Information, allocations, multi-countries and transition LATIN AMERICA AND CARIBBEAN REGION Information, allocations, multi-countries and transition 13 November 2017

LAC GENERAL OVERVIEW (past and future) Overall we have 22 countries and 46 individual country grants in the new allocation – (consolidation of 4 countries into MCC ( HIV/TB 4 countries), and other into HIV/TB 3 countries ) – not including any regional grants Allocations 2014-16 vs. 2017-19 DISEASE 3 YEAR ALLOCATION EQUIVALENT 2014-16 PROJECTED EXPENDITURE 2017-19 ALLOCATIONS % prior allocation % prior projected expenditure HIV 270,352,859 235,140,927 199,414,981 73.76% 84.81% TB 82,658,970.25 69,647,857.84 55,619,016 67.29% 79.86% Malaria 71,324,108 61,452,081 47,206,031 66.19% 76.82% HIV/TB 16,700,000 15,500,000 9,952,565 59.60% 64.21% TOTAL 441,035,937 381,740,866 312,192,593.00 70.79% 81.78%

Allocation comparison Country Disease Currency Allocations 2014-16 spend to end of grant Country total 17-19 % of prior allocation % prior spend Belize Total USD 3,400,000 3,300,000 1,916,278 56.36% 58.07% Bolivia (Plurinational State) 32,632,236 27,200,000 18,632,258 57.10% 68.50% Colombia 14,600,000 11,800,000 10,014,581 68.59% 84.87% Costa Rica 3,700,000 3,160,005 2,120,098 57.30% 67.09% Cuba 16,400,000 18,400,000 13,253,226 80.81% 72.03% Dominican Republic 37,400,000 32,054,698 20,488,796 54.78% 63.92% Ecuador 12,259,984 9,227,431 5,328,421 43.46% 57.75% El Salvador 28,300,000 28,900,000 18,724,557 66.16% 64.79% Guatemala 55,600,000 46,702,701 31,985,369 57.53% 68.49% Guyana 13,920,015 7,300,000 6,105,356 43.86% 83.64% Haiti 91,011,032 78,200,000 105,712,929 116.15% 135.18% Honduras 30,694,820 25,600,000 18,124,919 59.05% 70.80% Jamaica 14,400,000 13,470,131 9,930,638 68.96% 73.72% Multicountry Carribbean3 4,000,000 3,550,000 88.75% Nicaragua 30,570,902 28,400,000 18,995,233 62.14% 66.88% Panama 5,800,000 5,400,000 2,685,892 46.31% 49.74% Paraguay 19,700,000 15,624,065 7,348,288 37.30% 47.03% Peru 20,846,948 17,951,835 13,463,877 64.58% 75.00% Suriname 5,050,000 3,811,877 65.72% 75.48%   441035937 381,740,866 312,192,593 70.79% 81.78%

Max.3 years funding to implement transition activities Co-Financing requirements along the development continuum work towards enhancing program sustainability and eventual transitions LMICs with low/moderate disease burden / UMICs LMICs with high disease burden Fully transitioned Ineligible LICs “Final Grant” Focus on long-term sustainability planning by supporting the development of robust national health strategies, disease specific strategic plans and health financing strategies Focus on sustainability and transition preparedness, particularly for countries projected to transition* Max.3 years funding to implement transition activities Haiti (HIV, TB,malaria) Bolivia (HIV, TB) El Salvador (HIV) Guatemala (HIV) Honduras (HIV) Nicaragua (HIV) Guyana (HIV, TB, M) UMIC Belize (HIV) Colombia (HIV) Costa Rica (HIV)* Dominican Republic (HIV) Ecuador (HIV) Jamaica (HIV) Paraguay (HIV) Peru (HIV, TB) Suriname (HIV and malaria) LMIC with L/M DB Bolivia (malaria)** El Salvador (TB, malaria)* Guatemala (TB, malaria)** Honduras (TB, malaria) Nicaragua (TB, malaria) Cuba (HIV) Belize (TB) Dominican Republic (TB) Paraguay (TB and malaria) Suriname (TB) Panama (TB and HIV) 3 components 9 components 20 components *(3 projected transitions in 2020-2022 allocation) ** (3 projected transitions in 2023-2025) 8 components 3 projected transitions in 2020-2022:

Who is transitioning now, and who is projected to transition?

