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Highlights

The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved about $7 billion in grants to developing countries; the U.S. has contributed $1.9 billion. The State Department's Office of the Global AIDS Coordinator (OGAC) coordinates the U.S. government's overseas AIDS programs, with participation from the Department of Health and Human Services (HHS) and the U.S. Agency for International Development (USAID). In 2003, Congress directed GAO to report on the Global Fund every 2 years. This report assesses the Global Fund's (1) documentation of information used to support performance-based funding decisions, (2) progress in implementing a risk assessment model and early warning system, and (3) oversight of the performance of "local fund agents" (LFAs), which monitor grant progress in recipient countries. GAO reviewed the documentation for funding decisions and interviewed key officials.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To enhance Global Fund operations, the Secretaries of State and HHS should work with the Global Fund's Board Chair and Executive Director to establish standardized expectations for LFA performance.
Closed - Implemented
The Office of the U.S. Global AIDS Coordinator (OGAC) at the State Department coordinates U.S. government efforts to combat HIV/AIDS overseas, including multilateral assistance to the Global Fund. The Global Fund contracts with Local Fund Agents (LFA) in the field to provide financial and programmatic oversight. OGAC, on behalf of State and HHS, provided information to support closing this recommendation. In October 2010, the U.S. government issued a Call to Action for the comprehensive reform of the Global Fund to improve its impact upon the lives of people affected by HIV, tuberculosis, and malaria. In response, the Chair and Vice-Chair of the Board established the Comprehensive Reform Working Group, which developed a detailed reform agenda approved by the full Board in May 2011. According to OGAC, the United States strongly supports the plan for comprehensive reform developed by the working group and endorsed by the Global Fund Board, especially as it relates to LFA performance and accountability. The comprehensive package of reforms, when implemented, is intended to significantly improve the Global Fund's operations, governance, and fiduciary controls. The Secretariat committed to the implementation of these reforms and is to report back to the Board in November 2011 on progress. Regarding standardized expectations for LFAs, the reform package specifically called for an accountability framework for fiduciary control and risk management that clearly delineates the roles, responsibilities, and accountability of the Global Fund and its structures, including LFAs. It also called for reforms in independent audits and investigation functions and in national accountability structures, such as government ministries, regulators, and civil society.
Department of State To enhance Global Fund operations, the Secretaries of State and HHS should work with the Global Fund's Board Chair and Executive Director to establish standardized expectations for LFA performance.
Closed - Implemented
The Office of the U.S. Global AIDS Coordinator (OGAC) at the State Department coordinates U.S. government efforts to combat HIV/AIDS overseas, including multilateral assistance to the Global Fund. The Global Fund contracts with Local Fund Agents (LFA) in the field to provide financial and programmatic oversight. OGAC, on behalf of State and HHS, provided information to support closing this recommendation. In October 2010, the U.S. government issued a Call to Action for the comprehensive reform of the Global Fund to improve its impact upon the lives of people affected by HIV, tuberculosis, and malaria. In response, the Chair and Vice-Chair of the Board established the Comprehensive Reform Working Group, which developed a detailed reform agenda approved by the full Board in May 2011. According to OGAC, the United States strongly supports the plan for comprehensive reform developed by the working group and endorsed by the Global Fund Board, especially as it relates to LFA performance and accountability. The comprehensive package of reforms, when implemented, is intended to significantly improve the Global Fund's operations, governance, and fiduciary controls. The Secretariat committed to the implementation of these reforms and is to report back to the Board in November 2011 on progress. Regarding standardized expectations for LFAs, the reform package specifically called for an accountability framework for fiduciary control and risk management that clearly delineates the roles, responsibilities, and accountability of the Global Fund and its structures, including LFAs. It also called for reforms in independent audits and investigation functions and in national accountability structures, such as government ministries, regulators, and civil society.
Department of Health and Human Services To enhance Global Fund operations, the Secretaries of State and HHS should work with the Global Fund's Board Chair and Executive Director to require systematic assessments of LFA performance and the collection and analysis of LFA performance data to improve the management and oversight of LFAs.
Closed - Implemented
The Office of the U.S. Global AIDS Coordinator (OGAC) at the State Department coordinates U.S. government efforts to combat HIV/AIDS overseas, including multilateral assistance to the Global Fund. The Global Fund contracts with Local Fund Agents (LFA) in the field to provide financial and programmatic oversight. OGAC, on behalf of State and HHS, provided information to support closing this recommendation. In October 2010, the U.S. government issued a Call to Action for the comprehensive reform of the Global Fund to improve its impact upon the lives of people affected by HIV, tuberculosis, and malaria. In response, the Chair and Vice-Chair of the Board established the Comprehensive Reform Working Group, which developed a detailed reform agenda approved by the full Board in May 2011. According to OGAC, the United States strongly supports the plan for comprehensive reform developed by the working group and endorsed by the Global Fund Board, especially as it relates to LFA performance and accountability. The comprehensive package of reforms, when implemented, is intended to significantly improve the Global Fund's operations, governance, and fiduciary controls. The Secretariat committed to the implementation of these reforms and is to report back to the Board in November 2011 on progress. The reform package specifically called for an accountability framework for fiduciary control and risk management that clearly delineates the roles, responsibilities, and accountability of the Global Fund and its structures, including LFAs. In addition, according to OGAC, the Secretariat is working to implement a more rigorous and systematic LFA performance management system, including the collection of LFA performance data. The Secretariat also terminated 10 LFA contracts for poor performance.
Department of State To enhance Global Fund operations, the Secretaries of State and HHS should work with the Global Fund's Board Chair and Executive Director to require systematic assessments of LFA performance and the collection and analysis of LFA performance data to improve the management and oversight of LFAs.
Closed - Implemented
The Office of the U.S. Global AIDS Coordinator (OGAC) at the State Department coordinates U.S. government efforts to combat HIV/AIDS overseas, including multilateral assistance to the Global Fund. The Global Fund contracts with Local Fund Agents (LFA) in the field to provide financial and programmatic oversight. OGAC, on behalf of State and HHS, provided information to support closing this recommendation. In October 2010, the U.S. government issued a Call to Action for the comprehensive reform of the Global Fund to improve its impact upon the lives of people affected by HIV, tuberculosis, and malaria. In response, the Chair and Vice-Chair of the Board established the Comprehensive Reform Working Group, which developed a detailed reform agenda approved by the full Board in May 2011. According to OGAC, the United States strongly supports the plan for comprehensive reform developed by the working group and endorsed by the Global Fund Board, especially as it relates to LFA performance and accountability. The comprehensive package of reforms, when implemented, is intended to significantly improve the Global Fund's operations, governance, and fiduciary controls. The Secretariat committed to the implementation of these reforms and is to report back to the Board in November 2011 on progress. The reform package specifically called for an accountability framework for fiduciary control and risk management that clearly delineates the roles, responsibilities, and accountability of the Global Fund and its structures, including LFAs. In addition, according to OGAC, the Secretariat is working to implement a more rigorous and systematic LFA performance management system, including the collection of LFA performance data. The Secretariat also terminated 10 LFA contracts for poor performance.

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