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Supporting commun action on AIDS in developing countries ity

Analysis of Technical Assistance to Civil Society Recipients of Global Fund Grants
January 2010

In collaboration with

A collaborating centre:

International HIV/AIDS Alliance is a compan limited by guaran and registered in Londonwith number2883774 Charity number1038860 VAT registration number677 940287 y tee . .

Who is the International HIV/AIDS Alliance?
Established in 1993, the International HIV/AIDS Alliance (the Alliance) is a global partnership of nationallybased organisations working to support community action on AIDS in developing countries. These national partners help local community groups and other non-governmental organisations (NGOs) to take action on AIDS, and are supported by technical expertise, policy work and fundraising carried out across the Alliance. In addition, the Alliance has extensive regional programmes, representative offices in the USA and Brussels, and works on a range of international activities such as support for South–South cooperation, operations research, training and good practice development, as well as policy analysis and advocacy. Our mission is to support communities to reduce the spread of HIV and meet the challenges of AIDS. To date we have provided support to organisations from more than 40 developing countries for over 3,000 projects, reaching some of the poorest and most vulnerable communities with HIV prevention, care and support, and improved access to treatment.

Who is the Civil Society Action Team?
The Civil Society Action Team (CSAT) is a civil society-led global initiative that coordinates, brokers and advocates for technical support to civil society organizations implementing or seeking grants from the Global Fund to Fight AIDS, TB and Malaria. The International Council of AIDS Service Organizations (ICASO) is the global host of CSAT and coordinates the initiative internationally, while regional CSAT hubs link regional, national and local community organizations with the technical support they need, identifying technical support gaps and acting as a communications conduit for the CSAT network. Each regional CSAT hub has a coordinator responsible for CSAT activities in the region. CSAT has a fiveyear mandate (2008 – 2013) which includes identifying civil society technical support needs related to Global Fund proposals and projects; advocating for an expanded range of technical support services with providers; and promoting the inclusion of marginalized groups in all aspects of Global Fund grants. To deliver on this mandate, CSAT identifies, for instance, opportunities to provide information on technical support and guidance available to civil society organizations, and through its community action activities, mobilize advocacy and action on deadlines and emerging issues in Global Fund grant processes, such as announcements about funding opportunities or new policies aimed at strengthening civil society input in proposal development and grant oversight.

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Contents
1. 2. 3. 4. Background and context Aim and objectives Methodology Results 4.1 4.2 4.3 4.4 5. 6. Background to grants sampled Grant stakeholder responses TA provider responses Summary of key findings 10 11 11 14 14 17 25 28 30 32 36 37 41 43

Comparison with the McKinsey TA studies Recommendations

Annex 1: Representivity of sampled grants Annex 2: Interview guides Annex 3: List of people interviewed Annex 4. Comparison with other TA studies

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List of Acronyms
ACSM ASAP CBO CCM CoATS CS CSAT CSO CSW CSS DTF EFR FPM GIPA GIST GLC GMS GTZ HSS IDU IEC LFA MDR-TB M&E MOH Advocacy, Communication and Social Mobilisation AIDS Strategy and Action Plan Community Based Organization Country Coordinating Mechanism Coordinating AIDS Technical Support Civil Society Civil Society Action Team Civil Society Organization Commercial Sex Worker Community Systems Strengthening Dual Track Financing Enhanced Financial Reporting Fund Portfolio Manager Greater Involvement of People living with or affected by HIV/AIDS Global Implementation Support Team (former CoATS) Green Light Committee Grant Management Solutions Deutsche Gesellschaft für Technische Zusammenarbeit GmbH Health Systems Strengthening Injecting Drug User Information, Education and Communication Local Fund Agent Multidrug-Resistant Tuberculosis Monitoring and Evaluation Ministry of Health

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MSM NAC NTP OCP OD PAL PEPFAR PLHIV/PLHA PMTCT PR PSM RBM SR SSR TA TGF TS TSF UNAIDS UNICEF UNDP WHO

Men who have Sex with Men National AIDS Council National TB Program Organizational Competency Profile Organizational Development Practical Approach to Lunch Disease The United States President‟s Emergency Plan for AIDS Relief People Living with HIV/ People Living with AIDS Prevention of Mother to Child Transmission Principal Recipient Procurement and Supply Management Roll Back Malaria Sub-Recipient Sub-sub Recipient Technical Assistance The Global Fund to fight AIDS, Tuberculosis and Malaria Technical Support Technical Support Facility Joint United Nations Programme on HIV/AIDS United Nations Children's Fund United Nations Development Programme World Health Organization

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Executive Summary
This study investigates and analyzes responses to technical assistance (TA) provision within a Global Fund Round 6 cohort of civil society recipients with the aim of understanding the dynamics that affect the utilization of TA budgets in Global Fund grants that are managed by civil society organizations. This study follows on from two previous studies on TA in relation to the Global Fund conducted by McKinsey and Company, and compares the experience of civil society recipients with the experience of government recipients. The recommendations of the study will feed into a TA options paper being developed by the Global Fund. The study consisted of two simultaneous pieces of work involving interviews with CS grantees for six Round 6 grants (Mali Malaria, Senegal HIV, Paraguay HIV, Peru HIV, Ukraine HIV and Romania TB) as well as a selection of international and regional TA providers. Numerous factors were taken into account to ensure adequate representation in the sample, including region, grant size and TA budget spend. Summary of results During the proposal development process, one third of the grants sampled had not budgeted for TA in their proposals. Respondents reported that TA was either not included or insufficient due to budget ceilings being set by Country Coordinating Mechanisms (CCMs), a lack of understanding of the importance of TA in country, no formal process for TA needs assessments amongst prospective PRs/SRs, stigma by CS in stating that they had developmental needs, and a lack of PR/SR involvement in the proposal development process. Where TA was budgeted, the TA identified appears to have been program related, such as M&E or procurement (rather than organizational development related), and thus aimed at improving the capacity to implement specific programmatic elements of the proposal. All grants received some degree of TA for the proposal development. In the grant negotiation phase, two countries obtained TA to assist with any adjustments in the proposal documents. No TA budget was added in the two countries where no budget had been included in the proposal, and in one of the four grants where TA had been budgeted, this was decreased. During grant implementation, all grants needed TA regardless of whether this was budgeted for during proposal development or not, and partners have in many instances stepped in to address this shortfall. CS grant recipients (PRs and SRs) appear to have more TA needs beyond programme implementation than do government recipients, and require organizational and systemic developmental support. They are more likely to source funding for this support from outside of the TGF grant rather then from the grant budget. No budget reallocation towards TA occurred in any of the grants, in spite of increased identification of TA needs during implementation. With regard to TA budget spend, the 16 CS grants for Round 6 budgeted an average of 4.6% (range of 0% to 11.9%) of their budget on TA. TA budget spend at 12 months, ranges from 9.2% to 125.9% at an average of 55.9%, rising to an average of 92.1% by 18 months. While the overall average TA spend rate rises to over 180% by 24 months, the number of grants which had recorded this information at the time of the interview is too small to meaningfully interpret. Grant implementation is often a slow start up process and the speed of implementation increases in a non-linear manner. It is likely, therefore, that TA needs increase significantly after the initial stages of implementation and the increasing TA expenditure indicates a need for TA which exceeds the current TA budgeting norms. General comments on TA provision by grantees included the difficulty in identifying detailed implementation TA needs during proposal development, the general sense that TA is a “luxury” that unnecessarily inflates costs, the often overlooked potential role of PRs in providing TA to their SRs and the major need for more organizational development related TA to address the substantial organizational challenges which a civil
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society organization faces as a result of the influx of large amounts of TGF monies, as well as the reporting requirements imposed on these grant recipients. The TA providers interviewed agreed that there is a lack of understanding of CS TA needs as they extend beyond the “classic” Global Fund programmatic competencies, with limited structured TA needs identification. They furthermore agreed with grantees that stigma plays a role as many CS‟s may perceive that a request for TA is a tacit admission of weakness rather than a practical acknowledgement of a need. The lack of CS requests for TA is further exacerbated by the fact that CSOs are, in reality, in competition with each other to maintain their position as PR or SR or SSR and, where possible, to climb TGF grant responsibility ladder. Complying with TGF grant management requirements often changes the nature of the CSO. Whilst the need for TA for effective management of funds is essential, the deeper more systemic issues impacting on CS is not addressed and respondents felt that this kind of TA may well need to be sourced from a different pool altogether. Whilst respondents were clear that there will always be a place for short-term focussed TA, there was a strong call for longer-term sustained support for CS to address deep-seated systemic issues. The quality of TA delivered is also very variable and there is no common standard approach to evaluating the performance of a consultant or to evaluating the impact and effectiveness of TA. Respondents identified an urgent need for a co-ordinated response for CS TA for TGF grants based on shared information and common aims. As this study complements the McKinsey studies, a comparison with the findings of those studies indicates that grants with CS PRs are less likely to budget for TA in their proposal (67% of the CS sample vs 88% in the McKinsey study) and indeed budget less for TA (4.6% vs. 7.6%) when they do budget. In all grants, regardless of type of PR, proposals are developed by consultants disconnected from grant implementation, insufficient planning goes into TA needs, and TA requirements emerge and evolve during grant implementation with variable TA spending. Summary of recommendations 1. Commission a collaborative input to:

 

Identify the standards and requirements for CS with regard to Global Fund grants Review a TA „curriculum‟ for CSOs .

