On 16 August 2019, by electronic vote, the Global Fund Board approved funding for three country grants worth $32.7 million (Colombia HIV, Honduras TB/HIV and Kazakhstan TB). Domestic commitments for the programs included in the approved country grants amounted to $1.17 billion. Initiatives valued at $2.4 million were added to the Unfunded Quality Demand (UQD) Register. (See Table 1.)
Among the country grants, the largest award was $14.6 million for Honduras TB/HIV. The award included $1.9 million in matching funds.
The Board also approved two multi-country HIV grants worth $17.0 million (Table 2).
In addition, interventions from the UQD Register valued at $42.2 million were approved for eight grants in seven countries (Table 3). The funds for these awards come from funding set aside for portfolio optimization in 2018, for the 2017-2019 allocation cycle. These awards are for additional funding for revisions to grants that have already been approved by the Board. The largest award was $11.2 million for a Kenya malaria grant.
The Board was acting on the recommendations of the Technical Review Panel (TRP) and the Grant Approvals Committee (GAC). This was the 22nd batch of approvals from the 2017-2019 allocations.
|Amount approved 1||UQD||Domestic commitment 2|
|Honduras||TB/HIV||HND-C-CHF||CHF 3||14,648,346 4||2,353,328||75,657,039|
- Amounts shown are upper ceilings.
- The domestic commitments shown are for the disease programs and exclude RSSH.
- ENPDT = Empresa Nacional Promotora del Desarrollo Territorial | CHF = Cooperative House Foundation | NCTP = National Scientific Center for Phthisiopulmonology
- The amount approved for the Honduras TB/HIV grant includes $1,900,000 in matching funds.
- The end dates for these grants are as follows: Columbia HIV 31 October 2022; Honduras TB/HIV 31 July 2022; and Kazakhstan TB 31 December 2022.
|Principal recipient||Amount approved||UQD|
|MC Latin America ALEP||QRA-H-HIVOS2||HIVOS 1||10,500,000||82,145|
|MC Caribbean CARICOM-PANCAP||QRA-H-CARICOM||Carib. Comm. Sect.||6,500,000||1,238,000|
- HIVOS = Humanist Institute for Cooperation with Developing Countries
|Amount approved ($)||Revised
|Viet Nam||TB||NVM-T-NTP||National Lung Hospital||1,500,000||51,128,399|
|Zambia||Malaria||ZMB-M-MOH||Ministry of Health||6,218,534||57,493,044|
- MEF = Ministry of Economy and Finance | AGAMal = AngloGold Ashanti (Ghana) Malaria Control Limited | DDC = Department of Disease Control, Ministry of Public Health | VAAC = Viet Nam Authority of HIV/AIDS Control
In its report to the Board, the GAC provided comments on two of the three country grants (Honduras and Kazakhstan); on one of the two multi-country grants (ALEP); and on all of the countries that were awarded funding for interventions from the UQD Register. In the balance of this article, we provide a summary of the GAC comments.
PR: Cooperative House Foundation
The $14.6 million grant will support a program that has the following goals:
- New HIV infections among men who have sex with men account for a maximum of 30% of all new infections;
- 80% of persons living with HIV who are on antiretroviral therapy (ART) remain on ART;
- At least 85% of TB patients are detected by 2020; and
- TB mortality is reduced by 25% in 2020 compared to 2015.
As part of the grant, Honduras received $1.9 million in matching funds for two HIV strategic priority areas: (1) key populations impact; and (2) removing human rights-related barriers to health services.
To be eligible for matching funds, applicants need to meet four conditions:
- The program associated with the 2017-2019 allocation includes activities that directly support the designated strategic priority area;
- The allocation investment in the priority area is higher than in the previous allocation period (2014-2016) (known as the “increase in allocation” condition);
- Funding within the 2017-2019 allocation invested in the strategic priority area is equal to, or more than, the matching funds requested (known as the “1:1 matching” condition); and
- The programs proposed for the matching funds have clear potential to accelerate progress in the relevant strategic priority area and to maximize the impact of the overall program.
Although Honduras did not meet the 1:1 matching condition for addressing human rights barriers and the increase in allocation condition for the key-populations programs, the GAC nevertheless approved the matching-funds award on the grounds that Honduras has either maintained or increased its share of investments in the priority areas compared to the previous grant.
To fully access the co-financing incentive in the 2017-2019 allocation, the Government of Honduras needs to invest an additional $1.9 million ($1.5 million for HIV and $0.4 million for TB) in 2020-2022, over and above its spending levels in the previous period. As well, 50% of the additional co-financing needs to be invested in priority areas within the disease program.
The GAC stated that Honduras has submitted two official communications from the previous Minister of Health committing to not decrease the national funding for HIV, and to increase its contribution by $1.5 million (half of which will be invested in ARVs); and to not decrease the national funding for TB, and to increase its contribution by $0.3 million (half of which will be invested in anti-TB drugs).
However, the GAC said, confirmation of Honduras’s compliance with the co-financing requirements is still pending. Consequently, over the next six months, the Global Fund Secretariat will: (a) work with the government regarding whether the existing commitments still stand; (ii) confirm that the additional quantities of health commodities will be procured (including ensuring that appropriate budget lines have been created as per discussions with the Ministry of Finance); and (c) request that a finalized funding landscape table be prepared to assess if sufficient co-financing commitments have been made.
