Q&A on the progress of the Fund, July 2002

• Are you satisfied with the pace at which the Fund conducts its programme? 
• Were all 322 proposals reviewed by the Technical Review Panel (TRP)?
• How were the first round proposals approved?
• Why didn’t the Fund approve more proposals?
• Did the Fund encourage applicant countries to scale back the size of their funding applications?
• Why wasn’t the proposal from (country X) approved?
• Has the South African national government blocked the Global Fund from funding the proposal submitted by KwaZulu Natal?
• How long will it take to transfer money to those awarded grants?
• Is the Fund’s “fast track” process really that fast? 
• What has been improved upon in the new proposal guidelines?
• What is the Technical Review Panel?
• How was the Technical Review Panel selected?
• During the review, how can 17 TRP members realistically do justice to 150 proposals from so many different countries?
• What criteria were used to review proposals?
• How much new money is needed to fight AIDS, TB and malaria?
• How much of new money raised to fight AIDS, TB and malaria should go to the Fund?
• What percentage of the Fund’s resources will go to Africa?
• Will the Fund give greater support to prevention or to treatment?
• What percentage of the Fund’s resources will go to HIV AIDS?
• How much money has the Fund approved for antiretrovirals, and how many people will receive ongoing antiretroviral treatment as a result?
• Why is the Fund not giving more money to antiretrovirals?
• How will the Fund and its recipients procure drugs, such as patented antiretrovirals?
• How will you ensure that money will be well spent?
• What is to prevent countries from renegotiating already existing loans with the International Financial Institutions in light of their award with the Fund?
• Will proposals submitted to the Fund be posted to its website?
• Why were so many proposals from NGOs rejected?
• Some NGOs claim they have been blocked by their governments from applying for money from the Fund. Has this been the case?
• How can the Fund ensure that effective NGOs are actually around the table, and continue participating after an award is granted?
• How much money does the Fund have in its account?
• How will the Fund convince donors to make significant new contributions?

   

  Communications

  Are you satisfied with the pace at which the Fund conducts its programme? 

  The Fund is moving very quickly.  In a matter of months, the Fund has moved from a concept on paper to real entity that has processed and reviewed hundreds of country proposals, approving proposals requesting a total of US$ 1.6 billion and immediately committing to

  US$ 616 million of disbursement for the first two years of these grants.  As a result of this lightening pace, it has been challenging for the small staff of the Fund to manage the global scale of its work.

  A transition team of temporary staff has been brought together from different organizations, governments and the private sector.  The new Executive Director is just beginning his work this month, leaving his previous location and job only two months after being offered the position.  Other permanent staff members are currently and quickly being recruited.

  The Fund’s staff is small by design.  No one wants it to be a large bureaucracy. As procedures have become more established, both the Secretariat and the applicants understand better what is expected.  The permanent Secretariat will continue to be responsive to the needs of our partners and constituents.

  Awarding of Grant

  Were all 322 proposals reviewed by the Technical Review Panel (TRP)?

  A main purpose of the Fund is to fund proposals that are of the highest quality.  To accomplish this objective, a Technical Review Panel (TRP) has been established to recommend proposals to be funded by the Board, based on their quality and readiness for implementation. 

  The Technical Review Panel reviewed all proposals that met the basic eligibility criteria as set out in the proposal guidelines.  Many of the proposals submitted did not meet basic eligibility criteria and were therefore not reviewed by the Technical Review Panel.  Most of the ineligible proposals fell into one of two categories.

  • Some proposals were missing budgets or other required elements.  All of these applicants were contacted immediately, but some did not respond.
  • Some proposals were submitted by NGOs that did not provide adequate justification for bypassing the country-level planning and coordination process.

  The Board is committed to improving and streamlining the application process and helping potential grantees to submit high-quality proposals.  We hope that this will help to increase the percentage of proposals that meet the basic criteria in the future.

  How were the first round proposals approved? 

  The Technical Review Panel (TRP) did not include in its deliberations the amount of money available to the Fund.  Its recommendations to the Board were based on the stated goal of supporting the highest-impact proposals in countries with greatest need and vulnerability.  Proposals that were not approved in the first round were asked to resubmit with the expectation that money will continue to be available to support well designed programs which are ready to be implemented.

