The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) is a competitive international basket funding institution governed by an executive board with representatives from funding and recipient countries, civil societies, technical agencies, private sector and people living with any of the three diseases, assisted by the Geneva-based secretariat. The Global Fund generates resources from various sources, calls for proposals, which is then evaluated by an independent Technical Review Panel (TRP) before the recommendations are forwarded to the board.

The Fund has provisioned for a Country Coordination Mechanism (CCM) in each country to submit proposal, select Principal Recipients (PRs) and oversee the country fund. In principle, CCM should ensure active membership of government agencies, civil society, private sector, vulnerable population, people living with diseases, external development partners and technical agencies.The CCM time and again has been in controversy either denying or procrastinating progressive reform in its structure. Once an agreement is signed between a country and the Global Fund, the PRs receive and manage the grant in accordance with the National Action Plan (NAP). Besides the CCM, the Global Fund also appoints Local Funding Agent (LFA) in each country to ensure transparency in financial management and decision making. In a nutshell, the LFA in each country is the eyes and ears of the Global Fund.

Nepal has been submitting periodic proposals to the Global Fund since the first round The Ministry of Health and Population (MoHP) was made the PR for HIV component. Later on, due to the insurgency and inadequate absorptive capacity of MoHP, UNDP entered the fray, first as a Management Support Agency (MSA) and later as the PR. Global Fund board approved around $76 million for Nepal for the 7th round. All three components were covered, the caveat being that CCM of Nepal would reconsider the proposed PR. While submitting the proposal for 7th round, the CCM of Nepal had proposed MoHP as a single PR for the component of HIV, Nepal Tuberculosis Center (NTC) for TB and MoHP and PSI for Malaria. NTC is apolitical and considered one of the successful entities of its kind in South Asia. However, the issues of HIV and malaria are highly politicised.

As per the Global Fund request, the CCM revisited its previous decisions and proposed MoHP as PR and UNDP as co-PR. One of the Global Fund guidelines limits the involvement of UNDP as a PR only in conflict-hit places. Citing the rule, the portfolio manager of Global Fund wrote to CCM Nepal again to reconsider the PR appointment for HIV component.

CCM is insistent about appointing MoHP and UNDP as PR and co-PR while the Global Fund remains reluctant. While submitting the proposal, the CCM of Nepal had called an Expression of Interest (EOI) from the civil societies for the purpose of selecting a PR and some of the INGOs had submitted EOIs. The CCM disqualified all the INGOs for PR. In response, Association of INGOs in Nepal (AIN) alleged that the evaluation committee was biased and non-transparent. However, the allegation is in the process of review of the Global Fund.

This has been the cause of rift between CCM Nepal and Global Fund. CCM Nepal is not in a mood to alter its decision; the staff of Global Fund, on the other hand, are exerting pressure on CCM to reconsider its decision on re-selection of PR. A CCM member is now advocating CCM decision in an international forum. To counter such advocacy, AIN has sent a letter to the Global Fund.

The CCM is answerable to Global Fund and at the same time accountable to the citizens of Nepal. In the given unstable political situation and fragile economic condition, are we really in a position to cling on to our stance at the cost of lives of thousands living with HIV, TB and malaria? If Nepal is not able to receive the grant, the country’s economy will also be affected as it is heavily dependent on foreign aid and loans. In a stable political economy, the country could have more room to manoeuvre; that not being the case, Nepal cannot afford to lose the 7th round. Nepal is in a transitional phase and that the chances of CA polls are fairly bright. But even after the election, it is by no means certain that Nepal will have a stable political system.

In this scenario, no one can deny the role of UNDP as one of the PRs. All the major stakeholders, instead of making the selection process of PR a matter of prestige, should try to come up with a win-win solution. In this context, Nepal has two options: first, and the best, would be for AIN to withdraw its previous letter and rewrite a letter to the Fund requesting the acceptance of CCM decision on the issue of PR. If the AIN doesn’t comply, the other option is to reopen the process of selection of one more PR in addition to MoHP and UNDP from among civil societies.

Adhikari is Programme manager,

SPARSHA Nepal