I work as health program manager of a local NGO in Sierra Leone.

I would like to present a patient..... She is 30 years old, has 4 children and is HIV-positive, also has Tuberculosis and is just now suffering from a malaria attack.....3 prongs of the Global fund combined in one patient.

And that is exactly my point -- especially at the primary care level most interventions for the 3 diseases take place at the same facility or community and sometimes even in the same patient!! So why not make ONE prong - with all combined.

So just one Principal recipient per country instead of three - less double funding more value for less money etc. And select as much as possible sub-recipients who deal with all 3 diseases. The TB microscope can also be used for malaria slides.... Trainings can be integrated to deal with all 3 diseases etc. One supervision team (and so one vehicle) can supervise the HIV and TB and malaria activities... Of course there will still be specific TB, HIV and Malaria activities but I feel that a lot of the activities could be truly combined.