Observations from the Field about Challenges in Working with the
Global Fund and Suggestions for Improvements
These comments were responses to queries by Christian Connections for International Health to
identify FBO experiences with the Global Fund, problem areas, and suggestions of what might be
done to address the issues. They were shortened and edited by Ray Martin, May 8, 2007.
1. Observation from Kenya
The CCM tended initially to be not only government led, but also government dominated and
controlled. This resulted in a suspension of funding and an external evaluation of the Global
Fund program which identified serious governance challenges. A transition team was established
to oversee the implementation of the evaluation recommendations.
Consultations of the CCM members were held to develop a CCM Governance Manual which has
clarified the roles. This manual has now been adopted and is under implementation. In Kenya we
see this as the only sure way of ensuring that various stakeholders know there roles,
responsibilities and limits. Membership in the CCM has included four positions for FBOs:
Christian Health Association of Kenya, Catholics (KEC), Muslims & Hindus. It has also provided
for a Vice-Chairman's position who must be from civil society. Certain communications and
decisions must be ratified by both Chairman & Vice Chairman to ensure participation. The
current Vice-Chairman is the Secretary General of Kenya Episcopal Conference of the Catholic
Suggestions: Global Fund Geneva can assist in this process by demanding that each country
should have a governance manual developed through consultation and which provides for clarity
of membership and responsibilities.
The application process for implementers needs to be simplified. The Global Fund application
templates are complicated and sometimes have sections for indicators that are not relevant for
individual applicants. The fact that countries engage consultants to assist in writing applications
is evidence of the high level of capacity required, and which local FBOs often do not have.
The Global Fund should consider the possibility of providing technical assistance for proposal
development and M&E including financial reporting. This would enable local civil society &
FBOs to acquire the necessary capacity. Some international FBOs and churches have that
capacity. Smaller, local ones generally do not.
Request: Global Fund needs to specifically track FBO funding in their various country programs
to ensure there is intentional inclusion because of the significant role they play in service delivery
in developing countries.
2. Positive FBO Capacity Building Example from Uganda
With significant outside support, The Inter Religious Council of Uganda was able to grow in 16
months from a skeletal organization with one staff member who had not been paid in six months
to a functioning organization that has received $17 million for three years. This could be a case
study on the management steps needed to take on additional resources.
3. Potential of Working through More Religious Health Networks
It is understandable that donors like the Global Fund want to keep the management mechanisms
to small manageable number. This may make it easy for the donor to manage, but it creates a
reality that stands in the way of providing resources to faith-based and community organizations.
One possible solution: Health Networks, e.g. Christian Health Associations, can be well
organized and be strong partners of Ministries of Health. Their capacity to manage large grants
and programs will never be developed if they are never given the opportunity. With funding and
appropriate technical assistance, the CHAZ experience in Zambia could be replicated in many
4. Catholic Quotes from Publications
"To meet the challenges of universal access to prevention, treatment, and care posed by HIV and
AIDS, we need to match up the funds that already exist with the people who are delivering the
services, especially to the poor and marginalized."
-- Fr. Robert Vitillo ("Faith-Based Organisations Must Support Government HIV Strategies",
Christian Today, UK 27/03/2007, by Maria Mackay )
"An analysis of the funding patterns by the Global Fund to Fight AIDS, Tuberculosis and
Malaria, however, shows a serious imbalance between the funds made available to support FBO
programming and the burden of care for which they assume responsibility. Global Fund officials
explain that decisions on funding allocations are made within the recipient countries; however,
FBOs often report frustration and exclusion in response to their attempts at participation in such
decision-making processes. Recently, civil society activists have proposed a dual track system for
Global Fund applications – one that would allow direct application to the Global Fund by civil
society actors, including FBOs. It is the sincere hope of this speaker that donor governments and
all Global Fund Board members will consider this proposal in a favourable manner."
--Fr. Robert Vitillo, Special Advisor on HIV and AIDS, Caritas Internationalis, in a speech on
“Faith-Based Organisations Responding to the HIV Pandemic: Lessons Learned and Challenges
"CAFOD said that religious ‘assets’ were often overlooked by national and international policy
makers and called for a greater understanding of both the tangible and intangible support
provided by the agency and its partners."
