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Global Fund Observer

Newsletter

Issue 226: 27 August 2013

GFO is an independent newsletter about the Global Fund.
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CONTENTS OF THIS ISSUE:

1. NEWS: Funding Approved for Another 10 Interim Applicants

Funding in the amount of up to $363.7 million has been approved for 10 interim applicants. This brings to 15 the number of interim applicants for which funding has been awarded, out of the 48 invited to apply when the new funding model was launched.

2. NEWS: Renewal Funding Approved for 15 Grants

Incremental funding in the amount of up to $295.6 million has been approved for renewal of 19 grants from 15 applicants. The largest awards are for HIV grants in Mozambique and Cambodia.

3. NEWS: Renewal Funding Approved for Cambodia HIV Grant Despite Need to Appoint Fiduciary and Procurement Agents

The decision of the Global Fund Board to approve renewal funding for an HIV grant to Cambodia was made amidst concerns about the grant’s financial and procurement management. The Office of the Inspector General has completed an investigation into the principal recipient of the grant, but the report on the investigation has not yet been released. In the next period, the grant will focus more on most-at-risk populations and orphans and vulnerable children. The request for renewal funding raised issues related to incentive payments to health workers and management staff.

4. NEWS: Next Implementation Period of Guinea TB Grant Will See Some Changes, Including a New PR

For the next implementation period of a single-stream-of-funding grant TB grant to Guinea, activities related to the Practical Approach to Lung Health have been removed. The funds involved will be diverted to areas where performance has been weak or where gaps have been identified. Financial irregularities in the current implementation period have caused the Global Fund to require a change in principal recipient.

5. NEWS: Global Fund Pushes for More Rapid Scale-Up in Indonesia’s TB Grants

New and renewal funding of $37.5 million for two TB grants to Indonesia will be used to help ensure early and full access to the most appropriate diagnosis and treatment services. Technical assistance from partners is being provided to allow for a more rapid scale-up of services than Indonesia had originally planned.

6. NEWS: Request for Phase 2 Funding for Ecuador HIV Grants Approved After Two Resubmissions

In Phase 2 of two HIV grants to Ecuador, the focus on most-at-risk populations will be significantly increased. Phase 2 funding was recently approved, but only after the request was revised twice.

7. NEWS: New PR, New Focus for Phase 2 of Malaria Grant in CAR

Phase 2 of a malaria grant to Central African Republic will focus entirely on providing essential life-saving services and will be managed by a new principal recipient.

8. NEWS: Scale-Up of Treatment and Prevention Planned for Phase 2 of Mozambique HIV Grants

The $233.7 million in interim applicant and renewal funding for two HIV grants in Mozambique will be used to significantly scale up treatment and prevention. The scale-up will be phased in because of concerns about weaknesses in the country’s health systems, and challenges experienced during Phase 1 of the grants.

9. NEWS: NFM Funding for Nigeria Will Support Mass Distribution of LLINs

Most of the $167 million approved under the new funding model for two malaria grants in Nigeria will be used for a mass distribution of long-lasting insecticide-treated bednets in nine states where coverage is in danger of falling to a critically low point.

10. ANNOUNCEMENT: Latest Issue of GBCHealth Insights Focuses on Global Fund

The 13 August issue of GBCHealth Insights, a publication of GBCHealth, is devoted entirely to the Global Fund.

 
See section near the end of this newsletter listing additional articles available on GFO Live.
 
ARTICLES:

1. NEWS: Funding Approved for Another 10 Interim Applicants

Mozambique and Nigeria get the largest awards

The Board of the Global Fund to Fights AIDS, Tuberculosis and Malaria has approved funding in the amount of up to $363.7 million for 10 interim applicants in the transition phase of the new funding model (NFM). Five applicants were awarded funding for two components, and five for one component. See the table for details.

In approving the funding, the Board was acting on recommendations from the Technical Review Panel (TRP) and the Secretariat, including the Grant Approvals Committee (GAC).

This brings to 15 the number of interim applicants for which funding has been awarded. When the NFM was launched on 28 February, the Global Fund said that 48 interim applicants had been invited to apply. More approvals are expected in the coming months.

The largest awards went to Mozambique ($138.0 million for two HIV grants) and Nigeria ($167.0 million for two malaria grants).

