GPR 67281 v3 THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA, AND THE WORLD BANK’S ENGAGEMENT WITH THE GLOBAL FUND —ELECTRONIC SURVEY ADMINISTERED TO WORLD BANK TASK TEAM LEADERS AND GLOBAL FUND SECRETARIAT IN MARCH 2011— GLOBAL PROGRAM REVIEW Volume 6 Issue 1 THE WORLD BANK GROUP WORKING FOR A WORLD FREE OF POVERTY The World Bank Group consists of five institutions—the International Bank for Reconstruction and Development (IBRD), the International Finance Corporation (IFC), the International Development Association (IDA), the Multilateral Investment Guarantee Agency (MIGA), and the International Centre for the Settlement of Investment Disputes (ICSID). Its mission is to fight poverty for lasting results and to help people help themselves and their envi- ronment by providing resources, sharing knowledge, building capacity, and forging partnerships in the public and private sectors. THE INDEPENDENT EVALUATION GROUP IMPROVING DEVELOPMENT RESULTS THROUGH EXCELLENCE IN EVALUATION The Independent Evaluation Group (IEG) is an independent, three-part unit within the World Bank Group. IEG-World Bank is charged with evaluating the activities of the IBRD (The World Bank) and IDA, IEG-IFC focuses on assessment of IFC’s work toward private sector development, and IEG-MIGA evaluates the contributions of MIGA guarantee projects and services. IEG reports directly to the Bank’s Board of Directors through the Director-General, Evaluation. The goals of evaluation are to learn from experience, to provide an objective basis for assessing the results of the Bank Group’s work, and to provide accountability in the achievement of its objectives. It also improves Bank Group work by identifying and disseminating the lessons learned from experience and by framing recommendations drawn from evaluation findings. Global Program Review The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank’s Engagement with the Global Fund Electronic Survey Administered to World Bank Task Team Leaders and Global Fund Secretariat in March 2011 February 8, 2012 Public Sector Evaluation http://www.globalevaluations.org ©2012 Independent Evaluation Group, The World Bank Group 1818 H Street NW Washington DC 20433 Telephone: 202-458-4497 Internet: http://www.globalevaluations.org E-mail: ieg@worldbank.org All rights reserved This volume is a product of the staff of the Independent Evaluation Group (IEG) of the World Bank Group. It is part of an ongoing series that reviews global and regional partnership programs in which the World Bank is engaged as one of the partners. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. IEG does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of IEG concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this publication is copyrighted. IEG encourages the dissemination of its work and permits these reviews to be copied or otherwise transmitted, with appropriate credit given to IEG as the authoring body. How to cite this report: IEG (Independent Evaluation Group). 2012. “The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank’s Engagement with the Global Fund: Electronic Survey Administered to World Bank Task Team Leaders and Global Fund Secretariat in March 2011.� Cover photo: Children stand in a circle at a day school facility in Richards Bay, South Africa. The school is for children who have lost their parents to AIDS or have been affected in some way by HIV. Photo by Brent Stirton, courtesy of Getty Images. ISBN-13:978-1-60244-201-6 ISBN-10: 1-60244-201-0 Independent Evaluation Group Strategy, Communication, and Learning (IEGCS) E-mail: ieg@worldbank.org Telephone: 202-458-4497 Printed on Recycled Paper IEG Mission: Improving Development Results Through Excellence in Evaluation The Independent Evaluation Group (IEG) of the World Bank annually reviews a number of global and regional partnership programs (GRPPs) in which the Bank is a partner, in accordance with a mandate from the Bank’s Executive Board in September 2004. The three main purposes are (a) to help improve the relevance and effectiveness of the programs being reviewed, (b) to identify and disseminate lessons of broader application to other programs, and (c) to contribute to the development of standards, guidelines, and good practices for evaluating GRPPs. IEG does not, as a matter a policy, recommend the continuation or discontinuation of any programs being reviewed. A global or regional program review (GPR) is a review and not a full-fledged evaluation. The preparation of a GPR is contingent on a recently completed evaluation of the program, typically commissioned by the governing body of the program. Each GPR assesses the independence and quality of that evaluation; provides a second opinion on the effectiveness of the program, based on the evaluation; assesses the performance of the World Bank as a partner in the program; and draws lessons for the Bank’s engagement in GRPPs more generally. The GPR does not formally rate the various attributes of the program. Assessing the independence and quality of GRPP evaluations is an important aspect of GPRs in order to foster high-quality evaluation methodology and practice more uniformly across Bank-supported GRPPs. Providing a “second opinion� on the effectiveness of the program includes validating the major findings of the GRPP evaluation. Assessing the performance of the World Bank as a partner in the program provides accountability to the Bank’s Executive Board. In selecting programs for review, preference is given to (a) those that are innovative, large, or complex; (b) those in which the Bank is sufficiently engaged to warrant a GPR, (c) those that are relevant to upcoming IEG sector studies; (d) those for which the Executive Directors or Bank management have requested reviews; and (e) those that are likely to generate important lessons. IEG also aims for a representative distribution of GPRs across sectors in each fiscal year. A GPR seeks to add value to the program and to the World Bank beyond what is contained in the external evaluation, while also drawing upon IEG’s experience in reviewing a growing number of programs. It reports on key program developments since the evaluation was completed, including the progress in implementing the recommendations of the evaluation. A GPR involves a desk review of key documents, consultations with key stakeholders, and a mission to the program management unit (secretariat) of the program if this is located outside the World Bank or Washington, DC. Key stakeholders include the Bank’s representative on the governing body of the program, the Bank’s task team leader (if separate from the Bank’s representative), the program chair, the head of the secretariat, other program partners (at the governance and implementing levels), and other Bank operational staff involved with the program. The writer of a GPR may also consult with the person(s) who conducted the evaluation of the GRPP. Each GPR is subject to internal and external peer review and IEG management approval. Once cleared internally, the GPR is reviewed by the responsible Bank department and the secretariat of the program being reviewed. Comments received are taken into account in finalizing the document, and the formal management response from the program is attached to the final report. After the document has been distributed to the Bank’s Board of Executive Directors, it is disclosed to the public on IEG’s external Web site. Contents Abbreviations and Acronyms ................................................................................................... v Preface.................................................................................................................................... viii Background Questions to World Bank TTLs ........................................................................... 1 Background Questions to Global Fund Secretariat Staff .......................................................... 3 Questions Addressed to World Bank TTLs and Global Fund Country Programs Cluster Only........................................................................................................................................... 4 Questions Addressed to World Bank TTLs and All Three Clusters of Global Fund Secretariat Staff ......................................................................................................................................... 21 v Abbreviations and Acronyms AAA Analytical and Advisory Activities (World Bank) ACT Artemisinin combination therapy AIDS Acquired immunodeficiency syndrome ARV Antiretroviral therapy ASAP AIDS Strategy and Action Plan Service BCC Behavioral Change Communication CAS Country Assistance Strategy (World Bank) CBO Community Based Organization CCM Country Coordination Mechanism (Global Fund) CSO Civil society organization DFID Department for International Development (United Kingdom) FPM Fund Portfolio Manager (Global Fund) GAC Governance and Anti-Corruption (World Bank) GAMET Global HIV/AIDS Monitoring and Evaluation Support Team GAVI Global Alliance for Vaccines and Immunization (a global partnership program) GF Global Fund to Fight AIDS, Tuberculosis, and Malaria HIV Human immunodeficiency virus HRG High Risk Group HNP Health, nutrition and population HSS Health systems strengthening ICR Implementation Completion Report (World Bank) IDA International Development Association IDF Institutional Development Fund (World Bank) IEG Independent Evaluation Group, formerly OED (World Bank) IHP+ International Health Partnership and Related Activities JANS Joint Assessment of National Strategies JSDF Japan Social Development Fund (a World Bank trust fund) LFA Local Fund Agent (Global Fund) M&E Monitoring and evaluation MAP Multi-country AIDS Program (World Bank) MDGs Millennium Development Goals MOF Ministry of Finance MoH Ministry of Health NGO Nongovernmental organization OIG Office of the Inspector General (Global Fund) PAHO Pan-American Health Organization (WHO) PANCAP Pan Caribbean Partnership Against HIV/AIDS project (World Bank) PEPFAR President’s Emergency Plan for AIDS Relief (United States) PIU Project Implementation Unit PMU Project Management Unit PR Principal Recipient (Global Fund) RBF Results-based financing SWAp Sector-Wide Approach TA Technical assistance TAP HIV/AIDS Treatment Acceleration Project (World Bank) TB Tuberculosis TTL Task team leader (World Bank) UNAIDS Joint United Nations Program on HIV/AIDS UNODC United Nations Office on Drug and Crime UNDP United Nations Development Programme USAID United States Agency for International Development WB World Bank WHO World Health Organization vi Preface The Independent Evaluation Group (IEG) has conducted a review of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which focuses on the engagement between the World Bank and Global Fund-supported activities at the country level. As an input into this review, this electronic survey sought the views of World Bank and Global Fund staff on the breadth of this engagement since the Global Fund was established in 2002. The survey was administered to the staff of both organizations in March 2011. In the case of the World Bank, the survey was sent to the task team leaders of Bank- supported health projects that were disbursing when, or approved after, the Global Fund became active in the same country (the date of its first grant commitment to the country). At least one of the designated themes of their projects was HIV/AIDS, tuberculosis, malaria, communicable diseases, or health system performance. In the case of the Global Fund, the survey was sent to Secretariat staff in the Country Programs Cluster, the External Relations and Partnerships Cluster, and the Strategy, Performance and Evaluation Cluster. IEG gratefully acknowledges the assistance of Oren Ginzburg, Sandii Lwin, and Igor Oliynyk in administering the survey to Global Fund staff. Most of the questions in the two surveys were identical in order to compare the responses of the staff in the two organizations. Five questions were necessarily different, but still similar in nature. (See questions 6, 14, 17, 18 and 19.) This survey was confidential. The responses to the closed-ended questions are presented in aggregate form, making it impossible to identify individual responses. References to particular individuals and countries have been redacted from the responses to the open-ended questions also to preserve confidentiality. It goes without saying that the views expressed in the written responses to the open-ended questions do not represent the official views of the World Bank, the Global Fund, or the Independent Evaluation Group. 