Feb 27, 2006
Feb. 20-27 Discussion summary and lead contributors: improving grant performance
Lead Contributors:
(In no particular order)
Grace Kyeyune (Uganda), Stéphane Rousseau (Philippines), Tom Mboya Okeyo (Kenya); Richard Carr, (Switzerland) Babacar Thiam (Senegal) Ashish Srivasta (India), Souleyman Traore (Ivory Coast), Heath Wilder (FL, USA), Dioffo Ibrahim, Marshall (C. & West Africa), Nicholas T. Kingazi (Tanzania), Ben Karenzi (Rwanda), Tarig Dafallah (Sudan), Kokoi (Philippines), Timothy Mbugua (Canada), Rosmini Day (Indonesia), Mirta (Cuba), Adela F., Celia Wanstein (Argentina), contributor from (Kyrgyzstan), Samad (Russia), and Maria Wanza (Kenya)
Summary of contributions:
Question: How do you think the Global Fund can – working with its partners – help support countries to improve their grant performance, in particular by anticipating and addressing implementation challenges?
1. To ensure impact, the Global Fund should invest in effective and efficient partnerships at all levels that (a) promote increased funding, (b) invest in Health Human Resource, (c) provide affordable commodities and low-cost technologies, (d) promote IEC and support women-led community organizations to promote Human rights, reduce stigma & discrimination and promote gender equity- all these aimed towards ensuring universal access. The Global Fund should, through its structural and social relationships, assure funding and managing organizations that it is not out to compete but to cooperate.
2. The Technical Working Group (TWG) – (Newly referred to as the Joint AIDS Theme Group in many countries), a multisectoral partnership which plays a most important role in national strategic framework as well as individual programme design, implementation, monitoring, and technical support, should also be integrated into the Global Fund’s architecture, and its role extended beyond technical advisory to policy-making, CCM supervision and forewarning on project bottlenecks when appropriate.
3. To achieve real sustained impact in malaria control (as well as for AIDS and tuberculosis) there needs to be a concerted push to streamline, simplify and harmonize procedures and practices to improve the effectiveness of country-led responses and reduce the burden placed on countries, through the “Three Ones” principles:
• One result oriented strategic and operational plan
• One national coordinating mechanism for implementation support
• One monitoring and evaluation system
4. A high number of HIV, Malaria and T.B debilitated patients in Africa, (varying between 50% and 80% across the continent) use medicinal plants in healthcare and as part of therapeutic nutrition. The Global Fund should start supporting research in biomaterials, leading to their authentication, documentation and a confirmation of their therapeutic contribution.
5. Continue to promote additionality and transparency: The Global Fund should lobby governments to continue contributing towards country health budgets, in direct proportion with its funding, to avoid the latter’s delegation of financial responsibility. Where the PR is the Ministry of Health, to ensure its funding has an impact on country programmes, promotes accountability, and avoids confusion, the Global Fund should channel financing through independently run Programme Management Units.
6. Roles within the Global Fund’s architecture should be more elaborately specified and legally mandated to avoid overlaps, conflict of interest and friction, e.g. between CCM, PRs and SRs, since while CCMs are supposed to oversee projects, they lack a real legal mandate because grant signatories and implementers are the PR and SRs. The Global Fund should enforce equitable representation in the CCM, forestall problems such as elbowing out of ‘Weaker’ groups, and ensure that country ownership is maintained when CCM members outsource technical support for proposal writing without adequate consultation of the CCM.
7. To further prevent and increase efficiency in the diagnosis of TB and related lung diseases, (including nosocomially acquired TB), the Global Fund should invest in cytology, thoracentesis, bronchoscopy and invasive diagnostic approaches. It should also promote coordination between international organizations (e.g. ILO) with W.H.O expert committees for legislative & restrictive diagnostic & therapeutic measures.
8. To anticipate and and prevent challenges, the capacity and capability of implementors should be taken into consideration. In most cases programs and project implementation encounters problems because of personnels' limited knowledge in managing projects. The Global Fund should include, in the proposal process, the Training Needs Assessment (TNA) of implementors.
9. In reviewing proposals, a statement or plan on sustaining the program should always be included. Some grants can cause a degree of dependency on partner agencies or governments hence become unsustainable. The Global Fund should look into a well developed a "Weaning Process" in the proposal and this should be a part of policy in approving a grant. This means that the GF can always begin funding, but sustainability after the completion of timelines of every project should always be the responibility of partner agencies or governments.
10. Monitoring and process evaluation should be done by GF along with regular stakeholder meeting towards improvement of service and implementation of project.
