch/2460-prostitutes-in-ilford-to-be-forced-off-streets-under-dispersal-order-plan.
12. Human Rights Watch, Off the streets: Arbitrary detention and other abuses against sex workers in Cambodia
(2010). Available at http://www.hrw.org/reports/2010/07/20/streets.
13. N. Kulish, “In Germany, sex workers feed a meter” New York Times (August 31, 2011). Available at http://www.nytimes.com/2011/09/01/world/europe/01germany.html.
14. Sun.Star Cagayan de Oro, “24 nabbed sex workers no health cards – Police” (November 1, 2011). Available at http://www.sunstar.com.ph/cagayan-de-oro/local-news/2011/11/01/24-nabbed-sex-workers-no-health-cards-police-188173.
15. See, for example, the New Zealand Prostitution Reform Act of 2003, Public Act 28 (2003) Section 9(1). Available at http://www.legislation.govt.nz/act/public/2003/0028/latest/DLM197855.html.
16. H. Ünlu, T. Beduk, and D. Öztuna, “Evaluation of nature and impact of violence exposure among registered female sex workers,” Turkiye Klinikleri Journal of Medical Science
31/5 (2011), pp. 1167–1178; UNAIDS, Acting early to prevent AIDS: The case of Senegal. (Geneva: UNAIDS, 1999). Available at http://data.unaids.org/publications/irc-pub04/una99-34_en.pdf.
17. See The Parliament of Victoria, Sex Work Act 1994: Version No. 069A, No. 102 of 1994 (As amended by the Parliament of Victoria on January 1, 2011) Section 20, p. 31. Available at http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/LTObject_Store/LTObjSt5.nsf/DDE300B846EED9C7CA257616000A3571/998B3217B6D8FFEFCA257810001351B3/$FILE/94-102aa070%20authorised.pdf.
18. A. E. Albert, D. L. Wamer, R. A. Hatcher, et al., “Condom use among female commercial sex workers in Nevada’s legal brothels,” American Journal of Public Health
85/11 (1995), pp. 1514–1520.
19. D. Webber, “Criminal law: HIV and substantive criminal law issues,” in D. Webber (ed.) AIDS and the law, 4th edition (Aspen Publishers, 2011 Supplement), [F] Prostitution, pp. 7-40 – 7-43; K. McCurtis, S. Outlaw, C. Sardina, and P. Saunders, “Report submitted to Global Commission on HIV/AIDS,” Best practices policy project (August 7, 2011). Available at http://www.bestpracticespolicy.org/GlobalCommissionRep2011Text.html.
20. D. Taylor, “Sex workers ‘named and shamed’ on Met police website,” The Guardian
(August 6, 2010). Available at http://www.guardian.co.uk/ society/ 2010/ aug/06/ london-sex-workers-police-website; The Guardian, “China to end ‘shame parades’ of criminal suspects” (July 27, 2010). Available at http://www.guardian.co.uk/world/2010/jul/27/china-end-shame-parades-suspects.
21. H. Doyle, “Sex workers and HIV: When morality trumps science” Open Society Foundations
(June 7, 2011). Available at http://blog.soros.org/2011/06/sex-workers-and-hiv-when-morality-trumps-science/.
22. All Africa News, “Malawi: Sex workers sue govt after forced HIV test” (November 3, 2011). Available at http://allafrica.com/stories/201111130174.html.
23. International Planned Parenthood Federation (IPPF), Global Network of People Living with HIV (GNP+), and International Community of Women Living with HIV/AIDS (ICW), Verdict on a virus: Public health, human rights and criminal law (London: IPPF, GNP+, and ICW, 2008). Available at http://www.icw.org/files/verdict%20on%20a%20virus.pdf.
24. Radio National, “Shutting down Sharleen: The story of an AIDS pariah” Australian Broadcasting Corporation (Broadcast on March 21, 2010). Available at http://www.abc.net.au/radionational/programs/hindsight/shutting-down-sharleen/3115028.
25. See for example the Tennessee law Tennessee Code Annotated, § 39-13-516 – Aggravated Prostitution, (General Assembly of the state of Tennessee, Public Acts, 2010); Tennessee Code Annotated, § 40-35-111 – Authorized terms of imprisonment and fines for felonies and misdemeanors, (General Assembly of the state of Tennessee, Public Acts, 2010).
26. South African Law Commission, (2002) “Sexual offences: Adult prostitution,” (citation 8.43) in South African Law Commission, Chapter 8 – Prostitution and HIV/AIDS (Issue paper 19, Project 107). Available at http://www.saflii.org/za/other/zalc/ip/19/19-CHAPTER-8.html#fnB831.
27. C. Overs and K. Hawkins, “Can rights stop the wrongs? Exploring the connections between framings of sex workers’ rights and sexual and reproductive health,” BMC International Health and Human Rights
11/Suppl. 3 (2011).
28. Khao Ta, Secretary, Women’s Network for Unity, personal communication with the authors, (July 2009).
29. Overs and Hawkins (2011, see note 28).
30. C. DeBoise, “Stopping police and DAs from using condoms to convict sex workers” On The Issues Magazine (November 10, 2011). Available at http://www.ontheissuesmagazine.com/cafe2/article/180.
31. S. Rau and C. Sluggett, “Who stole the tarts? Sex work and human rights,” (Sangli: Sampada Gramin Mahila Sanstha (SANGRAM), 2009). Available at http://sexgenderbody.com/sites/default/files/who-stole-the-tarts_small.pdf.
32. Ibid.
33. UN in Vietnam, UN independent expert urges Viet Nam to close down compulsory rehabilitation centres for drug users and sex workers
(Hanoi: December 5, 2011). Available at http://www.un.org.vn/en/media-releases3/69-un-press-releases/1980-un-independent-expert-urges-viet-nam-to-close-down-compulsory-rehabilitation-centres-for-drug-users-and-sex-workers.html.
34. Human Rights Watch (see note 13); Overs (2009, see note 10).
35. See, for example, Plan International’s campaign to register all children at birth. Available at http://plan-international.org/birthregistration.
36. See Budhadev Karmaskar v. State Of West Bengal on 15 September, 2011: CRIMINAL APPEAL NO. 135 OF 2010 (Supreme Court of India, 2011). Available at http://indiankanoon.org/doc/99194/.
37. See The Kingdom of Swaziland, Swaziland Girls’ and Women’s Protection Act (1920).
38. Ibid.
39. International Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), G.A. Res.34.180 (1979), Article. 6. Available at http://www2.ohchr.org/english/law/cedaw.htm.
40. Human Rights Watch (2010, see note 13).
41. Kylie v. Commission for Conciliation Mediation and Arbitration and Others (Johannesburg: Labour Appeal Court of South Africa, Case No. CA10/08, May 26, 2010).