1 Background Questions to World Bank TTLs Question 1. Please indicate the countries in which you have been the TTL of record for a Bank-supported health project that was disbursing at the same time that the Global Fund was also active in the same country. If you identified more than one country, please answer this survey from the point of view of the country on which you worked the longest on a health project and in which the Global Fund has been the most active. World Bank TTL Respondents by Region Region No. of Respondents Share of Respondents Africa 20 48% East Asia & Pacific 6 14% Latin America & Caribbean 6 14% South Asia 5 12% Europe & Central Asia 4 10% Middle East & North Africa 1 2% a Total 42 100% a. This represents a response rate of 33 percent (42 of 128). Question 2. During the time period for which you were the TTL for the country you selected, please indicate where you were based. TTL Location No. of Respondents Share of Respondents In the World Bank office in the country 21 54% At World Bank headquarters in Washington, DC 15 38% In the World Bank office in a neighboring country 3 8% Total 39 100% Question 3a. Please indicate your professional background. Professional background No. of Respondents Share of Respondents Health, nutrition, or population specialist 24 62% Operations officer 7 18% Health economist 5 13% Other (please specify) 3 8% Total 39 100% 2 Question 3b. To what extent are you familiar with elements of the Global Fund’s current reform agenda such as the new grant architecture and grant consolidation process, National Strategy Applications, and the Country Team Approach? Level of familiarity No. of Respondents Share of Respondents A great deal 2 5% Substantially 9 23% Somewhat 16 41% Not at all 12 31% Total 39 100% 3 Background Questions to Global Fund Secretariat Staff Question 1. Please indicate the Cluster in which you are working. Cluster No. of Respondents Share of Respondents a Country Programs Cluster 36 69% Strategy, Performance and Evaluation Cluster 9 17% External Relations and Partnerships Cluster 7 13% b Total 52 100% a. This represents a response rate of 62 percent (36 of 58) for those questions that were only addressed to the Country Program Cluster. b. This represents an overall response rate of 49 percent (52 of 106) for the questions that were addressed to all three Clusters. Question 2. Please indicate the geographical area for which you are answering this survey. If you are a Fund Portfolio Manager that has worked on more than one country, please answer these questions from the point of view of the country on which you have worked the longest and in which the Global Fund has been most active. Country Programs Cluster Respondents by Region Region No. of Respondents Share of Respondents Africa 14 39% East Asia & Pacific 7 19% Latin America & Caribbean 5 14% South Asia 5 14% Europe & Central Asia 2 6% Middle East & North Africa 2 6% Global 1 3% Total 36 100% Question 3. Please indicate your professional background. Professional background No. of Respondents Share of Respondents Public health 18 38% Business administration 11 23% Medicine 3 6% Financial management 1 2% Accounting 1 2% Other (please specify) 14 29% Total 48 100% 4 Questions Addressed to World Bank TTLs and Global Fund Country Programs Cluster Only Question 4. In which of the following country-level processes of the Global Fund did World Bank staff or consultants participate during the years that you were working on this country? (Sorted in descending order: See Figure 1.) Responses by Organization Yes No Don’t Know Total Q4a: Member of the Country Coordinating Mechanism (CCM): World Bank Task Team Leaders 12 23 7 42 Global Fund – Country Programs Cluster 13 21 2 36 Q4g: Providing formal technical assistance to the Principal Recipients of Global Fund grants: World Bank Task Team Leaders 9 28 5 42 Global Fund – Country Programs Cluster 10 19 7 36 Q4b: Helping to prepare grant proposals for submission to the Global Fund: World Bank Task Team Leaders 11 27 4 42 Global Fund – Country Programs Cluster 9 20 7 36 Q4f: Helping with the oversight/supervision of Global Fund-financed activities: World Bank Task Team Leaders 8 30 4 42 Global Fund – Country Programs Cluster 8 19 9 36 Q4d: Helping to select Principal Recipients to implement approved Global Fund grants: World Bank Task Team Leaders 3 34 5 42 Global Fund – Country Programs Cluster 8 22 6 36 Q4e: Helping with financial management/procurement of Global Fund-financed activities: World Bank Task Team Leaders 4 34 4 42 Global Fund – Country Programs Cluster 7 23 6 36 Q4c: Participating in the selection of grant proposals for submission from the CCM to the Global Fund: World Bank Task Team Leaders 7 30 5 42 Global Fund – Country Programs Cluster 5 19 12 36 Question 5. In what other ways were World Bank staff or consultants involved in country- level activities that directly or indirectly contributed to the work of the Global Fund during the years that you have been working on this region, subregion, or country? (Sorted in descending order: See Figure 2.) Responses by Organization Yes No Don’t Know Total Q5c: Supporting ANALYTICAL WORK in relation to STRENGTHENING HEALTH SYSTEMS: World Bank Task Team Leaders 25 13 4 42 Global Fund – Country Programs Cluster 22 3 11 36 Q5a: Helping to prepare COUNTRY STRATEGIES such as an AIDS Strategy and Action Plan (ASAP) for combating HIV/AIDS, TB or malaria: World Bank Task Team Leaders 26 12 4 42 Global Fund – Country Programs Cluster 21 5 10 36 Q5b: Supporting ANALYTICAL WORK in relation to COMBATING HIV/AIDS, TB, or MALARIA: World Bank Task Team Leaders 19 18 4 41 Global Fund – Country Programs Cluster 16 7 13 36 Q5d: Helping to BUILD HUMAN RESOURCE CAPACITY to prepare and implement Global Fund grants in the country: World Bank Task Team Leaders 18 20 4 42 Global Fund – Country Programs Cluster 10 11 15 36 5 Figure 1. In which of the following country-level processes of the Global Fund did World Bank staff or consultants participate during the years that you were working on this country? (Percent “Yes�) Member of the Country Coordinating Mechanism Providing formal technical assistance to the Principal Recipients of Global Fund grants Helping to prepare grant proposals for submission to the Global Fund Helping with the oversight/supervision of Global Fund-financed activities Helping to select Principal Recipients to implement approved Global Fund grants Helping with financial management/procurement of Global Fund-financed activities Participating in the selection of grant proposals for submission from the CCM to the Global Fund 0% 10% 20% 30% 40% GF � Country Programs Staff WB � Task  Team Leaders 6 Figure 2. In what other ways were World Bank staff or consultants involved in country- level activities that directly or indirectly contributed to the work of the Global Fund during the years that you were working on this country? (Percent “Yes�) Supporting analytical work in relation to strengthening health systems Helping to prepare country strategies such as an AIDS Strategy and Action Plan (ASAP) for combating HIV/AIDS, TB or malaria Supporting analytical work in relation to combating HIV/AIDS, TB, or malaria Helping to build human resource capacity to prepare and implement Global Fund grants in the country 0% 20% 40% 60% 80% 100% GF � Country Programs Staff WB � Task  Team Leaders Question 5 (to World Bank TTLs). If you answered “Yes� to any of the above, please give the name and date of the products produced.1 The Bank was engaged in reviewing and providing comments on the HIV/AIDS medium-term strategic plan (2010–2015). Through the IDA-financed project assisting GAC in the development of the Youth Strategy and the BCC communication strategy. Through the ----- country status report in health, helping conduct a health systems review in relation to identifying areas for strengthening health systems. "Gender mainstreaming" in the National Aids Strategy and in the HIV/AIDS proposals. The WB ASAP team helped ----- prepare its National Strategic Plan for 2010–2014, which was approved by the Government in April 2010. A socioeconomic impact study of HIV/AIDS was prepared. Revised draft submitted in July 2010 that was funded by the WB project but not directly done by WB staff or WB consultants. Providing comments and ideas to proposals for GF funding, preparing and obtaining ASAP funding, financing general population survey, behavioral surveillance survey, sexual networking studies, and health facility survey. The ----- health program is being implemented as a SWAp against a comprehensive health sector strategy, which was developed in 2005. HIV/AIDS is one of the priority programs under the SWAp. Dialogue to seek resources from Global Fund for areas in the health sector related to three diseases which needed finances. The ----- National HIV/AIDS Strategic Plan – various dates, the latest in 2008. 1. The names of countries and individuals have been deleted from the open-ended responses in order to preserve the confidentiality of the respondents. 7 Implementation Completion and Results Report on a loan to ----- for a TB/AIDS Control Project. WB Working Paper #33, MDG Goals for Health in Europe and Central Asia: Relevance and Policy Implications (2004); WB Working Paper #20, HIV/AIDS and TB in Central Asia: Country Profiles (2003); WB Working Paper #54, Reversing the Tide: Priorities for HIV/AIDS Prevention in Central Asia (2005). Our Project supported reforms in the health sector that, among other topics, assisted in improving health networks effectiveness and efficiency in the provision of basic health services. Part of support provided under ongoing health projects. Participating in meetings of HIV/AIDS Donor Partner Coordination Group. Ensured within the context of donor coordination that the Global Fund project worked within the overall sector context and not merely as a vertical program ignoring the sectoral context. The Global Fund selected the existing World Bank's HIV/AIDS project implementing agency to be the recipient of the Global Fund grants, due to existing capacity in this agency in implementing projects. National HIV/AIDS strategy including support from ASAP. Design of the national HIV/AIDS Monitoring and Evaluation system with GAMET support on which the GF’s own system was inspired. National Heath Strategy. National Results-Based Financing Strategy and health project supporting strategy. Public Expenditure Review that included the health sector. Health Sector Financing Note. Implementation and supervision of MAP projects I and II. Two national AIDS surveys. Assessment of civil society capacity. Financing of most of the personnel of the national HIV/AIDS commission. Constant policy dialogue on how best use HIV/AIDS resources and how to set up a steering body for ARV procurement and monitoring. Proposing and carrying out joint missions with GF Fund Portfolio Managers. Providing comments for GF evaluation reports. Covering the financial gap left out by the GF not approving a round, through preparing a second MAP project. (1) Multi-Sectoral HIV/AIDS Strategy in 2000. (2) M&E Framework in 2002. (3) SPM I in 2005. (4) SPM II in 2009. (5) SPM II Roadmap in 2010. It was a direct target country for PANCAP analytical work and through a PANCAP implementing partner agency – the Pan American Health Organization (PAHO) – received (1) training support for its health workers in the use of rapid test and Provider-Initiated Testing and Counseling and (2) establishment of the conceptual framework and strategy for the Elimination of Mother to Child Transmission of HIV and Congenital Syphilis in the Caribbean, including a protocol for certification and horizontal collaboration between ----- and -----. Under the Central America HIV/AIDS Project, ----- benefitted from the analytical work undertaken on effectively targeting vulnerable communities (disabled populations and indigenous communities) with HIV/AIDS prevention messages and received a toolkit to shape its response for the disabled population. Assessment of Pharmaceutical Supply Chain System for -----. Strengthening partners’ coordination. Strengthening community-based activities. Lending operation to improve the quality of health workforce, especially doctors, dentists, nurses and midwives (2009–2014). Analytical works on health insurance schemes for the poor (2008–2010). Allocating resources for HIV/AIDS response in Guangxi (about 2006). A. Wagstaff, M. Lindelow, S. Wang, S, and S. Zhang. 