As it does for each round of funding, the Technical Review Panel (TRP) has identified a number of issues with respect to the Round 7 applications and review process, and has made several recommendations to the Global Fund (and others) that could lead to changes in future rounds. The TRP's recommendations are contained in a report entitled "Report Of The Technical Review Panel And The Secretariat On Round 7 Proposals" (the Report).
In this article, Aidspan summarizes the major issues and TRP recommendations. Some of these issues were "new" to Round 7, meaning that were not present, or at least were not very prominent, in previous rounds. This information in this article will be useful to CCMs and other organisations that are considering applying for funding in Round 8 in 2008.
(The full text of the Report is available at www.theglobalfund.org/en/about/technical/report.)
Impact of previous grants. In order to be recommended for funding, proposals have to describe any challenges encountered with grants currently being implemented; what actions have been taken to overcome these challenges; and how the new proposal will complement and add to existing grants. The TRP wants to see evidence that previous investments by the Global Fund are being well used before recommending additional funding. In its Report, the TRP says that it "continues to hold the view that the existence of prior Global Fund (or other donor/partner) grants, and the disbursement history and performance of these grants are themselves fundamental to judgments about absorptive capacity, feasibility and likelihood of effective implementation…"
As a result of recommendations made by the TRP at the end of Round 6, changes were made to the Global Fund's Round 7 guidelines and proposal form to ensure that information on existing grants was clearly requested. Nevertheless, as the TRP observes in its Report, many Round 7 proposals contained insufficient information on the impact of existing grants.
When evaluating proposals, the TRP also looks at the success that PRs nominated in a new proposal have had in implementing previous grants. In its Report, the TRP reiterates some of the observations it made at the end of Round 6. It says that where there is a significant grant from the previous round either which has not yet been signed, or which has been signed but for which disbursements have not yet commenced at the time of the TRP review, "the TRP pays particular attention to the increased burden that two concurrent same disease components may have on the implementation capacities of both the nominated Principal Recipient and the in-country implementation partners. In such circumstances, where the new proposal is for a scale up of the same interventions, rather than addressing a separate and clear gap in a national program or strategy, the TRP is less likely to recommend the proposal for funding absent demonstrated clear absorptive capacity." In its Report, the TRP recommends that applicants consider carefully the timing of their applications, particularly where the same PR is proposed.
The TRP also notes that while it has access to the most recent Grant Performance Reports (GPRs) prepared by the Global Fund Secretariat, these reports were not always adequately completed. The TRP recommends in its Report that the Secretariat improve the accuracy and relevance of the information provided in GPRs.
Use of multiple PRs. As reported previously in GFO, starting with Round 8, the Global Fund will strongly encourage the use of dual-track financing, whereby there are multiple PRs - e.g. one from government and one from civil society. (See "Main Decisions Made at Global Fund April Board Meeting" in GFO Issue 75, 30 April 2007, available via www.aidspan.org/gfo.) In its report, the TRP says that the use of multiple PRs can improve grant implementation, but that there are also risks and challenges associated with this practice. The TRP says that multiple overlapping activities could lead to difficulties in achieving harmonization and alignment; and that where the activities of the respective PRs are interlinked, there are inherent risks to performance and achievement of outcomes if one of the PRs has a stronger implementation capability than the other(s).
The TRP recommends that when multiple PRs are proposed, the Round 8 proposal form require that applicants clearly outline how coordination will be achieved between or among the PRs, in much the same way that applicants are currently asked to explain the inter-relationships among different SRs. The TRP recommends that applicants be required to focus not only on coordination between PRs at the oversight level, but also in regard to day-to-day integration of activities and, where possible, harmonization of key reporting and disbursement dates.
Building local capacity to develop proposals. In Round 7, there was a notable improvement in the quality of malaria proposals as compared to previous rounds. In its report, the TRP says this appears to be largely due to the support applicants received from the Roll Back Malaria Harmonization Working Group and the World Health Organization's Global Malaria Programme throughout the Round 7 proposal development process. (In Round 6, there was a similar improvement in the quality of tuberculosis proposals, which was attributed to support provided by organisations such as the Stop TB Partnership.)