2. Agree to additional guidelines for TGF proposal development:

      

Evidence of a formal TA assessment process Development of tools to assist in the needs assessment Evidence of potential SR involvement in the planning process. Submission of appropriate TA as a prerequisite for grant approval Inclusion of TA provision from PRs to SRs and SSRs Indications of what TA components will be potentially funded . An indication in proposals of how TA will be managed and capacity enhanced

3. Engage with partners, TA providers and stakeholders on attitudes and approaches to TA:

  

Broaden the definition of TA to enable longer term technical support Broaden the recruitment of consultants and TA provider Increasing access to quality assured, relevant and timely TA

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4. Agree on alternative internal approaches to TA:

  

Increased TA budget flexibility FPMs to initiate a process of rapid assessment of Round 8 and 9 grantees Engage with all FPMs to ensure that attitudes towards TA budgets is consistent

5. Engage with representative CS groupings to agree processes to:

  

Formalize co-ordination of TA providers. Facilitate communication between CSOs. Improve access to funding for CSOs who are not as yet grantees

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Analysis of Technical Assistance to Civil Society Recipients of Global Fund Grants
1. Background and context
McKinsey and Company (McKinsey) conducted a Gates Foundation funded Technical Assistance (TA) Landscape Analysis in relation to the Global Fund (TGF), and presented the results in a variety of venues including a pre-Board meeting during TGF Board meeting in Geneva in May 2009. A priority issue which emerged from the presentation as well as from discussions with key partners and agencies such as WHO, UNAIDS, CoATS, and the US government, was the need to improve the understanding of TA budgeting dynamics and the use and non-utilization of TA budgets from a country perspective. TGF commissioned McKinsey to analyze financial data on technical assistance budgeting and spending along with an in-depth analysis in 5-6 select countries, from a Round 6 cohort, in order to gain a better understanding of the underlying reasons for differences in expenditure. In addition to the TA analysis, McKinsey gathered information on bilateral support for technical assistance at the country level. This work complemented the initial TA landscape analysis and other ongoing efforts such as the UNAIDS examination of technical assistance for proposal development in Round 9 and UNAIDS Technical Support Strategy to inform partner discussions on a way forward on technical assistance. The outcome of that research will assist with the development of an options paper on technical assistance to be presented to TGF Policy and Strategy Committee meeting in 2010 as indicated in the Partnership Strategy. Initial findings from the Round 6 analysis indicated that, while civil society (CS) grants budget nearly the same percentage of TA as other Principal Recipients (PRs), they are less consistent in doing so. CS grants showed a tendency to adjust TA budgets downwards from the original proposal during grant negotiation or Phase I implementation, and had difficulty accessing TA particularly for non-core TA areas e.g. advocacy. Discussions resulting from the outcomes of the McKinsey Analysis on TA spending (October 21, 2009) indicated that this issue could be explored further with a larger sample size, specifically targeting CS. This study builds on the findings of the research by McKinsey, and focuses particularly on CS grant recipients to determine if there are any differences between the experience of governmental and nongovernmental PRs in terms of the utilization of TA. The outcomes of this study will provide further input by this sector into an options paper on TA being prepared by TGF for consideration by the Board at an upcoming meeting. This study was conducted by the International HIV/AIDS Alliance (the Alliance) in close liaison with, and with input from, the Civil Society Action Team (CSAT) and the Global Fund secretariat. Comments on the draft report were solicited from the PR Working Group, members of the southern NGO delegation to the Global Fund board, the Alliance Technical Support Hubs, the CSAT regional hubs, and the UNAIDS Technical Support Facilities (TSFs).

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2. Aim and objectives
The aim of this study was to investigate and analyze responses to TA provision within a Round 6 cohort of CS grantees to complement the findings of the earlier TA landscape study undertaken by McKinsey. The objectives were to: a. Conduct a targeted analysis of in-country dynamics that affect the utilization of technical assistance budgets, provision and use in seven Round 6 CS PRs b. Analyze and compare the experience of CS with the experience of government PRs as reported by McKinsey c. Review existing literature and collate recommendations from TA providers on the Ta provision to Round 8 and 9 CS PRs and SRs. d. Summarize findings and make specific recommendations relevant to the TA options paper being developed by The Global Fund

3. Methodology
The methodology consisted of two simultaneous pieces of work involving interviews of CS grantees for Round 6 (referred to in this study as TA grant stakeholders) as well as a selection of TA providers. Of the 85 Round 6 grants, 16 had CS PRs as described in Table 1 below:

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Table 1: List of round 6 grants with civil society PRs
Grant 1 2 3,4 5 6 7 8,9 10 11 12 13 14 15 16 Romania HIV Romania TB Ukraine HIV Paraguay HIV Peru HIV Guatemala TB India HIV Bangladesh Malaria Sri Lanka TB Thailand TB West Africa Regional HIV Senegal HIV Mali Malaria Cote d‟Ivoire Malaria PR Romanian Angel Appeal Foundation Romanian Angel Appeal Foundation International HIV/AIDS Alliance in Ukraine; All-Ukrainian Network of People Living with HIV CIRD – Fundación Comunitaria Centro de Información CARE Peru Vision Mundial Guatemala Population fund of India; India HIV/AIDS Alliance BRAC Bangladesh Rural Advancement Committee Lanka Jatika Sarvodaya Shramadana Sangamaya World Vision Foundation of Thailand Organisation du Corridor Abidjan-Lagos Alliance Nationale Contre le SIDA Groupe Pivot Santé Population CARE International in Cote d‟Ivoire

An attempt was made to sample these, taking into consideration the following factors to ensure appropriate representivity of the sample:

      

Regional balance HIV, TB and Malaria grants Grant budget size TA Budget differences EFR budget spend Country Income level Grant rating

On the basis of these factors, and in conjunction with TGF and CSAT, seven PRs were selected for inclusion in the study. However, due to the unavailability of some respondents, and the short time period available for the study, some substitutions were made resulting in the following six grants being included in the sample:

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Table 2: Round 6 grants sampled in this study
Grant PR

1 2 3 4 5 6

Romania TB Ukraine HIV Paraguay HIV Peru HIV Senegal HIV Mali Malaria

Romanian Angel Appeal Foundation All-Ukrainian Network of People Living with HIV/AIDS CIRD – Fundación Comunitaria Centro de Información CARE Peru Alliance Nationale Contre le SIDA Groupe Pivot Santé Population

An explanation of the representivity of this sample based on the above criteria is included as Annex 1. Utilizing a questionnaire agreed between the International HIV/AIDS Alliance, CSAT and the Global Fund, interviews were conducted based on Global Fund introductions to key incountry partners including, but not limited to, members of the CCM, relevant Principal Recipients (PRs), Sub-Recipients (SRs) and, where possible, Fund Portfolio Managers. For the TA provider interviews, an agreed questionnaire was administered to a group of TA providers selected in collaboration with CSAT and TGF. Of the 17 organizations / individuals selected for interview, the following 11 organizations or groups were interviewed:

          

GMS UNDP Clinton Foundation GTZ UNAIDS Roll Back Malaria USAID CSAT International HIVAIDS Alliance Technical Support Hub in Ukraine Technical Support Facility Southern Africa Independent regional consultant

A full list of individuals interviewed is attached as Annex 2. Telephone interviews were conducted over a two week period in December 2009. Some interviewees provided written follow up early in January 2010. The questionnaires utilized are attached as Annex 3.

3.1 Limitations
Cognizance must be taken of the following limitations when interpreting the findings of this study:

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3.1.1

Availability of interviewees

The timing of this study (December) and the short time frame within which the study was conducted meant that some interviewees were not readily available for interview. In addition, there was limited availability to cross reference findings with other grantee stakeholders. It was, however, ensured that Round 6 grants for all three diseases were included. 3.1.2 Sample Size

Due to the above unavailability, substitutions were made in the countries identified from the sampling framework and the number of countries samples was slightly less than originally envisaged. 3.1.3 Generalizability of the results

In view of the above, the results of this study may not be fully generalizable to all CS grantees but, read in conjunction with the McKinsey study and other TA studies, provides good indications for options for TA for CS grantees 3.1.4 Historic gap

Many respondents said that it was hard to recall exact details of the R6 grant, particularly the proposal development stage. 3.1.5 Lack of TA budgeting

Two of the countries sampled did not budget for any TA (for CS PRs) in their proposal rendering some of the questions superfluous. However the response of these countries to TA needs during grant implementation is still very relevant to the objectives of this study. 3.1.6 Centralized location of TA provider interviewees

Only three of the TA provider interviewees were located at the regional level. The study could have been further enriched by the opportunity to explore the experiences of providers operating at a local level. 3.1.7 Qualitative vs. quantitative data

A part of the interview of the TA providers was devoted to understanding the scale and scope of the TA provided by the organisations interviewed but these questions were more geared towards understanding the role of the organisation than towards documenting statistics. As this was by no means an exhaustive study of all providers across the spectrum, the study did not yield significant quantitative data regarding the scope and scale of the TA landscape but focused more on drawing qualitative comment based on experience.

4. Results
4.1 Background to grants sampled
A brief background to the grants sampled for this study is included in Table 3.

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Table 3: Background on sampled grants
Grant Budget $mill PR Focus Comment

All-Ukrainian Network of PLHA Ukraine 131.5 HIV/AIDS Prevention, Treatment and Care for Vulnerable Populations

This grant has two CS PRs. The network is responsible for access and care for IDUs, PLWHA, advocacy, strengthening of the national system of M & E

International HIV/AIDS Alliance in Ukraine

The Romanian Angel Appeal Foundation (RAAF) is the principal recipient for TGF HIV/AIDS and TB grants. However it has been the main sub-recipient (SR) for Scaling up TB control in Romania 11.0 Romanian Angel Appeal Foundation Romania poor by and focusing on HIV/AIDS grants since round 2, in which there was a component on TB and HIV coinfection. According to the National TB Programme (NTP) Manager, the RAAF was selected for its successful experience as a SR for HIV/AIDS grant, solid expertise in public health in Romania and strong M&E system. During Phase 1 of the TB round 6 grant there were 7 sub-recipients (3 governmental and 4 non-governmental organisations). CIRD is the PR for HIV/AIDS grants on round 6 and 8. Major sub-recipients are the National AIDS Control Programme (PRONASIDA), the leading agency for the country HIV/STI project in six regions HIV/AIDS response, and the National Centre on Addiction Control, which provides healthcare services to IDUs. Both agencies are under the Ministry of Health and Welfare. Other sub-recipients are CSOs implementing peer-education and community mobilization among PLHIV, IDUs, MSM and CSW CARE Peru has been PR for HIV/AIDS and TB grants in previous rounds (2 and 5). Peru 33.4 CARE Peru Multi-sectoral integration of resources against HIV There are 10 sub-recipients for this grant, ranging from non-governmental organisations, community-based organisations and universities, the major ones being: INPPARES (objective 1 and 4), Vía Libre (objective 1), and Max Salud (objective 2 and

vulnerable

populations

Fundación comunitaria centro de Paraguay 8.8 información y recursos para el desarrollo (CIRD)

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3). This grant is a “dual-track” grant, with one CS PR and one governmental PR. The CS Group Pivot Santé Mali 18.2 Population Distribution of long lasting insecticide treated nets Ministry of Health PR (Groupe Pivot) has two SRs: PSI, and Fenascom which is the local community health federation. Groupe Pivot is also SR under the Government PR for the same grant.

