Global Fund HIV Proposal
Development for Key Population
Proposals and for the Targeted Pool in
Round 11
TOOLKIT
UNAIDS
2011
Version 1
1|Page
Table of Contents
Acknowledgements .......................................................................................................... 7
1.
Acronyms and Abbreviations ..................................................................................... 8
2. Introduction ............................................................................................................... 10
2.1 How to Use this Guide ................................................................................................................ 12
3. Stages in Global Fund Targeted Pool Proposal Development ....................................... 13
3.1 Flowchart outlining the stages in proposal development .......................................................... 13
3.2 STAGE 1: Prepare for proposal development ............................................................................. 13
3.3 STAGE 2: Determine the focus of the proposal .......................................................................... 14
3.4 STAGE 3: Solicit and review submissions for possible inclusion in the proposal ........................ 15
3.5 STAGE 4: Develop a proposal framework ................................................................................... 15
3.6 STAGE 5: Develop indicators and establish targets .................................................................... 15
3.7 STAGE 6: Build consensus and obtain concept approval ............................................................ 16
3.8 STAGE 7: Draft proposal .............................................................................................................. 16
3.9 STAGE 8: Obtain CCM endorsement ........................................................................................... 16
3.9 STAGE 9: Submit final proposal to the Global Fund.................................................................... 17
4. Round 11 Call for Proposals ........................................................................................ 18
4.1 Making the decision to apply ...................................................................................................... 18
4.2 New Global Fund architecture .................................................................................................... 18
4.3 Global Fund guidelines and fact sheets ...................................................................................... 19
5. Strengthening Targeted Pool Proposals to the Global Fund ......................................... 20
5.1 Development, preparation and management of MARPs-related proposals .............................. 20
6
5.2
Summary of recommended actions for Targeted Pool proposals ........................................ 20
5.3
Resources and reference guides ........................................................................................... 21
Resources and Tools to Strengthen MARPs-Related Proposals.................................. 22
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6.1 Action Point 1: Document expertise and experience of those contributing to the proposal in
working with the key affected populations targeted in the proposal, including CCM members, staff
of participating PRs and SRs, and consultants and advisers. ............................................................ 22
6.2
Reference guides................................................................................................................... 23
6.3
Checklist for documenting in line with Action Point 1.......................................................... 24
6.4
Examples of how countries have effectively documented in line with Action Point 1 in
Round 10 MARPs proposals .............................................................................................................. 27
7
Principal Recipient and Sub-Recipient selection ....................................................... 28
7.2
8
Resource and reference guides ............................................................................................ 28
Situational, Response and Gap Analysis ................................................................... 29
8.1 Action Point 2: Compile and cite quantitative and qualitative data to specify target key
affected populations ......................................................................................................................... 29
8.2 Action Point 3: Compile and cite quantitative and qualitative data to specify HIV burden and
impact in target populations............................................................................................................. 34
8.3 Action Point 4: Compile and cite quantitative and qualitative data to define, for target
populations, the current baseline coverage of HIV interventions, the target coverage, and plans,
indicators, and capacity to achieve, monitor, and evaluate progress and results ........................... 38
8.4 Action Point 5: Compile and cite indicators of existing human rights environments for the
target key affected populations, and plans, indicators, and capacity to improve these
environments. ................................................................................................................................... 40
8.5
Examples of how countries have effectively documented in line with Action Point 5 in
Round 10 MARPs proposals .............................................................................................................. 41
9 Proposed Interventions and Groups ............................................................................. 41
9.1 Defining the combination of HIV interventions .......................................................................... 41
9.2 Action Point 6: Define an appropriate combination of HIV interventions for the target
populations, building from global guidelines and local practice. ..................................................... 42
9.3 Examples of how countries have effectively documented in line with Action Point 6 in Round
10 MARPs proposals ......................................................................................................................... 45
10 Monitoring and Evaluation......................................................................................... 47
11 Financial Gap Analysis, Budgets and Procurement and Supply Management .............. 48
11.1 Costing and budgeting for each HIV intervention .................................................................... 48
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11.2 Action Point 7: For each planned programme intervention, calculate costs and a budget that
will achieve sufficient quality, coordination, reach and scale to achieve an impact on HIV in the
target population. ............................................................................................................................. 49
11.3 Examples of how countries have effectively documented in line with Action Point 7 in Round
10 MARPs proposals ......................................................................................................................... 49
11.4 Demonstrating value for money in Global Fund proposals ...................................................... 51
11.5 Action Point 8: Cite qualitative and quantitative data to demonstrate value for money ........ 55
11.6 Justifying budget item amounts and allocations ...................................................................... 56
11.7 Action Point 9: Provide adequate justification for costs, particularly where certain activities
have been allocated large proportions of the budget ...................................................................... 56
12 Stronger tools for measuring results in light of Round 11 ............................................ 58
12.1 Action Point 10: Define appropriate measures for quality, outcomes and impact of
interventions ..................................................................................................................................... 59
12.2 Examples from three Round 10 proposals highlight how measures for quality, outcome and
impact of interventions can be addressed. ...................................................................................... 60
13 Providing greater contextual data on MARPs for Round 11 ......................................... 62
13.1 Action Point 11. Compile and cite evidence to support selection of target populations, and
goals, objectives, and activities of the proposal strategy ................................................................. 62
13.2 Examples from Round 10 proposals highlight how using evidence to support proposal content
can be addressed. ............................................................................................................................. 62
14 Guarantee that actions harmonize with aims and objectives ...................................... 64
14.1 Action Point 12: Ensure that activities reflect goals and objectives of the programme .......... 64
14.2 Examples from Round 10 proposals highlight how activities can appropriately reflect
programme goals and objectives. ..................................................................................................... 64
15 Showing that plan will enhance, not duplicate, previous grants .................................. 66
15.1 Demonstrate the synergies and complementarity of the proposed program with any previous
Global Fund grants ............................................................................................................................ 66
15.2 Examples from Round 10 proposals highlight how synergies and complementarity between
proposed programme with any previous Global Fund grants can be demonstrated ...................... 66
16 Cross-Cutting Issues ................................................................................................... 68
16.1 Health-System Strengthening ................................................................................................... 68
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16.2 Civil Society Strengthening ....................................................................................................... 68
16.3 Gender ...................................................................................................................................... 68
16.4 TB/HIV ....................................................................................................................................... 68
16.6. Private Sector ........................................................................................................................... 69
16.7 Greater Involvement of People living with HIV/AIDS ............................................................... 69
16.8 HIV/AIDS and the Media ........................................................................................................... 69
16.9 Human Rights Approaches ........................................................................................................ 69
17 Annex ........................................................................................................................ 70
17.1 Glossary of Key Terminology Used in HIV/AIDS Programming ................................................. 70
17.2 HIV/AIDS programming terminology ........................................................................................ 70
17.3 Terminology specific to Global Fund programmes ................................................................... 74
17.4 Monitoring and Evaluation terminology ................................................................................... 80
17.5 Other glossaries ........................................................................................................................ 82
17.6 References used in this glossary: .............................................................................................. 82
18 Appendices ................................................................................................................ 85
18.1 Appendix 1A .............................................................................................................................. 85
18.2 Appendix 1B .............................................................................................................................. 86
18.3 Appendix 2A .............................................................................................................................. 87
18.4 Appendix 2B .............................................................................................................................. 89
18.5 Appendix 2C .............................................................................................................................. 91
18.6 Appendix 3A .............................................................................................................................. 93
18.7 Appendix 3B .............................................................................................................................. 95
18.8 Appendix 4A .............................................................................................................................. 98
18.9 Appendix 4B ............................................................................................................................ 100
18.10 Appendix 4C .......................................................................................................................... 102
18.11 Appendix 4D .......................................................................................................................... 103
18.12 Appendix 5A .......................................................................................................................... 106
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18.13 Appendix 5B .......................................................................................................................... 109
18.14 Appendix 6A .......................................................................................................................... 113
18.15 Appendix 6B .......................................................................................................................... 114
18.6 Appendix 6C ............................................................................................................................ 115
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Acknowledgements
This toolkit was developed by AIDS Projects Management Group (APMG) with funds and technical
support provided by UNAIDS.
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1. Acronyms and Abbreviations
AIDS
Acquired Immune Deficiency Syndrome
APCASO
Asia-Pacific Council of AIDS Service Organisations
APN+
Asia-Pacific Network of People Living with HIV/AIDS
APNSW
Asia-Pacific Network of Sex Workers
AusAID
Australian Government Overseas Aid Programme
CCM
Country Coordinating Mechanism
CSS
Community Systems Strengthening
CSW
Commercial Sex Work/er
GF
Global Fund to fight AIDS, Tuberculosis and Malaria
HARPAS
UNDP HIV/AIDS Regional Programme in the Arab States
HBV
Hepatitis B Virus
HCV
Hepatitis C Virus
HIV
Human Immunodeficiency Virus
ICASO
International Council of AIDS Service Organizations
IDU
Injecting Drug User
FHI
Family Health International
M&E
Monitoring and Evaluation
MARPs
Most-At-Risk Populations
MENA
Middle East and North Africa
MSM
Men who have sex with men
NSF
National Strategic Framework
OHCHR
Office of the United Nations High Commissioner for Human Rights
PEPFAR
The United States’ President’s Emergency Plan for AIDS Relief
PLHIV
People Living with HIV
PLRI
Paulo Longo Research Initiative
PR
Principal Recipient
PSE
Population Size Estimation
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PSI
Population Services International
PSM
Procurement and Supply Management
SR
Sub-Recipient
TB
Tuberculosis
TERG
Technical Evaluation Reference Group (Global Fund)
TRP
Technical Review Panel (Global Fund)
UNAIDS
The Joint United Nations Programme on HIV/AIDS
WHO
World Health Organisation
UNFPA
United Nations Population Fund
UNDP
United Nations Development Programme
UNODC
United Nations Office on Drugs and Crime
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2. Introduction
This toolkit is designed to assist countries to prepare HIV proposals for the Targeted Pool in Round
11, and will also be useful to countries preparing HIV proposals for the General Pool in which
activities for key affected populations form part of the proposal.
In its Round 10 Call for Proposals, The Global Fund to Fight AIDS Tuberculosis and Malaria (the
Global Fund) established a separate funding reserve for proposals addressing HIV among Most-AtRisk Populations (MARPs). However, Global Fund HIV proposals have, in the past, often neglected to
prioritise key affected populations. (UNDP [2011]. Analysis of key human rights programmes in
Global Fund-supported HIV programmes, PDF (Eng).
This toolkit refers to MARPs instead as ‘key populations’, defined as communities of subpopulations
that are key to the dynamics of a country’s epidemic. These have HIV-prevalence rates that are
higher than those in the general population. Key populations often comprise, but are not limited to:
sex workers, men who have sex with men, people who use drugs, and transgender people.
Four valuable UN policy documents on key populations are:
 UNAIDS (2009). Action Framework: Universal Access for Men Who Have Sex with Men
and Transgender People,
 UNAIDS (2009). Guidance Note on HIV and Sex Work, and,
 WHO, UNODC, UNAIDS (2009). Technical Guide for countries to set targets for
universal access to HIV, prevention, treatment and care for injecting drug users.
The UNODC also recommends that men and women in closed settings be included in the definition
of key affected populations and draws attention to the fact that Global Fund proposals have also
neglected to focus on this subpopulation in previous rounds.1 UNAIDS policy documents central to
this key affected population include:
 UNODC, WHO, UNAIDS (2006). HIV/AIDS Prevention, Care, Treatment and Support in
Prison Settings: A Framework for an Effective National Response (PDF), and,
 UNODC, WHO, UNAIDS (2009). HIV testing and counselling in prisons and other closed
settings: technical paper (PDF)
Please note that as per the new eligibility criteria of the Global Fund, applicants may need to focus
their proposals on ‘specific populations’. The Fund defines ‘specific populations’ as “underserved
1
“Thirty million men and women [are] at risk for HIV every year in closed settings … In nearly all countries HIV prevalence
in closed settings is particularly high, and higher than in the community, causing serious challenges to governments, nongovernmental and international organisations.” UNODC web page.
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and most-at-risk populations within a defined and recognized epidemiological context that have
significantly higher levels of risk, mortality and/or morbidity, AND whose access to, or uptake of,
relevant services is significantly lower than the rest of the populations”. The key populations
referred to in this toolkit, depending on the country epidemic and context, may indeed fall under the
category of ‘specific populations’ for HIV. However, it is important to recognize that ‘specific
populations’ are not limited to the subpopulations of sex workers, men who have sex with men,
people who use drugs, or transgender people. Specific populations, in the context of HIV, may also
comprise, for example, women, young people and refugees. Applicants, depending on their country
epidemic and context, must thus make sure to identify the appropriate specific populations based on
the Global Fund’s guidelines.
For HIV, MARPs proposals will continue to be accepted by the Global Fund in Round 11 as part of a
Targeted Pool. Increasingly, all countries addressing HIV are being encouraged to check the situation
among MARPs and, if necessary, seek funding to address HIV among MARPs.
In Round 11, applicants must submit consolidated proposals either to (1) a general pool for any
proposal, or (2) a targeted pool for proposals focusing on specific populations or interventions.
Several changes have been introduced to the Round 11 proposal forms to take into account the new
policies of the Global Fund. Recent field testing of the HIV forms2 suggests that these are improved,
well structured, and easy to follow. However, respondents were unclear on the meaning of some
language in the forms, how to address certain sections when data is lacking, and how to populate
the two new tables on ‘priority interventions’ and ‘discontinued activities’.
The new policies applied to Round 11 suggest that more MARPs-focused proposals may be
submitted, and that applicants may require guidance in determining how to complement and build
upon existing Global Fund grants in light of the obligation to submit consolidated grant proposals.
Most-at-risk populations are defined as those already engaging in high risk behaviours such as
clients of sex workers, those having unprotected anal sex with multiple partners and/or injecting
drug use with non-sterile equipment. Key populations include male and female people who use
drugs with non-sterile injecting equipment; men who have unprotected sex with other men; and
adult women, men and transgender people involved in sex work.
Subpopulations of MARPs include Most-at-risk adolescents (MARA) and young people (MARYP)
including young male and female who use non-sterile injecting equipment, young males who have
unprotected sex with other males (MSM), and young people who sell sex. All young people under
the age of 18 years involved in sex work are victims of commercial sexual exploitation.3 MARA and
MARYP may not fit into the adult categories of MARPs: some with risk behaviours are not identified
as MSM, IDUs or sex workers and are therefore not included in surveys of risk behaviour. Equally,
services established for MARPs may not be able, for practical, legal and other reasons to reach
MARA and MARYP.
2
Carried out by APMG for the Global Fund Secretariat: report is currently not available for distribution.
UNAIDS Guidance Note on HIV and Sex Work 2009 affirms that all forms of the involvement of children
(defined as people under the age of 18) in sex work and other forms of sexual exploitation or abuse contravenes United
Nations conventions and international human rights law.
3The
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2.1 How to Use this Guide
This toolkit provides guidance on planning for and developing Global Fund HIV proposals
which partially or entirely target key affected populations. It is a resource designed for use
by all individuals involved in writing proposals for the general or the targeted funding pools,
since even applicants to the general pool may need to, depending on national income, focus
their proposals or “special groups” which also comprise key affected populations.
The toolkit is divided into five main topic areas:
1. Stages in proposal development: a flowchart which outlines the steps to be followed
when developing an HIV proposal for the Global Fund. This is followed by a list of
specific actions and considerations to be taken under each step of proposal
development.
2. Applying for Round 11: this section builds on the previous section to highlight
important factors and actions which must be taken into account when taking the
decision to submit an HIV proposal to the Global Fund. It also provides all the
relevant Global Fund guidance (guidelines, information notes and other documents)
for Round 11.
3. A recommended series of 13 action points, which if documented or implemented, will
help to strengthen HIV proposals targeting key affected populations. The action
points have been developed based on the criteria which the Global Fund’s Technical
Review Panel judges proposals and feedback from the Panel on developing strong
proposals.
4. A collection of tools and resources which will help to document or implement each
action point, along with examples from Round 10 proposals of how applicants have
effectively documented each action point listed in this toolkit.
5. A glossary of key terms: this provides definitions of terms used in HIV and Global Fund
programming. Annex A.
It is important to note that this toolkit is a resource to be used when developing Global Fund
proposals only, it does not provide guidance on how to design or implement national
programmes for key affected populations. Applicants must also make sure to thoroughly
read guidelines and information notes issued by the Global Fund.
This guide is best used as an online tool. UNAIDS have asked APMG to upload the Toolkit at
our website as an interim measure.
There are plans to eventually establish a UNAIDS Global Fund Information Portal to provide
countries with access to a range of information - including resources, tools, references
guides and case studies/examples of best practice, possibly divided up by regions - to assist
in the development, implementation and monitoring/evaluation of GF proposals and funded
programmes. The portal will be regularly updated and additional resources and tools will be
added as they become available.
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3. Stages in Global Fund Targeted Pool Proposal Development
This is an overview of the stages in the development of a Global Fund Targeted Pool proposal. The
materials were developed by the Aids Project Management Group (APMG), and are based on Global
Fund and AIDSPAN guides. The flowchart below describes the entire proposal development process,
while those following describe each step in detail.
This resource has been developed as a guide for Global Fund applicants. It must be recognised that
the actual process may differ depending on the context within each country. Applicants must make
sure they thoroughly read the guidelines issued by the Global Fund for the given Round.
Flowchart outlining the stages in proposal development
3.2 STAGE 1: Prepare for proposal development
Decide on type of proposal
•
•
•
New proposal or a resubmission?
For the general pool or the targeted pool?
Take into account:
o Weaknesses and strengths of previous proposals submitted.
o Status and performance of current Global Fund programmes being implemented, (if
any).
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o
o
Global Fund country eligibility criteria.
Criteria for each funding pool.
Hold a stakeholder forum
•
•
•
•
Enlist broad stakeholder participation in the proposal development process.
Share information on proposal requirements and Global Fund criteria.
Solicit initial inputs or ideas.
Take into account or ensure:
o Global Fund CCM eligibility criteria are related to broad stakeholder participation.
o Participation of key affected populations that will be targeted in the proposal.
o Clear documentation of the process (e.g., through meeting minutes).
Establish structures for managing the process
•
•
•
•
Establish a coordination team and specialist teams (e.g., programme, M&E, budget, PSM).
Identify technical assistance requirements.
Create a work timetable.
Take into account:
o Resources required, and how these will be funded.
o How external resource persons will be identified and selected.
o Timelines.
o Expertise of people assigned to various teams.
o Participation of key affected populations that will be targeted in the proposal.
o Participation of service providers and service users in proposal development.
Commence the process of selection of the principa l and sub-recipient(s)
•
Take into account:
o Global Fund CCM eligibility criteria regarding selection of PRs and SRs.
o Global Fund policy on dual-track financing.
o New Global Fund policies on grant consolidation and consolidated proposals.
3.3 STAGE 2: Determine the focus of the proposal
Conduct a situational, response and gap (SRG) analysis
•
•
•
Prepare a situational overview of the HIV epidemic, which provides epidemiological and
demographic information, and a snapshot of the cultural, social and legal situation related to
HIV.
Analyse the response to the HIV epidemic, looking at: (1) programmes or initiatives
addressing HIV prevention, treatment and care; (2) broader programmes addressing
vulnerability factors and cross-cutting issues such as health-systems strengthening, CSO
strengthening, gender dynamics; and (3) HIV strategic and M&E plans, legislation,
frameworks, guidelines and policies within the country (4) local /municipal level variations
Based on the situational overview and the response analysis, determine where the gaps are
in the response. What is working and needs to be continued or expanded?
o What is not working and needs to be adapted?
o What is irrelevant and should be dropped?
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o
What has not been addressed at all?
Based on SRG analyses, identify the focus areas of the proposal
•
Take into account:
o Global Fund CCM eligibility criteria on ensuring broad stakeholder participation and
transparency throughout the proposal development process.
o ’Participation of key affected populations that will be targeted in the proposal.
o Participation of service providers and service users in proposal development.
o National HIV strategy/plan.
o Interventions proven to be effective and appropriate when targeting key affected
populations, based on global guidelines or local experience.
3.4 STAGE 3: Solicit and review submissions for possible inclusion in the proposal
Identify and implement a process for soliciting submissions from different
stakeholders
•
Consider:
o Global Fund CCM eligibility criterion on the process for soliciting and reviewing
submissions.
o Methods and process by which a call for submissions will be issued.
o Whether predefined criteria will be developed regarding content and review of
submissions.
Review proposals based on focus areas identified in the previous ste p and any
other criteria
•
Consider:
o Global Fund CCM eligibility criterion on the process for soliciting and reviewing
submissions.
o Representation of different sectors on the committee reviewing submission.
o Criteria by which submissions will be reviewed.
o Are there any conflicts of interest?
3.5 STAGE 4: Develop a proposal framework
•
•
•
•
•
Based on eligible submissions, develop a proposal framework outlining activities,
stakeholders/partners, time frames, inputs required and sub-recipients where possible.
Agree on Proposal Budget Range.
Finalize draft unit costing template.
Draft Acronyms and Abbreviations.
Ensure or take into account:
o
o
o
o
Activities reflect overall goals and objectives of the proposal.
Value for money.
Issues such as gender equality, equity, addressing stigma and reduction.
Global Fund counterpart financing criteria.
3.6 STAGE 5: Develop indicators and establish targets
•
Identify impact, outcome/coverage, process, and output indicators and targets.
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•
•
•
Develop draft Attachment A.
Develop draft work plan.
Ensure or consider:
o
o
o
o
Impact and outcome indicators are identified where relevant.
Sources of data for measuring indicators are also identified.
Consistency across different documents.
Using population size estimation methods and calculations, and data triangulation
where required.
3.7 STAGE 6: Build consensus and obtain concept approval
•
•
•
•
Present proposal framework and draft work plans to various stakeholders - for example, at a
single forum, through a series of sector meetings, or other means.
Build a consensus amongst stakeholders to obtain agreement on proposal content.
Get endorsement of the proposal framework from the CCM.
Ensure or take into account:
o
o
o
Wide stakeholder participation.
Clear process documentation (such as in meeting minutes).
Maintaining regular communication.
3.8 STAGE 7: Draft proposal
•
•
•
•
•
•
•
•
•
Establish coordinated team processes.
Assign proposal components to specialist teams.
Review work plan and time frames.
Monitor and track progress.
Hold regular feedback and input sessions.
Share draft proposal with key stakeholders.
Review and update proposal.
Final proof and coherence check.
Consider and ensure:
o
o
o
o
o
Identifying sections that can be drafted early on, and those that can only be
developed at later stages.
Expertise required within proposal writing team.
Maintaining regular communication.
Process is clearly documented (such as in meeting minutes).
Wide stakeholder participation, including key affected populations and service
providers.
3.9 STAGE 8: Obtain CCM endorsement
•
•
•
•
•
•
Present draft proposal to the CCM.
Send draft to CCM members for review.
Amend proposal if required.
Resubmit revised proposal to the CCM for endorsement.
Obtain the necessary CCM member signatures.
Consider:
o
o
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Maintaining regular communication.
Clearly documenting the process (such as in meeting minutes, e-mail records).
3.9 STAGE 9: Submit final proposal to the Global Fund
•
•
•
•
•
•
Final proofread.
Prepare all attachments.
Prepare electronic package.
Complete proposal and attachment checklists.
Submit proposal before deadline.
Consider:
o
o
o
All relevant sections have been filled.
All documentation has been provided.
Global Fund eligibility criteria have been met.
References
Garmaise, D. and Greenall, M. (June 2011). The AIDSPAN Guide to Round 11 Applications to the
Global Fund. Volume 1: Getting a Head Start. AIDSPAN. Available online.
Global Fund to Fight AIDS, Tuberculosis and Malaria. Round 10 Guidelines. Available online.
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4. Round 11 Call for Proposals
On 15 August 2011 the Global Fund released the Call for Proposals for submissions to Round
11 of the Global Fund.
Round 11 Application Package and Guidelines can be downloaded here
CCMs considering applying to Round 11 should take note of the special arrangements for
Round 11 and further information is available above.
For Round 11, countries will also be required to determine whether they are eligible to
apply to a new Targeted Pool.
4.1 Making the decision to apply
A decision to submit for the Round 11 call, and if deciding to, to which stream should be
based on the following issues:
 Does the Country clearly meet the CCM Minimum requirements and have the
evidence to back up the eligibility
 Does the Country have a current and ongoing National Strategic Framework with
detailed costed implementation and M&E Plan
 Has the Country clearly identified the current response and gaps in programming for
the NSF
 Has the Country clearly identified and costed its technical support needs
 Is there sufficient strategic information, including surveillance data to provide an
understanding of the HIV context in country and provide baseline information for the
performance framework
 Is there a clear Government and country commitment to working with most at risk
and marginalised populations including sex workers, injecting drug users, men who
have sex with men, prisoners, refugees, etc
 Has the Country considered the new prioritisation levels for Round 11 and
implications on the funding
 Existing HIV funding availability to sustain the key priorities for the response.
4.2 New Global Fund architecture
Global Fund representatives at the workshop provided presentations on new Global Fund
Architecture recently approved by the Global Fund Board which will impact on:




How countries apply for funding
How the financing is structures
How performance management is conducted; and
How decisions are made about future funding.
Additional information regarding the new the Global Fund architecture is available through
the links below.
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 New GF Grant Architecture Website
»
»
»
»
Architecture High Level Concept Note
Fact Sheet for Implementers
Board Decision Point on Architecture Transition
Frequently Asked Questions
4.3 Global Fund guidelines and fact sheets
Specific fact sheets that should be read for Key Affected Population-related proposals
include:
»
»
»
»
Most common weaknesses identified by the TRP in Round 10:
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23344
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24885
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24886
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24883
»
»
»
»
Community systems strengthening:
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=15216
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24025
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23165
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24026
»
»
»
»
Harm reduction
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23083
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23297
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23346
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23345
»
»
»
»
Addressing sex work, MSM and transgender people in the context of the HIV epidemic
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=15214
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23302
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23168
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24454
»
»
»
»
Strengthening implementation capacity
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=22403
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24555
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23169
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24888
»
»
»
»
Addressing women, girls and gender equality
English: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23084
Spanish: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24876
French: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=23281
Russian: http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=24923
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5. Strengthening Targeted Pool Proposals to the Global Fund
5.1 Development, preparation and management of Targeted Pool proposals
Decisions by Country Coordination Mechanisms (CCMs) and stakeholders to submit
applications to the Global Fund should not be taken lightly. In determining whether an
application should be submitted, CCMs should take into account a range of issues including:





The availability of a broad range of strategic information to guide the
development of the proposal interventions;
Whether there are current national strategic plans, costed implementation plans,
M&E plans and systems for monitoring the response;
Preparedness in country to address the needs of most at risk and vulnerable
populations from a rights based approach;
Clear capacity to meet the Global Fund Guidelines including CCM minimum
standards and demonstrated capacities for the identified PRs and SRs; and
The required technical and programmatic capacities or ability to bring in the
required technical assistance to support the proposal development.
5.2 Summary of recommended actions for Targeted Pool proposals
Action 1: Document expertise and experience of those contributing to the proposal in working
with key affected populations targeted in the proposal, including CCM members, staff of
participating PRs and SRs, and consultants and advisors.
Action 2: Compile and cite quantitative and qualitative data to specify target key affected
populations.
Action 3: Compile and cite quantitative and qualitative data to specify HIV burden and impact
in target populations.
Action 4: Compile and cite quantitative and qualitative data to define, for target populations,
the current baseline coverage of HIV interventions, the target coverage, and plans, indicators,
and capacity to achieve, monitor, and evaluate progress and results.
Action 5: Compile and cite indicators of existing human rights environments for the target key
affected populations, and plans, indicators, and capacity to improve these environments.
Action 6: Define an appropriate combination of HIV interventions for the target key affected
populations, building from global guidelines and local practice.
Action 7: For each planned programme intervention, calculate costs and a budget that will
achieve sufficient quality, coordination, reach, and scale to achieve an impact on HIV in the
target population.
Action 8: Compile and cite qualitative and quantitative data to demonstrate value for money
Action 9: Provide adequate justification for costs, particularly where certain activities have
been allocated large proportions of the budget, and
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Action 10: Define appropriate measures for quality, outcomes and impact of interventions
Action 11: Compile and cite evidence to support selection of target populations, and goals,
objectives, and activities of the proposal strategy,
Action 12: Ensure that activities reflect goals and objectives of the programme,
Action 13: Demonstrate the synergies and complementarity of the proposed programme with
any previous Global Fund grants
It is vital to ensure that representatives of key affected populations are involved in CCMs,
and in Planning, Implementation and Monitoring activities related to key affected
populations.
A range of resources and tools are available to support region countries to develop
proposals focusing entirely or partly on specific key affected populations.
5.3 Resources and reference guides
Planning Global Fund proposal submissions



Aidspan (2010). Guide to Round 11 Applications to the Global Fund – Volume 1:
Getting a Head Start
Euro Health Group (2006). Assessment of the Proposal Development and Review
Process of the Global Fund to Fight AIDS, Tuberculosis and Malaria: Assessment
Report – Euro Health (2006)
Aidspan (2009). A Beginner’s Guide to the Global Fund – AIDSPAN (2009)
Stages to Global Fund Proposal Development (UNAIDS Workshop, Cairo, 2010)
Technical Assistance Planning
 UNAIDS (2009). Guidance Note on Technical Support Planning at the Country Level
- Coordinating and managing technical support



Global Fund Applicant Information Notes
UNAIDS Technical Support Facilities
Tools and templates

