The Global Fund’s new 2020-2023 grant implementation cycle has been launched with the expectation that it will produce greater results in the 23 countries of the West and Central African constituency. This builds on the fact that these countries have started to implement the recommendations of the Global Fund’s Office of the Inspector General, which in May 2019 published a review of grant performance in these constituencies. The review detailed the issues that led to poor performance and outlined recommendations to address them.
Following the publication of this report, the Global Fund Secretariat undertook peer reviews for each of the countries concerned, which resulted in a series of country-specific recommendations and an action plan to improve the implementation of their grants. The representatives of the West and Central African constituencies on the Board, Professor Pascal Niamba, Dr. Djalo Mele, representative on the Global Fund Strategy Committee, and the ACB Bureau carried on this activity to gather feedback from countries on the process, the results and the way forward.
“This reflection is very timely, as the Global Fund is about to celebrate its 20th anniversary and the millions of lives saved since its inception. While it is clear that the Global Fund’s unique partnership model has achieved remarkable results on the continent, there is a need to break down all the barriers that stand in the way of ending the epidemics,” said a senior official from the African Constituency Bureau.
Subsequently, the African Constituency Bureau organised a series of four virtual meetings with representatives of five or six Country Coordinating Mechanisms and Principal Recipients. The 23 countries participating in this exercise were grouped into four session rounds to allow time for exchange and discussion. During these meetings, the speakers collected feedback on the peer review process and other relevant and related information. Other topics discussed included the grant absorption bottleneck, the Additional Safeguard Policy and the Zero Cash Flow Policy.
What are the key points from these discussions?
During the discussions, countries indicated that upon receipt of the OIG’s report, several measures were taken to address the problems identified. Although each of these countries adopted measures specific to its particular context, the following positions can be applied to all participants.
Consultation and planning meetings at national and local levels with key partners to ensure ownership and implementation within the country structures.
Each country developed a joint work plan, a sort of roadmap with key stakeholders to outline the way forward. Policy and technical partners were involved in the development of the roadmap. Ownership by the government and civil society organisations played a key role in the process. It should be noted that the joint work plan is important for the joint reviews and the integration of the OIG’s response plan.
Countries reported that in most cases, the Ministry of Health or governments have risk management and mitigation policies, but most of these are not implemented. Thus, they agreed on strengthening the capacity of the Ministry of Health – CCMs work closely with the Ministry of Health and implement Global Fund grants through the structures of the Ministry of Health. On this point, the participants agreed that the capacity of the Ministry of Health should be strengthened in terms of frontline staff, accounting staff, and specifically the project implementation unit.
Countries also agreed that CCMs should be strengthened to improve their performance. CCMs were considered critical to the successful implementation of Global Fund grants and, as such, their capacity is vital to ensure success.
During the discussions, countries also pointed to inadequate funding and poor administration of funds as a shortcoming. For example, they trained the Ministry of Health’s accounting officers to ensure smooth budget implementation and control. Co-financing to fill the funding gaps is also in progress.
During the discussions, participants were also unanimous in highlighting weaknesses in health systems strengthening, particularly at the community level, which is important to ensure effective implementation of the 3 epidemics.
Countries also agreed that technical assistance is necessary, but felt the need to support local expertise with multiple skills to effectively implement the 3 epidemic activities. It should also be noted that some countries such as Mali and Togo partially implemented their activities in some areas due to security issues.
Thus, this collaboration, exchange and support between countries, representatives of the West and Central Africa constituency and the ACB Bureau will continue in order to ensure the improvement of the performance of Global Fund grants as recommended by the Office of the Inspector General.