The grant is “dual-track”, with one CS PR and one Governmental PR. The CS PR Alliance Nationale Strengthening Response for HIV/AIDS Universal (ANCS) had sixteen SRs under Phase 1, and this will increase to 21 under Phase 2. All of the SRs are Senegalese organizations. All work as intermediaries to support grassroots implementing organizations. SRs tend to have a specific thematic role, e.g. on gender, PMTCT, etc.

Contre le SIDA Senegal 31.9 The National AIDS Council of Senegal

Access to Care, Treatment and Prevention

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4.2 Grant stakeholder responses
The responses were categorized according to entry points for TA planning or provision during a grant life cycle from proposal development to implementation. For the purposes of this study, respondents identified TA as mostly shorter term initiatives rather than longer term capacity building.

4.2.1

Grant Proposal Planning Process

Inadequate TA budget inclusion Four of the PRs sampled had TA budgeted in their proposals for CS grantees. Neither the Senegal nor the Mali CS PR proposal contained planned TA although the Mali proposal had budgted TA for the government PR. Respondents reported that, during the proposal development process, TA was either not included or insufficiently included for one or more of the following reasons.

    

Budget ceilings are set by Country Coordinating Mechanisms (CCMs) or proposal development teams and the constant downwards revision of cost estimates precludes TA budget inclusion. There is a lack of understanding of the importance of TA by proposal development committees. TA costs are often seen as detracting from “real” activities. There is no formal process for TA needs assessments amongst prospective PRs/SRs beyond the main Global Fund requirements for a PR. At the time of proposal development, many CSO‟s didn‟t consider that they had major TA needs, or “down-played” these in order to be seen as competent to fulfill the PR role. The PR did not participate in the grant proposal planning and writing process, but was selected later in the process. Prospective PRs have limited opportunity, therefore, to identify and include their own developmental needs. This is further exacerbated for SRs who are usually even further removed from the proposal development process. There appeared to be no correlation between overall size of grant budgets and inclusion of TA.

Types of TA budgeted Some TA was planned in the remaining four (67%) grants sampled (Paraguay, Peru, Romania and Ukraine) and, interestingly, all four had obtained substantive TA during proposal development (pro-bono or funded assistance from multilateral and bilateral partners including UNAIDS, USAID, UNICEF, WHO and Clinton Foundation). All respondents who received this support indicated the invaluable contribution this made to the ultimate success of the proposal. (Mali‟s proposal was written by a multi-sectoral committee, with some limited TA nationally for the final proposal development, while Senegal‟s proposal was mostly written internally with UNAIDS providing support for the writing of the combined components). At the time of proposal development, the TA identified to be included in the proposals appears to have been program related (rather than organizational development related), and thus aimed at improving the capacity to implement specific programmatic elements of the proposal such as the following examples from a HIV and a TB proposal:

Type Report Name Here

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Paraguay HIV

   

Development of computerized information system/Monitoring & Evaluation(M&E)strengthening; Design of training modules for peer-education and IEC materials; Updating and development of manuals for Prevention of Mother To Child Transmission(PMTCT); Situation analysis of health services.

Romania TB

   

Policy and programme development; Advocacy, Communication and Social Mobilisation (ACSM); Operational Research; M&E.

The TB grant in this sample (Romania), demonstrated an inclusive and detailed process in identifying TA needs although this still fell short on including organisational TA requirements for prospective PRs and SRs .The thematic areas were identified by WHO programme review missions, epidemiological data provided by the National TB Programme and country situation analysis against the objectives of the Global Stop TB Plan. Furthermore, there were discussions amongst key stakeholders, including the NTP, WHO, Doctors of the World and the Penitentiary System. Conversely, the Ukraine proposal process identified only two of the main PR requirement areas of TGF, namely Procurement and M&E. Understanding and costing of TA Where TA was budgeted, the general understanding appears to have been that technical assistance was for short-term consultancies or services to address gaps in knowledge and programmatic advice with the budget being based on a percentage of the total proposal budget. In Romania, the proposal team set a ceiling of +/- 10% of the total budget and calculated costs based on fees and per diems for the WHO‟s international consultants and their previous experience from round 2. The SR respondents in the various countries in this study did not have any idea how TA costs were calculated as they were largely excluded from these deliberations. In Peru, potential TA for capacity building for CS was included in the narrative section of the grant proposal. Peru included a budget for short term TA mostly for M&E, advocacy, communications and training. 4.2.2 Grant Negotiation

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The International HIV/AIDS Alliance

Provision of TA Only respondents from two countries (Paraguay and Peru) indicated that TA was provided during the grant negotiation process (funded by UNICEF and UNAIDS respectively), to assist with any adjustments in the proposal documents (work plan, budget, indicators, manuals, M&E guidelines and Procurement). Review of TA during negotiation No TA budget was added to the budget during grant negotiation in Senegal and Mali, the two countries where no budget had been included in the proposal. Of the four countries where TA had been included (Romania, Peru, Ukraine and Paraguay), Romania was left unchanged and the Paraguay budget decreased. While no TA or planned activity was removed in Paraguay during the grant negotiation process, some TA budget lines were reviewed in order to obtain savings from hiring national consultants (instead of international consultants), and from obtaining additional financial support from other development partners for the provision of TA. These savings were reprogrammed and allocated to other budget lines. In Peru, the budget remained unchanged but some prioritization and reallocation between budget lines occurred. In Ukraine, the Local Fund Agent (LFA) identified several weaknesses during the assessment. As a result, during the grant negotiation process, TGF added two „Conditions Precedent‟ to the grant documents requiring that the PR strengthen its M&E and PSM capacities. According to the PR, the FPM recommended a specific TA provider to carry out the capacity building required. There were varied reports on the levels of satisfaction with the M&E TA.

4.2.3

Grant Implementation

Amendments to TA plans/budgets In Senegal and Mali, where no TA was budgeted in the final grant documents, the CCM and/or PR did not request a budget realignment to reallocate existing resources toward TA during project implementation, even though such needs were indentified, due to grant implementation budget constraints. For the proposals with TA included in the budget, TA provision in Paraguay remained in line and consistent with the work plan approved and signed by TGF and PR at the end of grant negotiations with its reduced TA budget. In Romania, there were very limited adjustments made to the TA work plan but the budget remained consistent with the approved work plan. For Ukraine, (the largest grant in the sample) more than 100% of the TA budget was spent at the time of the interviews. With ongoing grant implementation, new capacity development needs have been identified by SRs and PRs, particularly in the field of organizational capacity building. There is however, no budget provision for this.

Analysis of Technical Assistance to Civil Society Recipients of Global Fund Grants

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The Ukraine respondents also identified the area of CS staff turnover and the need to include budget to address this, either through staff retention mechanisms or for training new staff on TGF requirements. In addition, a TA need that was identified was to better support SR partners in fulfilling TGF reporting and other requirements. In Peru, the PR requested technical assistance from the International Centre Technical Cooperation (ICTC) in Brazil, in order to assist the PR and SR in realigning operational plans and budgets. This activity had not been initially considered in the work plan, and as a consequence, the grant implementation began six months after the signing of the contract (May 2008). This initial delay represented a great challenge for grant performance, which received an alert from TGF, although the investment in support for the PR and SR positively assisted the grant in performance thereafter. TA provision during grant implementation Although the Senegal CS PR did not have a budget for TA, a need arose during implementation for TA on GIPA, and TA was provided with funding from UNAIDS. The SRs have also identified TA needs, but stated that obtaining access to this from local partners (local organizations, bilateral and multi-laterals) was more difficult to obtain for CS PRs as the perception was that partners were more “geared” toward supporting government PRs. They further indicated that they may not have the “autonomy” which PRs have in requesting TA. The PR did acknowledge locally available sources as a possible support when TA is needed, Mali, which also did not have a TA budget for the CS PR, required TA for the national net quantification system. As there is no budget in the grant for this Roll Back Malaria (RBM) has agreed to financially support this TA. In Paraguay, TA has been geared towards technical programme support rather than direct organizational PR / SR support and the PR has hired short term expertise in identified areas to support implementation. TA implementation support in Romania has been substantial and includes both organizational development support and programme support. SRs‟ work plans included TA for:

   

the elaboration of guidelines and manuals development of an advocacy strategy training (short-term consultants) WHO/Green Light Committee missions etc.

The PR provided capacity building to SRs in 3 areas: organisational and programme development, financial management and procurement and M&E through seminars, coaching sessions etc. Although many of these TA activities were not budgeted, the PR reports that SRs have responded positively to the TA, based on the annual standard organisational survey (ISO certified). The PR considers that the TA success is confirmed by the high standards of SR‟s performance. The WHO country office and WHO/EURO have also been major TA providers in Romania, as follows:

 

Green Light Committee (GLC) mission and technical assistance on MDR-TB, which was paid for with grants funds and WHO. Advice on operational research and proposal selection on a pro bono basis.

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The International HIV/AIDS Alliance

 

Development of national strategy and implementation guidelines for Practical Approach to Lung Health (PAL): which were partially financed with TGF and WHO support (consultancy fees, travel costs and per diem). The WHO also carried out periodic NTP reviews which have also been partially paid for with TGF grants.

