We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by kwakfut from Nigeria.

Thank you for your contribution!

Marcela.
e-Forum Facilitator

---

Thanks for your mail.

From last week's question.

From our point of veiw and experience, we experience delays through our LFAs. There has been a high turnover of the officers who are often always new and not too conversant with TB issues. Most often on completion with us they return with more questions which often cause delays. This adversely affects early disburseement!

Kwakfut 

We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by NOVATUS LIHEPANYAMA from Tanzania.

Thank you for your contribution!

Marcela.
e-Forum Facilitator

---

Some Aspects:

1. The CCM is not well known to the target groups.
2. The contributions of the recepients is very small or sometimes nothing to the envisaged projects.
3. Lack of knwledge in writing and presenting proposals.
4. No direct contact between Global Fund and infected people.
5. The religious bodies are not properly used.

 Thanks,

N. L. LIHEPANYAMA

MTWATA - TANZANIA.

We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by ASHISH SRIVASTAVA from India.

Thank you for your contribution!

Marcela

e-Forum Facilitator

---

Received above discussion.Regarding Global-Fund current process,
Phase 2 funding could give complete component for capacity-building,
prevention program & participation.Due to phase funding ,component
can evaluate ,audit of program performance.Global-Fund current
process should focus in accessment of life saving anti-reteroviral
(ART) in Asia& third world.Program performance,evaluation aspect
could be vital for accessing funding.
Disbursal of fund should address crucial needs,
action in epidemic,project suitability to the country,national
participation & interest addressing to the need,fund's standard
allocation pattern in various countries.
Another aspect is understanding of availability of resources in
countries.Availability of resources,climatic condition,human
condition ,basic health information system may differ from country
to country.
Global-Fund current process should take an account of
above factors before disbursement.Funding should not based on
predictions & consider budgetary allocation of national organisation,
participation of public&private organisation.
Rolling continuation channel application process is
based on technical approaches,proposals,procurement&mechanism of
multi-countries applicants process.These process may be useful in
determining crucial needs,norms,standard,effective mobilization,
strategic intervention,integration of indigenous support& services,
demographic status,potential for contribution ,innovation,gross-
availability of resources to counter needs in various countries.

Thankyou
ASHISH SRIVASTAVA
ex-International marketing
CCM(SEAR-INDIA)81237

Dear Fenna, Thank your for your email. You are expressing the views from the root of the problem. Role of the Globalfund CCM and the working organizations exist in a distant in reality. It is not only the relation of payer and payee, but to combat the pandemic of HIV/AIDS, TB and Malaria. Millions of people around the world are deprived from their rights. The social and non-government organization are performing a great deal inspite of their limitation of fund. The government has a fund to act but the small initiatives working in the grassroot have no way to knok the doors of the donors. The GlobalFund may consider the voice of the small social organization and strengthen the challenge to combat HIV/AIDS.TB and Malaria. Asima Chakraborty General Secretary The Organization for Peace Environment and Human Rights [TOPER] Kolkata, India

Thanks Jane for enlightening me on these above issues

Abraham, I admire your courage and fortitude. Simplication of these bureaucratic processes always works.

Thank you so much Ihuwaoma. I support you 100%.You have said it all loud and clear. I stand behind you!!!

Asima, I heard you loud and clear. It is my impression from discussions with many grassroot organizations in 2 countries that from the CCM and the few structures in between (the grassroot excluded) there is so much competition who can have fastest access to the funding for their personal priorities and also their friends NGO's. This doesnt include the legitimate applicants at the grassroots. A bulk of the proposals come from their small CBOs but yet they will not receive funding. The small man at the grassroot is not even getting the left overs but ends up with nothing since he is told the money never came or they didn't send enough. As long as international organizations don't sit on CCMs with a 50% majority the corruption will never be stemmed. The local people don't like the idea of foreigners in their affairs because the know they cant steal and pocket funds since we will forcefully put accountability structures in place. This will be the only deterrant to stop corruption on all levels because foreign NGO's can do the spot checking once an arrangement is worked out where this is compensated for services provided.

