GLOBAL FUND OBSERVER (GFO), an independent newsletter about the Global Fund provided by Aidspan to over 8,000 subscribers in 170 countries.
Issue 102: 25 March 2009. (For formatted web, Word and PDF versions of this and other issues, see www.aidspan.org/gfo)
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CONTENTS
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1. NEWS: Global Fund Launches "First Learning Wave" of National Strategy Applications
The Global Fund Secretariat has invited 22 CCMs to take part in the "first learning wave" of national strategy applications (NSAs). NSAs are a new way to apply for Global Fund money; they involve submitting a national disease strategy as the primary basis of the application for Global Fund financing.
2. NEWS: Aidspan Releases Report To Help Round 9 Applicants Learn from Best Round 8 Proposals
Aidspan has released a new report on "Key Strengths of Round 8 Proposals to the Global Fund." The purpose of the report is to inform Global Fund Round 9 applicants about what were the key attributes of strong Round 8 proposals.
3. NEWS: Global Fund Needs $4 Billion To Address Needs Through 2010, Says Kazatchkine
The Global Fund needs an additional $4 billion to address its budget needs through 2010, Executive Director Michel Kazatchkine said last week ahead of a meeting the Fund will hold with donors at the end of this month.
4. NEWS: Global Fund Is Urged To Be More Open with Its Policies Regarding PRs
A group of five large PRs has recommended that the Global Fund share with all PRs a clear summary of its internal policies that affect PRs.
5. NEWS: Global Fund Seeks To Add Members with Gender Expertise to the TRP
The Global Fund is planning to appoint five new TRP members who have expertise on gender and on issues faced by sexual minorities.
6. NEWS: Kazatchkine and Other Health Leaders Dispel AIDS Myths
Michel Kazatchkine, head of the Global Fund, has co-authored an article in the Lancet that examines, nearly thirty years into the AIDS epidemic, "what we – the international community – got right, what we got wrong, and why we need to urgently dispel several emerging myths about the epidemic and the global response to it."
7. EXCERPTS: Three Excerpts from Aidspan's Report on Strengths of Round 8 Proposals
Three excerpts are provided from the new Aidspan report on "Key Strengths of Round 8 Proposals."
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1. NEWS: Global Fund Launches "First Learning Wave" of National Strategy Applications
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The Global Fund Secretariat has invited 22 CCMs to take part in the "first learning wave" of national strategy applications (NSAs). NSAs are a new way to apply for Global Fund money. NSAs involve submitting a national disease strategy itself – rather than a Global Fund-specific proposal form – as the primary basis of the application for Global Fund financing. NSAs are part of the Fund's effort to streamline its applications and funding processes.
The decision to establish NSAs was taken by the Global Fund Board in April 2007. At its most recent meeting, in November 2008, the Board approved the launch of the first learning wave. (For details, see GFO Issue #99, available at www.aidspan.org/gfo.) This wave is called "first learning" because NSAs are still a relatively new concept and involve developing a new set of policies and procedures. The Global Fund plans to refine these policies and procedures based on its experience with the first learning wave, and to then do a broader roll-out of NSAs, probably starting in 2010.
The Global Fund has identified the following anticipated benefits from NSAs:
- improved alignment of Global Fund financing with country priorities, and with national programmatic and budgetary timeframes;
- reduced transaction costs and paperwork for countries;
- improved harmonisation with other donors that have agreed to use the same criteria for reviewing national strategies;
- a focus on managing for results and accountability within national strategies; and
- in the longer term, improved quality, consistency and credibility of national strategic frameworks.
The first learning wave focuses on national HIV, TB and malaria strategies only. National health strategies may be included at a later stage. Nine CCMs have been invited to consider submitting NSAs for HIV, six for TB and eight for malaria. (The Rwanda CCM was invited to consider an NSA for both HIV and TB.) The list of CCMs, by disease, is as follows.
