The Global Fund’s paradigm of oversight, monitoring, and results in Mozambique

Abstract

BackgroundThe Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients’ misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique.MethodsWe conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing.ResultsAnalysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund’s structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement.ConclusionsTo date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique’s in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.Electronic supplementary materialThe online version of this article (10.1186/s12992-017-0308-7) contains supplementary material, which is available to authorized users.

Partnership and Participation—A Social Network Analysis of the 2017 Global Fund Application Process in the Democratic Republic of the Congo and Uganda

“…The Global Fund's ability to reform is recognized as a unique strength of the organization [44], and recent reforms to differentiate the application process deserve further exploration to ensure they are delivering on intended goals of streamlining and efficiency. Relative to Uganda (>85%), many fewer respondents in the DRC perceived partnership to have contributed to approved grants more responsive to country needs (42%), to have supported more timely execution of planned activities (58%), or to have leveraged an organization's competitive advantages (44%).…”

Incorporating operational research in programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria in four sub-Saharan African countries.

“…Although e ciency on both programme implementation and use of resources was mentioned thoroughly across stakeholders and disease programmes, the donors, CCM or high-level government authorities did not articulate concrete demands in this regard. Some stakeholders mentioned that they "do not feel a strong pressure from Global Fund to optimize e ciency", a perception that has been previously described in other studies [24][25][26]. The status quo of the programmes funded by the Global Fund did not commonly include OR.…”

Incorporating operational research in programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria in four sub-Saharan African countries

“…Although e ciency on both programme implementation and use of resources was mentioned thoroughly across stakeholders and disease programmes, the donors, CCM or high-level government authorities did not articulate concrete demands in this regard. Some stakeholders mentioned that they "do not feel a strong pressure from Global Fund to optimize e ciency", a perception that has been previously described in other studies [21][22][23]. The status quo of the programmes funded by the Global Fund did not commonly include OR.…”