11. Careful and thorough review of existing policies and guidelines should be done in order to adapt to the trend of everchanging needs as determined by evidence - based studies.
From the Russian Forum
12. In order to anticipate and prevent implementation challenges, it is necessary to have a definitive set of universal references and priority areas that would need to be achieved.
13. Transparency: The proposal selection criteria and the process of arriving at results or recommendations must be transparent, it is necessary to involve the media in this process.
14. Promoting collaboration through a clear partnership model: It is important to have a clear partnership / collaboration model and apply it- this model should mirror the multiple facets of societies and communities, meaning that the individual model partners must be differentiated, but integrated through this model: NGOs, businesses, authorities, media, Church, private individuals- this model must not exclude, but integrate members. The advantage of such a model is that it contributes to effective implementation, hence impact. To be able to curb AIDS or tuberculosis, it is necessary that all members of a society cooperate: NGOs, priests, journalists, businesspeople, doctors, etc.
From the French Forum:
(Language varies slightly to uphold original 'tone' of discussions)
1. Ground work: The Global Fund must work with the NGOs who go to remote regions (in hamlets, camps, villages). This is necessary because, according to a participant from Abidjan, statistics show that 60% of the population of sub Saharan Africa, being farmers and illiterate, do not understand the importance and the extent of the issues raised by HIV/AIDS.
2. The partnership between the Global Fund and the participants must be dynamic and flexible. Each financial partner must find space to evolve (Senegal).
3. The Global Fund and the other financial partners may, especially in the context of the Three Ones, find a consensus through the implementation of a consultation area called the "Partnership Forum", different to the CCM (Country Coordinating Mechanisms). This will allow these partners to come to agreements on a single finance, implementation, monitoring and evaluation procedure manual. In summary, the key principles of the Three Ones will be strictly respected: namely a single strategic plan, a single main authority, a single monitoring and evaluation system.
4. To help prevent implementation problems, the Global Fund should ensure, together with the CCMs, that the potential Principal Recipient (PR) is known at the time the proposal is developed. This will allow the PR to follow and understand how the proposal is put together in all areas (technical, financial and human resources). The Global Fund must also assist PRs in preparing implementation documents, a task which requires specific expertise and involves additional costs which are not within the reach of a PR from the private sector or of civil society in poor countries. The Global Fund programming and monitoring documents must be made as simple as possible to make the disbursements more flexible and at the same time intensify relations between the LFA (Local Fund Agents), the PR (principal recipients) and the SR (sub recipients).
5. For the partnership, the sub-recipients (SR) normally come from civil society (NGO, charities). The CCM of the recipient countries should therefore be asked to select and index them. This selection should be based on well defined criteria and be fully transparent. It must also enhance their ability to take over the reins, and ensure the durability of the programs after the withdrawal of financing by the Global Fund.
6. Education: the CCMs must get involved with Universities and educational institutions in general. The Global Fund must insist that governments benefiting from subsidies sign up for their prevention activity programs.
7. Put in place control measures for the use of funds: What are the mechanisms for the control of funds allocated to countries for the fight against AIDS, Malaria and Tuberculosis? If they exist, strengthening them is a better initiative. If not, they must be created to then evaluate all the programs already financed in order to redefine the principles.
From the Spanish Forum:
(Original wording maintained to uphold 'tone' of discussion)
These are the proposals and comments taken from our e-forum:
1. The Global Fund can help by reducing the bureaucracy for countries and, much more importantly, by being involved from the start, and not just in the evaluation. Taking this role alone means that its functions are very limited.
2. The Global Fund should ensure greater involvement in the project by the Coordinator, both remotely, via mail or telephone, and in the field.
3. All countries must have access to the Early Alert System, all must be included in its database, since it is a reference tool for the evaluation of the project.
4. The Global Fund must, through project financing, combine the efforts of the civil population, governments and the private sector. The Global Fund must support the growth of the country’s economy, adopting its national industry as suppliers.
5. The Global Fund must ensure impartiality in the financing of the fight against the three diseases (Theme for this week).
The Global Fund can now work on finding the strategies necessary for optimum payment of the subsidies. The theme of good synergies can and should be one of the pillars arising from "strategic alliances between its different associates".
The Global Fund should bring the base and land communities closer together and place the necessary financing within the reach of the NGOs and professional associations, thus improving the scale of total participation. The formation of working teams is suggested, as they allow work to be carried out more efficiently. From there we can all continue thinking and making plans more permanent, with new and enhanced possibilities.