Guidelines for Assessing Future Scenarios submissions

-         The ideas will be collated and translated into the four languages.

-         The evaluation panel will then be sent all of the ideas submitted.

-         Ideas will be identified with a number but the name of the individual and the region will not be made available to the reviewers. This will ensure transparency and also focus on the quality of the idea.

-         Each idea will be marked out of 50.

-         Each section of criteria published will be marked out of 10 (ie: potential efficiency; acceptability; practicality; originality and innovation), making a final total out of 50.

-         Each reviewer will be expected to provide some comments to justify the marks given

-         A short list of the best 5 ideas will be made and a final decision on the best two will be made via teleconference.

-         The results will be posted on www.MyGlobalFund.org during the week of October 13.

1. The future Global Fund should be made in such a way which will be fully helpful to the people who are Underprivileged people from the development World.

a) Women and child (mother and child, health, early marriage & malt marriage, venerable women )

b) Child health and education, child labor stop or education.

c) Disabled child Rehabilitation 

2. Specially it should be implemented on the third World countries.

3. We think that it will be more successful. If it is funded with the N.G.O which works in the gross root level in any third World countries.

4. The gross root level N.G.O works well because they want to improve themselves with their works. The root level N.G.O of Bangladesh works well than national N.G.O. The National N.G.O mixes their program with another. With the works of a program they get benefit of the other. But the root level N.G.O has no opportunity to make such a profit.

But all root level N.G.O has no real existence. The Global Fund should be aware of it.

5. Global Fund should be implemented on the human rights. Many people in the World are suffering from various epidemic diseases like HIV/AIDS and Arsenic.

Arsenic Most of our rural and urban people do not know about pure water and sanitation and also they are not getting pure water. For that cause more children are affected for water disease and almost died, except, they all are suffering many harmful diseases. Like, as arsenic, it is a harmful disease. Most of our people are illiterate they do not know about arsenic and rural and urban people are always drinking arsenic attach water and also household work with arsenic attach water.

6. Before funding on any subject, a token fund may be implemented for testing on any organization. If they work well, they may be able to get a big fund and this big fund may be for a certain time such as two years, one year etc.

It seems that our ideas and views are not so well but if one word becomes beneficial we will be grateful to you.

Your kind cooperation and necessary action for the above mentioned subject is expected

Sincerely yours.                                                                                                      

Ali Kodar                                                                                                      

Executive Director

A Model Universal Access Community

1                    I am looking at the Global Fund as a whole

2                    My idea could bring about a total turn around to the pandemic

3                    Things that need to happen to make this idea a reality is total empowerment of communities

4                    Obstacles will be overcome if ownership of the program is with community

5                    My idea should be considered because there is ownership sustainability inbuilt in the program can be a model for other countries

Future Scenario

A sustainable Universal Access Intervention

1          Carry out a baseline in the community and assess community needs

2          feedback findings top the community and find the way forward with the community

3          facilitate the community to identify what they can do themselves and where they need outside help and what type of assistance?

4          create community debates on health and encourage the community to take charge of their health and find solutions that are lasting to their problem.

5          Do treatment literacy discussions with service providers and service recipients

6          Encourage parent to child dialogues on growing up sex and sexuality

7          encourage formation of support groups for the infected and affected. Provide lots of information through reading and watching films.

8          provide health centers with human power and drug and law enforcement agents to be educated on the need to work closely with health workers for the purposes of the community members accessing post exposure prophylaxis after rape within the stipulated timeframe.

9          encourage the community to create relationships with the health workers

10        communities to learn facts about their bodies, understanding them and listening to the body

11        Community to learn about illnesses, STI, HIV abd AIDS plus their symptoms

12        communities to seek for early treatment at their nearest health centre when they get ill

Idea Submission to Partnership Forum (Dakar, Senegal, 8-10 December 2008)

Planning for Accountability, Coverage, and Sustainability (PACS)

I envision a more strategic utilization of Global Fund inputs toward increased coverage, sustainability, and accountability in drug and commodity distribution to combat AIDS, TB, and Malaria. This would entail the streamlining of the existing system, with key expertise embedded in the appropriate government ministries within each country accessing GFATM funds.

