On 19 April 2019, the Global Fund Board approved funding for 11 country grants and supplementary funding for a 12th –– for a total value of $589.9 million. Interventions worth $248.9 million were added to the Unfunded Quality Demand (UQD) Register. Domestic commitments for the programs included in the approved country grants amounted to $7.5 billion. (See Table 1 for details.)
The Board was acting on the recommendations of the Technical Review Panel (TRP) and the Grant Approvals Committee (GAC). This was the 19th batch of approvals from the 2017–2019 allocations.
The country grants were for four countries: Benin, Chad, Nigeria and South Africa. About 63% of the total funding for country grants went to South Africa, which had four grants approved. The largest single award ($173.7 million) was for a South African grant administered by the National Department of Health, ZAF-C-NDOH.
|UQD||Domestic commitment 2|
|Benin||RSSH||BEN-S-CNLS-TP 5||CNLS-TP 4||13,706,091 3||5,871,925||N/A|
|Chad||HIV||TCD-H-MOH 5||Ministry of Health||38,770,180||7,048,283||17,909,401|
|NGA-H-FHI360||Family Health Intl.||87,666,232|
|TB/HIV/RSSH||NGA-C-LSMOH||Lagos State MOH||10,841,912 7||6,072,398||N/A|
|RSSH||NGA-S-MSH||Mgmt. Sc. for Health||42,996,203|
|South Africa||TB/HIV||ZAF-C-AFSA||AIDS Foundation S.A.||59,762,556 6||189,031,883||7,456,708,765|
|ZAF-C-NDOH||Natl. Dept. of Health||173,716,011|
- Amounts shown are upper ceilings.
- The domestic commitments shown are for the disease programs and exclude RSSH.
- Includes $2,404,259 in matching funds.
- CNLS-TP = Conseil National de Lutte Contre le VIH/SIDA, la Tuberculose, le Paludisme, les Hépatites, les infections sexuellement transmissible et les epidémies | NACA = National Agency for the Control of AIDS | SFHNG = Society for Family Health Nigeria | NACOSA = Networking HIV, AIDS Community of South Africa
- For grants denominated in euros, an exchange rate to the dollar of 1.1242 was used.
- Includes $16,000,000 in matching funds.
- This brings to $15,931,763 the total amount approved for this grant; $5,089,851 was previously approved for the TB component.
The Board also approved funding for a multi-country grant worth $7.5 million (see Table 2).
Table 2: Multi-country grant approved from the 2017–2019 allocations –– 19th batch ($)
|Applicant||Grant name||Principal recipient||Amount approved||UQD|
|Multicountry Eastern Africa||QPA-T-IGAD||IGAD 1||7,500,000||N/A|
- IGAD = Intergovernmental Authority on Development.
The $589.9 million approved for country grants includes matching funds in the amount of $18.2 million. An additional $5.3 million in matching funds was approved for two HIV grants to Sénégal and a malaria grant to Guinea. The Board had previously approved funding from the country allocations for these three grants. (See Table 3.)
|Applicant||Comp.||Grant name||Principal recipient||Amount approved ($)||Strategic priority area|
|Sénégal||HIV||SEN-H-CNLS 1||CNLS 2||1,187,772||HIV: Key populations impact
HIV: Human rights barriers
|SEN-H-ANCS 1||ANCS 2||1,140,427|
|Guinea||Malaria||GIN-M-CRS||CRS 2||3,000,000||RSSH: Integrated service delivery and health workforce|
- For grants denominated in euros, an exchange rate to the dollar of 1.242 was used..
- CNLS = Comité National de Lutte Contre le Sida | ANCS = Alliance Nationale des Communautés pour la Santé | CRS = Catholic Relief Services – United States Conference of Catholic Bishop
In addition, interventions from the UQD Register valued at $70.5 million were approved for 12 grants (see Table 4). The funds for these awards come from a portfolio optimization exercise that was carried out in 2018 for the 2017–2019 allocation cycle.
