In preparation for the 36th Global Fund Board meeting that took place on 16 to 17 November 2016, the Africa constituencies Bureau convened from 31 October to 1 November 2016 in Kigali, Rwanda to look at critical issues brought to the attention of the board.
For better planning of the 2017-2019 Global Fund allocation period, the African constituencies used the 36th Global Fund Board meeting as an opportunity to advocate for issues of strategic importance to the African constituencies. Firstly, the occasion will be used to advocate for more benefits from the available Catalytic Investments. The Catalytic Investments represent an additional funding opportunity for countries to serve three purposes: to incentivize innovative strategies; to fund multi-country or regional approaches to ending the epidemics; to fund strategic initiatives in line with the priorities outlined in the new 2017-22 strategy. Catalytic investments has been capped at $800 million, subject to the amount and timing of the fulfillment of donor pledges. The name ‘catalytic investment’ is new but the concept is not: under the New Funding Model these were called ‘incentive’ or ‘above-allocation’ funds. Africa-based catalytic investments equal some $144 million ($31m in West/Central Africa; $113m in East/Southern Africa).
Furthermore, members of the African constituencies resolved that issues like Health Strengthening Systems (HSS) should be given paramount importance during the upcoming 36th Global Fund Board meeting. Health Strengthening Systems is priority number one for the African constituencies. Other strategic important issues to be brought forward include calling for more emphasis on the issue of women and girls since they suffer a disproportionate burden for HIV/AIDS, increasing domestic funding with a proposal to the Global Fund to leverage its position as a significant contributor to country programs dealing with AIDS, Malaria, and Tuberculosis. The allocation approach with a proposal to the Global Fund to revisit and reconsider the present allocation approach by giving more weight to the disease burden since African constituencies bear the greatest disease burden for AIDS, Malaria and Tuberculosis and it’s the one with greatest unmet need for interventions, this should go hand in hand with reconsidering the necessity of provisions in the current funding model such as incentive funding and unfolded quality demand.
Other operational issues that were discussed
Other issues included the low absorption capacity by the Principal Recipients (PRs) which affects funds disbursement and budget execution, present structures and available resources for the CCMs, concerns on the existing coordination within Global Fund actors, looking at how the Global Fund Strategy can be linked to other national and agendas, the role of different technical partners and other measures on how to improve performance.
During the meeting, delegates stressed the need to strengthen CCMs to guarantee the highest possible level of performance and to reach the expected impact set in the new Global Fund strategy in line with the Sustainable Development Goals (SDGs) era.
They pointed out that capacity building and strengthening of the CCMs requires assessing the current structure and roles of various CCMs Sub- Committees, reviewing of the present Country Coordinating Mechanism Strategic Plans, assessing how the new Global Fund strategy can be linked to other national and Global strategies, and regular orientation of members to new developments.
The call comes at a time when the Global Fund is changing focus from timely grant implementation and absorption capacity of the Global Fund recipients to focus on the new era of the Sustainable Development Goals. The latter approach takes into consideration some of the core principles of the Global Fund such as country ownership, and partnership. Therefore, CCMs being the national coordinating structures of the Global Fund need to be strengthened and supported in order to be aligned to the new focus.
To ensure a harmonized working framework and better coordination mechanisms, the participants at the Kigali meeting called on the Global Fund Secretariat to develop Standard Operating Procedures (SOPs) and Terms of Reference (TORs) for the Country Teams and FPMs. Having TORs and SOPs for Country Teams and FPMs will help provide clarity on their roles and responsibilities, and the scope of their decision-making in the recipient countries.
In the same spirit, they requested for better coordinated Country mission visits by the Country Teams and FPMs. This should be accompanied by well scheduled mission visits. The objectives and the schedules should be shared with the CCMs, PRs, Governments, Partners and various stakeholders in advance of the mission visits to the recipient countries. as some of this visit do slow down implementation of activities and some actors are feeling left out.
During the discussions, it was noted that strengthening of the CCMs requires reconsidering their mandate and establishing Resilient and Sustainable Systems for Health (RSSH) since it is one of the objectives of the Global Fund Strategy 2017-2022 and it is in harmony with the Universal Health Care agenda.
In addition, members acknowledged that CCMs need capacity building and adequate resources since they are expected to work in partnership with other health sector stakeholders to contribute to Universal Health Care. This will root out duplication of roles, increase accountability and ownership. It will also entail dealing with aspects that are detached from the health sector. Such aspects include finance and good governance. CCMs must be able to actively engage in decision-making processes to ensure planning of integrated services for the Global Fund programmes.
Delegates noted that to achieve those requirements not only calls for strengthening of the CCMs but also the need to reconsider the mandate of the Country Coordinating Mechanisms, adding that CCMs need to be consulted, supported, strengthened and most importantly, empowered to reach the objectives. And that the capacity development for CCMs members needs to be provided to foster a common understanding of the appropriate interventions required to comply with their mission while building Resilient and Sustainable Health Systems in their specific context. They affirmed that the current functioning of the CCMs needs to be overhauled to enable them to become innovative drivers during the implementation of the new Global Fund Strategy. They cited a number of changes that need to be reviewed in order to create a functional environment for the Country Coordinating Mechanisms.
Identified challenges include lack of a capacity building strategy, complicated procurement and supply chain systems that delay the delivery of supplies. The effects of complicated procurement and supply chain systems can be manifested in other critical areas such as low absorption of funds, thus slowing down activity implementation. Other challenges that were identified include, inadequate resources including human and capital resources, the increasing involvement of Global Fund Portfolio Managers that delay the approval of funds, and poor coordination among the Global Fund actors such as the Local Fund Agents (LFA).
They also called for the review of the existing structure of the CCMs and the legal status in accordance with the local context, strengthening the capacity of the CCMs secretariats by equipping them with the right skills that can enable them to analyze programmatic and financial documents hence making it easy for the CCM members.
Proposed solutions and recommendations include being innovative and tapping into other in country existing sources of funds from domestic partners and other available domestic resources in order to address the issue of inadequate funding, better coordination with the LFA, timely feedback on audit findings, using and taking advantage of the Global Fund initiatives to strengthen harmonized country systems and coordinated country systems. To address the challenge of procurement and supply chain management systems, it was recommended that CCMs should work with the Principal Recipients, and the Sub Recipients to embrace the culture of early planning, have procurement plans prepared and approved early, and put an effort sensitizing and advocacy of line ministries to embrace mainstreaming of procurement systems.