Agape - Mar 31, 2006

The Global Fund as I understand is the result of target oriented funds. A system of M&E (MONITORING AND EVALUATION) to network into the activities of countries with the priorites of Global Fund targets to know on physical terms the impact of previous funds. For example, if drugs for malaria are channelled to pharmacy shops in the cities, the masses who are the poor people cannot benefit, but if such drugs are sent to general hospitals, health centres in the local satelite areas, then that is more result oriented. Coordinators should not monitor in their countries. Other donors should be free to use their indipendent evaluations. This way the target will be met with minimal errors. AGAPE

Mar 31, 2006

Message from Ashish Kumar Srivastava, India.

Regarding better coordination with other donors, priorities & systems, universal access is very important. The Global Fund has approved the largest grants for Asian AIDS projects very few years before but due to misinterpretation, lack of commitment, to system development, performance and alleviating environmental hazards, the HIV/TB, HIV/AIDS, Malaria and pneumonia are still pandemics in Asian countries.

Promoting high coverage of interventions and integrated management, including the systematic collection of data at state and national level is a very important aspect to support health and planning services. Coverage and the rate of monitoring is inadequate in low and mid-income Asian countries.

The Global Fund should be more active in low GDP countries in ASIA, where there is poor availability of safe drinking water, more pollution, more hunger and malnutrition and low quality of medical services. Effective low cost interventions & universal coverage of essentials of survival can prevent a pandemic in low income countries globally.

Ashish Kumar Srivastava
CCM India

Mar 30, 2006

Message from Mohammed Saka Jimoh, Nigeria.

Thanks for your message, am also learning through the forum.
Many issues hinder harmonious implementation of M&E, procurement, and other principles depending on the level of system development.
I think common to all are:
-Issues of ownership,
-Involvement of all
-Leadership of a sector, system etc, commitment, seeing value on what they are doing and why they are doing it, too many forms to fill.
-Issues on flexibility of budget spending on line items, looking at programmatic/ administrative and financial spending.
-Who is motivating and rewarding the compliance in the system when they are frustrated, or not?
- Importantly very high level of politicization on who should do what, where etc?

For GF to coordinate better in solving these issues and still be more in line with the priorities and activities that countries have set towards managing the three diseases. From country-specific activities there is always a short fall, weakness, and this will be a good point of entry for GF.

Whoever the partners are, GF must ensure that they have the:
-Technical skills required to conduct the project,
-Ability to adequately staff the project,
-Commitment to issues addressed by the project,
-Administrative skills to implement the project and manage finances, and -The ability and willingness to comply/harmonize GF standards of operation with others. Of course we do not expect 100% of all these but commitment will carry the weight.

-All effort should be put on sustainability, for example, the M&E capacity building should not be limited to INGOs, or NGOs. Let’s look at existing institutions. The Department of community health of our teaching hospitals work with local government (LGA), state government and tertiary level care institutions. GF can support staff to work with LGA, SMOH and FMOH.
-When providing M & E training, update courses, workshops, they should be spread across academia, FBOs and stepped down to others.

-To the Global Fund, this means an additional budget for M&E . GF will need to have a flexible budget in relation to spending on in-line items.

GF can support M&E and other principles in the education of health workers, nurses, medical school postgraduate training courses in epidemiology, statistics, and social sciences.

What about those with a phobia for M&E? Let program officers /coordinators/ managers / Directors have basic knowledge and involvement in the M& E system.

Politically, the candidate can be employed as a bencher and not stater in the implementation; these become more relevant when working with government institutions or volatile areas. Waiver for branding is important especially at the beginning of launching a system in an area that opposes the system for political/ ideological/ reasons.

Leadership skills are very very important.

Best regards

Dr. M.J. Saka (Nigeria)

spectranine - Mar 30, 2006

For many good reasons, which I will not try to repeat here, collaboration and coordination between Sexual and Reproductive Health efforts in countries and HIV/AIDS prevention and treatment should be encouraged. Unfortunately, this has not always been the case in places where HIV programme managers compete with other divisions for Global Fund and other donor AIDS funds.

The United Nations Population Fund (UNFPA) is helping countries set up Reproductive Health Commodity Security (RHCS) Working Groups that include representatives of government, NGO, donor and community organizations to better coordinate the planning, execution and monitoring of procurement and service delivery, including male and female condoms, diagnostics and drugs for sexually transmitted infections. The coordination efforts of the in-country RHCS Working Groups are linked together via their association with a global entity called the RH Supply Coalition.

