The formulation of HIV-related proposals to the Global Fund: contrasting intentions with realities - the Peru GHIN study
C.F. Caceres1, C. Sandoval1, R. Valverde2, A. Silva-Santisteban2
1Cayetano Heredia University, Unit of Health,Sexuality and Human Development, Lima, Peru, 2Cayetano Heredia University, Unit of Health, Sexuality and Human Development, Lima, Peru
Background: Out of nine Global Fund (GF) funding rounds so far, Peru has applied to five, and has obtained funding on rounds II, V and VI (approximately US$ 77 million), failing on rounds I and VIII. Criticisms have been made about the procedures through which some of such proposals were developed, particulary regarding evidence base, relevance, consistency and evaluation process. A study was designed to assess those aspects, so as to support future local processes, but also to inform global discussions around strenghts and weaknesses of GF procedures.
Methods: We analyzed
the contents of the official texts of four
HIV-focused proposals submitted to the GFATM (on rounds II, V, VI and VIII). Four best
case-scenario hypotheses were posed to assess how the proposals addressed:
1. Analysis of epidemic context and the use of evidence as a point of
2. Identification and prioritization of needs to develop interventions;
3. Internal and external consistency; and
4. The use
of appropriate means of verification.
Results: Analysis of the epidemic context was generally poor, partly as a result of lack of recent, good quality data - while many estimates are available from academic research, their utility is limited by representativeness and availaility issues. Despite the high concentration of HIV on MSM, there is no priority setting across various loosely defined "vulnerable groups". Moreover, interventions only replicated traditional health sector activities and did not address vulnerability per-se nor reflected evolving international standards-of-prevention. Limited efforts were made to describe the impact of previous GF grants and articulate the importance of new projects. M&E systems were usually weak, with poor selection of indicators, often not clearly operationalized, targets of limited utility, and lack of established measurement routines.
Conclusions: Processes of GF proposal preparation should be substantially strengthened in Peru. Various mechanisms, including technical support, are needed to strengthen GF-funded HIV programming globally.
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