Summary: transition components FINAL GRANT Grant End grant date TRA status TRA work-plan Funding request Others Cuba (HIV) 31-Dec-2017 Completed W1 Autodiagnosis completed Belize (TB) 31-Dec-2018 On-going To be developed W5 (April18) TRA also includes HIV; (HIV/TB funding request) Dom. Republic (TB) W5 (April 18) Separate HIV/ TB funding request

Countries prioritized as UMI, and LMI with moderate disease burden where work on transition needs to begin

Countries/components transition 3 to 6 and 9 years

Components that remain depending on trends and resources as per eligibility today

Status - new allocation submissions

Funding from different allocation periods can no longer overlap Unlike the transition period/last replenishment, existing funding does not carry over into next allocation cycle

Allocation Utilization Period Any end-date revision (formerly known as ‘extensions’) will use funding & time from the next allocation period IP1 End date revision to IP 1 IP2 6 months 2.5 years Original IP/grant end date 2M 8M Funds Time Example: Allocation Utilization Period Start date of new IP/grant Grant end-date revisions to the existing implementation period will be deducted from the next allocation in funds and time Unused funds at the original grant end date will be used for portfolio optimization investments and to top-up grants with high absorption levels and good performance In order to avoid this, countries can still make program revisions to their grants up to 14 months before the end date of grant implementation to improve absorption levels e.g. an IP of only 2.5 years using 8M out of 10M country allocation SPECIFIC INTERNAL GUIDANCE IS BEING PREPARED FOR COUNTRY TEAMS ON THIS ISSUE

Multicountry approach As per Board Decision GF/B36/04 and on technical partner recommendation funding is to be directed towards multicountry approaches for the following purpose: “to target a limited number of key, strategic multicountry priorities deemed critical to meet the aims of the Strategy and not able to be addressed through country allocations alone” Malaria US$ 145/6M LAC Tuberculosis US$ 65 M/ 4.5 M LAC HIV US$ 50 M/17M LAC Regional added value and complementarity to the national grants. MC has to complimentary to the national grants/allocations, and not duplicate the national efforts being covered in the national allocations.

Multi- county for TB and Malaria TB – 4.5 million for a new grant integration of CSO into the reposnse as grants transition - will come with others in Window 6, TORs to be launched in April 2018 . Malaria – 6 Million – went through Window 3 , Blended finance with IDB, Gates (CHAI) , GF, PAHO , COMISCA , RCM- To help accelerate the elimination of malaria in Central America, the IDB together with all key partners and countries is setting up a blended finance facility (as part of the Regional Malaria Elimination Initiative – RMEI) to help strengthen technical assistance, harmonize donor and technical partner Malaria elimination efforts.

Approved Multicountry Allocation US$ millions Regions selected for MC approach for HIV: Sustainability of services for key populations Regions Approved Multicountry Allocation US$ millions EECA 13 LAC 17 SE Asia 12.5 MENA 7.5 Total 50 Summary: Out of the 200 mi on HIV from the catalytic investment, 50 mill is for MC HIV, and from this 17 mil are for LAC. No African regions are included in this distribution. The priority for MC on HIV was defined for sustainability for KP, referring to the portfolios preparing or gearing up for transition out of GF financing.

Strategic Priority: Sustainability of services for key populations in LAC region Operational priority: RFP based on consultation Upper Ceiling Allocation: US$ 17,000,000 Estimated number of grants: 1-2 in Latin America and 1 in Caribbean region Key population scope: To be defined based on further consultation. Geographical Focus: To be defined based on consultation process. Focus on the needs of sub-regions: Caribbean, Central America, South America. Aim: Strategic support for development, innovative delivery of services and sustainability of community-led service delivery and monitoring, and support for regional advocacy, address legal barriers, also laying the groundwork for continuity of these services as part of a transition process*. TBD based on consultation process. *This is based on the board document on catalytic investment.