This article contains several brief extracts from the report of the Technical Review Panel (TRP) on the funding requests it reviewed in Windows 1 and 2 of the 2017-2019 allocation period. The extracts are from Part Two of the report (technical observations).
(See also a separate article in this issue on what the TRP said about the importance of reaching key and other vulnerable populations; and the article in GFO 325 summarizing Part One of the report [general observations].)
On procurement in upper-middle-income countries:
“Domestic procurement of affordable and quality HIV medicines in some upper middle- income countries is fraught with challenges, as a result of countries’ lack of capacity to tap into the competitive drug pricing market at the international level. This makes the achievement of the second 90 goal more difficult.”
On strengthening health systems:
“Striking a balance between investments in disease programs and in resilient and sustainable systems for health to allow disease programs to function well is challenging. The gaps and needs for resilient and sustainable systems for health are extensive in many countries and their scope largely surpasses the resources available through the Global Fund allocations.”
On supply chain management:
“Supply chain management continues to be weak in many countries, partly due to the multiplicity of donors and technical agencies seeking to support countries, which leads to coordination challenges.”
On community health workers:
“Community health workers’ multiple responsibilities continue to increase with service integration, but often these health workers do not receive the support they need such as cash payments, continuing education, supervision, resupply of commodities and links to the formal health system, which hinders their effectiveness and retention…. Donors do not provide a standard or sufficient salary scale for non-governmental community health workers, which results in high turnover of community health workers in search of a better income.
“[We are] very concerned about the long-term sustainability of community-level health services. Many countries rely on volunteer, non-salaried community health workers to deliver services, and few funding requests propose taking over support for the vast number of community-based organizations and civil society organizations funded by the Global Fund that support the provision of community health services.”
On decentralized health systems:
“Managing decentralized health systems … is challenging. Decentralization offers great opportunities for improved responsiveness and local governance, but must be carried out with careful consideration for capacity, quality, coverage and accountability if it is not to lead to serious declines in services and outcomes.”
On innovative financing:
“Innovative financing approaches should be evaluated to determine whether they provide better opportunities for sustaining program interventions. This includes exploring the risks and benefits for impact and sustainability of results-based financing, cash on delivery, social impact bonds and debt buy-downs. [In addition,] a better definition and stronger guidance on what value for money means within the Global Fund is necessary to inform such an evaluation. Throughout TRP discussions, the TRP noted value for money is best defined as a narrative rather than a number.”
“The Report of the Technical Review Panel on Funding Requests Submitted in the First and Second Windows of the 2017-2019 Allocation Period” is available at https://www.theglobalfund.org/en/technical-review-panel/reports/.