Working with the Ministry of Health to build systems for expanding TB diagnosis and treatment
Like other former Soviet Union countries, Armenia is facing a serious tuberculosis problem. Despite substantial efforts to enroll patients in treatment programs, access to diagnosis and treatment is limited in certain regions, and multidrug-resistant tuberculosis is of grave concern. The country, through the Ministry of Health as the Principal Recipient, had received one Global Fund grant and was hoping to be awarded a second grant to address the problem.
The Ministry identified issues relating to program implementation of the ongoing grant and conditions that had to be met to obtain the new grant. They then requested assistance from the Grant Management Solutions (GMS) Project. In 2009, a three-person team, one of whom was an IDEAS staff member, collaborated with the Ministry of Health’s Project Implementation Unit to design systems to improve management structures, define staffing patterns, and align the financial system to respond to both Global Fund and Government of Armenia requirements. These systems were then incorporated into a comprehensive operations manual. As a result of the assignment, the Ministry met the requirements and received additional funds.
Integrating monitoring and evaluation systems and improving data quality
After completing a five-year HIV-AIDS Global Fund grant, the Republic of Armenia received a three-year extension to continue its national response to the disease. Two new Principal Recipients (PRs) were selected — Mission East, a Danish non-governmental organization with substantial experience in Armenia, and a new Program Implementation Unit within the Ministry of Health.
Both of these organizations requested technical assistance in integrating and strengthening monitoring and evaluation (M&E) systems and improving data quality. The GMS Project selected an IDEAS staff member to lead and manage the assignment with three team members who had expertise in relevant areas. Under the IDEAS leader, the team worked with M&E staff from the two PRs and from the national AIDS control program to achieve the desired results:
- Self-assessments by the PRs and sub-recipients of their M&E systems and preparation of formal M&E system-strengthening plans;
- Development of a grant M&E Plan which integrated the performance frameworks and M&E systems of both PRs;
- Development of standardized data collection and reporting forms and procedures across all implementing organizations (PRs and sub-recipients);
- Introduction and adoption of the Routine Data Quality Assurance (RDQA) tool as an approach to addressing data quality issues identified by the Global Fund’s Local Fund Agent.
The M&E technical assistance provided by the GMS team enabled both PRs to meet the conditions imposed by the Global Fund, thereby ensuring continued funding for the national HIV-AIDS program. In addition, the team fostered a spirit of collaboration that resulted in new relationships among these organizations – relationships that have been maintained since the assignment ended..
Strengthening the Global Fund’s Principal Recipient
In order for Bhutan’s government to effectively implement its HIV/AIDS and TB grants, the Secretary of Health requested assistance from the Grant Management Solutions (GMS) Project in the spring of 2009. Unlike the malaria grants, which were running smoothly in Bhutan’s south central region, the HIV/AIDS and TB programs were having some difficulty working within the central government’s requirements and procedures.
GMS fielded a team of four consultants headed by an IDEAS staff member. To facilitate clear understanding of the Global Fund’s grant management requirements, the team carefully crafted and facilitated a three-day orientation for representatives of all the stakeholder organizations. By the end of the sessions, the participants had achieved a common understanding of the concepts and realities of performance-based contracting – the core of grant management.
The team built on workshop recommendations, as well as on Global Fund experience in other countries, to help clarify the roles and responsibilities of Principal Recipients; sub-recipients; ministries; and finance, program and project officers. The newly achieved common understanding of grants management also enabled the stakeholders to work in small teams towards common goals, rather than as individuals with varied agendas.
During two later visits, the GMS team and its counterparts agreed on many organizational approaches and activities, which were later implemented. The team also assisted the Ministry of Health to prepare Phase 2 proposals for HIV/AIDS and tuberculosis.
Rapid response to urgent closeout planning
The Bhutan Ministry of Health requested assistance to complete the required closeout plan for the Global Fund’s tuberculosis (TB) Round 4 grant before signing Phase 2 agreements for TB and HIV/AIDS. The deadline was imminent and the assignment urgent, and IDEAS responded quickly and effectively. The GMS Project engaged the IDEAS staff member who had headed the previous GMS team, as well as a financial expert. As leader of this new team, the IDEAS staff member brought together the local consultant and experts in TB, finance, and project management who had worked effectively together on the previous assignment with the Ministry.
Within two weeks, the team had finished their complex assignment – before the deadline. Due to their work, the Ministry fully met the Global Fund requirements, the Global Fund signed the TB and HIV/AIDS Phase 2 agreements, and both new programs began on schedule..
