Cablegate: Post Recommendations On Global Fund Phase 2 Renewals

This record is a partial extract of the original cable. The full text of the original cable is not available.



E.O. 12958: N/A


1. Following is post review on the overall grant for Sri Lanka
under the Global Fund. Due to limited time available for
responses, this cable will provide general comments on the
performance of the Global Fund for Tuberculosis and Malaria
collectively, based on post discussion with key stakeholders to
the project.

Sri Lanka/South East Asia

2. The implementation of the Global Fund in Sri Lanka for
Tuberculosis and Malaria has reported encouraging results,
although there is room for improvement in terms of the
operational aspects and structure of the Country Coordinating
Mechanisms (CCM). Some NGO's representing the CCM are of the
view that the government tends to dominate proceedings at the
CCM with NGO's not given due consideration as per the mandate of
the Global Fund. The frequent participation of the current
Minister of Health at CCM meetings does not create a conducive
environment for productive discussion and active participation
by all representatives. The venue of CCM meetings in recent
times are within the Ministry of Health (MOH) and not a neutral
venue. This also serves to heighten government ownership of the
program. According to World Banks sources, Sri Lanka's health
sector services are largely provided by the government, unlike
other countries in the region. Therefore, government direction
is to be expected in health sector programs.

3. According to the principal recipient for NGOs, a sub-
recipient for the TB program has not been suitable in terms of
capacity and financial accountability. The CCM approved payment
to the sub-recipient is based on an independent assessment.
However, questions remain on the financial veracity of the sub-
recipient. Suggestions have been tabled at a recent CCM meeting
for financial audits of funding to recipients that demonstrate
lack of a framework thus far for financial accountability within
the existing CCM structure in the country. The TB program of
the MOH has brought positive results in terms of number of
detections, treatment and public awareness campaigns, according
to the principal recipient for the NGO sector.

4. A key issue raised by NGOs pertains to procurement. There
is heavy political pressure on contracts and the principal NGO
recipient to award contracts to suppliers with political
affiliation. According to the principal recipient, the
government has expressed keen interest in handling all
procurement for the program.

5. The Secretary to the MOH (who chairs the CCM) states that
although some difficulties have been experienced, there have
been no major issues hindering the progress of the programs.
Funding disbursement is a major constraint for development in
the country, given inefficiencies in the government bureaucracy.
Funding disbursement is also an issue for the global fund,
though not at the same unproductive level. The Secretary
recommends certain changes and improvements to the CCM such as a
permanent secretariat, a constitution and reduction of CCM
membership, as he believes the present number is too large and

6. Comment: The structure of the CCM needs to be reviewed in
terms of the responsibility of all members towards achieving
Global Fund goals. Currently, there does not seem to be an
equal partnership between government, NGOs, civil society and
private sector, with the government dominating CCM proceedings.
Private Sector participation appears to be nominal. Mechanisms
to ensure transparency and financial accountability need to be
applied to the CCM in order to select qualified and competent
recipients and ensure funds are utilized appropriately. The
government's role in procurement should be examined, as
widespread corruption reportedly prevails in government
purchases. Funding could be continued at current levels as
there is widespread consensus that the Global Fund can play an
important role in combating the spread of malaria, tuberculosis
and HIV/Aids in Sri Lanka if all stakeholders participate
equally in the program and necessary accounting systems are
incorporated into the CCM.

7. These comments are a summary of the overall performance of
Global Fund in Sri Lanka. Post will be happy to provide any
clarifications on requests concerning specific aspects of the
Global Fund in Sri Lanka. Embassy contact is Richard Merrin


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