In Ukraine, apart from the M&E support and Procurement and Supply Management (PSM) support already mentioned and provided to the PR, the following additional TA was required and implemented:

  

Orientation of employees Training of SRs on M&E conducted by the Network‟s M&E specialists Limited organizational development. (As a result of the TGF grant, the organization took on new activity areas and employed new staff, having to make changes in its organizational structure and therefore requiring organizational development and management support) Treatment

Part of the TA was financed by the Ukrainian Network as one of the PRs for the Round 6 TGF grant with the total amount of budget spent under the agreement (USD 300k). Apart from the early deviation from the work plan in Peru, the remainder of the TA provided was consistent with the original work plan approved and signed by TGF and PR at the end of grant negotiation. The PR also made arrangements for technical assistance to SRs on capacity-building training to plan the development of the Regional Multi-sectoral Coordination on Health (COREMUSA), developing guidelines, M&E support and finance and programming. Attitudes towards type of TA The following perceptions were evident amongst the respondents:

  

 

Providing TA “on site” or “in country” is preferred to sending some staff out of the country to be trained, in order to maximize the number of people who benefit from the TA. Obtaining TA from partners like RBM appears to be straightforward and easier than trying to negotiate with TGF to reallocate grant costs towards TA where TA budgets were not included in the proposal. National consultants have been preferred due to their experience and in-country knowledge, lower cost and easier procurement procedures. Interviewees stressed that during proposal development and grant implementation, national consultants proved to perform more effectively than international consultants due to their knowledge of the country context and delivery of services that were more suitable to their needs. However, the importance of international TA provided was recognized for “standard” Global Fund requirements such as the development of PSM norms and procurement of drugs. The utilization of national consultants may save TA budget (as in Paraguay with 87% of the budget spent). New thematic areas, for which the country may require TA, are constantly being identified during the grant implementation. An example of this is integrated treatment and care. While mostly short term TA was procured, there are benefits of longer term TA, as this fostered a relationship between the organization and the consultant, allowed for a greater understanding of local and organizational contexts and supported ongoing capacity development and skills transfer.

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  

The most suitable TA providers for TB have been renowned organisations with solid experience in thematic areas (WHO on PAL, GLC on MDR-TB) and the country (e.g. Doctors of the World in Romania). For one HIV grant, the utilization of expertise from Universities and large organizations was most beneficial due to the mix of TA competencies that included technical, programmatic and organizational developmental approaches. Interviewees generally expressed their satisfaction with the TA provided during grant implementation (with one exception).

TA Needs assessment and preparation for TA Where no TA was included in the proposal there was, not surprisingly, no formal process for TA needs assessments during the proposal development or later, during grant implementation. During interviews in one country with an international PR/SR, it was stated that the organization would be reluctant to request TA as it is “expected” that such an organization would have the requisite capacities, or, if not, could draw upon its international technical network for support. In a sense, it is expected that an organization like this may have an informal “built in” TA component even if it is not specifically costed in the proposal. This, together with the need of smaller organizations to appear to be competent in order to obtain their position as PR or SR limits their requests for assistance. A similar response was obtained from TA provider interviews on this “stigma” associated with requesting TA. In some grants, such as in Romania, the PR convened meetings with the sub-recipients and provided TA in programme management and M&E. Following an in-depth evaluation of subrecipients, the PR provided TA to all SRs in the form of training workshops on M&E and financial management, meetings and on-site monitoring visits. According to at least one FPM however, despite the best planning and intentions, TA may often be sacrificed in favor of infrastructure building and other urgent requirements during the grant implementation process. Interestingly, in one respondent country, the PR reported that no additional thematic area was identified during grant implementation or any deleted or altered, yet the major SR gave examples of TA activities that had been cut from the work plan, causing an adverse impact on the quality of the grant implementation. 4.2.4 TA budget spend

The 16 CS grants for Round 6 budgeted an average of 4.6% (range of 0% to 11.9%) of their budget on TA, but it is unclear what constituted TA in their proposals. TA budget spend at 12 months, ranges from 9.2% to 125.9% at an average of 55.9%, rising to an average of 92.1% by 18 months. For the grants sampled in this study which had budgeted for TA, the average TA budget in the proposal and spend at 12 and 18 months was 4.6%, 55.4% and 93.9% respectively, indicating that the countries are indeed representative of all CSO grants in Round 6 for TA budget spent.

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While the overall average TA spend rate rises to over 180% by 24 months, the number of grants which had recorded this information at the time of interview is too small to meaningfully interpret. Grant implementation is often a slow start up process and the speed of implementation increases in a non-linear manner. It is likely, therefore, that TA needs increase significantly after the initial stages of implementation and the increasing TA expenditure indicates a need for TA which exceeds the current TA budgeting norms. This is further confirmed by the considerable amount of TA reported by respondents to be sourced from outside of the TGF budget, and that, in spite of this, respondents reported unfunded and unmet TA needs, particularly for OD support for SRs (Ukraine and Senegal). The TA budget per grant, the budget spend (as recorded in the EFR), the TA required and sources of TA funding are included in Tables 4 and 5 below.

Table 4: TA needs during implementation amongst sampled grants
TA budgeted in proposal TA needed during implementation

Grant

Funding of TA

Ukraine HIV

Yes

PSM, M&E, OD

TGF grant, Alliance Ukraine

M&E, PSM, SR OD, Romania TB Yes financial management, guidelines Grant negotiation, SR workplans and training M&E, PSM,baseline studies, management capacities, IEC Malaria net quantification system GIPA, SR support TGF grant, WHO

Paraguay HIV

Yes

TGF grant, UNICEF

Peru HIV

Yes

TGF Grant, UNAIDS, National AIDS Programme

Mali Malaria

No

RBM

Senegal HIV

No

UNAIDS

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Table 5: EFR budget spend amongst sampled grants

Grant

TA budget (% of total Phase I budget)

EFR 12 month spend (%)

EFR 24 month spend (%)

Ukraine HIV Romania TB Paraguay HIV Peru HIV** Mali Malaria# Senegal HIV#

6.8 11.8 1.56 7.27 0 0

27.3 125.9 88.7 41.3 0 0

538.2 112.4* 87.6 91.4 0 0

# According to respondents no TA was budgeted for CS grantees in Mali and Senegal. * At 18 months ** Peru EFR details from TGF different to figures provided by PR. The table includes the PR figures.

4.2.5

General Comments on TA

The following general comments were made on TA for CS grants: Lack of planning Some respondents felt that the lack of TA planning was circumstantial and that it is not always possible, at proposal development stage, to describe TA at the level of detail required by TGF. The exact needs of grant implementation and organizational capacities required, is not known and therefore, TA is not included. There is also a sense that TGF may not value or easily approve TA costs, and that it is therefore easier to find TA elsewhere. Perceived stigma associated with requesting TA exacerbates this problem. Respondents agreed that, if possible, challenges regarding provision of TA can be minimized as long as it is planned in advance. Structured needs assessments, TA planning, and inclusion of PRs and SRs in TA budgeting would assist in strengthening TGF implementation. Proportion of budget spent In Romania, the TA budget was overspent and this was seen as result of an underestimated budget. The TA budget was completed with cost-savings from other budget lines. In Ukraine, part of the TA budget was under spent during Phase I as requests for diversion of TA funds for organizational development were not approved. However, TA from non Global Fund sources was also utilized as described earlier. In Paraguay, the spending tracked the TA budget availability and in Mali and Senegal funding for TA was obtained from external sources.

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The PRs did not report any difficulties in the allocation of technical assistance to a budget line of the Enhanced Financial Report (EFR). In fact the EFR has helped differentiate the expenditure more effectively than the previous system, which used to group different/unrelated activities under the same category. General constraints in TA provision

 

There is a general sense that TA is a “luxury” that unnecessarily inflates costs, or that is hard to justify, given the resource constraints. The CCM tries very hard to keep the overall budget of TGF proposals down and therefore TA is often sacrificed early in proposal development. An important and often overlooked aspect of TA is the potential role of PRs in providing TA to their SRs. It is not clear whether this is well understood, and how it is presented in budgets. Presumably this “internal” TA would not be costed as TA in the proposal budget. SRs report that grant implementation would be more effective if PRs engage with them early in the process for TA provision. In some countries, difficulties are experienced in sourcing good local consultants, even though they are the preferred type of consultant, and while cost may not be an obstacle, ready availability of required TGF skills may be. A major gap is the need for more OD related TA to address the substantial organizational challenges which a CS faces as a result of the influx of large amounts of TGF monies as well as the reporting requirements imposed on these grant recipients. An example of this was the call for proposals by the Ukrainian PR for medium to long term TA support which includes the following:  workforce recruitment, evaluation and development  Assessment and planning for organizational development of Network regional partners and sub-recipients.

4.3 TA provider responses
The TA providers interviewed were mostly based at international “head offices” and thus their responses were largely of a global nature rather than specific to the countries interviewed above. A total of nine major challenges to providing effective TA to civil society Global Fund grant recipients were identified: 4.3.1 Lack of understanding of Civil Society Organisations TA needs

For the most part, Civil Society Organisations (CSOs) have developed out of a felt need in a particular country and that need has determined the shape and functioning of that organisation. By their very nature, therefore, CSOs are not the same as government and therefore need to be approached differently within TGF context. Firstly, on the whole, CSOs have been through a process of consensus building during their establishment which leaves them with a legacy of participatory functioning. In principle, this legacy is a positive one. In practice though, it has the potential to increase the complexity of apparently simple issues due to the need for ongoing broad based consensus. Secondly, CSOs develop out of the personal efforts of dedicated individuals and, to maintain their legitimacy, they remain accountable to the original vision of those individuals.

