The use of national strategy applications (NSAs) is attractive to countries, technical partners, donors and the Global Fund's own Technical Review Panel (TRP). This is the conclusion of the Global Fund Secretariat, based on evaluations that have been conducted on the first leaning wave (FLW) of NSAs and other feedback.
NSAs involve CCMs submitting a national disease strategy itself - rather than the usual Global Fund proposal form - as the primary basis of the application for Global Fund financing. (For background information on NSAs, see GFO 102 at www.aidspan.org/gfo.) The FLW was conducted in 2009; five of the seven NSAs submitted were approved for funding by the Global Fund Board in November 2009 (see GFO 110).
The FLW involved a three-stage process, as follows: Stage 1: a desk review of the national strategy and accompanying documentation, conducted by a Strategy Review Team made up of members of the TRP; Stage 2: if the outcome of this desk review was favourable, a country visit by the Review Team to seek clarifications and collect additional information; and Stage 3: submission by the CCM of the actual NSA.
Feedback on the FLW was generally quite positive. The participation of "national facilitators" (independent country stakeholders) during the country visits conducted by the Review Team was cited as being crucial to provide "local context."
However, some concerns were expressed regarding aspects of the process. For example, countries said that the process was rushed and that they would have appreciated more time. Also, countries said that they would prefer the freedom to determine for themselves whether or not to apply for an NSA and which diseases to submit, rather than being invited to participate. The Global Fund Secretariat said that being invited to participate in the FLW raised expectations of a successful outcome for many stakeholders, despite clear and consistent Global Fund messages designed to manage expectations.
In addition, many stakeholders could not see a clear distinction between the review of the national strategy (Stage 1 above) and the review of the actual NSA (Stage 3). The Secretariat said the fact that both were done exclusively by the TRP contributed to this. (In future waves, it is expected that Stage 1 will be handled differently.)
Some stakeholders questioned the prominent role given to CCMs during the FLW on the grounds that the CCM does not "own" the national strategy. On the other hand, participation in the NSA was seen as helping countries strengthen and clarify the roles and responsibilities between national disease authorities and CCMs, and improving their partnership, particularly in countries applying for AIDS NSAs.
The evaluations concluded that the NSA approach has generated considerable enthusiasm and buy-in, and that it is seen as a promising new funding strategy for the Global Fund. At the same time, the TRP cautioned that the shift from project funding to programme support is complex and will require attention at each stage. The TRP said that unless NSA-derived grants are managed using more aligned and consolidated grant management processes, this will likely lead to grants that are substantively unchanged from current Global Fund grants. In the view of the TRP, this would limit the extent to which NSAs could be really innovative.
The above information is based on findings in the following reports, none of which are yet available at the Global Fund website:
- "Technical Review Panel Lessons Learned Report on the Global Fund's National Strategy Application First Learning Wave." This report provides feedback synthesised from the full TRP group that worked on the FLW.
- "Presenting National Strategic Plans on HIV/AIDS to the Global Fund Through the National Strategy Application Modality - Country Experiences from the First Learning Wave." Commissioned by UNAIDS, this paper provides insights into the experiences of selected stakeholders in three countries that participated in the FLW on the basis of their HIV/AIDS strategy - Kenya, Malawi and Rwanda.
- "Study of Country Stakeholder Experience with the NSA First Learning Wave." Commissioned by the Global Fund and carried out by external consultants McKinsey & Company, this study report provides an in-depth analysis of the FLW based on structured stakeholder interviews conducted across 11 countries selected to represent all three diseases, three continents and examples of different degrees of success in the NSA application process.