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Proposal Development Timeline Tool
6 Resources and Tools to Strengthen Targeted Pool Proposals
Country Coordinating Mechanisms
Any Global Fund proposal should be based on broad consultation among key stakeholders engaged
in implementing HIV-related programmes. Consultation is done to assure alignment with perceived
needs and existing programmes, to avoid duplication, and to maximize synergy among the national
and regional programmes working on HIV. With regard to HIV programmes addressing the needs of
people who use drugs, men who have sex with me and sex workers, it is particularly important that
proposals document efforts to draw on local experience and expertise related to the health and
rights of these populations, including from people with field-based experience in sexual-health and
drug-treatment services and rights-based interventions.
6.1 Action Point 1: Document expertise and experience of those contributing to
the proposal in working with the key affected populations targeted in the proposal,
including CCM members, staff of participating PRs and SRs, and consultants and
advisers.
Organisations to identify additional advocates and stakeholders in your
country
Female, male and transgender sex workers
 Network of Sex Work Projects (NSWP) with presence in 40 countries – www.nswp.org




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




APNSW – www.apnswdollhouse.wordpress.com
TAMPEP – www.tampep.eu
SWAN – www.swannet.org
ICRSE – www.sexworkeurope.org
ASWA – www.africansexworkeralliance.org
RedTraSex – www.redtrasex.org.ar
RedLACTRans – www.redlactrans.org.ar
Latin America Sex Worker Union – http://www.nswp.org/members/latin-america
Caribbean Sex Work Coalition at www.nswp.org
Francophone NSWP Africa – www.nswp.org
African Men for Sexual Health and Rights (AMSHeR): www.amsher.org
Then there are sex work advocates:
 Open Society Foundation – Sexual Health and Rights Project (SHARP)
 Paulo Longo Research Initiative www.plri.org
MSM

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Global Forum on MSM & HIV (MSMGF) - www.msmandhiv.org



APCOM – the Asia-Pacific Coalition on Male Sexual Health – www.msmasia.org
ASICAL –a Latin American MSM-focused coalition – www.asical.org/
Behind the Mask - African LGBTI communication initiative - www.mask.org.za
People who use drugs
 Open Society Institute Global Drug Policy Programme http://www.soros.org/initiatives/drugpolicy
 International Harm Reduction Development Programme http://www.soros.org/initiatives/health/focus/ihrd
 International Network of People who Use Drugs (INPUD)
 International Harm Reduction Association: http://www.ihra.net/
 Law Enforcement and Harm Reduction Network: http://www.leahrn.org/
 Eurasian Harm Reduction Network: http://www.harm-reduction.org/
 European Harm Reduction Network: http://www.EuroHRN.eu
 Intercambios Civil Association: http://www.intercambios.org.ar/english/marco.htm
 Caribbean Harm Reduction Coalition:
http://www.caribbeanharmreductioncoalition.htmlplanet.com/
 Asian Harm Reduction Network: http://www.ahrn.net/
 Middle East and North Africa Harm Reduction Network (MENAHRA):
http://www.menahra.org/
Men and women in closed settings
 African HIV in Prisons Partnership Network: www.ahppn.com
 The Monitoring Centre – Observatorio VIH y Cárceles de Latinoamérica y el Caribe
All key affected populations
 Global Network of People Living with HIV: http://www.gnpplus.net/
 CVC – Caribbean Vulnerable Communities Coalition: www.cvccoalition.org
6.2 Reference guides









GF Round 11 Guidelines and Requirements for Country Coordinating Mechanisms
GF Important Notice to all Round 11 Applicants: CCM Eligibility
GF Round 11 Minimum Requirements page
GF Clarifications on CCM Minimum Requirements
GF Guidance Note: CCM Requirements Issued in: June 2011
GF CCM Eligibility for Grants
GF Guidance Paper on CCM Oversight
UNAIDS (August 2011). Guidelines for M&E of HIV Programmes for Sex Workers,
Men Who Have Sex with Men, and Transgender People
WHO (2011). Prevention and treatment of HIV and other sexually transmitted
infections among men who have sex with men and transgender people:
Recommendations for a public health approach. Website PDF
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








Aidspan (2007). Guide to Building and Running an Effective CCM (2nd Ed.)
Aidspan (2009). Guide on the Roles and Responsibilities of CCMs in Grant Oversight
GF Country Coordinating Mechanism Model: CCM Oversight Practices
GF Report on the Assessments of CCM
GF CCM Funding Policy
GNP+ (2007). Challenging, changing, mobilizing: A guide to PLHIV involvement in
country coordinating mechanisms
Aidspan (2010). Germaise D. Commentary: Time to Revisit the CCM Minimum
Requirements
UNODC (2010) HIV in prisons: Situation and needs assessment toolkit
http://www.unodc.org/documents/hivaids/publications/HIV_in_prisons_situation_and_needs_assessment_document.pdf
UNODC, WHO, UNAIDS (2009). Technical paper for HIV testing and counselling in
prisons and other closed settings
Case Studies

Global CCM Report 2008
Tools and Templates



Link to Checklist for Documenting Action Point 1 Annex A
CCM Dashboard
CCM Performance Checklist and Users Guide
6.3 Checklist for documenting in line with Action Point 1
Document expertise and experience of those contributing to the proposal in working with the key
affected populations targeted in the proposal, including CCM members, staff of participating PRs
and SRs, and consultants and advisors
When developing Targeted Pool Global Fund proposals, it is important for applicants to map out
available resources and expertise in order to effectively manage the proposal development process
and develop strong, coherent proposals. The latter – having individuals with expertise and
experience in working with the key affected populations targeted in the proposal and in-country
experience – is particularly critical to producing a successful proposal.
The below form has been designed to help applicants in documenting Action Point 1. Documenting
expertise and experience of those contributing to the proposal helps to gain a better understanding
of the knowledge and skills represented within the teams working on the proposal. The information
collected can also be used to effectively respond to questions in various sections of the Global Fund
proposal such as those relating to Country Coordinating Mechanisms (CCM) (section 2).
This tool is a checklist that helps applicants to identify whether all relevant information has been
collected. Where answers to any of the questions below are negative, it is recommended that
applicants consider whether the information missing will contribute to enhancing responses in the
proposals and accordingly source it.
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Status
Item
Country Coordinating Mechanism (CCM) or relevant body
Does the CCM (or sub-CCM, regional CCM, non-CCM body) have members who
have researched or currently research the key affected populations which your
proposal is targeting?
If yes, have you documented the details of their research? Example: which key
affected populations were researched, where, what interventions, results found,
relevance of research to the proposal.
Does the CCM (or sub-CCM, regional CCM, non-CCM body) have members who
have worked or currently work with the key affected populations your proposal is
targeting?
If yes, have you documented the details of their work?
Example: which key affected populations they worked with, where, for how long,
what interventions, how the work experience is relevant to proposal.
Does the CCM (or sub-CCM, regional CCM, non-CCM body) have members who
are from the key affected populations targeted in the proposal?
If yes, have you mentioned this in the proposal (while recognizing and respecting
that members may wish to remain anonymous)?
Non-CCM members
Other than consultants, are there persons (example advisers) involved in
proposal development who have previously researched or currently research the
key affected populations which your proposal is targeting?
If yes, have you documented the details of their research? Example: which key
affected populations were researched, where, what interventions, results found,
relevance of research to the proposal
Other than consultants, are there persons (example advisors) involved in
proposal development who have previously worked or currently work with the
key affected populations targeted in your proposal?
If yes, have you documented the details of their work? Example: which key
affected populations they worked with, where, for how long, what interventions,
how the work experience is relevant to proposal.
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(check box if
response is yes)
Status
Item
Have consultants (national and international) involved in proposal development
previously conducted research on the key affected populations targeted in the
proposal?
If yes, have you documented the details of their research? Example: which key
affected populations were researched, where, what interventions, results found,
relevance of research to the proposal.
Have the consultants (national and international) involved in proposal
development previously worked with the key affected populations your proposal
is targeting?
If yes, have you documented the details of their work? Example: which key
affected populations they worked with, where, for how long, what interventions,
how the work experience is relevant to proposal.
Were any non-CCM members involved in proposal development members of the
key affected populations targeted in the proposal?
If you answered yes to the above question, has this participation been
documented (whilst recognizing and respecting that the persons may wish to
remain anonymous)?
Principal and Sub-Recipients
Do the nominated principal recipients have experience working with the key
affected populations your proposal is targeting?
If yes, have you documented the details of their experience? Example: which key
affected populations they worked with, where, for how long, what interventions,
how the work experience is relevant to proposal
Do the nominated sub-recipients have experience working with the key affected
populations targeted in your proposal?
If yes, have you documented the details of their experience? Example: which key
affected populations they worked with, where, for how long, what interventions,
how the work experience is relevant to proposal.
Documentation
If you answered no to any of the questions regarding documentation of expertise
and experience, is there information already available that you can use?
If yes, can this information be readily accessed?
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(check box if
response is yes)
Status
Item
(check box if
response is yes)
If documentation has been completed or is ongoing, is this being stored in the
same location?
If not, can the documentation be readily accessed and reviewed?
Have you used any of the information documented to support your responses in
the proposal, where relevant and appropriate?
6.4 Examples of how countries have effectively documented in line with Action
Point 1 in Round 10 MARPs proposals
Document expertise and experience of those contributing to the proposal in working with the key
affected populations targeted in the proposal, including CCM members, staff of participating PRs
and SRs, and consultants and advisers
The links below show how Argentina and Panama demonstrated expertise in and experience
working with key affected populations within their CCMs, when responding to questions in Section 2
of their Round 10 proposals.
Both applicants explicitly state how CCM members have experience working with the key affected
populations targeted in their proposals. Their responses are strengthened by the fact that they
provide specific details on the work experience (for example by stating whether it is in advocacy,
operational planning, or design of programmes). Panama also mentions the length of time that
members have worked with key affected populations.
Click here to access Argentina’s Round 10 proposal, please refer to Section 2.1.3.
Click here to access Panama’s Round 10 proposal, please refer to Sections 2.1.2 and 2.1.3
27 | P a g e
7 Principal Recipient and Sub-Recipient selection
Procedures for selection of Principal Recipients (PRs) and Sub-Recipients (SRs) should follow
the guidelines mentioned below, but there are some additional criteria that should be
considered.
Sub-recipients working on issues affecting key populations are most often NGOs but not all
NGOs are appropriate SRs to work with key populations. At the very least, organisations
seeking to become SRs should be able to provide a clear statement from their Board or
other governance structure that the organisation is committed to providing assistance to
the specific populations. Preference should be given to SRs and PRs that possess other
attributes, such as legal status, financial management systems, required by all PRs and SRs,
but also have experience working with key populations. If possible, at least some SRs should
be selected from organisations based within key populations – i.e., organisations of MSM,
sex workers, or IDUs/ex-IDUs. These community-based organisations may require significant
technical assistance.
7.2 Resource and reference guides
» GF (2003) Fiduciary Arrangements for Grant Recipients
»
Civil Society Success on the Ground: CSS and Dual-Track Financing – AIDS Alliance
28 | P a g e
8 Situational, Response and Gap Analysis
The following is a list of tools and resources that can assist countries in considering key aspects of
strategic information that should be described in a Round 11 Global Fund proposal. Countries
should also be aware that for each of these areas, Global Fund proposals can include funding
requests to strengthen the evidence base around marginalized and most-at-risk populations, for
example through:
 The strengthening of epidemiological surveillance systems to understand the role of sexual
minorities in national HIV epidemics;
 Improving the evidence base for effective interventions for sexual minorities, including
through operational research;
 Introducing indicators to measure to what extent sexual minorities are being reached; and,
 Improved tracking of resource flows to sexual minority groups.
Defining target populations
Men who have sex with men, people who use drugs and sex workers may, at a broad population
level, are vulnerable to HIV and AIDS (as indicated by high HIV prevalence) and vulnerable to human
rights violations (as indicated by laws or instances of violence, blackmail, or arrest). Men and women
in closed settings too are exposed to both vulnerabilities. However, these populations are not
homogenous in terms of their marginalization or vulnerability to HIV. Global Fund proposals should
try to specify subpopulation characteristics by economic status, drug-use patterns, the context of sex
work, age, location, and other social or structural factors including mobility and undocumented
migration, and also by (if known) HIV incidence and HIV prevalence rates, rates of condom use and
other sexual risk-reduction practices, and patterns of sexual behaviours and practices. Reports from
community led groups of men who have sex with men, people who use drugs, female, male and
transgender sex workers and transgender people are important: often the available data does not
accurately reflect the situation.
8.1 Action Point 2: Compile and cite quantitative and qualitative data to
specify target key affected populations
Resources
 UNAIDS (2003) UNAIDS, IMPACT, FHI, Estimating the size of populations at risk for HIV:
issues and Methods. Geneva.
 WHO (1998), Rapid Assessment and Response Guide on Injecting Drug Use (IDU-RAR),
http://www.who.int/entity/substance_abuse/publications/en/IDURARguideEnglish.pdf
WHO (2004). Rapid Assessment and Response: Adaptation guide on HIV and men who
have sex with men. www.who.int/hiv/pub/prev_care/rar/en/index.html
Family Health International (FHI). Qualitative Research Methods: A Data Collector’s Field
Guide

International HIV/AIDS Alliance (2009). All Together Now: Supporting community action
on AIDS in developing countries.
www.aidsalliance.org/includes/Publication/All_Together_Now_2009.pdf
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

WHO (2008). Rapid Assessment of Alcohol and Other Substance Use in Conflict-affected
and Displaced Populations: A Field Guide:
http://www.who.int/entity/mental_health/emergencies/unhcr_alc_rapid_assessment.pdf
Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages: A Generic
Guide: http://www.theglobalfund.org/documents/rounds/9/RapidAssessmentTool_SRHHIV.pdf
Defining population sizes
This is probably the single most difficult task for countries preparing targeted proposals. In most
countries, male-male sex, illicit drug use and sex work are hidden behaviours, making it difficult to
find and calculate the numbers of people who use drugs, men who have sex with men and sex
workers. Sophisticated, rigorous population size estimation is expensive and time-consuming and
often leads to arguments about whether the estimates are greater or smaller than the real
populations. UN organisations have assisted some countries to define population sizes, which can be
used in Global Fund proposals, especially if they were conducted in the previous one-to-two years.
In countries with older or no official estimates of the numbers of people who use drugs, men who
have sex with men, transgender people and sex workers, a modified Delphi approach can allow a
broad estimate to be produced quickly. This process defines a group of people who may be
knowledgeable about the behaviour being examined – male-male sex, injecting drug use and/or sex
work. The group’s members may vary according to the specific behaviour being examined but
usually includes:





Governmental and NGO staff from as wide a range of locations as possible (i.e. not
confined to the capital or larger cities)
Staff from HIV and AIDS Departments, including epidemiologists
Medical staff, including STI and drug-treatment staff
Representatives of law enforcement bodies
Representatives of key affected populations: if possible, these should include members of
key affected populations or, at least, people who can claim close knowledge of key
affected populations.
Where possible, the group should be briefed, provided with any studies that have been carried out
into key affected populations, most particularly those conducted WITH the community organisations
of men who have sex with men, people who use drugs, sex workers and transgender people. The
group is then asked to agree on the number of people in each key affected population. In a
facilitated discussion, many different estimates may be discussed after which the facilitator attempts
to narrow the distance between the largest and smallest estimate. If agreement is not reached on a
single figure, it is usually possible to agree on a fairly narrow range. The range then becomes the
official estimate for each key affected population and the midpoint of the range is used for the
Global Fund proposal and coverage calculations.
It needs to be stressed that population size estimation (PSE) using the above method may not be
accepted for every country. It is more likely to be acceptable for conflict and post-conflict situations
and countries that have only begun to acknowledge the existence of specific key affected
populations. Where the Delphi approach is used, interventions for key affected populations should
include at least one round of population size estimation during the life of the grant, either with
funding from the grant itself or from international or bilateral partners.
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Resources



FHI (2004). FHI’s Experience in Estimating the Size of Subpopulations at High Risk for HIV:
http://www.globalhivmeinfo.org/DigitalLibrary/Digital%20Library/ActivitySummarySizeEst
imation6-16-04.pdf
WHO, UNODC, UNAIDS (2009). Technical Guide for countries to set targets for universal
access to HIV prevention, treatment and care for injecting drug users:
http://www.who.int/hiv/pub/idu/idu_target_setting_guide.pdf
Consultation draft on the Operational Guidelines for Monitoring and Evaluation of HIV and
Men who have sex with men, sex workers and transgender people (prepared in draft by
UNDP, UNFPA, WHO, UNODC, UNAIDS Secretariat, MEASURE, USAID, GFATM and ICASO)
2011 in draft
Resource for documenting in line with Action Point 2
Compile and cite quantitative and qualitative data to specify target key affected populations
When submitting a proposal to the Global Fund, irrespective of whether it is for the general or
targeted pool, it is essential to provide data to specify target key affected populations. Data on the
population size, HIV burden, and prevalence of unprotected sex and unsafe injecting practices –
among target key affected populations – helps the Technical Review Panel (TRP) of the Global Fund
to assess the proposal’s ‘soundness of approach’. Such data also helps to justify the focus of the
proposed programme, and demonstrates the planning and implementation of an evidence-based
HIV response.
In many countries however, reliable data on certain target populations may not be available. The
behaviours or practices of key affected populations, for example, may be illegal or stigmatized and
therefore these populations are often hidden and mobile. When there is a lack of strategic data
available from within existent health information systems, data can be obtained from different types
of sources. Indeed, for quantitative indicators such as population size or HIV burden, information
from various sources is often triangulated to produce estimates. Similarly, qualitative data and grey
sources can be used to provide information on the social determinants of health-seeking behaviours
of target populations.
The table below provides an overview of the different sources of data that can be used to specify
target populations when strategic information is lacking. Please note that the following table only
lists types of data. In many cases, various estimation methods may need to be applied to the
available data in order to obtain reliable estimates (for example on population size).
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Table 1: Data sources that can be used to specify target key affected populations
Type of indicators for which
data is required
DEMOGRAPHIC
For example:




Population size
Education status
Employment status
Economic status
DISEASE BURDEN
For example:




HIV prevalence
HIV incidence
AIDS deaths
STI prevalence
KNOWLEDGE AND
BEHAVIOURS/PRACTICES
For example:
 % of key affected
population who can
correctly identify ways of
preventing HIV
 % of key affected
population reporting the
use of a condom at last
sexual intercourse
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Sources of data
 Census
 Population
estimation studies
 Surveys
 Vital registrations
 Sentinel surveillance
 Second-generation
surveillance
 Biological surveys
 Behavioural surveys
 Integrated biological
behavioural
surveillance
 Population-based
surveys
 Studies undertaken
at specific sites
within sample
populations
 Health facility
surveys
 Vital registrations
 Behavioural surveys
 Population-based
surveys
Examples of entities producing the data
 Government ministries
 United Nations reports (e.g. UN
Population Division or UNGASS)
 United Nations agencies’ reports (e.g.
UNAIDS, WHO)
 Multilateral organization reports (e.g.
World Bank)
 Reports of organizations focusing on
key affected populations or key
affected populations-related issues
(e.g. OSI, IHRA, NSWP, INPUD, GFMSM,
PLRI)
 Academic studies or scientific journals
 NGO studies or reports
 Ministry of Health and related
departments (e.g. for IDUs in prison this
will be the relevant authority) reports
and statistics
 United Nations reports (e.g. UNGASS)
 United Nations agencies’ reports and
studies (e.g. UNAIDS, WHO)
 Reports of organizations focusing on
key affected populations or key
affected populations-related issues
(e.g. OSI, IHRA, NSWP, INPUD, GFMSM,
PLRI)
 National science or medical institutes
studies and reports
 Academic institute studies and reports
 NGO studies or reports
 Ministry of Health and related
departments
 United Nations Agencies’ reports and
studies (e.g. UNAIDS, WHO)
 Reports of organizations focusing on
key affected populations or key
affected populations-related issues
(e.g. OSI, IHRA, NSWP, INPUD, GFMSM,
PLRI)
 National science or medical institutes
studies and reports
 Academic institute studies and reports
 NGO studies or reports
Type of indicators for which
data is required
USAGE AND COVERAGE OF
HEALTH SERVICES
For example:
 % of key affected
population with advanced
HIV infection receiving ART
 % of key affected
population reached by HIVprevention programmes
CONTEXTUAL FACTORS
INFLUENCING HEALTH
SEEKING BEHAVIOURS
For example:





Service quality
Barriers to accessing care
Human rights issues
Stigma and discrimination
Cultural practices
influencing health-seeking
behaviours
Sources of data
 Health facility
medical records
 Patient registries
 ART registers
 Population-based
surveys
 Health facility
surveys
 Programme
monitoring or
evaluations
 Programme
evaluations
 Qualitative research
studies
 Operational
research studies
 Desk review
 Grey literature
 Key informants
Examples of entities producing the data
 Health facilities
 Ministry of Health and related
departments
 United Nations agencies’ reports and
studies (e.g. UNAIDS, WHO)
 Reports of organizations focusing on
key affected populations or key
affected populations-related issues
(e.g. OSI, IHRA, NSWP, INPUD, GFMSM,
PLRI)
 National science or medical institutes
studies and reports
 Academic institute studies and reports
 NGO studies or reports
 Academic institute studies or reports
 NGO studies or reports
 Reports of organizations focusing on
key affected populations or key
affected populations-related issues
(e.g. OSI, IHRA, NSWP, INPUD, GFMSM,
PLRI)
 Key informants
 Agency (multilateral, bilateral and
others) reports looking at specific topics
 Media
Examples of how countries have effectively documented in line with Action
Point 2 in Round 10 MARPs proposals
Compile and cite quantitative and qualitative data to specify target populations
This action point is particularly important as it proves the existence of the target populations within
the country. Within Global Fund proposals, applicants are required, in Section 4.2, to provide
information on the epidemiological profile of target populations, which involves specifying HIV
burden as well as population size. Therefore, it is in these sections particularly, that applicants need
to effectively specify populations within their answers to questions of 4.2.
As there is overlap between the outcomes of Action Points 2 and 3, below we provide examples of
three applicants that effectively documented both points in their Round 10 key affected populations
proposals.
Please refer to examples provided under Action Point 3.
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Defining HIV burden and impact
Key data points for potential Global Fund Round 10 proposals will be the national HIV statistics
reported through the 2010 UNGASS process and in national HIV surveillance. In the 2010 UNGASS
reporting, many countries have described:
• the percentage of people who use drugs, men who have sex with men and sex workers who
are HIV infected (this is usually data from the country’s largest city/ies) and,
• the percentage of HIV-infected people who use drugs, men who have sex with men and/or sex
workers who are on combination HIV antiretroviral treatment 12 months after initiation of
antiretroviral treatment (this should come from longitudinal clinic data).
In addition, for most countries, data about HIV prevalence among people who use drugs, sex
workers and men who have sex with men have been published in leading international peerreviewed journals.
8.2 Action Point 3: Compile and cite quantitative and qualitative data to specify HIV
burden and impact in target populations
Resources
•
UNAIDS epidemiological software and tools (2009). Estimation and projection
package.
http://www.unaids.org/en/KnowledgeCentre/HIVData/Epidemiology/EPI_softwa
re2009.asp
• UNAIDS (2005). Modelling the expected short-term distribution of incidence of
HIV infections by exposure group.
http://data.unaids.org/pub/Manual/2005/IncidenceSpreadsheet_manual_en.pdf
• UNAIDS (2008). Modes of transmission study guidelines for country teams.
http://gametlibrary.worldbank.org/FILES/1110_Guidelines%20for%20Synthesis%
20for%20UNAIDS%20ESA%20Modes%20of%20HIV%20Transmission%20work.pdf
• UCSF HIV surveillance training materials.
http://globalhealthsciences.ucsf.edu/PPHG/surveillance/index.html
• Magnani R, et al. 2005. Review of sampling hard-to-reach and hidden
populations for HIV surveillance. AIDS, 19 (Suppl. 2):S67-S72.
www.respondentdrivensampling.org/reports/AIDS_2005.pdf
• WHO (2009). Toolkit for Monitoring and Evaluation of Interventions for Sex Workers.
Cited: http://www.searo.who.int/en/Section10/Section18/Section356_4612.htm
Defining baseline and target HIV intervention coverage and plans, indicators,
and capacity to achieve, monitor and evaluate progress and results
A common weakness in many Global Fund proposals has been lack of measurable coverage targets
and weakness of plans for monitoring and evaluation (M&E). Reasons include:
• a lack of baseline data from which to measure change,
• an inadequate choice of indicators,
• potential bias in the selected indicators and in data-collection methods,
• poor integration of M&E data across governmental and non-governmental implementers,
• poor management and integration of external researchers,
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• a lack of data analysis capacity, and,
• limited reporting and use of findings.
Baseline data is important for situational assessment but also monitoring and evaluation. Ideally
baseline data used in the proposal provides the basis for the M&E framework. Data should therefore
be measureable over time. Broadly data can be divided into quantitative and qualitative.
Key data points for potential Global Fund Round 11 proposals will be the national HIV statistics
reported through the 2010 UNGASS process. In the 2010 UNGASS reporting, many countries have
reported:
• percentage of people who use drugs, men who have sex with men and/or sex workers, who
both correctly identify ways of preventing the sexual transmission of HIV and who reject
major misconceptions about HIV transmission (behavioural surveys)
• percentage of people who use drugs, men who have sex with men and/or sex workers
reporting the use of a condom with their most recent client (behavioural surveys)
• percentage of people who use drugs, men who have sex with men and/or sex workers who
received HIV testing in the last 12 months and who know the results (behavioural surveys)
• percentage of people who use drugs, men who have sex with men and/or sex workers
reached by HIV prevention programmes (behavioural surveys)
Behavioural surveillance datasets – particularly those conducted annually or every two years – can
be a valuable source of data. Behavioural surveillance is considered second generation and gives
“early warning” data that can be useful to evaluate certain issues over a long time span.
• Prevalence of risk behaviour among key affected populations such as use of non-sterile
injecting equipment, lack of condom use at the last sex encounter,
• Prevalence of trading sex for drugs or money, and
• Knowledge of HIV routes of transmission and prevention
Resources

FHI (2000). Behavioural Surveillance Surveys. Guidelines for repeated behavioural surveys
in populations at Risk of HIV.
 UNAIDS, WHO (2000). Working group on global HIV/AIDS and STI surveillance. Guidelines
for second generation HIV surveillance: the next decade.
http://www.who.int/hiv/pub/surveillance/pub3/en/index.html
 UNAIDS, WHO (2004). Guidelines for effective use of data from HIV surveillance systems.
http://data.unaids.org/publications/irc-pub06/jc1010-usingdata_en.pdf
 Reintjes, R. and Wiessing, L. (2007). Second-generation HIV surveillance and injecting drug
use: uncovering the epidemiological ice-berg:
http://www.springerlink.com/content/q6422348351l5147/
 FHI (2004) Experience in estimating the size of subpopulations at high risk for HIV.
http://www.globalhivmeinfo.org/DigitalLibrary/Digital%20Library/ActivitySummarySizeEst
imation6-16-04.pdf
 WHO, UNODC, UNAIDS (2009). Technical guide for countries to set targets for universal
access to HIV prevention, treatment and care for injecting drug users.
http://www.who.int/hiv/pub/idu/idu_target_setting_guide.pdf
Data triangulation is an important method to consolidate data from multiple sources. It is useful to
build a more detailed picture, particularly when data is limited.
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Resources

UNAIDS (2009). HIV triangulation resource guide: synthesis of results from multiple data
sources for evaluation and decision-making.
http://data.unaids.org/pub/Manual/2009/20090915_hiv_triangulation_resource_guide_e
n.pdf
Key affected populations are vulnerable to more than HIV. Research itself may put members of key
affected populations at risk of arrest, harassment, injury, or death. In general, they are much more
likely to have contact with law enforcement services, serve time in jail and have unstable housing, as
well as a reduced ability to generate legitimate income. For these reasons, programmes and services
designed to collect data from these populations need to be carried out ethically and with care that
the research does no harm to the researched. This issue has most prominently been taken up by and
on behalf of people who use drugs.
Resources