Table: Countries that have been invited to consider NSA applications to the Global Fund
| HIV | TB | Malaria |
| Algeria Cambodia Cuba Djibouti Kenya Malawi Nigeria Rwanda Swaziland | El Salvador Ghana Morocco Mozambique Nepal Rwanda | Azerbaijan Bhutan China Ethiopia Gambia Guyana Madagascar Viet Nam |
The 22 CCMs were asked to respond by 13 March 2009 concerning whether they want to take part in the first learning wave. GFO is not aware which CCMs responded or what they said.
The 22 CCMs were selected based on a range of factors, including that their countries:
- have a well articulated and documented national strategy, developed through an inclusive process that runs through to at least to the end of 2012;
- have a strong partnership with bilateral donors and technical agencies in the country to support them in the application process (where necessary) and in grant implementation; and
- were not successful in Round 8 for the disease in question.
The reason why countries that were successful for a particular disease component in Round 8 have not been invited to submit first learning wave NSAs for that disease is that the Global Fund wants to enable national programme staff in these countries to focus on negotiations for the Round 8 grants.
The first learning wave entails a two-stage process. The first stage involves a desk review of the national strategy and accompanying documentation (such as an operational plan) to ensure that they contain enough information to be considered as the basis of a funding application. The review will be done by a Strategy Review Team made up of members of the Global Fund's Technical Review Panel (TRP). If the outcome of this desk review is favourable, the Review Team will make a country visit to seek clarifications and collect additional information. More importantly, a favourable desk review also means that the CCM can proceed to the second stage, which involves the CCM submitting the actual NSA, which will consist of a short application focusing on the financial request, and which will be reviewed by the TRP.
The NSAs can request funding for the remaining time frame of their national strategies, up to a maximum duration of five years. To ensure parity with the rounds-based channel of funding, initial funding commitments will be for two years, and funding for the balance of the term will be dependent on satisfactory performance. As with rounds-based proposals, NSAs will be screened by the Global Fund Secretariat to ensure that the applicant CCM has met the minimum requirements for CCMs.
The CCMs who have been invited to take part in the first learning wave have been told that they cannot also submit an application for the same disease in Round 9, unless the desk review of their NSA turns out to be unfavourable. In the event of an unfavourable desk review, any CCM that wants to apply for Round 9 will be given an extension to the 1 June 2009 deadline for Round 9 applications. The extension will be until 8 July 2009.
The Global Fund Board has decided that the NSA first learning wave applications will have the same priority for resource allocation as Round 9 applications.
The following timelines for the first learning wave have been established (all dates are in 2009):
13 March: Deadline for the 22 CCMs to indicate whether they expect to apply
3 April: Deadline (for those CCMs who responded positively by the March 13 deadline) to provide national strategy documents
4 May: Completion of the desk reviews, and decision on which CCMs will be invited to submit an NSA
25 May to 4 July: Country visits by the Strategy Review Team
31 August: Deadline for submission of NSAs by CCMs that pass the desk review
First week of November (tentative date): Board decision on NSAs
Some time between 31 August and the first week of November, the TRP will review the NSAs and provide a recommendation to the Board concerning which ones should be funded.
In addition to the letter of invitation, the 22 CCMs invited to take part in the first learning wave have received three documents:
- "Global Fund Financing Through 'National Strategy Applications': Basic Information for Potential Applicants to the 'First Learning Wave' "
- "Global Fund Financing Through 'National Strategy Applications': Practical Information for Potential Applicants to the 'First Learning Wave' "
- "Attributes for a Sound National Strategy" (prepared by the International Health Partnership Working Group on National Strategies)
These documents have not yet been posted on the Global Fund website. However, they are available on the website of the China CCM at www.chinaccm.org.cn/en/node/227.
Although 22 CCMs have been invited to take part in the first learning wave, the final number of CCMs submitting NSAs will likely be much smaller because (a) some CCMs will decide not to take part; and (b) some CCMs will not receive a favourable desk review. And the number of NSAs recommended by the TRP for board approval will presumably be smaller still.
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2. NEWS: Aidspan Releases Report To Help Round 9 Applicants Learn from Best Round 8 Proposals
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Aidspan has released a new report on "Key Strengths of Round 8 Proposals to the Global Fund." The purpose of the report is to inform Global Fund Round 9 applicants about what were the key attributes of strong Round 8 proposals.
