THE GLOBAL FUND SUSTAINING THE GAINS AND IMPACT Uganda December 2013

UGANDA PORTFOLIO Portfolio Background and Context Total portfolio signed to date of US$ 579M Total disbursed since 2003: US$ 490M 9 active grants: – 2 Health Systems Strengthening (HSS): MoFPED/MoH - TASO – 2 HIV: MoFPED/MoH - TASO – 4 Malaria: 3 MoFPED/MoH – 1 TASO – 1 TB: MoFPED/MoH

Investments in Uganda (US$) Active grants Disease / Number of grants Signed grantsAmount disbursed to date % disbursed HIV/AIDS2 171,235,647130,441,07377% TB1 17,516,7119,855,55556% Malaria4 273,836,962237,660,24987% HSS2 14,444,4689,820,44368% Total 477,033,788387,777, %

Current Performance Rating of Uganda Grants GrantPerformanceTop 10 Indicators All Indicator s UGD-405-G05-M (31 Dec 2011)CB2C UGD-708-G07-H (31 Dec 2012) B1A2B1 UGD-708-G08-M (30 Nov 2011) B1A2B2 UGD-011-G09-S (31 Dec 2012) Grant start date: 1 Aug 2012 B1A1B2 UGD-011-G11-M (31 Dec 2012) Grant start date: 1 June 2012 B1 UGD-T-MoFPED (31 Dec 2012)B1

Key milestones in 2013 and m nets distributed which will translate to 3 nets distributed per household and should have a significant impact on malaria control in Uganda, including averting deaths in the next 3 years Full roll out of option B+ and scale up of Prevention of Mother-to- Child Transmission (PMTCT) Scale up of Antiretroviral Therapy (ART) Sustaining DOTS Establishment of MDR TB wards and scale up of treatment TB prevalence survey Health Information Systems (HIS) strengthening Supply chain management strengthening

Investing for Impact: Uganda (HIV)  Reversal of HIV trends noted in Uganda. Scale up of ART: 566,000 patients  Contributing factors: Low levels of comprehensive knowledge Multiple sexual partnerships Low condom use  Programmatic level: Sub-optimal attention to prevention programs Loss of intensity and focus 6  Strategic Investment: Reinvigorate prevention programs Targeted programs for key populations Strengthening delivery of defined, quality comprehensive prevention program packages Scale-up ART/ PMTCT /TB-HIV/Safe Medical Male Circumcision to desired coverage levels to make an impact

ART coverage

HIV among different groups; including MARPs in Uganda

Investing for Impact: Uganda (tuberculosis) Amongst the 22 high burden countries. Contributes to 0.8% of the global TB burden. Generalized HIV epidemic is the key driver of the epidemic Steady decline in TB incidence, prevalence and in mortality Strategic investments – Expand and consolidate high quality DOTS. Strengthen TB/HIV collaborative activities – Strengthen TB control in Uganda prisons – Ensure availability of anti-TB medicines for both susceptible and drug resistant TB patients – Strengthen programmatic management of drug resistant TB to ensure all diagnosed MDR TB patients are enrolled on treatment

Investing for Impact: Uganda (malaria) Global Fund supports mass LLIN distribution to achieve universal coverage Support reprogramming for impact: – Moved from targeted coverage (Under 5 and pregnant women) under Phase 1 to Universal coverage in Phase 2 Reinvest grant saving to achieve coverage Additional 4 million LLINs being procured – from savings Strengthening Partnerships: Additional resource mobilization feasible to achieve desired impact – Gap of ~ 5 million nets to achieve universal coverage covered – Partners: Government, President’s Malaria Initiative (PMI), Department for International Development (DFID) and World Vision Mass distribution planned in

