A critical analysis of Peru's HIV grant proposals to the Global Fund

Abstract

2 Peru has applied to six of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) rounds for funding, achieving success on four occasions. The process of proposal development has, however, been criticised, especially concerning the use of evidence, relevance/consistency, and performance indicators.We aimed to analyse the Peruvian Global Fund proposals according to those dimensions, providing feedback to improve future local efforts and inform global discussions around Global Fund procedures. We analysed the content of four HIV-focused proposals (rounds 2, 5, 6 and 8) regarding epidemic context, needs identification and prioritisation, and monitoring and evaluation systems.Peruvian proposals submitted after round 1 were described as resulting from collaborative inputs involving formerly unrepresented sectors, principally 'vulnerable populations'. However, difficulties arose regarding the amount and quality of evidence about the epidemiological context; limited consideration of social determinants of the epidemic; lack of theory-driven interventions and little synergy across projects; and the inclusion of weak monitoring and evaluation systems, with poor indicators and measurement procedures.Prioritising the development of analytical and technical skills to generate Global Fund proposals would enhance the country's capacity to produce and utilise evidence, improve the technical-political interface, strengthen information systems, and lead to more informed decisionmaking and accountability. HIV/AIDS proposal elaboration processes have undergone different phases in Peru. The unsuccessful proposal for round 1 (which was not available and does not form part of this analysis) was formulated independently by the Ministry of Health. This proposal was followed by three consecutive, successful proposals (rounds 2, 5, and 6) and another unsuccessful proposal submitted for round 8. A new proposal submitted for round 10 under the special provision for key populations has recently been approved but was also not part of this analysis. The proposal approved for the 10th round (for US$12.5 million) in 2011 brought the total amount for HIV/AIDS activities by the Global Fund to approximately US$90 million (Global Fund, 2010). Table 1 presents a brief description of the four proposals that served as a basis for this study. from one proposal to the other; c) to assess whether the proposals include the appropriate mechanisms for monitoring and evaluating impacts and outcomes. These three dimensions encompass the key technical aspects of a programmatic proposal, all of which should be evidence-based: background, goals and activities, and performance assessment. For each of these objectives, we formulated indicators intended to operationalise the key dimensions identified for analysis (see Table 2). Study limitationsThis study has limitations such as the difficulty in defining a single, detailed evaluation framework across different proposals in an evolving context; restrictions in assessing the context where eac...

Public Private partnerships in education and health in the global South: a literature review

“…In addition, they have privileged technological fixes to public health issues, denying the embeddedness of health systems within broader social, economic and political realities. This trend has been reinforced by public health research itself, which has been dominated by quantitative, deductive studies to the detriment of qualitative, inductive research that is more amenable to in-depth understanding of the multifaceted dimension of health issues (Cáceres, Amaya, Sandoval, & Valverde, 2013;Gideon & Porter, 2015). The instrumental role of the BMGF in promoting an overly technological and managerial approach over the 'messy and complicated politics' of public health (Birn, 2014, p. 12) has been particularly emphasised (Birn & Lexchin, 2011;McGoey, 2014;Moran, 2011;Storeng, 2014).…”

Challenging Gendered Inequalities in Global Health: Dilemmas for NGOs

“…Other concerns can also arise. For example, Cáceres et al (2013) found that broader knowledge around HIV/AIDS prevention can become lost in practice where the medical components of models are prioritized over and above other more participative approaches involving a wider range of stakeholders.…”

Unpacking ‘women’s health’ in the context of PPPs: A return to instrumentalism in development policy and practice?

“…Indeed, this reinforces the findings in other studies, for example, in relation to work around HIV/AIDS in the context of the Global Fund. Cáceres et al (2013) found that broader knowledge around HIV/ AIDS prevention can become lost in practice where the medical components of models are prioritised over and above other more participative approaches involving a wider range of stakeholders.…”