1. Reflections on previous rounds’ proposals Laksami Suebsaeng WHO/SAERO

2. AIDS in Asia An estimated 8.6 million people were living with HIV/AIDS in 2006 960,000 newly infected individuals Approximately 630,000 people died from AIDS- related illnesses. Although the number of people receiving ART has increased more than three-fold since 2003, reaching an estimated 235,000 people by June 2006, this only represents16% of the total number of people in need of ART in Asia.

3. SE Asia – HIV/AIDS Has the second highest burden of HIV in the world. Although the overall adult HIV prevalence in the Region is less than 1%, the total burden in terms of absolute number of affected people is huge due to a large population base. By the end of 2006, there were an estimated 7.2 million people living with HIV in SEAR. This includes 0.77 million new infections in 2006. Approximately half a million persons died of AIDS during 2006

4. HIV remains concentrated and uncontrolled in populations engaged in high-risk behaviors, such as, SWs, IDUs, and MSM. In countries with long standing epidemics such as Thailand and India, HIV is now spreading from high-risk populations to their male clients and then to their monogamous spouses. Thus, women are being increasingly affected. Further, a high burden of STIs effects the HIV epidemic. Social factors such as poverty, low literacy and widespread stigma provide an adverse setting for spread of HIV. Moreover, health systems in many Member States are weak. These place constraints on expansion of prevention, treatment and care services.

5. Tuberculosis Southeast Asia: With an estimated three million new cases of TB each year, this is the world's hardest-hit region.

6. Tuberculosis control: progress and long-term planning Progress: good to excellent Focussed attention needed on: HSS, sustainability and quality, partnerships including community involvement, and impact evaluation and research Addressing newer challenges: Drug resistance, TB-HIV, fighting complacency Building technical and managerial capacity at country level a key priority

7. Malaria Focus has been on malaria in Africa Big burden of malaria in Asia: 100 million cases annually; affecting all age groups; repeated attacks common; monotherapy prevalent; drug resistance expanding; outbreaks occurring frequently Need to scale up evidence-based, local-specific prevention and treatment interventions using multi-sectoral and integrated approach Prevention based on ecological, environmental and behavioural determinants and treatment using appropriate/effective combination therapies

8. Region Number of people receiving ARVs East Africa 115,000 Southern Africa 109,000 East Asia & the Pacific 73,000 West and Central Africa 45,000 Latin America & the Caribbean 28,000 South Asia 9,000 Eastern Europe & Central Asia 3,000 North Africa & the Middle East 2,000 Total 384,000 Total 384,000

9. GFATM-supported Results of Global Fund-supported programs for the major indicators show millions are receiving lifesaving services, results are doubling each year and Global Fund targets for 2006 have been met or exceeded.

10. GROWTH SINCE 2005 AND PERCENTAGE OF 2006 TARGETS REACHED TOP THREE INDICATOR RESULTS Results end 2006 % increase over 1 yr % of end 2006 targets HIV: PEOPLE ON ART 770,000101%120% TB: TREATMENT UNDER DOTS 2,000,000100%167% MALARIA: ITNs DISTRIBUTED 18,000,000134%128%

11. TB Global Fund grants are helping to detect 5 million additional cases of infectious tuberculosis cure 3 million people through the internationally approved DOTS treatment strategy 24,000 new treatments of multi-drug resistant tuberculosis

12. Malaria finance 109 million bed nets to protect families from transmission of malaria, thus becoming the largest financier of insecticide-treated bed nets in the world deliver 264 million artemisinin-based combination drug treatments for resistant malaria

13. Thailand: The Global Fund supports 70 to 80 percent of the investment in laboratory infrastructure, CD4 count and viral load machines, and 25 percent of the CD4 count and viral load reagents. The Global Fund supports procurement of ARV drugs that cover 25 percent of the national ART program. The Global Fund also supports the provincial data coordinators for M&E and care programs for PLWHAs in 140 hospitals.