Table: Interim Funding Awards for July 2013

Country
Component
Grant Number
Ceiling
($US million)
Bangladesh
TB
BAN-T-NTP
$1.9
TB
BAN-T-BRAC
$2.1
Belarus
TB
BLR-S10-G04-T
$1.0
India
HIV
IDA-708-G14-H
$10.3
HIV
IDA-708-G15-H
$8.1
Indonesia
Malaria
IND-M-MOH
$17.3
 
TB
IND-809-G10-T
$1.2
Jamaica
HIV
JAM-708-G02-H
$2.4
Mozambique
HIV
MOZ-911-G09-H
$9.7
HIV
MOZ-911-G10-H
$128.3
Nigeria
Malaria
NGA-089-G11-M
$73.7
Malaria
NGA-089-G14-M
$93.3
Russian Federation
HIV
RUS-506-G05-H
$2.5
Sudan
Malaria
SUD-708-G10-M
$7.0
Zimbabwe
TB
ZIM-809-G12-T
$4.9
TOTAL
$363.7

All of the amounts shown in the table are ceilings; the amounts finally committed could be less.

The breakdown of funding by disease is as follows: malaria $191.3 million (53%), HIV $161.3 million (44%) and TB $11.1 million (3%).

Three of the 10 applicants – Belarus, Indonesia and Mozambique – were also awarded grant renewal funding (see next article in this issue).

The Global Fund has adopted a new, simplified process for assessing small funding requests for well performing grants. Under the simplified process, funding recommendations are made by the Secretariat and endorsed by the GAC, usually without review by the TRP or the GAC. Generally speaking, requests under $10 million will go through the simplified process. But that figure is just a guide. Some requests of $10 million or more will go through the simplified process if they are mostly a continuation of existing services to avoid a disruption. In addition, some requests of under $10 million will still trigger a GAC review – for example, when a grant has historically had implementation challenges.

The simplified process was used for all of the components shown in the table where the approved funding was under $10 million. It was also used for India (IDA-708-G14-H, $10.3 million) and Indonesia (IND-M-MOH, $17.3 million).

For the components approved under the simplified process, the GAC made only brief comments. These comments are summarized below:

BANGLADESH (two TB grants): The two principal recipients (PRs) – the Ministry of Finance and the Bangladesh Rural Advancement Committee –­ will use the additional funding of $4.0 million to deliver a 62% increase in enrolment of multiple-drug-resistant TB (MDR-TB) cases on second-line treatment during the 2013–2014 fiscal year, and a 75% increase in 2014–2015.

BELARUS (TB grant): The PR, the United Nations Development Programme (UNDP), will use the $1.0 million in approved funding (along with $8 million from the renewal process) to focus on addressing MDR-TB and extensively-drug-resistant TB, and strengthening the HIV/TB component.

INDIA (two HIV grants): The additional funding of $10.3 million for IDA-708-G14-H (PR: India Nursing Council) will be used for programmes to ensure: (a) proper qualification of auxiliary and general nurse-midwives; (b) involvement of medical officers in training and supervision; (c) access of nurses to HIV and TB patients; and (d) moving towards the concept of “nurse practitioners” for nurses working in HIV and TB. The additional funding of $8.1 million for IDA-708-G15-H (PR: Tata Institutes of Social Sciences) will be used to improve: (a) uptake of the integrated counselling and testing centre (ICTC) services by high-risk, vulnerable groups, as well as those who live in difficult geographical terrain; (b) linkages between ICTCs and TB clinics; (c) follow-up of positive people, including pregnant women, for continuum of care; and (d) HIV counselling and testing.

INDONESIA (malaria grant): The additional funding of $17.3 million will be used by the PR, the Ministry of Health, to procure and distribute 3.2 million long-lasting insecticide-treated bednets (LLINs), and to distribute an additional 260,000 LLINs being procured by the national government.

JAMAICA (HIV grant): The additional funding of $2.4 million will be used by the PR, the Ministry of Health, to complement the Transitional Funding Mechanism grant previously approved in 2012 by supporting the treatment component – specifically, procuring antiretrovirals (ARVs), providing living support and promoting an enabling environment.

RUSSIAN FEDERATION (HIV grant): The PR, the Russian Harm Reduction Network, will use the additional $125 million to maintain programmes targeting people who inject drugs in 32 cities, covering 61,015 people annually.

SUDAN (malaria grant): The additional $7.0 million will be used by the PR, UNDP, to support the procurement of one million LLINS and 33.6 tons of insecticides. The GAC also endorsed the request for an extension of this grant using $2.7 million in savings from the current implementation period.

ZIMBABWE (TB grant): The PR, UNDP, will use the additional funding of $4.0 million to maintain the following existing initiatives: (a) a TB prevalence survey; (b) programmatic management of multiple-drug-resistant TB; (c) a drug-resistant-TB survey; and (d) community TB care.

The GAC provided more extensive comments for the applicants awarded larger amounts of funding – Mozambique and Nigeria. See separate articles on these countries in this issue.