I suggest we consider a CCM that consists of three key positions of high level expertise: 1) a Director or Manager with expertise in management, planning, and high-level policy-making; 2) an Economist/Financial Planner with expertise in national-level budgeting, financial planning and policy, and health care financial tracking systems; and 3) a Commodity Logistics and Drugs Procurement Specialist with significant expertise in developing, implementing, and managing effective commodity procurement and logistics systems with governmental health care counterparts.

In order to promote transparency, accountability, capacity building, and sustainability, I suggest the CCM be embedded within the appropriate governmental agencies. The Director and Economist/Financial Planner could be embedded within a Ministry of Financial Planning & Budgeting (MoF), or the equivalent governmental ministry where national budget proportioning and policy-making take place. The Economist/Financial Planner would report to the Director and lead a team that included a government counterpart and national, state (or district), and local level civil society organizations representing key stakeholders. By reducing the footprint of the CCM, the Global Fund could provide additional resources for improved computer and internet connectivity and administrative support.

The Commodity Logistics and Drugs Procurement (CLDP) Specialist could be embedded within the Ministry of Health (MoH) where s/he would lead a team of:

§         Governmental drugs procurement and commodity logistics counterparts

§         National epidemiologist(s) and Directors of the HIV/AIDS, TB, and Malaria Divisions within the Ministry of Health (and/or equivalent parastatal)

§         Representative(s) of the Ministry of Women’s Affairs (or equivalent)

Teams of state (or district) and local level MoH specialists in HIV/AIDS, TB, and Malaria care and treatment, commodity logistics and drug procurement specialists, health management information systems (HMIS), and monitoring and evaluation (M&E) would report to the CLDP Specialist. Each state (or district) would select a team lead from the state (district) MoH team to lead the team. Representatives from selected civil society organizations representing stakeholder concerns (e.g., local health associations, traditional birth attendants, traditional healers, pharmacists, persons living with HIV/AIDS associations, etc.) would also participate on state (district) teams.

The key objective of this strategy is: Improved access and sustainability of AIDS, TB, and Malaria treatment through responsible national budget allocation, drugs procurement/ management, and distribution.

By embedding the CCM within appropriate governmental agencies, transparency would be increased, and sustainability promoted through skills transfer and capacity building. Involvement of civil society organizations would encourage greater ownership and advocacy for continued responsible allocation of governmental resources, federal budgeting, and planning.

In order to realize this strategy, governments would need to make a commitment to supporting the structure by allocating a percentage of staff time within the appropriate ministries and agreeing to serious and responsible considerations of national budget allocations to health, as informed by recommendations coming from the CCM’s governmental team.

Potential obstacles represented by corruption, inertia, weak or inadequate infrastructure, and lack of cooperation or collaboration would have to be overcome by identifying highly motivated personnel for key positions and introducing a realistic audit plan.

________________________________

Laura Arntson, Ph.D., MPH

Global Fund: What should the Global Fund look like in 5 or 10 years time?

CHAMECC: The Global Fund should be the last hope for those suffering from TB, HIV/AIDS and Malaria. It should try to widen its scope of operation in financial aid to the target rural population in the hinterlands.

Global Fund: What should it be doing?

CHAMECC: It should be financing local projects that will help the local population.

 Global Fund: How should it be doing it?

CHAMECC: It should be doing this by collaborating with grass root organizations like us.

Global Fund: Who should be involved?

CHAMECC: Those involved should include the civil society organizations (CSOs) and non governmental organizations (NGOs) like us, who are experienced execution partners in the field.

Global Fund: what is your idea about the future of the Global Fund?

