In this first audit of the Global Fund Capacity Building and Technical Assistance, the Office of the Inspector General (OIG) found that the strategy and governance structures for guiding technical assistance and capacity building investments require "significant improvement.” The OIG also found that the policies, processes, and controls to enable capacity building and technical assistance are “partially effective.” Similarly, the processes to ensure economy and efficiency in managing these investments are rated as “partially effective.”
The OIG used a four-tier rating that ranged from ineffective, needs significant improvement, partially effective to effective.
What are capacity building and technical assistance?
According to the OIG report, the Global Fund did not formally define capacity building; it is understood as activities aiming to enable countries to develop competencies and skills critical to the success of programs or to help improve the effectiveness and efficiency of health systems.
The Global Fund defined technical assistance as the engagement of people with specific, relevant technical expertise to support inclusive country dialogue, preparatory activities, grant-making processes, or implementation of Global Fund-supported programs. Technical assistance covers a wide range of activities that include training, mentoring, literature reviews, data analysis, development and dissemination of tools and guidelines to address specific technical needs. Technical assistance can be short-term to fill a gap, or long-term to support Country Coordinating Mechanisms (CCMs), grant implementers like Principal Recipients, sub-recipients or other institutions that carry out the Global Fund’s activities. Such technical assistance can occur at any stage of the three-year grant cycle: when countries develop their funding requests; at the grant-making stage, for instance, when first-time Principal Recipients prepare to sign a grant agreement; or during grant implementation to support countries to reach their program’s targets, use their grant efficiently, address implementation bottlenecks, or long-term country capacity development.
The Global Fund has three categories of investments within technical assistance and capacity building.
The first category of technical assistance and capacity building is funded by the Global Fund grants and is estimated at $839 million for the 2017-2019 funding cycle. Since there is no mechanism to track all the technical assistance and capacity building activities and related expenses, this amount may be an underestimate. The capacity building component is estimated at $500 million. Technical assistance expenditures are often in-country professional fees paid to specialized agencies like the World Health Organization (WHO) to support grants and national programs. Technical assistance can support areas like financial management program implementation, governance, procurement, and supply chain. The Global Fund spent about $339 million for the 2017-2019 cycle.
The second category of investments in technical assistance and capacity building is the bilateral “set-asides” estimated at $332 million. Set-asides are a percentage of a donor’s pledge to the Global Fund that the donor manages to provide support to the Global Fund interventions. For example, 5% of France’s pledge to the Global Fund during the 5th replenishment goes to Expertise France, which provides technical assistance to countries within the Global Fund portfolio.
Finally, technical assistance and capacity building investments are included within Strategic Initiatives, but those are not separately identifiable. The Global Fund’s strategic initiatives are investments to “support the success of country allocations but cannot be funded through disease-specific components of grants.” Strategic initiatives, which are part of the Global Fund catalytic investments, have a budget of $233 million. Aidspan described them earlier.
There are some technical assistance and capacity building activities that benefit the Global Fund programs but are not provided through either one of the categories listed above. An example is the Resilient and Sustainable Systems for Health (RSSH) that may be funded through the Ministry of Health or other donors.
The OIG audit aimed to assess the:
- Global Fund’s strategy and governance structures for guiding and overseeing capacity building and technical assistance investments
- policies, processes, and controls for enabling capacity building and technical assistance
- processes in place to ensure economy and efficiency in managing capacity building and technical assistance investments.
The Secretariat’s weak governance structures of capacity building and technical assistance lead to reduced monitoring.
According to the OIG, the Secretariat has only limited data to monitor the scope, status, and impact of capacity-building and technical assistance activities, whether these are implemented by multilateral or bilateral partners.
The main multilateral partners that provide technical assistance and capacity building are the WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), The United Nations Children’s Fund (UNICEF), and Stop TB partnership. The Global Fund grants pay for capacity-building and technical assistance activities, but the report indicates that the Secretariat is not fully aware of the impact of those activities.
A similar situation exists with regard to the bilateral set-asides; the difference being that the Secretariat does not control those funds. However, one exception is the GIZ’s Backup Health initiative (the German government’s set-aside) which has a fully transparent approach with the Global Fund – from the initiation of in-country technical assistance to the assessment of impact and release of results. This approach has allowed the Global Fund Country Teams to assess, together with countries, their needs and remaining gaps after the GIZ support, and reprogram where necessary.
The absence of a Global Fund strategy for partnership engagement in the areas of capacity building and technical assistance further limits monitoring. In practice, the responsibilities of overseeing and coordinating technical assistance and capacity are scattered among several departments and divisions of the Global Fund Secretariat. This is illustrated by the diagram extracted from the report below. The Department of Technical Advice and Partnership (TAP) coordinates the support of multilateral partners.
Figure 1: Global Fund structure for managing technical assistance and capacity building
Source: The Global Fund capacity building and technical assistance audit
Acronyms: M&E (Monitoring and Evaluation); CRG (Community Right and Gender); GMD (Grant Management Division)
Agreed Management Action 1
The Secretariat will develop a Partnership Engagement Workplan to build on and implement the 2019 outputs of the Global Fund’s Partnership Engagement Steering Committee. The Head of the Strategy, Investment, and Impact Division is responsible for this; the deadline is on 31 July 2020.
Inadequate policies, procedures, and tools to initiate, implement and monitor capacity building, and technical assistance
The TAP has developed important guidance notes, a framework, and other tools to guide the engagement of multilateral partners. Unfortunately, those documents are not part of the Global Fund Operational Policy Manual and have not been formalized through any other governance structure. Their use is, therefore, limited. In addition, the OIG indicated that the department of TAP is under-resourced.
The Secretariat does not use any needs assessment tools or templates to initiate technical assistance investments. Technical assistance provision often follows in-country practices and regulations following the Global Fund principle of country ownership. Technical assistance varies in terms of scope and is not always clearly defined in terms of specific deliverables or timelimes. The Secretariat and country teams often fail to monitor technical assistance investments at the Secretariat and implementer level, even when amounts are substantial or when technical assistance is vital for grant program objectives.
Previous OIG audits in Myanmar, Sudan, Chad, Niger, Ukraine, and Nigeria, and the advisory report on Grant Implementation in Western and Central Africa revealed that technical assistance and capacity building investments were deployed for several years without any notable improvement in performance.
The Global Fund has limited ability to assess investments against needs and reprogram where necessary. Historically, investments in technical assistance have had low absorption rates (49% in 2016, 80% in 2017, and 40% in 2018). This disconnect highlights either a misalignment between the need for technical assistance and the budgeted amount or a challenge in deploying the technical assistance, where it is needed.
Agreed Management Action 2
The Secretariat will develop an implementation plan to monitor capacity building-related technical assistance financed by the Global Fund. The owner of this action is the Chief Risk Officer, and the deadline is 30 June 2021.
- This Report: Audit of the Global Fund Capacity Building and Technical Assistance (GF-OIG-20-009) 3 April 2020, Geneva, Switzerland.
- Advisory Report: Grant implementation in Western and Central Africa (WCA) (GF-OIG-19-013) May 2019, Geneva, Switzerland.