Feb 02, 2006

Theme: The Global Fund’s Strategic Positioning;
The Fund’s unique roles and participants’ opinions on its performance

The second and third week’s discussions focused on the Fund’s strategic positioning: it’s unique or different roles in comparison to those played by other organizations funding the fight against AIDS, Tuberculosis and Malaria. The participants were requested to state the roles that they thought the fund had played well, and those that the Fund had played less well. The majority of contributing forum members had experience working with Global Fund sponsored programmes, and their contributions generally adopted a positive tone:

Contributors:

Alain Mbongo -Congo DR, (MD), Biro Diawara -Guinea/ Switzerland, Lalit Shah-India, Rose Joshi –Nepal (private sector, ICT), Heath Wilder-USA, Shahid Mallick- Bangladesh, Tschering Lama –Nepal/UK (Student), Christina-USA (Private Donor), Neelima Mathur- India, Maria Gutierrez-Panama, Ada-Ghana, Sumit Punnakari- Thailand (SR), Luc Comhaire- Belgium (Project manager, NGO supporting Stop TB programme), Benjamin Udodigbo- Nigeria, Lili Rubinstein-Argentina, N. Hussain- Guyana- (Government), ‘rewbdog’ – (Nurse), Ashish Srivastava- India, Marcella Montero- Philippines (Project Assistant- GFATM Project), Becky McDonald-USA / S.Africa- (V.Chair-Hospice Foundation), Sammi Fredenburg- USA (Dev. Volunteer), President ONG-BIB - Benin, Kurt Frieder, Diane – France, Fatoumata Diallo, Yimian Kabore- Burkina Faso (Global Fund M&E, UNDP), Gregory - Russia, Jeremiah Kiponda- Kenya (Clinical Officer-NGO), Pascalina Chanda- Zambia (National Malaria Control programme), Richard Hoff II.


A. The Global Fund’s unique, well played Roles & difference between the Fund and most funding organizations

Acting as a financing mechanism as opposed to implementing or technical agency:

1.) The Global Fund's efforts have led to a huge reduction in the price of ARVs, and in some cases, availed them free of charge in resource-poor countries.
2.) The Fund ventures beyond financial grants into skills building e.g. it's activities promoting “Self-sufficiency and Solidarity"
3.) The Fund has helped not only in fighting the diseases, but also in poverty reduction efforts.
4.) Transparent multisectoral partnerships and engagements.
5.) The Fund applies unique resource mobilization methods engaging both the private commercial sector and individuals, e.g. RED campaign.
6.) Unique structure of the CCM, by bringing together stakeholders from a multi-sectoral background to assess and discuss project implementation, ensures cross-learning in countries with dwindling health-personnel to patient ratios, among other advantages.
7.) The Fund’s strategic value of broad international consensus during its creation, to finance efforts that have a broad coverage.
8.) The Fund’s strategy of allowing countries to work out their own priorities without undue inteference allows for better implementation.
9.) The broad thinking behind the Fund’s inception: There are mechanisms in place to deal with a variety of common donor issues, e.g. accountability and stakeholder participation.
10.) Quality service delivery, universal access: The Fund is one of a few organizations with the financial capacity and flexibility / versatility to provide universal access and quality service delivery to various remote areas in many countries at once: e.g. Philippines.
11.) Non-Repayment: Granting, not loaning: That the Global Fund’s comparatively huge financial assistance is provided free, on a non-repayment basis demonstrates the will to alleviate poverty and disease in the long term ''Without burdening our children and great grand children with debt''.
12.) Collectively funding the three diseases in wide geographical, social segments: is a strategy that could harness funders’ collective efforts and save many lives.
13.) Funding has been availed to other areas previously unfunded by many organizations, e.g. migrants and other vulnerable populations in the Philippines.
14.) Length of funding at initial signing allows for ample planning, continuity and programme effectiveness e.g. the Thailand PHAMIT Project (5 years), which is unlike most organizations.
15.) The Fund has the ‘Invisible’ role of providing an innovative and transparent project management methodology whose success would inspire other organizations.
16.) Advocacy: Adding its voice to the lobby for a drop in ART prices, and its insistence on universal access to ARVs, has facilitated the management of the three diseases e.g. in Nigeria.
17.) Additionality principle & innovative resource leveraging: This has increased the variety of funding sources and size of available funding, without discouraging alternative sources of funding; has also encouraged a participatory process in programme planning and implementation.
18.) Capacity Building: The Global Fund has provided value in capacity building for project planning and implementation, e.g. VCT centers, laboratories, personnel training centers for psychosocial care, etc.