When reflecting on the challenges for increasing the effective demand we unavoidably arrive at the GF grant architecture. Working with some 40 AIDS actors in 35 countries I can confirm that a huge unmet demand exists. There must be something on the ‘market place’ that causes the ‘supply’ not to meet the demand. As many contributors have already signaled, the functioning of the CCMs is one of the main bottlenecks in the process. In many cases it directly affects the predictability and therefore the reliability of the process. I know from direct experience that many organizations have given up on efforts to get into the system (i.e. having their proposals accepted in the CCM proposals). As CCMs were originally created to coordinate the process, GFATM has the right to approve or disapprove (and everything between) the performance of the CCMs. In the early rounds GFATM may have been too permissive and ignorant about what really happened on the ground. Also in our organization (Lutheran World Federation) we hear a lot of stories about highly questionable behavior either by CCMs as a whole or by individual members. In a situation where the functioning of CCMs is of crucial importance for the effectiveness of a multi-billion dollar unique initiative, the criteria and requirements for the functioning of CCMs should be much further elaborated. Of course one could think of a certification system to systematically monitor and screen the performance and operations of the CCMs. There is a strong risk that this would develop into yet another highly bureaucratic process. However, the basics of certification, especially the maintaining of basic principles of transparency, good clear and well planned time lines, clear and published standards and criteria (etc. etc.) should be pursued. For the GFATM this monitoring of the performance of the CCMs should result in clear consequences, with as ultimate consequence an explicit disqualification and subsequent disconnection. There are a couple of countries where a fresh start with much stricter guidelines would make sense. GFATM board and staff can easily have some countries in mind where a completely new forum for coordination would make sense, rather then a continuation of the present endless battles with two steps forwards three steps back. With Dual Track Funding the issue of non-conducive PRs was effectively addressed. GFATM knows that many grassroots health activists have called on bypassing non conducive CCMs. While the principle of national coordination should remain unaltered, the modalities for effective national coordination should be much more critically assessed. A second comment I would like to make on demand is about its quality dimension. I doubt whether the present centralized TRP process is able to discern the appropriateness of proposals and their respective approaches. I am worried that the effectiveness of many ‘projects’ maybe questioned and especially their cost effectiveness. We should not forget that we are working in a global context where critics claim that ‘projects’ have not had a sustainable impact (money evaporates). In the coming 5 years the GFATM will increasingly be submitted to result and impact evaluations. From my own superficial observations I have the impression that large percentages of the GFATM grants are not reaching the majority of the targeted population. (This is not said to be discredit the system – it is a common critical factor in most project work, but it is said to direct our attention a major weakness in the present set-up). How can the quality of the demand be improved? By pulling together on national level task forces that bring together people from CBOs, FBOs NGOs and government institutions. Technical review has to take place prior to submission to the respective Round. Major investments are needed to facilitate this planning process on national levels. Here the ‘perfect match’ can be created by bringing together solid grassroots connections and technical translation into complex project planning documents. It requires a careful bottom-up planning process that starts at a district or regional level. Ability to organize and facilitate such processes should be important yard sticks for the scrutiny of the performance of the CCMs. Here the Community Systems Strengthening (CSS) can be practiced as a key component by organizing the planning process from districts and regions up, through provinces/states towards the national level. At this level discussions should be held about appropriateness of approaches and about cost effectiveness. From that level up the plans should come and be brought together with all necessary diversity and variety. A Technical Review on national level should ensure that all these different processes are adequately reflected in the national proposal and that –subsequently- the proposal stands out for its high level of (community) participation. If ever we start a process in a capital city, how will there be full and open participation in a remote small rural village (RSRV)? It is impossible that from the capital adequate processes can be designed to honor the capacity and the needs of the RSRV. This is not only a plea for bottom-up planning, but it especially addresses the issue of ‘developing demand’. It means a more balanced demand, because it provides participation in planning processes of those people and groups that are not roaming in the capital city. In my experience low technical, high human value interventions are most effective. The present system of planning for the three killer diseases does not provide room for this, because the emphasis is on the technical frameworks and technical language is spoken that is not understood by many potential participants in the health plight, nor is it effectively reaching the RSRV. It is high time that many excellent and low cost proposals can be taken up in the new GF grants. This is in my view an approach that strengthens demand and increases CBO and FBO participation. Jaap schep

The major obstacles can easily be summerised into the following categories; 1. THE MYSTERY OF THE GLOBAL FUND. To many end users of the funds provided by the globalfunds,the fund organizers are very distant to them. They can not identify with the providers of the fund, there are no direct linkages, and the CCMs are ensuring that that remoteness is maintained. IF the fund can be de-mystified, it will go along way in helping people know how the fund operates, what is feasible and what will amount to a waste of time.The quetion is: WHAT DOES THE OPERATORS OF THE GLOBAL FUND WANT? It is only the major recipeints that can answer that quetion. 2. THE next major problem is the CCM. We are told that this represents major stake holders in the ATM funding process.Again the imformation about them is hoarded. What criteria did you use to choose them? What qualifies one to belong to it? Many of us can not identify with our reprentatives at the CCM. There are no proper information system, neither do we have access to them, thus our veiws are not really represented. 3. The GLOBAL FUND has not yet devised a means of ensuring that the communities who are the actual beneficiaries of this funds, recieve them. WHY CAN'T THE CSOs, THE FBO'S, the CBO's etc have direct access to the funds? The global funds therefore has limited impact on the there target populations. 4. A new modus operandi will therefore needs to be devised for effective impact. eg aconference and/or consultation of the stakeholders will to be called in order to carry every body along.The CCM needs to devise a means of communicating with the public especially opinion leaders