2009. Reforming Rural Health System in China. Washington, DC. Country sector strategies in health and HIV/AIDS for 2006–2010 and 2011–2015. Sector Institutional Assessment for the national Response, 2009. ----- HIV Prevention Response and Modes of Transmission Analysis. Facilitated the various analytical work on HRH in the health sector. Capacity building for public expenditure tracking through HIV/AIDS expenditure tracking Health PER. Benin – Health and Poverty Report. (AAA51). Benin – Santé, nutrition et population: rapport analytique santé et pauvreté (2009). 8 Question 6 (to World Bank TTLs). Which of the following managers/staff/agents of the Global Fund did you contact and work with during the years that you were working on this country? (Sorted in descending order. See Figure 3.) Occasion- Don’t Responses Regularly Not at all Total ally Know Q6d: Principal Recipients of Global Fund grants, in 12 12 18 0 42 their role as Principal Recipients: Q6c: The Country Coordinating Mechanism (CCM): 11 10 21 0 42 Q6b: The Fund Portfolio Manager (FPM), based at the 3 17 21 1 42 Global Fund Secretariat in Geneva: Q6a: The Global Fund Country Team Leader, based at 4 13 24 1 42 the Global Fund Secretariat in Geneva: Q6e: The Local Fund Agent 3 13 25 1 42 Question 6 (to Global Fund Country Programs Cluster). Which of the following managers and staff of the World Bank did you contact and work with during the years that you have been working on this region, subregion, or country? (Sorted in descending order. See Figure 4.) Occasion- Don’t Responses Regularly Not at all Total ally Know Q6b: The Task Team Leader (TTL) of World Bank- 7 13 14 2 36 supported projects in the country: Q6c: The Project Implementation Units of World Bank- 2 15 17 2 36 supported health projects in the country: Q6e: Lead Human Development Specialists or 6 4 21 5 36 Economists: Q6d: The Regional Sector Manager for Health, 3 7 22 4 36 Nutrition and Population: Q6a: The Country Director for the country on which 1 9 22 4 36 you were working: 9 Figure 3. World Bank Task Team Leaders: Which of the following managers/staff/ agents of the Global Fund did you contact and work with during the years that you were working on this country? Principal Recipients of Global Fund grants, in their role as Principal Recipients The Country Coordinating Mechanism (CCM) The Fund Portfolio Manager (FPM), based at the Global Fund Secretariat in Geneva The Global Fund Country Team Leader, based at the Global Fund Secretariat in Geneva The Local Fund Agent 0% 20% 40% 60% 80% 100% Regularly Occasionally Not at all Figure 4. Global Fund – Country Programs Cluster: Which of the following managers and staff of the World Bank did you contact and work with during the years that you have been working on this region, subregion, or country? The Task Team Leader of World Bank-supported projects in the country The Project Implementation Units of World Bank- supported health projects in the country Lead Human Development Specialists or Economists The Regional Sector Manager for Health, Nutrition and Population The Country Director for the country on which you were working 0% 20% 40% 60% 80% 100% Regularly Occasionally Not at all 10 Question 7. Overall, how would you best characterize the relationship between the World Bank and the Global Fund during the years that you were working on this country? (Choose only one.) Responses by Organization Global Fund – Country World Bank TTLs Programs Cluster Collaborative: The two organizations' staff, consultants and agents worked together on common activities in the pursuit of commonly 2 6 agreed objectives. Complementary: The two organizations' staff, consultants, and agents 9 5 worked alongside each other in the pursuit of common objectives. Consultative: The two organizations' staff, consultants, and agents 4 5 consulted each other regularly in the course of their own activities. Sharing information only: The two organizations' staff, consultants, 12 4 and agents only shared information about each other’s activities. Unrelated and independent: The two organizations worked independently of each other supporting different health initiatives in the 8 8 country. Competitive: The two organizations competed for business among the 0 2 same potential clients. Other (Please specify.) 7 6 Total 42 36 Question 7. Open-ended responses to “Other (Please specify.)� From World Bank TTLs Initially the relationship was competitive. There was not enough capacity for additional funding, but they came in anyway. Once their project also stopped progressing, they began to take a more consultative approach. Ranging between sharing information only and consultative as a means to try to complement activities and avoid duplication. So far there has been less than optimal collaboration partly because the Bank was not involved in financing HIV/AIDS activities in -----. Through our Bank grant in -----, we were focused on surveillance (H1N1 response) and did not initially work with the Global Fund due to the focus area. A year later, once we received a JSDF grant which allowed us to scale up our work, we then began a wider dialogue with key country health actors including the Global Fund. We are now in contact with the National AIDS Program which is a Global Fund recipient and we are discussing the gaps they have in TA which the Bank can help fill. On the other hand, our coordination with the Fund for the PANCAP and Central America project were pretty regular and we did coordinate on activities and budget. Initially the relationship was collaborative, but later with change in FPM the relationship became consultative and in some cases sharing of information only Leveraging, i.e., the Global Fund leveraging Bank funding and vice versa. 11 From Global Fund – Country Programs Cluster The World Bank decided to stop activities after the coup d’état. When the Global Fund started its investigation, WB was willing to get the conclusions and approached the OIG for that. After the suspension by GF, and when WB was thinking of resuming funding, sharing information was done. Complementary/collaborative would have been better, to avoid any attempts at country level to make the two organizations competitive. I have consulted the Bank's program manager on one program. The World Bank has been ramping up its program in ----- after a long hiatus of very limited engagement. As of April 2010, there were no active projects in the portfolio and two were being prepared for Health, HIV/AIDS and TB and Local Government development, respectively. There are no related World Bank health initiatives in -----. World Bank support is geared towards agriculture and education. Potentially complementary, but for the fact that the WB health loan for HIV and TB faced implementation hurdles that were never fully resolved. Figure 5. Overall, how would you best characterize the relationship between the World Bank and the Global Fund during the years that you were working on this country? Collaborative: The two organizations' staff, consul- tants and agents worked together on common activ- ities in the pursuit of commonly agreed objectives. Complementary: The two organizations' staff, consultants, and agents worked alongside each other in the pursuit of common objectives. Consultative: The two organizations' staff, consultants, and agents consulted each other regularly in the course of their own activities. Sharing information only: The two organizations' staff, consultants, and agents only shared information about each other’s activities. Unrelated and independent: The two organizations worked independently of each other supporting different health initiatives in the country. Competitive: The two organizations competed for business among the same potential clients. 0% 10% 20% 30% 40% GF � Country Programs Staff WB � Task Team Leaders 12 Question 8. During the years that you were working on this country, what was the MOST SUCCESSFUL EXAMPLE of engagement between the Global Fund and the World Bank in terms of achieving positive results for this country? Describe very briefly. Question 9. Why and how was this successful? What positive results were achieved? Question 8. Most successful example. Question 9. Results achieved. From World Bank TTLs Good collaboration on scaling up AIDS treatment, Good collaboration with government counterparts with WB supporting initial AIDS treatment through and local health partners, which facilitated link to MAP; then GF scaled up further to another GF funding process. thousand patients, then WB TAP project piloted further scaling up, which has now been taken over by GF. Honesty, I cannot tell any specific story but the The planning did take into consideration the fact that both organizations came together to existence of each institution. support the central committee against HIV/AIDS and both avoided intervening in the same places (good distribution of place of interventions). No contact with GF. The Bank is an observer on It was successful because the NGOs were in the CCM. The most successful example was that charge of orphans and people living with HIV, the Bank project took over from the Global Fund and they were promoting HIV awareness. when they stopped financing NGOs in -----. This was made possible because of the Ministry in charge of HIV/AIDS, who contacted the Bank. The Government decided to use the funds from There was a complementarity that was achieved the WB project to finance activities related to between WB and GF efforts. For example, GF HIV/AIDS that could not be financed by the resources were used to finance drugs and the Global Fund grant. WB project was used for other complementary inputs and activities. Carrying out a joint mission. We presented a united front on a shared problem, and had greater leverage. There is still ongoing discussion with the Global N/A Fund to have its support integrated under the SWAp. There is potentially an opportunity to do so under the next health sector strategy (currently being finalized). The Government has been in the position to Good cooperation on the Government side to better coordinate, and avoiding overlapping. avoid duplication in the project activities. Global Fund support for HIV/AIDS when Bank Collaborative and consultative process of was financing the main program. supporting one program Change toward a better cooperation since There is a more united front of development replacement of the Fund Portfolio Manager by a partners on restructuring the CCM; selection of new person who saw opportunities and PR, etc. The Government receives consistent advantages of joint engagement and partnership. messages from all development partners. With the support of ASAP, the quality of the Increasing the success of the applications. application and success of applications have Building a Regional Coordination Committee. significantly increased. 