GFO reported on previous approvals of funding for interim applicants here and here. Information for this article was taken from Board Decisions GF-B29-EDP3 and GF-B29-EDP4, and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 21 August 2013.]

To comment on this article, click here.

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2. NEWS: Renewal Funding Approved for 15 Grants

Largest awards go to Mozambique and Cambodia

The Board of the Global Fund to Fights AIDS, Tuberculosis and Malaria has approved funding in the amount of up to $295.6 million for 15 applicants submitting requests for continued funding. See the table for details.

In approving the funding, the Board was acting on recommendations from the Technical Review Panel (TRP) and the Secretariat, including the Grant Approvals Committee (GAC). The largest awards went to Mozambique ($95.7 million for two HIV grants) and Cambodia ($57.7 million for an HIV grant).

Table: Funding Awards for Grant Renewals, July 2013

Country
Component
Grant Number
Ceiling
($US million)
Belarus
TB
BLR-S10-GO4-T
$8.1
Cambodia
HIV
CAM-H-NCHADS
$57.7
Central African Rep.
Malaria
CAF-810-G08-M
$15.4
Ecuador
HIV
ECU-910-GO7-H
$13.8
Guinea
TB
GIN-T-MHSP
$4.3
Guyana
Malaria
GYA-M-MOH
$0.4
Honduras
HIV
HND-H-CHF
$6.3
TB
HND-T-UECFSS
$2.4
Indonesia
TB
IND-T-MOH
$29.7
TB
IND-809-G10-T
$6.6
Lao PDR
TB
LAO-T-GFMOH
$7.5
Mali
HIV
MAL-809-G07-H
$21.1
Mongolia
TB
MON-T-MOH
$7.0
Mozambique
HIV
MOZ-911-G09-H
$20.1
HIV
MOZ-911-G10-H
$75.6
Sao Tome & Principe
Malaria
STP-M-UNDP
$4.8
Senegal
TB
SNG-T-PLAN
$6.1
TB
SNG-T-PNT
$5.4
Sri Lanka
HSS
SRL-911-G15-S
$3.3
TOTAL
$295.6

All of the amounts shown in the table are ceilings; the amounts finally committed could be less.

(Note that the amounts shown in the table represent incremental funding for the grants. The total budgets for the next implementation period will usually be higher than what is shown because they include unspent funds from the last implementation period.) 

The breakdown of funding by disease is as follows: HIV $194.6 million (66%), TB $77.1 million (26%), malaria $20.6 million (7%) and health systems strengthening $3.3 million (1%).

Three of the 10 applicants – Belarus, Indonesia and Mozambique – were also awarded funding as interim applicants under the new funding model (NFM). (See previous article in this issue.)

The Global Fund has adopted a new, simplified process for reviewing relatively small funding requests for well performing grants. Under the simplified process, funding recommendations are made by the Secretariat and endorsed by the GAC, usually without review by the TRP or the GAC. Generally speaking, requests under $10 million will go through the simplified process. But that figure is just a guide. Some requests of $10 million or more will go through the simplified process if they are mostly a continuation of existing services to avoid a disruption. In addition, some requests under $10 million will still trigger a GAC review – for example, when a grant has historically had implementation challenges.

The simplified process was used for all of the components shown in the table where the approved funding was under $10 million, except for Guinea and Senegal.

For the components approved under the simplified process, the GAC made only brief comments. These comments are summarized below:

BELARUS (TB grant): The principal recipient (PR), the United Nations Development Programme (UNDP), will use the $8.1 million in approved funding (along with $1 million in NFM funding) to focus on addressing multiple-drug-resistant TB (MDR-TB) and extensively-drug-resistant TB, and strengthening the HIV/TB component.

GUYANA (malaria grant): In Phase 2, the PR, the Ministry of Health, will aim to decrease malaria morbidity by 70% (from 24,154 cases in 2012 to 7,246 by 2016) in the four most affected regions of Guyana, which account for 98% of all malaria cases.

HONDURAS (one HIV and one TB grant): Phase 2 of the HIV grant, HND-H-CHF, for which the PR is Cooperative Housing Federation, will focus on the most-at-risk populations (MARPS) in the 42 most affected municipalities, reporting 80% of the national cases and mostly located in the northern coast of the country, which is showing a prevalence rate close to 1%. In Phase 2 of the TB grant, HND-T-UECFSS, the PR, the Ministry of Health, will attempt to increase case notification rates amongst new smear positive cases from 25.6 to 37.4 (per 100,000) by 2016 and maintain treatment success rates above 85%.

LAO PDR ( (TB grant): Phase 2 of the grant, for which the PR is the Ministry of Health, will focus on achieving higher impact for critical areas including case notification, increasing the number of patients put on treatment, improving MDR-TB and strengthening collaboration between HIV and TB.

