General Comments and Red Flags

Last-minute requests for peer review imply countries are not well prepared and have started the FR process late

• At the Mock TRP (Nairobi, March 2023), six draft FRs were reviewed. Prior to the Window 1 deadline with eight working days left, ten FR drafts from a potential 15 countries were received within the space of three working days and with less than two weeks to a week prior to submission. The VSD provided nine peer reviews (of the ten, one arrived one working day before submission with a request to review  it!) in the five working days before submission of the final draft to Global Fund. This is not sustainable for Window 2, which has more countries.
• For Windows 2 and 3, the VSD should push countries for

  more sane deadlines

   beyond which it cannot promise peer reviews.

• As a result of running out of time, 

  some countries submitted incomplete packages

    to the GF with missing annexes and even missing some CCM member signatures for endorsement

  .

Failure to follow the GF instructions/template

Failure to submit all related documents/annexes

did not complete their narrative form in compliance with the instructions

, resulting in misalignment and garbled language, inconsistencies and rambling text. Following the instructions is key to a relevant, succinct FR.

Poorly written and organized drafts

• Follow the narrative guidance

  , including regarding numbers of pages.

• On 

  formatting:

  a badly formatted, messy draft with margin errors, bad spelling, poor structure, etc. does not inspire confidence in the technical content!

Weak rationale and consistency

• A 

  good rationale

  , and 

  consistency in prioritising the right interventions

   in line with the NSPs and guiding documents is very important, and key to what the Global Fund is looking for.

• Failure to provide evidence of current performance:

  for example, why targets had not been met or exceeded as justification for scaling up, scaling down or revisiting.

Interventions misaligned with budget

• Systematically number

   activities in the FR in line with the Budget: e.g. some countries had long lists of activities, many of which probably wouldn’t have their own budget line.

• Some countries

  narrative was not reflected in adequate budget allocations, especially for prevention and key population activities.

Use of jargon and meaningless phrases

• Some FRs were very ‘wordy’.

  It is relatively easier to write badly written text, and regurgitate the verbiage from GF guidance documents, than make text concise and focused. As one reviewer said: “My fingers itched to edit the two FRs that I read. I could have cut them both by half and not cut any substance, I think.” Less is more!

• In places, many drafts had a lot of 

  bullet lists of ‘key words’

   of Global Fund language and phrases (saying what countries thought the Global Fund would like to hear?), but without a lot of thought/analysis behind the words.

Repetitions in resilient and sustainable systes for health (RSSH) sections, whereas RSSH is cross-cutting

• Most countries struggled with this key Annex.
• Many FRs 

  still addressed RSSH on an individual disease-by-disease basis

  , resulting in a siloed approach with many repetitions between disease components, when one RSSH intervention to address all components would have been appropriate, e.g. procurement supply management (PSM), human resources for health (HRH) such as community health workers (CHWs).

• CHWs cut across many public health issues and are not connected to any one disease in particular. Countries should use the CHW programmatic gap table to assist with this.
• There should be 

  ONE consolidated RSSH Annex

  across all three diseases. The Country Coordinating Mechanism should make the final prioritisation.

• However, it should be noted that at the Bangkok workshop the Global Fund admitted that there was some inconsistency in the RSSH instructions which perhaps explained this confusion.

One the five funding modalities/approaches, the “Tailored for NSP” approach caused the most problems

• Three countries

  submitted draft FRs Tailored for NSPs for peer review but without the accompanying NSP.

• Timing/readiness of the revised NSP

  (or addendum) was an issue that affected the quality of the FR submission.

• Countries are meant to be using their NSPs to guide the applications for GC7.  But apart from one country with a brand new NSP, the duration (timeframe) of the revised NSPs for three others reviewed all fall short of the duration of the proposed grants.
• Consequences of this misalignment of the NSP for the grants were not made clear in the FRs, but in any case, they are poorly aligned (in content and timing), especially for two of the four countries reviewed.
• Conclusion:  for three out of four FRs 

  this model of application was not relevant for these countries

  . This is because (i) NSPs were under revision or being developed almost at same time; and (ii) the versions of NSPs used for developing FRs were incomplete – while the Global Fund says this is acceptable, this is a subjective assessment of what constitutes completeness. It meant that the specifics of several parts of the FRs were not well developed (or were non-existent).