CHAMECC: My idea is that the global fund has been funding only projects from specific countries and through selected NGOs and CSOs. This is not fair. The Global Fund should be transparent in its functioning and award of projects. It should constantly update the media on its activities in the field.

Global Fund: What specific aspects of the Global Fund does your idea refer to?

CHAMECC: We are referring here to the poor execution of projects in the domain of malaria, HIV/AIDS and tuberculosis. Cameroon, being a country of corrupt officials, projects in the above domains were given to NGOs that are non institutional and nonfunctional in the field. Consequently, they were poorly executed.

Global Fund: Is it about the Global Fund as a whole?

CHAMECC: No, but some specific parts or components of the fund, like the three in focus. But The Global Fund should be more focused on the malaria and tuberculosis components. More emphasis has been put in the HIV/AIDS component here in Cameroon; we have realized that malaria kills even more and faster than HIV/AIDS disease.

Global Fund: What difference do you think your idea would make?

CHAMECC: My idea will alert the Global Fund, here in Cameroon to be cautious in the award of its projects for execution. We work in the media and communication sectors including that of governance, transparency, accountability and conducting surveys. We should be included in the list of executing NGOs.

Global Fund: What sort of things need to happen to make your idea a reality?

CHAMECC: All the CSOs and NGOs, in Cameroon, and especially in the North West province (Bamenda) should be involved in the procedure of projects award for execution. They should also be requested to submit projects for funding in the three respective dodmains.

Global Fund: How might any obstacle be overcome?

CHAMECC: Obstacles might be overcome by financing survey projectrs from NGOs like us to survey and give you a feed back on the effective execution of Global Fund projects in Cameroon, or at least the North West province, with headquarters in Bamenda.

Global Fund: Why should your idea be considered?

CHAMECC: My idea should be considered because it is original and comes from the first and only media and Communication NGO and CSO in the North West provincial capital of Bamenda. Our idea is original because we are the first NGO and CSO since the advent of multiparty politics in Cameroon, in 1990, to have conducted a parliamentary accountability survey on the performance of members of parliament in their respective constituencies on the province. The presentation, during a press conference, was highly acclaimed by the public, with encouragements to do so in the health and other sectors in the North West province of Cameroon. (If you so wish, we could send you a complete report of the survey and the methodology used in the field).

Global Fund: Give a name to your Future Scenario

CHAMECC: “Global Fund: New Hopes, New Vision”

In our submissions (question and answer format), we tried to consider the following five broad criteria:

·        Potential Efficiency

·      Acceptability

·      Possibility of implementation (how realistic?)

·      Originality

·      Innovation

Thanks.

NJI Blasius Charles

Journalist/Media Consultant

Executive Coordinator

CHAMECC

1.0       FUTURE GLOBAL FUND

The HIV prevalence rate in sub Saharan Africa is very high. Some of the reasons that have been attributed to this are high poverty and illiteracy levels that prevail in this region. In Zambia for instance, the HIV prevalence stood at 16% until the 2007 DHS results which revealed a reduction of the prevalence rate to 14.3%. This figure is still very high. Among those who are most affected are women and girls due to their biological make up and because they form the majority of those who are poor (in most cases the most poor), own less assets, and are less educated when compared to their male counterparts. Women and girls also bear the brunt of care when family members are infected or affected by the HIV pandemic. By so doing, they lose out on opportunities to be in gainful employment, attend school or participate in businesses or activities that will help them generate income.

Funds provided by Global Fund have contributed towards increasing service delivery for those infected and affected by HIV and AIDS such as increased numbers of those accessing ARVs and treatment for opportunistic infections such as TB and Malaria, scaling up other interventions ranging from care and support to awareness raising.

Recently a component of the fund has been channeled towards Community Systems Strengthening and Health Systems Strengthening which is a remarkable stride taken towards improving the response to the HIV pandemic. Having said this, there is still room to make the fund more responsive to the needs of the fund beneficiaries by addressing issues that make people vulnerable to contracting HIV.