42. Ibid.
43. D. Kerrigan, P. Telles, H. Torres, et al., “Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil” Health Education Research 23/1 (2008), pp. 137–145; M. L. Rekart, “Sex-work harm reduction,” Lancet
366/9503 (2005), pp. 2123 – 2134; D. Swendeman, I. Basu, S. Das, et al., “Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases,” Social Science & Medicine 69/8 (2009), pp. 1157–1166; For the legal and policy environment and the rights of sex workers, see also, K. M. Blankenship, B. S. West, T. S. Kershaw, and M. R. Biradavolu, “Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India,” AIDS 22/5, pp. S109–S116 as quoted in UNAIDS Advisory Group on HIV and Sex Work, (2011, see note 5).
44. International Labour Office (ILO), Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200) (Geneva: ILO, 2010). Available at http://www.ilo.org/public/english/region/eurpro/moscow/info/publ/wcms_142706.pdf.
45. Ministry of Justice, New Zealand Government,  Report of the Prostitution Law Review Committee on the operation of the Prostitution Reform Act 2003. (Wellington, 2008).
46. Kylie v. Commission for Conciliation Mediation and Arbitration and Others (see note 41).
47. Bangladesh Society for the Enforcement of Human Rights and Others v Government of Bangladesh and Others 53 DLR (2001) 1, (Bangladesh High Court, Decided on March 14, 2000).
48. Budhadev Karmaskar v. State Of West Bengal on September 15, 2011 (see note 36)
49. Ibid.
50. Bedford v. Canada 2010 ONSC 4264 (Ontario: Superior Court of Justice, Court file No. 07-CV-329807 PD1, September 28, 2010).
51. J. Csete and J. Cohen, “Health benefits of legal services for criminalized populations: the case of people who use drugs, sex workers and sexual and gender minorities,” Journal of Law, Medicine and Ethics
38/4 (2010), pp. 816–831.
52. Open Society Foundations, Macedonia group protects rights of sex workers through video and legal advocacy
(October 1, 2009). Available at http://www.soros.org/initiatives/health/focus/sharp/news/macedonia-sexworkers-video-legalaction-20090901.
53. Csete and Cohen (see note 52).
54. A. Ahmed, “Feminism, power, and sex work in the context of HIV/AIDS: Consequences for women’s health,” Harvard Journal of Law and Gender
34/1 (2011) pp. 225-258.



quarta-feira, 23 de outubro de 2013

Funding global health

Sophie Smyth and Anna Triponel
Experience teaches that the Framework Convention on Global Health (FCGH) will need a financing facility if it is to garner widespread acceptance among low-income countries. The promise of financing is a well-established carrot to encourage countries to assume new convention-imposed obligations that will be costly to carry out. Promising to provide financing as part of an intergovernmental call for commitment also activates a rights-based approach. For donor and recipient countries, a funding facility embodies an actualization of their commitment to a convention’s collective undertaking to address a given issue. Donors signal their commitment through their contributions; recipients signal commitment through their efforts to use any support received to achieve the convention’s objectives. This essay highlights the need for an FCGH financing facility, provides a preliminary sketch of what it should look like, and urges the facility’s creators to adopt a bold and innovative approach that draws upon, but improves, current precedents.
Experience teaches that the Framework Convention on Global Health (FCGH) will need a financing facility if it is to garner widespread acceptance among low-income countries. The promise of financing is a well-established carrot to encourage countries to assume new convention-imposed obligations that will be costly to carry out. The Global Environment Facility (GEF), created in 1994 to fund low-income countries’ implementation of obligations assumed under the United Nations Framework Convention on Climate Change (UNFCCC), drove this message home.1 The message remains equally salient today. Since the GEF’s creation, multi-country commitments to address a global need and/or secure an essential right have been accompanied repeatedly by the promise of financing. This promise reinforces the commitment in a concrete way. The Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund, established in 2002), the Global Partnership for Education Fund (Education Fund, established in 2005), and the Green Climate Fund (established in 2010) are major recent examples of this approach.2
Promising to provide financing as part of an intergovernmental call for commitment activates a rights-based approach. In education, for example, the right to education, identified in the Universal Declaration of Human Rights (UDHR), gained momentum when the Education Fund was created.3,4 The Education Fund finances primary school education in developing countries, and therefore provides concrete help to developing countries to realize the right to education for their citizens.5 For donor and recipient countries, the Education Fund embodies an actualization of their commitment to education as a right: the donors through their contributions and the recipients through their efforts to use the support to make education available.
Similarly, the FCGH will require rich and poor countries to collaborate on finding ways to meet their respective sovereign responsibilities to safeguard their citizens’ right to health. For rich countries, acknowledging a universal right to health may well include an obligation to assist countries who lack the resources to secure that right for their citizens on their own.6 Drawing from precedents in the environment, education, and global health sectors, an FCGH financing facility can encourage low-income country support. A financing facility can also provide a mechanism through which high-income countries may partially discharge the responsibilities that attach to their recognition of a universal right to health.
This essay aims to raise consciousness about the need for an FCGH financing facility. We also begin to envision what an FCGH financing facility should look like. The second section tracks the background of the financing facility phenomenon, the reasons it has emerged, the aspirations of the stakeholders who have fuelled it, and the pertinence of those aspirations to the framers of the FCGH. We show how three competing models for creating a financing facility currently coexist. In section three, we identify the essential elements that the creators of an FCGH facility will need to address, as gleaned from the precedents; namely multi-stakeholder participation, technical expertise, resource mobilization, and resource allocation. Section four provides a preliminary sketch of the preferred approach for an FCGH financing facility.
Financing in context
The emergence of global financing facilities began with the GEF’s creation in 1994, springing from an ongoing quest by donors, recipients, and other stakeholders to find the optimal way to deliver financial assistance to those actors most likely to use it to address the identified global problem or need. A preliminary statement about the meaning of optimal in this context is appropriate here.
When parties agree to address a global need together, several layers of decision making are at play. At a fundamental level, the parties identify the substantive objectives of their collective international commitment, for example: universal primary school education by 2015, HIV/AIDS eradication, or reduction of greenhouse gas emission levels to 1990 levels. This is a first order decision. International agreement on the desirability of attaining these objectives sparks the next level of decision making—the specific actions and activities that must be carried out in order to attain the agreed objectives. The decision to provide developing countries funding to undertake those actions or activities may then follow. This third level of decision making is the focus of this article. At this level, those creating the financing facility aim to identify the collective financing model that maximizes the likelihood that the facility’s funds will reach the beneficiaries most likely to use them for activities and actions that the facility’s contributors decide are necessary to achieve their collective goals.