13 Question 8. Most successful example. Question 9. Results achieved. There is no engagement between the Global Fund and the World Bank, UNDP is the principal recipient of the funds in the country and the CCM is composed of UN Agencies and majors NGOs. The government participation is very limited. We carried out a joint review of the HIV portfolio It enabled better understanding and preventing of projects and this included the Global Fund, the clients from playing up one against the other. Bank, other partners and USAID projects. There was shared learning and focus on government performance. The WB and GF teams agreed on a set of This was successful and it reduced the burden on indicators to monitor the performance of their the borrower in monitoring the respective projects. projects. Complementarity of interventions. Critical mass of resources. Supporting the constitution of a steering Shortage of second-line ARVs reduced. committee for the procurement and distribution of ARVs. Since the World Bank can only support limited While the World Bank resources were used to number of districts in the country, Global Fund support 216 districts initially, a similar number of resources were used to increase the number of districts was covered using GF resources. This districts to scale up the community response has helped increase awareness-raising activities component. at the community level. We met with the National AIDS Program Chair It was successful because it initiated our and Director (Global Fund recipient) during our dialogue. No positive results as of yet, but we did attendance at the PANCAP Annual General identify some areas of TA and potential timelines Meeting in October 2010. This meeting then led for the TA where ----- would like Bank assistance. to their participation in our February supervision mission of the ----- Influenza Grant at which time we began our discussions on TA the Bank could potentially provide to help fill any gaps in key areas that the Fund could not address through its grant to -----. Purchase of bednets for the country. AIDS Six million bednets distributed to women and strategic plan design. CCM produced a good children. A well planned 5-year strategic plan proposal for AIDS. developed by the country. The proposal was approved. Addressing governance during the brief period Strong working relationship between Global Fund that the Global Fund had a team leader that was and WB Team Leaders during this period yielded equally committed to this issue. stronger work plans. We really did not engage. We rejected the first We improved the quality of the proposal. This proposal that ----- produced and helped with its created some negative reactions from some improvement for the following year. That was all. partners. Most partners (like DFID and WHO) just wanted to give money away. 14 Question 8. Most successful example. Question 9. Results achieved. Initially the Bank worked together with the Global See above. Fund and developed one plan for mainstreaming HIV/AIDS in the workplace, pursuing the same goals and taking into consideration the comparative advantage of each institution. Unfortunately the resources from the Global Fund took time to be released and by that time changes in FPM were made. The new FPM was not interested in working with the Bank. The HSS platform I mentioned earlier can be See above. such a good example, but it is still in the making. Note that the platform was set up because the three institutions had activities related to Results- Based Financing (RBF). The leveraging of funding for capacity building of See above. NGO/CBO managerial and fiduciary the NGO network to manage contracts for capacity is a major constraint to successful NGO prevention interventions among most at-risk contracting of TIs for MARPs. This is being populations. World Bank made initial investment overcome through this complementary financial (IDF grant) in institutional development/capacity support from WB and Global Fund. building (managerial and fiduciary) of regional NGO. Global Fund stepped in and continued supporting the capacity building of the network which qualified for Global Fund grant due to the initial Bank-supported skills development. This is helping building CBO/NGO capacity in the country. Sharing of experience at the end of each mission From Global Fund Country Programs Cluster At my last mission to the Country, the World Joint decision making; common understanding of Bank Senior Health Expert in charge of the WB's pressing problems; resolving common problems. investments accompanied me during the entire mission. It was truly a joint mission, and his contributions were extremely valuable. In fact, many of the decisions taken during the trip were taken in close collaboration with the WB. In addition to the joint mission, we have met in Geneva and have had numerous telephone conferences on issues concerning HIV/AIDS and malaria in the country. Participation in a joint mission to align and Health Systems Platform: GF / WB / GAVI. harmonize HSS support with national parties and Framework with precise steps for harmonization partners. and alignment on M&E and Finance has been designed and is to be signed by all partners. Sharing the same Project Implementation Unit at It allowed synergy and harmonization in the the level of one of the Principal Recipients (PRs). management of programs. The recent coordination of approaches to the Coordination led to avoidance of duplication at Health Systems Funding Platform the stage of Financial Management Analysis of MOH. Consultations on TORs led to better quality analysis and to a product that could serve more than one user. 15 Question 8. Most successful example. Question 9. Results achieved. The World Bank will be supporting one of the TA support for the Principal Recipient is not yet Principal Recipients, the ----- Council of NGOs to measurable. During the training it was evident implement Round 8 HIV/AIDS. The World Bank that the CCM training will result in a more will fund short to long-term TA on financial informed CCM that can own the grants. management, procurement and Monitoring and Evaluation. The staff were on board from March 2011. The World Bank funded CCM training (provided the financial logistics and the Global Fund provided the trainers from the secretariat). 17 CCM members received training on dual-track financing, grant consolidation and the CCM governance policy. Complementarity of funding. For example, WB The complementarity was part of the proposal funds STI drugs, and Global Fund ARV drugs. design. In -----, joint missions were conducted as long as Sharing of information, coordination for technical the MAP program was ongoing. That was a assistance funding, and definition of indicators to positive experience of coordination between the report against. two institutions. The possibility to carry out a joint assessment/ Not materialized yet, work in progress. The audit of the procurement capacity of MOH: WB, positive aspect is not to carry out the work as GF Canada, GF. only, but to get it through MOH as an initiative of the donor community (as a whole) for the benefit of MOH. Review of complementarity of interventions and The same PR managed both funding. The WB sustainability of HIV interventions in light of the staff really worked closely with the PR and fact that the MAP was ending. communicated and discussed with GF along the way to ensure that interventions remained seamingless. The PR is clear about components no longer funded by MAP that should be funded against the next GF request for funding. Consultation on a new World Bank program. The I sent information about the GF portfolio when the World Bank has been ramping up its program in WB was putting together its new program. We ----- after a long hiatus of very limited have received details in return and incorporated engagement. As of April 2010, there were no the financials in the HIV grant Phase 2 analysis. active projects in the portfolio and two were being prepared for Health, HIV/AIDS and TB and Local Government development respectively. No active engagements have occurred to date as N/A the World Bank does not have direct active presence in the health sector in -----. The case of ----- is probably the most vivid Common vision, complementary strategies and example of the two institutions reaching a good deeper knowledge of both institutions' roles, level of collaboration and synergy. Joint missions, responsibilities, plans and working specificities information-sharing and common analysis/ contribute to reaching a better understanding of possible solutions to the numerous issues faced how to put efforts together towards common by the country are some examples. goals and objectives. 16 Question 8. Most successful example. Question 9. Results achieved. In 2008, the World Bank evaluation of the The result was a more lean and operational National AIDS Secretariat served as the basis for institution managing the grant in a satisfactory the Global Fund decision on restructuring the manner. The weaknesses identified in the supply institution. More recently, reports produced by the chain management will be addressed in the World Bank consultant served as identification of Capacity Development Plan. Part of this plan is weaknesses in the supply chain management already being funded by the World Bank, allowing and consequently the need for further assistance the Global Fund to build on this work. on that area. Information exchange between the two It was negotiated that GF-funded national organizations regarding systems and processes programs did not need to fall under the SWAp enabled a more informed approach to financial and other implementation arrangements implementation deadlines of the World at the time of SWAP inception. It was negotiated Bank/AusAID SWAp and the relationship to GF- that the Program Management Unit and existing funded national disease programs. financial reporting system (utilized for GF-funded programs) could continue during the SWAp transition phase and opportunities to harmonize (fall under the administrative SWAp arrangements) be considered at the time of HIV Phase 2 review. This would also enable the new SWAp arrangement to be put in place and any issues/lessons learned be considered. In ----- cooperation, information sharing, and World Bank is part of the Health SWAp in -----, involvement of the World Bank in joint program which is a formal and effective cooperation reviews as SWAp member. mechanism. In other countries where there is no such a formal mechanism of donor coordination, GF and WB relationships are very sporadic, i.e., it depends on the individual initiative to meet and share information. Just recently (2010) I could engage in As a result of this, we have received copies of the conversations with WB regional officials to ASAP studies in -----, which will be useful for the discuss trends and potential collaborative efforts preparation of the request of continuation of in the mapping of donors. This happened in the funds in 2011. CONCA/SIDA event. The World Bank supported a project for NGO Complementary work and no overlap in the strengthening until 2009 in ----- and resources and the kind of support being provided. complemented the work being developed with GF The coordination at the Ministry of Health level resources. for both GF and World Bank was a good model of resource and technical capacity sharing. Thanks to ASAP support, the preparation of the Excellent tool which helps the country in ----- Sub-regional AIDS Strategy was completed. elaborating good databases and results-based frameworks. The Global Fund has been supporting the use of ASAP among ----- region. There is a potential for collaborative work of the The potential exists resumption of activities in HIV and AIDS in ----- and ensuring fiduciary systems are in place for ----- and -----. This was mainly limited to attempts to organize joint country missions. First HIV Joint Monitoring Mission in ----- in 2009. It was the first HIV Joint Monitoring Mission. All findings were shared first time with MOH. 17 Question 8. Most successful example. Question 9. Results achieved. Participating and working together on Joint As the two largest donors for the three diseases, Monitoring Missions. we could leverage our views on areas of concern with the programs better when we worked together than separately. At the Global Fund we could make better and more informed decisions with the information provided by the WB personnel, particularly on procurement. Very good collaboration with the World Bank in I believe it was successful mainly because of the -----, e.g., the review of the NSP (December excellent professional, i.e., -----, who was 2009) and mapping of High Risk Groups interested in taking things forward in ----- and (ongoing). The “Research Proposal on Mapping worked closely and tirelessly with the Global High Risk Groups for HIV Prevention in -----� was Fund, the Principal Recipient, the National Aids prepared by the University of Manitoba in close Program, UNAIDS and UNODC to make things collaboration with the World Bank. The WB paid happen. The main two positive results were that for professional fees and DSA of the University of we had a comprehensive review of NSP with Manitoba staff. clear recommendations which are being taken forward by NAP with close collaboration with partners. The other positive result was the first mapping of HRGs which is taking place in -----. We have the best partnership in ----- where we I think the colleagues from DC office and local consulted WB colleagues frequently on all three office were positively engaged with our teams in diseases. In addition, we had very good these countries. ----- and I spoke frequently about collaboration in ----- and -----. our collaboration and we ensured that we met the TTL of each country mentioned and engaged in dialogues. Question 10. During the years that you were working on this country, what was the LEAST SUCCESSFUL ATTEMPT of engagement between the Global Fund and the World Bank in terms of achieving positive results for the country? Describe very briefly. Question 11. Why and how was this unsuccessful? What negative consequences ensued? Question 10. Least successful attempt. Question 11. Negative consequences ensued. From World Bank TTLs Financing for new