The Technical Review Panel (TRP’s) has just completed its assessment of the funding requests submitted within the first window in March. It is sending notifications to the Secretariat’s country teams and the Country Coordinating Mechanisms (CCMs). Due to the disruptions caused by COVID-19, the TRP worked remotely to assess funding requests.
This article presents the TRP’s preliminary observations on window one submissions. Information for this article comes from publicly available documents and a presentation by the TRP Chair to the Global Fund Board during the 43rd Global Fund Board meeting conducted online in May 2020.
The process of submission
Source: TRP presentation, 43rd Global Fund Board Meeting
Over a period of six months, the TRP expects to assess 144 country and multi-country funding requests submitted for the 2020-2022 allocation cycle. The largest peaks of submissions are expected to be during March, May, and August. To adapt to the disruption created by COVID-19, the Secretariat has created three more windows to submit funding requests. This brings the total number of windows to six. The TRP reviewers will assess submissions for each window.
Dr Patricia Moser, the Chair of the TRP, indicated that the remote review had been a success; the TRP gave special attention to countries with the most significant allocation increases since the previous cycle. The President of the TRP acknowledged that the remote mode required more effort and time from TRP reviewers and the Secretariat. To assist this situation, TRP members who were experienced and had served on the panel before supported the incoming members. This composition resulted in a remarkable number of reviewers, totaling almost 100 for window 1. The TRP organized itself in six different teams.
The Secretariat observed that the TRP has been highly responsive, making a quick shift to working virtually, which was a remarkable learning experience. According to the Grant Management Division, the sessions between TRP members and country teams have been very professional and respectful.
First feedback on the funding requests
TRP members praised the improved quality of funding requests. The new guidelines have helped countries to prioritize interventions and select the most appropriate implementation arrangements.
Some funding requests to fund health system strengthening were particularly innovative: they promoted new approaches such as debt for help and blended financing. (According to the Global Fund innovative finance page, Debt2Health program converts debt repayments into lifesaving investments in health; blended financing often combines an initial Global Fund investment with other sources of funding). Activities for adolescent girls and young women have also shown some innovative approaches, in particular for the countries that had matching funds. Those matching funds are extra funding “to incentivize the programming of country allocations for priority areas,” according to the Global Fund funding model.
In general, the TRP had difficulties fully assessing activities relating to Resilient and Sustainable Systems for Health (RSSH) for two reasons. First, the context write-up was usually not detailed enough. Second, RSSH grants were not stand-alone; instead, RSSH funds and thus activities were split among HIV, TB and malaria grants. When countries submit funding requests for the different diseases in different windows, it becomes particularly difficult to grasp the RSSH activities fully.
The COVID-19’s impact on the funding request process
The TRP members expressed their deep concern about the effect COVID-19 would have on the elimination of HIV, TB, and malaria. Funding requests submitted within window 1 did not address this expected impact as the proposals were written before the rise of the COVID-19. Nevertheless, the TRP members discussed the potential effect of COVID-19 on grant implementation during the induction of the reviewers and partners. The TRP members reviewed the funding requests as they were, aware of probable service and implementation disruptions. For the time being, the TRP has responded with technical advice and issued a note to candidates and the Board, calling on countries not to lose the focus on the fight against the pandemics. The TRP members said they were ready to support countries to reprogram their grants when implementation begins. The TRP will consider the disruption in the countries and re-evaluate its impact during the grant-making process or grant implementation. According to Dr Patricia Moser, this process will not affect the integrity of the review but will support the applicants with flexibility in this challenging time.
The challenges of funding requests in the time of COVID-19
Several constituencies expressed their concern about the inclusion of all actors in the country dialogue preceding the funding request writing and submission. Many countries reduced movements of the population with limited transport, the prohibition of large meetings, and sometimes total lockdown. These restrictions do not favor inclusive dialogue and the transparent discussions necessary to prepare the funding requests. The Secretariat is confident that Civil Society Organizations (CSOs) were consulted; their involvement is one of the criteria for eligibility for Global Fund grants that is overseen by an entire team. Nevertheless, the Secretariat acknowledged that a CSO member’s signature on a consultation form is not sufficient evidence of a CSO’s meaningful participation during the process.
The process at country-level
It has been challenging to maintain dialogue and relations between consultants (who support the funding request process), the CCM, the Ministry of Health, and the CSOs. Because of limitations on transport, the telephone network and internet, and the pending distribution of mosquito nets in many countries, the discussions between local parties and the consultants, and among the consultants themselves have been limited.
These reduced discussions resulted in weaker proposals that did not clearly identify the lessons learned from the current cycle, and prioritize high impact activities for the future. It was not possible to discuss the specific barriers that limited impact or the successful activities that should be intensified. Several countries had planned surveys, studies such as Integrated Biological and Behavioural Surveillance (IBBS), discrimination index and diagnostics (of the laboratory system, of the supply chain, health-seeking behaviors, and gender responsiveness) that were postponed because of COVID-19. Therefore, key and updated information that could impact strategic decisions regarding funding requests is unavailable.
Furthermore, countries have to commit to co-financing, i.e. domestic contributions to complement the investments of the Global Fund. However, the economic crisis following COVID-19 may reduce their fiscal space to make new investments.
At this point, it is still too early to identify and measure the effects of COVID-19 on service delivery and utilization. Many CSOs have warned that the number of patients lost to follow up has dramatically increased, and many patients have not attended the health centers to collect their medications. All the activities conducted at night have been canceled and rescheduled because of prevailing curfews.
Disruptions related to COVID-19 imply that situation in-country should be re-assessed during the grant-making process and during the first year of implementation to adapt both the targets and the activities of the programs.