TRIPLE PUNISHMENT FOR COUNTRIES SUBJECTED TO ITERATION

Author:

Aidspan Team

Article Type:

Article Number: 6

Despite promises to make the grant application process as easy as possible, many countries’ applications for funding have been turned down

ABSTRACT Countries whose applications for funding have been rejected by the Technical Review Panel are subjected to a number of significant and additional requirements. They are required to respond to questions that could be quite complex regarding their initial application, rewrite and resubmit the application, and produce additional documents to support the new submission in a short time. This short timeframe is due to the requirement that grants are to be signed before 31 December 2020.

This year, 2020, is crucial in many respects: in addition to COVID-19, which took the world by surprise with its virulence and the havoc it has wreaked, it is also the year the Global Fund’s recipient countries have to submit applications for new grants. A total of $12.4 billion is available to countries for the fight against the diseases. Countries have to request funding and propose how these funds are to be spent.

This article analyses the results of application windows from March to August 2020. Aidspan had access to rejection letters from the Technical Review Panel (TRP) via the Country Coordinating Mechanisms (CCMs), as well as information on ten forms that the TRP or Secretariat is still expecting.

Is 2020 a special year for funding requests?

At the Board meeting that took place in May 2020, Dr Patricia Moser, Chairperson of the TRP, outlined the approved flexibility measures that would make the application process for recipient countries as easy as possible. For example, additional windows for the submission of requests were created to allow countries to defer their applications to the following month if not fully completed. The period for clarifying and revising proposals, and collating accompanying documents (targets, programmatic gaps, quantifications, budget, and performance framework among others) after their official submission deadline was extended to 15 days. This allowed applicants to make final modifications and compile the required documentation. Finally, to quote Dr Moser’s words during the Board meeting, “TRP members stated their readiness to assist countries in rescheduling their grant once implementation begins. The TRP considered how best to assess applications, taking into account the challenges currently faced by applicants in the preparation of funding applications … This will not affect the quality of the score review, but this flexible approach should help support applicants in these trying times.”

There was a collective sigh of relief from the countries: TRP members understood the challenge of having to respond to a pandemic that was undermining the health system and derailing the response to the three diseases, while simultaneously completing a lengthy application process, which involved two to three months of meetings, strategic discussions and drafting funding requests. To say the least, this year’s funding application process has been very unusual:

• In-person meetings of more than 10 people were banned in many countries. This restricted the inclusion and participation of all stakeholders, especially members of civil society.
• Many countries introduced curfews. Meetings had to be brief as participants had to rush home to avoid being outside at an unauthorized time. As a result, more residential workshops, which significantly increased the cost of this process, were set up to avoid travel. When money to set up residential workshops was not available, it was impossible for participants to meet.
• Consultants recruited to support national efforts were unable to travel but worked remotely. At times they struggled with poor internet connection while running online workshops: inaudible discussions, broken communication, delays, lack of interlocutors, and difficulty of remote follow-up.
• Several studies and consultations planned at the beginning of this year could not take place. This explains why audits of HIV patient numbers, gender or human rights diagnostics, studies on access to tuberculosis or malaria services, or even HIV Integrated Biological and Behavioural Surveillance (IBBS) survey have not been carried out. This prevents stakeholders from obtaining crucial information for effective strategy development.

Most African countries have been approved for funding. In some cases, the conditions imposed by the TRP are more of an iteration than an agreement to scale up the grant. However, the TRP rejected some applications and substantiated those decisions.

TRP’s requirements for re-application

Countries that have to resubmit their funding requests are sent a summary of the reasons for the rejection of the application, along with a series of questions. In addition, they are issued with a set of requirements that guide the development of the new application. Those countries need to redraft the concept note in a relatively short period of time, in order to complete the process before the end of December 2020.

If an extension of the current grant is to be avoided, the deadline cannot be missed. An extension of the current grant would be detrimental since, in addition to the extra work required, the extension would only cover the essentials (i.e. treatment for existing patients). An extension would exclude new patients as countries cannot run interventions aimed at screening patients or putting newly diagnosed patients on the treatment.