By far the largest award ($41.6 million) was for India TB. These funds will be used to buy down a $400 million loan from the World Bank. Aidspan plans to publish an article on this award in an upcoming issue of GFO.
|Revised program budget|
|C.A.R||TB/HIV||CAF-C-CRF 1||Croix-Rouge Française||10,518,634||48,149,853|
|Congo||TB/HIV||COG-C-CRF 1||Croix-Rouge Française||1,053,886||18,210,124|
|Eritrea||Malaria||ERI-M-MOH||Ministry of Health||1,399,078||17,941,608|
|Mongolia||TB||MNG-T-MOH||Ministry of Health||500,000||7,724,359|
|Moldova||TB/HIV||MDA-C-PCIMU 1||PCIMU 2||91,067||13,504,599|
|Nepal||TB||NPL-T-SCF||Save the Children Fed.||900,000||17,038,548|
|Togo||HIV||TGO-H-PMT 1||PMT 2||1,533,802||32,447,511|
|Viet Nam||TB||VNM-T-NTP||NTP 2||2,347,305||49,628,399|
- For grants denominated in euros, an exchange rate to the dollar of 1.242 was used..
- NERCHA = National Emergency Response Council on HIV and AIDS | IBRD = International Bank for Reconstruction and Development | PMT = Primature de la République Togolaise | PCIMU = Public Institution Coordination, Implementation and Monitoring Unit of the Health Systems Project | PMT = Primature de la République Togolaise | RCTC = Republican Center of Tuberculosis Control | NTP = Viet Nam National Lung Hospital
In its report to the Board, the GAC provided comments on all of the country grants; and on all of the interventions funded from the UQD Register. In the balance of this article, we provide a summary of the GAC comments. (The GAC did not comment on the multi-country Eastern Africa award.)
Below, we summarize the GAC’s comments for three of the four countries for which grants were approved: Benin, Chad and South Africa. Please see the separate article in this issue on the GAC’s comments for Nigeria.
Benin’s RSSH grant aims to expand high-quality integrated service delivery at community level; and to improve human resources management. The grant will also strengthen various information and monitoring systems.
The grant will be implemented by a new PR, Le Conseil National de Lutte contre le VIH/SIDA, la tuberculose, le paludisme, les hépatites, les infections sexuellement transmissibles et les épidémies (CNLS-TP), an entity recently created in the President’s office for coordinating all donor support in health. The GAC said that the formation of this new entity at a high level is evidence of strong national engagement and political leadership.
The GAC said that a capacity assessment of CNLS-TP, conducted by the Global Fund Secretariat, identified areas that need to be strengthened, including the recruitment of key staff in the program management unit and the installation of accounting software. The GAC stated that a fiscal agent will be contracted to support the work of the PR.
The GAC observed that during grant-making, the funding gap for the malaria program was reduced thanks to additional nets contributed by the (U.S.) President’s Malaria Initiative and lower net unit costs achieved by using wambo.org to procure the nets.
The GAC applauded the fact that the new grant will retain a strong focus on using community health workers.
The approved funding of $13.7 million includes $2.4 million in matching funds.
Chad HIV and TB
Chad’s HIV grant aims to reduce new HIV infections from 4,800 in 2016 to 3,397 in 2022; reduce new pediatric HIV infections from 21% of total infections in 2016 to 5% by 2022; decrease the number of deaths linked to HIV from 2,800 in 2016 to under 1,000 by 2022; improve psychological, social, economic and legal conditions for people living with HIV, community-based organizations and other affected persons; and ensure universal access to quality, global, integrated and continuous people-centered health care.
Chad’s TB grant focuses on reducing TB incidence and mortality through strategies such as expanding and decentralizing diagnosis and treatment services; improving collaboration with communities; promoting research and innovations; and strengthening the national health information system.
The grants will be implemented by a new PR, the Ministry of Health (MOH). Chad envisages that the new implementation arrangements will result in better coordination of health programs and greater accountability within the MOH (central, regional and district levels).
(The previous HIV and TB grants were administered by Le Fonds de Soutien aux activités en matière de population et de lutte contre le Sida, an entity established by the government. Chad also has a malaria grant for which the PR is the UNDP.)
The GAC said that the change of PR might result in the new grants getting off to a slow start. The GAC, therefore, welcomed the fact that Expertise France has already deployed four international experts to provide short-term technical assistance in four areas: governance; program management; M&E; and financial management. In addition, long-term technical assistance is planned to build the capacity of staff at the MOH’s program management unit.
In addition, the Global Fund will contract a fiduciary agent before the first disbursement is made; and all health products financed through the grants will be procured through the Pooled Procurement Mechanism and the Global Drug Facility.
Finally, the GAC welcomed the fact that the new grants will strengthen the focus on key populations as well as the integration of TB and HIV programs.
