My ideas are more or less consistence with that of the rule of law in a country and democratic elected government with fair and free election as well the right policy mix of the country would play a role to effectively result oriented G Fund but also one can consider the following 1.Try to build the right channell mainly a triad way governments,civil societies and beneficiaries but one has to be careful because most African country have their own stooges in terms of the two. 2. Irrespective of the problem fund should not have to be allocated with governments which have more than one percent military budget of their GDP,in this case but the funds have to be channelled through non-governmental organization who have the same program as GF and my be better to contract out some sevices to civil societies with strict supervision- 3.Refinement of countries annual plan of action must be detailly scrutnized as well the evaluation has to be done without the interference of the host governments because i have a lot of experience of doctored evidences i.e programs done by government funds are reported as they are achieved by /donor/aid/borrowed/ or the GF and the foreign currency stashed some where.

When the Global fund sends out calls for country proposals, they should look at the track record of applicants in terms of managing resources. Some organisations selected as sub-recipients have very poor track records of managing funds provided by other donor countries or organisations at country level and it is appaling to see them selected as sub-reciepients. There should be a thorough screening process with consultation with relevant stakeholders such as civil society, the private sector and all organisations representing and working with PLHAs at country level. The CCM should consult the intended benficiaries on what they think the focus of the proposal should be unlike them deciding what they think the country needs. A case in point would be the CCM has put in an application focusing on prevention when the wider PLHAs consulted feel that the proposal should have focused more on treatment as we are not sure what the implications of the elections in the USA will have on PEFAR funding to third world countries.

Dear Mridula, I do agree with you views expressed in the e-forum. A global fund management work in a local level. I hope your continuous participation of discussion in the forum. Thank you. Asima Chakraborty Kolkata, India

e-Forum 2008 Received above discussion.Regarding better predictability of sustainable funding at the country level, understanding of degree of capacity building , national health program effectiveness & response, capacity of national health infrastructure to counter epidemic,pandemic,& general health protection measures are essential. These factors could give prediction of additional,external support of funding.Uniform prediction for- -various countries can not give sustainable funding plan. Sustainable funding at the country level will depend upon country's need & response,changing condition, socio-economic attitude,capacity of available resources,correct utilization of disbursal. Better prediction could be made on the basis of Global-Fund's program performance,process evaluation,continuous audit. Scaling up plan could consider additional issues related to HIV,Malaria,TB e.g. immunization services,long term vaccines protection,establishment of testing labs in third world & developing countries,prevention of severe malnutrition link with TB,treatment coverage,early testing methods,accessment of Global-Fund program process& awareness in international tourism globally. In developing countries & middle income countries universal health insurance,micro insurance initiative in conjunction with Global-Fund could give additional sources of prediction of sustainable funding & effective scaling up plan. Scaling up plan could consider research& market effectiveness of treatment,formation of free therapy channels. Thank you ASHISH SRIVASTAVA ex-International Marketing & C.C.M(SEAR-INDIA)81237 ashish

HIV/AIDS is more than a purely health related issue, it is more than a disease only. a multisectoral approach is the need of the day to fight AIDS/TB/Malaria head-on. The involvement of NGOs needs to be improved as the grass root workers of NGOs identify themselves better with community & their messages go down better with masses. The sensitivity , creativity,interpersonal approach of volunteers go down well with PLHWAs and community at large. The areas of home based care, hospice care are major thrust areas apart from creating awareness & counseling. Also the networking between different NGOs needs to be developed to avoid duplication of efforts in the same region.. Organisation of antiretroviral therapy & monitoring the effect of the therapy ( CD4/CD8 count estimation & HIV viral load assays) needs to be provided at reasonable charges. Better participation of private organisations & diagnostic setups, which these PLHWAs still prefer(for want of confidentiality) can be encouraged. If funding is provided to these private setups assured quality care can be provided to PLHWAs. In the end I would like to suggest that the whole process of funding need to be simplified & made transparent as much as posiible so that more of it percolates directly to the target groups.