malaria treatment protocol was See above. a debacle. We are both financing HIV in the same country I don't know but we could do better. and we don't talk. No attempt. Possible duplications and overlaps on the ground in activities financed by the two institutions. When they got all the Gates funds and they had It led to our project coming to a full stop and to to disburse fast, they basically sort of moved in to theirs never moving very far. There was not take away our business in several countries. enough capacity for two large donors, and they asked me about it and I was very honest. But they just ignored the Bank and went ahead. The Bank couldn't pay salaries to the civil The payment system is not consistent. servants and the GF could. Therefore, the Government official always preferred to work for the GF. 18 Question 10. Least successful attempt. Question 11. Negative consequences ensued. The attempt, in the early days, to integrate the The interests in and control over Global Fund CCM structure into existing coordination resources made this impossible. The negative mechanisms. consequence was the creation of a parallel "project"-type mechanism. Attempt to integrate vertical HIV/AIDS and TB Above mentioned was mainly due to resistance programs into the health system. Attempt to of the ex-GF Portfolio Manager and GF PIU cooperate under the current ----- Health SWAp managers to cooperate and be accountable. with GF as a parallel financier. Attempt in Further strengthening of vertical TB & HIV/AIDS streamlining CCM and CCM Secretariat's roles programs. and functions due to different messages sent to the Government. The fact is that we were not really working in the Given that were working on different areas there same areas, as our projects were focused more were no major negative consequences. However, on maternal and child health and health sector we could have had greater synergies since we reform. Still, there were some common themes, were working with similar target populations. but the few approaches did not lead to much other than sharing of information. Interaction between Bank MAP and UNDP- No incentives from both sides to share implemented GF activities. information and work in a synergistic or even collaborative way. Sustainability for the Regional Laboratory. The attempts to build an endowment fund to finance it failed. Lack of communication. We had an ongoing Inevitably there was duplication and Sector-Wide program, but the Global Fund was disgruntlement among donors. Global Fund ran the largest and missing partner in the dialogue. their own show and there was no coordination. This also allowed the Global Fund portfolio managers to disband all norms and create their own direct linkages. We never got beyond a meeting and some e-mails in which we agreed to work closer together, but this never materialized. I suppose incentives – as well as probably resources – on both sides were not conducive Failing to secure funding from GF. Program partly unfunded. The attempt to combine the CCM with Health The insistence of Global Fund on having Partners group. This was not successful. separate systems. Trying to absorb and align the CCM into the The CCM is still acting as an independent body, country's health sector coordination body. in some cases going against the MOH and Government’s policy. Joint supervision and constant dialogue has not This has prevented the possibility for joint been held because the Global Fund has no assessment and planning. presence at the country level. Following a change in Global Fund team Little to no pull factor from the Global Fund. leadership, addressing governance issues – specifically misprocurement and misuse of funds. There is nothing positive about this experience. The whole idea is affected by the lack of transparency in the decision making process. In addition, the weakness of the fiduciary supervision does not help. 19 Question 10. Least successful attempt. Question 11. Negative consequences ensued. Attempts at harmonization of procedures and This did not work as GF perceived the Bank to be geographical distribution of activities. bureaucratic while the Bank wanted to ensure rigor and quality of interventions to guarantee results on the ground. The Bank perceived GF as not being results-oriented, but rather disbursement-oriented. To see if the disbursement of the resources from Non-collaboration between Bank staff and the Global Fund for HIV/AIDS in the workplace could FPM. go through the same disbursement mechanisms that was established in MOF under the MAP project. Unfortunately, the Global Fund established another PIU in the same Ministry. I was rather disappointed that in 2010 the GF did To some extent, damages were reduced, as we not take into account the new strategy developed were able to incorporate some of the GF-funded by the Government and several donors. This activities into the HSS platform. But there is still a revamped strategy has been used as the basis of lot of anger among local donors, as the GF did the IHP Compact (signed in November 2010). It not use the opportunity of the Compact. In other corresponds to a major effort of alignment and words, they are not involved in policy dialogue harmonization among donors and with the and their completely separate budget cycle can Government. The GF did not want to wait for the even undermine it. final approval of this strategy and preferred instead to fund a shopping list of activities (specially prepared for the GF). Failure of the Global Fund to participate Little absorptive capacity in the Global Fund – to substantially in joint implementation review learn and contribute. missions due to lack of experience and competence of junior Global Fund staff attending these missions – instead of senior staff. Relationship was quite limited beyond debriefing meeting, given the fact that there was a separate HIV/AIDS operation in the country financed by IDA and managed by another TTL. From Global Fund Country Programs Cluster One of the attempts that failed was the joint country missions that could have benefitted both organizations. No regular communication or interaction with N/A World Bank on Global Fund grant issues in the Pacific region. Initial lack of communication between the Lack of inclusion of GF by the World Bank in organizations led to complete lack of awareness early donor coordination/consultation meant that by the Global Fund that a SWAP was proposed. the GF was scrambling to catch up with the proposed approach and timelines. The GF was then perceived as “difficult.� However, the proposed approach potentially threatened the hard-won progress that had been made on GF- funded disease program implementation. In ----- and ----- there is a lack of involvement of Weak CCM. WB in CCM activities. 20 Question 10. Least successful attempt. Question 11. Negative consequences ensued. The Global Fund had to ask its PR to reprogram funding under the Round 1 grant to cover both prevention and treatment care and support objectives. When we requested information on -----, the The mapping exercise could not be completed, answer was that no activities were being funded as there was not a clear status of the WB support there. However, a bilateral donor mentioned that (loans, direct TA, etc.?). there was a cooperation financed by the WB. It could have been a misunderstanding, but the complexity of the WB structures is not easy to understand in the context of the three diseases on effective outcomes. The World Bank project ended and there was no It could have been more successful had there coordination for those NGOs that had been been an exit strategy that had been well receiving funding from the WB project. Many of coordinated with the GF, to ensure effective these organizations turned to the MOH for response by all parties involved. The country had support and funds had to be reprogrammed in to request reprogramming of resources to the GF grant to continue with some of the support the NGO community in their programs. activities being carried out by the NGOs. Regular coordination or collaboration. There is no clear coordination mechanism between the two organizations; therefore we have only sporadic cases of collaboration. There is a clear need to look at lessons learned from the MAP program, its institutional legacies in many countries and its impact on continuous capacity building for national AIDS commissions. HIV funding in -----. ----- project discontinuation Because the GF grant could not cover all gaps and also the pull out of HIV funding due to floods created by discontinuation of HIV funding by WB in August 2010. (the grant has an approved ceiling). I don't think the WB ever contacted me. I was always the person initiating the relationship. In -----, we simply did not have much I think we could have collaborated on Health collaboration since the WB was not involved in Systems. any of the three diseases. 21 Questions Addressed to World Bank TTLs and All Three Clusters of Global Fund Secretariat Staff Question 12. To what extent do you consider the World Bank to be a partner of the Global Fund AT THE GLOBAL LEVEL? Responses by Organization Negligible Modest Substantial High No Opinion Total World Bank Task Team Leaders 3 19 9 3 5 39 Global Fund – All Clusters 1 11 24 14 0 50 Question 13. To what extent do you consider the World Bank to be a partner of the Global Fund AT THE COUNTRY LEVEL? Responses by Organization Negligible Modest Substantial High No Opinion Total World Bank Task Team Leaders 8 19 9 1 2 39 Global Fund – All Clusters 3 22 15 8 2 50 Figure 6. To what extent do you consider the World Bank to be a partner of the Global Fund (a) at the global level and (b) at the country level? Global Fund – All Clusters: (a) At the Global Level: (b) At the Country Level: World Bank – Task Team Leaders: (a) At the Global Level: (b) At the Country Level 0% 20% 40% 60% 80% 100% High Substantial Modest Negligible 22 Question 14 (to World Bank TTLs): In your opinion, do the following factors make it easier or more difficult for World Bank staff or consultants to engage with Global Fund- supported activities at the country level? Answer all questions on a five-point scale from “much easier� to “much more difficult�. (Sorted in descending order from “much easier� to “much more difficult�. See Figure 7) Neither Some- Some- Much Much easier nor what Response by Subquestion what more Total easier more more easier difficult difficult difficult Q8n: The presence of other mechanisms through which the World Bank and the Global Fund may interact, such as the AIDS Strategy and Action Plans (ASAPs), the Joint Assessment of 5 16 14 4 0 39 National Strategies (JANS), and the Joint Funding Platform for Health Systems Strengthening. Q8d: The focus of the Global Fund on low-income countries 5 11 19 4 0 39 (similar to IDA-eligible countries). Q8i: The presence of civil society organizations on the Country Coordinating Mechanism. (CSOs help prepare grant proposals 2 16 17 2 2 39 and may implement some GF-supported activities as Principal Recipients or Sub-Recipients.) Q8j: The fact that the Principal Recipient (implementing agency) for Global Fund grants is not restricted to government agencies. 2 10 22 5 0 39 (International organizations such as UNDP, CSOs, and universities may be Principal Recipients.) Q8k: The fact that the Local Fund Agent is responsible for overseeing the integrity of the implementation of Global Fund 2 6 23 6 2 39 grants from the Global Fund perspective. Q8b: The success of Global Fund in mobilizing substantial donor resources to combat the three diseases. 2 4 26 7 0 39 Q8c: The fact that the Global Fund provides financial assistance 1 6 22 8 2 39 in the form of grants. Q8a: The absence of written Bank-wide guidelines or directives for engaging with the Global Fund beyond the general language 2 3 21 11 2 39 contained in the 2007 HNP Strategy. Q8l: The fact that Fund Portfolio Managers generally have a different professional background from the Bank’s health sector 1 0 24 12 2 39 task team leaders. Q8h: The fact that Global Fund uses a disease-specific monitoring system to support its performance-based funding 1 2 14 18 4 39 approach to development assistance. Q8g: The different project cycle of the Global Fund compared to the World Bank. (The Country Coordinating Mechanism is responsible for preparing, reviewing and submitting grant 0 0 19 16 4 39 proposals to the Global Fund, and for overseeing implementation from the country perspective.) Q8f: The lack of financial compensation for providing technical support. (This has represented an unfunded mandate.) 