Grant Implementation in Western and Central Africa
31 May 2019
Western and Central Africa (WCA) is critically important for the Global Fund. Since 2002, the organization has invested US$6.9bn in the region, with US$1.1 billion invested in Resilient and Sustainable Systems for Health since 2014, and US$10m provided annually in technical assistance.
WCA is a challenging operating environment characterized by high fragility and instability, weak health systems, limited fiscal space, low health financing and a significant funding gap. Despite this, significant progress has been made in reducing mortality from malaria (-37% since 2010) and HIV (-27% since 2010). WCA is however lagging behind in the fight against tuberculosis, with a 5% increase in TB deaths in the same period.
At the request of the Executive Director, the Office of the Inspector General conducted an advisory review on grant implementation in Western and Central Africa, to gain a better understanding of potential implementation barriers and to identify opportunities to enhance program performance.
The review found that balancing risk mitigation measures with simple, flexible processes that can be tailored to specific country contexts is a critical enabler to successful program implementation. Multiple implementation arrangements in place across WCA are dragging down performance, and barriers to accessing health services are contributing to the lagging performance on HIV and TB. In order to overcome current challenges and improve performance in the WCA region, the advisory review provided various recommendations related to Global Fund internal processes, implementation arrangements, technical assistance, and access to health.