The precedents offer three competing models. This article does not purport to state which of these models is preferred on an empirical basis. The research needed to support such a claim has not been done. Instead, this article shows, from a theoretical perspective, which approaches minimize agency costs and maximize accountability and participation. These attributes provide no guarantee that funding provided by a facility that has these attributes will be effective.  However, these attributes are generally associated with improving the likelihood that funding will reach its intended targets, that both the target beneficiaries and the approved action or activity will have credibility, and that there will be buy-in from those whom funding is intended to assist.7 In other words, having these attributes is associated with being an optimal financing facility.
Fusion versus autonomy

The threshold question that sovereign creators of any new global financing facility must address is the question whether and why they need a new facility. After all, there are legacy institutions – the World Bank (Bank), the UN, and WHO, set up to address development and health needs. Aren’t these, then, the institutions that sovereigns should turn to when a development and/or health need arises?8 In truth, however, the emergence of the financing facility norm that began with the GEF reflects a loss of confidence in the capacity of those institutions to address the need in question.
The precedent models reflect varying degrees of confidence in the legacy institutions. They differ among themselves according to the creators’ degree of willingness to cede or withhold control to or from the legacy institutions. At one extreme, the creators of the financing facility settle for fusion with a legacy institution. They pool their contributions in a central fund which is then administered by the institution, most commonly the World Bank or the United Nations Development Agency (UNDP). This is the Traditional Trust Fund model. At the other extreme, the creators of the financing facility create an autonomous legal entity, with legal personality and legal capacity, and its own, independent policies and procedures. This is the New Legal Entity model.9 In between these two extremes, the creators of the GEF devised a halfway house under the auspices of the World Bank. This model, which Professor Smyth has previously labeled the Quasi-Entity Fund, allows the creators of a fund to exercise active, ongoing control in allocating their pooled resources, while stopping short of creating the fund as an autonomous legal entity.10
The choice of model, or a decision to create a new model, engages core issues of global governance.11 The model determines who will control the facility’s resources, what policies, procedures, and practices will apply to their use, and the formal status of the facility in the outside world.12
The Traditional Trust Fund

In the Traditional Trust Fund model, contributors agree on broad objectives for the fund but surrender control to the entity serving as trustee (typically a legacy institution) to select what projects get funded and to administer the fund in accordance with its standard operating policies.13 Although this model has fallen into disfavor as being too legacy institution-centric, it is still in use. The Avian Flu and Swine Flu Facilities, created in 2006 and 2009, respectively, use this model.14 The Health Results Innovation Trust Fund, created in 2007, is also based on this model.15 All three of these funds are relatively narrow in scale and time bound, key factors influencing the choice of the Traditional Trust Fund model. Avian and Swine Flu have been seen as immediate but addressable and relatively short-term problems (in contrast, for example, to HIV/AIDS).  As its name implies, the Avian Flu Facility aims to minimize the risk of avian influenza (and other zoonoses) and of a possible human pandemic influenza in developing countries that lack adequate domestic resources and capacity to combat the disease.16 Similarly, the Swine Flu Facility aims to help control the spread of swine flu, A/H1N1.17 The Health Results Innovation Fund, meantime, pilots results-based financing schemes for health services that reduce infant mortality and improve maternal health. It was not created to be an indefinite life support. The World Bank, as trustee of these funds, makes all key decisions in their day to day implementation.
The Quasi-Entity Fund

Under the Quasi-Entity Fund model pioneered by the GEF, the fund’s creators set the new facility up as a trust fund with the World Bank named as trustee. They do not, however, give the World Bank full power over the fund. Instead, the creators control the allocation of the fund’s resources themselves. They reduce the trustee role to rudimentary financial management. The GEF’s creators pushed for a model different from the Traditional Trust Fund because they deemed the agency costs of putting the World Bank in control of the fund too high. At that time, the Bank had a dismal record on environmental protection and the GEF’s creators were concerned that the Bank, if left in control, would use the fund’s resources to further the Bank’s lending agenda at their agenda’s expense.18 At the same time, the GEF’s creators wanted to avail themselves of the Bank’s financial management experience.
The Quasi-Entity Fund has a fund-specific governance structure that effectuates the creators’ desire to stay in control of allocating the fund’s resources. In the GEF, this structure includes a general assembly, a governing council, a technical advisory body, and a secretariat.19 The assembly and governing council are comprised primarily of donor representatives. The assembly consists of high-level government representatives and retains the power to make any changes in the fund’s founding principles. The fund’s locus of power, however, is the governing council. This is the body that decides what projects and programs will receive funding.20 The fund’s technical advisory body, comprised of scholars as well as technical and scientific experts in the substantive areas to be funded, advises the governing council on the scientific and technical merits of funding proposals. The secretariat serves as the glue of the entire facility.21
Following the GEF’s creation, the popularity of the Quasi-Entity Fund model exploded and fast became the norm rather than the exception for setting up a collective financing mechanism to achieve development goals.22 No subsequent fund replicated the GEF exactly, but the same basic components of the Quasi-Entity Fund structure and the same driving forces behind their creation apply to subsequent funds. The structure always involves: one or more governing bodies comprised wholly or primarily of contributors that meet periodically during the year to make funding decisions, a dedicated secretariat to manage the fund day-to-day, and World Bank-provided financial management services.
The driving force for using the Quasi-Entity Fund model always involves an intention on the part of the fund’s creators to have the fund operate differently than it would operate if it were wholly under a legacy institution’s control. For example, in the case of the Education Fund, the fund’s donors had extensive experience in the education sector from previous bilateral funding efforts.23 Though committed to pooling their resources in support of a harmonized approach, they were determined to stay actively involved in the fund.24 They initially provided for this active involvement by creating a donor governing body (a Strategy Committee) to decide the countries that would receive financing, as well as the amount received, from the Education Fund.25,26 As initially established, the fund provided funding for the education sector on terms and conditions different from those that applied to International Development Association (IDA) funding (the primary source of World Bank funding for the countries that are the Education Fund’s target beneficiaries).27 Education Fund grants were made without the kind of specificity regarding deliverables, measurable outcomes, and policy reforms that equivalent IDA financing would require.28
In practice, the Quasi-Entity Fund model fails to achieve the goal of doing things differently from the legacy institutions. The model has limitations that stymie its potential to reduce agency costs and that generate accountability concerns.29 The Quasi-Entity Fund’s limited ability to reduce agency costs arises from the fact that the structure does not provide for independent legal status. This means that a Quasi-Entity Fund has no capacity to enter into contracts on its own behalf. For example, a Quasi-Entity Fund cannot hire staff for the fund secretariat. This lack of legal capacity means that instead of a Quasi-Entity Fund’s secretariat being employees of the fund, they end up being World Bank employees. This is because the World Bank, as trustee of the fund, is the only entity with formal legal capacity to act on the fund’s behalf.30 Although these funds are set up as Quasi-Entity Funds precisely because their creators want to do things differently than the Bank, from the time they are hired, their secretariat staff are placed in the impossible position of having to serve two masters with conflicting agendas.