2.0       MY IDEA OF HOW GLOBAL FUND SHOULD LOOK LIKE IN THE NEAR FUTURE  

I would like to see Global Fund that directly addresses the vulnerability issues of the most vulnerable in society, that is, women and girls. Just as Community and Health Systems strengthening have been identified and incorporated as areas where specific funding can be requested, the following areas also need special recognition and attention:

I therefore propose that the following areas should form part of Global Fund Call for Proposals:

2.1       Educational infrastructurer Fund

In Zambia like in many developing countries, school infrastructure is not adequate to meet the needs of the communities. Therefore, children drop out of school in some cases because of there are no school for them to attend. This results in increased illiteracy levels. Education has a bearing on making informed decisions, simulation of the awareness raising messages/information and equipping learners with the basic literacy required for job prospects. I would like to see a Global Fund that encourages improvement of the education systems through building infrastructure for both schools and skills training in areas where these are not available. Specific focus should therefore be given for a component in the proposal that will request for funding to meet infrastructural needs for Schools and skills training facilities. This can also extend to supporting the government bursary system and NGOs that offer bursaries to help support vulnerable children to continue with their education right up to tertiary/university level as well as those providing adult literacy classes.

2.2       Socio - Economic Empowerment fund

There is also need for a specific focus on programmes that promote access to loans, livestock restocking, capacity building of communities in areas such as business management, leadership, governance etc. Empowering women in this manner will help them participate more actively in decision making within their families and communities, choosing their community leaders from an informed perspective, improve their dietary needs and contribute economically towards the welfare of their families. Also, if women have access to capital such as loans, livestock etc, they will not be left destitute in the event that a bread winner dies.

Response to the Call for Idea

Future Scenarios

My idea about the future of Global Fund is to make it more visible, credible, efficient and transparent in its conduct. This idea is largely focused on introspecting the agenda and goal of GFATM by its stakeholders in general and top executives in particular.

Agenda from specific diseases viz. AIDS, TB and Malaria needs to be widened to the morbidities, the magnitude of which is consistently rising universally for last two decades. It implies that Global Fund should take in cognizance non-communicable diseases like cancers, accidents, mental health problems and cardio-vascular diseases. Since rising economies shall be greatly influenced by accidents and psycho-somatic diseases (natural calamities and terrorism adding to it!), more funds needs to be invested proactively to contain this threat. All of these diseases are rising in countries passing through transition created by new economic order. Probably, these are the same countries for which Global Fund is operating as a financial instrument. Thus Global Fund may revise its agenda on geographical and socioeconomic scale around the world.

Global Fund needs to elucidate lucidly its role when agencies from United Nations as well as a number of bilateral agencies are working on the same mandate. It should clearly spell out its linkages with World Health Organization. 

Concurrently Global Fund may enhance transparency to leverage the financial resources it creates for the countries in need. My understanding is that current strategy of working through technical support unit needs a review. Although it consciously creates a mix of economists, public health experts and other social scientists but a limited number of Experts get an opportunity to join the Board.

In all humility, I wish to submit that acceptance of my idea may help us strike a balance between physical-social environment and host of diseases in the context of epidemiological triad.   Paying attention to this idea may accelerate our efforts to make planet Earth disease free and raise the status of Community Health.

Lastly, I wish to name such a future scenario as “Coping with Third Millennium”.

Future Scenarios – The Global Fund

From the perspective of promoting good governance through funding support, there are many positive and admirable aspects of the approach taken by the Global Fund especially in their management policies to require improved accountability and transparency of recipient agents.

To picture future scenarios for the Global Fund perhaps an examination is needed that identifies both the core functions of the organization and in what ways could the Global Fund could better position itself in the future to absorb new shocks and to influence health outcomes/policy.

Although other important governance elements are evident such as the role and function of the Board, the TRP and various TORs, a review of the website does not clearly identify the overall strategic objectives of the Global Fund.