-- CAFOD (Catholic Agency for Overseas Development) quoted in "Faith-Based Organisations
Must Support Government HIV Strategies", Christian Today, UK 27/03/2007, by Maria Mackay
5. From an Ethiopian Church Leader
Although the Ethiopian Orthodox Church was able to access the first round of Global Fund
financing even before the Country Coordination Mechanism was organized, in the early days of
the CCM, they were not so interested in the faith community, but it is now becoming more
My church so far has been denied access to the Global Fund, but now the door seems to be
opening. We are being offered a Principal Recipient role by the CCM in a round 7 proposal, but
it took a long time of advocacy and lobbying with the government to reach this stage. Access to
this large fund will position us to respond in a better way and bring a meaningful impact.
6. Advice from a Church Leader Working Internationally
The church’s strength is nurturing and expanding local response. Local empowerment drives
expansion. Faith undergirds and sustains. Emphasize the strengths of local response and learning
without neutralising the faith-based identity. We can do it without funds, but we could do better
7. Insight from an Authority on FBOs and Decentralized Health Systems
I think that the most important point to make to Global Fund is that they understand the potential
for using FBO health networks as principal recipients and grants managers. They need to move
beyond thinking about FBOs in terms of scattered, uncoordinated service providers, and realize
that they could tap into whole networks by working through the national network(s). CHAZ is
one example. ECC in the DR Congo could be another. The strengths of this approach are
increased speed in the disbursement of funds and the capacity building of national groups as PRs
(as opposed to capacity building of organizations such as UNDP)
8. Frustration and a Suggestion from an FBO Partnering with Many Small, Local Partners
We have seen few partners trying to access Global Fund money. Usually, they can't even make a
connection with anyone on the CCM in the first place. If you're not a 'known player', it feels
difficult to get anyone to notice you. So the folks that are busy working the hardest, often with
small organizations, get overshadowed by the folks from flashier, bigger agencies that have
people that ‘know people.’
They are often seen as too small to be considered for even the sub-grants. I guess the bigger issue
there is that when the grants are held by the governments, especially, even when they say they
will include FBO involvement, they seem to try hard to avoid it when push comes to shove.
Many countries just don't have functioning channels that allow small groups to feed into the
I'm not sure how this could be changed. I think a start would be for CCMs to hold some public
forums that allow participation from all interested parties so that everyone is clear about the
process and has a more equal chance to participate in the development of plans. I also think it
would be helpful to have a mechanism by which smaller organizations can learn about bigger
plans being developed - perhaps submitting proposals to become a sub-grantee - as opposed to
having the big players preparing the grants picking the same, known partners all the time.
9. Observations from a Religious Network Leader in India
The Indian experience of FBOs with GFATM has improved. There has been an evaluation
recently, and the present government itself is more open to FBOs. The CCM accepted a
combined Protestant and Catholics bid for OVCs in 2005, but the entire India proposal was
turned down at Geneva. The Catholics are part of a successful joint Government-NGO
consortium bid in 2006.
For Protestant FBOs, the problem is that there are many groups and they do not have the
advantage of scale. The Catholics have the advantage of a unified body, and international support
for seed money, advocacy and building a high profile. They also negotiate with international
NGOs to form partnerships.
We are afraid that with the advent of the international NGOs in a big way, it will prove more
difficult for the FBOs to be involved, unless these international NGOs themselves have a mandate
to include FBOs. For USAID funds, for example, linking with FBOs gives the NGO a
competitive advantage. This may need to happen for GFATM as well.
10. Experience of an International Advocate and Facilitator
It's so difficult to bring the FBOsNGOsCBOs into the picture for multiple complex reasons.
The sad situation is that these groups are so weak with little documentation of what they are
doing or could do if given the resources. Many of them are already engaged in the context of
national programs, but with no capacity to bundle multiple organizations into a consolidated
A positive example is World Vision Kenya which became a champion for the other FBOs and
worked toward forming an FBO Consortium. This got the attention of some donors who realized
that without the NGOFBO community engagement to bring in the behavior change
communication piece, results would be less than desired.
Considerable technical assistance is needed to enable NGOFBOCBO groups to undertake the
organizational and planning steps needed in order to develop winning proposals with a quality
community-based component. So many globally funded initiatives provide considerable sums of
money to a national level, but fail to anchor activities at the community level to achieve
sustainability and ownership needed for longer-term success.