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Thirdly, CSOs often develop relatively informal business processes which are adopted because they work at the time and on the scale at which they are working. They often bear no resemblance to the norms present in more formal institutions like, for example, government. Also, historically donors have tended to invest funds in programs rather than operations strengthening because they assume existing capacity. Therefore CSOs have developed their operational systems gradually over time using small amounts of program funds where possible. Bearing the above in mind, it then becomes evident that once a CSO becomes engaged in a complex system like TGF, it will need to go through a fairly profound transition if it is to succeed. It was the opinion of the majority of respondents that the requirements of this transition are not fully understood and therefore are neither properly supported by the TA currently available nor properly identified at the time of developing proposals. There was also a strong feeling that, without an understanding of the requirements of transition, TA needs identification at the time of proposal development remains a “shot in the dark” rather than a structured evidence based activity that draws on a common understanding of what should be. 4.3.2 Incorrect thematic focus for TA

All respondents indicated a sense that current TA provision may well be aimed at the wrong set of problems in that it is focussed on how to be an efficient and effective grant management organisation rather than at the more basic issues of how to be an efficient and effective organisation first. The focus has been on ensuring that CSOs comply with TGF requirements without the pre-requisite attention being given to strengthen them as organisations which would then have the capabilities, processes and competencies to comply with any stringent set of donor requirements. 4.3.3 Variable quality of TA provided

Many respondents raised the issue of the variable nature of the quality of TA and the fact that there is no common standard approach to evaluating the performance of a consultant or to evaluating the impact and effectiveness of TA. The absence of a basic standard platform from which to evaluate quality makes it possible for some consultants to have a limited impact. Even where the TA is of good quality, often the emphasis is in fixing an urgent existing problem rather than on imparting capacity and skills (a natural consequence of short term TA). 4.3.4 Stigma

The majority of respondents cited the fact that CSOs that are already Principal Recipients are loath to spend money on TA even if it is budgeted and that Sub-recipients are even more hesitant to raise the need for TA. Respondents felt that CSOs perceive that a request for TA is a tacit admission of weakness rather than a practical acknowledgement of a need. This is further exacerbated by the fact that CSOs are, in reality, in competition with each other to maintain their position as PR or SR or SSR and, where possible, to climb TGF grant responsibility ladder. Respondents felt that this combination of perceived stigma coupled with competition potentially creates a situation which militates against the optimum uptake of TA.

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4.3.5

Change of CSO focus

The principle of reaching out to CSOs and facilitating their participation and leadership of a response to challenges facing their countries is based on an understanding that, by definition, they are close to the nub of the problem. Taking those same CSOs and turning them into grant management organisations may have the potential of reducing the very characteristic that gave them value in the first place. They potentially change from outward-looking service oriented organisations to inward-looking administration oriented organisations intent on complying with fairly complex Global Fund auditing and reporting requirements. The challenge then is to design TA that firstly, strengthens the organisation to fulfil its original purpose as a CSO and secondly (and often consequentially to good OD TA), to enable it to solicit and manage donor money. It can sometimes to be prudent to guide CSOs as to the suitability of them becoming PR‟s or SR‟s in the first instance. 4.3.6 One-sided TA provision

Because of the failure to recognise the difference between CSOs and government with respect to TA needs, the sourcing of TA expertise for CSOs has really remained within the Global Fund “family” of TA providers, which has a specific approach and focus geared towards enabling the effective management of funds aimed at specific programmes. Whilst the need for this kind of TA will remain, (and there have been efforts to promote access to CSS to contribute to the development of sustainable CSOs), the deeper more systemic issues impacting on CSOs are not fully addressed. Respondents felt that this kind of TA may well need to be sourced from a different pool altogether e.g. Management and Development consultants. 4.3.7 TA in the context of development

Many respondents expressed the opinion that TA, it its current format, is essentially only available to those organisations that are developed enough to be “on the Global Fund Bus” already. There was concern, however, that there is not much help for those organisations that are, as yet, outside of that system. In the normal scheme of things, organisations develop over time and acquire the skills, systems and processes necessary to compete with each other for funds. The advent of TGF, however, has catapulted some organisations into a state of accelerated development whilst leaving others very far behind. If attention is not paid to ensuring that organisations outside of TGF system also develop, there is the potential for serious development vacuums to occur. 4.3.8 ‘Parachute ’ TA versus long term technical support

Whilst respondents were clear that there will always be a place for short-term focussed TA, there was a strong call for longer-term sustained support for CSOs. It was felt that the kind of deep seated systemic issues that act as obstacles for the effective functioning of CSOs as Principal Recipients are not issues that one can fix by parachuting a consultant in for a defined number of days but require a more sustained and developmental approach. When asked about the difference between the terms Technical Assistance and Technical Support, the majority of respondents agreed that, whilst there was no formal difference, they felt that Technical Assistance referred to short-term interventions and that Technical Support refers to longer term programmatic support or Capacity Development. They acknowledged that there is a place for both but that long-term work is problematic within the current modus operandi of both funders and providers. The Technical Support Facilities of UNAIDS have grappled with this issue and have developed frameworks for longer term mentoring as well as utilising the same consultant for repeated assignments in the same country so that a longer term, developmental relationship may emerge.

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There may well be value in formalising the distinction to enable the longer term option to be properly understood. 4.3.9 Lack of longer term TA co-ordination

Interestingly, none of the issues that have emerged from this study are new insights. All respondents were aware of the fact that they have been identified before. Respondents identified an urgent need for a co-ordinated response for CS TA for TGF grants based on shared information and common aims. There was also a strong sense that the current perceived lack of co-ordination is enabling duplication and the less than optimal utilisation of limited resources. It also potentially places TA providers in competition with each other in relatively small thematic areas whilst other, equally if not more important areas are receiving little or no attention. Respondents raised concerns about the lack of a co-ordinated effort to build local capacity and to capitalise on existing local capacity with a view to enabling long-term sustainability. 4.3.10 Utilization of international versus regional or national consultants Respondents raised the issue of the different remuneration standards being applied to international consultants or agencies compared with local or regional consultants or agencies. Much is made of the value of utilising local knowledge and building regional and local capacity. At the same time, local consultants earn considerably less than international consultants even if their qualifications and experience are equivalent. The outcome of the current approach is a potential devaluing of the very local capacity that the programmes claim to be developing. In addition, there was a sense that perhaps TA providers are not as aware of local capacity as they could be. Having said that, however, it is acknowledged that there will always still be a need for international capacity – mainly to deal with issues where there are real or perceived conflicts of interest, CCM strengthening processes or for other similar areas of specialization. Interviewees responded that the type of consultant should be chosen based on the specific need of the grant.

4.4 Summary of key findings
4.4.1 Grant stakeholders All grants have needed TA during implementation regardless of whether this was budgeted for during proposal development or not. TA is not included during proposal development or curtailed due to imposed budget ceilings by CCMs and a lack of understanding of the importance of TA by proposal development committees In one of the four grants where TA was budgeted, this was reduced during grant negotiation. Where TA has been budgeted this is often sacrificed during grant implementation for programmatic needs with increased cost such as infrastructure There is no formal process for TA needs assessments amongst prospective CS PRs/SRs beyond the four main TGF requirements for a PR and CS tends to “downplay” any major TA needs so that they may secure these positions. There is some stigma attached to CS voicing organizational development needs and TA may be more likely to be available for government PRs.

    

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       

All grants have some form of TA during proposal development, but TA needs during implementation are often left for partners to fund. Inclusive multi-stakeholder involvement in proposal development tends to increase the likelihood of TA inclusion but this is almost exclusively programmatic or linked to TGF PR requirements such as PSM or M&E. CS grant recipients (PRs and SRs) have TA needs beyond programme implementation and require organizational and systemic developmental support. They are more likely to source funding for this support from outside of the TGF grant CS SRs and SSRs are often left out of the TA net yet desperately need this support in terms of implementation and organizational development. The TB and malaria grants in this study indicated extensive external TA from WHO and RBM respectively yet it is reported that this was discreet disease specific support without much cross-grant collaboration with HIV. Apart from standard best practice implementation such as PSM, drug procurements where international consultants are readily accepted, grant recipients prefer longer term national or regional TA. For TB and malaria grants, support from WHO and RBM is considered vital. EFR spend indicates an exponential increase in the TA budget spent over time during phase I. Almost all grants appear to have unbudgeted TA needs as grant implementation progresses. The PRs did not report any difficulties in the allocation of technical support to a budget line of the Enhanced Financial Report (EFR). In fact the EFR has helped differentiate the expenditure more effectively than the previous system, which used to group different/unrelated activities under the same category. In some instances a lack of TA planning may be due to the fact that, at proposal development stage, to describe the TA that will be required over five years at the level of detail required by the TGF.

4.4.2

TA providers There is a lack of understanding of CS TA needs as they extend beyond the “classic” Global Fund programmatic competencies TA needs identification at the time of proposal development remains a “shot in the dark” rather than a structured evidence based activity. Current TA provision for CS may well be aimed at the wrong set of problems in that it is focussed on how to be an efficient and effective grant management organisation rather than at the more basic issues of how to be an efficient and effective organisation first. The quality of TA delivered is very variable and there is no common standard approach to evaluating the performance of a consultant or to evaluating the impact and effectiveness of TA. Stigma plays a role as many CS‟s may perceive that a request for TA is a tacit admission of weakness rather than a practical acknowledgement of a need. The lack of CS requests for TA is further exacerbated by the fact that CS‟s are, in reality, in competition with each other to maintain their position as PR or SR or SSR and, where possible, to climb TGF grant responsibility ladder. Complying with TGF grant management requirements often changes the nature of the CS. They potentially change from outward-looking service oriented organisations to inwardlooking administration oriented organisations intent on complying with fairly complex Global Fund auditing and reporting requirements.

