Lessons Learned from the Review of TFM Proposals
In the report to the Board on TFM proposals, the Technical Review Panel (TRP) devoted a large section to lessons learned from its review of the proposals. This article provides a summary of the lessons learned that apply to all proposals. (In a separate article, we describe the observations of the TRP that relate to the proposals for each of the three diseases.)
Domestic investment. According to the TRP, limited advances have been made in leveraging increased investments from domestic sources. The TRP noted that this may be a structural issue because agreements are signed with principal recipients (PRs); and, even when these are government PRs, they are seldom in a position to be held accountable, or demand accountability, for domestic financial commitments. The TRP recommended that the Global Fund consider negotiating formal agreements with implementing country governments to establish a road map for increasing the level of domestic investment.
Scope of the TFM. The TRP noted that TFM funding requests were limited to the continuation of essential services already funded by existing grants, and that these existing grants were based on proposals that were written five years ago or more. The TRP said that this limitation may have had an unintended negative effect on other important essential services which happen not to have been previously funded under Global Fund grants – and that this was particularly evident for prevention services and services for most-at-risk populations. The TRP recommended that the Global Fund give special attention to such cases in the next funding opportunity.
Counterpart financing. The TFM was the first funding opportunity for which the TRP was requested to assess country compliance with the Global Fund’s counterpart financing requirements. It was also the first time that the new counterpart financing requirements applied (they were adopted prior to Round 11, but Round 11 was aborted).
The TRP said that the fundamental issue associated with compliance with the counterpart financing requirements was the availability and credibility of data. For most countries, the TRP said, the health and disease expenditure data was imprecise, ad hoc or inconsistent –or the data wasn’t provided at all. The TRP also observed that in countries where the disease programmes are well integrated into the health system, estimating non-disease health systems costs, such as human resources and hospital beds, and attributing them to disease expenditures, is likely to be very imprecise or arbitrary.
If the current Board policy is to be seriously applied, the TRP said, the Secretariat must provide much greater support – including preparing country profiles describing the budgetary context, the government contribution (past and future) and financial support from other sources (past and future).
Human resources and sustainability. The TRP pointed out that in many instances applicants continue to depend on the Global Fund to finance public sector human resources even after 5–7 years of Global Fund support. (The TRP noted that in the TFM proposals, significant funding was requested for human resources despite the limited scope of the TFM.) The TRP recommended that applicants start developing plans for taking on these recurrent costs; and that they develop a monitoring framework that can track progress.
Heavy reliance on external funding for community interventions. The TRP expressed concern about the sustainability of programmes that heavily rely on community interventions for their success, such as community DOTS to improve case detection. It said that these activities are often entirely left to civil society organisations (CSOs) to implement with donor funds and without government contribution.
The TRP said that in order to ensure the sustainability these programmes, national governments should begin to assume some of the costs of community interventions that are currently funded entirely by external sources. The TRP recommended that applicants be told that future proposals must demonstrate shared responsibility for these costs and a clear plan to transition from external funding.
Global Fund engagement in national and donor reviews. The TRP said that its assessment of proposals was challenging because there was very limited information available on activities at country level supported by donors. To address this problem, the TRP recommended that Global Fund Secretariat staff participate in relevant national or donor coordination meetings and reviews.
Lack of evidence of programmatic achievements. The TRP said that information in the TFM proposals on past programmatic achievements was either inadequate or missing, despite years of Global Fund support. The TRP said that it was particularly cautious about recommending activities that had shown no evidence of progress at the outcome level and, therefore, did not represent good value for money. The TRP recommended that applicants and the Secretariat ensure that with respect to programmes that have been implemented for several years, strong evidence of programmatic achievements be provided, at the very least at the outcome level.
Performance frameworks. In general, the TRP said, performance frameworks continue to be weak. It said that the frameworks were very often not focused on the right populations, and emphasis was frequently placed on national indicators. The TRP said that national indicators by themselves generally do not provide sufficiently disaggregated data to assess programme performance, outcomes and impacts.
Data quality and use . The TRP said that there is a need to improve data quality, to develop adequate data collection and analysis systems, and to allocate adequate resources for data collection. The TRP said that the Secretariat should consider a data access policy where information collected from the Global Fund goes into the public domain after a reasonable period of time. The TRP said that this would increase the utility of the data, and would allow more extensive use for decision-making by the Global Fund, its partners and national programmes.
In addition, the TRP said that it expects to see stronger M&E systems, with more frequent assessments of implementation progress.
The role of United Nations agencies. The TRP said that it “continues to be concerned” about the role and the number of UN agencies being nominated as PRs and SRs after almost a decade of Global Fund investments. The TRP said that the continued use of UN agencies may create parallel systems, fail to build local capacity and not represent value for money. The TRP recommended that applicants provide strong justification in their proposals in cases where UN agencies are nominated as either PRs or SRs; and that when a UN agency is proposed as a PR, a clear plan be developed to transition responsibilities to a local PR.
The report of the Secretariat and the TRP on the TFM proposals is available on the Global Fund website at www.theglobalfund.org/en/trp/reports.