While it is encouraging to see that global resources now are being committed to improve the
health of the poor, these massive infusions of resources often lack the availability of partners with
the absorptive capacity to make the most cost-effective use of these funds to truly reach the
beneficiaries "at the bottom of the pyramid." If these resources were available to well-
established, credible and time-tested networks of country level NGOsFBOs, this would help to
close the gap between the end-users at the community level and the national planners back in the
capital. Unfortunately very few countries have been able to undertake the formation and
mentoring of these networks for their own sustainability. Somehow it is expected that these
NGOs can "do it alone" and become successful partners in Global Fund programs. That just
won't happen on its own; but as we have learned from existing networks in multiple African
countries, when they are do participate, they are very successful.
11. Observation from a Fairly Large US FBO
The upside of working with the Global Fund is similar to our experience with PEPFAR—it
expands our capacity and service delivery on the ground by providing much needed resources.
In one country, the logistical issues of release of funds for us as a sub-recipient, from the
Principal Recipient, has been a problem because most CBOs and FBOs at the grassroots level
cannot “float” funding to their projects if funds are delayed. Many partners stopped programming
altogether when the funds are delayed.
Most FBOs and CBOs, even most international FBOs, would not have the desire or capacity to be
a prime recipient for GF in any country. However, they would be excellent at implementing
programs as sub-recipients. Unfortunately, the process for working as a sub-recipient is fairly
murky. Several of our offices and partners in a number of countries have reported to me that the
CCM delegates will be open and welcoming to proposed plans, but because the CCM has power
but no funding, it is ultimately up to the prime recipient to help make programming a reality.
- FBOs in the Ukraine were told there was no point in trying to be included in a round 7
- In Cambodia, GF funds are all funneled through the MOH and government, and these
groups have not made efforts to partner with FBOs/CBOs in any visible way, though many of
these groups are providing services in line with GF goals.
- In Uzbekistan, various local organizations including FBOs were invited to submit short
concept papers, but then the CCM announced that a government group had received all of the
available funding. Perhaps this was because of technical capability, but our office viewed this
move as an unwillingness to partner with civil society organizations.
The system would greatly benefit by some mechanism aimed at helping demystify and build
capacity for partners unfamiliar with navigating the system of CCMs, prime recipients, etc., that
could help CBOs/FBOs engage at a broader level. In addition, it would be a great benefit for GF
to consider some strong outcomes/impacts as targets and should implement more rigorous M&E
of current programming. Our GF-funded programs seem to receive little criticism or guidance in
terms of increasing effectiveness, planning for sustainability, etc. Perhaps CCMs could be
strengthened to audit programming using some standard protocol for measuring program
12. Critique of an Administrator with Major Experience with Small Grants Programs
The selection process for CCM membership is frequently biased against FBOs and persons with
Many AIDS activists who have succeeded in obtaining positions in the Global Fund, in the
Technical Review Panels, and on CCMs, exhibit an inherent animosity toward the faith
community. The absence of a stronger pro-FBO inclination in the GF has a negative impact.
Quite recently, an GF insider said that it is still the belief of many that the faith community
should raise their own money and the GF shouldn't yield to the growing pressure to appease them.
Denigration of faith and values approaches to HIV prevention, for example, are rampant within
the GF structure, although not as much at the country level. Preference for harm reduction
approaches to HIV prevention and bias against harm avoidance is observed on the Technical
Review Panels. So with such an orientation, they don’t even perceive that there is a problem if a
CCM submission does not include FBOs, despite the major role they plan in AIDS treatment,
care, and prevention.
13. Experience of an Indian Church and Medical Leader
An FBO group was led to believe by the CCM that their request would be incorporated into the
CCM proposal, but the CCM apparently maneuvered so that it was never submitted. When this
became apparent later, the CCM “apologized” and said that nothing could be done at that stage.
Once when this leader was making a presentation during a CCM meeting, one member got up and
said, “What prevention can a Christian organization do without a condom?” This suggested some
cynicism in the CCM about Christian and AIDS prevention.
He suggests that one member of the CCM in every country should be a faith-based person who
should be looking to fund FBOs, and that perhaps a percentage of the money should be allocated
expressly for FBOs.