In a presentation prepared recently, the Technical Review Panel (TRP) identified key lessons learned from the funding requests received from countries in Window 4. The presentation was used at the pre-meeting, on 8 May, of the 9–10 May Board meeting in Macedonia.
The deadline for Window 4 requests was 7 February. The TRP reviewed the requests from 17–27 March. The TRP identified four key lessons learned, as follows:
- There is a need for greater prioritization within programs that have reduced funding.
- There is a need for earlier transition planning and efforts to achieve sustainability.
- Programs need to be anchored in universal health coverage (UHC) processes.
- There is a need for better analysis of epi data to guide the selection of prevention interventions across all three diseases.
In the next section, we provide a brief summary of what the TRP said about each lesson learned. Because the presentation was in the form of a slide deck, some of the information is somewhat sparse.
Summary of lessons learned
Some countries that were experiencing reduced funding were able to successfully prioritize interventions and develop more efficient strategies, the TRP said. Nevertheless, the TRP observed that there was tension in some countries between the reality of the funding cuts and the perceived expectation that the countries would address all strategic areas, including health systems. Where countries failed to prioritize, the TRP stated, the result was that funds were spread too thinly across multiple interventions with little change in strategy.
Transition planning and sustainability
The TRP said that the countries that are planning for transition and sustainability are those whose funding requests demonstrated:
- country ownership, genuine commitment and multi-sectoral engagement;
- a clear transition readiness assessment and a transition plan with prioritized activities and a timeline;
- clear and sustainable implementation arrangements, with government progressively assuming the costs of programs financed by the Global Fund; and
- incorporation of Global Fund–funded workforce into the national payroll or other local system.
The Window 4 funding requests revealed that some countries were not sufficiently prepared for pre-transition and transition, the TRP said. The requests had some or all of the following characteristics:
- the Sustainability, Transition and Co-Financing (STC) Policy was not sufficiently used to guide the request;
- timelines for sustainability-related activities were unclear and there were no milestones;
- service delivery costs were still a significant part of the requests;
- there was limited prioritization of catalytic components meant to accelerate integration and government takeover of programs; and
- domestic investments in activities targeting key populations was still insufficient.
The TRP observed that the program continuation format which some countries used for their funding request was not adequate in the case of countries expected to transition from Global Fund financing within two funding cycles.
Universal health coverage processes
The TRP said that in the Window 4 funding requests, there was insufficient consideration of HIV, TB and malaria service integration. In addition, populations that are vulnerable to the three diseases were more likely to be excluded in insurance enrolment.
Further, the TRP noted, few efforts have been made to integrate prevention, care and treatment for HIV, TB and malaria into UHC benefits. Finally, the TRP observed that community health workers are still siloed, with few plans for designing and funding integrated community health systems.
Analysis of epi data
In general, the TRP stated, the Window 4 funding requests showed a poor analysis of epidemiological data to guide the choice of prevention interventions. In addition, the TRP observed that the indicators used to measure the outcomes and impact of prevention interventions were unclear.
Windows 5 and 6
There were two more windows scheduled for 2018. Window 5 (deadline: 30 April) generated 18 country funding requests. These were reviewed by the TRP on 3–11 June. The deadline for Window 6 applications is 6 August, with the TRP scheduled to review the funding requests on 9–21 September. The Secretariat estimates that another 18 country funding requests will be submitted in Window 6. There are no additional Windows scheduled for 2019, but the Secretariat expects that three funding requests will be submitted in 2019 and will be reviewed by the TRP remotely. These will be the last of the 2017–2019 funding requests.
Editor’s Note: It is not known whether the TRP will prepare a lessons learned document for either Window 5 or Window 6 (or for the two windows combined). There is a good chance that the TRP will produce a lessons learned document covering all of the 2017–2019 funding requests.
A presentation entitled “Update from the Technical Review Panel & Update on Country Funding” was prepared for the pre-meeting (on 8 May) of the Board meeting held on 9–10 May is Skopje, Macedonia. The presentation is not available on the Global Fund website. Other documents prepared for the Board meeting are available at www.theglobalfund.org/en/board/meetings/39.