This embedded conflict of interest has led to instances of stalemate and paralysis throughout the history of the GEF and the Education Fund.31 The record of conflict between the GEF Secretariat and the World Bank contributed to the Green Climate Fund creators’ decision to reject the Quasi-Entity Fund model. It also contributed to their rejecting the notion of having the GEF secretariat expand to serve as the secretariat of the Green Climate Fund. These conflicts were eased in the Education Fund when the fund restructured in 2010 to integrate more fully into the World Bank’s regional portfolio and to bring its policies and procedures more in line with those of the Bank.32 However, the Education Fund’s secretariat’s dual reporting role to the fund’s governing bodies and to the Bank as the host organization remains.33
The Quasi-Entity Fund presents accountability concerns because it shifts responsibility for use of a fund’s resources away from the World Bank as trustee and onto the donor representatives and other members of the fund’s governing body.34 This shift is not inherently bad. But to maintain accountability in the face of this shift, donors and the World Bank need to agree upon a clear framework that articulates: (i) who of the donor governing body(ies), the secretariat, and the World Bank as Trustee will assume responsibility for monitoring the use of the fund’s resources and (ii) how the responsibility the governing bodies owe to donor country citizens (whose taxes supply the resources that governments contribute to these funds) will be discharged. Clarity is also needed regarding the scope of the governing bodies’ responsibilities to other affected parties for its decisions; and regarding what policies and procedures the governing body(ies) will follow in making its decisions.35 In the absence of articulated standards, their observance cannot be judged. Nor can any failure to observe unarticulated and undefined  standards be sanctioned. Without articulated, observable and sanctionable standards, there is no accountability.36
Having rejected the Traditional Trust Fund model and the World Bank policies and procedures that automatically apply under that model, the creators of a Quasi-Entity Fund must enact an alternative accountability framework. Such accountability gaps have actual and potential negative outcomes. These include failure in the oversight of the funds’ resources resulting from misaligned responsibilities among the fund’s organs, liability and reputational risk for donors and the World Bank, and the application of ad hoc rather than optimal fiduciary practices.37 The accountability gaps in the Quasi-Entity Fund model are curable once acknowledged and addressed. Accountability may be achieved by specifying what other policies and procedures apply and by creating checks and balances to ensure they are implemented. It is the unacknowledged lacuna that gives rise to an accountability deficit. The agency costs that arise from the Quasi-Entity Fund model’s lack of independent legal capacity, however,  are an intractable deficit.
The New Legal Entity

The Global Fund is the landmark precedent for the New Legal Entity model. Its creators established it as an. independent entity because they wanted to address HIV/ AIDS, malaria, and tuberculosis at the grassroots level, a level the legacy institutions were ill-equipped to serve.38 The fund is a legal entity under Swiss law.39 Its Board of Directors allocates the fund’s resources and makes all other key decisions. The World Bank, UNAIDS, and WHO are members of the Board but do not have a vote.40 The World Bank manages the fund’s resources, but is not involved in deciding how they are allocated. GAVI Alliance, a public-private collaboration which includes the Gates Foundation, donor countries, the World Bank, WHO and United Nations Children’s Fund (UNICEF), became an independent legal entity under Swiss law when it restructured in 2009.41 Like the Global Fund, GAVI Alliance is formally and operationally distinct from the legacy institutions. The World Bank, WHO, and UNICEF have permanent seats on GAVI Alliance’s board, but do not control it. Instead, they are just three members of a 28-member board where all board members have one vote.42
The Green Climate Fund is the  most significant recent example of the New Legal Entity model.  This fund seeks to catalyze developing countries’ greenhouse gas reduction efforts, by providing resources to them for those purposes.43 In marked contrast to the GEF, the Green Climate Fund’s governing charter provides that it possesses juridical personality and legal capacity.44 Furthermore, the fund purports to provide legal personality and capacity at both the national and international level. It improves on the Global Fund, which only has legal status at the national level and is thereby excluded from some advantages that accrue from being recognized as a legal entity at international law.45
The key drawbacks of the New Legal Entity model are the enormous commitment and costs involved in setting up an entirely new legal entity, complete with fund-specific policies, procedures, and processes. The administrative costs are also formidable. The creators of a new initiative invariably start out by declaring that the new initiative will be a lean, mean financing machine, an implicit rebuke to the legacy institutions, which are perceived as bloated bureaucracies. That goal translates initially into a skeletal secretariat staff, charged with the perfunctory tasks of serving as the repository of new proposals, convening meetings, handling logistics, and serving as the key purveyor of information about the initiative to the outside world.  But quickly, the secretariat expands and frequently adds to its functions the preparation of technical papers and other substantive and qualitative responsibilities that require a substantial staff. Both the Global Fund and GAVI Alliance have followed this trajectory. The danger here is that the secretariat becomes one more bloated bureaucracy.
A preferred approach

Taking stock of the precedent models, it is clear that none of the existing models are optimal. The Quasi-Entity Fund jumpstarted the move away from the fusion involved in the Traditional Trust Fund. It sowed the seeds for the New Legal Entity model.  Its intractable agency costs, however, make it a disfavored model. The New Legal Entity model offers advantages, but the proliferation of autonomous institutions, each with institution-specific policies, procedures, and processes gives cause for concern on many levels—coordination, duplication, and high administrative costs among them. For these reasons, the creators of an FCGH financing facility should aim for a new approach that both staunches proliferation and incorporates best practices from the precedent entities. What we need is an umbrella framework that allows different global health initiatives to retain their respective identities and fill their particular niches, but provides for a single set of policies, procedures, processes, and standards to apply across the spectrum. Before considering how the formal contours of such an umbrella framework might work, it is worth examining the essential elements it would have to incorporate.
The precedents indicate that several elements are key to the credibility and staying power of any financing initiative. These elements include (i) multi-stakeholder input, (ii) access to cutting edge expertise, (iii) the capacity to mobilize resources from a variety of sources and mechanisms; and (iv) qualifying conditions on which the facility’s resources will be allocated.
Multi-stakeholder decision making

The legacy institutions have been faulted for affording inadequate voice to developing countries, nongovernmental organizations, and civil society.46 Their exclusively governmental nature also inhibits the scope of their interaction with foundations and the for-profit private sector. The GEF made strides in multi-stakeholder decision making, giving non-donor countries a say in the allocation of the fund’s resources.47 It also gives nongovernmental organizations observer status at meetings of its governing bodies But the health sector has taken more radical steps towards multi-stakeholder participation.