The report is based on an analysis of the strengths of all approved Round 8 proposals, as identified by the Technical Review Panel (TRP) when it reviewed the proposals. Aidspan developed a list of the 12 most important strengths that characterise a successful proposal. These key strengths are as follows:
KEY STRENGTH 1 – Implementation Strategy. The proposal presents a strong and coherent implementation strategy that flows throughout the proposal – including on the proposal form, in the Performance Framework, in the workplan and in the budget – and that includes timing and sequencing of activities, identification of who is responsible for implementing individual activities, and clear statements of planned outcomes.
KEY STRENGTH 2 – Epidemiology. The proposal contains a solid description of the current epidemiological situation.
KEY STRENGTH 3 – Situational Analysis. The proposal contains a solid analysis of the current response to the disease and the gaps in that response.
KEY STRENGTH 4 – Capacity Building. The proposal identifies capacity constraints among implementing agencies and contains solid strategies to address them.
KEY STRENGTH 5 – Drivers of the Epidemic. The proposal includes clear strategies to address the more challenging drivers of the epidemic in ways that will have a meaningful impact on preventing further infections.
KEY STRENGTH 6 – Multiple Sectors in Service Delivery. The proposal includes the use of multiple sectors and partners to deliver services, so as to scale up more quickly towards universal access.
KEY STRENGTH 7 – Monitoring and Evaluation. The proposal has a clear plan for monitoring activities and evaluating the impact of interventions.
KEY STRENGTH 8 – Detailed Budget. The proposal includes a budget with sufficient detail and assumptions to allow for the costs of activities to be fully assessed.
KEY STRENGTH 9 – Coordination and Management. The proposal features a strong coordination and management plan.
KEY STRENGTH 10 – Complementarity and Additionality. The proposal complements and adds to other initiatives, including previous Global Fund grants, programmes funded by other donors, and government initiatives.
KEY STRENGTH 11 – Alignment. The proposal is clearly aligned with national development strategies, and national policies and plans for the disease.
KEY STRENGTH 12 – Absorptive Capacity. The proposal includes a clear and realistic analysis of implementation and absorptive capacity constraints.
For each strength, Aidspan identified a few Round 8 proposals that exemplify the strength in question. There is a separate section of the report on each of the 12 strengths. Within each section, for each proposal mentioned, the report cites the comments made by the TRP, identifies the specific parts of the proposal relevant to the strength in question, and provides links to those parts of the proposal (as well as to the entire completed proposal form.)
In all, 35 proposals are cited in the report. While most of the proposals mentioned are disease-specific, some Health Systems Strengthening (HSS) components are also included.
The report is available in English at www.aidspan.org/aidspanpublications. French, Spanish and Russian versions of the report will be available soon.
Three excerpts from the report are provided in article 7, below.
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3. NEWS: Global Fund Needs $4 Billion To Address Needs Through 2010, Says Kazatchkine
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The Global Fund needs an additional $4 billion to address its budget needs through 2010, Executive Director Michel Kazatchkine said last week ahead of a meeting the Fund will hold with donors at the end of this month.
"In 2010, the Global Fund will be facing a gap which we estimate to be around $4 billion," Kazatchkine said, according to press reports, adding that he hopes the two-day meeting will prompt existing donors to increase their contributions. He also said that he hopes the meeting – which will be held in Spain and will review the Global Fund's performance and consider additional funding needs – will result in new donors, despite the global economic crisis. According to Kazatchkine, the economic situation means that developing countries will find it harder to fund their health programs. He said that this provides an additional reason for increasing financial support to the Global Fund.
One month earlier, Rajat Gupta, chairman of the Fund's board, said in a conference call with reporters that pledges to the Fund from donor nations are running about $5 billion short of what is needed through 2010. "I'm hopeful and confident that donors will continue to finance this," Mr. Gupta said, promising to scrutinize expenditures carefully and "tighten our belts."