0 1 17 17 4 39 Q8m: The absence of a Memorandum of Understanding between the Global Fund and the World Bank for collaborating at the 0 0 13 21 5 39 country level. Q8e: The limited country presence of the Global Fund. (Their Fund Portfolio Managers are based in Geneva.) 0 0 10 14 15 39 23 Figure 7. World Bank Task Team Leaders: In your opinion, do the following factors make it easier or more difficult for World Bank staff or consultants to engage with Global Fund-supported activities at the country level? The presence of other mechanisms through which the World Bank and the Global Fund may interact, such ASAPs, JANS, and the Joint Funding Platform. The focus of the Global Fund on low-income countries (similar to IDA-eligible countries). The presence of civil society organizations on the Country Coordinating Mechanism. The fact that the Principal Recipient for Global Fund grants is not restricted to government agencies. The fact that the Local Fund Agent is responsible for overseeing the integrity of the implementation of Global Fund grants from the Global Fund perspective. The success of Global Fund in mobilizing substantial donor resources to combat the three diseases. The fact that the Global Fund provides financial assistance in the form of grants. The absence of written Bank-wide guidelines or directives for engaging with the Global Fund. The fact that Fund Portfolio Managers generally have a different professional background from the Bank’s health sector task team leaders. The fact that Global Fund uses a disease-specific monitoring system to support its performance-based funding approach to development assistance. The different project cycle of the Global Fund compared to the World Bank. The lack of financial compensation for providing technical support. The absence of a Memorandum of Understanding between the Global Fund and the World Bank for collaborating at the country level. The limited country presence of the Global Fund. (Their FPMs based in Geneva.) 0% 20% 40% 60% 80% 100% Much easier Somewhat easier Neither easier nor more difficult  Somewhat more difficult Much more difficult 24 Question 14 (to Global Fund Staff): In your opinion, do the following factors make it easier or more difficult for Global Fund managers, staff or agents to engage with the World Bank at the country level? Answer all questions on a five-point scale from “much easier� to “much more difficult�. (Sorted in descending order. See Figure 8.) Neither Some- Some- Much Much easier what Response by Subquestion what more Total easier nor more more easier difficult difficult difficult Q14e: The relatively strong country presence of the World Bank. (Their Task Team Leaders are often based in the country, depending on the 10 25 13 2 0 50 size of the Bank’s country program.) Q14i: The fact that the World Bank provides technical and/or financial support to strengthen country-level health sector monitoring and 6 29 15 0 0 50 evaluation systems. Q14l: The fact that a Task Team Leader is responsible for overseeing the implementation of World Bank-supported projects and technical 4 17 28 1 0 50 assistance activities. Q14b: The success of the Global Fund in mobilizing substantial donor 4 13 30 3 0 50 resources to combat the three diseases. Q14o: The presence of other mechanisms through which the World Bank and the Global Fund may interact, such as the AIDS Strategy and Action Plans (ASAPs), the Joint Assessment of National Strategies 5 20 14 8 3 50 (JANS), and the Joint Funding Platform for Health Systems Strengthening. Q14d: The focus of the Global Fund on low-income countries. 1 8 41 0 0 50 Q14m: The fact that Bank health sector Task Team Leaders have a 0 3 41 5 1 50 different professional background from Fund Portfolio Managers. Q14f: The World Bank requirement of Bank budgetary or trust fund resources for everything done by staff, including provision of technical 0 6 29 14 1 50 support. Q14k: The fact that World Bank-supported projects are implemented by government agencies (although governments may enlist NGOs and civil 1 6 28 9 6 50 society organizations for implementation). Q14c: The fact that the World Bank provides financial assistance 0 4 30 12 4 50 primarily in the form of loans as opposed to grants. Q14a: The absence of written Global Fund guidelines or directives for 0 3 26 19 2 50 engaging with the World Bank at the country level. Q14h: The fact that World Bank investment projects and technical assistance activities are based on a Country Assistance Strategy (CAS) negotiated between the World Bank and the Government. (The health 0 8 18 19 5 50 sector, including World Bank funding for it and associated budget support for project supervision, has to compete with other sectors for its place in the CAS.) Q14g: The different project cycle of the World Bank compared to the Global Fund. (Bank-financed projects are generally prepared 0 2 20 24 4 50 collaboratively by Government staff and consultants, with World Bank staff support, and negotiated between the Government and the Bank.) Q14j: The fact that the World Bank is less engaged with civil society 0 1 21 17 11 50 organizations compared to the Global Fund. Q14n: The absence of a Memorandum of Understanding between the 0 1 18 23 8 50 Global Fund and the World Bank for collaborating at the country level. 25 Figure 8. Global Fund: In your opinion, do the following factors make it easier or more difficult for Global Fund managers, staff or agents to engage with the World Bank at the country level? The relatively strong country presence of the World Bank. (Their Task Team Leaders are often based in the country.) The fact that the World Bank provides technical and/or financial support to strengthen country-level health sector monitoring and evaluation systems. The fact that a Task Team Leader is responsible for overseeing the implementation of World Bank- supported projects and technical assistance activities. The success of the Global Fund in mobilizing sub- stantial donor resources to combat the three diseases. The presence of other mechanisms through which the World Bank and the Global Fund may interact, such as ASAPs, JANS, and the Joint Funding Platform. The focus of the Global Fund on low-income countries. The fact that Bank health sector Task Team Leaders have a different professional background from Fund Portfolio Managers. The World Bank requirement of Bank budgetary or trust fund resources for everything done by staff, including provision of technical support. The fact that World Bank-supported projects are implemented by government agencies. The fact that the World Bank provides financial assistance primarily in the form of loans. The absence of written Global Fund guidelines for engaging with the World Bank at the country level. The fact that World Bank investment projects and technical assistance activities are based on a Country Assistance Strategy (CAS). The different project cycle of the World Bank compared to the Global Fund. The fact that the World Bank is less engaged with civil society organizations compared to the Global Fund. The absence of a Memorandum of Understanding between the Global Fund and the World Bank for collaborating at the country level. 0% 20% 40% 60% 80% 100% Much easier Somewhat easier Neither easier nor more difficult Somewhat more difficult Much more difficult 26 Question 15. Indicate other factors, if any, which have made it EASIER for the World Bank and the Global Fund to engage at the country level. Question 16. Indicate other factors, if any, which have made it MORE DIFFICULT for the World Bank and the Global Fund to engage at the country level. Question 15: Easier Question 16: More Difficult From World Bank TTLs The CCM team should participate in the country SWAp, and provide a forum for review of GF project implementation and performance to a wider stakeholder audience. More recently, there clearly have been signals The uncertainty of the GF grant-making from Geneva for staff to seek greater mechanism significantly complicates annual collaboration with WB and other organizations planning. A good example from my time in ----- is (seeing this during my current post in -----). when – under pressure from WHO and to some extent GF – the MOH changed its malaria treatment protocol from chloroquine to ACT combinations (which increased costs from pennies per pill to over one dollar). Doctors were trained in the new protocol and then GF rejected the malaria grant proposal on “technical� grounds. We had to scramble with Roll Back Malaria funds to try to finance both ACTs and bednets. The governance mechanism for GF, particularly CCM, is fundamentally different than those governing SWAps, etc., so this complicates coordination, even if WB is on CCM. Difficulty in having World Bank consultants working with other consultants paid by the UN system. Lack of openness about what they are really doing. Given the nature of the SWAp and the recommendations made in several Joint Annual Reviews, it would be of utmost importance to integrate vertical programs like the GF. This would facilitate efforts and would allow for a more comprehensive review of the HIV/AIDS priority program under the SWAp. Someone from GF should be represented in the No representative in the country country. Understanding of ground realities. Global Fund has its own agenda which is not clearly defined in my view for good collaborative work. In addition, as proposals are the reviewed and approved by Global Fund, it is somewhat more difficult to have a dialogue when one is not sure of the outcome of proposal process. 27 Question 15: Easier Question 16: More Difficult Good personal relationships with the Portfolio (a) The parallel coordinating structure in the form managers, LFA and PR staff. of the CCM. (b) The unpredictability of large sums of Global Fund grants. (c) The usual lack of consensus on which organization can formally represent civil society in the CCM. (d) The fact that civil society participation in Global Fund activities has resulted in the view that part of Global Fund resources can be rightfully claimed by CSOs, irrespective of the results to be achieved and who has a comparative advantage of achieving them. (e) The distortions that huge Global Fund resources create – with which we don't always want to be associated. (f) The "project" approach of Global Fund grants processing, especially when the Bank is pursuing a SWAp. (g) The fact that Global Fund grant cycles are usually not aligned with government budget cycles. CCM mechanism. Unwillingness of ex-Fund Portfolio Manager to engage with other development partners under Health SWAp in any form of cooperation. Sustainability of the interventions. Only limited presence and involvement of WB in the country – no human and financial resources to do anything else than project supervision. Weak capacity in the WB country office to liaise / work strategically with other partners. When ----- did not get funding for AIDS for one The insistence on using a mechanism separated round, the dialogue with the implementation team from existing national coordination mechanisms to of GF-financed activities improved and there was design coordination and fiduciary reviews and not a certain degree of alignment to the country really supporting the national programs. The strategy. distorted image of being a lean and independent organization, while they rely on other technical agencies, particularly WHO and other donors to prepare and supervise technically their projects and then claim credit for the totality of the results at the global level. The sheer size of grants that introduce substantial distortions in: (a) the health system, displacing much needed human and fiscal resources toward one or two areas to the detriment of other issues; (b) the macroeconomic balance and government budgets of small economies; (c) the overall MDG as the impact of the distortions in the overall health of the population goes unmeasured. The resistance to financing the country's implementation institutions beyond the Fund's limited implementation team. The use of low-quality consultants and lack of technical review of the products of these consultants. The irregularity and uncertainty of funding as rounds may or may not get approved. The assessment of proposals by people that often have not put a foot in the country. 