The Global Fund represents a novel approach to multi-stakeholder participatory governance.48 Its governing bodies reflect two key goals of its proponents: the capacity to function at the country level, informed by local needs and practices; and the capacity to incorporate the for-profit (especially pharmaceutical corporations) and not-for-profit (especially nonprofit organizations involved in health care delivery in developing countries) arms of the private sector.
At the global level, the Board of Directors is the fund’s supreme governing body, with authority to set the fund’s policies and strategies, and allocate its resources.49 Twenty of its 28 members are voting members, of which four are NGO representatives, seven represent developing countries, eight represent donor countries, and one is a representative of the for-profit private sector.50,51 At the country level, the fund receives proposals exclusively through a local governance process known as the Country Coordination Mechanism (CCM), which brings together within a single structure all actors working on AIDS, tuberculosis, and malaria within a given country.52 The CCMs include representatives from the government, academic institutions, multilateral and bilateral agencies, NGOs, private business, and people living with HIV/AIDS, malaria, and tuberculosis.53
As others have pointed out, the value of multi-stakeholder participation in any institution is only as good as the processes the institution employs to ensure such participation is transparently and equitably achieved.54 The Global Fund has a stringent system for ensuring the competence, accountability, and ongoing representativeness of the representatives who participate in its governance.55 Each constituency group represented on the board is elected in accordance with processes agreed upon by their respective constituencies in accordance with minimum guidelines set by the fund.56 CCMs, for example, must document their selection processes, identifying required skills, competencies, and roles and responsibilities.57
The fund tackles potential concerns about participants’ accountability by pursuing detailed procedures for selecting board and CCM participants from large pools of eligible organizations.58 For example, its system for rotating NGO representatives allows for a continual monitoring of NGO representatives’ bona fides. These procedures, therefore, provide reassurance that representatives who participate are accountable entities at their selection and throughout their participation.
The fund’s gatekeeping also addresses conflict of interest concerns. These concerns arise when participants on the board or CCM are themselves eligible to submit proposals for funding. The fund requires board and CCM voting members to disclose their work programs as a means of managing this concern. Finally, the fund implements strict diversity criteria so that board and CCM participants will in fact represent the voice of the communities to which the fund’s assistance is directed.  The Education Fund followed the Global Fund’s lead on multi-stakeholder participation when it restructured in 2009.  Education NGOs now have a voting role in the Educations Fund’s decision-making bodies.59
Meanwhile, GAVI Alliance’s governance structure aims to cement a relationship between private industry involved in manufacturing vaccines, developing country health authorities, and public and private sources of funding.60 It also forges a nexus between vaccine funding and cutting edge research. Its board, the supreme governing body, is heavily weighted towards technical expertise.61 Of its 28 members, 18 represent technical expertise who include vaccine industry representatives from both the emerging and the industrialized vaccine industry, one representative from a technical/health research institute, and nine unaffiliated experts.62 At the country level, GAVI Alliance operates through Inter-agency Coordination Committees and Health Sector Coordination Committees. These bodies, respectively, review proposals for immunizations services, new vaccines, and injection safety support; and proposals for health system strengthening and civil society support.63 Both bodies include recipient country representatives, donor country representatives, and international and local NGOs.64
These initiatives show that the governing bodies of a development  imitative do not have to be government-only clubs. Representatives of donor governments may participate as equals alongside representatives of recipient countries and other entities. A norm of multi-stakeholder participation has emerged, although differing degrees of such participation are possible. The Global Fund’s template serves as a possible approach for other initiatives.  Whether this approach reflects best practice is controversial. The fund has been criticized for superimposing on recipient countries a new structure inconsistent with the principle that assistance should work through established country processes.65 The GEF and Green Climate Funds’ NGO observer approach offers a more restrained alternative.66 Both templates contrast sharply with the government-only, top-down processes of the legacy institutions’ governing bodies.67
Technical advisory body

The technical advisory body is a core component of any new initiative’s governance structure because it is the initiative’s avenue to up-to-the minute scientific and technical research on which funding decisions will be based. The precedents provide insight into the kind of criteria that creators of a new initiative must set to ensure the ongoing quality of this advisory body. They also illustrate the kind of processes required to ensure that this body’s input feeds into funding decisions. The GEF introduced the idea of having a scientific and technical advisory panel (STAP) as part of an initiative’s governance structure. The global health initiatives have advanced the design of such a body to a fine art.
The Global Fund’s Technical Review Panel reviews all funding proposals addressed to the Global Fund for technical merit (including soundness of approach, feasibility, and potential for sustainability).68 The panel is a team of forty independent scientific and programmatic experts with expertise in HIV/AIDS, tuberculosis, and malaria.69 They also reflect a balance in terms of gender, regional representation, and sectoral experience.70 They apply review criteria established by the Fund’s board and recommend for funding only those proposals that reflect genuine, broad participation and ownership of all interested groups.71
GAVI Alliance has a heavy representation of technical experts on its board and also relies heavily on an Independent Review Committee composed of an interdisciplinary team of independent experts identified and nominated by board members.72 This process was recently queried by an external review of GAVI Alliance’s Independent Committees which suggested that an open and competitive appointment of members would provide greater assurance and transparency of independence.73 Nonetheless, the Global Fund and GAVI Alliance offer highly evolved processes for securing technical and scientific input to inform their decision making. Other initiatives, such as the  Green Climate Fund, which has yet to assemble its expert body, are likely to follow suit.
Resource mobilization

Autonomy provides the freedom to avail of a range of resource mobilization devices. The use of innovative financing mechanisms in the health sector outpaces anything that has been seen in the environment or education sectors to date. The Global Fund and GAVI Alliance have taken full advantage of both old and new forms of resource mobilization. Both began with ad hoc funding arrangements but have since moved to regular replenishment cycles.74 In addition, they both pursue private philanthropy initiatives. The Global Fund, for example, launched (PRODUCT) RED and Debt2Health to increase its available financing.75 Though these particular programs have drawn criticism as insufficiently transparent, the idea of using creative mechanisms to attract previously untapped sources would seem a good one, subject to adequate controls. GAVI Alliance has created a US charitable organization, the US friends of GAVI Alliance organization, to enable US donors to make tax-deductible donations to GAVI Alliance.76
GAVI Alliance is also the beneficiary of the International Financing Facility (IFFIm) and the Advance Market Mechanism (AMC), two sophisticated financing arrangements which avail of private investor interest and private industry capacity to meet niche needs in global health. IFFIm, founded by a group of government donors in 2006, serves as a financing device through which long-term government pledges of development aid are converted into immediately available cash by issuing bonds in capital markets.77 The World Bank handles the mechanics of IFFIm’s bond issuance and financial management.78 All of the bond proceeds, however, go to GAVI Alliance.79
The AMC was launched by a group of government donors and the Gates Foundation in 2007 to provide vaccine manufacturers an incentive to develop and produce affordable vaccines tailored to the needs of developing countries.80 It began with a pilot scheme to create a market for vaccines against pneumococcal disease which went into effect on June 12, 2009.81 The AMC effectively guarantees vaccine manufacturers a pre-agreed price for target vaccines.82 Notably, the AMC’s operations involve the active engagement of several of the legacy institutions, including the World Bank, WHO, and UNICEF. Under the AMC’s framework arrangements, the Word Bank holds donor contributions to the AMC on trust, pending their disbursement to GAVI Alliance for vaccine purchases. WHO pre-qualifies vaccines as an initial step in their being deemed eligible for AMC funding, and UNICEF handles the procurement of eligible vaccines.83 However, the AMC’s principal governing body, which is dominated by unaffiliated technical experts, drives funding decisions.