Jeffrey Sachs, a prominent development economist who joined Mr. Gupta on the call, was more outspoken. The poor are refused $5 billion, he said angrily, while wealthy countries have found trillions for bank bailouts and Wall Street bankers have awarded themselves billions in bonuses while accepting those bailouts.
"This is absolutely in violation of the life and death pledges that the rich world made to the poor," he said. "I would suggest the [US] administration reclaim these bonuses which are absolutely unjustified, completely unconscionable, and put the money into the Global Fund immediately."
As of the end of 2008, the Fund estimates that programmes it has supported have averted more than 3.5 million deaths by providing AIDS treatment for two million people, anti-tuberculosis treatment for 4.6 million people, and 70 million insecticide-treated bed nets for the prevention of malaria worldwide. The Fund has so far approved funding in 140 countries worth $15 billion.
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4. NEWS: Global Fund Urged To Be More Open with Its Policies Regarding PRs
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A group of five large Principal Recipients (PRs) has recommended that the Global Fund share with all PRs a clear summary of its internal policies that affect PRs. (At present, these policies are contained in "Operational Policy Notes" that are only shared with individual PRs on an occasional and somewhat random basis.)
This was one of several recommendations agreed upon last month by the five PRs, subsequent to a meeting they held in November 2008. The PRs in question (CARE, the International HIV/AIDS Alliance, Population Services International, UNDP, and World Vision) are "internationally linked" and administer a significant number of Global Fund grants. The document containing the recommendations has been posted by GFO at www.aidspan.org/documents/other/ILPR-recommendations.doc.
The five PRs also recommended that the Global Fund should:
- ensure that there is consistency among Fund Portfolio Managers in the application of procedures and policies;
- share LFA assessments with PRs and CCMs;
- develop written guidance about the different circumstances in which it might or might not be appropriate for different types of international organisation to serve as PR in different types of country, and provide this guidance to CCMs for use during PR selection;
- clarify to CCMs and PRs the role of LFAs, and ensure that the role is carried out in a consistent manner. (This clarification should deal, in particular, with the extent to which LFAs serve the GF Secretariat, the extent to which they serve or support the CCM and PR, the extent to which they audit PRs, and the extent to which they provide answers to technical questions.);
- include in the proposal guidelines that potential PRs should be selected early enough to be involved in the proposal development process;
- encourage CCMs to include in their proposals a costed capacity building plan that clearly specifies what capacity will be built, by whom, and for which organisations or types of organisation; and
- request that a conflict of interest management plan be included in proposals.
In addition, the five PRs recommended that all internationally linked PRs should:
- openly raise concerns about any GF decisions and practices that create an unnecessary burden for GF grant implementers;
- recognize all CCMs, PRs and Sub-Recipients (SRs) as true partners – engaging with them, and getting their feedback when designing activities; and
- document ways in which national-level SRs can be identified and supported so that they have the potential to become future PRs and highly performing SRs.
[Disclosure note: The Editor of GFO served as a facilitator at the above-mentioned meeting.]
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5. NEWS: Global Fund Seeks To Add Members with Gender Expertise to the TRP
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The Global Fund is planning to appoint five new Technical Review Panel (TRP) members who have expertise on gender and on issues faced by sexual minorities, as well as expertise and experience in the three diseases.
The TRP is an independent, impartial group of experts who review proposals to the Global Fund and who make recommendations to the board concerning which proposals should be approved for funding. Persons appointed to the TRP normally serve for four rounds of funding (in the rounds-based funding channel). Only part-time involvement is required; expenses and a modest honorarium is paid.
The deadline for applications is very soon – 1 April 2009. Candidates must use the Fund's application form (available at www.hlsp.org/workingwithus/globalfund). This website also contains more information on the entitlements and expectations of TRP members. Questions can be directed to globalfund.trp@hlsp.org.
Applications will be screened through a two-step process. First, a review panel composed of senior officials in the Global Fund Secretariat will prepare a short list of applicants. Second, the candidates on the short list will be reviewed by a pre-selection panel consisting of representatives of the Global Fund and leading technical agencies (including UNAIDS, WHO, Stop TB Partnership, Roll Back Malaria Partnership, and the World Bank).
