The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health.  Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America.  The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua.  This study sought to examine local stakeholders’ (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua.  The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights.  Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups.  The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006.  Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant.  In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern.  In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed.  The focus on human resource development via the GF was considered a strength of the project.  Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua.
The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development