The Implementer Voting Group (ImG) of ten constituencies of the Global Fund Board met for its annual retreat in Dakar, Senegal, from September 11 to 13. The objectives of the ImG’s 2019 retreat included to identify the related priorities, strategies and positions of the ImG in relation to Global Fund Board decisions, and to strengthen action to advance country ownership and political will across a range of aspects of the Global Fund Board’s mandate.
It also focused on exploring progress against the ImG’s 2017–2019 Roadmap and the Global Fund’s strategic objectives; agreeing on collective actions for the future Roadmap; and exploring draft “Ways of Working” for the ImG. The group acknowledged the outgoing leadership of the ImG, Chair Felipe da Costa and Vice-Chair Maurine Murenga (the ImG’s new leadership is expected to be announced by October 16).
In 2016, the Implementer Voting Group (ImG) of the Global Fund Board endorsed the 2017 – 2019 Roadmap that guides the priorities of the ImG’s ten constituencies, made up of seven government-representing constituencies and three communities- and civil-society delegations. The overarching objective of the Roadmap was to formalize four shared priority areas for the 2017-2019 period, and to develop and plan a timeline to action them.
The four priority areas were: to improve the Implementer Group’s effectiveness; to improve absorptive capacity; sustainability and transition; and human rights and gender equality.
Underpinning all of these, the ImG had agreed at the 2017 retreat, was strengthened engagement by Country Coordinating Mechanisms (CCMs).
2019 Implementer Group retreat
The 2019 retreat was well attended, with a range of participants from the African Constituency Bureau Secretariat, some members of the Global Fund Board and Committees’ leadership (from the implementers’ side), staff from the Secretariat’s Office of Board Affairs, other Secretariat staff, Aidspan, and the Global Fund’s Executive Director, who participated virtually in some sessions.
The whole meeting provided an opportunity for a review of the ImG’s own performance, which was documented. This assessment was done in groups with the meeting’s participants collectively agreeing on which elements had successful outcomes, which require improvement, and which areas the ImG should continue to focus on.
What worked: The push by implementers on advocacy around Human Rights and Gender has increased the focus on the community, rights and gender global agenda; what is needed now is to focus on its sustainability, including the possibility in some countries that such advocacy is financed domestically, with the potential inclusion of the private sector, especially if there is concrete evidence on what has worked. In addition, aided by the ImG pushing for CCM strengthening, the pilot of the CCM evolution initiative was launched in 18 countries. Also noted as a success was improved communication between constituencies and other key in-country gatekeepers who can help to facilitate, in a harmonized way, the sustainability, transition and co-financing policy of the Global Fund.
What did not work: The ImG concluded that accountability for domestic
financing is an issue – some countries are not able or willing to fulfil their co-financing commitments. In some countries, especially in instances where separate grants have different PRs, there is weak capacity to align and coordinate between grants. In addition, a perceived lack of clear transition plans, at both the Secretariat and country level, is a problem that must be addressed if the Global Fund is to attain the 2030 vision of eradicating the three diseases.
Areas to focus on: There is a great opportunity to consolidate on the immediate gains at country level in fighting HIV, TB and malaria, and to achieve sustained gains, by developing a clear plan with a monitoring framework on how to guide domestic resource mobilization and its utilization. These gains could also be sustained, the group felt, by strengthening country ownership, starting with the funding request, in which country context and government investment in health systems is considered. Also, the group proposed increasing spending on the capacity building of healthcare providers, improving oversight of programs with systematic community engagement as part of the process, exchanging learnings among constituencies, and adding further technical assistance to clearly support CCM strengthening and civil society organizations’ engagement.
The topics of country ownership and absorptive capacity were still considered top priority (as they are in the current roadmap) as – along with many other challenges – they affect most constituencies within the Implementers Group. The constraints on absorption were said to include a lack of timely, high-quality guidance from the Secretariat and then in turn from Principal Recipients to Sub-Recipients] on programmatic implementation. It was felt that the Secretariat’s focus is more on fiduciary management which comes with a high degree of control (and which can cause delays), multiple reviews (by the Local Fund Agent, fiscal agents, and Country Team, who together provide assurance) placing conditions on financing operations. The help of the Global Fund Secretariat was considered critical for absorption to improve, in order for grants to achieve their intended impact.
