1. Challenging operating environments (COEs)

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

3. 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

4. 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

5. 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

6. ‘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

7. 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

8. 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

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

10. 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

11. 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

12. 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.

13. 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.

14. 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

15. 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

16. 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.

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

18. 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)