  Nonetheless, it is important to recognize that if all proposals received had been eligible and of the highest quality, the Fund would not have had sufficient resources to commit to funding them all.  The 322 proposals received by the Fund asked for a total of approximately US$ 5 billion over five years, but pledges to the Fund currently stand at US$ 2.1 billion. This highlights the urgent need for the Fund to mobilize additional resources.

  

  Why didn’t the Fund approve more proposals?

  Of those proposals reviewed by the Technical Review Panel, all that were judged immediately ready for implementation were approved by the Board. The others will need to be revised and re-submitted in the second round

  The 322 proposals received by the Fund asked for a total of approximately $5 billion over the next five years, but pledges to the Fund currently stand at $2.1 billion.  The TRP did not include in its deliberations the amount of money available to the Fund. Nonetheless, it is important to recognize that if all proposals received were eligible and of the highest quality, the Fund would not have had sufficient resources to fund them all.  But this was not the case in the first round.

  The Fund has just issued a second call for proposals.  The Fund anticipates receiving even more proposals in the second round, because many applicants from the first round will re-apply, and there will also be new applicants.  This underscores the importance of mobilizing additional contributions to the Fund, so that it will be able to support more proposals in the future.

  Did the Fund encourage applicant countries to scale back the size of their funding applications?

  No. The proposal guidelines did not place a ceiling on the amount of funding that could be requested, and the Fund did not encourage applicants to scale back the size of their proposals.

  It should be noted, however, that the Fund is not intended to provide all the money necessary to address AIDS, tuberculosis and malaria.  The Fund supplements, but does not replace, existing national, bilateral and multilateral donor programs.  Therefore, the guidelines do require applicants to identify current resources available from other sources, and to clearly demonstrate how additional resources from the Fund would achieve results.

  Why wasn’t the proposal from (country X) approved?

  All applicants have been provided with comments regarding their proposals whether or not they were immediately recommended for funding.  The Board has decided that comments on specific proposals will not be made public given relevant issues of privacy and ownership.  Applicants can be contacted directly for details on specific proposals. 

  The proposals were consistently judged based on needs of targeted populations, potential for impact and the encouragement and application of effective partnerships.  All proposals were reviewed according to the established criteria.  The Fund encourages applicants whose proposals were not immediately approved to resubmit their proposals or to submit new ones that are in line with accepted criteria.

  Has the South African national government blocked the Fund from funding the proposal submitted by KwaZulu Natal?

  The Fund hopes to quickly disburse resources to all proposals approved in the first round, based on a country-led and nationally coordinated process.  In some cases, clarifications have been requested of proposal applicants before disbursement can proceed. 

  The Board of the Fund decided that sub-national proposals are eligible for funding, provided they receive endorsement of Country Coordinating Mechanisms (CCMs), to ensure a harmonized and synergistic national response.  The Provincial Coordinating Mechanism from KwaZulu Natal, therefore, has been asked to coordinate its proposal with that of the CCM. 

  The Fund looks forward to an outcome that allows both proposals to be fully funded, to maximize the response to the HIV AIDS in South Africa, the country with the most number of people living with HIV AIDS in the world.  Formal correspondence from the applicants indicates that their discussions are proceeding in a positive direction, and the Fund expects that an optimal arrangement will soon be reached by these partners. 

  How long will it take to transfer money to those awarded grants?

  The Fund intends to move expeditiously, while ensuring there are effective accounting systems in place for managing money within countries. The Fund intends to be a hands-off financial mechanism with quick response and disbursements.  At the same time, contributors expect and deserve a high level of accountability.  This requires that innovative fiduciary mechanisms be established to reach these two goals.  The development of these mechanisms will extend the time required for disbursement in the first round, but this time will be well spent as these mechanisms will accelerate the ongoing flow of financial resources to target populations and patients after the grant agreement is signed.

  Some factors are out of the Fund’s immediate control.  For example, each CCM is required to propose one or more Principal Recipients to serve as the legal entity which receives and manages money from the Global Fund.  Sound fiduciary arrangements must also be in place to ensure, for example, that funds are properly used and reach the intended beneficiaries.