South Africa TB/HIV
Four grants were approved for South Africa, each with a different PR: AIDS Foundation South Africa; Beyond Zero; Networking HIV, AIDS Community of South Africa; and the National Department of Health.
With an HIV prevalence of 14% (21% among people aged 15–49), South Africa has the largest HIV epidemic in the world. South Africa is also among the 14 countries with the highest burden for TB, MDR-TB and TB/HIV co-infection.
Among the objectives of the TB/HIV grants are the following: to accelerate prevention by providing treatment, care and adherence support; to address the social and structural drivers of HIV, TB and sexually transmitted infections (STIs); and to ground the response to HIV, TB and STIs in human rights principles and approaches.
According to the GAC, the Government of South Africa is committed to increasing funding for HIV over the period of these grants: ($6.6 billion) and TB ($766.0 million). For the HIV component, the government is allocating $34.0 million for key populations interventions. The $6.6 billion for HIV programs represents a 49% increase over the previous implementation period.
The funding awarded to South Africa includes $16.0 million in matching funds for three priority areas: human rights barriers to health services (HIV); adolescent girls and young women (HIV) and finding missing TB cases.
The GAC noted that the environment in South Africa “is conducive to forward thinking, bringing new initiatives and implementing at scale.” Accordingly, the GAC emphasized that for the grants to contribute to greater impact, the strategic focus of programs should be “catalytic” so as to enable greater collaboration with partners in country, foster innovative approaches and focus on the most effective interventions.
The GAC noted the efficiencies gained as a result of using a market rate for the conversion of the allocation amount into local currency (ZAR) during grant-making versus the fixed rate used in the funding request. The GAC observed, however, that there is a risk that a volatile exchange rate may erode these gains over the lifecycle of the grant. The GAC recommended that certain risk mitigation measures be put in place.
The GAC noted that following the recommendation of the Technical Review Panel (TRP) concerning prioritizing adolescent girls and young women aged 10–14, and defining a package of interventions for this age group, the Secretariat has been actively collaborating with the country coordinating mechanism and partners (specifically PEPFAR and South Africa’s Department of Basic Education) to determine the scope and the quality of the programs.
Additional funding for UQD interventions
The GAC provided comments on the awards of additional funding for UQD interventions for 12 countries. Below, we provide a brief summary for the awards in 11 of these countries. The award for the 12th country (India) involves a loan buy-down; as indicated above, we hope to write about this award in an upcoming issue of GFO.
C.A.R. TB/HIV. The additional investment will allow the C.A.R. to increase antiretroviral treatment (ART) cohorts by 7,500 people a year, and to expand ART coverage from 23% to 39%.
Congo TB/HIV. For the TB component, the added funds will provide treatment for 90 additional patients bringing the total number treated for MDR-TB to 340 by end 2020. For the HIV component, the additional investment will ensure continued PMTCT (prevention of mother-to-child transmission) activities.
Eritrea malaria. The added investment will allow Eritrea to implement a change in diagnostic strategy and procure some new products.
Eswatini TB/HIV. The extra funds will be used to scale up voluntary medical male circumcision.
Kenya malaria. The additional investment will enable Kenya to procure 2.2 million additional bed nets.
Mongolia TB. The additional funding will allow Mongolia to support training and capacity building for health care workers.
Moldova TB/HIV. The added funds will enable 496 patients to transition to a new MDR-TB treatment regimen and cover the costs of drugs for these patients.
Nepal TB. The extra funding will allow Nepal to support the roll-out of its recently adopted public-private mix strategy.
Togo HIV. With the additional resources, Nepal will increase ART coverage from 69% to 74% in 2020, and viral load testing from 29% to 50% in the same period.
Tajikistan TB. The additional investment will enable Tajikistan to transition 496 patients to a new treatment regimen and cover the costs of drugs for these patients.
Viet Nam TB. The extra funding will support the development of guidelines for a public-private mix treatment of childhood TB.
The Board approved a 6-month extension to 30 June 2019 for a TB grant to Gabon. The purpose of the extension was to prevent program disruption while a funding requests from the 2017–2019 allocations is in grant-making. The cost of the extension, $185,302, is funded from the allocations. The amount used for the extension will be deducted from the allocation amount available for the coming grant; and the grant implementation period will be shortened accordingly.
Most of the information for this article was taken from Board Document GF/B40/ER09 (“Electronic Report to the Board: Report of the Secretariat’s Grant Approvals Committee”), undated. This document is not available on the Global Fund website.