In response to the same organization being the PR on consecutive rounds for the same disease area...it would appear that The Global Fund was created as a reaction to the disparities that exist in the arena of public health. The disparities are so profound, that many have seen no improvement in 20 years. If in fact we cannot improve conditions in 20 years, how possibly could a PR make significant sustainable contributions in one cycle of grant funding? I began my journey in public health as a Peace Corps volunteer in 1990. The Peace Corps model is ideal in it works directly with local counterparts on project development. They are a networking agency, with continued presence in the same field; when one volunteer finishes their service another takes over their project, which establishes continuity of care.
In my opinion, sustainability cannot be achieved without continued grant funding. The quagmire of the same PR receiving consecutive rounds of grants is abuse of the allocation of these funds. NONE THE LESS ... if grant cycles are not renewed then the diligent work that took place during one round may dissipate into the pages of a grant report but not effect change due to a dwindled budget.
Many replies to the E-Forum from diverse countries were similar in thought... try to not re invent the project wheel, collaborate with those groups/organizations/governments who are in the country and working on similar projects. Once again, the Peace Corps taught me about the importance of collaborative effort. Our projects could not exist without the influence and assistance of international aid organizations and the participation of country nationals. I firmly support that an organization be able to remain as the PR for consecutive rounds for the same disease area, in order to establish continuity and sustainability. It may be that over time the amount of the grant is reduced due to the functioning of successful projects. Keep strong with your ethics of transparency and if there is fraud stop the project.
P.S I did realize that this question was for the Country Proposals Team of which I am not, but I added an opinion because sustainability, although a somewhat over used term, is an area of profound weakness in developing countries. We will never eradicate poverty and the need for public health projects... it is a constant.