1
The New Funding Model
Key features and implementation
Principles of the new funding model
Principles
of the new
funding model
•
Greater alignment with country schedules, context, and priorities
•
Focus on countries with the highest disease burden and lowest
ability to pay, while keeping the portfolio global
•
Simplicity for both implementers and the Global Fund
•
Predictability of process and financing levels
•
Ability to elicit full expressions of demand and reward
ambition
Key features
The new funding model changes the way
applicants apply for funding, get approval of
their proposals and then manage their grants
Predictable
funding
• Applicants are given an indicative funding range over a 3-year period
• The Secretariat will hold indicative amounts for applicants until they apply
Timing of
requests
• Applicants apply for funding when they want
• Applicants can submit different disease or HCSS requests at different times
• Applicants can use in-country planning cycles
Length of
grants
• Three years
Early
feedback
• Applicants submit a funding request through a “Concept Note”
• Early feedback from the Secretariat and the TRP = higher success rate
Incentive
funding
• Competitive funding in addition to indicative range
• Rewards high impact, well-performing programs
• Encourages full expression of demand
Grantmaking
• Upfront risk and capacity assessments
• Differentiated processes to ensure disbursement-ready grants
• Funding requests negotiated before Board approval
Overview of the new funding model
NSP
support
NSP
Determination
of split between
diseases &
HCSS
Grant
Approval
Committee
TRP
review
Country
dialogue
Determine /
approve adjusted
funding amount
Concept Note
Unfunded
quality
demand
Board
approval
Grant-making
Indicative funding
Incentive
funding
Band allocation
Allocation formula
1
2
3
4
5
6
7
Events leading up to the Board’s decision
and implementation
When
Key event
2011
New Global Fund
Strategy approved
Established the framework to replace
“Rounds” with a substantially changed
funding model
2012
Decisions on New
funding model
Design and Agreement on all key
features of the new model, with timelines
for implementation
Outcome
Create grants for a limited number of
countries based on funds available
2013
Implementation
2014
Full implementation of the new funding
model after replenishment
In new funding model, disease programs
fall into one of three categories
How they receive funding
What they do
Early
Applicants
New grant: eligible for
indicative and incentive
funding.
All steps of the new funding model
process – country dialogue,
submitting a concept note, TRP
review, grant-making.
2
Interim
Applicants
Renewals and extensions
of existing grants, and
redesigns to access
funding in 2013.
Country dialogue
3
Standard
Applicants
Prepare for applications
to be submitted in late
2013 or in 2014.
Country dialogue
1
Implementation Timelines
2013
1
2
Early
Selection of
early
applicants
Interim
Selection of
interim
applicants
3 Standard
Application
plus real
time learning
2014
New grants signed
Interim funding through renewals, grant
extensions and redesigned programs
In-country preparation and
national strategy development
New grants signed
Application, review
and grant-making
2015
How were applicants selected for funding?
Purpose of the transition
This enabled...
Board approved
immediate
launch of the
transition to the
new funding
model
• Investment of available funds, for early
impact
• Focus on those most in need (e.g.
underfunded or facing disruption)
• Implementing elements of the new model
How were applicants selected for funding?
Participation in the transition
Countries positioned to achieve rapid impact
Who was
invited to
participate?
Countries at risk of service interruptions
Countries receiving less than they would under the new
funding model principles
Country Dialogue
• Builds upon existing, on-going mechanisms &
dialogue in health and development, not only with
Global Fund
Country dialogue
Indicative funding
• Brings together Governments, donors, partners and
civil society and key affected populations / MARPs
• Provides inputs into the concept note development:
- Strategic investment guidance from technical
partners
- Info and analysis on Global Fund grants
- Amount of indicative funding available
• Concept notes and Global Fund funding request
developed from these discussions, based on
national strategy/investment case
Preparing for the NFM: All applicants
All applicants could consider the following actions...
1
Strengthen
national
health/disease
strategies
2
Identify
programmatic
and funding
gaps
3
Review CCM
eligibility
requirements
•
During 2013, or according to their national planning cycle, countries can
assess the strength of their National Health Strategy and their
National Disease-specific Strategies for HIV, TB and malaria, and, if
necessary, take steps to strengthen them.
•
They can identify programmatic and funding gaps in these strategies.
They could organize joint reviews of their strategies (e.g. Joint
Assessment of National Strategies (JANS)), if needed.
•
As an alternative, they can develop an investment case to be included in
the Concept Note.
•
CCMs can review eligibility requirements for themselves and the
Global Fund’s Minimum Standards for PRs, to assess potential issues
and make any necessary improvements before 2014.