WHO, Department of HIV/AIDS. (June 2003). Principles and practices: The implementation
of ethical guidelines for research on HIV
http://www.who.int/hiv/strategic/mt020603/en/
Ethical issues in research on preventing HIV infection among injecting drug users:
http://www.springerlink.com/content/970t058224530856/
Australian Injecting and Illicit Drug Users League. National statement on ethical issues for
research involving injecting/illicit drug users.
http://www.aivl.org.au/files/EthiicalIssuesforResearchInvolvingUsers.pdf
Engagement, reciprocity and advocacy: ethical harm-reduction practice in research with
injecting drug users
http://informahealthcare.com/doi/abs/10.1080/09595230600876606
IHRA, Open Society Institute and Human Rights Watch (2010). Briefings on human rights
and drug policy for the UN Commission on Narcotic Drugs.
http://www.idpc.net/publications/ihra-hrw-osi-briefs-human-rights-drug-policy
http://www.hrw.org/sites/default/files/related_material/Human%20Rights%20and%20Dr
ug%20Policy%20Briefings.pdf
HRW, IHRA (2009). A reference guide to human rights and drug policy.
http://www.hrw.org/sites/default/files/related_material/3.9.2009_Health_BuildingConse
nsusDrugPolicyGuide_0.pdf
WHO (2003). Health and Human Rights Working Paper Series No 2. the domains of health
responsiveness – a human rights analysis.
http://www.who.int/hhr/information/en/Series_2%20Domains%20of%20health%20respo
nsiveness.pdf
UNAIDS (2006). International guidelines on HIV/AIDS and human rights. Consolidated.
http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf
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Examples of how countries have effectively documented in line with Action
Point 3 in Round 10 MARPs proposals
Compile and cite quantitative and qualitative data to specify HIV burden and impact in target
populations
This action point is particularly important as it helps the TRP to understand the extent of the HIV
epidemic among key affected populations being targeted by the proposal. This is one of the factors
that the panel takes into account when determining whether the proposed program merits funding.
In Round 10, Kazakhstan, Malaysia, and Uruguay are examples of countries that effectively
documented Action Points 2 and 3. The TRP noted that the justification for selection of MARPs in all
three proposals was based on good epidemiological evidence.
In responding to section 4.2 on the epidemiological profile of target populations, all three countries
provide quantitative and/or qualitative evidence (for example from surveys undertaken) to specify
HIV burden in the target populations. Uruguay draws on evidence from different types of studies
(such as census, survey on behaviours, attitudes, and practices, second generation study) in
describing its proposal’s target populations. All three countries provide information on population
size, HIV prevalence, and prevalence of behaviours related to HIV – and all evidence is referenced. In
addition, Uruguay provides information on the impact of the HIV epidemic among its target
populations of male sex professionals and transgenders, and also provides demographic
information, such as on educational status, to specify men who have sex men.
In parts (c) and (d) of the question, all requested information, with recent data, has been provided in
the table for each of the target populations. Kazakhstan, where possible, has also disaggregated data
by age or gender.
Click here to see Kazakhstan’s Round 10 proposal, please refer to Section 4.2
Click here to see Malaysia’s Round 10 proposal, please refer to Section 4.2
Click here to see Uruguay’s Round 10 proposal, please refer to Section 4.2
Further data on coverage among people who use drugs, men who have sex with
men and sex workers
UNGASS reporting about coverage among people who use drugs, men who have sex with men, sex
workers, and men and women in closed settings, should be supplemented with more information.
For example, quantitative and qualitative information can answer some of the following questions:
• What are population perceptions of possible HIV exposure?
• What are population attitudes about HIV testing?
• What is the prevalence and incidence of sexually-transmitted infections (STIs)?
• How are people reached by a spectrum of HIV interventions at an individual, network, and
structural level?
• Are there multiple HIV services providers and access points for these populations?
• What are the frequency, regularity, and intensity of contacts between HIV service providers
37 | P a g e
and individuals in these populations?
• What does contact involve? Condoms, information, and referrals; or this plus direct services
and/or peer support?
• How many people are contacted directly or through secondary contact (for example, a peer
network that distributes condoms, syringes, or information)?
• Are interventions sufficiently attractive and accessible to the targeted population?
• What is the relative investment of public-sector and private-sector investment into these HIV
interventions?
• How do people balance fear of stigma and discrimination against access to health
interventions?
• What is the percentage and rate of people who report being rejected from, or discriminated
against in, health care settings?
• What is the incidence of reported human rights violations such as violence or blackmail?
• What are population perceptions of their own empowerment (especially over negotiation of
unsafe sex, or interactions with institutions such as health-care providers and police)?
For most countries of the world, additional data about HIV intervention coverage among people who
use drugs, men who have sex with men, sex workers and men and women in closed settings have
been published in leading international peer-reviewed journals. In contexts where research is
constrained by laws and stigma, programmes may rely on data that is unpublished, qualitative,
and/or limited in its extent. This evidence does exist in many places; at least some formative
evidence has been generated about HIV and the health of men who have sex with men in more than
60 countries around the world, documenting vulnerabilities and potential for interventions.
8.3 Action Point 4: Compile and cite quantitative and qualitative data to define, for
target populations, the current baseline coverage of HIV interventions, the
target coverage, and plans, indicators, and capacity to achieve, monitor, and
evaluate progress and results
Resources:
 UNAIDS (2009). Monitoring the Declaration of Commitment on HIV/AIDS. Group on global HIV
and STI surveillance. Guidelines on construction of core indicators for 2010 reporting.
Geneva. http://data.unaids.org/pub/Manual/2009/JC1676_Core_Indicators_2009_en.pdf
 UNAIDS (2008). A Framework for Monitoring and Evaluating HIV Prevention Programmes for
Most-At-Risk Populations. Geneva.
http://data.unaids.org/pub/Manual/2008/jc1519_framework_for_me_en.pdf

UNAIDS (August 2011). Operational Guidelines for Monitoring and Evaluation of HIV
Programmes for Sex Workers, Men Who Have Sex with Men, and Transgender People
 WHO. Service Availability Mapping (SAM)
www.who.int/healthinfo/systems/serviceavailabilitymapping/en/
 UNODC (2000). Evaluation workbook on Client Satisfaction Evaluations.
 The World Bank. Are You Being Served? New Tools for Measuring Service Delivery
 The World Bank (2009). Institutionalizing Impact Evaluation within the Framework of A
Monitoring and Evaluation System.
 USAID, MEASURE Evaluation Project (October 2005) Priorities for Local AIDS Control Efforts
(PLACE): A Manual for Implementing the PLACE Method; MEASURE Evaluation Monitor (July
2008), and, The PLACE Method for M&E of HIV Prevention Programmes page on the
MEASURE Evaluation website.
 USAID, Family Health International (FHI). Clinical Facility and Services Assessment Field Guide:
Quality Assurance (QA) and Quality Improvement (QI)
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 Pathfinder International (2006). Using Mystery Clients: A Guide to Using Mystery Clients for
Evaluation Input
 UNODC, WHO, UNAIDS (2006). HIV/AIDS Prevention, Care, Treatment and Support in Prison
Settings: A Framework for an Effective National Response (PDF), and,
 UNODC, WHO, UNAIDS (2009). HIV testing and counselling in prisons and other closed
settings: technical paper (PDF)
Examples of how countries have effectively documented in line with Action
Point 4 in Round 10 MARPs proposals
Compile and cite quantitative and qualitative data to define, for target populations, the current
baseline coverage of HIV interventions, the target coverage, and plans, indicators, and capacity to
achieve, monitor, and evaluate progress and results.
Here, the examples of Macedonia and Kazakhstan are cited in how they documented Action Point 4.
The example of Macedonia is particularly good in showing how all aspects (i.e. current baseline
coverage, target coverage, and plans, indicators and capacity to achieve, monitor and evaluate
progress and results) of the action point have been captured in the proposal. The country uses
evidence from implementation of previous Global Fund grants and other studies to determine
current baseline coverage of HIV interventions. In presenting this data, the applicant is thus able to
arrive at and justify target coverage figures proposed under the program described in the proposal
(in section 4.4.1). Later in section 4.6.1, Macedonia shows how evidence from current or planned
studies will be used to report on outcome and impact indicators includes in the proposal, as well as
to determine the capacity building required within the M&E system. In section 4.6.2, Macedonia
clearly lists the indicators to be used in impact and outcome assessment and the sources of data that
will be used for measurement of these indicators.
Kazakhstan, in section 4.6.2, clearly lists the indicators to be used in impact and outcome assessment
and the sources of data that will be used for measurement of these indicators. Kazakhstan has also
thoroughly completed the performance framework, providing baseline coverage figures along with
data sources, as well as target coverage to be achieved and sources for measurement to be used for
all indicators.
Click here to see Macedonia’s Round 10 proposal, please refer to Section 4.4.1, 4.6.1, and 4.6.2, as
well as the performance framework
Click here to see Kazakhstan’s Round 10 proposal, please refer to Section 4.6.2 and the performance
framework
Defining rights environments and interventions related to HIV programmes
The Global Fund has stated that promotion of human rights is central to success of HIV programmes
working with people who use drugs, men who have sex with men and sex workers. UN technical
partners including UNAIDS and UNDP reinforce the need to focus on an enabling legal environment
and the reduction of stigma and discrimination as part of a broad approach targeting most-at-risk
and/or criminalised populations.
Round 11 proposals to the Global Fund related to people who use drugs, men who have sex with
men and sex workers should include baseline data about rights environments, such as whether these
populations are identified in national policy documents as target groups for HIV interventions (NCPI
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2010 reporting) and the restrictiveness of countries’ legal frameworks related to sexual diversity
(Caceres, UNAIDS, 2009). Proposals related to men who have sex with men and sex workers should
describe how the intended activities will promote human rights such as rights to free expression,
freedom of association and assembly, freedom from unlawful arrest and detention, and equal access
to justice. Round 11 proposals can include activities such as human rights training for health-care
workers; training and sensitization of law-enforcement agents, judges and lawyers; programmes to
promote gender equality and sexual rights in the context of HIV; “know your rights and laws”
campaigns; stigma and discrimination reduction programmes; the provision of legal services; and
programmes to reform and monitor laws relating to HIV.
8.4 Action Point 5: Compile and cite indicators of existing human rights
environments for the target key affected populations, and plans, indicators,
and capacity to improve these environments.
Resources

UNAIDS (2010). National Composite Policy Index reporting,
www.unaids.org/en/KnowledgeCentre/HIVData/CountryProgress/2010_NCPI_reports.asp








UNAIDS (2009).
Review of Legal Frameworks and the Situation of Human Rights related to Sexual Diversit
y in Low and Middle Income Countries
IDLO, UNAIDS and UNDP. Tools to improve access to legal services for vulnerable
populations. www.idlo.int
UNAIDS (2006). Guidance Document: Guide for Strategic Actions to Prevent and Combat
Discrimination Based on Sexual Orientation and Gender Identity. www.unaids.org
UNAIDS and OHCHR. International Guidelines on HIV/AIDS and Human Rights 2006
Consolidated Version
UNDP (2005). Programming for Justice, Access for All: A Practitioner’s Guide to a Human
Rights-Based Approach to Access to Justice.
World Bank (2007). Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform.
USAID, Abt Associates (2009). Economic Strengthening Programmes for HIV/AIDS
Affected Communities: Evidence of Impact and Good Practice Guidelines.
Population Council, USAID (2002). HIV/AIDS-related Stigma and Discrimination: A
Conceptual Framework and an Agenda for Action.
Resource and Reference Guides
 UNAIDS (2009) HIV Triangulation Resource Guide
 UNAIDS Guide to Strategic Planning Module 1
 UNAIDS Guide to Strategic Planning Module 2
 UNAIDS Reference Group on Estimates, Modelling and Projections
Guidelines to Effective Situation, Response and Gap Analysis
Handout - Comprehensive HIV Situational Analysis
Tools and Templates
 UNAIDS. Epidemiological Software and Tools
 APMG (2010). Prioritisation Matrix (PowerPoint)
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8.5 Examples of how countries have effectively documented in line with Action
Point 5 in Round 10 MARPs proposals
Compile and cite indicators of existing human rights environments for the target populations, and
plans, indicators, and capacity to improve these environments
Argentina and Peru are examples of countries that included human rights activities within their
Round 10 MARPs proposals. Both applicants cited plans, indicators, and capacity to improve human
rights environments for the key populations being targeted. There are no examples, however, of
how indicators of existing human rights environments were cited. This is largely due to the lack of
systems to track or measure progress in rights environments.
One major component of Argentina’s Round 10 proposal consisted of activities aimed at addressing
stigma and discrimination towards target populations. Whilst the proposal does not cite baseline
values for indicators to describe existing human rights environments, a description of the
environment is given in section 4.4.1. In the same section, a description of the specific strategies and
actions that will be undertaken to change human rights environments is also provided. Indicators for
each activity are also provided. In the performance framework of its MARPs proposal, Argentina lists
indicators to measure progress in changing human rights environments. An example of an indicator
used is ‘number of friendly institutions and services’.
In its description of interventions, Peru cites plans to improve existing human rights environments
for populations targeted in the proposal. Similar to Argentina’s proposal, even though baseline
values are not provided for human rights indicators in Peru’s proposal, the description of
interventions gives an indication of the existing environment in relation to particular activities. In the
performance framework of its MARPs proposal, Peru lists indicators to measure progress in changing
human rights environments. An example of an indicator used is ‘% of transsexuals that report
improvement in their educational conditions, work place or access to human rights’.
Click here to see Argentina’s Round 10 proposal, please refer to section 4.4.1 and the performance
framework
Click here to see Peru’s Round 10 proposal, please refer to section 4.4.1 and the performance
framework
9 Proposed Interventions and Groups
9.1 Defining the combination of HIV interventions
Good clinical and public health practice in HIV epidemics recommend targeting defined populations
with a combination of interventions that promote health, reduce risk of infection and illness, and
increase access to and utilization of appropriate testing, treatment, and services. Good practice also
recommends rights-related interventions to improve human rights environments and human rights
protections to facilitate realization of health for all.
A range of interventions has been proven internationally to reduce the impact of HIV and AIDS on
men who have sex with men, sex workers, and other people marginalized because of sexual
orientation, gender identity, and consensual sexual practices. These can be described under three
broad categories:

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Engagement: Provide people with basic information about HIV and health and rights,
and basic means for health such as condoms, water-based lubricants and health-service
referrals. Also provide people with basic information about human rights, and basic
protections and security against violence, blackmail, arrest and incarceration, and social
and economic marginalization.
Services: Work with people at risk for HIV and AIDS to educate, counsel, screen and
treat for HIV and STIs, and ensure comprehensive quality sexual and reproductive
health, and provide training, counselling, representation, support, and social
mobilization and empowerment for health and rights.
Structural support: Working across institutions such as law enforcement, health care, or
media, and within communities across social networks and sexual networks, build
coalitions and conditions to combat HIV and advance positive environments about
health, and to advance positive norms about gender, diversity, pluralism, and rights.