Building the capacity of a new Global Fund Principal Recipient
IDEAS served on a team which helped the National Center for Parasitology, Entomology, and Malaria Control (CNM) in a paradigm shift, from its significant experience as a sub-recipient of Global Fund support funds to its new role as a Principal Recipient. The team worked to strengthen CNM in several areas, with emphasis on building the capacity of the Finance Unit in financial and grant management. Over three country visits, the Grant Management Solutions-Principal Recipient (GMS-PR) team helped to:
- create a robust structure for the Finance Unit and delineate the roles of the senior finance staff
- develop Subsidiary Financial Guidelines
- develop and implement a chart of accounts and train unit staff in its use
- develop internal procedures for the unit
- strengthen CNM’s management of its sub-recipients.
Establishing a new monitoring and evaluation capability at the national level
When the National Tuberculosis Program in Fiji received its first Global Fund grant in November 2009, the Ministry of Health requested assistance from the Grant Management Solutions (GMS) Project to facilitate the development of a new monitoring and evaluation (M&E) system for the program, enabling it to meet Global Fund M&E requirements. Although IDEAS was not initially involved in this assignment, a staff member was subsequently asked to assume leadership of the M&E team for its third and final visit.
The team successfully completed two important activities which were already in progress: development of an M&E systems strengthening plan, and preparation of a new M&E Plan for the National TB Program. The Global Fund accepted these plans as meeting its M&E requirements, thereby ensuring continued funding for the program.
In addition, the IDEAS team leader provided introductory training on the Routine Data Quality Assurance (RDQA) tool, a methodology for routinely assessing data quality and developing system-strengthening responses to identified weaknesses.
Staffing and strengthening a Grant Management Unit
IDEAS was a member of the Grant Management Solutions-Principal Recipient (GMS-PR) team which assisted the Government of Fiji in meeting the conditions for the first ever Global Fund grant to Fiji–a grant designed to address the country’s serious tuberculosis problem. The team helped to facilitate the recruitment of staff for the Grant Management Unit (GMU) of the Ministry of Health and to strengthen the ability of the GMU to manage the grant.
Faced with challenges in the start-up phase, the team worked with the GMU to develop the Grant Implementation Manual and the Sub-Recipient Management Plan. The GMU has since used these documents to manage their grant and to assist sub-recipients and implementing units in revisiting, analyzing, and revising their work plans and budgets. With assistance from the team, the GMU adopted a strategy for communications within the unit and among its many stakeholders. And finally, the team helped the GMU to establish and maintain the systems that ensured the smooth flow of funds in support of all grant activities..
Hashemite Kingdom of Jordan
Restructuring a Global Fund Country Coordinating Mechanism
Jordan’s Country Coordinating Mechanism (CCM) for the Global Fund had been formed in 2002, at the time of the first grant proposal. In 2008, the Global Fund concluded that the CCM had to be restructured to separate the roles of the CCM and the Principal Recipient, the Ministry of Health. An IDEAS staff member served on the team that successfully completed this assignment.
The initial task was to engage the CCM members in clarifying their roles and responsibilities. In two later visits, the GMS team assisted the CCM action committee to prepare manuals for governance and secretariat operations, a structure and process for grant oversight, and a proposal to the Global Fund for funding to strengthen CCM’s oversight capacity.
Eight months after the workshop, the CCM had implemented the revised policies, and six months after that, the CCM signed an agreement with the Global Fund for staff to support the CCM’s operations, with an emphasis on its oversight functions..
Technical strengthening of a Global Fund sub-recipient
As part of a team of three international consultants and one local consultant, an IDEAS staff member provided technical assistance, through the Grant Management Solutions (GMS) Project, to the Honduran National Association of People Living with HIV/AIDS (ASONAPVSIDAH). The mandates of this NGO are to advocate for and support public policies while encouraging people living with HIV/AIDS (PLWA) to form support groups, and use these groups to improve their living conditions. They had received funds from the Global Fund as a sub-recipient but had encountered administrative and management issues which lowered their status and required temporary supervision from a higher level.
The assignment required review of the structure of the organization and its policies and processes; analysis of the staffing of the management unit; and examination of their administrative and financial procedures. The GMS team helped them to develop detailed operational manuals, restructure the board, and hire highly qualified staff in key positions. Through this assignment, the organization regained its status as a sub-recipient, able to function without the special close supervision that had been required..