      

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 

Whilst the need for TA for effective management of funds is essential, the deeper more systemic issues impacting on CS is not addressed and respondents felt that this kind of TA may well need to be sourced from a different pool altogether. In the normal scheme of things, organisations develop over time and acquire the skills, systems and processes necessary to compete with each other for funds. The advent of TGF, however, has catapulted some organisations into a state of accelerated development whilst leaving others very far behind. If attention is not paid to ensuring that organisations outside of TGF system also develop, there is the potential for serious development vacuums to occur. Whilst respondents were clear that there will always be a place for short-term focussed TA, there was a strong call for longer-term sustained support for CS. Deep seated systemic issues that act as obstacles for the effective functioning of CS as Principal Recipients are not issues that one can fix by parachuting a consultant in for a defined number of days but require a more sustained and developmental approach. There is a lack of longer term TA co-ordination and this is enabling duplication and the less then optimum utilisation of limited resources.

5. Comparison with the McKinsey TA studies
A number of studies have been undertaken in the past relating to TA provision and the results of this study must be viewed against the backdrop of wider research. A comparison of the findings of this study with a selection of alternative studies is included as Annex 4. As this study complements the McKinsey Round 6 analyses, a summary of the comparison of key findings in the two studies is included below. Comparison of key findings with the McKinsey Round 6 TA spending analysis

 

Grants with CS PRs are less likely to budget for TA in their proposal (67% of the CS sample vs 88% in the McKinsey study) CS grants budget less for TA - 4.6% vs. 7.6% in the McKinsey study. (This is in contrast to the findings in that report)

70 60 50 40

%

All R6 grants CS grants only

30 20 10 0 Low TA <5% Mod TA 5-10% High TA >10%

  

Thus, 63% of grants with CS PRs, budgeted less than 5% for TA compared with the whole Round 6 cohort, while at the other end of the scale 18% budgeted more than 10% vs 22% for the whole cohort EFR data is incomplete and a minority of grantees have completed the 24 month EFR On the limited data available, CS PRs appear to spend a greater proportion of their TA budget and are more likely to overspend by the end of phase I

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    

As in the McKinsey study, there do not appear to be any differences between the TA spend patterns for grants across the three disease groupings. As in the McKinsey study, this study confirms that African countries budget the least for TA and Latin America the most. In all grants, regardless of type of PR, proposals are developed by consultants disconnected from grant implementation, insufficient planning goes into TA needs and TA requirements merge and evolve during grant implementation with variable TA spending In all grants there is a preference for longer term TA A greater emphasis in CS grants appears to be the systemic, developmental and organizational requirements for TA beyond programmatic competency requirements.

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6. Recommendations

Summary of key recommendations

1. Commission a collaborative input to:

 

Identify the standards and requirements for CS with regard to Global Fund grants Review a TA „curriculum‟ for CSOs.

2. Agree to additional guidelines for TGF proposal development:

       

Evidence of a formal TA assessment process Development of tools to assist in the needs assessment Evidence of potential SR involvement in the planning process. Submission of appropriate TA as a prerequisite for grant approval Inclusion of TA provision from PRs to SRs and SSRs Indications of what TA components will be potentially funded. An indication in proposals of how TA will be managed and capacity enhanced Identify TRP criteria for TA assessment

3. Engage with partners, TA providers and stakeholders on attitudes and approaches to TA:

  

Broaden the definition of TA to enable longer term technical support Broaden the recruitment of consultants and TA provider Increasing access to quality assured, relevant and timely TA

4. Agree on alternative internal approaches to TA:

  

Increased TA budget flexibility FPMs to initiate a process of rapid assessment of Round 8 and 9 grantees Engage with all FPMs to ensure that attitudes towards TA budgets is consistent

5. Engage with representative CS groupings to agree processes to:

  

Formalise co-ordination of TA providers. Facilitate communication between CSOs. Improve access to funding for non-grantee CSOs

Prior to there being any chance of improvement in the TA to CSOs it is essential that the fact that they are different is acknowledged and celebrated. Their very difference from government structures and other TGF role players is the essence of their value to the global response and therefore needs to be taken into account. Steps need to be taken to enable CSO to effectively manage grants without losing their essential character and focus.

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It is recommended that, based on the findings of this study, the Global Fund should undertake the following in support of CS involvement in TGF grants. 1. Commission a collaborative input to: a. Identify the standards and requirements for CS with regard to Global Fund grants, by means of identifying the characteristics of a CSO that is competent to perform at the various levels within TGF grant architecture both at a technical and organisational level. The development of an Organisational Competency Profile (OCP) for the suggested levels of PR, SR and SSR is recommended and would provide a standard against which CSO‟s can be measured, and by which they could measure themselves. b. Review a TA „curriculum‟ for CSOs based on the above which should extend beyond classic technical competencies and should include issues such as Organisational Development, Change Management, Human Resource Management, Programme/project management, Financial Management, Business Process Improvement and Design, Community mobilisation and support etc. 2. Agree to additional guidelines for TGF proposal development which should include: a. b. c. d. Evidence of a formal TA assessment process being included in proposal submissions Development of tools to assist in the needs assessment Evidence of potential SR involvement in the planning process. Submission of appropriate TA plan as a prerequisite for grant approval, consistent with the above assessment e. TA provision from PRs to SRs and SSRs with skills transfer included in the above plan. f. Indications by TGF of what TA components will be potentially funded (which will extend to both technical and systemic needs). g. An indication in proposals of how TA will be managed, harmonized and evaluated at the country level and how national capacity will be built in this regard. 3. Engage with partners, TA providers and stakeholders on attitudes and approaches to TA which should include: a. Broadening the definition of TA and increase flexibility of TA funding to enable longer term technical support with skills transfer to ensure that ad hoc “fixing” of isolated elements within a dysfunctional system is averted. b. Broadening the recruitment of consultants and TA providers to ensure that systemic problems that beset organisations in the fields funded by TGF are addressed to improve grant performance which will include expertise from sources not traditionally associated with health/HIV/Global Fund related activities (which may be local, regional and a pool of international experts). c. Increasing access to quality assured, relevant and timely TA: defining minimum standards and quality measures for TA through creating harmonized approaches for TA provision, possibly through voluntary pooled procurement. 4. Agree on alternative internal approaches to TA including: a. Increase TA budget flexibility to improve responsiveness – this may be agreeing to allow flexibility of a percentage of budgeted TA along the grant cycle or the creation of a separate TA funding stream at the TGF Secretariat that PRs can access over the course of the project.

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b. For Rounds 8 and 9 with CS grant recipients, that FPMs initiate a process of rapid assessment of grantees based on the competency framework included in recommendation 6.1 (This assessment should be undertaken by an organization or individuals with knowledge of the sector and not necessarily by LFAs). Categorization of development needs to enhance grant performance will provide a baseline for TA which can also be shared with partners. c. Engage with all FPMs to ensure that attitudes towards TA budget lines are consistent with the above approach. FPMs must acknowledge the importance of TA and not use the TA budget line as the first source of needed revenue when reprogramming occurs during the grant implementation cycle. Continuous joint review of the grant implementation among the different stakeholders must include a review of developmental, organisational and programmatic challenges requiring increased TA. 5. Engage with representative CS groupings to agree processes to: a. Formalize co-ordination of TA providers for CS grantees. This may include a high-level TA Reference Group that could be a working group coordinated by an existing organization with an international remit, experience with TGF and a focus on CS, or one possibly attached to TGF secretariat, which can assist with identifying trends and setting standards. The reference group would need to look at all forms of TA but should develop a mechanism for focusing on the unique needs of CS. b. Facilitate communication between CSOs to ensure the continued development of CSOs that are not yet competent to become PR‟s, SR‟s or even SSR‟s. Respondents recommended that attention be given to facilitating the building of coalitions as this would enable the transfer of skills and knowledge in a way that breaks down the sense of competition and contributes to strengthening CS beyond the requirements of TGF. c. Improve access to funding for CSOs who are not as yet grantees, so that they may be exposed to information and developmental initiatives to grow the pool of CS grantees.

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“We need to take a longer term view – parachuting consultants in only solves short-term problems.” “The landscape is complex and crowded and therefore difficult for Civil Society to navigate.”

“We are mobilising armies of consultants but still the proposals are not fitted to the country priorities.” “We need to support Civil Society to remember what made them become what they are.”

“When they set up, Civil Society Organisations had a vision which could not be achieved because of the lack of money. The Global Fund brings money not necessarily related to their original vision…so they chase the money.” “To access TA they need to be in the „system‟ but they cannot get into the system without TA.” TA should develop according to regional need but from a basic standard platform”

“Everyone knows we need a co-ordination framework but nobody has stepped up to do it. Also, it will need funding.” “For a Civil Society Organisation to become a Principal Recipient is a huge mountain to climb if they are truly local organisations and not local representatives of an International NGO.”

“A lot of Civil Society Organisations won‟t admit to having the need for Technical Assistance in case they are seen as weak” “The problem is no longer money it is the processes involved in managing that money and delivering a service.”