The TRP says that while support from key partners obviously leads to technically stronger proposals, it also makes it more difficult to determine the extent to which the proposal reflects ownership by the country and local stakeholders. So, while the TRP encourages applicants to seek technical support in the preparation of proposals, it also says that applicants ought to be able to obtain such support locally. For that to happen, the TRP says, more resources need to be allocated to building local capacity to develop strong, fundable proposals. The TRP says that the necessary resources should come either from applicants including capacity building within prior proposals, or from governments or their development partners prioritising it in their budget and planning processes.
Health systems strengthening. The Round 7 proposal form included a detailed section on health system strengthening (HSS), designed to encourage requests for financial support for strategic actions to address health system constraints. The TRP notes that of the $2,762 million in total funding approved by the Global Fund Board in Round 7, $363 million is targeted towards funding HSS actions, and says that this represents a major investment. However, the TRP believes that there is an opportunity to do much more in this area.
In the opinion of the TRP, there is still confusion among many stakeholders concerning what actions can be considered within a Global Fund proposal. The TRP says that many proposed HSS actions focus too much on addressing obstacles to delivery of health services, and not enough on planning, financing and building the health systems in the first place. The TRP recommends that there be an intensified effort at country level to improve the understanding of what HSS is and is not, and to strengthen CCM capacity to address HSS issues.
In its Report, the TRP advances a series of recommendations that it hopes will stimulate a broader discussion on this topic. Specifically, the TRP recommends that the Global Fund and/or its partners focus their support on:
- including information on health systems and institutional development in regional briefing sessions before and during proposal preparation;
- providing intensive technical support on HSS for Round 8 similar to that provided on malaria for Round 7 proposals;
- making a small number of revisions to the HSS section in the Global Fund's guidelines and proposal form to better highlight the difference between systems strengthening issues and the tools necessary to implement the systems (e.g., training, equipment and renovation of infrastructure or buildings); and
- adding further health systems indicators to the monitoring and evaluation framework.
Budget template. A common reason for not recommending proposals for funding is that there are substantial weaknesses in the budget. In its Report, the TRP notes that many proposals submitted for Round 7 had budgets that contained substantial calculation errors, lacked clarity on what is being requested, or lacked details that would permit an informed assessment of the feasibility of the proposal.
The TRP says that although there have been several attempts over the years to develop useful guidance, applicants still vary enormously in the level of detail they provide in their budgets. For this reason, the TRP recommends that the Global Fund develop a standardized budget template for applicants to complete as a required part of future proposals (while still allowing applicants to present additional information in alternative formats as annexes to the proposal).
(In the past, the Global Fund has been reluctant to provide a budget template, preferring to have applicants come up with their own format. The Fund provided what it called a "Budget Analysis Template" for Round 6, but did not include this for Round 7. Instead, the Fund provided on its website some model budgets from previous rounds of funding, but told applicants that the model budgets were "not templates for applicants to copy, but simply examples of good budgets.")
Strengthening research capacity. Although the Global Fund does not fund clinical or basic science research, it is prepared to support operational research. In its Report, the TRP says that the "operations/implementation" research components within proposals submitted in Round 7 were generally weakly articulated, and that this constitutes "a major missed opportunity … Within the extraordinary scale-up of the fight against the three diseases, there are many areas where the most effective and efficient methods to overcome bottlenecks are not yet known."
The TRP says that it believes that operations/implementation research needs to go beyond the monitoring and evaluation of interventions supported by Global Fund financing and should "seek systematic solutions to existing bottlenecks, and contribute to a country's understanding of the effectiveness of different interventions, including how differing interventions contribute to the attainment of planned outcomes and impact."
In its report, the TRP says that applicants should be encouraged to include within their proposals realistic plans for strengthening local capacity to carry out operations/implementation research that is closely tied in to the overall objectives of their projects. The TRP recommends that the Secretariat make adjustments to its Round 8 guidelines to incorporate further guidance for potential applicants.