THE PROBLEM

The COVID-19 pandemic is stressing country health systems and global health security on a scale not seen since the spread of HIV in the 1980s and 1990s and the 1918 influenza A pandemic. The Global Fund has been monitoring the impacts of these stresses on HIV, TB, and malaria programs and other essential health services. Simultaneously, the Fund is actively protecting the gains made in HTM programs during the past two decades from the impacts of the COVID pandemic while also assisting countries to fight COVID-19 directly and build stronger, more resilient health and community systems to address COVID-19 and future pandemics.

In 2020, the Fund mounted a new grant facility, the COVID-19 Response Mechanism (C19RM). Through the mechanism, $757.3 million was granted in 2020 and around $3.6 billion is expected to be awarded in 2021, alongside an additional $231.7 million through existing grant flexibilities (reprogramming), to support a total of 125 countries.

While the Fund’s Management Executive Committee has been closely tracking the C19RM, and the Funds’ Office of the Inspector General (OIG) has conducted two audits of the facility and is planning a third, there is a timely need for a thorough and independent evaluation of C19RM.

In October 2021, Pharos Global Health Advisors was selected by the Fund’s Technical Evaluation Reference Group (TERG) to conduct such an evaluation, focusing on the 2020 cohort of $1 billion in grants (C19RM plus flexibilities), while also considering whether and how lessons from the first year were helping to shape the design and grantmaking of C19RM in 2021.

THE PHAROS SOLUTION

The purpose of this project, conducted by Pharos Global Health Advisors for the TERG, is to evaluate C19RM with the specific objectives of:

1. Determining the relevance and appropriateness of C19RM investments;
2. Analyzing whether, how well, and why the C19RM was effective in mitigating the impact of the COVID-19 pandemic on HTM and broader public health, with special attention to the protection of human rights and key and vulnerable populations;
3. Assessing how effectively C19RM assisted low- and middle-income countries (LMIC) countries to fight COVID-19 directly and to strengthen health and community systems to prepare these countries to prevent, detect, and respond to future pandemics;
4. Examining the results and merits of global coordination to roll out the C19RM grants through the ACT-A partnership, with attention to possible duplications and important gaps at the interface with other financiers; and
5. Providing lessons learned to inform enhancements to future C19RM grants and in the Global Fund’s capacity to respond to future pandemics, especially in the light of the major ongoing global conversation regarding a new architecture and financing for pandemics.

In the country and global assessment phase, the Pharos team reviewed and extracted information from key global documents on C19RM and conduct interviews with stakeholders both inside and outside the Global Fund. The general global analysis has been augmented by two areas where Pharos expects to explore in more depth: COVID-19 commodity procurement and supply chains and the ACT-A partnership.

To support and bolster the global analysis, the Pharos team completed eight country case studies with countries around the globe including countries where we have worked in recent years, such as Angola and Peru, to those that are new to our organization, such as Ukraine and Vietnam. The full list of countries includes: Angola, El Salvador, Malawi, Peru, Rwanda, South Africa, Ukraine, and Vietnam.

LOOKING AHEAD

Ultimately, this evaluation should inform the ongoing round of C19RM 2.0 as well as the final round beginning in 2022. The team submitted the final report to the Global Fund in May 2022, and it was published in July 2023.

Status: Complete, November 2021 – May 2022

Team Members Involved: Robert Hecht, Nathan Isaacs, Grace Chen, Soji Adeyi, Jeff Sinden, Krishna Jafa, Joan Tallada, Sara Allinder, Richard Butuare, Gabriela Cohen, Raminta Stuikyte, Carl Schutte, Steve Cohen, and Sajid Sherif

For more information, contact Robert Hecht at [email protected].