MAXIMIZING POSITIVE SYNERGIES - World Health Organization

PEPFAR’s funding practices were less transparent to respondents. Many stated that there the
distribution of funding was not as centralized, there were too many overheads, and some felt that
working through NGOs created inefficiencies. One informant commented:
American NGOs have different rules; the contract they sign with the American
government they sign it as American NGOs, and they manage the resources the
American way, and their context is a context of a rich country. A rich country
spends a lot in accordance to its riches. The staff get higher salaries. As managers
we cannot afford the salaries they get. Any cost related to their activities,
logistics and all that is very high compared to ours. That is why like they say their
overhead is very high that is why the level of their operations is higher than ours.
To me that is the difference.
A few others commented that the GoR could not evaluate the efficiency of the PEPFAR-funded
NGOs because the funding information was not shared with it.
Perceptions of the PEPFAR steering committee were mixed. Some felt that the committee was
collaborative and valuable, while others thought that PEPFAR’s priorities still dictated final
decisions. Some commented that it was less flexible in its funding requirements than the Global
Fund, but not necessarily inflexible.
Impact of GHI funding process on recipients
As mentioned, both the Global Fund and PEPFAR’s funding processes have improved over time,
but there are still shortcomings with each one. Some data suggested the Global Fund occasionally
changed its requirements suddenly. While the Global Fund initially approved the MOH as head of
the CCM, it later said that its leadership represented a conflict of interest, and requested that a
different body take the lead. The National Council for the Fight against Aids (CNLS), which works
closely with the MOH, took over leadership of the CCM, and the MOH remains the Principal
Recipient. Because the MOH remained closely involved with the Global Fund’s funding process,
there was general approval of its funding decisions. Sudden changes to the Global Fund M&E
requirements have also been difficult for recipients:
What I can just say it’s that reporting is a good thing, but Geneva always changes
rules and procedures and they are very tiring… What is good today will not be
good tomorrow. It just comes from the sky, we don’t know why. Many of those
changes are absolute. Doesn’t fit in our national policy. Disturbs us. It doesn’t go
for what work in our country, and we are obliged to go with that. But it’s not the
best way to do. That’s my point of view. Probably as it’s Global Fund it’s global
and it’s difficult to do things that will fit in all national policies and strategies, but
they should be more generic and more based on results than on process and
they’re very focused on process.
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