In his fourth annual report to the Global Fund Board since taking office in early 2019, Peter Sands delivered a well-articulated and specific speech on the challenges facing the past six months. He organized his actions according to three main priorities: an assessment of the progress towards the 2020 priorities announced one year ago; an overview of the response to COVID-19 and an early consideration of the priorities for 2021 and beyond.
Assessment of progress towards the 2020 priorities announced a year ago
Peter Sands divided this assessment into six categories.
Figure 1: Six categories of progress assessment
Actively support countries to develop impact grants for the next three-year period
According to Peter Sands, most countries are on track to sign high-quality awards ready for implementation by the start of the next cycle. Approximately $ 11.4 billion in grant funding will be reviewed by the end of 2020 and recommended by the Technical Review Panel (TRP), which is nearly 90 percent of the initial amount allocated, compared to $ 9 billion and 88 percent at the same point in the last cycle. The top priority for most of the secretariat is the finalization of the award ceremony, the award ceremony and the signing of awards: 171 awards representing $ 9.3 billion are in the second half of the year for approval registered by the Awarding Committee.
However, given delays with the submission of TRP, ongoing logistical constraints and acute pressure on capacity in the country, the peak of GAC registrations slipped from late October to late November. In this context, it seems inevitable that interim arrangements will have to be made for a short period in several countries while the new awards are finalized.
There are different options to offer such flexibility, which will be used depending on the circumstances in specific countries. The secretariat will only start grant extensions where absolutely necessary (for example when very long delays are expected), as the heavy procedures associated with extending the grant will only aggravate the workload for the main recipients and the secretariat.
Figure 2: Current versus historical registrations for grant approval committee
Source: The Global Fund, report by the executive director; Grant Operating System (ACE), from 23 October.
In the context of the challenging COVID-19 environment, Peter Sands emphasized that award quality is a source of concern. Although 89 per cent of the allocations in Windows 1 and 2 were ‘good’ or ‘very good’ by the TRP, both technical partners and the TRP noted that the quality of funding submissions was affected by the pandemic. Most of the shortcomings in the funding submissions highlighted by the TRP reflect known weaknesses (e.g. extent and robustness of HIV prevention and community system investments, quality of data, integration of services or limited focus on human rights and gender), rather than new. issues.
The Executive Director acknowledged that the extent of the disruption of Country Coordination Mechanisms (CCMs) and the difficulties in providing technical assistance had limited some of the quality of submission quality that the Secretariat would like to see in the next cycle. Some of the issues raised by the TRP on individual grants are addressed in the current award cycle.
Of the $ 915 million catalytic funding for the new cycle, including corresponding funds, multilateral funds and strategic initiatives, we expect approximately $ 400 million to be offered for Council approval this year following the GAC’s recommendation for integration into enable awards starting in January 2021.
Promote the impact of current grants in their final stages
According to Peter Sands, the Global Fund partnership continued to have a huge impact in 2019, helping to save six million lives, 20 percent more than in 2018, and take the cumulative total to 38 million. This is despite the fact that the Global Fund Partnership has not deviated from its 2030 targets for all three diseases. Continued progress in reducing HIV deaths is unmatched by equal progress in reducing new infections, which has risen to 1.7 million in 2019 since 2018.
The Global Fund Partnership has continued to make progress in detecting missing people with tuberculosis (TB) and to reduce the treatment gap for those with multidrug-resistant tuberculosis (MDR-TB). However, with about three million undiagnosed and untreated people with TB, and about 1.5 million deaths annually, the results underscore that much greater effort is needed. In addition, the effects of COVID-19 on TB patients were dramatic: resources were diverted, TB patients were stigmatized, and the ongoing efforts to identify missing cases were partially lost. The results for malaria treatment show that deaths are still declining, albeit at a slower rate.
However, there is little progress in reducing the number of cases, and there are worrying increases in some of the countries with the highest burdens. In addition, COVID-19 hindered the achievement of these ambitions and disrupted the prevention and treatment of all three diseases. About 70 percent of the service delivery programs for all three diseases experienced interruptions.
