Recorded presentation

Ruairi Brugha, MB BCh MSc MD, Health Policy Unit, London School of Hygiene and Tropical Medicine, 140 Keppel St, London, United Kingdom, Kate Stillman, MPA, Partners for Health Reform plus, Abt Associates, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, 301-347-5148, kate_stillman@abtassoc.com, and Zillyham Rojas, PhD, MPS, BS, Central American Institute for Health, Apartado 2234, Managua, Nicaragua.

Issues: The processes developed by the Global Fund to Fight AIDS, TB and Malaria, to govern the design, and selection of projects, represent new approaches to development assistance. They are designed to expedite the transfer of resources and stimulate innovative approaches to program design and implementation. Description: This research examines: (a) how Global Fund support has affected the types of actors involved in policy development (b) the extent to which the Global Fund is supporting approaches that are aligned with the country’s existing policies and (c) the extent to which the planning, funding and monitoring processes for GFATM funds are aligned with existing processes in-country. The study involved in-depth interviews with stakeholders from the national and sub-national levels in six countries. Lessons Learned: Global Fund Country Coordinating Mechanisms (CCMs) have typically grown out of existing bodies like the National AIDS Commission. Despite Global Fund requirements that civil society representatives are represented on the CCM, private sector actors are often not well represented. Stakeholders at sub-national levels are also poorly represented. The perceived legitimacy of the CCM varies from country-to-country. The roles of different stakeholders during implementation are frequently unclear at the country level. In countries where large amounts of money are being disbursed, issues have arisen regarding how Global Fund grants fit into national expenditure plans. Recommendations: Many problems are due to the short time frame initially available for preparing proposals. Guidelines developed by the Global Fund on the role of different actors need better dissemination at the country level.

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