MONGOLIA (TB grant): The focus of Phase 2 of the grant, for which the PR is the Ministry of Health, is on underserved and most-at-risk populations (MARPS). Phase 2 will include high-impact interventions. It will also involve scaling up community-based directly observational therapy, short course (DOTS) by family group practitioners who are providing TB services covering vulnerable groups, such as prisoners and homeless people.

SAO TOME & PRINCIPE (malaria grant): The main focus of Phase 2 of the grant, for which the PR is UNDP, will be on malaria prevention, involving an all-region indoor residual spraying campaign.

The GAC provided more extensive comments for Guinea and Senegal, and for the applicants awarded larger amounts of funding – Cambodia, Central African Republic, Ecuador, Indonesia, Mali and Mozambique. This issue contains articles on most of these countries; articles on Mali and Senegal can be found on GFO Live.

Information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 21 August 2013.]

To comment on this article, click here.

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3. NEWS: Renewal Funding Approved for Cambodia HIV Grant Despite Need to Appoint Fiduciary and Procurement Agents

Grant to focus more on MARPS and OVC

Issue of incentive payments to health workers and management staff sparks considerable discussion

The Global Fund Board decided to approve renewal funding for an HIV grant to Cambodia even though the Fund is concerned about problems in financial and procurement management.

GFO reported in the previous article in this issue that Cambodia was awarded renewal funding of up to $57.7 million for the next implementation period of a single-stream-of-funding grant, CAM-H-NCHADS, for which the principal recipient (PR) is the National Centre for HIV/AIDS, Dermatology and STI (NCHADS).

In the next implementation period, the focus will shift somewhat to include more prevention activities for the main most-at-risk populations (MARPs), and more support for orphans and vulnerable children (OVC).

The shift in emphasis reflects similar changes to Cambodia’s national HIV strategy. Another reason for the shift is that bilateral funding for Cambodia from the US is moving away from financing service delivery and towards supporting technical assistance. In addition, other donors are ending their support for OVC in Cambodia. The Global Fund remains the main donor for HIV service delivery in Cambodia.

The Grant Approvals Committee (GAC) recommended that a unified strategy be developed with technical partners to address (a) human rights barriers that negatively impact outreach to MARPS; and (b) long-term resourcing issues. The latter refer to what the Global Fund sees as the need for increased contributions from the Government of Cambodia and for strategies to ensure the retention of staff within the national HIV programme in the Ministry of Health.

Fiduciary and procurement agents appointed

According to a version of  the programme scorecard prepared for the Board, the Office of the Inspector General (OIG) completed an investigation of NCHADS in mid-2012 and is in the process of finalising its report. (“Programme scorecard” is the new name for the grant scorecard.)

Based on information from the OIG, the scorecard said, the Secretariat decided to engage a fiduciary agent to manage funds dispersed to NCHADS and to strengthen its financial management control systems. The scorecard said that the Secretariat has decided to extend the mandate of the fiduciary agent to the next implementation period of the HIV grant.

In addition, the scorecard revealed, the Secretariat decided to embed a procurement agent in NCHADS to manage the procurement and supply management (PSM) function and to strengthen controls within the procurement unit. Procurement of health products will be handled by an international entity (either UNICEF or the Fund’s pooled procurement mechanism).

Further, the scorecard said that in order to mitigate risks regarding a particular sub-recipient (SR) that was also a subject of the OIG investigation, the Secretariat has extended the terms of reference of the fiduciary agent in NCHADS to cover financial management and controls in the SR.

Procurement issues at NCHADS

According the scorecard, in the first period of implementation of the HIV grant, NCHADS had weak PSM capacity. This led to poor forecasting and inventory counts, delayed approval of PSM plans and delayed procurement of health products. These delays have ultimately caused Cambodia to experience stock-outs of drugs, test-kits and condoms, the scorecard said.

The scorecard said that the Secretariat will endeavour to strengthen the PSM capacity of NCHADS, with the help of partners, such as the Clinton Health Access Initiative, USAID and France’s 5% Initiative, during the rest of 2013 and into the next period of implementation of the grant. Efforts will focus on strengthening databases at antiretroviral (ART) sites to accurately record patient numbers, regimens dispensed and stock in hand. The scorecard said that investments in the physical infrastructure of ART sites, planned for first implementation period but then postponed, will be carried out in the next implementation period.

Incentive payments

There was considerable discussion within the GAC concerning the payment of incentives to staff implementing the grant. In its report to the Board, the GAC said that although it acknowledges donors’ concerns about paying incentives to retain staff, it believes that the incentives should continue in the short term while a longer-term strategy is developed.