  Based on a series of criteria for diversity of countries and proposals, and in consonance with staff available both at the Secretariat and with partners, applicants will be divided in “waves” that will be dealt with sequentially.  The result of this process in each recipient country will be a negotiation culminating in Grant Agreement with a disbursement plan.  Applicants will be informed through a direct communication about when to expect this process to move forward.  Simultaneously, they will be encouraged to advance their preparations so negotiations can proceed as expeditiously as possible.

  

  Is the Fund�s “fast track” process really that fast? 

  To date, the Fund has been exceptionally rapid in terms of screening, reviewing and approving proposals. Indeed, the first round of approvals occurred barely three months after the initial Call for Proposals

  Going forward, the Fund staff is working around the clock to ensure rapid disbursement to all successful applicants.  The pace of this disbursement will be affected by two factors.  First, speed must be balanced with the need for sound fiduciary systems and local ownership of fund management.  Second, the Fund is a new mechanism that hopes to apply innovative processes that do not replicate those of existing aid programs.  As a result, disbursement will require more time in the first round than in subsequent rounds.

  The result of this investment for first round applicants will be efficient ongoing flows of funds and local empowerment.  In time, as the Fund’s mechanisms and processes are developed and tested, future grant recipients will receive initial disbursements ever more quickly.  And as the Fund matures, the entire process, from proposal submission to financial disbursement, will prove faster than comparative aid programs.

  What has been improved upon in the new proposal guidelines?

  The Fund and its partners have learned much during the first round of grant applications and will continue to make revisions to make the process more effective.

  The new guidelines require greater attention and clarity in specifying the results each program will achieve in reducing infections, disease burden and deaths, and strengthening health systems. The new guidelines place greater emphasis on documenting financial expenditures and how they relate to the outputs they will achieve. The descriptive and analytical aspects of the CCM are also more detailed.

  In an effort to expedite the process during the first round of grants, countries had only a month to prepare proposals. The time for preparing proposals in the second round has now been extended to three months.

  Technical Review Panel (TRP)

  What is the Technical Review Panel?

  The TRP has been established to review, evaluate and recommend proposals to the Board of the Fund. In reviewing proposals, the TRP seeks evidence of technical best practice and immediate readiness of applicants to implement planned programs; members also take into consideration the specific country context and the need and vulnerability of the targeted populations.

  The TRP is comprised of 6 HIV AIDS experts, 3 TB experts and 3 malaria experts from developed as well as developing countries. In addition, there are 5 cross-cutting experts who have deep knowledge of systemic health and development issues.

  The first TRP has been selected for the first two rounds of proposals. As this is still a learning process, and in an effort to continuously improve the Fund�s ways of working, the whole TRP process – from selection to recommendation – will be reviewed.

  How was the Technical Review Panel selected?

  The TRP was selected in March 2002.  600 applications were received from around the world. A screening process based on candidates’ technical knowledge and experience in or with developing countries narrowed the pool to 100.  A Working Group of the Fund’s Board then selected 17 TRP members as well as their alternates.  The selection process sought gender and geographical balance to ensure that the TRP could draw on relevant and necessary perspectives on proposed programs.  The TRP members chose their own Chair and Vice-Chair: Michel Kazatchkine from France is the TRP Chair and Alex Coutinho, from Uganda, is the Vice-Chair.

  During the review, how can 17 TRP members realistically do justice to 150 proposals from so many different countries? 

  TRP experts were chosen based on their technical expertise as well as their applied knowledge and experience from developing countries.  In fact, more than 50% of the TRP’s members are from developing countries.  During the two-week review period during which the TRP met, its members spent long days and nights reviewing and discussing the merits of each proposal.  Each proposal received the same amount of attention and scrutiny from multiple TRP members, and the ultimate recommendation of the TRP on each proposal was the product of consensus.  In addition, members benefited from the support of WHO and UNAIDS experts to provide factual background information on countries.  

  What criteria were used to review proposals? 

