Technical assistants are a vital, although often invisible, part of the Global Fund grants, aiding at each step of the grant life cycle. They help write funding requests at the request of the Country Coordinating Mechanism and assist principal recipients (PRs) to determine financial and program targets during grant-making. During grant implementation, technical assistants assist PRs to address issues such as risk management and grant absorption.
Technical assistants help build longer-term capacity of the implementers' staff and support grant monitoring and auditing. Local Fund Agents contract them to monitor grant implementation and conduct spot checks. The Office of the Inspector General (OIG) contracts them to help audit grants. As such they are great assets to the Global Fund: they offer valuable skills and competencies but do not draw salaries and benefits, helping the organization stay cost efficient.
In May 2020, the OIG's audit of the Global Fund's technical assistance and capacity building expenditure estimated that more than $839 million was spent on technical assistance from grants in the 2017-2019 cycle.
Bilateral partners funding technical assistance spent an extra $332 million. The OIG found that the Secretariat does not track expenses on capacity building and Aidspan summarized the finding from this report. Three years earlier, the Secretariat had published a document that discussed issues related to technical assistance and actions to solve them.
This article aims to shed light on the work of technical assistants in the Global Fund grant context. We interviewed six consultants who have provided or are currently providing technical assistance to the Global Fund grants.
Other than Dr Demba Dione, a medical doctor and public health specialist with more than 20 years experience, they requested anonymity in order to speak candidly to Aidspan. Moreover, they often sign confidentiality agreements so they cannot use related data or talk about their work. Our sources have worked mostly in Africa and Asia. We also added information from other publicly available documents.
The work of technical assistants
Technical assistants either work for a short term of a week or two, for several visits of a week or so over many months, or for a longer term where they are integrated into the PR team. According to the OIG report and our interviewees, the country laws and rules govern technical assistance, funded by the grant.
This adherence to public procurement rules often results in delays in recruitment that may delay activities. Time lost due to some of those delays cannot be recovered in a three-year cycle, even with a catch-up plan. One of the ways government PRs eschew such situations is to work with United Nations (UN) agencies, which are not constrained by the State's rules. The UN agencies have their own standard operating and procurement procedures. The UN agencies often provide technical assistants to help with the grants. The Global Fund has existing frameworks of collaboration with several UN agencies.
Technical assistance is partly funded with bilateral "set-asides." Donor countries set aside a portion of their pledges to the Global Fund for technical assistance. The donor countries manage those funds directly. For instance, the French government, the second largest contributor to the Global Fund after the United States of America, allocates 5% of its pledge to the Global Fund to the "Initiative 5%" which provides expertise at the request of the beneficiaries. On its website, the Initiative 5% states that between 2011 and 2018, it deployed 970 experts (the other name for technical assistants) who worked on the Global Fund grant-related issues for 22 910 days.
United Nations agencies provide technical assistance
According to the OIG, UN agencies like the World Health Organization (WHO), United Nations International Children's Fund, and the joint United Nations Programme on HIV/AIDS (UNAIDS), as well as Stop TB are the main providers of technical assistance to the Global Fund countries.
A UNAIDS report entitled Optimizing Global Fund grants in Asia and the Pacific 2017-2018 detailed the types of technical assistance it offered in the region: support the development of strategic plans, country dialogues, grant making, and the implementation of programmes.
Technical assistance opportunities
We asked our interviewees how they learnt about work opportunities. According to one source, some technical assistants are contracted as part of a bid put together by large consulting firms, UN agencies or by the government agencies managing set-asides. These large firms or agencies keep rosters of people who can support their work in different areas and enlist their services when needed. Some experts proactively contact others that "are connected." However, all agree on the importance of an active network to stay informed of work opportunities.
Our sources stated that consultants, whether they have been incorporated into a company or not, rarely meet the criteria to independently submit proposals (RFP) or apply for other big tenders issued by governments or multilateral entities.
One of the consultants with experience in Francophone Africa explained that to apply for some of the funding from the French government, corporations need to have SIRET or SIREN numbers which are unique identifiers issued to businesses by France's National Institute of Statistics and Economic Studies. Many African consultants who work in francophone countries lack this number and can therefore only be sub-contractors of French-based companies.
Evaluation of technical assistance and capacity building
The OIG reported that the evaluation of technical assistance and capacity building in countries varied widely: some contracts detailed deliverables and work plans while others lacked such details.
We asked our sources how their work was assessed. All of them indicated that their contracts include a section on deliverables upon which their consultancy work is evaluated.
Some countries deliver a "certificate of satisfactory execution" that is useful when applying for other work. In addition, when officials in a country are happy with a consultant's work, they can request the support of the same consultant again. As one source said, "When you work in a country and later the country requests that you come back to help them [with another type of work], then you know you have done a good job." Our sources also said they did not have to pay bribes to obtain work but they heard that some other consultants do to secure further assignments.
By design, the Global Fund is a financier institution that relies on other partners such as governments, civil society organizations and multilateral institutions like UN agencies to carry out the technical work. According to another source, the Global Fund's technical assistance budget sometimes funds positions in the UN agencies.