The CCM request for renewal funding included money to pay health workers and staff in the management unit of NCHADS incentives ranging from $40 to $200 per month. In the programme scorecard, the Secretariat said that incentives were also included in the budget for the first implementation period of the grant, and were paid until the end of 2012. They were stopped following pressure from a number of donors to support efforts to achieve comprehensive compensation reform in Cambodia.

In the scorecard, the Secretariat said that it is reassessing its decision to stop funding incentives. The Secretariat argued that:

  • it is not realistic to expect that the reform will be completed in the near future;
  • if the workers are not adequately paid, they will be forced to look for alternate sources of income; and
  • if the incentive payments are not reinstated, this would have a negative impact on the morale of workers, and would likely lead to staff shortages at NCHADS.

The Secretariat also said that the situation is exacerbated when development partners fund projects within the health sector that include well-remunerated “project positions,” which contributes to a diminishing work force of core staff within the Ministry of Health.

Following detailed discussion with development partners, a board condition and a management action were added to the approval of renewal funding. The board condition stated that once development partners and the Government of Cambodia agree on a new comprehensive health sector compensation scheme, all governmental PRs and other governmental implementing entities shall comply with the scheme.

The management action is that the Global Fund commits to holding extensive discussions with the Government of Cambodia and development partners in Cambodia with the aim of reaching agreement on an interim solution for incentive payments. The management action calls for a final decision on the solution to be taken by 31 October 2013.

Information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website. Additional information was taken from the programme scorecard, a version of which should be posted on the Global Fund website shortly.

[This article was first posted on GFO Live on 22 August 2013.]

To comment on this article, click here.

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4. NEWS: Next Implementation Period of Guinea TB Grant Will See Some Changes, Including a New PR

For the next implementation period of a single-stream-of-funding TB grant, activities related to the Practical Approach to Lung Health (PAL) have been removed. The funds involved will be diverted to areas where performance has been weak or where gaps were identified during a programme review conducted with partners in November 2012 – for example, diagnosis and treatment of smear-negative cases, improved TB detection in children, lowering the default rates (currently high), strengthening the laboratory network and improving TB/HIV coordination.

As reported in the second article in this issue, Guinea was awarded renewal funding of up to $4.3 million for this grant (No. GIN-T-MSHP).

Other objectives for the next implementation period are to continue improvements in high quality directly observational therapy, short course (DOTS); and to improve diagnosis and management of TB/HIV co-infection and multiple-drug-resistant TB.

Stakeholders in Guinea were generally supportive of the decision to divert funds from PAL-related activities to other areas.

According to the Grant Approvals Committee (GAC), financial irregularities in the implementation of this grant were recently identified. The GAC did not provide details. However, stakeholders in Guinea said that the “official” line is that the financial irregularities occurred in the management of TB medicines. They added, however, that they believe the irregularities are more widespread. The CCM has not yet been formally notified of the irregularities.

As a result of the financial irregularities, the Global Fund insisted on a change in principal recipient (PR) for the next implementation period. A new PR, not yet named, will take over from the Ministry of Public Health.

Stakeholders told GFO that it may take some time to identify a new PR for two reasons: (1) due to the political instability in Guinea, the CCM has not planned any meetings in the next few months; and (2) widespread corruption in the country may discourage suitable organisations from taking on the role of PR. This may cause delays in grant implementation, stakeholders said.

Once the CCM does take up the issue of identifying a new PR, stakeholders expect there will be a spirited discussion.

The request for continued funding was originally presented in August 2012. The Grant Renewals Panel (predecessor of the GAC), found the request to be weak and invited the CCM to re-submit. The CCM did so on 26 June 2013.

The GAC recommended that a long-term technical assistance plan for the Guinea TB programme be developed by the Global Fund and its technical partners.

Some of the information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website. Our regional correspondent for West and Central Africa, Bertrand Kampoer, contributed to this article.

[This article was first posted on GFO Live on 22 August 2013.]

To comment on this article, click here.

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5. NEWS: Global Fund Pushes for More Rapid Scale-Up in Indonesia’s TB Grants

The objective of the second phase of two TB grants to Indonesia is to ensure early and full access to the most appropriate diagnosis and treatment services in both the public and private health sectors for everyone suffering from TB.

As reported in the second article in this issue, Indonesia was awarded renewal funding of up to $36.3 million by the Global Fund to Fight AIDS, Tuberculosis and Malaria for two TB grants: IND-T-MOH ($29.7 million), for which the principal recipient (PR) is the Ministry of Health; and IND-809-G10-T ($6.6 million), for which the PR is the Central Board of Aisyiyah. Indonesia was also awarded $1.2 million in new funding model (NFM) interim applicant funding for the Aisyiyah grant (see first article in this issue).

