An overview of the progress achieved by Chad as part of the implementation of Global Fund grants

Since 2005, the Global Fund has awarded over $557 million (€557.3 million) of grants and disbursed more than $425 million (€425.2 million) to Chad. Active grants total $149.6 million (€149.7 million) for the 2020-2022 funding allocation period (June 2021 to December 2024 implementation period). It is worth noting that the Global Fund operates in a specific context in Chad given that the country is classified as a Challenging Operating Environment with high political instability and security issues. In 2009, the country was placed under the Additional Safeguard Policy to ensure the return on investment in a country plagued by institutional instability.

The Additional Safeguard Policy allows the Global Fund to select implementing partners in countries, most of which are international NGOs. In the case of Chad however, since 2018, the Ministry of Public Health acts as Principal Recipient and manages some of the Global Fund grants through its Project Management Unit (PMU), established in 2017 with the main objective of centralising and overseeing all external health funding (the Global Fund, Gavi, Bill and Melinda Gates Foundation and ALIKO Dangote), as well as ensuring their efficient use for a consistent and sustainable management of all health projects.

The PMU contributed to improve the Global Fund programmatic and financial indicators.

Early this year, the Office of the Inspector General (OIG) pointed out in its February 2023 audit report that over the last ten years, Chad progressed in the fight against the three diseases reducing both new infections and deaths.

The report indicates that the absorption rates for the three Global Fund grants under the New Funding Model 2 (NFM 2) for 2019-2021 stood at 88.5%, 92% combined with the malaria UNDP grant, with no ineligible expenditure. This successful management is made possible through the use of high-performance tools such as the software TOM²PRO for accounting and the mobile money system used for the payment of all field operations. Given the size of the country, the PMU is currently engaged in a decentralisation process in all the 23 provinces with a pilot phase which began this year in 5 provinces.

Grant cycle 5 (New Funding Model 2)					Budget			Disbursement				Expenditure
Component	Grant	Principal Recipient	Period	Status	Standard	C19RM	Total	Standard	C19RM	Total	%	Spent	Absorption rate
HIV	TCD-H-MOH	Ministry of Public Health	1/4/2019 31/12/2021	C	38.7	2.4	41	33.5	1.8	35.3	86%	35.3	86%
MALARIA	TCD-M-UNDP	UNDP	1/7/2018 30/6/2021	C	56.0	0.4	56.4	56.1	0	56.1	99%	54.5	97%
TUBERCULOSIS	TCD-T-MOH	Ministry of Public Health	1/4/2019 31/12/2021	C	4.2	0.1	4.3	4.0	0	4.0	93%	3.9	91%
Total					98.8	2.9	101.7	93.6	1.8	95.4	94%	93.7	92%

C = Completed

Since the establishment of the PMU, evident progress has been observed in grant implementation resulting in a continuous increase of the Global Fund grants to Chad after each renewal of the funding cycle.

Address the shortcomings

Skills development and capacity-building of recruited staff

Good performance in grant management also depends on the quality of human resources. For this reason, all PMU staff are recruited through a competitive, open and transparent process carried out by a committee appointed by the Minister and totally independent from the PMU.

Once recruited, their capacities are strengthened through a residential technical assistance programme, provided by Expertise France, in 4 main areas namely: governance, finance-accounting-audit, procurement and inventory management and follow-up and evaluation, as well as through a fiduciary agency that performs regular financial control of all operations undertaken by the PMU.

Nonetheless, staff turnover remains high. In fact, some agents, after their capacity-building at the PMU, see their value increase in the job market and seek employment elsewhere, resulting in a constant need for training. The PMU is presently reflecting on ways to become more appealing so as to keep its key employees.

Improve understanding of internal procedures

The PMU has reviewed and validated its manual on administrative and financial procedures based on a participatory process involving the main implementing actors (SRs and SSRs) together with technical and financial partners following the validation of the manual, dissemination workshops were organised with implementing actors at central and decentralised levels, represented by provincial delegates along with managers.

These workshops helped to resolve several misunderstandings but also to take account of any concerns in order to ensure better understanding of administrative and financial procedures.

Poor quality of reports and delay in reporting

In the past, once the data validation workshop was over, the various programmes submitted consolidated databases to the PMU which enabled the unit to prepare the period’s progress reports on its own. Thereafter, meetings were organised with the programmes to validate the reports.

This method did not allow the actors to fully understand the process of drafting these progress reports. For this reason, the PMU organised a workshop bringing together all implementing actors to jointly draw up the progress reports and funding request for the second half of 2022.

The organisation of this workshop helped to strengthen the capacities of implementing actors as regards the preparation of progress reports. By means of this innovative approach, the quality of the reports significantly improved. The PMU is committed to ensuring the sustainability of this approach which makes it possible for the various reports to be submitted on time..

However, major issues regarding programmatic data quality still need to be addressed. The PMU is currently working with the Health Information Department and programmes to make the DHIS2 operational throughout the country and improve the quality of the data collected.

Persistent difficulties in distributing health products down to the last mile

Quantification of products is carried out jointly by the pharmacists of the PMU and SRs. A procurement plan is then developed for all health products to be supplied and PMU experts order them via the Wambo platform. All orders are tracked by regularly updating the procurement plan. Products are delivered directly at the Central Medical Store (CMS) and the PMU uses the in-country distribution circuit of inputs through the CMS and provincial medical stores (PPA). To supply health centres, needs are recorded by the programmes through focal points and provincial medical stores.

Thus, for more than 3 years, stock-outs have rarely been recorded at central level for TB and HIV drugs managed by the PMU. Yet at operational level, cases of stock-outs are still reported, as clearly described in the OIG audit report of February 2022.  This is mainly due to shortcomings identified in the development and proper implementation of in-country distribution plan from central level to health facilities.

The serious lack of logistical resources, in particular transport vehicles, is at the root of these problems.

To address these issues, more than 40 transport vehicles have been ordered and are currently being delivered to improve the distribution of inputs down to the last mile, under the various grants managed by the PMU… A supply chain transformation plan has also been drawn up, and its ongoing implementation will provide lasting solutions to the above mentioned issues.

Improvement in the functioning of governance/coordination bodies

The PMU has a steering committee that holds quarterly meetings. During the last 2 years, a great deal of effort has been made to ensure that these meetings take place on a regular basis.  Likewise, coordination meetings are planned between the PMU and SRs, and they are increasingly held on a regular basis.

The Global Fund expects a high level of transparency and good management from Principal Recipients of the public sector. Although this requirement is justified, it sometimes represents a challenge for the PMU on a daily basis. As noted by the OIG, a number of challenges are still to be resolved with regard to the management of Global Fund grants in Chad, and in particular the implementation of the Supply Chain Transformation Plan. Nevertheless, great progress has been made and deserves to be acknowledged. The PMU will continue to improve with the support of all national and international partners.