On 22 February 2019, the Global Fund Board approved one multi-country grant, one matching funds request and one set of interventions on the Unfunded Quality Demand (UQD) Register –– worth a total of $16.0 million. The Board was acting on the recommendations of the Technical Review Panel (TRP) and the Grant Approvals Committee (GAC). This was the 17th batch of approvals from the 2017–2019 allocations.
The multi-country award was for a malaria grant for Southern Africa, QPA-M-E8S, worth $12.2 million. Interventions totaling $1.3 million were added to the UQD Register.
Matching funds in the amount of $2.1 million were approved for a Liberia malaria grant, LBR-M-MOH. The funds were added to a grant previously approved (in December 2018) worth $23.3 million, bringing the revised program budget to $25.4 million.
Interventions from the UQD Register valued at €1.5 million were approved for a TB/HIV grant to Guinea-Bissau, GNB-C-MOH, taking the total program budget from €13.5 million to €15.0 million.
This grant, which covers eight countries in Southern Africa (known as the Elimination 8 or E8 countries), is a continuation of an existing regional initiative aiming to eliminate malaria within the sub-region.
Four of the countries –– Botswana, Namibia, South Africa and Eswatini –– have reduced malaria transmission and, according to the World Health Organization, have passed the threshold between pre-elimination and elimination. However, these “frontline elimination” countries face importation of malaria from four neighboring (“second-line”) countries to the north –– Angola, Mozambique, Zambia and Zimbabwe. The GAC said that the second-line countries are unlikely to achieve elimination before 2030.
The grant aims to “accelerate zero local transmission” (i.e. strengthen efforts to maintain zero transmission) in the four frontline countries by 2020 by:
- Strengthening regional coordination in order to achieve elimination in each of the E8 countries;
- Expanding access to early diagnosis and treatment for border communities as well as mobile and migrant populations; and
- Strengthening regional epidemiological and entomological surveillance systems.
The grant will provide support (a) to health cadres staffing 48 diagnostic and treatment sites for mobile and migrant populations in border districts; and (b) to indoor residual spraying (IRS) operators in Southern Angola.
The GAC said that there are challenges associated with the lack of sustained financing for the malaria programs in all eight countries, which could lead to a risk of resurgence. The GAC emphasized the need to mobilize additional resources, including from domestic sources, and to explore innovative financing mechanisms.
The GAC echoed concerns expressed by the Technical Review Panel (TRP) regarding (a) the need for greater synergies between this grant and the MOSASWA multi-country grant, a public-private initiative involving Mozambique, South Africa and eSwatini (see GFO article from 25 February 2019); and (b) the need for alignment with the national malaria programs in the E8 countries.
The $2.1 million in matching funds will be added to the Liberia malaria grant that the Board approved in December 2017 (see GFO article from 12 December 2017).
To be eligible for matching funds, applicants need to meet four conditions:
- The program associated with the 2017-2019 allocation includes activities that support the specific strategic priority area;
- The investment in the priority area is higher in 2017-2019 compared to 2014-2016;
- Funding from the 2017-2019 allocation invested in the priority area is at least equal to the matching funds requested (i.e. at least a 1:1 ratio); and
- The initiatives proposed under matching funds have clear potential to accelerate progress in the relevant priority area and to maximize the impact of the overall program.
Liberia met three of the four conditions, but not the 1:1 ratio. The GAC approved an exception to this criterion (as it has for numerous other matching-funds requests), noting that Liberia’s 2017-2019 allocation was slightly reduced from its 2014-2016 allocation, thus making it difficult to achieve the 1:1 ratio.
The €1.5 million for interventions on the UQD Register will allow Guinea-Bissau to cover some gaps in its HIV program regarding testing and treatment. It will enable Guinea-Bissau to increase the number of people receiving treatment by 2020 from 14,000 (31% coverage) to 18,080 (40% coverage).
The funds will also assist Guinea-Bissau to implement a differentiated approach to testing (i.e. provider-initiated HIV counselling and testing at the health facility level; and targeted testing for vulnerable populations).
The funds for this award come from a portfolio optimization exercise that was carried out for the 2017-2019 allocation cycle.
Most of the information for this article was taken from Board Document GF/B40/ER06 (“Electronic Report to the Board: Report of the Secretariat’s Grant Approvals Committee”), undated. This document is not available on the Global Fund website.