When it reviewed the funding requests, the Grant Approvals Committee (GAC) emphasised the need to scale up coverage of TB/HIV and multiple-drug-resistant TB (MDR-TB). The GAC said that it acknowledged the country’s preference for a gradual approach, as expressed in the request for continued funding. The GAC also acknowledged concerns expressed by the MOH in relation to increasing absorption, and the need to balance rapid scale-up with strengthening financial management systems and programme quality. (Up to the end of Semester 3 of Phase 1, the MOH had absorbed only 50% of the cumulative budget.)

However, the GAC noted that significant investments in technical assistance are being made by partner organisations to complement Global Fund resources. These include support to NGOs to pilot models of care, as well as investments in improving MDR-TB programme quality, and financial management capacity. The GAC added that if the TB programme were able to achieve scale-up and demonstrate an ability to increase absorption, Indonesia would be well placed to apply for additional resources under the NFM.

The GAC noted that the Phase 2 budget does not include any money for first-line drugs (FLD) and said that it expects that Indonesia will continue its full financing of national FLD requirements.

Information for this article was taken from Board Decisions GF-B29-EDP3 and GF-B29-EDP4, and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 22 August 2013.]

To comment on this article, click here.

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6. NEWS: Request for Phase 2 Funding for Ecuador HIV Grants Approved After Two Resubmissions

Focus on MARPs will be significantly increased

The request from the Ecuadorian CCM for continued funding for two HIV grants was rewritten twice before finally being recommended for funding by the Grant Approvals Committee (GAC).

As reported in the second article in this issue, Ecuador was awarded incremental renewal funding of up to $13.8 million for Phase 2 of a Round 9 grant, ECU-910-GO7-H, for which the principal recipient (PR) is the Corporacion Kimirina. The other HIV grant up for renewal, ECU-910-GO6-H, for which the PR is the Ministry of Health (MOH) did not receive any incremental funding; instead, unspent funds from Phase 1 will be used to implement Phase 2.

The original request for continued funding was reviewed by the Grant Renewals Panel (the predecessor of the GAC) in December 2012. The Panel recommended that the request be resubmitted and the Global Fund Board confirmed the resubmission request in January 2013 (see GFO article). (The reasons for the Secretariat’s recommendation were not made public.)

When the GAC reviewed the resubmission request in May 2013, it concluded that the guidance from the Grant Renewals Panel was only partially followed and that the resubmission was still not strong enough. For example, the GAC said, the CCM did not re-programme funds at a scale necessary to reach high coverage of most-at-risk populations (MARPs). According to the GAC, the MOH request included a range of activities which did not meet the requirement for upper-middle-income countries like Ecuador that 100% of the request be focused on MARPS. In addition, the GAC said, the scale of coverage of key populations was not ambitious; and the proposed areas of intervention were dispersed all over the country instead of being focused on the “hot spots” where vulnerable key populations are most concentrated. Finally, the GAC said, the prevention packages were not clearly defined.

So, the CCM was invited to resubmit again. Meanwhile, in June, the Global Fund’s country team for Ecuador organised a mission along with UNAIDS and the International HIV/AIDS Alliance to visit Ecuador to support the CCM in the resubmission process.

The GAC said that the CCM and the mission collaborated closely. This resulted in a revision of the key population size estimates, the identification of hot spots, the design of the prevention packages and the development of new linkages between the two PRs implementing HIV grants. The coverage goal for services to MARPs went up to 80% compared to 16% in the previous submission.

Representatives of stakeholders in Ecuador told GFO that the fact that data on the size of two populations – men who have sex with men, and trans people – were recently made available explains why coverage goals could be increased significantly. The representatives also said the mission provided valuable assistance in developing the goals, indicators and budgets for the request.

During Phase 2, the MOH will focus on development of a national comprehensive policy framework on MARPS, including defined intervention packages and plans for their roll-out at service delivery points. The MOH will also focus on support for vulnerable groups, such as pregnant women accessing pre-natal services in private clinics, and TB/HIV patients; and interventions to improve the quality of life for persons living with HIV/AIDS. Corporacion Kimirina will be designing, developing and implementing peer-to-peer and community-level behavioural change and prevention packages.

Stakeholders in Ecuador told GFO that the final proposal included two innovative strategies. One strategy is the use of “community entertainers.” They are similar to peer counsellors but will reach people where they live. The second strategy is the use of social networks where targeted communities interact.