Not unexpectedly many of the comments of people currently involved in Global Fund projects were centered from their perspective around operational issues both in terms of project implementation and reporting. Although most operational issues can or should be resolved within the management framework of the project, there are sometimes limitations because of the inherent emphasis the Global Fund places on assigned ‘activities’.

Because an ‘activity’ approach is by definition ‘input based’ there is no real incentive for recipients to focus on outcomes or overall improvements in quality whether that be in a clinical sense or in the management of projects. On a broader level, a focus on these three diseases can potentially act as a disincentive for recipients to strengthen integrated health care.

There are of course aspects through the monitoring and evaluation system and to a lesser degree in the selection of indicators to encourage quality services/behaviors, but there is no real impetus for recipients to pursue continuous quality improvement because their projects are intractably linked to reporting on individual activities.

Perhaps a fundamental change is needed towards the role of the Global Fund from activity and input based, to program based and outcome focused, with quality assurance /quality improvement as the overall monitoring tool which is negotiated at the beginning of the grant.

This would mean that a re-configuration of the Global Fund to some extent and a change of involvement from scrutiny of individual activities to a more arm’s length approach, with greater analysis of the factors that are contributing to overall health outcomes.

In terms of recipients, an ‘outcome’ approach could be supported by what ever management tools are required to manage a project, align with local health priorities, and ultimately improve health outcomes.

The Global Fund has built its goals and objectives around the prevention and treatment of malaria, HIV and Tuberculosis as well as related activities that fall under Health Systems Strengthening. From a recipient perspective, changes to what the Global Fund will or won’t fund are immaterial so long as the delineation is clear, along with a set financial cap.

In addition recipients might find it useful if the Global Fund was able to provide access to a range of specialist services or products to help recipients to review and improve their internal management plans as an adjunct to grant implementation.

The Global Fund should be commended for the opportunities given to grant recipients to provide comment and feedback on Global Fund services.

Summary:

§          Define The Global Fund strategic objectives

§          Change to Program/Outcome based framework

§          Clearly define what will and won’t be funded, and include a financial cap

§          Set a budget for each recipient to achieve defined outcomes

§          Maintain arms’ length to processes for project implementation

§          Concentrate on quality measures as part of performance / monitoring

§          Provide ancillary support services as an adjunct to grant administration

§          Provide support for recipients to re-align or modify their overall planning policies

WHAT SHOULD THE GLOBAL FUND LOOK LIKE IN 5 OR 10 YEARS TIME? WHAT SHOULD IT BE DOING? HOW SHOULD IT BE DOING IT? WHO SHOULD BE INVOLVED?

GLOBAL FUND FOR POVERTY ERADICATION/GF FOR ALL.

There is no doubt the fact that the GF is actually doing a lot. 

In the next 5 – 10 years, it would be expected that with proper use of suggestions, contributions and inputs from CSOs at the grassroots, the GF would be scaling up their programs to a point that would aim at total attainment of the objectives of the GF and MDGs.

Eradicating poverty is regarded as the most important goal of human development. Indeed, it is widely believed that at its core, development must be about improvement of human well-being, removal of hunger, disease and productive employment for all.

A Nation’s first goal must be to end poverty and satisfy the priority needs of all its Citizenry in a way that will not jeopardize the opportunity for the future generations to attain the same objectives.

Poverty has been defined by the poor themselves (World Bank 2000) and by most development Agencies, in relation to several dimensions of human life such as hunger, poor material standards, no assets, poor health, lack of education, insecurity, lack of freedom, abuse of human rights and no voice and power in decision-making (UNDP1997).

Thus, poverty is multidimensional with a Material dimension (income, assets), a Physical dimension (hunger, poor health, poor education) and a Psychological dimension (voice, freedom, power).

The World Bank’s study “The Voice of the Poor” based on interviews with more than 60,000 poor men and women in a number of developing countries and emerging economies, provides an in-depth view of the various dimensions of poverty and also the critical roles markets and the private sector tend to play in their lives. (World Bank 2000) It shows inter alia  that various dimensions and manifestations of poverty are generally inter-related at the individual level. For example, Low income leads to vulnerability and often to poor health and the inability to educate children, Lack of education and poor health reduce the ability of poor people to improve their living conditions, ie it is a vicious circle.

