Structured Abstract
| Document Title: | Global Fund Country Case Study Report. January 2003 |
| Institution: | DFID Health Systems Resource Centre |
| Authors: | C. Grace, M. Bannerman, P. Mokaya, L. Ollier, S. Sohani. RM. De Loor |
| Study commissioned by: | Department for International Development (DFID) Health and Population Department (HPD). |
| Objectives: | (1) to better understand the challenges countries faced during the first round application process, the functioning of the country coordinating mechanisms (CCMs), the degree of compatibility of Global Funds with country-led development processes, and implications for the poor. |
| Methods: | Case studies were conducted during August and September 2002 in five countries : Ghana, Kenya, Malawi, Uganda, Ukraine. The case studies included review of documents and interviews of key persons involved in the process. |
| Results: | The paper first describes the context in each country, then presents overall findings and recommendations with a cross-country comparison. Several issues for improvement are then discussed:
(See original Executive Summary). |
Executive Summary
This study was commissioned by the Department for International Development
(DFID) Health and Population Department (HPD) and is based on the experiences
of five countries in dealing with the Global Fund for AIDS, Tuberculosis and
Malaria. The study's aim is to better understand the challenges countries
faced during this first round application process, the functioning of the country
co-ordination mechanisms (CCM), the degree of compatibility of Global Funds
with country-led development processes, and implications for the poor. General
policy lessons, comparative experience, and consensus have been drawn out in
this paper.
When the process for preparing and submitting proposals to the Global Fund was
designed, it was recognised that revisions would be required, based on experience
in the first round. Indeed, the country case studies undertaken for this report
revealed specific examples of where revisions are needed, for example, the timeframes
during the first round were too short, communication asymmetric across countries,
and clarity lacking in the proposal format. Countries were also of the view
that the criteria by which proposals were judged lacked appropriateness, clarity,
and seemed to be inconsistently applied. The Technical Review Panel (TRP) feedback
also needed to be more specific and more equitably distributed across countries.
The composition, inclusiveness and performance of the Country Co-ordinating
Mechanisms also differed across countries. There was evidence of governance
problems in one study country; the Global Fund will need to have policies in place to
deal with such situations. Overall, there are steps the Global Fund can take to help
facilitate better performance and transparency for all recipient countries,
including drafting a global CCM constitution for local adaptation and establishing
guidelines for tendering processes, for use in countries where a bidding process
is being used to vet proposals from implementing partners.
Compatibility of the Global Fund proposal with country-led development processes
was variable across countries, seemingly more compatible where country-led processes
were previously strong. The Global Fund was consistently viewed, in interviews,
as being more disease than health systems orientated; countries are finding
various ways to deal with this. All five countries initially developed a proposal
that sought to obtain financing for unmet need in implementing or scaling up
existing health service provision. However, in two of the five countries, external
influence intervened, encouraging the countries to submit a substantially larger
bid. Interviewees expressed doubt in capacity to implement the proposal in all
study countries; human resources were seen to be the major constraint. Capacity
for performance monitoring and infrastructure for financial management differs
across countries. The process of trying to set up the latter had been a major
pre-occupation in all the study countries during the time the case studies were
conducted.
None of the countries studied had explicit policies regarding the criteria for
rationing access to Anti-retroviral (ARV) therapy or whether ARVs (and the cost
of the care that goes with their use) would be offered free, subsidised or at
cost. Issues of equity and how Global Funds would affect the poor were consistently
found to be neglected across the study countries.