“Donors funding Technical Assistance focus on specific deliverables even though the entire organisation is dysfunctional. So that is what consultants do – even though they see the bigger problems”

SELECTED QUOTES

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Annex 1: Representivity of sampled grants
Region Grant Type of PR international small <20 mill Grant size med large 20> 100 100mill mill

EE Romania Ukraine Paraguay Peru Mali Senegal

LAC

AFR

HIV

TB

Malar.

local

TA proposal budget

EFR TA budget spend underspend overspend

WB Income lowmid

Rating

<5% Romania Ukraine Paraguay Peru Mali Senegal

>5%

low

A1,2 nr

B1,2 nr

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Annex 2: Interview guides

Interview guide grant stakeholders
Introduction This interview is aimed at helping the Global Fund secretariat to better understand differences in TA budget versus expenditure for grants managed by PRs that are Civil Society Organisations. TA is budgeted for during the proposal planning process. Often TA budget is then adjusted downward during grant implementation and, even though, is often underspent. The Global Fund secretariat would like to understand the reasons of TA under-spending in order to better support countries. Note: This interview is for TA to CSO PRs for ROUND 6. Not all questions will be relevant to all interviewees. Possible interviewees:

    

PR Major SR FPM UCC (HIV grant) or WHO (TB grant) CCM Chair or Vice Chair Grant background and information

1. PR/SR Responsibilities Are you PR or SR for other grants? 2. Round 6 SRs How many SRs, are there for this Round 6 grant reporting to the CSO PR and what is their role in the grant. What type of CSO SRs are there? Which is the major SR should we interview them? Contact name, number? Grant proposal planning process 3. Proposal writing Did you have TA support in writing the proposal? Who provided the TA support and who funded it? Were partners involved in providing support? Were you happy with the quality of the TA? 4. TA understanding When the proposal was written, what was the general understanding of what could be included in the proposal:  What TA?  Amount of TA?  Type of TA?  What budget line the TA was included as? 5. TA thematic areas What thematic needs for TA were identified? 6. TA needs identification How were these TA thematic needs identified? Who was involved in this TA planning and needs identification? Were the TA providers identified? (For FPM – are they aware how this was done) 7. TA budget
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How did you calculate the budget for TA? (For FPM – are they aware how this was done) Grant Negotiation 8. Grant negotiation TA Was TA support provided during grant negotiation? Who provided the TA support and who funded it? Were partners involved in providing support? Were you happy with the quality of the TA? If none provided would it have helped and in what way? 9. Amendments to planned TA  Was the TA budget amended during grant negotiation? Why? Did this amendment adversely affect the grant and how?  Were any additional TA thematic needs identified during grant negotiation or any deleted or altered?  If the TA budget was changed did a technical partner step in to cover any gaps or add to TA? Grant Implementation 1. TA for implementation support Has any TA support been provided during grant implementation? Who provided the TA support and who funded it? Were partners involved in providing support? Were grant role players happy with the quality of the TA? Amendments to agreed TA Has TA been in line and consistent with the original approved workplan signed off at the end of grant negotiations? Length of TA What was the average length of TA? Short, medium or longer term and which served your needs better and why? TA provider type Which type of TA provider is generally most responsive to your needs? Give reasons. Amendments to agreed TA Were any additional TA thematic needs identified during grant implementation or any deleted or altered? How did this affect the grant programmatically General Comments on TA 6. Phase I TA budget How much was the agreed TA budget during Phase I and how much was spent by the end of Year 1 and the end of year 2 [SENEGAL ONLY] TA budget spend Have the PR under or over spent on the TA budget by the end of Phase I or are you on target? How has this affected grant performance? If under spent: Does it mean that the TA needs are not met (not done), not needed, or that someone else is providing them (i.e paid beyond grant budget)? 9. If the TA needs are not met, what are the gaps, and why has the PR not managed to access the required TA?

2.

3.

4.

5.

7.

8.

What happened to the unused TA money? 10. If over spent: Why? Explain. Where did the PR cut the budget / workplan to cover this extra TA cost

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11. If on target with the spend, does it mean that all the grants TA needs were filled? 12. Did the PR experience any difficulties in allocating TA to a budget line in the Enhanced Financial Reporting (EFR)? 13. TA general Can you identify major challenges or barriers in relation to TA for your grant? Is the process of sourcing TA different if sourced from the grant or partners? 14. Do you have any recommendations to the Global Fund on improving TA provision to TGF grants?

Interview Guide TA Providers
Introduction The Global Fund recently commissioned McKinsey to undertake two studies on Technical Assistance (TA) provision in relation to various aspects of grant support. A follow up study is now being conducted to better understand TA provision to Civil Society PRs in Global Fund grants. One part of this study is interviewing TA recipients and the second (this) part of the study involves interviewing major TA providers to civil society PRs, specifically for Rounds 8 and 9. UNAIDS are also reviewing their technical support provision during Round 9 and the outcomes of that will compliment this study. The Global Fund has contracted civil society with the International HIV/AIDS Alliance as the lead in partnership with CSAT and other agencies to conduct this study. As Civil Society is PR in numerous grants, independent consultants have been contracted to conduct this study to ensure complete impartiality and objectivity. In this interview, we are specifically wanting to hear about your experience of TA provision to CS, challenges associated with this, what you anticipate for the future and importantly any firm recommendations you may have for the Global Fund to improve TA support to civil society for TGF grants. In January 2010, The Global Fund will host a multi-stakeholder consultation to provide input into a technical assistance options paper being developed for review by the PSC at its next meeting. In preparation for this meeting the CS and PS Team is supporting a group of CS networks to carry out research on the specific needs of CS in accessing technical assistance (TA) in preparing proposals and in implementing TGF grants. The outcomes of this study will contribute to this options paper for consideration by the Global Fund Board. Background information on TA provision 15. What has been the role of your organisation with respect to specific civil society TA support to TGF grants for Round 8 and 9. 16. Did you provide TA to CSOs in Rounds 8  During proposal development  During grant negotiations  During grant implementation  Other? 17. Did you provide TA to CSOs in Rounds 9 for proposal development, or are you being contracted for grant negotiation support 18. Generally what percentage of your organisations support to CSO TGF grants is spent on each of the three areas of proposal development, grant negotiation and grant implementation. 19. What main thematic areas do you provide support to CSOs for grant support

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20. What is your usual source of expertise for TA (own staff, international consultants, local consultants, sub-contracted to other organisations etc). In your opinion which serves the clients needs better. Grant proposal planning process (skip if no TA provided for this) 21. What was the extent of your TA provision for proposal development for CSOs in the two rounds–pls specify quantity of TA 22. Who funded this support? 23. How successful was the proposal development support (% of grants approved) for rounds 8 and 9 Grant Negotiation (skip if no TA provided for this) 24. What was the extent of your TA provision for grant negotiation for CSOs in round 8- pls specify quantity of TA. 25. Who funded this support? (PR / CCM themselves or partners such as USAID, UN agencies etc). Grant Implementation (skip if no TA provided for this or check for Round 7 TA provision) 26. What was the extent of your TA provision for grant implementation support for CSOs in round 8- please specify quantity of TA 27. Who funded this support? 28. What was the average length of TA? Short, medium or longer term? In your opinion, what length of TA is most beneficial in supporting grants for you as a provider and for the client and why? General Comments on TA 29. To the best of your knowledge, are TA needs for the grants identified during proposal development and included in the proposals or refined during grant negotiations? Have you as a TA provider been involved in the TA needs assessment process? 30. Some TA is contracted directly by the client and some by partners / other funders – which is the easiest for you as a provider and why. 31. Do you have any comments about the amount of TA included in the grant budgets. How would you improve this? In your opinion, what proportion of the grant should be for TA? 32. What thematic areas need more funding and why? Can you please specify in relation to your grant (HIV, TB, Malaria) 33. What are the major obstacles to adequate TA provision for CSOs in TGF grants 34. If you had the opportunity to revise the approach of role players in TA provision, what would your recommendations be to improve TA provision to CSOs? 35. Do you have any suggestions or proposals to other partners and PRs/ CCMs themselves or to any other role player in this regard?

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Annex 3: List of people interviewed
Grant stakeholders
Organization Senegal CCM Chair PR (ANCS) SR (Enda) Mali FPM CCM Chair PR (Group Pivot) SR (PSI) Romania FPM PR WHO TB Officer NTP/Sub-recipient Paraguay PR NAP/Sub-Recipient Peru PR SR (4) SR (2) SR (3) Ukraine PR (All Ukrainian Network of people living with HIV/AIDS) SR (Coalition of HIV Service Virginia Baffigo de Pinillos Fernando Cisneros Dávila Max-Salud Vía Libre 05 January 2010 05 January 2010 05 January 2010 05 January 2010 Mary Royg Nicolás Aguayo 17 December 2009 22 December 2009 Maria Kirova Dr. Silvia Asandi Dr. Cassandra Butu Dr. Elmira Ibrahim 11 December 2009 16 December 2009 17 December 2009 18 December 2009 Magdi Ibrahim Christine Sow (UNICEF) M. Souleymane Dolo Steve Lutterbeck 18 December 2009 17 December 2009 18 December 2009 18 December 2009 Prof Doudou Ba Magatte Mbodj Daouda Diouf 16 December 2009 16 December 2009 16 December 2009 Name Date interviewed

Hanna Shevchenko

21 December 2009

organizations) SR (Gay & Lesbian Activist org)

Tamila Klotlyarevskaya

18 December 2009

Chaz Zhytta Plus

21 December 2009

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TA providers

Organization Technical Support Facility Southern Africa GMS UNDP Clinton Foundation AIDS Alliance TS Hub Ukraine GTZ UNAIDS Roll Back Malaria Independent Consultant USAID CSAT

Name Jeff Tshabalala Catherine Severo Nadia Fuleihan Elya Tagar Ana Dovbakh Kristina Kloss Aina Saetre Louis Da Gama Shaun Samuels Ritu Singh Kibibi M. Thomas Mbwavi

Date Interviewed 15 December 2009 14 December 2009 22 December 2009 14 December 2009 16 December 2009 16 December 2009 18 December 2009 18 December 2009 18 December 2009 15 December 2009 17 December 2009

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Annex 4. Comparison with other TA studies
A number of studies have been undertaken in the past relating to TA provision and the results of this study must be viewed against the backdrop of selected wider research.

GIST study 2008
In November 2008, the Global Implementation Support Team (GIST) undertook a review of studies of 1 TA support and demand with the aim of providing a clearer understanding of the most recent outcomes and ongoing analyses of technical support demand and provision. Participation in the studies referred to in this report included the Global Fund, GTZ, PEPFAR, UNAIDS Technical Support Facilities, and other UN agencies and ASAP of the World Bank. Key findings included the following:

   

TA provision: Countries struggle to manage TA and CCM‟s are poorly resourced and unable to fulfill this role. The issue is exacerbated by the low capacity of CS and the absence or poor quality of TA plans TA measurement: Outcomes of TA are not being measured and evaluated although there is considerable collection of input data, and there is confusion regarding what a TA plan should look like and who should be responsible for them. TA responsibilities: Synergies occur more by accident than by design and the roles and mandates of the numerous role players are undefined due to the lack of an overall strategy for country level TA. The Global Fund needs an overall Partnership strategy that defines roles. TA funding: The advent of the Global Fund has created a new set of TA needs that were not part of the original mandate of some TA providers. The pressure to support countries in the acquisition and subsequent management of Global Fund grants therefore burdens these providers with an essentially unfunded mandate.