28 Question 15: Easier Question 16: More Difficult From Global Fund Staff The fact that the Global Fund funding can complement areas that are outside the scope of the World Bank Country assistance strategy. The relationship between the Fund Portfolio More time would need to be invested in building Manager and the World Bank task leader has this relationship and more engagement is made country engagement easier. paramount to identify areas of possible collaboration. In ----- the WB is also supporting the civil society. Unclear at times who would be best contact person for GF within WB for a given country/portfolio. At times I encountered non- responsiveness (for a country in which WB has reduced its engagement/"pulled-out" of health sector). When the interlocutors are well known, and the When one of the two parts is not seeing the individuals are pro-active in sharing the interest of coordinating. It is easier for the WB information. When both sides are ready to share when there is a country office to know what are financial information. To get the list of who's who the other sources of funding, and liaising with GF from both sides, so that we know who to contact counterparts. I am currently struggling to get the for country X or Y. From GF side, information can contact person in one of the countries where I be found, browsing on internet (name and work, to reinforce the coordination. As part of a address of the FPMs are there). But the contact specific meeting on malaria, I shared with details of staff in charge of country X or Y at WB? Washington interlocutors the list of FPMs for the At Washington level? At country level? Unit, and requested to get the list of counterparts, per country – first step for increasing the collaboration and coordination. No answer at all. The level of engagement and commitment of staff Once a decision is made to disengage from a in-country certainly makes it easier. sector, staff can no longer commit time for it. The collaboration works well where there are It's always difficult for an FPM to maintain a fluid common interests and common objectives. You relationship with people based in a third country, cannot force collaboration if the above is not i.e. neither in Geneva or in the country. There is a present. lot of coordination that needs to happen, which may be difficult. Lack of interest, flexibility, competitiveness between the two organizations at country level. Perhaps organizing more systematic meetings between TTLs and FPMs would contribute to enhanced collaboration. Lack of interest at the level of WB staff in interacting with GF staff. The two are just very different. JANS will only complicate things further as will a joint health systems funding platform. More active involvement from in-country WB staff Distance and lack of presence of either WB or GF in grant issues through CCM, contact with FPM, in Pacific Island countries. and providing TA to government PR, especially in the financial management system and Health Systems Strengthening. 29 Question 15: Easier Question 16: More Difficult Updates and communications between GF and In 2006–2007, lack of recognition/inclusion of the World Bank about planned country visits so that GF as a donor/stakeholder led to exclusion of the we could coordinate visit schedules. GF in early planning discussions led by the World Bank. Health SWAp. Weak CCM. Complementary, defined and costed objectives The WB's effort to catch up on spending was at within aligned budgets would help in theory. times counterproductive. Some initiatives are shared with the different The absence of a permanent presence in CCMs. actors (ASAP), which facilitates understanding of Lack of detailed information on effective support the epidemiological situation and other related to countries and conditions for it. The Global factors. Fund is not being invited into WB negotiations with governments – at least as an observer – (generates lack of coordination, duplication of efforts, etc.). The same applies in the opposite way. When World Bank is more focused on other areas in a country, there may not even be someone on the ground interested in learning about the GF project or coordination. This was the case in ----- specifically when we went for a visit in October 2009. The World Bank had closed the HIV project and there was no one to discuss future support or actions at the country level. Nor were we referred to discussion for other types of technical support that ----- would be able to access through regional mechanisms at the World Bank. Interest in fiduciary responsibilities. Different modalities of engaging with national partners, and non-systematic presence of the World Bank at the level of the CCMs. The fact that the World Bank has a great professional such as -----, Program Coordinator HIV/AIDS, Human Development, ----- Region. I also had the privilege to work with other two outstanding World Bank professionals. Their professionalism, interest and engagement made it easy to establish very good and close working relationships between the Global Fund and World Bank, which I believe were highly beneficial for the countries, i.e. ----- and ----- TB. Attitude of the teams at the country level and We are country-proposals driven and the Fund TTLs. Portfolio Managers are not part of the initial design and discussions. We also do not have the sectoral support arrangement that WB has. 30 Question 17 (to World Bank TTLs). The Global Fund and PEPFAR (the U.S. President’s Emergency Fund for AIDS Relief) are now the two largest providers of financial resources for combating communicable diseases in developing countries. In your opinion, to what extent has their presence had the following impacts on the World Bank since the two programs were established in 2002 and 2003, respectively? Much No Much Don't Response by Subquestion Higher Lower Total higher Change lower Know World Bank lending for combating communicable diseases is LOWER OR HIGHER 0 2 4 20 11 2 39 than it otherwise would have been. World Bank lending to the overall health sector is LOWER OR HIGHER than it otherwise would 0 2 11 16 8 2 39 have been? World Bank lending for strengthening health systems is LOWER OR HIGHER than it 0 5 16 11 4 3 39 otherwise would have been. High Substantial Modest Negligible Don't Response by Subquestion Total impact impact impact impact know The way in which the World Bank operates at the country level has become MORE INCLUSIVE than it otherwise would have been, 2 4 13 15 5 39 involving more engagement with civil society organizations. World Bank lending to the health sector has become MORE RESULTS-FOCUSED than it 2 7 8 16 6 39 otherwise would have been. World Bank-supported activities reflect a greater degree of COUNTRY OWNERSHIP 2 8 7 16 6 39 than would otherwise have been the case. 31 Figure 9. World Bank Task Team Leaders: In your opinion, to what extent has the presence of the Global Fund and PEPFAR had the following impacts on the World Bank since the two programs were established in 2002 and 2003, respectively? World Bank lending for combating communicable diseases is lower or higher than it otherwise would have been. World Bank lending to the overall health sector is lower or higher than it otherwise would have been? World Bank lending for strengthening health systems is lower or higher than it otherwise would have been. 0% 20% 40% 60% 80% 100% Much lower Lower No Change Higher Much higher The way in which the World Bank operates at the country level has become more inclusive than it otherwise would have been, involving more engagement with civil society organizations. World Bank lending to the health sector has become more results-focused than it otherwise would have been. World Bank-supported activities reflect a greater degree of country ownership than would otherwise have been the case. 0% 20% 40% 60% 80% 100% Negligible Modest Substantial High Source: IEG Survey of World Bank HNP Task Team Leaders and Global Fund Secretariat staff, administered in March 2011. 32 Question 17 (to Global Fund Staff). The Five-Year Evaluation of the Global Fund was completed in May 2009. In your opinion, to what extent have the findings and recommendations of the Five-Year Evaluation had the following impact on the Global Fund? (Sorted in descending order. See Figure 10.) Response by Subquestion High Substantial Modest Negligible Total The Global Fund has sharpened its practices in the areas of PROCUREMENT, AUDIT, AND ANTI-CORRUPTION. 7 29 13 1 50 The Global Fund has become MORE PROGRAM-BASED, as opposed to individual grant based, in its funding decisions. 7 26 15 2 50 The Global Fund is improving the ALIGNMENT of its grants with each country’s planning and budgeting cycles. 9 23 16 2 50 Global Fund grants are providing more support to STRENGTHENING NATIONAL HEALTH MANAGEMENT 3 21 23 3 50 INFORMATION SYSTEMS. The Global Fund is devoting more resources to ENHANCING THE CAPACITY AND EFFECTIVENESS OF CCMS in their 0 22 25 3 50 full range of functions. Global Fund grants are putting more focus on DISEASE- PREVENTION ACTIVITIES, as opposed to treatment, care 2 13 29 6 50 and support activities, taking into account the local context of each epidemic. The Global Fund has improved its ability TO ADEQUATELY REWARD AND RETAIN ITS STAFF. 1 4 24 21 50 33 Figure 10. To what extent have the findings and recommendations of the Five-Year Evaluation had the following impacts on the Global Fund? The Global Fund has sharpened its practices in the areas of procurement, audit, and anti- corruption. The Global Fund is improving the alignment of its grants with each country’s planning and budgeting cycles. The Global Fund has become more program- based, as opposed to individual grant based, in its funding decisions. Global Fund grants are providing more support to strengthening national health management information systems. The Global Fund is devoting more resources to enhancing the capacity and effectiveness of CCMs in their full range of functions. Global Fund grants are putting more focus on disease-prevention activities, as opposed to treatment, care and support activities, taking into account the local context of each epidemic. The Global Fund has improved its ability to adequately reward and retain its staff. 0% 20% 40% 60% 80% 100% High Substantial Modest Negligible 34 Question 18 (to World Bank TTLs). Which of the following do you consider the most important COMPARATIVE ADVANTAGES OF THE GLOBAL FUND among international development agencies in terms of achieving positive results for the three diseases at the country level? Please rank the top five in order of importance (1 = most important, 2 = second most important, etc.) Mobilizing donor resources to combat the three diseases in the short term Promoting country-owned strategies and other responses to combat the three diseases Sustaining financial resources to combat the three diseases over the long term Facilitating an effective rapid response to the three diseases in the short term Developing specialized expertise in the prevention, treatment, and care and support in dealing with the three diseases Lowering the transactions costs of development assistance from the point of view of donors Promoting a results focus to development assistance Average Lowering the transactions costs of development assistance from the point of view of beneficiaries Building institutional and human resource capacity to combat the three diseases over the long term Ensuring that aid resources are used efficiently and effectively 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 35 Question 19 (to World Bank TTLs). Please indicate any other comparative advantages of the Global Fund in relation to other international development agencies that you consider important at the country level. (1) GF able to work with public and non-public sector agencies more easily. WB lending on the other hand restricts our easy engagement with private sector. (2) GF able to engage CSOs more easily. Significant amount of funding for each disease-specific project Global Fund is able to work with the private sector better than what the Bank does. I think that right now the main and only comparative of the GF is to raise resources for the short term. If the GF were to go back to its original roots of being a mere mechanism to raise funds and channel them to the countries national programs, taking into consideration the country resource levels in health, it could also become a good way to raise resources for the long term. GF was successful in generating resources in a short time. They can provide grants. Funding for community-based and civil society organizations. They have a lot of money and they sometimes fund shopping lists (i.e. not articulated strategies), with a lot of "income-generating" activities (i.e. training). 