London School of Hygiene & Tropical Medicine (LSHTM)
Governance, funding, civil society
To draw on the findings of a four country Tracking Study, conducted by LSHTM and partners, for generic lessons on and some potential implications of new donor assistance instruments and approaches more generally, intended to stimulate discussion and pose questions to policymakers, particularly at the global level.
Secondary analysis of empirical qualitative data from four country studies.
This report draws on empirical studies of early Global Fund (GF) processes, undertaken by LSHTM and partners, in four countries Mozambique, Tanzania, Uganda, and Zambia which were among the first to receive GF monies for HIV/AIDS efforts. This paper presents a cross-country comparison of issues that affected all four countries:
- The GFs evolutionary approach caused difficulties for countries, both during proposal preparation and subsequently when they were trying to respond to the GFs information needs.
- The most effective strategy in proposal preparation was the use of long-term donor-funded country-based technical assistance.
- An inherent weakness in the GFs approach was that it was not well placed to assess the strengths and weaknesses of individual country systems.
- Bilateral and multilateral donors played an often marginal role in GF application and setting up processes, which was probably detrimental to a coordinated country strategic planning process.
- The tracking studies did not shed much light on the costs to countries in applying for GF support. It was not possible to determine whether country Ministries of Health (MOH) would be better off if GF did not exist.
- There was no evidence that global health initiatives were trying to promote a co-ordinated approach to the financing, planning and monitoring of HIV/AIDS control at the country level.
- Lack of good partnership models was partly responsible for sub-optimal Country Coordinating Mechanism (CCM) arrangements.
- GFs learning as we go model led to unclear guidance and guidelines for CCMs.
- Perceptions by countries of slow disbursement of funds reflected a crisis of expectations rather than actual Fund performance.
- The functions of CCMs continued to be unclear despite dissemination of guidelines from the GF in mid 2003.
- The report suggests Human resources are the key to the success of the GF and other GHIs. If retention levels are not improved, morale and motivation raised, funds could be mis-used and wasted.
The report ends with a substantive section aimed at policymakers, suggesting ways to help countries incorporate and harmonise the range of recently launched global health initiatives (GHIs), and to ensure best use of new sources of funds for strengthening health systems.
- Balance the need to establish clear systems and ensure country-level buy-in with the need to move quickly, and learn and apply lessons to improve new systems.
- Provide a Technical Assistant to assist countries with their grant applications
- Implement a bottom-up approach, where comprehensive country systems analyses are a prerequisite to obtaining major new global funding.
- Strengthen lines of communication between the GF Secretariat and recipient countries.
Donor co-ordination and harmonisation need to be both top-down and bottom-up, that is driven from the global and country levels.
- National AIDS councils need support.
Country level donors could do more to support government and civil society to forge partnerships, through resourcing and building capacity on both sides for these new roles.
- A lack of coherence at the global level was evident in the contradictory policy pressures put on aid-recipient countries.