  Four key dimensions were looked at when evaluating proposals (1): the soundness and additionality of the proposed program(s); (2) absorption capacity and program management; (3) the potential for sustainability; and (4) the monitoring and evaluation approach. These were, of course, looked at in light of the particular country contexts.

  

  Use and Distribution of Funds

  How much new money is needed to fight AIDS, TB and malaria?

  Billions of new dollars are needed – and needed quickly – if the world is to mount and to sustain an appropriate response to HIV AIDS, tuberculosis and malaria.  No figures can do justice to the magnitude of the need and to its urgency in terms of human life. 

  A number of estimates do exist, all of which credibly assert the massive need, the large portion of that need which must be financed by international sources, and the important role of the Fund as a new vehicle for resource mobilization and disbursement.  Most recently, the Commission on Macroeconomics and Health estimated that the annual funding need for HIV AIDS, tuberculosis and malaria will be US$ 17 billion in 2007, rising to 27 billion by 2015. 

  No number, though, is the “right” answer.  Estimates often underestimate the need.  Expansion of the diseases, often beyond expectations, will push the numbers up.  Fully accounting for the expansion of local health systems pushes the numbers up.  And being more ambitious about goals and targets pushes the numbers up.  So the best answer remains: the world needs much, much more money to fight these killers, and it needs it now.  

  How much of new money raised to fight AIDS, TB and malaria should go to the Fund?

  The Fund is a financial mechanism that complements other donors, including bilateral programs, multilateral loans, foundation grants, and private sector initiatives.  Coordination among these different parties is essential, but none has specific portions of the world’s need for public health financing assigned.

  The Fund is in the process of further developing its strategy and articulating resource mobilization targets.  For now, it will continue to commit to funding based on the frequently-stated commitment of its donors to provide new resources as high-quality proposals and programs continue to be developed and move forward.

  What percentage of the Fund’s resources will go to Africa? 

  The Fund does not set quotas on what portion of its funds will go to particular diseases, geographies or interventions.  Its awards are based on the needs of developing countries and the “implementation-readiness” of the proposals it receives.  At the same time, the Fund aspires to distribute its resources in a manner consistent with international best practice. 

  Africa is the current epicenter of the HIV AIDS and malaria pandemics, and a large share of resources must be mobilized for African countries.  60% of the HIV AIDS funds approved in the first proposal round by the Fund will be disbursed to 13 countries in Africa.  The Fund will approve proposals from additional African countries in the rounds to come, as it continues to distribute substantial resources to the entire continent. 

  Will the Fund give greater support to prevention or to treatment?

  The grants announced underscore the Fund’s strong commitment to a comprehensive approach to fighting HIV AIDS, TB and malaria that balances prevention and treatment.  Most of the approved grants include both prevention and treatment components, and many specifically include funding to purchase antiretrovirals for ongoing treatment for HIV.

  What percentage of the Fund’s resources will go to HIV AIDS? 

  The Fund does not set quotas on what portion of its funds will go to particular diseases, geographies or interventions.  Its awards are based on the needs of developing countries and the “implementation-readiness” of the proposals received.  At the same time, the Fund aspires to distribute its resources in a manner consistent with international best practices.

  There is a clear and urgent need for substantial new resources to fight HIV AIDS, and the first round of proposal approvals by the Fund reflects this need.  The budgets of the proposals approved amount to over US$ 1.6 billion over five years, of which US$ 616 million has been immediately committed for the first two years.  Nearly 70% of these resources are for HIV AIDS programs, which will be distributed across 28 countries (of the 40 with approved Fund proposals). 

  How much money has the Fund approved for antiretrovirals, and how many people will receive ongoing antiretroviral treatment as a result?

  Of the 28 countries with approved HIV AIDS proposals from the first round, 20 – over 70% – include money for highly active antiretroviral therapy (HAART).  In addition, 45% of the funds approved in the first round are for products and commodities, including essential medicines such as antiretrovirals.