For people who use drugs, the UN system has endorsed harm-reduction approaches as essential
interventions to help countries meet universal access goals. The comprehensive package for the
prevention, treatment and care of HIV among people who use drugs as identified by WHO, UNODC
and UNAIDS, comprises:
1. Needle and syringe programmes (NSPs)
2. Medication-Assisted Treatment (MAT) and other drug-dependence treatment
3. HIV testing and counselling
4. Antiretroviral therapy (ART)
5. Prevention and treatment of sexually transmitted infections (STIs)
6. Condom distribution programmes for people who inject drugs and their sexual partners
7. Targeted information, education and communication for people who inject drugs and their
sexual partners
8. Vaccination, diagnosis and treatment of viral hepatitis
9. Prevention, diagnosis and treatment of tuberculosis
Peer education and outreach are also highlighted as means for contacting difficult to reach
populations with credible, relevant HIV and other harm-reduction information and commodities.
These interventions, applied together, have the greatest impact on HIV prevention and treatment.
For the past several years, international researchers, harm-reduction practitioners and
representatives of international agencies have worked on a guide on both how to set targets for
countries in the implementation of the Comprehensive Intervention, and how to assess national
progress towards high coverage. This work has resulted in the WHO, UNODC, UNAIDS technical
guide for countries to set targets for universal access to HIV prevention, treatment and care for
injecting drug users, released in 2009. Such a comprehensive target-setting guide exists for no other
group at highest risk for HIV.
9.2 Action Point 6: Define an appropriate combination of HIV interventions for the
target populations, building from global guidelines and local practice.
Resources (global guidance):
 WHO (2009). Priority interventions: HIV/AIDS prevention, treatment and care in the
health sector
 Global HIV Prevention Working Group www.globalhivprevention.org
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 Vermund SH Allen KL Karim QA (2009). HIV-prevention science at a crossroads:
advances in reducing sexual risk. Current Opinion in HIV and AIDS, 4(4):266-273.
www.ncbi.nlm.nih.gov/pubmed/19532063
 Piot P Bartos M Larson H Zewdie D Mane P (2008). Coming to terms with complexity: a
call to action for HIV prevention. Lancet, 372(9641):845-859.
www.ncbi.nlm.nih.gov/pubmed/18687458
 Coates TJ Richter L Caceres C (2008). Behavioural strategies to reduce HIV transmission:
how to make them work better. Lancet, 372(9639):669-684.
www.ncbi.nlm.nih.gov/pubmed/18687459
 Merson M Padian N Coates TJ Gupta GR Bertozzi SM Piot P et al. (2008) Combination
HIV prevention. Lancet, 372(9652):1805-1806.
www.ncbi.nlm.nih.gov/pubmed/19027478
People who use drugs
 WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV
prevention, treatment and care for injecting drug users:
http://www.unodc.org/documents/hiv-aids/idu_target_setting_guide.pdf
 WHO Evidence for Action series: Technical papers and policy briefs on HIV/AIDS and
injecting drug users
http://www.who.int/hiv/pub/advocacy/idupolicybriefs/en/




Technical Paper (2007): Interventions to address HIV in prisons: HIV care, treatment and
support
Policy Brief (2005): Antiretroviral therapy and injecting drug users
Technical paper (2004): Effectiveness of community-based outreach in preventing
HIV/AIDS among injecting drug users
Policy Brief (2004): Reduction of HIV transmission through outreach
Technical Paper (2004): Effectiveness of sterile needle and syringe programming in
reducing HIV/AIDS among injecting drug users
Policy Brief (2005): Provision of sterile injecting equipment to reduce HIV transmission
Policy brief (2005): Effectiveness of drug dependence treatment in preventing HIV
among injecting drug users
Policy brief (2004): Reduction of HIV Transmission through drug-dependence treatment
The evidence for action series forms a supplement to the International Journal of Drug
Policy, 16(Supplement 1):1-76 (December 2005).
WHO/UNODC/UNAIDS position paper (2004). Substitution Maintenance Therapy in the
Management of Opioid Dependence and HIV/AIDS Prevention
WHO/UNODC/UNAIDS (2004). Advocacy Guide: HIV/AIDS Prevention among Injecting Drug
Users
European Monitoring Centre for Drugs and Drug Addiction Best practice portal:
o Treatment options for opioid users
http://www.emcdda.europa.eu/html.cfm/index102185EN.html
o Treatment options for amphetamines users
http://www.emcdda.europa.eu/html.cfm/index102316EN.html
o Treatment options for cocaine users
http://www.emcdda.europa.eu/html.cfm/index102340EN.html
Walsh N (2010). The silent epidemic: Responding to viral hepatitis among people who inject
drugs, in Cook C (Ed) et al (2010). In The Global State of Harm Reduction 2010: Key issues for
broadening the response, London, International Harm Reduction Association.
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 Gunneberg C Getahun H (2010). Enhancing synergy: Responding to tuberculosis epidemic
among people who use drugs. Also, in The Global State of Harm Reduction 2010: Key issues
for broadening the response, London, International Harm Reduction Association.
Sex workers
 UNAIDS (2009) Guidance Note on HIV and Sex Work.
2011http://data.unaids.org/pub/BaseDocument/2009/jc1696_guidance_note_hiv_and_sex
work_en.pdf (also in French, Spanish, Russian)
 Global Fund (2011). Round 11 Information Notes. Addressing sex work, MSM and transgender
people in the context of the HIV epidemic. (Available also in French, Spanish and Russian):
http://www.theglobalfund.org/WorkArea/DownloadAsset.aspx?id=15214
 Asia-Pacific Network of Sex Workers (APNSW), UNFPA,UNAIDS (March 2011). Building
Partnerships: Report of the First Asia-Pacific Regional Consultation on HIV and Sex Work
 WHO (2010) HIV/AIDS sex work toolkit. http://www.who.int/hiv/topics/vct/sw_toolkit/en/
 UNAIDS (2007). Operational guides portal. Practical guides for intensifying HIV Prevention
 UNAIDS (2008). Framework for Monitoring and Evaluating HIV Prevention Programmes for
Most-At-Risk Populations.
 UNDP (2005). Programming for Justice: Access for All. A Practitioner’s Guide to a
Human Rights-Based Approach to Access to Justice 2005
 See also the PLRI site: www.plri.org
MSM





WHO (2011). Prevention and treatment of HIV and other sexually transmitted infections
among men who have sex with men and transgender people: Recommendations for a public
health approach. Website PDF
UNAIDS – UNDP, UNFPA, UNESCO, WHO, UNAIDS Secretariat (2009). Action Framework:
Universal Access for Men who have Sex with Men and Transgender People
WHO, UNDP, UNAIDS, Hong Kong SAR Dept. of Health (2009) consultation report. Health
Sector Response to HIV/AIDS among Men who have Sex with Men
UNDP, WHO, UN Technical Working Group on MSM and HIV/AIDS (2008). Occasional Paper:
Enabling effective voluntary counselling and testing for MSM: Increasing the role of
community based organizations in scaling up VCT services for MSM in China. Beijing.
WHO (2009). WHO report on Prevention and treatment of HIV among MSM and transgender
groups. Geneva.
UNDP, UN Technical Working Group on MSM and HIV/AIDS (2008). Beijing. International NGO
and Donor Consultation. Meeting Report: Supporting Community Reponses to HIV among
Men who have Sex with Men
Men and women in closed settings
 UNODC, WHO, UNAIDS (2006). HIV/AIDS Prevention, Care, Treatment and Support in Prison
Settings: A Framework for an Effective National Response (PDF), and,
 UNODC, WHO, UNAIDS (2009). HIV testing and counselling in prisons and other closed
settings: technical paper (PDF)
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Resources (local practice):














UNFPA: www.unfpa.org/hiv/index.htm
UNDP: www.undp.org/hiv/
USAID AIDSTAR-One: www.aidstar-one.com
Network of Sex Work Projects (NSWP), with presence in 40 countries www.nswp.org
Paulo Longo Research Initiative www.plri.org
International AIDS Alliance www.aidsalliance.org
International Planned Parenthood www.ippf.org
The Global Forum on MSM & HIV (MSMGF): www.msmandhiv.org
International Treatment Preparedness Coalition
www.itpcglobal.org/index.php?option=com_content&task=view&id=80&Itemid=28
amfAR MSM Initiative: www.amfar.org/msm
Behind the Mask – African LGBTI communication initiative: www.mask.org.za
APCOM – the Asia-Pacific Coalition on Male Sexual Health: www.msmasia.org
ASICAL – a Latin American MSM-focused coalition: www.asical.org
CVC – Caribbean Vulnerable Communities Coalition: www.cvccoalition.org
Tools and Templates

APMG (2007). Logical framework template
» FHI (2001). HIV/AIDS Prevention and Care in Resource-Constrained Settings: A
Handbook for the Design and Management of Programmes
» UNAIDS/UNDP/ World Bank (2005). Mainstreaming AIDS in Development Instruments
and Processes at the National Level
» UNAIDS (2005). Support to mainstreaming AIDS in development: UNAIDS Secretariat
strategy note and action framework, 2004-2005
» Ethiopia HIV/AIDS Prevention and Control Office (HAPCO) and UNDP Ethiopia Country
Office (2005). A Handbook for HIV and AIDS Mainstreaming: for an Up-Scaled Gender
Sensitive Multi-sectoral Response
9.3 Examples of how countries have effectively documented in line with Action
Point 6 in Round 10 MARPs proposals
Define an appropriate combination of HIV interventions for the target populations, building from
global guidelines and local practice.
This action point is particularly important given that it helps to demonstrate ‘soundness of
approach’, which is one of the TRP’s assessment criteria for proposals. Here we cite the examples of
Malaysia and Uruguay in effectively documenting Action 6, as the TRP noted that the proposals of
both countries proposed strategies appropriate for the populations targeted. In addition, these
specific countries have been chosen because both explicitly cite the use of evidence in selection of
activities.
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In describing the activities included in the proposed program, Malaysia specifically mentions that
selection of activities was based on global guidelines – UN recommended comprehensive package of
harm-reduction activities – or local experience. Later in section 4.4.3, Malaysia notes basing
selection of the activities proposed on accumulated experience in implementation of HIV
programmes within the country. Thus, the proposal explicitly states that interventions have been
based on evidence - local experience and global best practices.
Similarly, in summarizing its Round 10 MARPs proposal, Uruguay explicitly states that program
design has been based on global and regional guidelines issued by UNAIDS and the Pan-American
Health Organization (PAHO). The response then goes on to provide an overview of the goals,
objectives, and activities of the proposed program. In the description, Uruguay mentions where
relevant, how activities have been adapted to suit the local context – such as use of an internet
portal to reach out to the hidden population of men who have sex with men. The TRP noted the
internet portal as being an innovative communication strategy to reach out to hard-to-reach
populations.
Click here to see Malaysia’s Round 10 proposal, please refer to section 4.4.1 and 4.4.3
Click here to see Uruguay’s Round 10 proposal, please refer to section 3.4 and 4.4.3
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10 Monitoring and Evaluation
A strong M&E framework is essential for a successful proposal. Although there are a number of
generic M&E resources for health systems, few focus exclusively on the key populations.
Resources and Reference Guides
»
»
»
»
»
»
»
»
»
»
»
»
UNAIDS (August 2011). Operational Guidelines for Monitoring and Evaluation of HIV
Programmes for Sex Workers, Men Who Have Sex with Men, and Transgender People
UNAIDS (2008). A Framework for Monitoring and Evaluating HIV Prevention Programmes for
Most-At-Risk Populations
UNAIDS (2006). M&E of HIV Prevention Programmes for Most-At-Risk Populations: A guide to
monitoring and evaluating national HIV prevention programmes for Most-At-Risk
Populations in low-level and concentrated epidemic settings; with applications for
generalized epidemics
The Global Fund (2009). Monitoring and Evaluation Toolkit … Part 1: The M&E system and
Global Fund M&E requirements
The Global Fund (2009). Monitoring and Evaluation Toolkit … Part 2: HIV component
UNAIDS (2009). UNGASS, Monitoring the Declaration of Commitment on HIV/AIDS. Guidelines
on Construction of Core Indicators – 2010 Reporting
UNAIDS (2008). Organising Framework for a Functional National M&E System
FHI/DFID (UK)/USAID (2000). BSS Guidelines for Repeated Behavioural Surveys in Populations
at Risk of HIV
FHI/USAID (2004). Monitoring HIV/AIDS Programmes: A Facilitator’s Training Guide
The Global Fund (2009). Performance-Based Funding microsite. PDF Brochure
WHO South-East Asia (2003). The Global Fund to Fight AIDS, Tuberculosis and Malaria:
Guidelines for Performance-Based Funding
UNODC (2010) HIV in prisons: Situation and needs assessment toolkit
Tools and Templates


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APMG (2007). Logical framework template
PGF Performance Frameworks
11 Financial Gap Analysis, Budgets and Procurement and Supply
Management
11.1 Costing and budgeting for each HIV intervention
Global Fund Round 11 proposals should cost and budget for all interventions with the following
considerations:
 Costs of implementing at high quality (including costs of appropriate salaries, stipends and
fees, training, supervision and support, sufficient quantity and quality of equipment and
supplies, and quality assurance and monitoring);
 Costs of linking and coordinating each intervention with the rest of a combination of proven
HIV interventions (including costs of case managers and peer navigators to help people
access and benefit from interventions, and incentives, such as health supplies, food,
transport, or vouchers for transport, telephone minutes);
 Costs of appropriately targeting and reaching the population (including costs of satellite
locations, off-site interventions, and subsidy of private-sector and community-based
providers); and,
 Costs of implementing at a sufficient scale to have an impact on HIV in the target population
(indicated by numbers of access points, numbers of providers and numbers of people
reached).
Budgeting considerations should include timing (noting that expenditure rates may be delayed
during start-up); cost per process output (for example, cost per STI diagnosed and treated, cost per
person enrolled in case-management or follow-up programming); and balance of staffing and costs
directly benefitting the target population (as opposed to management, administrative, and indirect
costs). Standard financial management considerations should include capacity to record and track all
financial transactions; an oversight and authorization process to ensure responsible allocation of
funds and prevent kickbacks or conflicts of interest; ability to disburse funds in an efficient, timely,
transparent and accountable manner; and ability for regular financial reporting.
Regarding HIV programming for MSM and sex workers, major cost items will include:
 People (salaries, stipends, and fees): A major budgeting consideration should be the allocation
of funds to people and partners in the target population whose efforts are crucial to
engagement, services and structural change. This can include stipends, materials and
meeting costs of peers, and can include contractual costs for people working within key
institutions, such as police, schools, public housing and shelters, or clubs and bars.
 Equipment, supplies and materials: Budgets should plan for procurement of sufficient
supplies of condoms; packets/sachets of water-based/silicone-based lubricants; point-ofcare diagnostics for STIs (such as gonorrhoea and syphilis); and incentives to ensure access
and follow-through on referrals. For programmes with internet-based or phone-based
outreach and interventions, equipment and supplies will also need to include telephones
and computers.
 Space: An important budgeting consideration should be the allocation of budget to “safe
space” such as drop-in centres that provide HIV services. Planned budgets should consider
costs of:
o Rent and security;
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o
o
o
Furniture (such as enough chairs for a group meeting, file cabinets and desks that
can lock (for safe storage of information and equipment, at least one couch large
enough for someone to sleep on in an emergency and a set of files or boxes where
individuals can receive mail);
Kitchen or water supply, refrigerator, microwave, coffee machine;
Equipment related to communications, such as telephones and internet service, a
voice-mail machine that can accept and store voice-mail for multiple users,
computers with internet access (as peer resource and organizing tool), and a
printer/copier/scanner/fax.
11.2 Action Point 7: For each planned programme intervention, calculate costs and
a budget that will achieve sufficient quality, coordination, reach and scale to
achieve an impact on HIV in the target population.
Resources