36 Question 18 (To Global Fund Staff). Which of the following do you consider to be the most important COMPARATIVE ADVANTAGES OF THE WORLD BANK among international development agencies in terms of achieving positive results at the country level? Facilitating dialogue with Ministries of Finance, Planning and other Central Ministries. Helping to improve financial management and procurement. Providing finance for long-term investments in health infrastructure. Helping to design and prepare investment projects in the health sector. Helping to formulate appropriate strategies and policies in the health sector. Helping to reform health care finance systems over the long term. Helping to strengthen health delivery systems over the long term. Average Organizing and facilitating policy dialogue at the national, sectoral and project levels. Managing country-specific donor trust funds. Supervising investment projects and field operations. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 37 Question 19 (To Global Fund Staff). Please indicate any other comparative advantages of the World Bank that you consider important. Planning: the Health Economics outlook, familiarity with cost-benefit measurement tools. Before Implementation: International Agreements with Governments; During implementation: clear, uniform, stable guidelines for procurement and financial management. The World Bank has local infrastructure which is helpful in monitoring resources and investments. The Team or Task Leaders are also closer to the beneficiaries and this enhances a certain level of impact. WB is a mature, systematized organization. It would bring a lot to the GF to enhance the partnership level with the WB, this not meaning losing GF's identity and principles. Long term engagement in health sector reforms – although the long-term perspective also has a perverse effect of "extending" the length of those reforms. Its position as a multinational actor respected around the world. It is not a "profit entity". WB is a knowledge bank and has huge technical expertise. 38 Question 20. What changes would you like to see in the Global Fund and the World Bank to facilitate greater engagement between the two organizations to achieve positive results at the country level, while also respecting each organization’s fundamental purposes and principles? Responses by Organization Yes No Don’t Know Total The Global Fund's participating in multi-donor Sector-Wide Approaches (SWAps) in support of nationally-defined programs to combat the three diseases. World Bank Task Team Leaders 36 0 3 39 Global Fund – All Clusters 22 20 7 49 The Global Fund’s donors establishing a trust fund at the World Bank for financing Bank-supervised technical assistance in support of Global Fund-supported activities. World Bank Task Team Leaders 35 1 3 39 Global Fund – All Clusters 16 18 15 49 The Global Fund’s co-financing World Bank projects in the health sector, like bilateral donors currently co-finance Bank projects. World Bank Task Team Leaders 32 3 4 39 Global Fund – All Clusters 17 26 6 49 The World Bank’s being an ex officio member of the Country Coordinating Mechanism wherever the Bank is an active player in the health sector in the country. World Bank Task Team Leaders 26 7 6 39 Global Fund – All Clusters 40 4 5 49 The Global Fund’s providing direct financing for World Bank-supervised technical assistance activities in support of Global Fund-supported activities. World Bank Task Team Leaders 25 5 9 39 Global Fund – All Clusters 19 19 11 49 The two organizations' establishing an active staff exchange program. World Bank Task Team Leaders 23 8 8 39 Global Fund – All Clusters 42 3 4 49 The World Bank’s playing the role (for a fee) of the Local Fund Agent overseeing selected Global Fund grants, like Bank staff currently oversee projects financed by the Global Environment Facility. World Bank Task Team Leaders 21 12 6 39 Global Fund – All Clusters 16 27 6 49 The Global Fund’s using the World Bank’s Project Implementation Unit as the Principal Recipient for selected Global Fund grants, and World Bank staff overseeing these grants like for Bank projects. World Bank Task Team Leaders 20 12 7 39 Global Fund – All Clusters 14 30 5 49 39 Figure 11. What changes would you like to see in the Global Fund and the World Bank to facilitate greater engagement between the two organizations to achieve positive results at the country level, while also respecting each organization’s fundamental purposes and principles? (Percent “Yes�) The Global Fund's participating in multi-donor Sector-Wide Approaches in support of nationally- defined programs to combat the three diseases. The Global Fund’s donors establishing a trust fund at the World Bank for financing Bank-supervised TA in support of Global Fund-supported activities. The Global Fund’s co-financing World Bank projects n the health sector, like bilateral donors currently co- finance Bank projects. The World Bank’s being an ex officio member of the CCM wherever the Bank is an active player in the health sector in the country. The Global Fund’s providing direct financing for World Bank-supervised TA in support of Global Fund-supported activities. The two organizations' establishing an active staff exchange program. The Global Fund’s using the World Bank’s Project Implementation Unit as the Principal Recipient for selected Global Fund grants, and World Bank staff overseeing these grants like for Bank projects. 0% 20% 40% 60% 80% 100% GF � All Clusters WB �Task  Team Leaders Question 21. What other changes would you like to see? From World Bank TTLs. The question of whether it would be useful for GF to use WB project PMUs is country specific. Would recommend in some cases, particularly if there is good alignment with country systems. Would not recommend in other cases (e.g., Burkina, Cambodia, Timor) where this would either overload the PMU or lead to overconcentration of power and resources in a unit that is not aligned with national structures. Bank financing of the Government and Global Fund financing of TA, private sector and supervision directly. The Global Environmental Facility model would be, in my opinion, the ideal model for the GF if implemented in its totality. This would mean that: (a) the secretariat would be extremely lean (50–75 staff vs. 550–600 in the GF) and independent; and (b) secretariat would respond to a board in which all country constituencies were represented and the Bank supervises ONLY those projects that the Bank itself has sponsored/proposed. The GF should have country representation. 40 The Global Fund staff I have met are not health specialists and are more like fund managers. If this is how it is globally, I don't think a staff exchange would be of much benefit to the Bank because we already have operations officers that do these tasks and would know how to manage the Fund grant within the Bank guidelines and are already familiar with the Bank processes. Building capacity of the GF staff in HSS would help also. The Bank can do it. From Global Fund Staff The two organizations can work better together if they collaborate and this can also be achieved by identifying core technical expertise of each of them. The questions above were not simple to respond to without being given a chance to further justify the answer. To align/harmonize reporting tools (financial and programmatic). The WB to take into consideration grants in the pipeline when developing their own plans. The GF has no "power" on proposal submission since it's done at the country level; then, the only GF margin is to approve or reject the proposal. While the GF is directly involved in the development of projects they are going to fund. So, WB could better consider what is already in the pipeline at GF level. Building more on common objectives, sharing PRs. The Global Fund oftentimes is reaching out to the World Bank in-country. It would be great to see more instances where WB staff also initiate the contact and nurture this valuable relationship for countries. In some cases I responded "Don't know", but in fact the appropriate response should be "It depends on each particular case." Collaboration should be enhanced, not a standardized /"macdonaldized" one, but a tailor-made, specific country oriented/customized partnership. The difficulty with item 2 on the list above is that the World Bank's mandate to work through government runs the risk that its work is too dominated by government views, and therefore the Bank may be perceived as too focused on pleasing the government and not taking a full, open, and transparent multi-sectoral approach to maximizing impact through those constituencies that are best placed to deliver on impact in a specific country setting. The two are just different, so I don’t see how the two can come together. Enhanced communication in-country. Increased communication at global and country level. Specific guidelines for country-level engagement and coordination with WB and GF. A specific collaboration to undertake fiduciary arrangements in the country while still using national PRs. The Global Program Review Series The following reviews are available from IEG. Volume #1, Issue #1: ProVention Consortium Issue #2: Medicines for Malaria Venture Issue #3: Development Gateway Foundation Issue #4: Cities Alliance Volume #2, Issue #1: Critical Ecosystem Partnership Fund Issue #2: Association for the Development of Education in Africa Issue #3: Population and Reproductive Health Capacity Building Program Issue #4: International Land Coalition Volume #3, Issue #1: Consultative Group to Assist the Poor Issue #2: Global Development Network Issue #3: Global Forum for Health Research Issue #4: Global Invasive Species Program Volume #4, Issue #1: Stop Tuberculosis Partnership Issue #2: International Assessment of Agricultural Knowledge, Science, and Technology for Development Issue #3: The Global Water Partnership Volume #5, Issue #1: Multi-Donor Trust Fund for the Extractive Industries Transparency Initiative Issue #2: The Mesoamerican Biological Corridor Issue #3: Marrakech Action Plan for Statistics, Partnership in Statistics for Development in the 21st Century, and Trust Fund for Statistical Capacity Building Volume #6, Issue #1: The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank’s Engagement with the Global Fund GPR The Global Fund to Fight AIDS, Tuberculosis and Malaria was founded in 2002 to mobi- lize large-scale donor resources for the specific purpose of reducing infections, illness, and death caused by the three diseases. The Global Fund has since become the largest of the 120 global and regional partnership programs in which the World Bank is currently involved, disbursing more than $3 billion in grants to developing and transition countries in 2010. The World Bank plays three major roles in the Global Fund: (a) as the trustee of donor contributions to the Global Fund, (b) in the corporate governance of the program, and (c) as a development partner at the global and country levels. This Review found that the Bank has had extensive engagement with the Global Fund at the global level through the Global HIV/AIDS Program, the International Health Partnership, and related initiatives, but has been less engaged at the country level. The Global Fund has fostered new approaches to development assistance. This Review found that its Country Coordinating Mechanisms have successfully brought country-level stakeholders together to submit grant proposals to the Global Fund, but have lacked the authority and the resources to exercise effective oversight of grant implementation. The situ- ation has improved in recent years in terms of the World Bank and other partnersʼ providing technical assistance in support of Global Fund activities, but these technical support func- tions need to be defined with greater clarity and formality within the context of improved donor harmonization. Collective donor efforts have contributed to increased availability and use of disease-con- trol services, particularly for HIV/AIDS, and increased coverage of affected communities. However, sustaining client countriesʼ disease-control programs in the face of decelerating external support will require a substantially more coordinated approach than has occurred to date. The scarce resources available to fight the three diseases — including those raised by each country and those provided by external partners — need to be allocated collectively and proactively in each country in accordance with a long-term strategy for fighting each dis- ease that is agreed among all the principal stakeholders.