Greater transparency needed on country-specific information
The ImG discussed the issue of transparency between the Global Fund Secretariat and its stakeholders, including country implementers, specifically the idea of providing country-specific financial and programmatic data. The issue seemed to concern country examples shared at committee level when illustrating a best practice or a problem; retreat participants wondered why the Global Fund doesn’t specify a country name when providing data (in this context), as other organizations do, some said. It was felt this was important for a ‘partnership’ model, and that implementers’ difficulties in reconciling country data/information with that officially put out by the Global Fund is an issue negatively affecting absorptive capacity.
The lack of visibility into funds that remain unspent at the country level was one concrete example given; this has contributed to countries’ inability to start timely reprogramming, participants said. This has also meant that in some cases Principal Recipients reprogram only for service implementation gaps, which are mostly management and administration matters. The country’s funding may then be penalized within the current funding cycle if timely reprogramming is not done.
One critical example of this lack of transparency in data provided was the Price Quality Reporting (PQR) and reconciliation of cash balances, given that the Secretariat is usually responsible for direct disbursement for purchases made through the pooled procurement mechanism (PPM) or for any order made by a PR through Wambo.org. The inability of the country or the PR to obtain information on the actual cost of commodities or products ordered through the platform has been considered an obstacle to determining the actual expenditure for the period under review, depending on when the disbursement notification is received by PR or the CCM. It was noted that the Secretariat does provide such information to countries – but how and when this is done seems sometimes to be a cause of concern. The timing, it was felt, really affects the timeliness with which reprogramming can be done, if that is needed.
It was suggested that the Secretariat could be pro-active by, for example, updating each implementing country at the end of each year with a form of accounting for what has and has not been spent, in pooled procurement, for example, and where the Secretariat thinks the country could improve its performance.
Sustainability and country ownership
The current efforts of countries to sustain the gains made in the fight against the three diseases was discussed with optimism at the retreat. However, the launch of the sustainability, transition and co-financing policy in 2016, designed in part to encourage greater country ownership, was observed as having come a bit later than anticipated [after 16 years…] when EECA and LAC pushed to have a clear policy around being pushed out. For the required changes to translate into results at country level, more time is needed, implementers felt, with joint advocacy to Government at higher level by civil society, other government entities, and other champions to promote and encourage ‘ownership’. This could be achieved with early engagement at the committee level on what can and would not work, based on documented evidence from country experience. High-level advocacy for domestic resource mobilization was identified as a high priority for the next version of the ImG Roadmap.
On communication, there was discussion about the time lag between committee decisions and the following Board meeting, as only then could decisions be made public. It was felt that CCMs should be updated on the Global Fund Board and committee meetings’ outcomes regularly. The ImG considered its roles, including the sharing of independent, country-level information that could be complementary to TRP and Secretariat comments as inputs into allocation methodology and policy. The topics discussed in this context were the TRP RSSH performance report, human right sand gender, sustainability, transition and co-financing. The ImG also recommended that the Technical Evaluation Reference Group (TERG) reports be made public.
The ImG considered that the current approach to consultation on defining the Agenda for Global Fund Board meetings could be more effective; the process used to create the Board meeting agenda should be reviewed with a view to making it more inclusive. Some implementers felt unable to make a meaningful contribution to Board Meeting agenda items as they affect them. The Country Ownership principle was considered eroded, with a lack of funding and political will to support constituency engagement beyond constituencies coming together during Board meetings.
Finally, the ImG reinforced its collective conviction that the CCM must move from where it is – it should and must evolve. The CCM Evolution pilot was considered successful, with pockets of challenges that hopefully will be considered by the Board, before the CCM Evolution model is recommended for roll-out.