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HIV/AIDS: Straight Talk with Mark Eldon-Edington, Global Fund director of country programmes

WASHINGTON DC, 24 July 2012 (IRIN) - The Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria is changing the way it does business, and the way it disburses money. In 2010, after allegations of fraud among fund recipients in Mali, Mauritania and Zambia, the Global Fund put together an independent, high-level panel to review its financial controls and how grant money is spent. The Fund is now implementing the panel's recommendations.

IRIN/PlusNews sat down with Mark Eldon-Edington, the Fund's Director of Country Programmes, at the 19th International AIDS Conference, in Washington, to find out what the changes in the grant-making process will mean for beneficiaries.

QUESTION: Why reform grant management?

ANSWER: One [reason] is better predictability of funding for countries. We'll probably move away from a round-based system that comes every one or two years, to a series of funding windows.

We want to significantly increase the success rate of proposals. If you look at the success rates among HIV proposals in recent years, it's about 40 percent and that's unacceptable - that's a lot of wasted time.

It would be better to have a concept note approved and signed off before proposals were developed in detail. The process hasn't been worked out yet, but [if] proposals were approved as concept notes, that would allow us to weed out inappropriate interventions and cut costs, and it wouldn't be just us, but the technical partners such as RBM [the World Health Organization (WHO) Roll Back Malaria programme], the [WHO] Stop TB Partnership [and others].

I've been pushing hard for the concept of grant-ready proposals and disbursement-ready grants. We need to cut down the one-year negotiation time that happens after the [Global Fund] Board has approved proposals. I have a list of approved grants against which no disbursement has ever been made. Honestly, I don't think some will ever be made. Why? Because some of those grants had 58 different conditions when they were signed. You focus on signing a grant, but you don't focus on signing disbursement-ready grants.

Q: What changes have you made at your Geneva secretariat?

A: We've put about 75 percent of Global Fund staff resources towards grant management... we've eliminated a lot of positions that were not directly relevant to grant management. We've created three high-impact units, which [oversee] 20 focus countries that account for more than 70 percent of the global disease burden within the three diseases. Two teams deal with Africa and one [with] Asia. The idea behind this is that if we can move the needle in those 20 countries, than we can move the needle globally.

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We've also applied the country-team approach to grant management. It used to be that you'd have  someone from procurement, someone from legal... on teams. Those people used to sit on different floors and in different departments. We're trying to break down silos by forcing people to sit together. We haven't yet filled all the positions under the new structure. It's taken a while is because we're trying to raise the bar. We're being picky about the people we're choosing.

It's not hard to restructure - what takes time is changing the culture. The Global Fund has become very risk-averse in recent years. We're saying, 'let's roll out operation risk management frameworks, let's have good assessments of principle recipients, and let's mitigate risk where we can with development partners’.

But we also need to be clear about the risk we can expect. The greatest risk we face is… that we don't deliver on that mission because we're too risk-averse. Don't tell me we can't make disbursements, tell me how we can. It's about delivering on the Fund's mission. It will take several more months to drive that culture downwards.

Q: What will these changes mean for countries?

A: There will be an increased presence of portfolio fund managers and country teams on the ground. From the high-impact countries where we've done this, we're starting to hear some positive results. There's starting to be some engagement to identify issues - how do we get disbursements unlocked, and how do we get things moving. I won't pretend that this is happening in every country yet.

We've identified significant issues with the Local Fund Agents [LFAs] [hired to oversee grant performance]. I suspect it can't be easy being an LFA because they don't seem to be very loved.

We need to move away from a one-size-fits-all approach that has been quite prevalent in the last couple of years, which probably - and rightly - results in frustration on the part of the PRs [Principal Recipients]. I have resisted making quick changes to the LFA until it’s clear what our risk tolerance will be.

All of the LFA contracts are up for tender at the end of the year [2012], so that timing works well. If I had to guess, I'd say we'll continue to have LFAs because we won't be able to have enough country-team time in-country to compensate. I would like to see a minimum level of LFA work with Principle Recipients. Next year [2013], I'd expect the LFA budget go down, and for their work to be more strategic and more risk-based and more effective.

Q: What changes will the new funding model bring?

A: There's quite a bit of concern… about this. No decisions have been made, and the funding model is still under discussion… There are still a lot of opportunities for people to shape how the new funding model will look through consultations. I want to put to bed the idea that decisions have already been taken.

''If you look at the success rates among HIV proposals in recent years, it's about 40 percent and that's unacceptable - that's a lot of wasted time''
Q:
What will the changes mean for civil society involvement?

A: The Global Fund remains absolutely committed to civil society, and not solely for ideological reasons but for business reasons. If we are to deliver on our mission, we need to reach the people [that] governments can't or won't reach. Civil society is the way to reach those people… who are most at risk, like men who have sex with men and sex workers, but also those in remote areas.

We need civil society to be able to deliver on the Global Fund mission. We have a dual-track financing policy and we will continue… [funding both governments and civil society]. About 40 percent of our grants are implemented through civil society.

Q: Will middle-income countries be excluded in the future?

A: The Global Fund eligibility requirements have not changed and we will continue to fund MARP [most at risk populations]-related activities in those… countries. Obviously, we are focusing on lower- and lower-middle-income countries, and that will continue.

To quote US Secretary of State Hillary Clinton, 'We need to fight the virus where it is', and if it's MARPs in middle-income countries, I don't see that the funding model will change. It may sharpen the focus on activities, and they may be under more scrutiny, but I don't see us about to cut out a bunch of middle-income countries.

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Theme (s): Aid Policy, Care/Treatment - PlusNews, Governance, HIV/AIDS (PlusNews), Prevention - PlusNews,

[This report does not necessarily reflect the views of the United Nations]

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