In such cases it is difficult to evaluate the specific impact of the technical assistants or the capacity building they provide since "the person in that position does many things including supporting the Global Fund grants implementation when needed." However, even though their impact is not measured, without such a position, implementers of the Global Fund grants will have a hard time doing their work. He said, "imagine you work in [a country in] West Africa on a Global Fund grant and there is no malaria focal point in the WHO. [You] would have a hard time implementing that grant. So, it makes sense for the Global Fund to fund that position or part of it."
This situation is illustrated by one of the findings of the OIG. The OIG report highlighted how the Global Fund grants have been paying for technical assistance and capacity building in the WHO's country office in Indonesia since 2004 without an evaluation of the impact of funding.
The Secretariat indicated that the technical assistance by the WHO Indonesia Country Office covered a wide area of policy development and revision, implementation assistance for HIV prevention, and treatment. WHO also provided assistance with designing and revising the national HIV/AIDS data surveillance system (SIHA), and provided operational support on the roll out of the revised SIHA.
In this case, the Principal Recipient (PR) contracted WHO directly to provide the identified technical assistance needed, set the terms of reference, and oversaw the implementation of the technical assistance and the outputs.
The same source added that "the UN agencies are important in-country." He related an experience when working with colleagues in the ministry of health in an unnamed African country. They were unsuccessful in solving an implementation bottleneck related to key populations in an HIV grant. (This is a sensitive topic as key populations in the context of HIV--including sex workers, men who have sex with men, persons who inject drugs--are often criminalized and more vulnerable to HIV. HIV grants have specific interventions that aim to increase key populations' access to HIV prevention and care.) The country representatives of UNAIDS and WHO requested an appointment with the minister of health and were able to resolve the issue at this senior level.
The UNAIDS report cited above hinted at a similar occurrence when it stated that it "plays a pivotal advocacy role ... to optimize the national response."
Challenges and advantages of consultants
All the technical assistants interviewed affirmed that the success or challenges of their work depend heavily on the attitude and capacity of the national counterparts. International experts usually work with national counterparts from the civil society or the government. In many projects, funders encourage the participation of local consultants to help build the country's capacity.
Sometimes, the national counterparts are invested in the work and participate in the activities by working alongside the international expert and providing invaluable background documents, local intelligence and guidance. In other cases, national counterparts leave the work for the consultants arguing that "they are well paid for it". Often the difference in payment between national and international consultants, or even a team of international consultants is a sensitive issue. Local consultants are often paid only a small fraction of what international consultants receive, even with similar competence, according to our sources.
Technical assistance provision often requires extensive international travel that hampers experts who are not available to do so, in particular, women and mothers of young children. A source told us "it would be interesting to see if the COVID-19 pandemic changes this [model]" as the international experts can no longer travel and will have to rely extensively on national counterparts. Dr Maria Walusimbi, an international consultant based in West Africa, believes COVID-19 actually adds to the challenges of consultants and mothers.
As a mother to two young children , she is in charge of home-schooling and needs to timeously deliver her assignment while dealing with spotty internet connection, differing time zones and delayed responses from counterparts in other countries. She explained that in the past when working as a consultant on a Global Fund assignment, she would plan to visit a country for one week in which she would book appointments with officials.
The officials would often come to meetings with documents and other pieces of information. Now, she has to call to request documents (that she may or may not receive as promised) and she cannot visit officials to discuss important topics. It therefore takes longer to complete some assignments than before.
According to our source, another issue about technical assistance provision is "the same consultants are recycled" in the different countries. While this indicates success for some firms and individual experts, it may suggest that the same ideas and interventions for treatment and prevention spread regardless of their merits in different contexts.
All our interviewees said that the main advantage of being a consultant is the flexibility that comes with this type of work along with the high income, even though the levels of effort and income are often unpredictable. Consulting work comes with its risks; the consultant may not get assignments; an assignment can take longer or shorter than expected; payment can be delayed, and medical insurance is more expensive as it is not acquired through a group.
Dr Demba Dione said one of the greatest advantages of being a consultant instead of an employee of the government, or other multilateral agencies, is the freedom to think and speak. Good consultants are "free thinkers". As such they must be innovative and be able to speak honestly in order to assist with their assignments.
The following question was posed to the Secretariat regarding technical assistance and capacity building:
The Global Fund published a document called Technical Assistance in 2017. The document has a section called: "What the Global Fund Secretariat can do to improve TA". Were those suggested actions implemented? Did the Secretariat publish a follow-up document?
The Secretariat responded as follows:
Since 2017, the Global Fund has been implementing an innovative holistic approach to partnerships called "Partners Engagement Framework" that includes mapping and prioritization of partnerships, driving fit-for-purpose partnerships with value for money, a view of all types of technical assistance (funded through set-asides, strategic initiatives and grants), and strengthening resource tracking, among others. In addition, the Global Fund issued a guidance note for grant budgeting which includes a subsection on the budgeting for technical assistance (p.55).
All actions related to technical assistance implemented since 2017 are listed in the latest Global Fund report on Technical Cooperation and in the latest OIG report on Technical Assistance.
Audit report Audit Report Audit of Global Fund Capacity Building and Technical Assistance GF-(OIG-20-009) 3 April 2020 Geneva, Switzerland.
UNAIDS technical support Optimizing Global Fund grants in Asia and the Pacific 2017-2018 Geneva, reference 2018.