  The first round proposal form did not request specific data from applicants on how much money would be expended on antiretrovirals nor how many people would be placed on antiretroviral treatments.  However, the following illustrative examples demonstrate the substantial impact the Fund will have on accelerating global access to treatment for people living with HIV AIDS:

  • In Malawi, resources from the Fund will expand current antiretroviral treatment from 1,000 to 40,000 persons over the next five years
  • Over this same period, Thailand will use Fund grants to expand its antiretroviral treatment from 3,000 to 70,000
  • Partners in Haiti will apply Global Fund finances to expand treatment in one region from just over 100 people to 100% of the patients admitted for clinical care and meet treatment guidelines, close to 4,000 by 2006 

   

  Though the Fund has made a major contribution to expanding access to treatment, it remains out of reach to hundreds of thousands of people living with HIV AIDS (PLWHA).  For treatment to be an integral component of national responses to HIV AIDS, that gap must be narrowed.  The Fund expects that its contributions to this effort will be substantial, and it plans on raising the resources necessary for continuing to support comprehensive responses to HIV AIDS including treatment.

  

  Why is the Fund not giving more money to antiretrovirals?

  The Fund has already approved significant funds for antiretrovirals, for both HAART and the prevention of mother to child transmission (MTCT) of HIV.  The Fund does not set quotas on the funds it will distribute to particular interventions, nor does it instruct applicants on what they should request. 

  The Fund encourages a country-led process to create proposals that develop and expand balanced responses to HIV AIDS, tuberculosis and malaria.  A balanced overall approach to HIV AIDS must include funds for prevention, treatment, care and support.  The funding of that approach will come from a variety of sources, and the Fund will endeavor to “bridge the gap” to ensure that the overall distribution of financial support is comprehensive.  The Fund’s commitment to the use of antiretrovirals is reflected in the number of approved country proposals including HAART programs and the estimates of the number of PLWHA who will receive antiretrovirals as a result.

  Additional funds for antiretrovirals will be approved in subsequent rounds as high-impact proposals are received by the Fund, proposals which include resources for antiretrovirals as a critical component of a balanced response.

  How will the Fund and its recipients procure drugs, such as patented antiretrovirals? 

  The Fund is a financial mechanism that seeks to mobilize and to disburse resources directly to countries.  As such, it will not conduct procurement directly.

  The Fund applauds efforts to make quality drugs and products available at the lowest possible prices.  The Fund encourages and will require its recipients to conduct procurement in a manner that ensures the safe and effective use of essential medicines.  It will monitor the performance of grantees to ensure that the quality of drugs is assured, that access to such drugs is increased so that they are available to poor and marginalized populations, and that the procurement of drugs is conducted in a manner consistent with international law and agreements. 

  The Fund has not set any policies or restrictions on procurement.  The Board has requested that a set of international procurement experts advise the Fund on what guidelines it should use to further the goals above.  The Board of the Fund will consider these issues in the months ahead.

  Monitoring and Accountability

  How will you ensure that money will be well spent?

  The Fund will work closely with its grantees to monitor programme implementation, financial management and health outcomes.  The Board has discussed in detail ways to ensure that good accounting systems are in place for spending our funds.  In fact, the proposal process itself, by being selective, promotes the quality of projects and guarantees that money will be well spent.

  What is to prevent countries from renegotiating already existing loans with the International Financial Institutions in light of their award with the Fund?

  This issue is addressed in the initial proposal guidelines and is more specifically stated in the new guidelines.  The Fund does not intend to replace any existing sources of resources but add to them.  Proposals are required to show how they supplement existing resources, not replace them.  Additionality is one of the criteria for selection. Before signing a grant agreement, the Fund will review this topic with the CCM and the PR(s)

  Furthermore, one of the issues being followed through the proposed M&E mechanisms is precisely whether other streams of resources are diverted as a result of awards.  Naturally, it is reasonable to assume that countries may prefer to access a grant mechanism like the Fund before they request loan mechanisms to complete the funding of their overall disease response.  Nonetheless, the Fund will do its utmost to ensure its resources do not replace already existing sources and, in fact, encourage new resources to the fight against AIDS, tuberculosis, malaria and other diseases and health burdens of poverty

  Will proposals submitted to the Fund be posted to its website?

  The Fund has not requested from its applicants permission to publicly post or distribute their proposals.  To respect the rights of applicants, the Fund will not unilaterally choose to post proposals to its website.