GF Funding for Malaria since 2004 YearDisbursements Principle Recipient Grant No.CommittedDisbursementBalance 20049,749,358PR 1UGD-011-G11-M$26,846,021.96$17,050,578 $9,795, ,149, ,715,494PR 2UGD-011-G12-M$20,614,350.00$15,541,806 $5,072, ,175, ,335,768PR 1UGD-708-G08-M $112,550, $109,108,068 $3,442, ,985, ,078,370PR 1UGD-405-G05-M $112,427, $95,959,797 $16,467, ,465, ,091,440PR 1 UGD-202-G02-M- 00$21,054,781.35$21,054, ,968, ,715,030 $258,715, January 2012 Core Slideset

Successes in Malaria Control Recent data suggests that coverage of proven anti-malarial measures are improving in Uganda and malaria is declining thanks to GF support: – Percentage of households that own at least one insecticide-treated nets (ITNs) has increased from 16% in 2006 to 60% in 2011; – Proportion of children under-five sleeping under an ITN has increased from 10% in 2006 to 43% in 2011; – Proportion of pregnant women sleeping under an ITN has increased from 10% in 2006 to 47% in 2011; January 2012 Core Slideset

Successes (cont’) – Children under-five with fever who took an ACT (the proven malaria drugs) has increased from 3% in 2006 to 44% in 2011; and, – Number of malaria related deaths has declined by 30% between 2001 and 2010 contributing to an impressive under-five mortality decline of 10% during the same period – Uganda has made progress towards achieving the Millennium Development Goals (MDGs) but the pace of progress is slow January 2012 Core Slideset

Upcoming extensions- January 2014

CCM oversight

1.Operate as a financial instrument, not as an implementing entity 2.Make available and leverage additional financial resources 3.Support programs that reflect country ownership and respect country- led formulation and implementation 4.Operate in a balanced manner in terms of different regions, diseases and interventions 5.Focus on performance by linking resources to the achievement of clear, measurable and sustainable results at every phase of the lifecycle of a grant (allocation of funding, request for funding, grant making, disbursements). The Global Fund Guiding Principles

Partnership Approach to Governance Donors Recipient Countries Private Sector Private Foundations ● NGOs from Global North ● NGOs from Global South ● Communities living with, and affected by, the diseases ● WHO ● UNAIDS ● World Bank ● UNITAID ● RBM ● Stop TB Partnership Civil Society Technical Agencies and Partnerships Private Sector Public Sector (Governments and Agencies) A diverse partnership reflected in the Board and Country Coordinating Mechanisms

CCM Oversight What; How and Who?

What is CCM Oversight? CCM Oversight consists of providing strategic guidance to PRs to ensure and enable effective grant management and performance Most important CCM function upon grant approval A continuous process throughout grant cycle Focused on broad objectives of improving performance, not micro-issues

What is CCM Oversight? Constituency engagement is a key approach for CCM effective oversight as : Are the programs relevant  Reflect the views and concerns of diverse stakeholders in CCM discussion, decisions and ultimately programs brought up from the constituencies  Empower communities to express demand  Use the expertise and experience of different sectors to identify and manage bottlenecks and risks  Ensure program performance, impact and accountability

Focus Areas: 1.PROPOSAL DEVELOPMENT- policies, strategies and country priorities 2. PROGRAMMATIC PERFOMANCE Achievement of output, outcome, impact results 3. MANAGEMENT Effective and timely work plan implementation 4. FINANCE Efficient and appropriate use of funding

5 key questions for every grant & PR 1.Where is the money? 2.Where are the commodities ? drugs, the nets, and other medical supplies and equipment 3.Are the sub-recipients receiving resources and technical assistance as planned and delivering to the intended beneficiaries ? 4.Are the grants being implemented as planned in line with the set strategies and priorities? 5.Are the results meeting the performance targets?

CCM oversight

How Through committee 1.Executive Committee 2.Program Oversight Committee 3.Finance and Procurement Committee 4.Resource Mobilization and Proposal Development Committee The representatives from the each CE seat at these committee and it where most of the work happens.

Coordination…

QUESTIONS