According to the Global Fund'sOffice of the Inspector General (OIG):

• The way that calls for proposals in the rounds-based channel are structured is inconsistent with the Global Fund principle of supporting country-driven programmes.
• While a good proposal may be fitted into the Global Fund's proposal form, it is by no means clear that a proposal would be significantly shaped and improved by following the form.
• There is little scope for the Board to provide assurance on the financial soundness of proposals.
• After seven years of activity, the Global Fund's relationship with its partners remains poorly defined and even, in some ways, uncomfortable.
• The present obscurity of the TRP's deliberations represents something of a contrast to the rest of the Global Fund's business model.
• The current grant application process impairs the ability of theGlobal Fund Board to set policy and strategy.

These are among the observationsin a wide-ranging, 107-page audit report released in April 2010, "TheOIG Review of the Global Fund Grant Application Process." In thisarticle, we summarise some of what the OIG said on the following topics: thehigh rejection rate of proposals; the lack of Global Fund presence in-country;the limitations of the screening process; the timing of principal recipientassessments; and the lack of investment in forging and maintaining moreeffective relations with partners. We also report on what the OIG saidconcerning the roles of the Fund's Country Programs staff and the TechnicalReview Panel (TRP). In two other articles in this issue, we summarise the OIG'sobservations related to, respectively, the rounds-based proposal form, and howthe applications process affects the Global Fund Board's policy and governanceprocess. Highrejection rate TheOIG said that after eight years of operation, the Global Fund's proposalrejection rate remains relatively high. The OIG said that "although anargument is sometimes made that a rejection rate in the region of 50%demonstrates the technical rigour of the TRP review process consistent with theGlobal Fund's high standards, this may not stand up to scrutiny when the GlobalFund's wider objectives are taken into account." Accordingto the OIG, as a key player in the fight against the three diseases, the GlobalFund has an interest in identifying and funding as many good programmes aspossible. "Although the Global Fund continues to hold back fromintervention in proposal development," the OIG said, "it has a stronginterest (not least for its own reputation) in working to ensure that a greatershare of the proposals submitted are of higher quality. This is especially truenow that the Global Fund has eight years of experience in reviewing proposalsand assessing programmes, and thus a good basis for demonstrating to potentialrecipients the type of proposal that is likely to succeed." TheOIG said that while a simple numerical or percentage target for approvals maynot fit the Global Fund's approach to the application process, it might bepossible to work with an objective for a percentage increase in successfulproposals over an agreed time frame. GlobalFund presence in-country Ina section of its report on national strategy applications (NSAs), the OIG saidthat among views put forward by those canvassed for its audit was thesuggestion that, contrary to current Global Fund practice, the implementationof programmes funded in response to NSAs would ideally require some permanentGlobal Fund presence in country. The OIG added that "more traditionallyorganised development organisations consider presence on the ground, oralternatively a strongly identified representation via another organisation,essential to support national strategies." Screeningprocess Inits report, the OIG said that there may be benefit to the Global Fund inclarifying and strengthening the screening process, perhaps making it possiblefor poor proposals to be rejected at this stage, rather than going forward tothe TRP. The OIG said that "setting out the results of screening in a waywhich goes beyond simple confirmation of eligibility, and offers informedjudgements on the status, function and performance of a CCM, would be helpfulto the TRP." TheOIG added that there are important areas where all proposals could be examinedmore thoroughly before TRP review, including the soundness and reliability ofbudgets; the adequacy of proposed procurement arrangements; provisions formonitoring and evaluation; and consistency within the proposal of programmeobjectives, service delivery areas, activities in the workplan and budgetlines. The OIG noted that under current arrangements, these issues are notsubject to full scrutiny until grants are negotiated, which happens after theBoard has approved proposals. It said that "work on these issues shouldbecome an essential part of the planning and development of proposals, ratherthan arising as matters for retroactive review." PRassessments Localfund agents (LFAs) evaluate nominated PRs once the Board has approved theproposals. The OIG believes that, in terms of the effectiveness of theevaluation as a control, this is too late. The OIG said that because the PR isthe Global Fund's contractual partner in country, usually over the lifetime ofa grant, the soundness of the PR should be determined before proposals arepresented to the Board for approval. Roleof partners TheOIG said that when it reviewed proposals for this audit, confusion abouttechnical assistance - its availability, how and when to apply - was a commontheme. TheOIG said that a 2006 external assessment of the Global Fund's proposaldevelopment process concluded that if the Fund is to rely on partners tosupport the development and subsequent implementation of high qualityprogrammes, there is a need for a significant investment in forging andmaintaining more effective relations with these partners. The OIG said thattoday this investment is still lacking, and that the Global Fund's relationshipwith its partners remains poorly defined and even, in some ways, uncomfortable. TheOIG noted that the value of partnerships has been demonstrated at the level ofindividual proposals. It said that three proposals it reviewed were "veryconvincing documents in terms of their presentation of material and therelevance of replies to questions in the proposal form." All three hadbeen developed with assistance from one or more of the multilateral partners. Roleof Country Programs staff Inearly rounds-based TRP review sessions, the Global Fund's Country Programsstaff were available to answer questions. The OIG said that this is no longerthe case, and that the staff see an advantage in the practice being revived.The OIG added that "it seems unnecessarily rigid to exclude countryprograms staff from the review process." TheOIG noted that while Country Programs staff play no direct part in the processof grant application or approval, they assume a critical role after the Boardhas approved a proposal. "One way or another," the OIG said, "aftereight years of Global Fund operations, the case for greater involvement on thepart of country programs staff, with the knowledge and experience that theypossess, is increasingly compelling," particularly as the Global Fundmoves to a single stream of funding as the norm. Roleof the TRP TheOIG noted that despite the Global Fund's status as a financing instrument,intended to leverage financing for interventions designed by recipientsthemselves, many of the grants now provide support for disease programmes thatis similar to traditional development programmes. The OIG said, "Now that the Global Fund has maturedand built an active portfolio of grants over eight years, in the processforging close relationships with most of its recipients, it may be timely toreview whether the TRP arrangements remain entirely appropriate in all theirpresent aspects." TheOIG pointed out that the Global Fund's requirements are different from those oftraditional development programmes, in respect to the way applications aresolicited and assessed. The emphasis for both applicants and reviewers is onthe wider country context and on previous and existing Global Fund-supportedactivity. According to the OIG, the Global Fund's new NSA approach comesclosest to a broad review of country context and health sector policy. The OIGsaid that the TRP review process for the rolling continuation channel (nowdiscontinued) came closest to including an obligatory assessment of pastperformance, but that "the rounds-based review - which provided aneffective model for the start of the Global Fund's activities - may be lesswell adapted to current circumstances, with so many countries already in receiptof Global Fund financing." TheOIG said that "as the Global Fund develops a history with each of itsrecipients, it is difficult to limit the review of proposals to so-called 'technical'issues only" and that "there is an increasing expectation that theTRP will look also at performance issues in detail. Performance could become animportant criterion when allocating resources among competing proposals." Seealso articles 2 and 5 in this issue. "The OIG Review of the Global FundGrant Application Process," April 2010, is available at