»
»
»
The Global Fund (2010). Guidelines for Budgeting in Global Fund Grants
ICASO International Council of AIDS Service Organizations (2009).
Community Systems Strengthening
The Global Fund (2003), Fiduciary Arrangements for Grant Recipients
The Global Fund (March 2011). LFA Budget Review Guidance Note
The Global Fund (2009). Guide to the Global Fund’s Policies on Procurement and
Supply Management
» The Global Fund Guide to Writing the Procurement and Supply Management Plan
Tools and Templates
 AMPG (2010). Budgeting: Unit Costs Template
 The Global Fund (2010). PSM Plan Template
 WHO, UNAIDS (2010). Resource kit for writing Global Fund HIV proposals for Round
10, including a Workplan and Budgeting Tool
 APMG (2010). Handout – Financial Gap Analysis
11.3 Examples of how countries have effectively documented in line with Action
Point 7 in Round 10 MARPs proposals
For each planned programme intervention, calculate costs and a budget that will achieve sufficient
quality, coordination, reach, and scale to achieve an impact on HIV in the target population.
Effectively documenting Action Point 7 is critical to developing strong proposals. A review of TRP
comments on proposals from Rounds 8, 9, 10 show that good budgets are those that:
 Provide a summary budget (as required by the Global Fund) and general assumptions
 Are clearly presented, for example by objective, SDA, and activity
 Provide quantities, unit costs and assumptions for each activity
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Resources
For more details, please see the AIDSPAN publication on Key Strengths of Rounds 8, 9 and 10
Proposals to the Global Fund, available at:
http://www.aidspan.org/index.php?page=aidspanpublications
Applicants must also note the Global Fund’s criterion on value for money when planning the
program budget. And, where large proportions of the budget have been allocated to a particular
area or activity (example human resources or training), it is critical to provide justifications for these
costs. As budgets are not publically available to source and cite, here a list of “Do’s and Don’ts” is
provided to aid applicants in development of budgets:
11.3.1 Do’s and Don’ts of Global Fund budget preparation
A Global Fund budget proposal helps to financially quantify a country’s a plan of action for a health
intervention in order to aid the coordination and implementation of programmes. In most cases, the
budget is the best practical approximation to a formal financial investment model of the health
intervention which supports its objectives, inputs and outputs. The constraint of any budget is that it
is based on estimated rather than actual data, typically guided by historical data which may not
adequately account for economic volatility and future events. The provision of accurate predictions
of future consequences while time consuming and demanding, validates the financial model.
Therefore, it is important to take into account unpredictable cost elements particularly variable
costs, where possible. The foundation of a Global Fund budget is the yearly work-plan proposed.
DOs
DO refer to existing health interventions/programmes historical cost to guide future estimated costs
to avoid under or overestimations.
DO consult with programme implementers (whether government or civil-society organizations) in
determining estimated costs as they are in the best position to predict what is likely to happen.
DO take into account individual country’s human resource guidelines where possible in order to
reach an informed decision on salaries and allowances. More often than not, human resource costs
for community workers without paper qualifications and skill sets are undervalued and not easily
compared to other professional positions in the country.
DO take into account inflation rates and allow flexibility over the time interval of the grant period.
DO account for unexpected expenditures which may be required by the Global Fund, such as the
establishment of a Project Management Unit for the Principle Recipient, insurance for assets
purchased, audits for the principle recipients and sub-recipients, tax, social benefits and other
statutory expenses.
DO ensure that the budget will be sufficient to adequately reach the coverage the proposal is
expected to. Therefore, reference to the targets in the Performance Framework will help to
determine unit costs.
DO refer to the budget of a costed National Strategic Plan (where available)
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DO keep in mind there are recommended percentages of total budget value which needs to be
allocated for monitoring and evaluation activities; and a costed Technical Assistance Plan
DO take into account foreign exchange trends as it will affect the budget significantly if the currency
used is volatile
DON’Ts
DON’T develop a budget without a finalised work plan and performance framework to avoid
multiple edits. Work on developing unit costs based on historical costs first.
DON’T use only one source of reference. Compare existing budgets of different service providers
and use the average costs as baseline, particularly for procurement of assets and health products.
DON’T forget to remind country CCMs that a costed technical assistance plan is necessary to support
the implementation of activities and ensure quality of service delivery as this component is often
missing in budget proposals, including allocations for future proposal development,
evaluations/assessments and strategic information development (IBBS, BSS and other research
activities)
11.4 Demonstrating value for money in Global Fund proposals
‘Value for money’ (VFM) is an important criterion taken into account by the Global Fund’s Technical
Review Panel (TRP) when examining proposals submitted for funding. Thus, it is important that
applicants to the general or targeted pools demonstrate VFM within their proposals.
VFM, as defined by the Global Fund, comprises three key elements:



Effectiveness, that is, proposed activities are technically well-designed and represent the
best way to achieve the desired impact, outcomes, and sustainability given the prevailing
conditions within the country context;
Efficiency, i.e., desired outputs of proposed activities are obtained at least cost in terms of
inputs; and
Additionality, i.e. that requested Global Fund support is additional to existing efforts and
will not substitute for other resources (national, private sector, or international).4
In summary, VFM is about “using the most cost-effective interventions as appropriate to achieve the
desired results”5 and demonstrating that additional funding is needed from the Global Fund to
achieve these desired results. It must be recognized though, that low cost doesn’t necessarily imply
VFM. In Round 10, where costs for activities were high, applicants could still demonstrate VFM if
justification for these costs was given. The UNAIDS guidance note (referenced at the end of the
document) provides further information on this.
VFM is a concept that has recently come to the fore in global health, and thus guidance on how to
apply it practically is still evolving. The Global Fund has issued an Information Note on Value for
4
This definition is based on the Round 11 Value for Money Information Note issued by the Global Fund (2011), available at:
http://www.theglobalfund.org/en/application/infonotes/
5 This quote is directly taken from the UNAIDS Round 10 Guidance Note on Addressing Value for Money, which in turn
references the Global Fund Round 10 FAQs and Value for Money Information Note. The UNAIDS Round 10 Guidance Note
is available at: http://data.unaids.org/pub/BaseDocument/2010/20100618_unaids_vfm_guidancenote_en.pdf
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Money for Round 11 available at http://www.theglobalfund.org/en/application/infonotes/, and all
applicants are recommended to read over it carefully along with the Round 11 proposal guidelines.
Also, the Global Fund and its partners are currently working on standardizing the measurement of
the cost per person of delivering key services. This tool, when finished (unavailable at time of
publication), can be used by applicants in costing. Please check the link below to see if it is available:
http://www.theglobalfund.org/en/performance/effectiveness/value/
While the above documents should be applicants’ primary point of reference and guidance, listed
below are factors to consider in demonstrating VFM in proposals. The list has been developed based
on TRP feedback from review of Round 10 proposals6, and guidance issued by the Global Fund and
UNAIDS on VFM.1,2,7 The UNAIDS note (referenced below) provides further guidance on VFM and is
an important resource.
11.4.1 Factors to consider in demonstrating VFM in Global Fund proposals
Effectiveness
 Does the proposal justify selection of the health problems which are targeted? Is evidence
provided to show that these health problems are a priority within the national health
strategy or plan?
 Is the proposal strategy coherent? Do activities reflect the goals and objectives of the
proposed program? Does the proposal show how activities complement each other and
contribute to the goals and objectives?
 Are the proposed activities appropriately designed to achieve the desired outcomes and
impacts?
 Are the proposed service delivery areas and activities based on evidence (local and global)
that suggests that these are most appropriate for the given context? Does the proposal
explicitly state this evidence?
 Where possible, does the proposal cite how the selected activities have achieved desired
outcomes and impacts previously? Where new activities have been selected, does the
proposal cite reasons for this and show how these are better suited to the prevailing
conditions?
 Does the proposal state the expected benefits of the activities and how these will be
measured?
 Does the proposal provide evidence to show that activities are sustainable and can continue
even after the Global Fund grant expires?
Efficiency
 Does the proposal relate strategies and activities to unit costs and budget assumptions?
 Is the budget calculated at a level necessary to achieve the desired impacts?
 Where possible, have lowest cost quality products been used (in accordance with
international agreements and property rights)?
 Where possible, have costs from previous Global Fund grants been used to inform budget
calculations?
6
Report of the Technical Review Panel and the Secretariat on Round 10 Proposals Available at:
http://www.theglobalfund.org/en/trp/reports/?lang=en
7 Guidelines for proposals – Round 11. Single Country Applicants. Available at:
http://www.theglobalfund.org/en/application/materials/
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



If the lowest possible costs have not been used, have justifications been provided to show
that higher costs are more appropriate, effective, or sustainable?
Have budget assumptions or justifications been provided for costs?
Does the proposal show that well-designed and well-functioning systems (such as structure
and management of health systems, distribution chains, health personnel policies) exist for
delivery of health services given the country context?
If well-designed and well-functioning systems are not in place, does the proposal put
forward and describe plans, as well as request funding to improve functioning of these
systems?
Additionality
 Does the proposal show that requested Global Fund funds are additional to existing financial
resources (national and international), and will not replace these funds?
It is also important to note, that VFM must be considered as an integral component of the entire
Global Fund proposal. In other words, VFM is something which must be reflected in the entire
proposed program, and not just in the responses to questions which specifically relate to VFM in the
proposal. The country examples listed under the action point relating to VFM in this toolkit show
how applicants have demonstrated VFM in MARPs proposals submitted in Round 10.
11.4.2 Resources
The resources listed below provide additional information on value for money and how to
demonstrate it within proposals. Resources are listed in order of utility and relevance (i.e., those
deemed as being most relevant listed first), and a short description is provided for each one to help
applicants understand what information is available.
1. UNAIDS (2010). Technical Guidance Note: Addressing value for money in round 10 proposals for
the Global Fund to Fight AIDS, Tuberculosis and Malaria. Available at:
http://data.unaids.org/pub/BaseDocument/2010/20100618_unaids_vfm_guidancenote_en.pdf
Summary: This note was specifically created for applicants of Round 10, and thus provides
important guidance on how to demonstrate value for money in proposals to the Global Fund.
While it was developed for the previous round, the information provided is still very useful.
Topics covered include: cost analysis, calculation of unit costs, and justification of selection of
service delivery areas. Applicants are advised to check whether UNAIDS has issued any updates
or revised guidance notes for Round 11.
2. International HIV/AIDS Alliance (2010). Measuring and Improving the Value for Money of HIV
Programming: The Approach of the International HIV/AIDS Alliance – A Discussion Paper.
Available at: http://www.aidsalliance.org/includes/Publication/VfM-the-Alliance-approach-Dec10.pdf
Summary: This discussion paper by the International HIV/AIDS Alliance provides an overview of
the importance of value of money, and also explains what the concept means. Pages 2-4 will be
particularly useful to applicants. Please note that this resource is recommended for background
reading and to substantiate existing guidelines provided by the Global Fund. Applicants must
always refer to the definition provided by the Global Fund when developing proposals.
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3. Improvement Network (2010). What is value for money? Available at:
http://www.improvementnetwork.gov.uk/imp/core/page.do?pageId=1068398
Summary: This webpage provides a definition of value for money. Again, while applicants must
always refer to the definition used by the Global Fund, this is a useful page to consult to gain
more background information on the concept. The page also outlines the different ways in
which value for money can be demonstrated.
4.
Bertozzi SM (2009). It could get ugly, but we can do more with what we have. Presentation to
the HIV/AIDS Implementers Meeting in Windhoek, Namibia on June 11, 2009. Available at:
http://www.hivimplementers.com/pdfs/GSs/Implementers_meeting_Bertozzi_11%20june%20fi
nal.pdf
Summary: This resource is a presentation given by Dr. Stefano Bertozzi, previously at the
National Institute of Public Health (Mexico) and now director of the HIV and Tuberculosis
programme at the Gates Foundation. While it is not directly relevant to Global Fund proposals, it
is a good resource to consult for background on the rationale for value for money, and
understanding how to achieve it value for money. Slides 25 – 43 are particularly useful.
11.4.3 Evolving character of VFM as Round 11 looms
In practice, the application of value for money is still evolving. For Round 10 proposals, the
Secretariat’s approach (mirroring that of the TRP) looked at four levels:
1. Overall strategy: Has the proposal strategy been accurately translated into a grant which can
achieve its goals?
2. Effectiveness: Does the grant agreement ensure that interventions will be implemented in an
effective way (as described in the proposal)?
3. Efficiency: Is the grant achieving outputs at an appropriate cost?
4. Additionality: Is the grant additional to existing activities and financial resources?8
However, responses to these sections, with wide variations in interpretation across countries, were
not as illuminating as intended by the Global Fund. Therefore, the TRP recommended that for
Round 11, “ ... the value for money concept be addressed by asking applicants to justify, per service
delivery area, the technical appropriateness of the approaches being proposed and to provide the
evidence upon which this is based. The TRP recognizes that there may be situations in which the
interventions proposed are not at the least possible cost, but that a higher cost could be justified by
the applicant based on appropriateness, effectiveness and/or sustainability”. 9
The Round 11 proposals will add policy questions related to VFM within specific sections of the
proposal. Responses should show that interventions represent good value for money (i.e. using the
most cost effective interventions, as appropriate, to achieve the desired results).
8
http://www.aidspan.org/index.php?issue=151&article=7&highlights=value~for~money (accessed 20/7/11)
Report of the Technical Review Panel and the Secretariat on Round 10 Proposals
http://www.theglobalfund.org/en/trp/reports/?lang=en
9
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11.5 Action Point 8: Cite qualitative and quantitative data to demonstrate value for
money
Currently, the Global Fund and its partners are working on standardizing the measurement of the
cost per person of delivering key services. Key services for which per person unit costs will be
measured include:


DOTS treatment for TB patients (WHO’s Stop TB Department)
ARV therapy to control HIV and AIDS (With PEPFAR and international technical partners,
WHO’s Global Price Reporting Mechanism; and analysis of grant expenditure data on ARV
therapy reported by supported programmes through the Global Fund’s Enhanced Financial
Reporting system.)
11.5.1 Examples from two Round 10 proposals highlight how value for money can
be addressed.
11.5.1.1 Example 1A. Round 10 MENAHRA proposal:
The proposal highlights that harm-reduction interventions are already demonstrated to be cost
effective and, by definition, great value for money. It is also noted that the cost of inaction on IDU
epidemics is much higher than any investment. The section response also states that proving value
for money in advocacy and capacity-building areas is difficult however previous experience has
demonstrated the importance of creating an enabling environment. Further, it might be assumed
that the TRP recognise added value in this regional level proposal in its potential to homogenize
activities and policies. (For a full extract of the relevant sections, see Appendix 1A).
11.5.1.2 Example 1B. Round 10 Macedonia proposal:
This proposal reflected much research and analysis in setting out value for money where costs of
service to individuals in most-at-risk populations were carefully estimated. Budgeting processes
were constructed to achieve the best possible results for the lowest possible price. An example of
cost efficiency was made of the intention to ‘double-up’ population size estimate studies with biobehavioural and RDS research. Another example of value for money is described in the focus on
linking capacity building to broader development frameworks. As with the MENAHRA proposal, the
relevant section of the Macedonia application (citing a key reference from UNAIDS, WHO and
UNODC ) stresses that proposed interventions are internationally acknowledged as evidence based
and cost effective. (For a full extract of the relevant sections, see Appendix 1B).
Resources



The “Report of the Technical Review Panel and the Secretariat on Round 10 Proposals” is at
www.theglobalfund.org/en/trp/reports and sets out details for how value for money should
have been documented for Round 10 proposals, and how the TRP evaluated these sections.
The Global Fund is developing a tool to measure value for money. The measurements will
demonstrate linkages between financial investment in key services and program outcomes,
and between investment and impact on disease burden. Check:
http://www.theglobalfund.org/en/performance/effectiveness/value/ to see if it is now
available.
The Global Fund Framework for Value for Money
http://www.theglobalfund.org/en/performance/effectiveness/value/framework/, sets out
the principles for how to assess whether country programmes are obtaining the maximum
benefit from resources in terms of services scale-up.
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
GFO (May 13, 2011). 146(1) http://www.aidspan.org/index.php?issue=146&article=1
Provides an analysis of the evolving concept of value for money in Global Fund proposals.