Human rights and justice are therefore, equally important as foundations for poverty eradication and Global Development as the Material and Physical aspects. This places emphasis on democratic governance, freedom of expression, equal rights between men and women, rights of children and disadvantaged groups in society.

To achieve the MDGs the Global Fund is expected to touch other dimensions of poverty as they are inter-related. We can have GLOBAL FUND FOR POVERTY ERADICATION  since HIV/AIDS, Malaria and Tuberculosis are all dimensions of poverty.

For the GF to attain her highest height globally, there will be need to work with CSOs and welcome suggestions and inputs from CSOs working in different areas (resource persons) at the grassroots who incidentally are the actual implementers of the programs.

Intensify monitoring, impact assessment and evaluation of existing programs, which were being impended and then re-programming for re-implementation and scaling up where need be.

More emphasis would be on detailed reporting from the national, regional and zonal resource persons through grassroots implementers. This of course can be evidenced through verifiable indicators, site seeing and routine checks.

JANE CHUKWUKERE - NIGERIA

I HAVE A DREAM

THE-GLOBAL-LIFE-FUND Circa 2008-2018.

A Presentation By:

Pastor Richard Rotimi Johnmark

President/National Coordinator

GLOBAL LIFE-IMPACT FOUNDATION

NIGERIA

Calvary greetings to you all in the name of Jesus Christ.

I give Glory to God Almighty for giving good success to such Noble Men that brought about the Establishment of THEGLOBALFUND geared towards eradicating  HIV/AIDS, Malaria and Tuberculosis, God bless you all.

My contributions and dreams to the Future Scenario of The Global Fund in the coming 10years are summarised below:

I write on behalf of GLOBAL LIFE-IMPACT FOUNDATION. We are a Faith-Based Community Christian Outreach Ministry / Organization, working towards: Establishing Free Computer Trainnings, ConductingLeadership & Character Development Trainnings, Visiting & Supporting Missionaries on the Field esp in material provosions and in Capacity-Building, Non-Medical Interventions for HIV/AIDS Care & Supports for the; Infected, the Affected and the Involved, Meaningfully Networking with other Ministries, Governments at all levels, Associations,NGO, CSO & CBO to improve Life, Humanity and Social/Medical Existence, particularly in Nigeria but having a Global View.

1. I HAVE A DREAM, Please intencify more of NETWORKING, come down from your high pedestal. To impact more lives, you need to move away slightly from Capital Cities of Countries and move to smaller Districts by establishing Offices to re-enforce your activities to the Grassroot populace.

2.I HAVE A DREAM, It is unfoutunate that many Governmental Ministries you often parnter with are only interested in your Fund, Grants & Donation which majorly are been wasted on 'Overhead Costs', I dream of THEGLOBALFUND parnering with privately owned NGO, CSO, FBO and Community-Based Organizations.

3.I HAVE A DREAM, seeing your Communication/Information Outfit speaking several Languages beyond the usual [French, English, Spannish German Italian & Portugese]. For Example; Nigeria has 20 major languages but with 300 dialects, Within IDOMA Speaking Community we are based, there are twenty different variations.

4.I HAVE A DREAM, I see THEGLOBALFUND extending their NETWORKING on a DIRECT-REACHED BASES Religious Oganizations, Churches, Christian Ministries, HIV/AIDS Support Groups, Islamic Organizations. You will agree that Religion is another means of recieving absolute attention, acceptability, recognition, fulfillments and proper workability of your projects and activities in the heart of World populace.

5.Future venues of Seminars, Workshops and Conferences should be taken or diverted to rural, semi-rural or semi-urban locations [not minding the short-term inconveniences]. Most of the 'Elites Attendees' will be able to appreciate the practical needs of the rural dwellers where majorities of African & Asian countries populations are.