Despite tight timelines, there has been
significant progress to date
• All 50 CCMs accepted the invitation to participate in the NFM
•
Three early applicants - El Salvador, Myanmar and Zimbabwe - have
submitted their Concept Notes and aim to sign grants by June Board
•
•
•
•
Another three - DRC, Philippines and the Mekong Artemisinin
Resistance Initiative - aim to complete Concept Notes by October
•
•
Country dialogue was well received and considered a significant improvement
Simpler Concept Note said to focus CCMs on strategic areas to drive impact
Greater work needed on the budget and performance reporting tool
Learnings from the first early applicants will improve the NFM process
Interim applicants are moving forward rapidly to access funding
•
•
One country – Pakistan – submitted its funding request in March
Five countries planning to submit funding requests in May
Investing for Impact
Global Fund results and impact
Contents
1. Update on results in numbers
2. Coverage and Impact
3. Challenge and Opportunity
4. Impact evaluation plan
Rapid increase in results
Millions
4.2 mil
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
-
New smear-positive TB cases
detected and treated
9.7 mil
12
10
8
6
1.4 mil
2.9 mil
4
2
-
2006
Millions
Thousands
People currently on ART
2007
2008
2009
2010
2011
2012
2006
2007
2008
2009
2010
2011
Nets distributed (ITNs & LLINs)
310 mil
350
300
250
(Reported numbers from
GF supported programmes)
200
150
46 mil
100
50
2006
2007
2008
2009
2010
2011
2012
2012
Coverage of key interventions
% ART coverage (SSA)
60
56
50
40
30
20
5
10
0
2000
2011
%
80
60
40
60
50
40
30
20
10
0
%
ITN coverage (SSA)
53
3
2000
TB detected (World)
67
43
20
0
2002
2011
2011
ART Coverage
2009
2011
Legend
ART_africa
2009Covera
no data/not in Sub-Saharan Africa
<20%
20-49%
50-79%
80%+
People on ART : 310,000 (2004)  3.8 mil (2009)  6.1 mil (2011)
ART coverage :
N/A (2004)  41 % (2009)  56 % (2011)
Source: UNAIDS 2012
18
ITN Coverage
2002
2006
2011
Average coverage increased: 3% (2000)  53% (2011)
Source: WHO 2012
Malaria prevalence in Tanzania
2008
Tanzania
2012
Malaria Prevalence (%)
0-9
10 - 19
20 - 29
30 - 49
Every week 500 children
saved from malaria deaths
Coverage supported by
Decreasing unit
costs
600
TDF + FTC + EFV
Domestic financing in 3 diseases
in GF eligible countries
TDF + FTC + NVP
9
AZT + 3TC + EFV
Price per patient per year (US$)
500
Domestic investment (US$ billions)
AZT + 3TC + NVP
d4T+ 3TC +NVP
400
d4T+3TC+EVF
300
200
100
8.10
8
7.04
7
6
5
4.35
6.00
6.24
2008
2009
4.80
4
3
2
1
0
0
2007
2008
2009
2010
2011
2012
2006
2007
2010
2011
Estimated costs of common First Line
Adult Anti-Retroviral Regimens
Source: Global Fund Price & Quality Reporting System
Source: UNAIDS, Stop TB, GMP
21
Challenge and opportunity to maintain
and invest in increased coverage
• Major challenge : to maintain coverage
– e.g.) Malaria cases have rapidly increased when
Zambia and Rwanda faced a funding gap.
• Major opportunity : multiplier effects when
achieving universal access
– e.g.) Rwanda and Ethiopia achieving universal
access show great impact on MDG 4,5 and 6,
and potential to control 3 diseases epidemics.
Health/Community system
strengthening (HCSS)
Challenge and opportunity to fight 3
diseases
GF HSS funding (TRP-recommended )
• Amount of funding: USD 2.4 billion
• Number of proposals funded: 107
• Number of Countries: 69
Example: Ethiopia – 20% towards HSS
Out of total disbursements 1.2 billion (2003-2012)
HIV
Immunizati
on
TB
Malaria
0%
76%
Reduced mortality
54%
82%
ANC
51%
Health
coverage
92%
77%
72%
TB
55%
40%
60%
80%
100%
Increased coverage
Reduced mortality
2005
6%
20%
-40%
-49%
Maternal Mortality
(MDG 5)
0%
2011
56%
0%
-40%
Child Mortality
(MDG 4)
4%
ART
-32%
-60%
49%
ITN
-20%
-22%
-20%
-40%
-60%
-47%
MDG Impact
Evaluation plan
• Program review with partners in high impact
countries to assess impact and others
• Data quality assessment
• Thematic review on cross-cutting issues like
MDG 4&5, fragile states
• Synthesis report of GF on results for mid-term
and end-term of the new strategy 2012-16
Impact reviews and Inputs to grants
Country/
Disease
Cambodia/TB
- TB prevalence reduced by
43%, but mainly among young
adults
- Funding beyond 2013
uncertain
- Decreased morbidity and
mortality
Myanmar/Malaria
- Inaccessible areas
- Major risk of artemisinin
resistance
- Increase in HIV prevalence
Uganda/HIV
Grant Recommendations
Key Findings
- Inadequate prevention
- Moderate ART and PMTCT
coverage
-
Scale up routine contact
investigation among elderly
and children
- Increase government
contribution, improve
efficiencies and cost savings,
and expand TB/ HIV
- Target hard-to-reach townships
collaboration
while maintaining nation-wide
intervention efforts
- Strengthen drug resistance
monitor and encourage regional
approach to counter artemisinin
resistance
- Strengthen targeted
combination prevention
approaches
- Prioritize quality and coverage
of ART and PMTCT programs
Conclusions
• Rapid increase in access to key services,
especially last five years
• Improved coverage of key interventions
– Challenge to sustain coverage of key interventions
– Returns of impact if reach universal access
• Impact evaluation plan: underway and
contributing to focus on impact in grants