The two-day meeting that brought together 32 delegates from 13 countries classified as Challenging Operating Environments (COE) by the Global Fund has come to a close. The meeting, organized by the African Constituency Bureau, was launched on June 22 in Lomé (Togo) by Mrs. Zoutéhatou Kassah-Traoré, Minister of Public Works and Chairperson of the Country Coordinating Mechanism (CCM) Togo. The Minister was thrilled by the fact that the meeting was being held in Togo and recalled the importance of COE countries for the Global Fund and for the West and Central Africa constituency of the Global Fund. This constituency is home to 11 of the 29 COE countries in the world. To these, should be added the two countries in East and Southern Africa. In total, 13 countries in the African constituencies are classified as COEs. In her view, beyond the security and structural challenges, all countries can learn from and support each other.
The meeting’s objectives included (i) Engaging WCA participants from Challenging Operating Environment countries to reflect on Global Fund policies and processes that affect their grant implementation and to propose solutions (virtual session), (ii) Identifying regional priorities for COEs, with the aim of influencing Global Fund platforms and other global health institutions, (iii) Discussing the progress of WCA COEs on Global Fund grant performance during the current cycle.
Challenging Operating Environment: kézako?
This conversation on COEs was launched on June 15 with a virtual session in which Mr. Francesco Moschetta of the Global Fund’s COE department reviewed some of the guiding principles of the COE policy. “The COE Policy codifies the Global Fund’s commitment to “improve effectiveness in challenging operating environments’ through innovation, increased flexibility, and partnerships,” as expressed in the Strategic Framework of the Global Fund’s 2017-2022 Strategy, this Policy is based on analytical work conducted between 2014 and 2016 and several consultations with external partners conducted in 2015 and 2016. In addition, it draws heavily on the experience and expertise of Global Fund country teams.
Challenging operating environments refer to countries or regions characterized by weak governance, poor access to health services, and man-made or natural crises. This policy identifies countries in the Global Fund portfolio with the highest external risk index levels. Classification as a challenging operating environment is the first step in qualifying for the provisions and flexibilities described in the policy, but does not automatically guarantee that they will be applied.
In practical terms, Global Fund investments in challenging Operating Environments aim to expand coverage of HIV, TB and malaria prevention and treatment services to reach key and vulnerable populations and to save lives. They also seek to improve resilience by strengthening community and health systems, and to overcome gender and human rights related barriers to accessing services. In emergency situations, the scope of Global Fund investments may be more limited and narrowed to ensuring continuity of essential treatment and services for people affected by the three diseases, and to preventing and curbing disease outbreaks .”
Currently, in the Global Fund’s governance, 29 countries in the world are classified as COEs: Afghanistan, Burkina Faso, Burundi, Central African Republic, Chad, Democratic Republic of Congo, Eritrea, Guinea, Guinea-Bissau, Haiti, Iraq, North Korea, Lebanon, Liberia, Mali, Myanmar, Nicaragua, Niger, Nigeria, Pakistan, Palestine, Sierra Leone, Somalia, South Sudan, Sudan, Syria, Ukraine, Venezuela and Yemen ; 13 of these countries are in Africa and are part of the WCA and ESA constituencies.
Benefits of the COE Policy
Countries shared experiences on the innovations, flexibilities, and partnerships that the COE policy has enabled in their countries. This experience sharing allowed them to learn about what is possible under this policy to better achieve the goals of saving lives.
The Bureau promised to gather this information and share it with all COE countries.
As expected, despite national and geographical specificities, COEs face some common challenges with respect to this Global Fund policy. Meeting participants explained that their countries are also under additional safeguard measures, and most also have fiscal agents as a risk mitigation measure.
Some participants complained that they had never seen their country’s risk matrices, which partly drive these measures. Better knowledge of this matrix would allow them to take greater ownership of the mitigation measures. Many have also never seen the terms of reference for the fiscal agents assigned to their grants, so they are not aware of the scope and duration of the assignment; few are aware of an exit plan; and for most of them, no exit plan is defined.
It should also be noted that the discussions were very frank, with some participants explaining that in their countries, with a high corruption index, the presence of Global Fund fiscal agents helps implementers to resist the pressure of diverting funds.
Some countries struggle to absorb the funds allocated. Indeed, many countries experience delays in starting up activities, which results in activities not being implemented at the beginning of the grant and consequently in low absorption of funds. On average, it takes six months from the signing of the agreement to the first disbursements, which slows down implementation.
Participants also pointed out the length and hassle of reprogramming, which takes between four and seven months over three-year cycles.
Meeting participants proposed solutions such as strengthening partnerships, properly taking into account national plans, and improving actions to optimize resources. Several countries reported that interventions are carried out in an isolated manner without consulting national initiatives or partners, and that certain activities are sometimes duplicated. In addition, to address the issue of stock-outs, it was suggested to partners to use the logistics of humanitarian NGOs to deliver inputs to hard-to-reach areas, especially in these Challenging Operating Environments.
Participants requested that the African Constituency Bureau collect and share country experiences to build a database from which they can draw inspiration.
Many also highlighted the importance of this meeting and the need for further meetings to share experiences and improve grant implementation in their respective countries.