The panel will recommend which candidates should be appointed. The Global Fund Board is scheduled to vote on the recommendations by mid-May 2009.
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6. NEWS: Kazatchkine and Other Health Leaders Dispel AIDS Myths
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Michel Kazatchkine, head of the Global Fund, has co-authored an article in the Lancet that examines lessons learnt and myths that need to be dispelled nearly thirty years into the AIDS epidemic.
The article, which Dr. Kazatchkine co-authored with Peter Piot (former head of UNAIDS), Mark Dybul (former head of PEPFAR), and Julian Lob-Levyt (head of the GAVI Alliance), examines "what we – the international community – got right, what we got wrong, and why we need to urgently dispel several emerging myths about the epidemic and the global response to it."
The main myths surrounding HIV/AIDS that the authors examine are as follows:
- "Alarmingly, a myth has begun to emerge that too much money is spent on AIDS," say the authors. "But AIDS remains the leading cause of death in Africa and the sixth highest cause of mortality worldwide." Unfortunately, "new global challenges are competing for the attention of political leaders and donors at the same time as they face the present financial crisis."
- Another common myth is that HIV prevention is not working, the authors say. They point out: "Much evidence suggests that, in several countries, prevention programs are effective. Between 2005 and 2007, coverage of services to prevent mother-to-child transmission of HIV increased from 14 percent to 33 percent. As a result in 2007 we noted for the first time a substantial decrease in the number of children born with HIV".
- An increasingly recurrent myth is that one solution, or a so-called "silver bullet," will comprehensively prevent HIV transmission, says the article. "Elimination of concurrent partnerships, circumcision of all men, focusing of prevention efforts on sex workers, universal HIV testing, and provision of antiretroviral therapy as soon as possible after infection, have all received attention as potential solutions for prevention of HIV transmission… No approach will be enough on its own, and the promotion of one solution is, in our view, irresponsible. If we have learned one lesson in the past 27 years, it is that effective HIV prevention depends on customizing the right mix of interventions for every context."
- Another misconception is that heterosexual transmission of HIV is uncommon outside Africa. The article cites generalized epidemics in Haiti and Papua New Guinea and states that heterosexual transmission drives the epidemic between sex workers, their partners, clients, and clients' partners in Asia and elsewhere. It points out that the main method of transmission in Thailand is no longer between sex workers and their clients or between injecting drug users: it is between people who are married to each other. AIDS is also the leading cause of death among African-American women in the USA.
- The authors also dispel the myth that investments in AIDS are being made at the expense of health systems that are chronically underfunded. "Although AIDS has exposed weaknesses in health systems, funds for this disease are making a major contribution to strengthening of health systems." The Global Fund and PEPFAR are now among the biggest investors in health systems. Some 35 percent of the Global Fund's financing for AIDS, TB and malaria contributes directly to supporting human resources, infrastructure and equipment and monitoring and evaluation: all key components of health systems.
- A further myth that has emerged suggests that strengthening health services alone will solve the world's health problems, including AIDS. Improved health systems alone are not enough to end the epidemic, say the authors. "Whereas well functioning health and community services will be key to provision of antiretroviral therapy for decades to come – as well as services for the prevention of mother-to-child HIV transmission, blood safety, and male circumcision – most other HIV prevention activities are happening largely outside the health sector."
- A last myth is that AIDS has somehow been solved, says the Lancet article. "We need to recognize that AIDS is a long-term event. We have to identify now how to finance a sustained response to AIDS for another several decades, and develop longstanding links with broader efforts to strengthen health systems and health workforces as well as other developments, such as education and food security."
The authors also say the international community in the early 1980s underestimated the global effect the disease would have and the extent to which stigma and discrimination would remain formidable obstacles to tackling AIDS. But the sense of urgency that would eventually develop in the global AIDS movement was also underestimated and this has led to "an unusual convergence of political will, money and science."