The secure supply of good quality low cost commodities such as condoms and the scaling up of national systems to deliver them to everyone who needs them should be at the highest priority. The Global Fund can facilitate this by insisting that the work of the national RHCS working groups is represented in the CCM and that commodity-related proposals to the Global Fund demonstrate linkages between national plans and global coordination mechanisms such as the RH Supplies Coalition.

dr joseph stephen mambo - Mar 30, 2006

Ahsante sana moderator wetu sisi hatujambo. (Thanks moderator, we are fine.) On my side as I said earlier, I would suggest the system of cooperating much closer with the NGOS in most of sub-Saharan countries. In Tanzania there are more than 2 million cases of HIV/AIDs to be reached, let alone those undiagnosed ones. NGOs and govt. institutions are working very hard but the private sector on side of health services is serving around 80% of the activities. As it is said in the world there is about 6 million deaths of HIV/AIDs, efforts should be directed in empowering the private dispensaries, health centres and hospitals to complement the government efforts directly under the ministries of health whom by the end of the day should report to CCMs./RFAs etc.

The GF should have a country director whose role would be to monitor and evaluate right from the grass root levels where the services are scarce, and poverty and illiteracy are the major barriers. Let the ministry of health remain a sole distributor of ARVs and drugs for opportunistic infections under the central medical stores and NGOS/private heath facilities get access for obtaining them, be it at a low cost or for free, regardless of the present mentality, that if given an access are going to sell them.

Again the NGOs would have a permit to apply or submit proposals to CCMs, but if not treated in the right manner, would be allowed to appeal to GF head office in the country or directly to headquarters in Geneva.
Those few will enhance transparency and increase efficiency. Lastly, the current coordination with the existing stakeholders shoud continue, and I personnaly congratulate all of them for their ceaseless efforts in helping our fellow tanzanians. Viva USAID, OCAG, BILLS FOUNDATION, UNAIDS just to mention a few.

Tshabalala - Mar 30, 2006

The Global Fund may want to open the CCM mechanism as a general coordination mechanism beyond the principal support areas. Indeed, this should be preceded by deliberate investments in the strengthening of M&E capacities in the recipient countries -Converging this effort with sustainable reforms in public sector management and performance management that embeds a culture of monitoring and evaluation.

Specific actions may include strengthening:

Procurement Entities and authorities: Capacity building in supply chain management has not been given strategic attention by countries including development agencies. This process is essentially relegated to the administrative backroom of governemnt agencies including Ministries of Health.

ogenkemakolam - Mar 30, 2006

Global Fund should evolve into a direct funding mechanism that will engage Non Governmental Organizations in the direct supervision of projects selected through call for proposals instead of funding national governments and operations. Let the CCM play a leadership role in the engagement and capacity building of NGOs in the area of proposed project as well as the monitoring and evaluation of projects supervised by NGOs. While engaging NGOs in the direct supervision of GF funded projects,these projects should be implemented in phases or tranches,involving communities where projects are located in the direct implementation. This process provides for an inbuilt mechanism for accountability,cost effectiveness,control and effective monitoring and proper evaluation.E.g after the first tranche/phase, it will be the duty of the CCMs to ensure that the funds expended are propoerly retired,claims retired and projects evaluated before releasing funds for the next tranche.
This way it will only mean that GF will increase its operations and staff capacity at the local levels by establishing Regional and/or State offices in countries where operational to ensure grassroot reach and follow ups.

Less than $4 per capita is spent on health by national governments in Africa which is an average cost equivalent of an insecticide treated net used for the control of malaria upon huge amounts of money expended in aid assistance.If only less than half of the total funds disbursed by Global Fund were used to directly fund NGOs in the direct supervision of community based projects,a greater and far reaching results would have been achieved. It is only programs that involve the participatory engagements of communities that can actualize a cost effective and accountability value with a monitoring and evaluation process.NGOs are part of the people and of the people and will better appreciate the level poverty and diseases still ravaging Africa. It is no longer workable and fashionable to fund projects through national governments.
I appreciate the efforts of the GF and the total commitment of developed countries and the EU in ridding Africa of poverty and diseases and in reaching the Millenium Development Goals.

And thank you again for this opportunity to contribute to this forum and responding to the need to restructure Global Fund for effective results because if the GF is cost effective in its mechanisms it therefore means it will accomplish greater and far reaching tasks and reduce the burden of Malaria, HIV/AIDS and Tuberclosis globally.
From
Mr Oge Franklyn Nkemakolam
Executive Director
ANTI MALARIA & AIDS INITIATIVE NIGERIA
Tel:234-803-3135037
_________________
LETS HELP MAKE AFRICA FREE FROM DISEASES AND POVERTY ULTIMATELY SHOWING CONCERN FOR HUMANITY

Mar 30, 2006

Thank you all for your excellent messages. Let us now build upon them to find out challenges, their causes and propose some solutions:

International Partners, including the World Health Organization, The World Bank, UNAIDS, Measure Evaluation, CDC, USAID, US Department of State, OGAC, UNICEF, the Global Fund, and many others have come together and taken significant steps in supporting and promoting the principle of having one agreed country-level Monitoring and Evaluation System, one agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners, and One National AIDS Coordinating Authority, with a broad-based multisectoral mandate. The Inter-Agency procurement services office supported by UNDP and other partners, provides procurement services that can dramatically increase efficiency, quality and transparency whilst reducing costs and delivery times. A few issues relating to the implementation of these M&E principles, procurement services, frameworks and their harmonious uptake by local partners have been noted in this forum.

