One of the biggest challenges facing the Lesbian, Gay, Bisexual, Transgender, Queer and Intersex (LGBTQI+) community worldwide is access to healthcare, despite such groups being at a higher risk of some diseases. This can be caused by stigma, discrimination and criminalisation which can lead to ostracization, unemployment or even homelessness. This problem is even worse for LGBTQI+ people living in some low and middle-income countries (LMICs), where often the only healthcare that is available for them are the services that have been funded by Official Development Assistance (ODA) from high income countries.
ODA has been an essential part of creating development gains in LMICs, with ODA making up to 32% of health expenditure in some LMICs. This includes the provision of healthcare for vulnerable communities and funding for health infrastructure. However, these hard-won development gains are at risk of being jeopardised when donors perceive ‘development’ as having been achieved, taking a narrow approach as they withdraw ODA. This process is what we define as ‘transition’.
Globally, with an increasing number of countries moving from low income to lower-middle or middle-income status, transitions are occurring more frequently. Some transitions have been unfairly accelerated due to the financial constraints caused by COVID-19 on donor budgets, despite the persistence and worsening of poverty and inequality globally. Donor relationships in these countries shift from a focus on providing ODA through programmatic investments, to closer economic or diplomatic relationships instead, with domestic financing expected to replace the investment. Unfortunately, transitions are often planned and implemented poorly, which can lead to a reversal of development gains, and, crucially, cause harm to vulnerable communities.
One of the biggest factors contributing to poorly planned transitions is the use of Gross National Income status (GNI) as the main factor donors use to identify if a country is ready to start the transition process. While income status is a simple and quantifiable measure, it does not take into account the complexity of health systems, equity issues, and the diversity of conditions that each country brings. Economic growth does not automatically translate into improved health indices and can mask unequal poverty and health distribution.
Marginalised communities, including LGBTQI+ people, are most at risk of suffering from the health inequalities that are magnified by poor transition practices. In order to sustain the intended impact of ODA and protect the most vulnerable people in LMICs, there must be commitments from donors to implement a transition from ODA to domestic financing in a sustainable and holistic way.
One way in which this can be achieved, is if the UK Government commits to a robust transition policy which contains the following principles:
- A needs-based aid allocation methodology which looks beyond economic indicators, to include a broad range of social and political factors.
- Alignment with locally articulated poverty and inequality alleviation priorities by taking a democratic approach to aid that involves all relevant and representative stakeholders, including country governments, impacted communities, and a fully-funded civil society, to be at the decision-making table around the allocation, direction and withdrawal of donor funding.
- Clear communication and coordination with other donors of international finance, recipient country governments, civil society, affected communities, and other partners.
- Adequate planning for transition from the start of any investment that allows room for flexibility and includes robust, context-specific impact assessment, accompanied by a risk mitigation and monitoring and evaluating framework.
- Sustain development gains through continued technical and financial support for the most marginalised through all relevant stakeholders, including civil society organisations which deliver services and conduct advocacy.
The transition of development funding has a direct impact on “the Bodies, the Lives, and the Rights”  of the LGBTQI+ community in recipient countries. Therefore, the effort to sustain ODA impact is an effort that should be given attention by LGBTQI+ rights advocates. Previously, following engagement with the UK Sustainability and Transition Working Group, the then Department for International Development (DFID) identified transition principles for ODA. Since the department merger to form the Foreign, Commonwealth and Development Office (FCDO) have not recommitted to any transition principles. The UK Government should reaffirm its commitment to upholding the rights of the LGBTQI+ community by outlining a robust transition policy following the publication of the International Development Strategy. The UK government should also affirm its plans to create an LGBTQI+ fund to support access to healthcare for LGBTQI+ people globally.
When we ensure the sustainability of development gains in LMICs, we can work towards ensuring that LGBTQI+ people living in those countries have the right to live freely and with dignity.
______________ Langat, A., 2021. [online] www.devex.com. Available at: <https://www.devex.com/news/criminalization-and-stigma-limit-lgbtq-access-to-health-care-in-africa-99725>
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This blog was written by Amina Babirye, Advocacy Officer at STOPAIDS, with the support of Beatrice Coates, Policy Advocacy Coordinator at RESULTS UK, as co-chairs of the UK Sustainability and Transitions (ST) Working Group. The ST Working Group is made up of NGOs, think tanks and academic institutions working on issues relating to sustainability and transitions, primarily in the global health arena.