B. Roles Played Less Well


1.) Because the Fund lacks its own infrastructure in the countries where it works, it often depends on the efficiency of Principal Recipients. Often the choice is not a successful one. Problems can arise when there is no system to build the capacity of Principal Recipients. The situation becomes even more challenging when the Principal Recipient is a state organisation without experience working with the civil society.
2.)Quarterly targets (process, outcome indicators, etc. …) not being met in some countries due to bureaucracy.
3.) Problems arise in situations where officers of the Fund or the local PR and/or CCM members appear to patronize the strategic plan of the countries by imposing their views and strategies.
4.) Monitoring & accountability mechanisms: Poor accountability is still an issue in many countries, whether witnessed in the public, private commercial sectors or in the civil society.
5.) Delays in fund disbursement to Sub-Recipients due to bureaucracy and politics in some Principal Recipients, a number of whom are UN or government agencies addressing excessive administrative protocols. Bureaucracy also impedes a focus on operational activities, delays the purchase and distribution of life-saving materials, drugs, and negatively affects outcomes.
(Moderators' Note: The number of contributions arguing for increased accountability measures in the last two weeks, and those focusing more on timely disbursement devoid of bureaucracy, point to the possible existence of an accountability/protocol versus effectiveness trade-off which, according to one contributor, is currently affecting projects' probability to achieve impact.)
6.) Proposal submission and review process: needs to be made more inclusive, possibly through the review of project funding criteria, according to a contributor from Benin, who argues that poverty, also a great danger to life, is the major driving factor behind the high number of deaths in Africa.
7.) Russia: Local coordination is hampered by absence of a strong logistical network.
8.) Locating, funding and empowering those most in need: The policy of economic empowerment for people living with disease is a good one which needs to be strengthened; as well as ensuring that funding reaches the neediest.


C. Further participant suggestions:

1.)Suggested theme from the Russian forum: What is the nature of relations between the Global Fund and commercial organizations? For example, what is the financing, type of partnership etc. between the Global Fund and commercial entities?
2.) The vice chair of a hospice foundation argues for a broader definition of "treatment" and "fighting the pandemics" to include the funding of palliative care, including drugs for pain control, e.g. Morphine and training of the lay people and professionals providing this type of care, stating that the vast number of patients still dying each day (6300, of HIV/AIDS related complications in Africa alone) is an argument for this type of funding.
3.) French forum: It was suggested that the Global Fund constitutes a think-tank to promote advocacy on debt-relief, with a view to leveraging supplementary resources.

Further suggestions were that the Global Fund:

4.) Employs innovative methods in its work, e.g. by engaging itself to add to CCMs efforts to directly monitor projects.
5.) Shares information and create awareness more widely to increase public knowledge and attract more support.
6.) Decides on composition of CCMs to increase accountability, and act as observer.
7.) Creates an enabling environment for people living with disease, and lobbies governments to enact legislation against stigma.
8.) Encourages greater recognition and involvement of exemplary grassroots organizations.
9.) Explores ways to increase available resources to the Fund, in order to satisfy demand.
10.) Explores ways of operating within governing frameworks but outside the clutches of existing international lobbies or vested interests.
11.) Encourages greater involvement of people living with HIV/AIDS at all levels.
12.) Engages the private sector more in awareness creation activities in order to increase knowledge on the factors that cause vulnerability to infection with disease.

Country specific suggestions: (Argentina, Congo DR, India, Nepal, Panama)

13.) Explore ways of circumventing political problems to reach the affected in Nepal.
14.) Focus on ART and CD4 cell count equipment availability in India.
15.) Consider scaling up the Congo DR programme nationally, and managing drug resistance.
16.) From Argentina, a topic was suggested: “Transparency of mechanisms and the possibility to sustain the engagement of the communities, which sometimes feel left out''.
17.) Panama's national income level classification denies her needed Global Fund support.


Internet Links:
English: http://forum.theglobalfund.org/en/viewtopic.php?t=23
French: http://forum.theglobalfund.org/fr/viewtopic.php?t=14
Russian: http://forum.theglobalfund.org/ru/viewforum.php?f=4
Spanish: http://forum.theglobalfund.org/es/viewforum.php?f=3