Most people GFO spoke to in Ecuador said they were happy with the final proposal. However, one trans activist said that because civil society organisations (CSOs) will have to provide services to many more people in Phase 2, more money should have been allocated for CSO capacity building.

Some of the information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website. Our regional correspondent for Latin America, Lídice Lopez, contributed to this article.

[This article was first posted on GFO Live on 22 August 2013.]

To comment on this article, click here.

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7. NEWS: New PR, New Focus for Phase 2 of Malaria Grant in CAR

Because of the poor performance in Phase 1 of a malaria grant in Central African Republic (CAR), and because of the growing political crisis in that country, Phase 2 will focus entirely on providing essential life-saving services. Phase 2 will also bring with it a new principal recipient, the International Federation of Red Cross and Red Crescent Societies (IFRC), which takes over from the National AIDS Committee. The Grant Approvals Committee said that IFRC has experience operating in fragile states and complex humanitarian emergencies.

As reported in the second article in this issue, CAR was awarded incremental renewal funding of up to $11.8 million for Phase 2 of a Round 8 grant, CAF-810-G08-M.

Phase 1 had been designed to fills the gaps in national coverage, but failed to provide any long-lasting insecticide-treated nets (LLINs), rapid diagnostic tests or treatment for severe malaria.

Phase 2 will include a mass distribution campaign of 2.2 million LLINs through contracted agencies, as well as limited case management of uncomplicated malaria cases and intermittent preventive treatment of malaria for pregnant women. The goal of the LLIN distribution is to achieve universal coverage.

Mr Gremale Gilbert, Chairman of RECAPEV (National Network of PLWHA), said that CAR is facing two fundamental challenges: (1) the weak capacity of local implementers; and (2) a security situation that remains precarious.

Mr Gilbert said that the low capacity cuts across all functional areas (planning, management, M&E) and explains the problems with Phase 1 of the malaria grant. He said that the security situation will require that innovative strategies be developed for the successful implementation of the grant.

Mr Gilbert said that IFRC has a good reputation with most of the local players.

Information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website. Our regional correspondent for West and Central Africa, Bertrand Kampoer, contributed to this article.

[This article was first posted on GFO Live on 22 August 2013.]

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8. NEWS: Scale-Up of Treatment and Prevention Planned for Phase 2 of Mozambique HIV Grants

Scale-up to be phased in

Phase 2 of two HIV grants in Mozambique will see a significant scale-up of both treatment and prevention. However the scale-up will be phased in because of concerns about weaknesses in the health systems and challenges experienced in implementing Phase 1.

As reported in the first two articles in this issue, Mozambique was awarded both (a) renewal funding; and (b) interim applicant funding under the new funding model (NFM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria. See the table for details.

Table: Interim applicant and renewal funding awards for Mozambique HIV grants

Grant Number
Approved funding ceilings ($ million)
Renewals
Interim applicant
Total
MOZ-911-G09-H
$20.1
$9.7
$29.8
MOZ-911-G10-H
$75.6
$128.3
$203.9
TOTAL
$95.7
$138.0
$233.7

The Mozambican CCM submitted just one request for funding covering both renewals and the interim applicant funds available under the NFM. The NFM funding will be folded into the two existing HIV grants.

Phase 2 will see a significant scale-up of activities related to the provision of HIV testing and treatment. The number of adults on antiretrovirals (ART) is expected to increase from 287,687 to 520,076 by 2015. Over the same period, the number of children on ART is expected to increase from 25,891 to 90,087. The number of treatment sites will expand from 316 to 707.

Prevention activities will also be significantly scaled up. They will include voluntary medical male circumcision; corresponding community outreach activities; and focused behaviour change communication (BCC) activities for young women and girls in communities, as well as for most-at-risk populations (sex workers, truck drivers and migrant workers).

The Grant Approvals Committee (GAC) said that the plans for Phase 2 will be supported by activities to strengthen human resources, infrastructure, procurement and supply management, financial management and M&E. Funding for these activities will come for Mozambique’s Round 8 HSS grant, and from other donors and technical partners.

The GAC labelled the Phase 2 plans as "ambitious." The Technical Review Panel (TRP) said that the plan was technically sound and strategically focused. However, the TRP expressed concerns about the feasibility of the scale-up because of existing health systems weaknesses and programmatic challenges during Phase 1.

The TRP recommended that the CCM and the Secretariat consider a phased approach to the scale-up to ensure that weaknesses of the health system are addressed and service delivery targets are increased. The TRP said that it is important to maintain and improve the quality of current interventions while scaling up. The TRP recommended that there be an annual check-in on progress in scaling up and that there be an ability to implement adjustments as required. The GAC endorsed the TRP’s recommendations.

