Executive Director Mark Dybul’s first formal report to the Global Fund Board covered a lot of ground. In this article, we provide a summary of what Dr Dybul said on the following topics: (a) focus on impact; (b) generating better data at country level; (c) simplifying processes and requirements; (d) formation of the Grant Approvals Committee; (e) dual coverage of LLINs and IRS; (f) recoveries of misused grant funds; (g) efforts to reduce procurement costs; and (h) human resource challenges.
Focus on impact. Dr Dybul said that the Secretariat is pushing itself to look beyond the process indicators in Global Fund grants and to focus more on impact, outcomes and coverage for key interventions. He said that for countries going through the renewals process or accessing new funding, the Secretariat is working with partners to develop “impact profiles,” which bring together strategic information on a country’s disease burden, coverage, progress on impact and outcomes, Global Fund grant performance, resource gaps, and health and disease financing and spending.
Dr Dybul said that the Fund’s performance-based funding approach is being adjusted to reflect this change. He added, however, that this poses new challenges. For example, he said, new coverage targets require better information on populations at risk.
Generating better data at country level. Country data systems require significant strengthening, Dr Dybul said. The Secretariat is working with partners to carry out data system assessments to evaluate the availability and quality of the information and to identify where systems need strengthening. Dr Dybul cited the example of Thailand, where better surveillance data has allowed the Global Fund and other funders to re-programme their support to focus on the 26 provinces where 70% of HIV infections occur.
Simplifying processes and requirements. The Global Fund has long acknowledged the need to simplify its processes and requirements, Dr Dybul said, “but it is questionable how successful we’ve been. We will be looking for every opportunity to appropriately create process efficiencies and reduce the burden [on countries], whether through the changes to our new funding model and internal systems, or in everyday grant management policies and procedures.”
New Grant Approvals Committee. The new Grant Approvals Committee (GAC) will be the primary mechanism for reviewing and recommending grants for approval by the Board, Dr Dybul said. One of the biggest and most valuable changes has been the participation of partners in GAC discussions, he added. The recent inclusion of a civil society representative on the panel is “a particularly exciting development,” Dr Dybul said. “It is strengthening our collective ability to see the opportunities and deficiencies of programs with regards to reaching the most-at-risk populations, ensuring equity in access and taking maximum advantage of civil society’s implementation capacity.”
Dual coverage of LLINs and IRS. In the process of reviewing proposed funding for malaria in Ghana, Dr Dybul reported, the GAC identified an issue concerning dual coverage of both long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS). Both are important interventions for prevention, Dr Dybul said, but clear consensus is still lacking on the circumstances in which the use of both interventions is recommended. Dr Dybul said that the Global Fund is providing funding to facilitate the work of the World Health Organisation on this topic and that, in the meantime, the Secretariat is working with Ghana’s national malaria programme and with partners to clarify the case for dual coverage.
Recovery of grant funds. Dr Dybul said that limited progress has been made on recovering funds where misuse of grant money has been identified by the Office of the Inspector General (OIG). In September 2012, the Secretariat reported to the Board that it had recovered approximately $22 million in 13 of the 29 cases identified by the OIG, and that another eight cases were at an advanced stage of negotiations. In the seven months since then, Dr Dybul said, the Secretariat has reached final agreement in three cases and has retrieved an additional $6.6 million. There are firm commitments to recover another $1.4 million, he said, and it has been determined that $1.7 million could not be considered recoverable.
During the same period, Dr Dybul said, the OIG has released twelve new audit and investigation reports that included findings of misuse representing an additional $11.5 million. “To speed up the recoveries process,” Dr Dybul said, “a cross-Secretariat team has been formed, working under the guidance of a senior management Recoveries Committee, and we expect to be able to report more significant progress over the course of 2013.”
Reducing procurement costs. Dr Dybul said that the Global Fund is working with another major purchaser of insecticide-treated nets (ITNs) to harmonise purchases and negotiate long-term supply agreements on global tenders. The two organisations together account for 65% of the global purchasing of ITNs, he said; the collaboration is expected to result in a reduction of 20–25% in ITN prices. Dr Dybul said that the Secretariat is planning something similar for antiretroviral medicines.
“We’re working to do this in a way that maintains the role of the country as owner of the national program,” Dr Dybul said.
Human resource challenges. Dr Dybul said that as a result of reorganisation, the Secretariat now has a structure that’s better positioned to implement its core grant management mandate. However, he said, “the transformation work took a heavy toll; Secretariat morale and the trust are still recovering. And although Secretariat [staff] admirably continued to deliver and demonstrate their commitment to the mission throughout the restructuring process, for some their motivation and affinity to the institution was challenged.”
The Secretariat knows where we need to do better, Dr Dybul said. “We’re working hard to make open, two-way communication a cultural norm, and we are currently introducing a new ‘people strategy,’ which will provide us with a roadmap for improving the employment relationship and ensure that the Global Fund creates the right environment for employees to be productive and engaged, to develop their skills and to grow as persons and professionals.”
Information for this article was taken from the Report of the Executive Director, Board Document GF-B29-03, which is available on the Global Fund website at www.theglobalfund.org/en/board/meetings/twentyninth.