1

The New Funding Model Key features and implementation

Greater alignment with country schedules, context, and priorities Focus on countries with the highest disease burden and lowest ability to pay, while keeping the portfolio global Simplicity for both implementers and the Global Fund Predictability of process and financing levels Ability to elicit full expressions of demand and reward ambition Principles of the new funding model Principles of the new funding model

Key features Timing of requests Applicants apply for funding when they want Applicants can submit different disease or HCSS requests at different times Applicants can use in-country planning cycles Applicants submit a funding request through a “Concept Note” Early feedback from the Secretariat and the TRP = higher success rate Upfront risk and capacity assessments Differentiated processes to ensure disbursement-ready grants Funding requests negotiated before Board approval Three years Length of grants Early feedback Grant-makin g Applicants are given an indicative funding range over a 3-year period The Secretariat will hold indicative amounts for applicants until they apply Predictable funding Competitive funding in addition to indicative range Rewards high impact, well-performing programs Encourages full expression of demand Incentive funding The new funding model changes the way applicants apply for funding, get approval of their proposals and then manage their grants

Overview of the new funding model NSP Allocation formula NSP support Band allocation Concept Note Country dialogue Determine / approve adjusted funding amount Unfunded quality demand Grant-making TRP review Board approval 1345 Incentive funding Indicative funding 2 Grant Approval Committee Determination of split between diseases & HCSS 67

Events leading up to the Board’s decision and implementation New Global Fund Strategy approved Decisions on New funding model Implementation Create grants for a limited number of countries based on funds available Design and Agreement on all key features of the new model, with timelines for implementation Established the framework to replace “Rounds” with a substantially changed funding model When Key event Outcome Full implementation of the new funding model after replenishment

In new funding model, disease programs fall into one of three categories New grant: eligible for indicative and incentive funding. All steps of the new funding model process – country dialogue, submitting a concept note, TRP review, grant-making. Renewals and extensions of existing grants, and redesigns to access funding in Country dialogue Prepare for applications to be submitted in late 2013 or in Country dialogue Early Applicants Interim Applicants Standard Applicants How they receive fundingWhat they do

New grants signed Interim funding through renewals, grant extensions and redesigned programs In-country preparation and national strategy development Standard Selection of early applicants Early Interim Selection of interim applicants Implementation Timelines Application plus real time learning Application, review and grant-making

Investment of available funds, for early impact Focus on those most in need (e.g. underfunded or facing disruption) Implementing elements of the new model This enabled... Board approved immediate launch of the transition to the new funding model How were applicants selected for funding? Purpose of the transition

How were applicants selected for funding? Participation in the transition Who was invited to participate? Countries positioned to achieve rapid impact Countries at risk of service interruptions Countries receiving less than they would under the new funding model principles

Country Dialogue Builds upon existing, on-going mechanisms & dialogue in health and development, not only with Global Fund Brings together Governments, donors, partners and civil society and key affected populations / MARPs Provides inputs into the concept note development: -Strategic investment guidance from technical partners -Info and analysis on Global Fund grants -Amount of indicative funding available Concept notes and Global Fund funding request developed from these discussions, based on national strategy/investment case Country dialogue Indicative funding

During 2013, or according to their national planning cycle, countries can assess the strength of their National Health Strategy and their National Disease-specific Strategies for HIV, TB and malaria, and, if necessary, take steps to strengthen them. Preparing for the NFM: All applicants All applicants could consider the following actions... Strengthen national health/disease strategies Identify programmatic and funding gaps They can identify programmatic and funding gaps in these strategies. They could organize joint reviews of their strategies (e.g. Joint Assessment of National Strategies (JANS)), if needed. As an alternative, they can develop an investment case to be included in the Concept Note. Review CCM eligibility requirements CCMs can review eligibility requirements for themselves and the Global Fund’s Minimum Standards for PRs, to assess potential issues and make any necessary improvements before

All 50 CCMs accepted the invitation to participate in the NFM Three early applicants - El Salvador, Myanmar and Zimbabwe - have submitted their Concept Notes and aim to sign grants by June Board Country dialogue was well received and considered a significant improvement Simpler Concept Note said to focus CCMs on strategic areas to drive impact Greater work needed on the budget and performance reporting tool Another three - DRC, Philippines and the Mekong Artemisinin Resistance Initiative - aim to complete Concept Notes by October Learnings from the first early applicants will improve the NFM process Interim applicants are moving forward rapidly to access funding One country – Pakistan – submitted its funding request in March Five countries planning to submit funding requests in May Despite tight timelines, there has been significant progress to date

Investing for Impact Global Fund results and impact

Contents 1.Update on results in numbers 2.Coverage and Impact 3.Challenge and Opportunity 4.Impact evaluation plan

Rapid increase in results (Reported numbers from GF supported programmes)

Coverage of key interventions % % % 5 56

ART Coverage Source: UNAIDS 2012 People on ART : 310,000 (2004)  3.8 mil (2009)  6.1 mil (2011) ART coverage : N/A (2004)  41 % (2009)  56 % (2011)

ITN Coverage Source: WHO 2012 Average coverage increased: 3% (2000)  53% (2011)

Malaria prevalence in Tanzania Every week 500 children saved from malaria deaths Tanzania

Coverage supported by Source: Global Fund Price & Quality Reporting System 21 Decreasing unit costs Domestic financing in 3 diseases in GF eligible countries Source: UNAIDS, Stop TB, GMP Estimated costs of common First Line Adult Anti-Retroviral Regimens

Challenge and opportunity to maintain and invest in increased coverage Major challenge : to maintain coverage –e.g.) Malaria cases have rapidly increased when Zambia and Rwanda faced a funding gap. Major opportunity : multiplier effects when achieving universal access –e.g.) Rwanda and Ethiopia achieving universal access show great impact on MDG 4,5 and 6, and potential to control 3 diseases epidemics.

Challenge and opportunity to fight 3 diseases GF HSS funding (TRP-recommended ) Amount of funding: USD 2.4 billion Number of proposals funded: 107 Number of Countries: 69 Health/Community system strengthening (HCSS)

Out of total disbursements 1.2 billion ( ) Increased coverageMDG Impact Example: Ethiopia – 20% towards HSS

Evaluation plan Program review with partners in high impact countries to assess impact and others Data quality assessment Thematic review on cross-cutting issues like MDG 4&5, fragile states Synthesis report of GF on results for mid-term and end-term of the new strategy

Impact reviews and Inputs to grants Country/ Disease Key Findings Grant Recommendations Cambodia/TB Myanmar/Malaria Uganda/HIV - TB prevalence reduced by 43%, but mainly among young adults - Funding beyond 2013 uncertain -Scale up routine contact investigation among elderly and children -Increase government contribution, improve efficiencies and cost savings, and expand TB/ HIV collaboration - Decreased morbidity and mortality - Inaccessible areas - Major risk of artemisinin resistance - Target hard-to-reach townships while maintaining nation-wide intervention efforts - Strengthen drug resistance monitor and encourage regional approach to counter artemisinin resistance - Increase in HIV prevalence - Inadequate prevention - Moderate ART and PMTCT coverage - Strengthen targeted combination prevention approaches - Prioritize quality and coverage of ART and PMTCT programs

Conclusions Rapid increase in access to key services, especially last five years Improved coverage of key interventions –Challenge to sustain coverage of key interventions –Returns of impact if reach universal access Impact evaluation plan: underway and contributing to focus on impact in grants