Since 2004, the Global Fund a supported The Gambia in fighting HIV, TB and malaria. While the MoH currently serves as PR for the malaria grant, HIV/TB grants are still managed by external PRs (NAS and ActionAid). As the MoH relies on external entities to serve as PRs for HIV and TB, it can lead to challenges in aligning program implementation with national priorities and the unique health context of The Gambia. By assuming the PR role for all three diseases, including RSSH, the MoH would have direct control over grant management, enabling better integration of Global Fund initiatives, with national health strategies, policies, and systems. This transition would also streamline decision-making processes, enhance accountability, and provide opportunities for building institutional capacity with the MoH.

To strengthened national ownership and align with Global Fund goals of sustainable, country-led health programs, there is a push for the MoH to assume full PR responsibility for all grants. Transitioning the MoH into the PR role represents a strategic move to empower the country in its response to public health challenges and improve grant functionality through direct oversight and management.

A comprehensive readiness assessment is required to evaluate the MoH’s capacity to manage HIV/TB and RSSH grants. This includes reviewing financial systems, procurement, governance, and program oversight. The assessment will identify gaps and propose solutions to ensure a smooth transition.

The transition of the MoH in The Gambia to serve as the PR for Global Fund grants is a critical step toward achieving national ownership and sustainable health program management. This shift aligns with the Global Fund’s vision of empowering countries to take greater responsibility for managing and implementing donor-funded programs, ultimately fostering self-reliance and strengthening local systems.

However, the move to the PR role requires addressing several critical areas to ensure readiness and functionality. Key aspects include strengthening financial management systems to meet the rigorous accountability standards of the Global Fund, enhancing governance frameworks to delineate clear roles and responsibilities, and developing robust supply chain systems to improve the procurement, distribution, and management of health commodities. Furthermore, programmatic oversight capacity must be bolstered to ensure effective monitoring and evaluation of grant activities.

To support this transition, a comprehensive assessment is necessary to identify existing gaps and recommend actionable solutions. Engaging experienced consultants is essential for evaluating the MoH’s readiness and providing strategic guidance on capacity-building initiatives, policy reforms, and system enhancements. This proactive approach will enable the MoH to meet the Global Fund’s requirements and ensure a seamless transition to the PR role, ultimately strengthening The Gambia’s health sector and advancing its public health goals.