The GAC noted that the Secretariat is moving away from the approach of using conditions in grant agreements as a way to manage issues. The idea is to manage these issues during grant-making instead of during grant implementation, whenever it is feasible to do so.

Information for this article was taken from Board Decisions GF-B29-EDP3 and GF-B29-EDP4, and from B29-ER-02, the Report of Secretariat Funding Recommendations for May 2013. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 22 August 2013.]

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9. NEWS: NFM Funding for Nigeria Will Support Mass Distribution of LLINs

A mass distribution of long-lasting insecticide-treated bednets (LLINs) is planned for nine Nigerian states.

As reported in the first article in this issue, Nigeria was awarded funding of $167.0 million as an interim applicant under the new funding model (NFM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The funds will be used to top up existing Round 8 malaria grants implemented by the Society for Family Health (SFH) and the National Malaria Control Programme (NMCP). SHF will receive $73.7 million while the NMCP will get $93.3 million.

The majority of the funding request ($153 million) will be used to procure and distribute LLINs to sustain gains achieved in nine states – Plateau, Kaduna, Kano, Katsina, Kebbi, Akwa Ibom, Rivers, Niger and Ekiti. These are states where LLINs were distributed in 2009–2010, and where coverage is now in danger of falling to a critically low point, despite the fact that significant numbers of LLINs were being delivered through routine systems. Funding from technical partners and the government will support procuring and distributing LLINs in another seven states where coverage is falling off significantly. (Nigeria has 36 states and the federal capital, Abuja.)

The remainder of the request ($14 million) will be used to procure 3.1 million courses of artemisinin combination therapy (ACT) and 9.4 million rapid diagnostic test kits (RDTs).

The Grant Approvals Committee (GAC) noted that the LLIN strategy is part of a major partnership effort in the country to invest more strategically for rapid impact. The strategy is based on what is called “spatial targeting,” whereby LLINs are distributed to the highest-risk states where universal coverage can be achieved. The strategy is the result of lessons learned from spreading nets too thin.

When the Technical Review Panel (TRP) reviewed the interim request, it found it to be technically sound and strategically focused. However, the TRP identified several issues that it said needed to be addressed in final grant-making and implementation. These included the need to (a) revise the performance framework to better reflect the work plan and budget; (b) finalise the plan for RDT scale-up; (c) revise some budget items and PSM costs; and (d) better integrate LLIN distribution with other community-based activities.

The TRP also recommended that the CCM clarify (a) what policies and structures are in place to handle cases where a fever is tested using a rapid diagnostic test but the results show it is not malaria; (b) how lessons learned from previous deployment of LLINs, ACTs and RDTs will be incorporated; and (c) how linkages between routine and mass distribution of LLINs will be made.

Information for this article was taken from Board Decision GF-B29-EDP3 and from B29-ER-02, the Report of Secretariat Funding Recommendations for July 2013. These documents are not available on the Global Fund website.

[This article was first posted on GFO Live on 22 August 2013.]

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10. ANNOUNCEMENT: Latest Issue of GBCHealth Insights Focuses on Global Fund

The August 2013 issue of GBCHealth Insights is devoted entirely to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

GBCHealth Insights is a newsletter of GBCHealth. The organisation serves as a hub for private sector engagement on global health issues. The August 2013 issue includes an interview with Brian Brink, Chief Medical Officer at Anglo American, the outgoing representative of the private sector delegation on the Global Fund Board; an article on private sector partnerships by Paul Shaper, Executive Director of Global Public Policy at Merck & Co, the incoming Board member representing the private sector; and a summary of a conversation from April 2013 with Global Fund Executive Director Mark Dybul.

The August 2013 issue of GBCHealth Insights is available here.

[This article was first posted on GFO Live on 26 August 2013.]

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AVAILABLE ON GFO LIVE:
 
The following articles have been posted on GFO Live on the Aidspan website. Click on an article heading to view the article. These articles may or may not be reproduced in GFO Newsletter.

NEWS : Comprehensive Strategy for Phase 2 of Senegal TB Grants

The $11.4 million in renewal funding for two Senegal TB grants will be used to implement a comprehensive programme to fight the disease.

NEWS : New PR for Phase 2 of HIV Prevention Grant in Mali

A new principal recipient, Plan Mali, will implement Phase 2 of an HIV prevention grant in Mali. During Phase 1, the grant was suspended due to evidence that grant funds had been misused.

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This is an issue of the GLOBAL FUND OBSERVER (GFO) Newsletter.

We welcome suggestions for topics we could cover in GFO. If you have a suggestion, please send it to the Editor of GFO (see contact information below).

Author: All articles are written by David Garmaise (david.garmaise@aidspan.org), GFO Editor.

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