14. Approved funding by Region East Africa $2.59 billion Southern Africa $2.08 billion West and Central Africa $1.91 billion East Asia and the Pacific $1.55 billion South Asia$1.07 billion Eastern Europe and Central Asia$1.90 billion Latin America and the Caribbean$0.85 billion North Africa and the Middle East$0.76 billion Total $12.7 billion in 126 countries

15. Distribution of funding after 6 rounds

17. Round 6 – SE Asia and Pacific CambodiaMalaria13,148,61331,191,393 ChinaHIV/AIDS5,812,87514,395,715 Malaria7,047,93216,808,186 IndonesiaMalaria27,727,92057,965,100 Lao PDRHIV/AIDS3,418,6988,978,927 Malaria1,726,7014,099,092 PNGTB5,007,91220,869,303 PhilippinesHIV/AIDS7,474,96418,434,190 Malaria16,297,65922,344,786 ThailandTB7,726,76919,627,001 VietnamHIV/AIDS10,219,18028,771,590 TB1,614,33510,638,357 REGION TOTALS:236,390,316643,082,770

18. Round 6 – South Asia BangladeshHIV/AIDS13,998,84440,002,452 Malaria18,587,17939,062,586 BhutanHIV/AIDS1,812,8253,596,325 TB884,6901,773,135 IndiaHIV/AIDS75,954,670259,211,574 TB9,072,46424,271,555 MaldivesHIV/AIDS2,655,6854,865,956 Sri LankaHIV/AIDS1,009,7601,884,360 TB5,190,64114,291,187 REGION TOTALS:236,390,316643,082,770

19. Most common strengths of proposals submitted to GF – comments of TRP round 3-6 The proposal was clear, well organised and well-documented; the strategy was sound. e.g. Bhutan (H), Cambodia (H), Lao PDR (M), Maldives (H) The proposal demonstrated complementarity – i.e., it built on existing activities, including national strategic plans, and/or it built on earlier programmes financed by the Global Fund. e.g. Cambodia (M)

20. There was good involvement of partners (including NGOs and other sectors) in the implementation plan. e.g. Bhutan (H), India (H), East Timor (H) The proposal contained a good situational analysis. There was a strong political commitment to implement the programme. e.g. Bhutan (T)

21. Other strengths identified fairly frequently: Programme targeted high-risk groups and vulnerable populations, e.g. Bangladesh (M), Sri Lanka (H) Demonstrated sustainability – i.e., national budgets were identified to help sustain the activities once Global Fund support terminates. Demonstrated good co-funding. M&E plan was solid, e.g. Bhutan (H) Budget was well detailed, well presented and reasonable, e.g. Nepal (T), PNG (T). Proposal reflected comments made by the TRP during earlier rounds of funding. Good collaboration between HIV and TB. Realistic with respect to what could be accomplished, and/or had a limited and concentrated focus.

22. More strengths: The PR is a strong organisation, with experience managing similar programmes, e.g. Laos, Thailand The CCM was strong and had wide sectoral representation. The proposal was developed through a transparent, participatory process, e.g. China (H) Included capacity building measures and identified technical support needs, e.g. Indonesia (T) Built on lessons learned and best practices, India (H) Contained innovative strategies, some of which could lead to best practices. Had a strong human rights focus. Contained solid strategies for procurement and supply management (PSM), e.g. PNG (T)

23. The following strengths began to emerge during Round 6: The proposal described solid strategies for managing the programme, e.g. India (T) The proposal contained solid indicators and targets. The proposal identified the SRs, and/or provided a good description of the process for identifying the SRs, e.g. Lao (H) The proposal contained a strong section on health systems strengthening (HSS), e.g. India (T)

24. Weaknesses identified most often: Narrative description of the programme was inadequate, insufficient, unclear or questionable information on one or more of the following: the rationale, the strategic approach, the objectives, the activities, the indicators, the targets and the expected outcomes. Budget information was inaccurate, questionable and/or not sufficiently detailed. Did not demonstrate complementarity or additionality; it was not clear how the programme related or added to existing programmes, including programmes funded by the GF through earlier grants. Did not contain a good situational (i.e., gap) analysis.

