Grant renewals: Global Fund has become more prescriptive

3. ANALYSIS
20 Jan 2014

The Global Fund has become more prescriptive about what should be included in submissions for funding for the next phase of a grant. While this trend began under the Grant Renewals Panel, the formation of the Grant Approvals Committee (GAC) in the second quarter of 2013 brought with it a noticeable upswing.

The GAC, comprised of senior Secretariat officials and non-voting representatives of technical partners, reviews all requests for funding and makes recommendations to the Board.

When a continued funding request is under review, the GAC recommends or suggests changes to workplans and budgets – which are ultimately requirements that countries must adopt for funding to be approved.

Although the reports of the GAC are not posted on the Global Fund website, they are seen by members of the Board delegations and the people consulted by the delegations. Aidspan has access to the reports and has been reporting on their content in GFO.A list of recently approved requests was published here.

Aidspan has observed a number of trends emerging from the GAC recommendations, including the modification of programme elements, either adding them or eliminating them and shifting the resulting savings towards programming that targets key populations. Cost-cutting and switching to new principal recipients are also typical GAC requirements.

On occasion the GAC requires countries to revise and resubmit requests for continued funding. A Round 8 TB request from Guinea-Bissau required a change in PR from the ministry of health to the United Nations Development Programme as well as a programme review that could lead to further revision and validation of the most recent draft national strategic plan.

India was told which objectives should be prioritised in itsrequest for continued funding for three single-stream-of-funding grants: the expansion of TB notification rates and multiple-drug-resistant TB diagnosis and treatment; TB–HIV co-infection; and urban care models to reach more vulnerable and marginalised people.

In several cases, the GAC “recommended” actions that went beyond the grants themselves and targeted national programmes. When it reviewed the India TB grants, for example, the GAC said that a high-level inter-agency task force should be established to convince India’s political leadership to pick up a greater share of the costs of providing TB treatments.

Aidspan understands that a multilateral task force was subsequently established among technical partners including the WHO, the Stop TB Partnership and USAID. Additional input from Path, the Clinton Health Access Initiative (CHAI) and the Bill and Melinda Gates Foundation contributed to the group’s mandate, which emphasises new strategies for structuring of Global Fund investment to get out in front of the TB epidemic in India, which is proportionally the world’s largest.

In the case of two HIV grants from Namibia, the GAC asked for the country dialogue to include a district-by-district assessment of high HIV transmission areas, focusing on the most vulnerable groups.Namibia was also required to expand TB–HIV collaborative interventions to acknowledge gender issues including gender-based violence.

When it reviewed a renewal request for a Colombia HIV grant, the GAC said that the PR must implement activities targeting transgendered people to try and bring down the high HIV prevalence rates in that community. Activities targeting people who inject drugs were also added to the grant.

There are also notable consequences for countries that fail to implement GAC recommendations. In May 2013, the Board approved Phase 2 funding for a regional HIV grant in Latin America and the Caribbeanon the condition, set by the GAC, that the grant be completely reprogrammed. The grant was to be refocused away from the regional military and security forces and towards activities to reduce stigma and discrimination affecting populations such as sex workers, men who have sex with men, and transgendered people. Several months later, when the applicant had done little to re-work the grant, the GAC recommended it be discontinued and the Board agreed (see article here).

Under the old Grant Renewals Panel, also known as the Phase 2 Panel, the Global Fund also set conditions for the next phase of a grant, but it was less likely than the GAC to require the addition or removal of entire programme elements.

The requirements of the GAC with respect to the inclusion of certain key populations in programmes funded by Global Fund grants is clearly an attempt to ensure that marginalised and stigmatised populations – such as transgendered persons, people who inject drugs, and men who have sex with men – receive prevention and treatment services. In many countries, these populations are not covered by government-funded programmes. The focus on key populations is consistent with the objective of the Global Fund to concentrate on the hot spots of the HIV, TB and malaria epidemics.

Similarly, by requiring the addition in grant renewals of activities related to human rights and gender, the GAC is forcing countries to address issues that have not received enough attention in the past. For several years now, the Global Fund has been promoting the idea that programmes must include a greater focus on human rights and gender. The recent actions of the GAC indicate that the Global Fund’s initiatives have not borne enough fruit and that the Fund feels it must go beyond promotion – at least in some countries.

Another trend that Aidspan has observed is that when the GAC requires the removal of some programme elements, it is usually because the GAC believes that these elements will not have a major impact on the epidemics. Reinvesting the savings from these discontinued elements into initiatives that will have a greater impact is consistent with the value-for-money approach that the Global Fund has adopted.

From comments from the Global Fund Secretariat, Aidspan understands that these requirements are the direct result of a new, more strategic approach to funding embodied by the NFM that demands greater engagement by the Secretariat itself in the process of developing concept notes and grant proposals.

The GAC, according to the Secretariat, ensures that partners are present at the table to make sure that investments are better targeted, part of a better process that will ultimately maximize the impact of Fund investment at the country level.

It is too early to tell whether the actions of the GAC will have the desired outcomes, including improving the quality and impact of programmes targeting key populations. But these prescriptive requirements should, at their core, do more to expand the number of people, particularly among vulnerable populations, who are accessing services supported by the Global Fund.

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