Challenging operating environments (COEs)

Contents Introduction: COEs and the policy of the Global Fund Access to Funding for COEs Resources 1 2 3 1

Challenging operating environments “Countries or regions characterized by weak governance, poor access to health services, limited capacity and/or fragility due to man-made or natural crises.” COEs are a heterogeneous group and differ in terms of: Type / length / magnitude of crisis Strength of health system Vulnerability of key populations Disease burden Income level

The Global Fund COE Policy Emphasizes a differentiation of approach in COEs to improve effectiveness and ensure greater impact Underscores 3 principles for Global Fund investment in COEs: Innovation 1 Flexibility Partnership 2 3 Use new approaches and mechanisms, e.g. in procurement, service delivery, etc. building on lessons learned to address or circumvent challenges Apply policy exceptions to reduce administrative burden & increase agile response to changes in contexts, through contingency planning and reprogramming Strengthen in-country governance by optimizing partnerships and coordination; foster integrated service delivery; and improve technical assistance

COE types – some general characteristics Unsteady security situation Protracted economic crisis Low political will and/or high levels of corruption Health system weak and/or is in the process of rehabilitation Service coverage levels are low, and access to certain areas and populations is challenging CCM has longstanding weaknesses relating to leadership, inclusiveness and/or transparency National implementers have shown sustained weak performance Chronic instability Armed conflict, disease outbreak or natural disaster Volatile security situation Rapidly evolving context Health system destroyed or overwhelmed by crisis Major constraints with accessing certain areas and populations CCM is not functional or can’t coordinate country disease response National entities may lack legitimacy, and capacity to implement is weak. Acute emergency

‘Priority objective’ of the Global Fund in COEs Build resilient and sustainable systems for health and maintain or scale up effective coverage of services Chronic instability Deliver essential services, avoid program regressions, and support maintenance/ strengthening of health system where feasible Acute emergency COEs must strive to achieve the best possible outcomes and impact within their given setting, The ‘priority’ or minimum focus for Global Fund investment would depend on the type of COE

Other sources of funding Financing for COEs 1 Allocation Global Fund financing to COEs will generally be provided through country allocations COEs will submit a funding request (where applicable) to access their allocation. Allocations may be reprogrammed at any time to respond to crises or changing context. 2 Other sources of funding Global Fund allocations may be complemented by financing from the Emergency Fund Supports activities that cannot be funded through the reprogramming of existing grants during emergency

The Global Fund COE List Countries with the highest External Risk Index (ERI), and may be adjusted to include post-crisis countries or those experiencing emergencies Classification is valid for the allocation period. Updates to the classification, e.g. in response to changes in country situation will be approved by the EGMC

Contents Introduction: COEs and the policy of the Global Fund Access to Funding for COEs Resources for Country Teams 1 2 3 8

Implementation ongoing throughout grant lifecycle Differentiated application and review process Depending on the case, COEs will go through one of the three approaches to access their allocation Grant Implementation TRP validation Grant-making PROGRAM CONTINUATION TAILORED COE Material changes TRP Tailored Review GAC + Board Reprogramming request at any time FULL PROPOSAL TRP Full Review Implementation ongoing throughout grant lifecycle

COE application form Simplified  the request may be under 20 pages per component Adapted to both acute emergency and chronic instability COEs Designed to encourage use of existing country documentation, from national strategy documents to other, more ad hoc sources of information

COE application form accommodates all diseases and RSSH funding requests single-component funding requests joint funding requests, including two or more components for which applicants are eligible For example, an applicant may submit a funding request for TB only; or combining TB and RSSH; or combining HIV/AIDS and TB; or combining all three diseases and RSSH.

COE application form - questions Put emphasis on the challenging context Call attention to the need for appropriate programming focusing on feasibility Prompt applicants to clearly specify arrangements for operationalizing the grant (incl. who, what & how) Stress risk mitigation measures in light of the challenging and often-changing context Assess how the requested funding fits within the overall funding landscape Requests for contingency plans, where applicable, to ensure agile response in a changing context.

Core documents – WHAT ARE THEY? List of Health Products with Health Products Assumptions/ Quantifications Funding Landscape Tables Performance Framework Summary Budget Programmatic Gap Tables Part of the funding request, along with narrative Modular template no longer required. Instead, use of PF and budget tools. Level of detail on PF and Budget will vary: Application (strategic) vs Grant (detailed) List of Health Products (LoHP) needed with assumptions /quantifications information for key health products will vary at the application stage according to differentiation Core documents can be used beyond application stage: PF and budget will be negotiated. PGT can be updated in case of significant change. The LoHP is finalized or generated at grant-making based on the negotiated proportion of national health products needs forecast that is funded by GF

Implement. and Revisions Core documents Application Grant-making Implement. and Revisions Performance Framework High-level information: impact, outcome, modules, annual or bi-annual targets Alignment with D4I categories/ requirements Negotiation of details: Indicators, targets, reporting, etc. Can be simplified, as applicable Used for monitoring, reporting, disbursing Updated as needed in case of material and non-material revisions Budget High-level information: Main interventions per module, implementer and year Negotiation of details: cost assumptions, activities, etc. Level of detail aligned with D4I requirements Updated as needed as per finance/D4I guidelines Revised at the time of material revisions Programmatic gap tables and Funding landscape tables Starting point for Prioritized Above Allocation Request Key documentation for reporting compliance with co-financing requirements Update in case of significant change Used for understanding gaps in programmatic coverage Basis for monitoring domestic financing commitments, measuring KPIs and strategy implementation plan indicators on domestic financing Key input to the Results Framework for reporting Global Fund Results Updated in case of changes (esp. for HI and some core countries) Can be used for deciding material revisions List of Health Products with assumptions /quantifications information Alignment with D4I and depending on proportion of HP budget LoHP required for HI countries and key health products Assumption/quantif. info. needed in free format Negotiation of details: List of all HP to be procured with grant funds Values of the LoHP is imported/reconciled in the budget Serves as the basis for grant supply plan for health products Used for monitoring procurement compliance with approved products and quantities The LoHP is updated annually to accommodate changes in demand and supply factors or reprograming Basis for contracting and allocation of suppliers for PPM

Flexibility in the TRP’s review of COEs The TRP recognizes that higher operational challenges and risks in COEs call for differentiation in the TRP’s review of COE funding requests. The TRP membership pool includes strong expertise in COEs, following the recent TRP membership recruitment process Drawing on lessons learned, the TRP has developed a clear framework to guide how TRP review criteria will be applied in COEs, The TRP will tailor its review criteria in COEs by applying certain considerations on a case by case basis, depending on country context.

Contents Introduction: COEs and the policy of the Global Fund Access to Funding for COEs Resources 1 2 3 16

Resources The Global Fund COE Policy Applicant resource Book Instructions, incl. TRP Review Criteria Considerations for COEs Operational Policy Note on COEs (Upcoming) The Global Fund Guidance Brief on Human rights and Gender Programming in Challenging Operating Environments (Upcoming)