Instead of intensifying the fight against HIV, TB and malaria, many of the partnerships had to try to mitigate the damage and protect profits. Early in the crisis, modeling by the World Health Organization (WHO), the United Nations Joint Program on HIV / Aids (UNAIDS) and the Stop TB Partnership clearly showed what was at stake. Without urgent action, Peter Sands regrets that all the gains made over the past decade could be lost.
Figure 3: COVID-19-induced level of service, product, and country system outages
Source: report of the executive director after the 44th board meeting
Planning and consulting for the next Global Fund strategy
As a result of COVID-19, the original plans for the Global Fund Strategy had to be adapted, including a direct withdrawal from the Board, Personal Strategy Committee (SC) and three local partnership forums. Under the leadership of the SC and the Council’s leadership, the process was held online, including open consultation, constituencies and partner dialogues, council and SC discussions, and eventually virtual partnership forums.
Figure 4: Timeline of strategy development
Most constituencies praised the secretariat’s efforts to stay on track with the original chronogram. A proposal to compile a working document that is available to councilors before the next Council retreats. Convergences (such as the importance of a person-centered approach, priority investments for the most difficult to reach population and resistance) and deviations will be communicated, as well as how this strategy will be implemented to deliver the expected impact, and what tools would be designed to correct these results to capture. This will help focus the discussion: the compromises to be made between short-term impact and longer-term sustainability of profits, the core mandate to eliminate the three diseases and the broader investment in health systems.
Strengthen capabilities and impact on key strategic priorities and improve efficiency and effectiveness
Some investments were made at secretariat level in line with the priorities identified a year ago. Some departments have undergone transformation (new appointments in the partnership for technical assistance and HIV specialists, as well as a new head of the department of health financing). Some initiatives such as the CCM Evolution whose implementation has been expanded (including the Code of Conduct) or the Acceleration of the Movement in West and Central Africa that have helped to identify and block barriers to absorption and impact.
The report also highlights some progress in risk management and governance that has enabled the Office of the Inspector General (OIG) to conclude that by March 2020, the Secretariat has reached an “embedded” status. the establishment of a process model for the activities of the Secretariat, with the definition of 52 key processes and corresponding performance measurements, which will provide a platform for continuous improvement.
However, some projects had to be postponed or reduced due to travel constraints and the need to focus scarce resources on immediate priorities, for example: CCM Evolution, including the implementation of the Code of Conduct; the introduction of updated codes of conduct for suppliers and recipients, numerous IT projects; and the development of the new monitoring and evaluation (M&E) framework. Peter Sands praised the high level of commitment and effort put in by staff, noting that the most recent survey conducted internally shows a high risk of burnout (55 percent of respondents believe that there are not enough staff members in their teams were around the workload) as well as feelings of discrimination (51 percent feel that everyone is treated fairly, and another 21 percent feel that they were the victims of some form of discrimination). He also acknowledged the progress that needs to be made on burning issues such as diversity and inclusion among the Secretariat, an issue raised by the Ombudsman after his internal discussions on the subject.
Main points of discussion during the Board meeting
All participants lamented the significant and devastating impact of COVID-19 on the fight against the pandemics as well as the international donor community, as the developed countries were largely affected by the pandemic and that they would benefit the investments in favor of protection. their own population with the vaccine. Deviations in activities need to be assessed, and priorities need to be identified so that those who have lost to follow up, who are often at greatest risk, are reached again.
KPIs were not on track before COVID-19 began, but it is clear that the pandemic has caused a major disruption in achieving results, and that some measures need to be taken to reflect on how the 2030 targets are met. to achieve sustainable development. According to some constituencies, an immediate hold on all transition plans drawn up by the Secretariat is justified for countries that have passed through COVID-19 (because those countries are going to have a recession after COVID-19).
The Council also praised the Secretariat’s high level of reactivity and flexibility with regard to COVID-19, the reprogramming and implementation of C19RM, which showed a positive adaptation to the external international crisis. Some constituencies have expressed concern about the additional workload associated with COVID-19, calling for a strong focus on the Global Fund’s core mission, namely to provide services to populations affected by HIV, TB and malaria.