Does the global fund has a graps of the health problem in each country? I mean hiv/aids malaria and TB.In this type of situations, where the global fund has been working with country CCM on the basis of confidence for many years now, It need a lot of home work to redress everything.Why not conduct an indepent enquiry in each country inorder to have a graps of the health needs- to know how much you have to invest in each country.I dont know why i should prolong on this issue ,view that there is something wrong some where in the country level, which if it is not redress you could not know how to pull resources to each benefiary country.Please ,who can understand my idea in this forum should say something.

Dear members,

This week we have very interesting contributions regarding the predictability of resources in order to achieve sustainability.

Here are a few very interesting ideas, and we look forward to hearing from you and the experiences in your country as well.

Thank you for your participation!

Marcela.
e-Forum 2008 facilitator

Abisha Kampira from Zimbabwe states:  “The issue of resource predictability is an economics issue centering on the supply and demand scenarios of resources versus the funds allocated towards these resources by various stakeholders. As such I feel an economic approach can be more appropriate in addressing the matter.” Abisha gives examples of how this can be analyzed from the economics perspective in order to create a possible framework to allow predictability of resources. He also explains where the information can come from and what possible calculations can be made. Full post.

Dr. Lucia Ihailescu from Romania suggests that one criteria to evaluate the needs could be to compare the estimated budget lines of a plan with the gaps identified by region and/or by areas of activity. She states that very often splendid programs and policies are not sustained in budget/infrastructure/staffing. She suggests that the Global Fund can promote a mechanism of independent budgetary situation analyses of programs; or generate a "MAP OF NEEDS AND GAPS" that can be used by the TRP (Technical Review Panel) of the Global Fund to evaluate how responsive country proposals are. Full post.

Naafo from Somalia suggests that it is important to engage different organizations in order to predict resources and do not forget to involve the physically challenged as they have the will and energy to contribute and participate of international development programs. Full post.

The global fund should involve international networks of non governmental organizations. These will help to check the current rampant corruption in the developing countries. These networks will help to strengthen networking and local NGOs capacity will be strengthened thus improving the capacity to monitor. There should be regional meetings to measure the successfulness of the projects. Measure indicated in the proposals is not enough. Countries should show commitments. This commitment should be in terms of presenting the projects and committing more resources. The countries that are receiving funding should contribute to the global funding cause; this is because some countries do not have budget for global funding programs. Countries should be encouraged to scale up the funding for these programs. Should improve monitoring at all levels ; corruption has been rampant in most countries. If this is done, the intention of global fund which is to cab down the rate of spread the of diseases will reduce. Epedimiological monitoring should also be strenghtened. This will help to establish what exactly is on the ground. This is important for proper planning in allocating resources. Proper Accountability should be a requisite for the recipient countries to get more funds for the programs.

It is very important that a transparent accessible system is established. It should be so designed that stakeholders get a feeling that they are being acknowledged. At present local systems are operating & they are at many times highly biased. It is important we make small begining by trusting few implementing agencies and later develop them as partners for scaling up interventions in their nearby area.we must develop system in such a manner that everybody can participate in implementing relevant programms, where the need be we shall help people in developing concepts too. we must acknowledge that people at the grass root level are less articulate but very accessible for the client. we need to have support mechanism for capacity building of such partners at local level. It can be done by bigger agencies at local level. Mridula Chandra

If we are looking in national budgets reported on “WHO – Stop TB, Planning & Budgeting for TB Control”, we can see how much discordant they are to the needs. One critera to evaluate needs could be to compare to estimated budget lines of the The Global Plan to Stop TB 2006 - 2015 and gaps identified by region and/or by areas of activity. It's easy to find that there are no money for ACSM, in generaly for prevention, as an example, in countries where TB burden is high. On the other hand, often splendid programs and policies are not sustained in budget/infrastructure/staffing. The GF can promote a mechanism of independent budgetary situation analises of TB programs. Or can ask, at least in Europe, organisms as ECDC, to do it. Perhaps a "MAP OF NEEDS AND GAPS" that can be used by TRP of the GF too see how responsive country proposals are. After that can put pressure to proove sustainability.

To strengthen partnerships between governmental entities and other sectors at both the national and local level in their efforts to provide service . The partnership between all concerned sectors in any country is crucial for sustainability . Private sector is important partner in this regard. Health systems in any country should take in consideration the role sectors . GF emphasis on this partnership is crucial. Ali Asad Jordan