On the other hand, the international community overestimated the speed with which the epidemic would spread in regions other than sub-Saharan Africa and was also excessively optimistic about "our capacity to devise technological solutions to prevent HIV."
The article is available at www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60321-4/fulltext.
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7. EXCERPTS: Three Excerpts from Aidspan's Report on Strengths of Round 8 Proposals
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This article contains three excerpts from the Aidspan report on "Key Strengths of Round 8 Proposals" (see article 2, above).
Excerpt #1: KEY STRENGTH 1 – IMPLEMENTATION STRATEGY
Swaziland Malaria (Category 1)
TRP Comment: Presentation of section 4.5.1 (interventions) is a model in clarity ensuring complete alignment of objectives, SDAs, indicators and implementing partners. The budget is realistic and consistent with activities and aligned to the project objectives.
In Section 4.5.1, for each objective in the proposal, the Swaziland CCM explained the rationale for the objective and provided information on the intended outcome and the target population. Under each objective, the CCM also provided the following information for each SDA: a description of the services to be provided, a description of the major activities, the output indicator(s); the targets for each of the five years in the programme; and a list of implementing and supporting partners.
The activities shown in the budget are presented by objective and are completely consistent with the activities listed in Section 4.5.1.
Excerpt #2: KEY STRENGTH 5 – DRIVERS OF THE EPIDEMIC
Eritrea HIV (Category 2)
TRP Comment: Strong gender based approach covering delicate social and political issues like male circumcision and female genital mutilation.
In Section 4.5.4 of the proposal form, the CCM describes gender issues in context of the HIV epidemic in Eritrea, and explains what how this proposal will address these issues. Examples of activities listed in this section are as follows:
- at least five gender train-the-trainer programmes for male and female health personnel;
- hiring of a gender expert;
- development of three training manuals on gender and reproductive health;
- a needs assessment to determine specific cases of violence against women, and the different response needs of women, girls, boys and men; and to obtain actionable evidence on the needs for gender empowerment and the ways to fight effectively against sexual violence.
- training for lawmakers and law enforcers on gender based violence issues such as early marriage, female genital mutilation, land ownership and other gender issues such as reproductive health rights, as well as the intertwining issues of gender and HIV/AIDS;
- training for almost 1,000 people at village level to enable them to become anti-female genital mutilation activists; and
- income generating programmes for more than 2,000 women-headed households.
In Section 4.5.1 of the proposal form, the last two objectives listed are under the heading of "Gender and Gender Violence." Nineteen activities related to these objectives are listed. These same activities can be found in the workplan portion of the proposal, along with, for each activity, targets, time frames for implementation, and an indication of who is responsible.
Excerpt #3: KEY STRENGTH 6 – MULTIPLE SECTORS IN SERVICE DELIVERY
Lesotho HIV (Category 2)
TRP Comment: Proposal strengthens links with civil society organizations and the private sector. Innovative approaches to BCC which target vulnerable groups (commercial sex workers, men having sex with men, prisoners, herd-boys).
The involvement of civil society organisations and the private sector is described as part of the overall implementation strategy in Section 4.5.1, but you have to search through the many activities listed to find those that are relevant. The following are some examples:
- Support programmes for out-of-school youth through civil society organisations.
- Train and support youth ambassadors on HIV and AIDS.
- Community-based organisations (CBOs), faith-based organisations, business and labour groups will be supported to develop and implement community HIV-prevention projects.
- CBOs will be supported to review initiatives and identify best practices that can then be replicated and scaled up.
- Support umbrella bodies to provide institutional and programmatic mentoring to their members.
The text of Section 4.5.1 of the Lesotho HIV proposal, in PDF format, is available at www.aidspan.org/documents/globalfund/trp/round_8/Lesotho-HIV-4.5.1.pdf.
The text of the full Lesotho HIV proposal form, in PDF format, is available at www.theglobalfund.org/programs/grant/?compid=1709〈=en&CountryId=LSO.
"Reproduced from the Global Fund Observer Newsletter (www.aidspan.org/gfo), a service of Aidspan."
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