Resource allocation

The precedent health financing initiatives are more advanced on resource allocation than other sectors and embody several core principles in their resource allocation strategies For one thing, a range of entities are eligible to be direct recipients.  The Global Fund provides its support for a particular country as a grant to a recipient (the Principal Recipient) designated by the Country Coordinating Mechanism.  Though the Principal Recipient will often be a government ministry, a range of other entities, including faith-based organizations, private sector firms, and foundations are also eligible to serve in the Principal Recipient role.84
Support for health may also be provided in innovative forms. For example, countries can apply to GAVI Alliance for five kinds of support: immunization services, injection safety, new and underused vaccines, health system strengthening, and civil society organization support.85 GAVI Alliance may provide direct funding to the recipient country or its board can decide to provide the required supplies of vaccine and injection materials to the recipient country.86 If GAVI Alliance’s Interagency Coordination Committee is satisfied with the country’s procurement practices, the country can receive cash in lieu of supplies.87
The health initiatives also demand evidence of beneficiary buy-in. The Global Fund demands the active engagement and program ownership from the recipient country.88 Further, GAVI Alliance adjusts the level of required co-funding according to the recipient’s poverty level.89
Grants are the sole form of support the Education Fund provides and, also, the primary form of support the GEF has provided (though its charter provides for it to provide support in other forms).  The Green Climate Fund’s charter, however, authorizes the fund to use a range of financing and co-financing instruments which allows for maximum flexibility as it forms its allocation strategies.
As the precedents show, the international community has changed how it mobilizes, disburses, and administers finance intended to help low-income countries address global problems. A new generation of global financing arrangements has emerged with a preference for creating new autonomous entities. The question arises, however, whether the world; donor and recipient nations; and other stakeholders, are optimally served by this host of new, autonomous legal entities designed to address a range of global needs. We suggest that the answer to this question is no. The precedent financing initiatives set in motion a vital process of change. That process began with the GEF’s introduction of the Quasi-Entity Fund, progressed to the Global Fund’s bold step in setting up a national legal entity under Swiss law, and culminated with the Green Climate Fund’s creation as an independent entity in both national and international law. But the time has come for the process to mature to enable all interested parties to reap the benefits of the changed norm while staunching needless proliferation.
Proliferation can result in reinventing the wheel and unnecessary costs.  Incurring costs to create a new mechanism to pursue substantively new activities (such as measuring progress on climate change or the attainment of certain good health indicators) is inevitable.  But it should not always be necessary to incur the costs involved in creating a whole new apparatus to conduct non-specialized, run-of-the-mill activities involved in staffing and running a new institution. Nor should it be necessary to re-devise a host of operational policies associated with monitoring and accounting for the use of funds. Proliferation can also result in imposing conflicting reporting and other demands on recipient countries. These demands fly in the face of the spirit of the Paris Declaration on Harmonization, which stresses simplifying, not multiplying reporting demands.90
So what might be an alternative to proliferation? The pre-1990s alternative was to have one model, the Traditional Trust Fund,which piggy-backed on the administrative and operational policies of the legacy institution serving as trustee while ceding all control of the initiative to the trustee. By voting with their feet, the creators of the post-1990 initiatives frequently reject that model as inadequate to meet today’s needs. We want more of a multi-stakeholder approach and greater flexibility than the legacy institutions allow. What’s been lost in moving away from that unitary model, however, is the ability of a new initiative to incorporate and rely on policies, procedures, and operational practices that reflect years of institutional history and work quite well.
These policies, procedures and operational practices include, for example, operational policies covering both fiduciary and social safeguards. In the area of fiduciary safeguards, for example, they cover procurement policies; practices for assessing potential recipients’ financial management capacity; and financial reporting standards.  In the area of social safeguards, they address such matters as minimum environmental standards and the treatment of indigenous groups.  The unitary model also has well defined administrative policies, such as human resources policies to govern the terms and conditions of employment governing a secretariat staff.
What we need, therefore, to replace the unitary model, is an umbrella framework that does not subjugate a new initiative to a legacy institution, but offers a template of policies, procedures, processes and standards. Different financing initiatives set up in accordance with the framework could retain their respective identities and fill their particular niches without reinventing standard processes and while still availing of best practices. One can visualize the umbrella framework operating like a food court in a mall: a cluster of distinct initiatives with distinct agendas and funding sources, but all availing of choice of template forms for their governance structure and standard operating procedures provided for under the framework. As done by the Global Fund and Green Climate Fund, initiatives created within the framework could draw upon the financial management services of the World Bank, again, avoiding the need to reinvent boiler plate financial management services.
The templates available under the umbrella framework could be devised using a mix and match approach that borrows liberally from different aspects of precedent initiatives that reflect best practices. For example, in the area of multi-stakeholder input, the uniform framework could include a template that sets standards for assessing and monitoring representatives based upon vetting processes devised by the Global Fund. The precedents show this kind of cherry picking of policies and practices can be done at an initiative level. The AMC, for example, has a multi-stakeholder governing body like the Global Fund. It also avails of the basic financial management practices of the World Bank, the procurement policies of either the Bank or UN, and the technical know-how of WHO. At the same time, the AMC’s use of these pre-existing practices is supplemented by additional specialized vetting committees, customized by the AMC, to conduct AMC-specific, specialized reviews. The fluidity of this kind of approach enables a new initiative to incorporate best practices based on the lessons of experience.
Though the precedents at an initiative by initiative level have laid the groundwork for an umbrella framework approach, the formal embrace of such an approach by the international development community and international legal order has not yet occurred. So how should the supporters of an FCGH financing facility proceed in the meantime? They could, of course, create a new autonomous FCGH financing entity that would operate alongside the Global Fund, GAVI Alliance, and other smaller global health initiatives that currently exist. This would follow the approach taken by the Green Climate Fund’s creators. The Green Climate Fund’s charter establishes a wholly new institution and provides for it to devise a host of new policies and procedures. This charge presents significant potential for reinventing the wheel at great cost. It therefore seems an ill-advised course for the supporters of a FCGH facility to follow.