  The Fund is committed to transparency and expects to provide information to the public on the use of its resources.  The second round proposal form has been revised to include a variety of “executive summary” data that will be used to more broadly describe proposals in the future.

  The Fund also encourages transparency on the part of its applicants and recipients.  While it does not require public posting of proposals, it encourages such efforts by applicants themselves.  The Fund also makes available on its website contact information for Country Coordinating Mechanisms (CCM), to support their direct local engagement with interested parties.  

  NGO Participation

  Why were so many proposals from NGOs rejected? 

  The Fund is strongly committed to supporting inclusive and effective partnerships.  The Fund announced when the first Call for Proposals was circulated that it would give priority to proposals developed by country-level partnerships of governments, NGOs, faith-based organizations, other civil society actors, multilateral and bilateral agencies, and the private sector.  These partnerships are known as Country Coordination Mechanisms (CCMs).

  Some NGOs claim they have been blocked by their governments from applying for money from the Fund.  Has this been the case?

  We know this has been the case in some countries.  Some governments are slow to change and to include new partners at the table, and we will not be able to change these old practices overnight.  In other countries, however, the Country Coordination Mechanism has truly accelerated the cooperation between public sector, private sector and civil society during the first proposal round.   The Country Coordination Mechanism (CCM) has been established precisely to ensure that NGOs, faith based organizations and the private sector are around the decision-making table.  Governments must change or they will increasingly find themselves ineligible for Fund money.

  How can the Fund ensure that effective NGOs are actually around the table, and continue participating after an award is granted?

  The Secretariat ensures that civil society is represented in all CCMs.  Obviously this representation is not identical in all places, as different societies have different participants.  For example, faith based organizations are more relevant in some societies than in others.  .  The Secretariat did not process some proposals in the first round because signatures were missing, or clarifications regarding the nature of civil society participants were not received.  Given the time pressure of that round it was not possible to enter into full reviews of those proposals that were complete, so it is possible that certain cases of inappropriate participation may have occurred.   

  Lastly, even if civil society seems well represented in the design process, it also has a role during implementation.  In other words, even if civil society seems well represented in the design process, if they do not receive part of the grant without a reasonable explanation, the Fund will not consider proposals that are not inclusive. Also, should the composition be significantly altered before completion of the grant agreement or after implementation starts, the Fund will want to clarify the nature of the change before starting or continuing disbursements. 

  The Fund intends to have a much more stringent approach to this topic in the second round.  Clear roles and responsibilities expected from CCMs are spelled out in the new guidelines, including active NGO engagement... In addition, the Fund is establishing independent agents in each country who will keep an eye, among other things, on whether or not the most important stakeholders are actually involved in the CCM process.  The Fund will monitor evolutions of the CCMs with the assistance of its Local Fund Agent, whose main duty will be to help in assessing arrangements for implementation and endorse requests for disbursements. 

  Resource Mobilization 

  How much money does the Fund have in its account?

  US$ 2.1 billion has been pledged to the Fund since the United Nations Secretary General Kofi Annan called for its existence in 2001.  Since the Fund was formally established in 2002, about US$ 1.2 billion of that total sum has been officially confirmed.  Approximately US$ 300 million has been received into the trust fund account being maintained by the Fund’s Trustee, the World Bank.

  How will the Fund convince donors to make significant new contributions?

  The existing donors of the Fund have committed publicly to honoring their existing pledges and to mobilizing additional resources as proposals in the pipeline move quickly towards implementation readiness and TRP recommendation.  The Board, Secretariat and TRP of the Fund expect that these commitments will be realized.

  In addition, the Secretariat is developing a robust resource mobilization plan to pursue new funds and new donors.  The Fund recognizes that it must demonstrate its upfront and sustained success to potential donors to raise resources.  Initially, the Fund must prove that it is operational.  It will take a step further when the Secretariat makes the first disbursements to countries.  Continuing to receive good quality and improved proposals will also be an important consideration.  Most important in the long term, the Fund must prove that the money it disburses is spent effectively and translates to demonstrated results in countries.