Recommendations included

    

Creating a mechanism for country-wide dialogue about the TA needs “Considering requests for technical assistance to be a strength (or possibly a requirement) of Global Fund proposals.” Develop outcome indicators for the provision of technical assistance in various areas, including M&E, strategic planning, civil society organizations programme implementation and capacity strengthening. The Board of the Global Fund should re-emphasize that countries‟ requests for technical assistance are considered a strength in any grant proposal, and grant proposals with comprehensive budget allocations for technical support are encouraged. Improve TA coordination within the UN Division of Labour and a Global Partnership Framework (i.e. a division of labour for coordinated and harmonized provision of technical support) to be implemented at the country-level with increased resource allocation for CCM‟s capacity development to enable them to undertake a technical assistance coordination function.

Notes:
1

Review of ongoing and recently completed evaluations and studies of technical support to AIDS programme implementation, Global Implemenetation Support Team, November 2009. http://data.unaids.org/pub/Report/2009/reviewofongoingandrecentlycompletedevaluationsandstudieso_en.pdf

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Comparison with current study The current study, although targeting CS grantees specifically, did not have different findings with respect to the limitations of country wide TA planning and management and a variety of additional (often unfunded) TA needs relating to their involvement in TGF grants. A difference in the current study is the emphasis on more systemic and organizational development needs for CS, as well as the greater difficulty of CS in recognizing and ensuring TA inclusion in the proposal budgets. The recommendation that TA inclusion in a proposal is viewed as a strength may militate against the practice of CS hiding their developmental needs due to associated stigma and perceptions of weakness.

CoATS study 2009
In 2009, Coordinating AIDS Technical Support (CoATS) undertook a study on Technical Assistance and 2 Technical Support to TGF Grant Implementation at a country level which aimed at exploring experience at a country level of TA for TGF support and included 9 countries at different stages of the epidemic and with strong UN and bilateral presence. Significant relevant findings were:

   

Access to TA: TA is more readily available for proposal development and is largely supply driven. It is not as readily available for implementation because countries are not able to articulate their needs or they are not clear about how to access it. TA effectiveness: National consultants are mostly more effective than their international counterparts. TA provision: TA support from UN agencies and Bilaterals is highly appreciated and acknowledged by recipient countries. TA sustainability: There are limited national level mechanisms to identify needs and gaps and limited leadership from key organizations like CCM‟s or NACs. There is a lack of information on availability of TA. Where there has been consultation with local stakeholders, a significant contribution has been made. Where this has been absent, there is a greater likelihood that the TA is considered to be unsustainable or inappropriate.

Recommendations included

    

National role players like CCMs and NACs should disseminate information on available TA and promote wider participation in TA planning. CCMs should ensure that TA plans and budgets are included in TGF proposals, drawing on a consolidated TA plan, and ensure greater participation by the proposed PR and identified SRs in proposal development to help define what support is needed. TA plans must be flexible enough to accommodate technical support needs that will emerge during implementation. CCMs need to be strengthened so that they can identify and manage TA needs effectively Support should be available for all the technical areas where needs have been identified or are anticipated. Furthermore, efforts should be made to ensure that such support utilizes national capacity and expertise where feasible and appropriate.

Notes:

Coordinating AIDS Technical Support (CoATS) Group, 2009. http://data.unaids.org/pub/GlobalReport/2009/studyontechnicalassistanceandtechnicalsupporttoglobalfund_en.pdf
2

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Comparison with current study Consistent with the above study, in the current study all countries sampled had TA for proposal development but not for implementation. Similarly, the utilization of national /regional consultants is preferred. The need for stronger national management of TA and increased flexibility of support and TA budget was also strongly supported in this study.

McKinsey study May 2009
It is essential to cross reference the findings of the McKinsey reports on TA to this study particularly as this study resulted from the last McKinsey research on TA. In the first half of 2009, McKinsey undertook 3 a study commissioned by the Bill and Melinda Gates Foundation “to provide a fact base and landscape of the users, providers and funders of technical assistance (TA) and to identify what is working and not working as it relates to Global Fund grants for HIV/AIDS, tuberculosis and malaria.” Over 80 interviews and consultations were held with those involved in the TGF TA landscape, which was supplemented by an extensive literature review. Significant findings were as follows:

   

TA funding: In 2008, over USD 66m was available for TGF related TA in budgeted proposals and programmes like GTZ, Backup and GMS, with a further USD 200-300m available from WHO and UNAIDS, and an unspecified amounts through bilateral agencies, country missions etc TA provision: Almost all countries use TA for proposal development yet there is a lack of consistency in approach and a disconnect between good proposal and future implementation. There is almost no TA pre-implementation and during grant negotiation. Type of TA: TA during implementation is usually reactive and more technical in nature. While this is usually short term in nature this may not result in the best value for money, although there is a lack of consensus on how best to deliver longer term support to implementation. TA challenges: There is a lack of an overall co-ordination strategy that identifies common goals, countries of greatest need and approaches to matching TA to the need. There is too little focus on providing management support, and a lack of clarity regarding funding sources and the „rules‟ that apply to utilization of funds.

Recommendations included To further investigate TA provision, improve TA planning and communication around TA, and improve transparency for budgeting and procurement of TA. Important recommendations included the need to recruit more TA in areas of skills gaps (and in particular management skills) and to develop and pilot models of longer term TA.

Notes:
3

Briefing document for Global Fund Pre-Board Session on Technical Assistance. Briefing document, 4 May 2009. http://www.theglobalfund.org/documents/board/19/McKinseyTASlides.ppt

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Comparison with current study All of the above is consistent with the findings of the current study, but, in many ways, is emphasized for CS recipients. Management TA over a longer more sustained period is probably a greater need amongst CS, and there is insufficient TA planning amongst CS and in spite of substantial TA needs. CS recipients are also not always clear on where to access this within the context of the TGF.

McKinsey study November 2009
The second McKinsey report was a discussion document (Analysis of Technical Assistance Budgeting 4 and spending ) completed in November 2009. Key findings were as follows:

   

Proposal development: Some proposals are written without the collaboration of partners and providers, preventing an accurate assessment of needs and costing and there is often a disconnect with TA requirements during grant implementation. There may be a tendency to over budget because contributions from partners are not clear at proposal writing. TA needs are added, dropped, and further evolve over time and during implementation; the proposal stage is too early in the process to be able to understand the full picture. Good practices include PR/CCM defining needs with partners during proposal process and agreeing on support to be provided. Grant implementation: Needs and funding are often identified in conversation with partners and TA is often provided outside of the TGF grant budget EFR data: There is sometimes confusion in how to classify TA vis-à-vis other areas, especially Human Resources, and on occasion, the Global Fund secretariat or partners may pay the provider directly, resulting in apparent under spending on the EFR. Overall Grant process: Under spending may be a result of a delay in TA spending, caused by slow implementation of the grant for a variety of reasons. Types of TA provision: There is a preference for ongoing long-term technical assistance over a period of years to help on an „as-needed‟ basis and local providers do not always have sufficient capacity to carry out TA needs. High capacity countries tend to have TA needs focused in highly technical areas whereas lower capacity countries often have additional needs focused in management areas. TA perceptions: There is an occasional reluctance to source TA providers due to a desire to be self-sufficient, stubbornness to change due to large bureaucracy at PR level or undesirable perceptions of consultants.

Comparison with current study The current study was undertaken as a follow-on from the McKinsey studies and the experience of CS is not markedly different from the findings mentioned above. The disconnect between TA requirements at the time of proposal development, the changing TA needs during implementation, variable TA spending, preference for longer term TA and a desire to appear more capable than reality were all recorded in the study. A greater emphasis in CS grants appears to be the systemic, developmental and organizational requirements for TA beyond programmatic competency requirements.

Notes:
4

Analysis on Technical Assistance Budgeting and Spending. The Global Fund discussion document, 27 November 2009.

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UNAIDS study August 2009
These requirements were highlighted in a study on TA commissioned by UNAIDS in August 2009 . That study states that it is assumed that the needs associated with the scale up of HIV responses can be overcome with TA. However, many of the problems are “symptoms of deeper frailties and constraints that plague the institutions and systems tasked with executing HIV responses”. In hyper-endemic countries many of these are “classic” developmental challenges and TA provision is not a “magic fix”. Poor governance, weak management capacity, and inadequate systems are the major impediments to HIV responses, and as the author asserts “...it‟s vital that TS be understood as part of a much larger „developmental‟ endeavour”. While much benefit has emanated from HIV related TA, the following challenges are listed in the study:
5

    

TA requests: HIV implementers often do not recognize their need for support (as organizational and systemic needs assessments are not done) or they are reluctant to ask for help. TA planning: Is often not undertaken and TA is reactive in nature to respond to short term needs TA content: Often lacks depth and does not address underlying, systemic issues which create recurring problems, is often fragmented and un-coordinated, lacks “softer-skills” competencies amongst consultants, is sometimes of dubious quality and not sufficiently monitored. TA coordination: This needs to be improved beyond the UN Division of Labour and across other agencies and new initiatives which address “new” and systemic gaps must be linked into this system. TA ownership: Ownership of TA must reside with recipients and partners play a role in analyzing and supporting TA. Recipients have the responsibility of ensuring that TA processes extend through to desired outcomes and ownership is just as important for civil society organizations.

Comparison with current study This insightful research has considerable relevance for the current study and many of the findings are exacerbated for CS. The systemic, developmental and organizational needs, the lack of skills to support these, the lack of TA planning and long term TA sustainability have all been recorded in the current study.

Notes:

How UNAIDS Can Make Technical Support Work Better and Smarter for HIV Responses, by Hein Marais. UNAIDS, August 2009.
5

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