Alternatively, the supporters of an FCGH facility could expand the size of the Global Fund and the mandate of its governing bodies to become the FCGH Fund. The difficulty here might be that the Fund’s singular focus on HIV/AIDS, malaria, and tuberculosis and its public persona as a fund dedicated to those diseases may make it an inadequate anchor for a facility that is much broader in scope.
A third alternative would be to pioneer the umbrella framework approach described above, as an umbrella framework for global health financing. Under this approach, the different global health financing initiatives would retain their respective identities and fill their particular niches.  The framework, however, would provide ready templates for new initiatives created to fill the gaps. The precedent initiatives form a robust base from which to build the template governance structures and administrative and operational policies for such a framework. Moreover, the precedents have forced the legacy institutions to open up to the possibility of change. Key stakeholders, including representatives of the Global Fund, GAVI Alliance, WHO, the World Bank, along with donors, would have to agree on how to divide responsibility for devising and maintaining the framework.
Ideally, this framework approach would allow for an FCGH financing facility that reflects the optimal degree of fusion and autonomy without adding further to institutional proliferation. The goal would be to achieve an integrated approach that (i) makes use of the legacy institutions’ services in those areas where they have a comparative advantage, and (ii) draws upon the considerable investment that has already been made by a range of new and old institutions to devise standard operating procedures.
The FCGH is a bold and innovative move in global health. It could also pioneer a bold and innovative move in international financing for development.
Sincere thanks to Erica Dressler and Temple Law Librarian Noa Kaumeheiwa for excellent research assistance.
Ella Scheepers, LLM, is working in the field of human rights in Johannesburg, South Africa.
Please address correspondence to the author at ella.scheepers02@gmail.com.
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4. The fund was created by some of the countries who founded Education for All (EFA);World Bank, “The global partnership for education and the World Bank.” Available at http://go.worldbank.org/8EZE2MXEZ0.
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8. S. Smyth, “Collective action for development finance,” University of Pennsylvania Journal of International Law
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9. Smyth (2011, see note 8).
10. Ibid.
11. See Ibid; Hawkins et al. (see note 7), p. 9; M. Ivanova, “Institutional design and UNEP reform: Historical insights on form, function and financing,” International Affairs
88/3 (2012), p. 565; R. W. Grant and R. O. Keohane (see note 7), p. 29.
12. Smyth (2011, see note 8).
13. Smyth (2011, see note 8), p. 968.
14. Avian and Human Influenza Facility, AHI Facility document (2007), p. 3. Available at http://siteresources.worldbank.org/INTTOPAVIFLU/Resources/AHI.Facility.Rocio.May07.pdf; Wall Street Journal, World Bank approves $500M fast-track facility for swine flu (2009). Available at http://online.wsj.com/article/BT-CO-20090602-714268.html.
15. The World Bank, The World Bank and Results-Based Financing for Health
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16. AHI Facility document (see note 14).
17. World Bank approves $500 million fast track facility for swine flu (see note 14)
18. Smyth (2011, see note 8), p. 992.
19. Global Environment Facility, Instrument for the establishment of the restructured Global Environment Facility
(Washington, D.C.: GEF, 2011), pp. 15-19. Available at http://www.thegef.org/gef/instrument.
20. For small proposals, the Council may delegate this power to the Secretariat. GEF Council Document, Small Grants Programme: Execution arrangements and upgrading policy for GEF-5 (GEF/C.36/4; 2009). Available at http://www.thegef.org/gef/sites/thegef.org/files/documents/C.36.4%20Small%20Grants%20ProgrammeFINAL.pdf.
21. Smyth (2009, see note 7).
22. Smyth (2011, see note 8).
23. Ibid. United Nations Educational, Scientific and Cultural Organization (UNESCO), EFA global monitoring report 2010: Reaching the marginalized (Paris: UNESCO, 2010), p. 432. Available at http://www.unesco.org/new/fileadmin/MULTIMEDIA/HQ/ED/GMR/pdf/gmr2010/gmr2010-annex-05-aid.pdf.
24. Smyth and Triponel, “Education as a lynchpin of development: Legal and policy considerations in the formation of the education for all—Fast Track Initiative Catalytic Trust Fund,” Sustainable Development, Law, and Policy
6 (2005) pp. 8-10.
25. Ibid., p. 10.
26. Ibid., p. 8.
27. Education For All Fast-Track Initiative, Framework (2004), p. 7. Available at http://www.educationfasttrack.org/media/library/FrameworkNOV04.pdf.
28. Smyth and Triponel (2005, see note 24), p.; S. Smyth, “Agency and accountability in multilateral development finance: An agenda for change,” The Law and Development Review
4/1 (2011a), pp. 65-140.
29. Ibid.
30. S. Smyth, “Can business learn to love the environment? The case for a U.S. corporate carbon fund,” Rutgers Law Review
58/2 (2006), pp. 451-510.
31. Smyth (2011, see note 8), pp. 1015-1019.
32. Education for All – Fast Track Initiative, FTI Reforms: Reinvigorating the Partnership, Strengthening support for EFA Results. Available at http://www.globalpartnership.org/media/library/Secure/Board_Documents_May-2010/Final_FTI_Reform_final.pdf.
33. Ibid. 4.4.6.s.
34. Smyth 2011a, see note 28) pp. 105-111.
35. Smyth (2011a, see note 28), p. 109. Accountability, as defined in the seminal work by R. W. Grant and R. O. Keohane, “Accountability and abuses of power in world politics,” pp. 29-43 pp. 29-43 (see note 7).
36. Ibid.
37. Smyth (2011a, see note 28), pp. 117-118.
38. Smyth (2013, see note 7) pp. 410-411.
39. Global Fund,  By-Laws (amended November 21, 2011), p. 1. Available at http://www.theglobalfund.org/en/about/structures/board.
40. Ibid., Art. 7, pp. 2-3.
41. GAVI Alliance, “What we do (2013).” Available at http://www.gavialliance.org/about/mission/what/.
42. GAVI Alliance, Board composition. (2013).  Available at http://www.gavialliance.org/about/governance/gavi-board/composition/.
43. Green Climate Fund, Governing Instrument for the Green Climate Fund, UNFCCC Doc. No. FCCC/CP/2011/9/Add.1 (2011), pp. 2, 9. Available at http://gcfund.net/fileadmin/00_customer/documents/pdf/GCF-governing_instrument-120521-block-LY.pdf.
44. Ibid., p. 3 (Section II,B,7).
45. C. F. Amerasinghe, Principles of the institutional law of international organizations
, Second Edition (New York: Cambridge University Press, 2005), pp. 92-100; Smyth (2011a, see note 28), pp. 122-124.
