Mar 06, 2006

Question: What actions, if any, do you think the Global Fund should take to ensure that its overall portfolio of grants is balanced -- particularly across the three diseases, different types of interventions, different kinds of recipients, and regions?

Lead contributors, in no particular order:

English Forum: Ben Karenzi (Rwanda), Chike (MA, USA), Nurul Dulu (Bangladesh), Isao Arita (Japan), Becky Johnson (Switzerland), Thayer, Saka Mohammed Jimoh (Nigeria), Tarig Dafallah El Hassan (Sudan), Nityananda (Nepal), Bintu Sesay, Jerry (Brazil), Tshering Lama (Nepal, UK), Barry Coleman (USA, UK), Kokoi (Phillipines), Timothy Mbugua (Canada), Mina (Switzerland), Churchill Otieno (Kenya), Wei Guo (China), Firman Lubis (Indonesia), Krisi (NY, USA), Hicham Filali Zehri (Morocco), L.K Verma (India).

French, Russian and Spanish Forums: Essimi Martial (Cameroon), Fernando wa KATAMBA (DR Congo), Augustin Epinzagne (Ivory Coast), Alio Techi (Niger), Dioffo Ibrahim (Niger), Sylla Lanciné (Ivory Coast), Komlan Dossey (Togo), Enock Nodjikwambaye (Chad), Samad (Russia), Mirta (Cuba), Diego Postigo Otero (Spain), Clemente san Sebastian (El Savador).

A. Suggestions for the Global Fund to maintain current actions:

1. The Global Fund should stick to the business model where performance is pivotal, and maintain the technical aspects of proposals as reviewed by the TRP.
2. The Global Fund should still recognize special situations within countries (funding needs still vary from country to country.)
3. While Malaria and Tuberculosis funding should not be reduced, the sheer impact of AIDS means that it merits a higher level funding focus.
4. Maintain strong collaboration with all funding agencies working in the same area of a certain region or country.
5. Continue to consider areas where disease is not prevalent, with a focus on prevention.
6.The Global Fund should continue to consider humanitarian and egalitarian principles in distributing grants.

B. Suggestions for the Global Fund to take new action or reinforce current action:

1. Support Country Capacity Building: The Global Fund should stick to the business model where performance is pivotal, and maintain the technical aspects of proposals as reviewed by the Technical Review Panel. However, Secretariat should consider capacity building (programmatic capacity building and technical support) measures to assist regions or countries that are not benefiting or performing. The Global Fund should, in addition to the additionality principle, work to strengthen capacity in countries and regions with little resources.
2. Support Community Capacity Building: The Global Fund should work to build capacity at the grassroots level by organizing workshops to train community-based organizations (including local leaders, faith based organizations, traditional healers, community care givers), while conducting advocacy and awareness activities to prevent spread of disease. The Global Fund should be open to innovative methods that add to capacity building efforts e.g. increasing the mobility of healthcare staff to stem shortfall in health personnel.
3. Perform Pre, ‘during’, and post- programme assessments: The Global Fund should constitute an independent assessment team to measure the cost-effectiveness of grants with a view to providing recommendations and anticipating the effects of grants. The allocation of funds across regions, between diseases or types of interventions should be based on a full scale initial assessment of country capacity to manage and to provide services, their credibity, corruption levels, and their commitments to sustain the fight against the three diseases?.
4. Broaden type of data used for decision-making: The Global Fund should look beyond epidemiological data into socio-economic indicators such as those in the Human Development Index, and whether health care delivery system reforms have synergistic and sustainability effects, etc.
5. Partner/ collaborate more closely and earlier in the pre-planning stage with the other large donor organizations and country funding organizations: Take into account the spending intentions of the other large donor organizations such as the Gates Foundation to avoid duplication.
6. Balance funding for interventions and regions by:
(a) Supporting and gradually increasing funding to credible NGOs and CBOs with high regional and local population reach and working proportionately across both treatment/ curative, care and preventative interventions , and should balance the interventions supported proportionally while ( between both preventive, curative and care programmes) and working with the most vulnerable and high risk categories in countries and regions
(b) Supporting technologies and strategies that, apart from promoting country ownership, could be shared across interventions and countries, while recognizing that funding needs still vary from country to country.
(c) Investing and capacity building in health staff that can increase local knowledge in all intervention areas simultaneously i.e. prevention, care and treatment and supporting their mobility to cover wider populations.
(d) Investing in general public health capacity building to promote generalized population awareness, which in turn would lead to collective citizen activity, ‘customization’ and ownership of health promotion programmes.
7. Support or facilitate knowledge and information exchange: between countries and communities, for direct exchange of experiences, best practice, sharing techniques etc. leading to faster implementation of intervention programmes, reduced transactional costs and increased disposable funds that could be targeted towards other interventions.
8. Policy: Research and review policies, benchmarks and evidence: on primary causes of vulnerability to disease, review policies on standards and benchmarks to fit into the objectives of grants. Grants should focus on unmet needs rather than targeted accomplishments.
9. Strengthen the Global Fund’s own policy-making bodies by making more evidenced- based/ generated policy, and more importantly rely on results of M&E on previous grant (successes or failure) which should play the key role before approval of proposals. "Equity" in giving grants could replace the word "balance."
10. Facilitate linkages between central and local governments (and by extension communities) for more synergistic implementation and balance.
11. The Global Fund should encourage organizations that connect the fight against TB to HIV/AIDS and those that are involved in all the three areas of prevention, treatment and care.
12. The Global Fund should look for ways of working directly with communities and reduce reliance on governmental structures.