For example, many specific issues hinder the implementation of a single M&E system , and they differ accross countries. These include the harmonization of indicators between different countries and vertically- from the international partners to the national, district and community levels. As participants have noted, reasons for non-compliance with this principle sometimes have their origins inside countries, while at times the Global Fund and other partners may be in a position to propose direct solutions. What are some of these issues that hinder the harmonious implementation of M&E and other principles by countries? What are some actions that the Global Fund could take to coordinate better with other partners, solve these issues and be more in line with the priorities and activities that countries have set towards managing the three diseases?

Dr. Saka Mohammed Jimoh - Mar 29, 2006

For GF to be more in line with country priorities and system for M & E. the first step would be to identfy country priority M & E systems. At the initial steps, the GF should make clear what the performace indicators or result framework are like in content and details as much as possible. It should not be too different from country's own where it thus, effort should be made to build it into the country's own record. because seperate M&E for GF and others is usually to many for effeciency. Let there be a situation where GF output and outcome results will be part of the National M&E system with organised harmonisation through a National workshop on M&E.

On supply management and procurement; I do not know GF policy on these but as much as possible local or country CSOs should be allowed limited procurement (be cautions of insincerity), however, where goods are coming from outside the country, all efforts should be made not to delay clearance, approval etc.
_________________
Dr. Saka Mohammed Jimoh

brunomoonen - Mar 29, 2006

When reading the short background message on this topic I noticed that some rather strong assumptions are made. Do countries have priorities for monitoring and evaluation, supply management and procurement? What the GFATM can do, and has indirectly done in many countries, is to force governments to have these as priorities and force them to clarify the processes. The LFA (a source of transaction cost?) could be asked to not only audit CCMs on the financial side but also to evaluate tools put in place for M&E, procurement and supply management (not once a year but more continuous).

The background also mentions "personnel" as transaction cost related and the fact that the GFATM was "designed to be an additional source of funding, complementing the efforts of existing donors". Is this always the case? I have a feeling that when it comes to personnel of certain (often UN Agencies) the GFATM has been used not as an additional funding source but rather a "new" funding source. I have no problem with this as such (as long programs are well run and the position is needed why not?) but the GFATM needs to clarify its position on this.
_________________
Dr Bruno Moonen
Malaria Technical Coordinator
GFTAM Malaria Programme Somalia

Saiki - Mar 29, 2006

In answering the first part of the question, it is better I take you back to the reply I sent on last week discussion. there I pointed out what I refered to as GPP (good planning process). the various steps highlighted in the reply, to me, I believe the Global Fund can prevent poor performance thereby reducing cost of transaction and ensuring the lasting impact of its funded programs.

Secondly, let me point it to you that it is TRANSPARENT EXERCISE that would help the organisation to coordinate with other donors of any level. let the programs be roll out, for all the parties involved to see the method at which the Global Fund intends to collaborating with the donors and the extend at which the organisation intends to carrying out the exercise.

This will help the Stakeholders (the donors) to contribute their view towards the planned programs. Once this takes place, it then means that there is cordial relationship between the donors and the organisation.

Thank you.

SAIKI SHEGUN

Mar 28, 2006

Message From: Mohammad Ahsan Sent: Monday, March 27, 2006 6:53 PM

If we are to go through public sectors, involving them then all the cost will be decreased. It would also be part of poverty reduction with strategic economic development.

Thanking you.

Mohammad Ziaul Ahsan

Stella Attakpah - Mar 28, 2006

The area of procurement is where the highest rate of corruption is registered both at the organizational and beneficiary levels. The global fund should ensure that this does not occur within its projects. Care should be taken to ensure that (i) equipment and materials delivered are what are actually needed by the projects/programmes and for the actual purpose for which they are needed; (ii) equipment and materials should be purchased locally or at least through local agents (iii) donors should not insist on purchasing equipment, materials and services solely from their institutions/countries... If possible local manufacturers should be encouraged to produce some of the needed materials at lower costs.
_________________
Stella

umesh - Mar 28, 2006

Things such as medicinal supply, other---- will be confirmed before signature of the scheme or supply. Reducing transaction cost is not more important than disease burden. It may be at global or country level. We have been under so much supply for a long time for diseases like malaria,tb,hiv other------, the disease burden has not reduced.

Reducing transaction cost depends on the disease load on country, and the supply of important materials.
Dr.Vanahalli

drvanahalli@gmail.com

bilal hasan - Mar 27, 2006

I think the globalfund should find most flexible and grass roots funding agencies who has a good credibility to perform, transit, networking and object oriented. This may be applied also at country level with those organizations who have done maximum work in short periods with wide coverage , who may be considered for this purpose.
thanks!