6.Consistent Monitoring, Proper Evaluations, Visiting of Out-Post Stations,Effective Follow-up plus proper trainning and re-training of personnel to fit in APPROPRIATELY to thier location. is desired.

7.By the use of local inhabitants to reach a group of people [ who knows the Terrain, understand the Cultural Diversities, speaks the peculiar Language] is better than using someone with a foriegn setting to speak to people esp in Africa 

8.If CNN, THE RED CROSS and THE BIBLE/KORAN can reach the remotest part of planet Earth, I see THEGLOBALFUND, penetrating by physically reaching all dwellings and seeing situations by yourself rather than relying on 'ARM CHAIR PROXIES' who will seat in thier comfortable offices and concort reports that are not applicable, realistic and truthful. With $150 [American Dollars] to a local indegine on quarterly bases, will give you more penetrations than wasting hundred of dollars to the City boys- am writing from practical exoeriences of Seminars i have attended and the reports ended on the tables of beurocrates.

9.I se THEGLOBALFUND funding NGO,CSO,FBO & CBO better by having direct connection and softening the procedures for obtaining Grants, instead of concentrating such awards to City Organizations, Honestly, most counties Capital Cities are saturated, This will encuorage worthwhile persons to set up Humanitarian Organizations in the rural, esmi-rural and semi-urban areas of thier countries making even distributions of facilities, materials and meaningful delopments.

When i arrive Dakar Senegal in Dec 2008, I shall elaborate these and many relevant points that may transform THEGLOBALFUND for HIV/AIDS, Malaria & Tuberculosis a world House-Hold name.

I am Pastor Richard Rotimi JOHNMARK [mnipr] 47years, widower of 6yrs now but about to remarry, with 5 children [13yrs-23yrs, 2males & 3females]. Am based in Benue State of Nigeria overseeing GLOBAL LIFE-LIFE IMPACT FOUNDATION, in Otukpo, Makurdi & Gboko.

I appreciate this privilege, I rest my submissions, ThankU

Pst Richard Rotimi Johnmark [nmipr]

THE GLOBAL FUND SHOULD SOIL ITS HANDS

My Names are Ben Odhiambo Onyango, I come from Nyanza Province In Kenya.

I wish to share with you my opinion on what I think the Global fund should look like in the next five to ten years if the fight against HIV/AIDs, Tuberculosis and Malaria is to be won significantly in Africa and other developing countries.

My paper as the title suggests rotates around, The global fund and its staff soiling their hands in order to reach the people who are in need of assistance. I will attempt to show that although the Global fund has done and   spent a lot of money in the fight against HIV/AIDs, Tuberculosis and Malaria, a significant volume of its efforts and the funds don’t reach the targeted communities who are the beneficiaries.

Working Through Others.

It is my opinion that the delivery methodology and the implementation approach currently in use by the global Fund where funds are channeled after a series of vetting processes to either National Aids Control Councils, NGOs, CBOs  or other community initiatives, has tended  to alienates the Fund from the core issues and the real problems on the ground.. I liken it to a hand protected by gloves; such a hand never gets soiled. It never gets to understand the real issues related to cleaning/washing the hand after handling the soil.

In my view the fund needs to invest in structures and an in- country system that will make it more able to take direct control of the planning, implementation and accounting for the funds that it makes available for the fight against the three conditions.

For this to happen, the fund needs to restructure and reorganize so as to have in -country presence in all the countries benefiting from its, assistance.

This can be achieved by adopting a project or programme based approach to implementation where specific projects or programmes are designed by undergoing the normal appraisal and costing process and then availing funds on a specified project/programme which is time bound with well specified targets and clear indicators.

This idea would make a difference because in-country teams are in the best position to appreciate and understand problems and challenges that exist within a particular locality and at the same time giving implementation a project approach ensures that all issues leading to the problem being addressed are taken into account from a holistic approach.

