The Global Fund to Fight AIDS, Tuberculosis and Malaria has released initial details on its new funding model, which will change the way countries apply for money. But as the Fund works to finalize the model before next year, civil society is criticizing the process for being untransparent and rushed.
The Global Fund board adopted guiding principles of the model at a mid-September board meeting in Geneva. Although the model’s finer aspects are still being developed, key elements include the allocation of funding to country groupings based on disease burden and ability to pay as well as largely foreseen changes to grant application procedures.
National strategic plans and national investment frameworks for the three diseases that demonstrate value for money will become increasingly important in the allocation of funds, according to the meeting’s decision points.
The Fund’s Strategy, Investment and Impact Committee (SIIC) is rushing to hammer out the model’s details and present them to the Global Fund secretariat in a paper by 15 October. According to board members on the SIIC, committee leadership will be engaging in multiple consultations in person and remotely for feedback until 10 October.
The Global Fund board is expected to make a final decision on the model at its November board meeting.
The new model arises after a high-level panel reviewed the Fund’s financial controls on how grant money is spent, following allegations of fraud among fund recipients in countries such as Mali, Mauritania and Zambia.
Among other changes, the new model will group countries by disease burden and World Bank income level, with resulting groups known as “bands”.
Although the Fund’s portfolio deals with three diseases, the Fund anticipates one set of country bands rather than a set of bands for each disease. The number and composite of country groups has yet to be determined.
Without a widely accepted measure of disease burden applicable across the three diseases, the Fund has decided that it will base funding allocations for each diseases on previously used levels for up to one year, until an alternate method of dividing the money can be devised, said Andrew Hurst, head of media relations for the Fund.
This has drawn protests from some groups, including those working to fight tuberculosis (TB), a disease that has traditionally received 16 percent of the Fund's resources; in the run-up to the Fund’s September meeting, advocates from these groups pushed hard to increase this allocation. The StopTB Partnership, for example, argued that if disease allocations were determined by mortality, TB programming would receive about 34 percent of all Global Fund monies.
“Concretely, these low funding levels would mean that the global TB funding gap of over US$2 billion per year for TB would widen, and that global scale-up of TB diagnosis and treatment will halt and potentially reverse,” said the StopTB Partnership in an statement released shortly before the Fund’s meeting in September.
It has since released a statement expressing hopes that a better method will be devised for determining funding allocations in the future.
“While we cannot be very happy with the decision to initially set funding levels for each disease according to historical allocations, it is important to note that this is a one-year temporary measure and that the level of allocation for TB is not set in stone,” said Lucica Ditiu, the partnership’s executive secretary, and Mario Raviglione, head of the World Health Organization’s Stop TB department, in a joint statement. “We understand, too, that this measure was proposed to allow the start of a discussion on a model that will make the Global Fund’s allocations more strategic.”
Grant system to become more flexible
The new model also cements the Fund’s move away from the ‘round’ system, in which calls for grant applications were issued periodically, and towards a more implementation-ready approach to grant provision.
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Under the new grant structure, the Fund will allow countries to apply throughout the year in line their national budgeting cycles. Concept notes will take on increasing importance in the system, a move welcomed by many civil society organizations such as the AIDS Rights Alliance of Southern Africa (ARASA).
“One key element of the new system will be for applicants to submit a concept note, shorter than previous applications, and then get early feedback from the [technical review panel of the] Global Fund, other donors and technical experts on how the proposal may need adjusting,” said the Fund in a statement. “That is expected to reduce waiting times and improve the overalls success rate of applications.”
With the changing availability of Global Fund resources, the panel will hold proposals that, while technically sound, cannot be funded at the time they are submitted due to insufficient resources. These will be re-reviewed when additional funding becomes available, although how these proposals will be prioritized remains unclear.
Civil Society asks Fund to ‘press the pause button’
As the Fund finalizes the model’s details, many African civil society organizations have expressed dissatisfaction with the speed and transparency of the process.
In late August, ARASA and the South Africa-based World AIDS Campaign launched the ‘Press the Pause Button’ campaign. Endorsed by almost 40 African NGOs, the campaign called for the Fund to develop a more robust and inclusive communication and consultation process around the model’s development.
According to ARASA Advocacy Officer Lynette Mabote, the bulk of African civil society remains largely clueless about the model’s selection and what it will mean for them as implementers.
“They don’t have a clue what this is and what this would mean,” said Rukia Cornelius, programme manager at the World AIDS Campaign. “Global Fund principle recipients are having heart palpitations because the old grant process was already so cumbersome and technical.”
The World AIDS Campaign and ARASA conducted a rapid consultation with almost 60 NGOs in Africa and found that, in the absence of communication from the Fund, the knowledge about the new model is almost non-existent.
“In two weeks, we consulted 56 organizations - and that was without any resources,” Cornelius told IRIN/PlusNews. “For an international financing mechanism like the Global Fund, that has resources, not to be able to do really quality work around consultations - that leaves much to be desired.”
Mabote agreed. “This was being discussed behind closed doors at the Global Fund. Civil society wasn’t privy to it,” Mabote told IRIN/PlusNews. “The Global Fund needs to explain how we got here, give us a timeline of events and explain how we got to this model.”