PR: National Scientific Center for Phthisiopulmonology
The goal of the TB program is to provide effective responses to drug-resistant TB (DR-TB), sustained through people-centered and evidence-based approaches, including those for vulnerable and at-risk populations. The $8.1 million grant will focus on (a) ensuring comprehensive and sustainable health system responses to the DR-TB challenge; and (b) sustaining universal access to quality and people-centered DR-TB diagnosis, treatment and prevention.
According to the GAC, Kazakhstan has consistently fulfilled its co-financing commitments in the past and the government successfully took over several interventions previously financed by the Global Fund. When measured in the local currency, which has experienced some depreciation against the U.S. dollar, government commitments for the 2017-2019 allocation period represent an increase over the prior period equal to about $6.9 million.
The GAC noted that the country coordinating mechanism (CCM) spearheaded the development of a transition plan for the period 2019-2021. The plan identifies the following priority areas (among others):
- Ensure continuous access to high-quality laboratory diagnosis and treatment of M/XDR TB, particularly in the penitentiary sector until the government assumes full funding;
- Strengthen mechanisms and expand the involvement of NGOs in TB control activities; and
- Build the capacity of health care workers and NGOs to perform efficient TB control activities.
The budget for the grant includes performance-based salary incentives and task-based payments. These costs are linked to delivery of services at a newly established Center for Clinical and GeneXpert roll-out at district level; the development of regulations for civil and penitentiary sectors, including guidance for NGO participation in the TB program; and the development of social contracting mechanisms, including defining the cost of NGO service delivery.
The GAC said that these costs will be transitioned to the National TB Program in Year 3 of the program.
Alianza Liderazgo en Positivo (ALEP) HIV
This grant covers 11 countries in Latin America, which have had varying levels of success in leveraging national budgets, especially for services for key populations. Given the general trend of declining donor funding, the GAC said, the sustainability of the HIV response will require additional domestic funding and innovative funding strategies, specifically for the key population response which is primarily implemented by civil society organizations.
The GAC noted that in the last week of grant-making, a regional organization representing sex workers, which was involved in the design of this program, withdrew, “quoting several factors linked to the misalignment of the grant implementation and governance approach with the organization’s operating model as their rationale.”
The GAC said that given the broad range of key population networks and organizations in the LAC region, new actors may well be interested in joining this program. Other participating networks and the PR are already exploring viable alternatives. The GAC stated that this development “would not have a material impact and will have no implications on activities at country level given that the funding is channeled per country rather than per network and all activities focus on all key populations.”
The Global Fund Secretariat told the GAC that the PR and the remaining key population networks remain fully committed to the engagement of sex workers in the program.
FUNDING FOR UQD INTERVENTIONS
Afghanistan malaria. The $4.8 million investment will help to close a gap in the procurement and distribution of long-lasting insecticide-treated bed nets (LLINs). An additional 1,616,363 LLINs will be purchased.
Cambodia TB/HIV. The additional $4.4 million will enable Cambodia to expand services for both TB and HIV. For TB, case notification rates will be increased, bringing coverage to 74% (vs. 66% currently). As well, the number of children under 5 receiving preventive treatment is projected to increase by 1,700 by December 2020. For HIV, the funding will support interventions in key populations in high-burden provinces. Cambodia expects that an additional 2,761 people (sex workers, transgendered persons and men who have sex with men) will be reached and tested. The funding will also support the operationalization of an existing Master Patient Index and the use of a Universal Unique ID Code as an identifier across all databases. This will help to ensure that clients are followed continuously during the disease cycle.
Ghana malaria. The GAC stated that “Ghana is a high-burden/high-impact country that is not on track to reach the targets set out in the Global Technical Strategy for Malaria and is [in the] vanguard [of] the fight against a resurgence of malaria morbidity and mortality.” The additional funding of $6.6 million will help to fill gaps in indoor residual spraying (IRS). The funding will enable Ghana to maintain IRS coverage for more than one million people in high burden districts.
Kenya malaria. The $11.2 million investment will be used to procure and distribute more LLINs. The current grant covers only 51% of the need for a mass distribution campaign planned for 2020. In April 2019, the Board approved $8.6 million in funding for LLIN-related initiatives on the UQD Register (see GFO article from May 2019), which increased coverage to 64% of the need. The current $11.2 million investment will increase coverage still further, to 82%. An investment from the (U.S.) President’s Malaria Initiative is expected to fill the remaining gap.
Thailand TB. The additional investment of $5.4 million will support several initiatives targeting prisoners, including the following: (a) TB case funding; (b) using mobile x-ray vans with digital chest x-ray scanners in high TB-burden prisons; and (c) renovating TB isolation rooms and directly-observed treatment corners. Three other ‘modules’ within these initiatives relate to case detection and treatment of MDR-TB.
Viet Nam TB. The $1.5 million in funding will support the roll-out of the World Health Organization’s new regimen for TB treatment. The funding will also be used to procure second-line drugs; to strengthen drug safety monitoring and management; and to support the strengthening of laboratories’ capacity to conduct second-line drug susceptibility testing.
Viet Nam HIV. The $2.1 million in extra funding will support activities related to the roll-out of post-exposure prophylaxis (PrEP).
Zambia malaria. The additional investment of $6.2 million will allow Zambia to achieve full coverage of IRS in 2019 and 2020.
The Secretariat has approved a 12-month no-cost extension of a malaria grant in Malawi, MWI-M-WVM. The new end date for this grant is 31 December 2021. The budget for the extension, $10.2 million, will come from already approved funding.
Most of the information for this article was taken from Board Document GF/B41/ER05 (“Electronic Report to the Board: Report of the Secretariat’s Grant Approvals Committee”), undated. This document is not available on the Global Fund website.