Treating the Symptoms

I Liken the current method of project identification and vetting used at the global fund to A Doctor who prescribes treatment to a patient by listening to his description of the symptoms over the telephone and prescribing drugs without ever getting to see the patient. Most likely this doctor will end up not knowing the root course of the symptoms described over the telephone.

Whereas the global fund has a meticulous and rigorous process of vetting projects for approval, The fact that it has no process on the ground to know the environment and the background against which each proposal is made, there often tends to be an over, or understatement of the situation on the ground by the various proposal writers who seek for funding.

Good proposals are often written on behalf of communities by the elite in society, often these are retired teaches, and or civil servants. The danger with this kind of scenario is that the real community issues   never get to come out as well as the community would have brought them if the planning process were participatory and the communities were afforded the opportunity to state their problems directly to in- country global fund staff or teams from the global fund with the specific interest of the communities at heat.

To have all issues leading to the problems of Hiv/Aids, Malaria and Tuberculosis brought out in their true perspective by the communities, the Global fund needs to adopt a participatory planning process where communities are assisted to come up with all the issues leading to a particular situation.

A number of issues predisposing women and children are tied to culture as it relates to agriculture and also attitude.

Participatory planning where communities re involved in the planning process would ensure that the courses of HIV/AIDs within the communities are addressed as opposed to the current situation where funds are channeled specifically to address disease situations.

The difference here would be that the root cause of a problem and the challenges and obstacles delaying adoption of certain technologies or interventions may be tackled in good time.,(a good example is the situation where a number of mosquito prevention nets given to communities in malaria prone areas along the shores of lake Victoria in Kenya are sold to fishermen for purposes of Fishing), presence on the ground would quickly diagnose such a problem and address its course.

In order for this idea to work, The fund needs to take charge of its field projects and either work in close collaboration with government departments or have specific staff working along side government and or NGO personnel to ensure that the funds devoted to any particular activities are well planned for and are applied to the purpose for which they are intended.

Creating Identity and Local Presence

Just like other development actors in Developing countries are identified Directly with their funding and their projects, In the coming five to ten years the global fund should put in place clear mechanism to enable it identify directly with the projects that it funds.As opposed o the current scenario where NGOs and other actors are identified with the success or failure of interventions using Global fund,, It should be a GLOBAL FIGHT, against HIV/AIDS, Tuberculosis and Malaria. And for any fight to succeed one needs to soil their hands. It is difficult to fight effectively through others.

Conclusion

The Global Fund should have projects and interventions that it supports and implements and make a comparison with those that it gives funds to other organizations to implement then make a comparison with a view to slowly moving to take charge of its projects in the field.

CCMs have been government department/ministries as in my opinion it becomes difficult for the sister entities to supervise each other. For instance where Ministries of Health and National Aids coiincils are CCM arms it becoms a big task to hold accountable another line ministry the  Ministry of Finance who is the PR. So an independent entity civil society or private sector should be mandated to do this.

this is in refference to the general oversight and acountability of the Global fund at country level  

o                                What difference do you think your idea would make?

This reduce on conflict of interest and protectionism and all the bureacracies in governments may be overcome is making decisions over GFATM  

o                                What sort of things need to happen to make your idea a reality?

the shoud be a call to governemet to advertise for private or civil society organisations with the reputation and credibility and might to become a CCM to ensure independence. the governement would do its mandated role oversee all the funding in the country but for GFATM and other specialised funding another entity should be responsible.

o                                How might any obstacle be overcome?  

the bureacracies will be avercome and there will be level ground in discussions with PRs as its not a sister line ministry involved and reduce on conflict of interest and protectionism

o                                Why should your idea be considered?

It is quite unique and bearing in mind of that in most countries Government ministries have been the CCMs, an innovation a diferent model could be tried to see how different and how better/faster the accountability/responsibility will be accomplished.  

o                                Give a name to your Future Scenario

civil society taking the lead in global fund governance