25. Other weaknesses identified frequently: Some of the proposed approaches or activities were inappropriate. There were problems concerning the PR or CCM. Programme was too ambitious; some or all of the goals, objectives and targets were not realistic. The use of partners (including NGOs) in the implementation of the programme was inadequate or unclear. Did not focus sufficiently on vulnerable groups.

26. M&E plan was inadequate. Plan for PSM was inadequate. Failed to adequately address issues of capacity building and technical Failed to address weaknesses identified by the TRP for proposals submitted in earlier rounds of funding.

27. More weaknesses: Insufficient attention was paid to human rights issues. Budget was imbalanced; too much or too little was allocated to one or more sectors or activities. Demonstrated insufficient co-funding. Proposal development process was not sufficiently transparent or inclusive. There were either no joint activities or insufficient joint activities involving TB and HIV; The treatment, care and support component of the proposal was missing or inadequate. Failed to demonstrate absorptive capacity. Information on sustainability was lacking. How health systems will be strengthened is not well explained.

28. Following weaknesses started to emerge in Round 6: Lack of information concerning problems with previous Global Fund grants. Failed to make the case for additional funding over and above that received from earlier grants. Insufficient information on how the project would be coordinated.

29. Health system Stewardship Financing Human resources Technologies and infrastructure Information and knowledge Service delivery Stewardship Financing Human resources Technologies and infrastructure Information and knowledge Service delivery Stewardship Financing Human resources Technologies and infrastructure Information and knowledge Service delivery Stewardship Financing Human resources Technologies and infrastructure Information and knowledge Service delivery HIV/AIDS control programme Malaria control programme TB control programme

30. Possible areas where GF resources may be used for HSD Primary Health Care infrastructure and service delivery Laboratory, blood safety, Drug procurement, logistics management Human resource development and management Linking with the Private sector Strengthening health information systems Surveillance monitoring and evaluation

31. Health System Component Not limited to health sector: may include education, workplace. But it must: –Demonstrate a clear benefit in the fight against AIDS, tuberculosis and/or malaria –Show that it is a necessary prerequisite to scaling up against any or all of the three diseases –Describe how it will have positive system-wide effects.

33. DOTS combines five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems, and use of highly efficacious regimes with direct observation of treatment

34. GUIDING PRINCIPLES Focusing on sustainability after GF projects are over Concentrating on cross -cutting aspects of health systems that benefit the fight against AIDS, tuberculosis and/or malaria Building on existing health systems and infrastructure to scale up service delivery for the 3 diseases Strengthening partnerships between the public sector, private sector, and NGOs

35. What’s new about the new Stop TB Strategy? Sustaining quality DOTS Additional interventions – –Address TB/HIV & MDR-TB – –Contribute to health system strengthening – –Engage all care providers – –Empower patients and communities – –Enable and promote operational research

36. Translating the strategy into action Member countries are requested to: – –Support the full implementation of the Regional Plan 2006-2015 aimed at achieving the TB related MDGs – –Develop long and medium-term plans based on the new strategy, adapted to country-specific contexts – –Sustain adequate financing through domestic and external funding, in line with WHA 58 resolution: “Sustainable financing for TB prevention and control”

37. Implementation at country level Build capacity: ensure adequate skilled personnel and infrastructure, including for laboratories Strengthen surveillance and monitoring systems Scale up public and private partnerships at all levels Accelerate interventions to prevent drug-resistance and enhance collaboration with AIDS programmes Augment significantly advocacy, communication and social mobilization approaches Strengthen delivery of TB services through primary health care systems

38. WHO’s role? To help governments through: Support for mobilising funds from Global Fund (and others) Ensuring that health system development is an integral part of GF proposals. Bringing together people and build networks of national institutions and WHO collaborating centres, which contribute to common health system goals Facilitating cross-country support and interaction in assessment and policy analysis

39. WHO SEARO Support Facilitating GFATM Regional technical meetings Briefing/communication on GFATM Board, SEAR Constituency and Task Force meetings Proposal development/mock TRP Technical support missions Facilitating mobilization of other sources of funds where GFATM support is not there