In my perception, Global Fund's have formal regulation about funding process. May be Global Fund's if possible make a simple way procedure. If possible, direct to give your aid to foundation. I am from indonesia, of cource have many problem related in HIV/AIDS, Malaria, Tuberculosis. We must fight tahts problem. And now, for example HIV/AIDS, malaria,TBC, tends to increase. My Foundation, Eukalyptus think how to eliminate thats big problems. We faced scarcity of funds. We hope fund from Global Fund's. But, we faced difficult birocratic ("red tape").Because funding from Global Fund's addresed to government of Indonesia (GOI), and we must write application letters to GOI, and that is very difficult, and no secure we can get aid from GOI. Now, in Nusa Tenggara Timur provinci, HIV/AIDS, TBC malaria need real action not only from government, many foundation prepare to combat it. Unfortunately, many foundation faced fund's problems. I suggest, Global Fund's must make a simple way to attain serious foundation to handle HIV/AIDS, TBC and malaria. We have enough capable human resources to handle that's problem. My self was trained HIV/AIDS prevention at University of Melbourne, Australia, 1996. I have field experience, live together a big community with malaria,TBC disease in Alor and Timor island, Nusa Tenggara Timur province,East Indonesia. I am sad meet with them. They need helper, but my foundation not power to do it. We have not fund to operational, to preventing thats problems in our community. I think this is high light opinion from me related with your last question. Abraham Cornelis FanggidaE

I think that the complexity of the application process makes technical assistance an almost unavoidable requirement for countries. Very often the perception from countries is that the responsibility of the process lies on the TA shifting TA's role from facilitating the process to leading it. The implications in terms of ownership of the proposal are important. I believe that simplifying the process of application may have a positive impact on CCMs and other actors involved on appropriating the process and hence making it more responsive and more coherent to countries needs and capacity. Countries and the GFATM have been mainly focussed on requesting and funding infrastructure but little has been invested in developing structural elements (e.g. policy, planning, production of evidence for policy making, etc.). Often we see countries getting important amounts of funding for HIV or a TB programmes lacking essential policy elements able to support the action. Operating in a policy vacuum, well funded programmes have often a pervasive effect on health systems making them more fragmented and hence more vulnerable. It is good to see that HSS is now a more independent element of the application but it is still far from ideal. Investing on health systems, particularly on policy, planning and financing, should be as important (if not more) than investing on the specific programmes. HSS should be not only assessed separately but allowed to be a fourth component of the funding policy able to attract funding by itself alone without having to depend on the approval of another element. In fact my view is that no TB, HIV or malaria funding should be approved unless there is an HSS element sustaining the action and ensuring a comprehensive approach to these three programmes.

TB CHALLANGE: missappropriate funding and atention payed to not cost effective interventions/programs/policies, such as 1. too many hospital beds 2. too long/unnecessary hospitalization, izolation of patients 3. over trusting in xRay, especially in MMR 4. TB suspects hospitalized before sputum examination 5. too centralized TB services providers CONSEQUENCES: frequntly above chalanges are hand in hand with lack of money for effective interventions as 1. early detection by sputum smear examination 2. lack of respiratory izolation in hospitals 3. cross infections 4. interuption of treatment 5. lack of acces to TB services. WHAT CAN THE GF DO? Incourage proposals of surveys/studies that inform cost effective actions and good practices and so help countries in making their TB control policies evidence based.

We invite you to post your contributions directly to the forums.

Dear members,

Here's a contribution by felixsammy from Kenya.

Thank you for your contribution!

Alastair
e-Forum Facilitator

 

---

 

What aspects of the global fund’s current processes for accessing funding are preventing adequate scale-up to address the needs? One of the aspects is their direct communication with only countries thus keeping out organizations or other projects this prevents adequate funding to all other actors in a country since it gives the country the power to decide their programs themselves. Therefore most of actors are neglected since the country favors their own choice. The use of country coordinating mechanism as the only bridge to focus a country, is not reliable since it is the final, it can give support to very few programs of their choice leaving very many needy ones out. Therefore the funds are wasted instead of meeting their implementations. The centralization of global funds interests on CCM actually overworks the body such that it can not give enough supervision to all the programs planned. And since everything is conducted through the CCM, there is the superiority complex which lead to reluctance in their operations this leads to proposal dalliance or total negligence. The principal of country ownership kicks out individual charities, this limitations favors those who are financially stable rather than the theme on how adequate scale-up can be met. The system of proposal rounds does not give adequate service since it operates for certain duration hence congestion is observed in the offices. In fact the reprogramming of the global fund operations should start by simplifying their means of accessibility.

I will ask Project Accountants - Previously released Funds not adequately consumed, could prevent adequate scale-up. - Work Plan not objective. - Date line for proposals not met. - No satisfactory evidence of capacity to perform. - Also the application of strigent yardsticks/measures or rationale for accessing funds from the principle receipients prevent most ready/willing CSOs from accessing funds for program implementation. - Where funds are given, the process of program implementation become complicated and tight for proper implementation by CSOs, as Donors would want to dictate the activities and how it should be run instead of bringing the CSOs into the planning to get their own ideas/views as they are the ones at the grassroot. - Even when program is implemented, the process of Evaluation becomes a trouble zone as Donors would want a sustained evaluation from CSOs with no proper fund allocation.