In May this year, the Office of the Inspector General (OIG) published an audit report of the Global Fund’s approach to grant monitoring. The report outlines achievements and areas with gaps, emphasising the importance of effective grant oversight for desired programmatic impact in the fight against HIV, TB, and malaria.
Grant Monitoring
Grant monitoring is a crucial process involving the collection, analysis, and application of data to track program performance. Given the complexity of interventions in HIV, TB, and malaria, where substantial data is generated, monitoring can be demanding but necessary. The Global Fund engages regularly with Principal Recipients (PRs), Country Coordinating Mechanisms (CCMs), and other key stakeholders to review performance and assess risks associated with grants. This collaboration ensures timely “course corrections” in program interventions, maximizing positive impacts and minimizing risks. By increasingly integrating monitoring systems into internal management functions such as performance, risk, and financial management, grant monitoring becomes not only vital but also multifaceted and challenging.
The Audit Findings
Achievements
The audit report highlighted key improvements in grant monitoring, such as the newly introduced Implementation Oversight Operational Policy Note and Operational Procedures. These elements now guide implementation planning, oversight, and accountability of the grant at the implementation level. Early warning oversight through Pulse Checks is now an active process for Principal Recipients (PRs) in High-Impact and Core portfolio countries. PRs can now provide updates on implementation progress, challenges, and reporting issues on selected coverage indicators and financial metrics. It would be important for countries (CCMS, PRs/SRs) to familiarise with and ultimately use the tools for their routine work.
The Progress Update and Disbursement Request (PU/DR) form has been integrated into the reporting and includes C19RM financial reporting, tax reporting, and prioritised recommendations for PRs and Local Fund agents. In addition, the Global Fund Partner Portal allows for online submission of the PU/DR and Pulse Checks. Performance letters to PRs are available through the portal to enhance reporting. Unlike before, a new rating methodology was introduced with three distinct ratings in place to better differentiate between grant performance and PR performance. This one-stop shop makes the navigation around many documents easier and quick to follow.
Audit Grant Rating
Overall, the approach to Global Fund grant monitoring was rated as follows:
- Approach to monitoring programmatic performance and impact – Partially effective
- Design of processes, guidelines, and tools for identifying, monitoring, and mitigating grant-facing risks – Partially effective
- Execution of the processes, guidelines, and tools for identifying, monitoring, and mitigating grant-facing risks – Needs significant improvement
- Structures, processes, systems, and tools for grant implementation oversight – Partially effective
Implications of the audit
The implications of the audit findings are that implementers of Global Fund grants should typically and comprehensively know coverage, outcome, and impact indicators relevant to their programs. These indicators are crucial for monitoring program performance and whether implementation is on the right course to achieving set objectives.
Some country programs lack SMART (Specific, Measurable, Achievable, Relevant, Time-bound) grant objectives linked to their national strategies, thus limiting the Global Fund’s ability to monitor impact. Sufficient engagement with stakeholders, including beneficiaries, is needed for alignment to ensure diverse priorities are captured and narrowed down to specific, agreed implementation objectives.
The audit established inherent data challenges and misalignment between grant investments and coverage targets, with some indicators based on population-based estimates. Programs therefore need to use the most current data to monitor progress as some estimates may be outdated, thereby increasing the likelihood of inaccuracies.
In Africa, the Global Fund grants face multifaceted risks arising from institutional capacities, weak governance, corruption, and political instability, which undermine risk monitoring efforts. On governance, it would be important for the Global Fund to explore some aspects of the CCM evolution that could be borrowed to strengthen this domain, including making recommendations to countries on how best to use the insights to address governance challenges. Further, building the technical and human resource capacity within PRs is advisable to enhance risk monitoring competencies. Such capacity will enhance follow-ups on key mitigating actions on risks facing the grant.
Conclusion
The OIG audit report of the Global Fund’s grant monitoring reveals significant strengths and critical areas for improvement. While the comprehensive risk management framework and ongoing engagement with key stakeholders demonstrate a solid foundation, challenges such as lack of SMART objectives and data accuracy issues hinder optimal performance. To enhance the effectiveness of grant monitoring, the Global Fund must promote the Integrated Risk Management Module, ensuring SMART objectives are clearly linked to national strategies. By doing so, the Global Fund can better manage risks, achieve its programmatic goals, and ultimately strengthen the fight against HIV, TB, and malaria.
Looking forward, it is essential for the Global Fund to leverage its existing strengths, implement the OIG’s recommendations, and foster greater collaboration among country stakeholders. These steps will ensure more robust grant monitoring and risk management, leading to improved health outcomes and efficient use of resources.
Dr Paul Nesara