Building the grant management capacity of a new Global Fund recipient
As a country whose strong economic performance had previously made it ineligible for support by the Global Fund, Mauritius submitted its first proposal to Round 8 for HIV/AIDS in 2008. The grant was approved and two Principal Recipients (PRs) were selected to implement the program: the National AIDS Secretariat (NAS) and the Mauritius Family Planning and Welfare Association (MFPWA).
As a first-time PR, MFPWA made a request to GMS for assistance in strengthening its grant management capacity. An IDEAS staff member served on the team of one local and three international consultants, which provided support to the MFPWA’s Project Management Unit (PMU) and helped orient the eleven sub-recipients to their new role.
The team worked with the PMU to establish a financial management and reporting system and assisted with the development of an operations manual and standard operating procedures. These products enabled the PMU to supervise and support its sub-recipients and meet Global Fund requirements..
Consolidating multiple Global Fund grants into a single funding stream
The Federal Democratic Republic of Nepal has one of the strongest national tuberculosis programs in South Asia, a distinction which was recognized by the Global Fund when Nepal’s National Strategy Application (NSA) grant was the only grant approved in the South East Asia and Western Pacific region in 2009.
To build on its strengths, the National TB Program requested assistance from the Grants Management Solutions (GMS) Project to assist in consolidating its existing Round 7 grant with the new NSA grant. GMS selected an IDEAS monitoring and evaluation (M&E) expert to lead an M&E technical support team.
IDEAS provided leadership and support to the M&E staff of the National TB Program as they completed the required grant consolidation:
- Revising and updating the M&E Performance Framework for the Round 7 TB grant and preparing the Performance Framework for the new NSA grant;
- Updating the M&E systems-strengthening plan to reflect the priorities of the NSA grant, as well as progress realized since the original plan was adopted;
- Updating the 2008 M&E Plan to reflect the expanded national TB program supported by the NSA grant.
Concurrently, the IDEAS staff member coordinated the work of the procurement and supply management team and the program and financial management team. The technical assistance for M&E made a major contribution to consolidation of the grants process and resulted in a single stream of funding for the national TB program..
Papua New Guinea
Assisting a Country Coordinating Mechanism to make structural reforms and build capacity to comply with Global Fund directives
An IDEAS staff member served on the Grant Management Solutions (GMS) technical support team for Papua New Guinea’s Country Coordinating Mechanism (CCM). The team oriented the CCM to its responsibilities under its Global Fund grant and helped to facilitate a stakeholders’ capacity-building workshop for relevant civil society organizations. The team also worked with the new CCM secretariat to clarify its functions and document its procedures, including the development of budget and operational manuals.
Strengthening the Principal Recipient for six Global Fund grants
In 2003, The Tropical Disease Foundation (TDF) was named by the Country Coordinating Mechanism (CCM) as Principal Recipient (PR) for the first Global Fund grant to the Philippines. By 2007, TDF was managing six of the eight Global Fund grants and in 2008, the organization was applying for two six-year continuation grants for TB and malaria, which represented a significant amount of funding.
As a non-profit NGO, TDF could operate more quickly than government agencies. Its track record for grant performance was very good overall and excellent in some cases. But the organization had grown rapidly – from 20 to 241 employees in four years – and needed a comprehensive management review and work plan to meet a Global Fund requirement for new contracts.
A four-person Grant Management Solutions (GMS) Project team, led by an IDEAS staff member, was invited to assist TDF in meeting some important challenges. The GMS team conducted three visits, during which TDF staff worked hard and cooperatively to address a series of challenges relating to staff functions and financial management. The GMS team and their financial and human resources counterparts completed a staffing analysis and clarified the assignments of TDF staff among the various contracts and sub-contracts. In collaboration with their counterparts, the team conducted a comprehensive management review, prepared a work plan, drew up an administrative budget, and improved the revenue reporting system in time to meet Global Fund requirements. The findings of the review also led to the restructuring and invigoration of the Board.
By the time of the six-month follow-up assessments, TDF had met all Global Fund conditions for continuing disbursement of the various grants.
Strengthening a first-time Global Fund Principal Recipient
In 2008, the Philippines Department of Health (DOH) requested assistance to improve implementation of the Round 6 HIV/AIDS grant. As a first-time Principal Recipient (PR), the DOH was having difficulty implementing the grant, though the specific causes were not clear. The hope was for quick improvements that would enable the Global Fund to concur with the government’s latest funding request.
The GMS project fielded a four-person assessment team, headed by an IDEAS staff member. During three visits, the team identified the key issues and proposed solutions that included the development of a project implementation manual, definition of staff roles and responsibilities and steps to improve the flow of funds. The DOH accepted and carried out these recommendations.