14 February 2019
Multicountry grants are designed to accelerate the end of the HIV, TB and malaria epidemics and to strengthen health systems by tackling regional bottlenecks and cross-border issues. They have the potential to achieve impact particularly where bottlenecks cannot be resolved by a single country application. The Global Fund Board adopted a refined allocation methodology for the 2017-2019 funding cycle to increase the impact, simplicity, flexibility and predictability of multicountry investments, and approved funding to be directed towards multicountry approaches targeting priorities deemed strategically critical.
To date, multicountry grants have facilitated regional coordination and an integrated approach towards issues such as malaria elimination, tuberculosis in miners and ex-miners, access to services for refugees, migrants and mobile populations, human rights and gender barriers to accessing HIV services. Multicountry grants have, however, faced challenges in their implementation; 71% of the multicountry/regional grants selected for review by the OIG performed below expectation at the last progress update in December 2017. The malaria program in the Greater Mekong Sub-region faces particular challenges.
While the Secretariat has streamlined some multicountry grant processes (such as grant applications), grant implementation arrangements could be further optimized. Equally, the lack of effective governance for one of the two main multicountry governance arrangements (Regional Organizations) has resulted in ad-hoc management of important processes. Issues relating to risk management and also grant monitoring need to be addressed.
One particular challenge faced by multicountry grants is the inability of current regional data systems to provide quality and timely programmatic data on the three diseases, while another relates to the alignment of various country reporting standards to ensure regional data is available.
Overall, multicountry grant processes, systems and resource allocation have not yet been adequately tailored to cater for their specificities and complexities.
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