In late February, members of Côte d'Ivoire's country coordinating mechanism (CCM) met with some 60 representatives of government, non-governmental organizations and civil society for a four-day workshop on how best to implement the Global Fund's new funding model in their country.
The workshop was held prior to the March 12 announcement of the West African nation's allocation under the NFM: $112.9 million for HIV, $28.5 million for TB and $118.7 million for malaria.
Bringing all stakeholders together was of utmost importance and incredibly urgent, according to Jean Kagubaré of Management Sciences for Health, the US-based organization that organized the meeting in the Ivorian economic capital, Abidjan.
"Grant proposals must be completed by June 2014 for the malaria program and April 2015 for the HIV program, so time is short for malaria," he told Aidspan, which was allowed to observe the meeting. "We also want to get things moving on the other programs as soon as possible."
The workshop was the first opportunity for most of the stakeholders to be inducted into the ways of working under the NFM; only the head of the national malaria program and the CCM chair had had prior exposure to the mechanics and the processes, during a December 2013 meeting organized in Kenya by the Roll Back Malaria partnership.
Workshop organizers used the four days to walk participants through the steps of the development of the NFM concept note, which is supposed to present both the country's request for funds as well as to map each stakeholder's envisioned role in implementing or monitoring activities in line with national priorities.
A lack of technical assistance
But while the CCM generally is supportive of the NFM, they are concerned that they don't quite have what is needed to ensure it is effectively implemented in the country. Critically lacking among their skillsets, they told Aidspan, was the technical expertise needed for developing a concept note that hit all the right notes and ticked all the right boxes.
"The methodology is extremely demanding," one CCM member, who works at the national AIDS commission, told Aidspan on condition of anonymity. "We don't have all the necessary skills; we need a team that is better-equipped."
Gisèle Takalea, who is the vice-chair of the national collective of civil society groups working to combat TB and other respiratory illnesses, COLTMR-CI, echoed these remarks and added, "the training was just too quick."
"There was too much new information to absorb and I really wonder if we are on the right path to succeed. There is a risk that it will be too complicated in the beginning," she continued. "We need another training, maybe with some scenarios and exercises to simulate [the concept note development process]."
A rapid, skills-building workshop is something not beyond the realm of possibility for MSH -- if there are funds available. "The CCM already has a lot of work to do, and we are able to give them limited support," said MSH's Alison Collins. "There is supposed to be a technical consultant seconded by PEPFAR from April, but the role is for overall support to the CCM, not limited to the NFM."
Côte d'Ivoire, like the other 122 eligible countries, will be able to apply for technical assistance furnished by the Global Fund itself as part of a $100 million special initiatives package approved by the Board during the 31st Board meeting in Jakarta in early March. Other development partners, including the 5% Initiative, which works exclusively with francophone countries on Global Fund-related activities, have also committed sums to help countries move through the NFM process.
The challenge for Côte d'Ivoire will be accessing these external resources in time for them to be as useful as they can be in the tight timeframe required by the NFM. Because as of now, there is no money available to recruit external consultants, the CCM member said.
"There's a whole host of activities we have to carry out that require a lot of financing, like the review of the national strategic plan," said Dr Gnamien Kouamé, permanent secretary for the CCM. "We need money to carry out studies, to organize meetings. And there's also a huge distribution of mosquito nets planned for this year -- how do we oversee that, and other programmatic activities, when we also have this concept note to develop? We're going to need outside help."
Despite these and other anticipated challenges related to the transition between financing mechanisms, however, there is a willingness to work within the parameters of the NFM and a degree of satisfaction that the training that has been provided thus far is sufficient.
"Under the [rounds-based approach], we had a lot of trouble because of slow disbursement mechanisms, or administrative procedures that lasted for years," said Marie Lattroh, a technical advisor to the Economy and Finance Ministry. "Now the [Fund portfolio manager] visits regularly, and she is helping us navigate the system. It remains to be seen, though, if the NFM will improve the situation."