The sustainability of critical services provided by CSOs depends on CSOs accessing diversified funding sources. “Social contracting” has been shown to be an efficient and cost-effective way to formally reinforce the link between CSOs and government, and to channel funding to CSOs to provide services that can strengthen national disease responses and health systems. While there is no universally adopted definition of social contracting, it is broadly understood as CSOs (which include and serve key populations) receiving domestic funding to deliver health prevention, treatment, care and support services.

The COVID-19 pandemic has further illustrated the critical role that CSOs can play in advocacy for and delivery of health services to vulnerable communities. Allocating public finances to civil society service delivery in the COVID-19 response is instrumental in leaving no one behind and building forward better.

In 2019, UNDP published a collection of case studies which features experiences from eight middle-income countries that are at various stages of developing social contracting mechanisms to support their responses to HIV. The case studies examine contextual factors such as health systems, human rights, governance systems, disease epidemiology and response, space for civil society overall and experience in social contracting.

A key message to country stakeholders, donors and technical partners from the eight case studies is that it is essential to start work on social contracting early, with meaningful community engagement, investing in enabling laws and policies, contextualizing and preparing customized solutions (testing and improving them) and, ultimately, integrating solutions into public health responses. Examples from countries with developed social contracting mechanisms convincingly demonstrate that these mechanisms can be effective and sustainable solutions for community-led service delivery.

The Sustainability, Transition and Co-financing guidance note by the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) is intended to support countries to strengthen sustainability, increase domestic financing and enhance preparations for the transition from the Global Fund support as they develop funding requests, implement the Global Fund grants and manage national HIV, tuberculosis and malaria programmes. To support country-level dialogue on the development of activities to support social contracting mechanisms, a specific annex dedicated to public financing of civil society service provision is now included in this guidance.

As part of its technical assistance to countries, UNDP supports evidence generation and advocacy to promote stakeholder buy-in, national leadership and increased investments in NGO social contracting for HIV prevention and other health services for key populations. As one approach to support advocacy for investments in social contracting, UNDP has adapted its existing social return on investment (SROI) methodology to determine the social returns of governments’ use of social contracting for health services. It piloted the SROI methodology with a focus on HIV activities funded by social contracting in three countries in Eastern Europe and Central Asia in 2020, with the results showing significant social returns. Building on this pilot, UNDP is developing a global guidance note to support stakeholders in other regions to apply the SROI methodology for HIV-related services delivered through social contracting to key and marginalized populations. SROI analyses can be used as part of lobbying activities to emphasize the benefits brought about by social contracting, increase domestic funding for it and inform decision-making to channel funds into NGO activities that yield the greatest social impact, with a focus on reaching the most marginalized groups.