The Global Fund is in the midst of formally evaluating its first five years of operations. The evaluation is being conducted under the oversight of the Technical Evaluation Reference Group (TERG). The TERG is an advisory body providing independent assessment and advice to the Global Fund Board on issues related to evaluation, including evaluation of the Fund itself.
The evaluation is divided into three study areas, one of which (Study Area 2) is the effectiveness of the Global Fund partnership environment. At the 18th Global Fund Board meeting recently concluded in Delhi, the TERG presented a paper entitled “Technical Evaluation Reference Group Summary Paper: Study Area 2.” The paper is available at www.theglobalfund.org/en/board/meetings/eighteenth/documents/. Look for “Report of TERG.”
In the paper, the TERG comments on a report by consultants that was commissioned for Study Area 2 (look for “Macro report” at the above web page), provides observations of its own and makes some recommendations to the Global Fund. This article summarises some of what the TERG said in three areas: communications and Global Fund partnerships; grant oversight capacity; and technical assistance.
Communications and Global Fund partnerships
The TERG paper said that there is “profound confusion among the many stakeholders in health and international development regarding Global Fund policies and partner roles and responsibilities…” The paper said that as a result of the variability in interpretation of these policies, there is inconsistent application of the rules and procedures.
The TERG said that the Global Fund faces difficulties in communicating and implementing its policies effectively and coherently at both the global and the country levels. To address this problem, the paper says that “consistent communications must be targeted to both Global Fund staff and external stakeholders at all levels.” The TERG recommends that Global Fund staff, particularly those working on country-level issues, receive training and adequate support to be able to provide clear, consistent and reliable information on Global Fund policies. It adds that Global Fund staff should be client-oriented and “sensitive to the fact that the Global Fund is serving country partners in their efforts to implement sound country programs.”
To improve its interaction with partners, the paper says that the Global Fund should work with partners to clarify roles and responsibilities at both global and country levels. The TERG recommends “governing body to governing body” discussions aimed at leading to direct negotiations of a “Global Partnership Framework” among the Global Fund and the World Bank, UNAIDS, WHO and bilateral development agencies – as well as those global partnerships most directly involved in the focus areas of the Global Fund (particularly the RBM and Stop TB Partnerships).
With respect to civil society, the paper said that although the Global Fund “has proactively created effective structures for the representation and participation of civil society organizations at the global and country levels,” there remain “recurrent barriers” to effective participation by civil society on CCMs. The paper observed that “challenges remain in working with the diversity of civil society organizations …, with governments at times being reluctant to include and empower civil society organizations, particularly those representing vulnerable groups”; and that “poor communication in some countries limits the scope of inclusion of civil society organizations.”
The paper noted that where civil society groups are organized into subgroups or networks, their representation and engagement is strengthened. The TERG said that it supported “the
establishment of a technical assistance strategy to provide civil society organizations with technical, managerial, and financial support.” The TERG also said that “civil society organizations should be supported in the establishment of networks to build institutional capacity and strengthen their engagement in policy setting.”
The paper also called on the Global Fund to develop more innovate ways to engage with the private sector.
In the paper, the TERG said that there is a need to review the role of CCMs. Calling CCMs “central to the creation of effective partnerships at country level,” the TERG acknowledged that during the fast start-up phase of the Global Fund, many CCMs were established quickly, in an ad hoc manner, to meet the requirements of the Global Fund. Specifically, the TERG recommended:
- that the Global Fund encourage country-level partners to “step back” and examine whether CCMs have exploited their full potential;
- that the Global Fund Secretariat encourage the review and adjustment of the roles of CCMs to strengthen their capacity to fulfil their dual functions of managing grant applications and grant oversight; and
- that CCMs be encouraged to establish bi-annual, moderated self-evaluations to ensure that they are adequately meeting country needs and acting as a “country-owned” coordinating mechanism.
Grant oversight capacity
The TERG paper said that while the Global Fund has made considerable progress in placing grant management and oversight responsibility in countries' hands, “capacity constraints for grant management and oversight interfere with progress in country ownership” and investment in capacity building is lagging.
The paper said that that overlapping roles for the PRs, LFAs and CCMs in oversight and coordination are compounded by the lack of a Global Fund presence in country and frequent changes in policy.
Interestingly, the TERG paper noted that the Study 2 Area Report found that implementation of Global Fund grants “is solidly in the hands of sub-recipients, who are not explicitly part of the Global Fund's grant oversight structure.” Although sub-recipients are key to effective implementation, there is no evidence that they are being monitored systematically by either the PR or the LFA. The TERG said that this limited oversight of sub-recipients “is not only a risk to grant implementation but also precludes identification of training needs or potential efficiency gains, for example, through pooled procurement.”
The TERG recommended that the Global Fund work with country-level partners “to systematically identify and address additional requirements for achieving adequate oversight at the sub-recipient level….” The TERG also recommended that the Global Fund, preferably together with development partners, conduct random performance audits of sub-recipients (and sub-sub-recipients).
The paper observed that the proliferation of policies related to grant implementation “has led to a complex web of interdependent policies which often limit the Global Fund's responsiveness.” The TERG said that the Global Fund Secretariat urgently needs to conduct a step-by-step review of its policies, guidelines and procedures in order to fundamentally streamline and simplify them.
Noting that concerns about the quality of data (particularly baseline data) in the reporting process “pose potential threats to the validity and credibility of the Global Fund's performance-based funding model,” the TERG recommended a comprehensive review of data quality, including the data used in relation to service quality, gender, equity and Paris Aid Effectiveness Declaration objectives “when setting in-country performance indicators and determining funding decision-making processes.”
The paper said that the fundamental issue identified in the Study Area 2 Report was the lack of a well-developed overall partnership strategy defining the roles and responsibilities of partners in identifying technical assistance needs and providing technical support. The TERG said that “another confounding factor is the persistent confusion as to whether or not financial support [by donors] to the Global Fund precludes the need to provide additional funds to other organizations, such as WHO and UNAIDS, to provide technical assistance to Global Fund grants.”
The TERG recommended that the Global Fund Board re-emphasize that it does not directly fund its partners to provide technical assistance and that the Board reinforce its message that countries are encouraged to submit grant proposals that incorporate comprehensive budget allocations for technical support. The TERG also said that development partners should re-examine the extent to which their existing resources and budgets can be targeted to more efficiently support countries in their implementation of Global Fund programmes. The TERG considers that providing technical support to countries is part of the core functions of partners such as WHO, UNAIDS, Stop TB, and RBM.
Finally, the TERG “strongly” recommended adopting a longer-term perspective in delivering technical support, “particularly for human resources capacity building, such as training support with a timeline of five to ten years.”