The TRP response form

The TRP provides feedback that guides countries through the new application process sets additional requirements that need to be addressed. Additional documents requested in the past were:

• operational plans for interventions in Congo Brazzaville
• studies on salary and benefit payments in the Democratic Republic of Congo (DRC)
• a detailed overview of Congo Brazzaville’s donors, the projects being financed and whether these projects complemented those run by the Global Fund
• a budget and plan for the supply of health commodities in Djibouti.

The often small team of consultants and the country stakeholders must carry out all these tasks (writing a new funding request, formulating a budget and compiling additional documents required) in a short period of time, and in difficult environments (iterations apply to countries classified as Challenging Operating Environments which are all fragile countries).

Note that many countries whose applications have been approved receive the same recommendations from the TRP as those whose applications are rejected. But there is a huge difference. For countries whose applications are accepted, it is up to the Secretariat to determine whether the country has fulfilled the recommendations. Many believe the Secretariat is often more lenient in their appraisal of funding requests. In addition, the changes recommended by the TRP in grant activities are implemented during the grant-making phase when deadlines are not as strict.

Conversely, countries whose applications are rejected (and they are often fragile countries characterized by a lack of qualified personnel in-country, weak administration and service delivery), are asked to answer difficult questions that are not addressed by Global Fund grant implementation.

For example, the question of user fees, sometimes called cost recovery, since patients who go to a health facility need to pay to receive care and medications, needs to be addressed (a study on user fees in the West African region will be published shortly). However, the Global Fund has no policy on the issue, nor any consolidated strategic dialogue with the rest of the donors whose rules on the subject vary. Yet this issue is raised in many TRP responses but is treated differently by different TRP committees. The TRP recommended that the Mali team look at this issue during grant making and grant implementation while the TRP required Congo to address the question and provide an answer within a couple of months.  Similarly, the TRP calls for alignment and complementarity with other donors, while planning cycles and operational processes vary widely between donors, such as the Global Fund and the World Bank, and funding strategies and planning are not always transparent.

The TRP expects these countries to obtain information, in a couple of months, that has not been available to the Global Fund for years.

One cannot expect to carry out, in the span of two to three months, an analysis and strategic piloting of interventions that are not routinely implemented. If countries and PRs do not analyze their data regularly, link disease component interventions and system strengthening activities, collaborate with some key stakeholders (in particular the Ministry of Finance but also the Ministry of Family and Youth), or interact adequately with partners (in particular GAVI, the World Bank, some donor country organizations like the British DFID, the French AFD, the German GIZ), it is unrealistic to ask them to do so within two to three months of developing the funding request.

This process is rendered inefficient by the country teams’ lack of involvement in monitoring implementation and the limited time they are given to prepare for the application process.

Recommendations or prescriptions?

Countries subjected to iteration and Global Fund country teams dread being rejected again, and every effort is required to submit new applications in a very short period of time.

Unfortunately, the context of these countries have not improved: strategic information that was unavailable at the time of the first submission is still not accessible, working conditions are more constrained than in the first quarter of 2020 (because of COVID-19), dialogue with other donors (whose representatives have left because of COVID-19 or are on leave during the summer) has not been possible, and national health accounts have yet to be made available.

In the Global Fund context, iterations are considered to be a failure by the country and the Global Fund teams. Immense political pressure that accompanies the funding request process, is placed on the technical and financial partners and consultants, who support the process.

What is expected of the TRP?

What is expected of the TRP in the future is a critical question for the Global Fund to answer. There are two competing views.

• The first one is that the TRP is a committee of experts whose role is to review whether funding requests are strategically and technically sound. Therefore, the TRP is partly composed of scientists who are familiar the latest studies. In this case, the TRP would not look at operationalization, nor issues such as co-financing and intervention modalities.
• The opposite view is that  the TRP should give guarantees that the expected results will be achieved. That is why emphasis is placed on the impact of all proposed interventions. In this view, one cannot limit oneself to an “academic” analysis because the environment matters in implementation.

The TRP’s expectations need to be redefined in order to promote greater effectiveness of the Global Fund. Unrealistic and unreasonable expectations render their work ineffective.