46. R. B. Zoellick, “The end of the Third World? Modernizing multilateralism for a multipolar world,” Law and Business Review of the Americas
16/3 (2010), pp. 371-384.
47. Global Environment Facility (2011, see note 19), pp. 15-19.
48. Smyth (2013, see note 7) pp. 398-99; A. Triponel, “Global Fund to fight AIDS, tuberculosis and malaria: A new legal and conceptual framework for providing international development aid,” North Carolina Journal of International Law and Commercial Regulation
35 (2010), pp. 173-232.
49. Global Fund, By-Laws (2011, see note 39), p. 6, Art. 7.4.
50. Definition of the Term Civil Society, 8th Policy and Strategy Committee Meeting, Geneva, September 19-21, 2007, GF/PSC8/07 (2007).
51. Global Fund, By-Laws (2011, see note 39), Global Fund, “Board, Art. 7. Ibid.
52. Global Fund, Guidelines and requirements: CCM guidelines and guidance notes (2013).  Available at http://www.theglobalfund.org/en/ccm/guidelines/.
53. Global Fund, Framework document (Geneva: The Global Fund, 2012), pp. 94-95. Available at http://www.theglobalfund.org/documents/core/framework/Core_GlobalFund_Framework_en/.
54. D. Brakman Reiser and C. R. Kelly, “Linking NGO accountability and the legitimacy of global governance,” Brooklyn Journal of International Law
36 (2011), pp. 1011-1073.
55. Global Fund, Global Fund Governance Handbook Section 7: Board Constituencies. Available at http://www.theglobalfund.org/en/library/documents/.
56. Global Fund (2011, see note 39), Art.7.1; Global Fund, Operating Procedures of the Board and Committees (amended November 21, 2011), Annex 1 at p. 53.  Available at http://www.theglobalfund.org/en/library/documents.
57. Global Fund, “Guidelines and requirements: CCM guidelines and guidance notes.” Available at http://www.theglobalfund.org/en/ccm/guidelines.
58. For an indication of the kinds of concerns that arise, see K. Anderson and D. Reiff, “Global civil society: A skeptical view,” in H. Anheir, M. Glasisus, and M. Caldor (eds.), Concepts of global civil society
(London: Sage, 2004), pp. 26-39.
59. Global Partnership for Education, “Catalytic Fund.” Available at www.educationfasttrack.org/financing/catalytic-fund.
60. GAVI Alliance, “Industrial country pharmaceutical.” Available at http://www.gavialliance.org/about/partners/industrialised-country-vaccine-industry.
61. GAVI Alliance Statutes (2008), Art. 13. Available at http://www.gavialliance.org/resources/GAVI_Alliance_Statutes.pdf. See GAVI Alliance By-Laws (revised 2010), Art. 3. Available at http://www.gavialliance.org/resources/GAVI_Alliance_By_laws.pdf.
62. GAVI Alliance Statutes (2008), Art. 9. Available at http://www.gavialliance.org/resources/GAVI_Alliance_Statutes.pdf; GAVI Alliance, “Board members.” Available at http://www.gavialliance.org/about/governance/boards/members/index.php.
63. GAVI Alliance, Inter-agency coordination committee (ICC).  Available at http://www.gavialliance.org/glossary/f-j/; GAVI Alliance, Handbook at 17, available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
64. Ibid.
65. J. Putzel, “The global fight against AIDS: How adequate are the National Commissions?” Journal of International Development
16/8 (2004), pp. 1129-1140; Organization for Economic Cooperation and Development, Do no harm: International support for statebuilding (Paris: OECD, 2010), pp. 9-27.
66. Global Environment Facility, The GEF and civil society organizations, a strategic partnership (May 2010) p. 5. Available at http://www.thegef.org/gef/sites/thegef.org/files/publication/GEF_CSO_partnership-CRA.pdf; Green Climate Fund, Governing Instrument (2011, see note 43).
67. Smyth (2013, see note 7) pp. 432-439.
68. Global Fund, Technical review panel (2013). Available at http://www.theglobalfund.org/en/trp/.
69. Ibid.
70. Ibid.
71. Ibid.
72. GAVI Alliance By-Laws (2010, see note 62, Art. 5.1).
73. GAVI Alliance, Review of Independent Review Committees. Available at http://www.gavialliance.org/results/evaluations/irc-review.
74. The Global Fund has had three replenishments – in 2005, 2007 and 2010.Global Fund, Replenishment mechanism (2013). Available at http://www.theglobalfund.org/en/donors/replenishment/. GAVI held its first formal replenishment pledging process in 2010. GAVI Alliance, Call for action and resources (October 2010). Available at http://www.gavialliance.org/funding/how-gavi-is-funded/resource-mobilisation-process/call-for-action-and-resources-october-2010/.
75. PRODUCT (Red) and the Global Fund, Available at http://www.theglobalfund.org/en/donors/private/red/; Innovative Financing Debt2Health_ Factsheet, Available at www.theglobalfund.org/documents/innovative_financing/InnovativeFinancing_Debt2Health_Factsheet_en.
76. GAVI Campaign, see note 75.
77. GAVI Alliance, Institutional timeline. Available at http://www.gavialliance.org/about/mission/origins/. IFFIm, “Overview.” Available at http://www.iffim.org/about/overview.
78. IFFIm, “Overview” (see note 77).
79. GAVI Alliance, Innovative finance (2013). Available at http://www.gavialliance.org/funding/how-gavi-is-funded/innovative-finance.
80. Department of Treasury, “Launch of the AMC Initiative” (June 12, 2009). Available at http://www.dt.tesoro.it/en/eventi/dettaglio.html?resourceType=/modules/eventi/elem_0110.html.
81. GAVI Alliance, AMC annual report 2009-2010 – background (Geneva: GAVI Alliance, 2010). Available at http://www.gavialliance.org/library/gavi-documents/amc/.
82. GAVI Alliance (2010, see note 106), p. 10.
83. GAVI Alliance, AMC annual report 2009-2010 – The AMC process: An overview (2010), p. 10.  Available at http://www.gavialliance.org/library/gavi-documents/amc/.
84. Global Fund, Guidelines for proposals round seven 35 (2007).  Available at ado.3cdn.net/cOff9fcc.72e189d85b_u3m6b93oe.pdf.
85. GAVI Alliance, “Types of support.” Available at http://www.gavialliance.org/support/what/index.php.
86. GAVI Handbook, p. 58. Available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
87. Ibid.
88. Global Fund, Partnership Strategy, Core_Partnership_Strategy-en.pdf. Available at http://www.theglobalfund.org/en/about/partnership.
89. GAVI Handbook, p. 11. Available at http://www.gavialliance.org/resources/Handbook_in_English.pdf.
90. Paris Declaration on Aid Effectiveness (2005). Available at  http://www.oecd.org/dac/effectiveness/34428351.pdf.