Global Fund financing gets greater oversight

Two challenges confront the Global Fund to Fight AIDS, Tuberculosis and Malaria: to raise enough donor financing to cover needs on the ground, and to ensure that the available money is properly spent. More than 60 percent of grants approved by the Fund are for Africa, based on proposals produced by Country Coordinating Mechanisms (CCMs), who oversee project implementation. By the end of September, grants worth more than US $1.4 billion will have been awarded to projects in the West and Central African region, although only around $220 million has been disbursed. It is a delicate balance between the priorities of speed - how rapidly funds aimed at saving lives are released - and accountability for how the programmes are run. "Maintaining a reasonable balance can be quite a challenge," said Mabingue Ngom, the Fund's programme manager for West and Central Africa. At a meeting last week in Abuja, Nigeria, to help improve CCM capacity and accelerate implementation of grant programmes, Ngom was forthright, warning that CCM performance "results were mixed". The Fund, which is strictly a financing mechanism, uses a performance evaluation system to manage its scarce resources and reward effective CCMs. Proposals cover a five-year implementation period, but projects are reviewed after two years of operation: those that have not performed well do not qualify for Phase 2 funding. Ngom told the Abuja meeting that Phase 2 funding extensions "will be impossible in some cases", but did not name which countries would be refused further funding. To help CCMs struggling to meet Fund performance requirements, an Early Alert and Response System (EARS) has been introduced to flag looming problems that need quick intervention to fix them. The first batch of countries to be placed on the EARS list is being compiled. "We set getting the house in order as a priority for all CCM meetings, from Africa to Asia," said Fund consultant Doris D'Cruz Grote. "Once CCMs put in place institutional structures and capacities, they start to work." CCMs were hurriedly set up when the Global Fund, then just a few months old, made its first call for proposals in 2002. They were inevitably urban-based, with government agencies over- represented, and roles and responsibilities not always clearly understood. In a series of guidelines the Fund has tried to improve governance and transparency to avoid conflicts of interest, such as a separation between the CCM chair - often the ministry of health - and the primary recipient of grants. NGO participation is also seen as vital to strengthening project implementation, and the Fund insists that their representatives should be chosen by civil society rather than appointed; it also urges the inclusion of "people living with the diseases" on the CCM. However, some of the Fund's conditions and operating procedures have proved daunting to under-resourced CCM members with limited administrative capacity or procurement and supply experience. "We'd like to see things being a little smoother - less bureaucracy, less paperwork," said Liberian health minister Peter Coleman. "Flexibility doesn't mean compromising transparency and accountability." He acknowledged that "things have changed [over the past three years] from when the Fund was very, very dogmatic to now, where they are a little bit more flexible", but stressed that the real goal was to tackle the three diseases accounting for the vast majority of deaths in the region. Given the responsibilities faced by the CCMs, a concern stressed by some delegates at the Abuja meeting was that they did not have the resources to meet their oversight functions. The Fund has recognised that in-country donor support was not always forthcoming to fill the financing gaps faced by CCMs; to help, the secretariat will now consider monetary support. But, D'Cruz Grote insisted, this would not entail paying for 4x4 vehicles or office extensions.