International HIV/AIDS Alliance (December 2010), Measuring and Improving the Value for
Money of HIV programming.
www.aidsalliance.org/publicationsdetails.aspx?id=505
Although it does not relate specifically to Global Fund programming, this is a good reference
for background on value for money.

Value for Money Information Note.
http://www.theglobalfund.org/en/application/infonotes/?lang=en
Information note on value for money from the Global Fund for round 11 proposals.

UNAIDS-ADB (2004). Costing Guidelines for HIV/AIDS Intervention Strategies.
http://data.unaids.org/publications/irc-pub06/jc997-costing-guidelines_en.pdf
For use in estimating resource needs in the Asia/Pacific region, this resource provides
country level guidance in costing selected HIV/AIDS interventions, including a spreadsheet
for generating local data on unit costs. The tool is designed to prompt understanding of the
relative efficacy and cost-effectiveness of interventions.

WHO (2008). User’s Manual GFATM Proposal Costing Tool
http://www.who.int/hiv/pub/toolkits/gfatm_costing_tool_user_manual_v1.1.pdf
The Global Fund Proposal Costing Tool has been developed to assist countries in costing
GFATM applications. It is based in part on the template developed by the GFATM for Round
8 applications, but modified to include more detailed activity components and to facilitate
input of unit costs.
11.6 Justifying budget item amounts and allocations
Poor justification for costing of budget items was identified as a weakness in Round 10 MARP
proposals. High proportions of the budget were allocated to human resources, planning and
administration, and overhead costs, raising questions of sustainability and value for money.10
11.7 Action Point 9: Provide adequate justification for costs, particularly where
certain activities have been allocated large proportions of the budget
In Round 10 proposals, sections 5.4.2 and 5.4.3 on human resources and other large expenditure
items provided opportunity for applicants to justify costs. Human resource costs can contribute a
large proportion of proposal budgets so added detail for justification is required, ideally
demonstrating accord with national human resource policies or other relevant national costing
structures.
Proposals should include a budget with sufficient detail and assumptions to allow for the costs of
activities to be fully assessed. The budget should be detailed and linked with presentation of costing
assumptions.
10
AIDS Projects Management Group (APMG) (June 2011). For UNAIDS Assisting Countries to Develop Global Fund Targeted
Pool Proposals: Recommendations for Revisions to the MARPs/Targeted Pool Toolkit.
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11.7.1 Examples from three Round 10 proposals highlight how justification for
costs can be addressed.
11.7.1.2 Example 2A: Round 10 MENAHRA proposal
The human resources component of the proposal represented 42% of the total budget and this
proportion was justified by acknowledging that human resources are central to the delivery of
intended activities, services and strengthening the capacities of civil society organizations. It is also
noted that the proposal does not happen to include expensive equipment or medicines and
accordingly the proportion of human resource costs was relatively high. (For a full extract of the
relevant sections, see Appendix 2A).
11.7.1.3 Example 2B Round 10 Macedonia proposal
The Macedonia proposal commits 28% of the budget to human resources due to an emphasis on
personnel for outreach work. The proposal explains that salaries are informed by previous approved
Global Fund grants as well as the national salary framework. The biggest portion of the budget goes
to Medicines and Pharmaceutical products (31.01%) and relates to provision of treatment for
hepatitis C infection among IDUs. (see Appendix 2B).
11.7.1.4 Example 2C Round 10 Sao Tome and Principe Proposal
An additional example reference (San Tome and Principe) is provided to complement the MARP
proposal examples (which were relatively few in number and not all including strong examples of
justification for budget proportions). The San Tome and Principe proposal presents unit costs and
assumptions that are well linked with the budget. The human resource component is clearly defined
and explained, referencing national salary standards. The proposal draws on the financial data of the
GF projects management unit (PMU) for costs of certain items. (see Appendix 2C)
Resources

ASAP World Bank (2008). ABC Model
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATI
ON/EXTHIVAIDS/0,,contentMDK:22081978~menuPK:2754898~pagePK:210058~piPK:210062
~theSitePK:376471~isCURL:Y,00.html
This resource helps to eliminate costs related to non-value-added activities, highlighting
overall allocations by activity, beneficiary group and cost categories to facilitate checking
against priorities. It includes a feature added to convert outputs to Global Fund proposal
format (based on Round 8 forms).
 Aidspan (June 2011). Key Strengths of Rounds 8, 9 and 10 Proposals to the Global Fund.
http://aidspan.org/documents/aidspan/aidspan-round-8-10-strengths-report-en.pdf
Details some of the costing strengths from past GFATM proposals.
 Regional Price Reference
http://bi.theglobalfund.org/analytics/saw.dll?Dashboard&nqUser=PQRExternalUser&PQRLA
NGUAGE=en&PortalPath=/shared/PQR%20External%20Users/_portal/PQR%20Public&Page=
Regional%20Price%20Reference To View the commodity prices that other Principal
Recipients are paying for a product in your region
Region specific resources

Futures Institute (2006). Resource Needs Model: Futures Institute Resource Needs for
HIV/AIDS: Model for Estimating Resource Needs for Prevention, Care, and Mitigation. 2006
57 | P a g e

http://www.futuresinstitute.org/pages/ResourceNeeds.aspx This resource (of particular
relevance to Asia-Pacific, Middle Eastern and North African countries) provides guidelines
for the prioritization of resources and for helping with developing local cost estimates for
appropriate activities using local costing figures based on local data.
UNDP-UNAIDS-ADB (2010). The Asian HIV/AIDS Resource Needs Estimation and Costing
Model http://www.aidsdatahub.org/dmdocuments/The_Asian_Model_Manual.pdf This is
an Excel-based tool designed to help with short-, medium- and long-term resource needs
estimation exercises, but is not designed specifically for Global Fund proposals.
MSM

USAID/Health Policy Initiative and Burnet Institute (2010). Resource Estimation Tool for
Advocacy.
http://www.healthpolicyinitiative.com/index.cfm?id=publications&get=pubID&pubID=1383
Although not specifically designed for Global Fund proposals, this resource tool for advocacy
helps to estimate resource needs for scaling up HIV prevention programming for men who
have sex with men, producing estimates of the resources needed for a five-year period,
based on user input of population size estimates, target coverage levels, and local costs of
HIV prevention services.
12 Stronger tools for measuring results in light of Round 11
For Round 11 proposals, measures for quality, outcome and impact will be detailed in the
Performance Framework, which should closely match with interventions set out in the budget and
work plan. Quality and impact indicators require different measurement tools. Impact can be
58 | P a g e
measured with IBBS data or any other type of regular surveillance tool. Quality measures are
essentially qualitative and include methods for data collection such as focus group discussions,
interviews, community observation and key informant interviews.
12.1 Action Point 10: Define appropriate measures for quality, outcomes and
impact of interventions
The Round 10 Guidelines for Proposals criteria that the TRP used to review proposals submitted for
Round 10 are unlikely to be changed substantially for Round 11. With regard to measuring quality,
outcomes and impact of interventions, the TRP looks for proposals that:



Build on and strengthen country impact measurement systems and processes to ensure
effective performance based reporting and evaluation;
Demonstrate that the proposal will contribute to reducing overall disease, prevalence,
incidence, morbidity and/or mortality;
Demonstrate how continuous process and impact monitoring and evaluation will be
implemented in order to improve on-going actions and determine overall program
impacts.11
The Performance Framework should list a concise number of indicators which reflect the
effectiveness of activities, provide clear targets for each indicator and can include comments on how
the results for each indicator will be measured. Impact indicators must have baseline data citing
source documents (published national data is preferred), targets and future data collection methods
to be used to measure the impact of the proposed activities. Planned outcomes (included as
indicators in the performance framework) should address and respond to current epidemiological
data. Applicants should focus on performance by linking resources (inputs) to the achievement of
outputs (people reached with key services) and outcomes (longer term changes in the disease), as
measured by qualitative and quantitative indicators.12
The term ‘highest-impact interventions’ has been newly introduced in Round 11, defined as
interventions that:




address emerging threats to the broader disease response; AND/OR,
lift barriers to the broader disease response and/or create conditions for improved service
delivery; AND/OR,
enable roll-out of new technologies that represent global best practice; AND,
are not funded adequately.
Applicants should use their proposal forms to justify the inclusion of ‘highest-impact interventions’.
The Global Fund recognizes that some interventions may require explicit attention. These may
include, but are not limited to:

the surveillance and response to HIV drug resistance;
11 Aidspan
(June 2011). Guide to Round 11 Applications to the Global Fund (Volume 1)
http://aidspan.org/documents/guides/aidspan-round-11-applying-guide-volume-1-en.pdf
12 Aidspan
(June 2011). Guide to Round 11 Applications to the Global Fund (Volume 1).
http://aidspan.org/documents/guides/aidspan-round-11-applying-guide-volume-1-en.pdf
59 | P a g e






HIV treatment for children and adolescents;
couples testing and treatment for people living with HIV;
comprehensive PMTCT programmes;
targeted HIV services for underserved and most-at-risk populations;
harm reduction interventions; and
‘critical enablers’ such as political, legal and human rights advocacy, community
mobilization, and responses to change risk environments.13
Most of the outcomes and impacts will be specific to the circumstance of the applicant country,
however applicants should include cross-cutting outcomes and impacts as relevant.14 Cross-cutting
outcomes are health systems and community systems strengthening interventions that, within the
country context, improve program outcomes for underserved populations in two or more of the
diseases by:






improving equitable coverage and uptake addressing any, and preferably all, of:
Availability of services
Access to services
Utilization of services
Quality of services
AND are not funded adequately. 15
12.2 Examples from three Round 10 proposals highlight how measures for quality,
outcome and impact of interventions can be addressed.
12.2.1 Example 3A from Round 10 Georgia Proposal
The Performance Framework is sound and realistic. Section 4.6.1 describes efforts over recent years
to build and consolidate more systematic monitoring and evaluation data collection. Indicators are
concise, match activities and are measured with an appropriate range of methods (BSS surveys
combined with population size estimation studies, operational research and routine program data
from the HIV/AIDS Clinical database). (see Appendix 3A).
12.2.2. Example 3B, Round 10 Macedonia Proposal
The proposal describes a well-established and improving system of epidemiological and bio
surveillance. Outcome indicators are well defined, aligned to proposed interventions and include
valid measurement methods (BSS, respondent driven sample surveys, size estimation studies and a
bio-behavioural survey). (see Appendix 3B)
Resources
13
Policy on Eligibility Criteria, Counterpart Financing requirements, and Prioritization of Proposals for Funding from the
Global Fund. http://www.theglobalfund.org/en/application/process/eligibility/
14 Policy on Eligibility Criteria, Counterpart Financing requirements, and Prioritization of Proposals for Funding from the
Global Fund. http://www.theglobalfund.org/en/application/process/eligibility/
15 The Global Fund (May 11-12, 2011) Twenty-Third Board Meeting. Geneva.
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
UNAIDS (2009-2011) Joint action for Results: UNAIDS Outcome Framework.
http://data.unaids.org/pub/Report/2010/jc1713_joint_action_en.pdf
This resource is intended to assist in creating greater clarity on the relationships between
needs, financing, activities and outcomes and sets out tips matching priority areas to
measurable outcomes. It is not written especially for Global Fund proposals.

The Global Fund, WHO, World Bank (2009). Global Fund Monitoring and Evaluation Toolkit
HIV Tuberculosis and Malaria and Health Systems Strengthening. 2009
http://www.aidsdatahub.org/dmdocuments/Global_Fund_M_E_Toolkit.pdf
This toolkit provides a table of output indicators that includes program level indicators that
can be routinely reported for areas in which countries have requested substantial funds
from the Global Fund. The table includes indicators for services provided by civil society or
community-based organizations.

WHO (2009). Toolkit for Monitoring and Evaluation of Interventions for Sex Workers.
http://www.aidsdatahub.org/dmdocuments/ToolKit_M_E_SW.pdf
This toolkit focuses on FSW populations and demonstrates how a small number of
recommended indicators can provide critical information to guide interventions.
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13 Providing greater contextual data on MARPs for Round 11
The TRP recommended that applicants of MARPs/key affected populations proposals provide more
contextual information regarding MARPs for Round 11. This can include surveillance data or special
survey reports addressing these populations as well as other data. Selection of key affected
populations and corresponding interventions needed to be based on thorough epidemiological
evidence and gap analyses.16
13.1 Action Point 11. Compile and cite evidence to support selection of target
populations, and goals, objectives, and activities of the proposal strategy
New tools being developed by the Global Fund (to be made available in August 2011) will provide
applicants with the epidemiological and financial information to help identify programmatic gaps.
Applicants are encouraged to source information that is most up to date. Where there is limited
epidemiological data available for key affected populations, this should be acknowledged and a
sound analysis of what information is available from various sentinel and behavioural surveillance
studies should be carefully presented. It is important to demonstrate that interventions chosen are
evidence-based and informed by experience to be sufficiently justified.
13.2 Examples from Round 10 proposals highlight how using evidence to support
proposal content can be addressed.
Information on epidemiology, which should be used to select target populations, was included in
Sections 4.2 of the Round 10 proposal forms. Examples 4A from Kazakhstan and 4B from Uruguay
are used to highlight strong epidemiological descriptions.
Goals, objectives and activities are developed and described across different sections of the Round
10 proposal form. The key section is 4.4.1., which should flow from 4.3.1 where constraints and gaps
are described. Examples 4C from Macedonia and 4D from Panama are used to emphasise strong
linkages between evidence defined in the gap analysis being used to shape goals, objectives and
activities.
13.2.1 Example 4A, Round 10 Kazakhstan proposal
There is a good description of the epidemiology within the target groups, using up-to-date data and
broken down by geographical areas. Reference is made to BBSS reports, AIDS Centre Epidemic
Updates, and data from the Ministry of Justice. Prison data is particularly rigorous and
comprehensive. The evidence points to a need to focus on injecting drug users in civilian and prison
sectors. The goal of the proposal is to achieve HIV control by increasing access of this key affected
population to a comprehensive package of harm reduction services. (see Appendix 4A).
13.2.2 Example 4B, Round 10 Uruguay proposal
The proposal presents a thorough epidemiological analysis that supports the proposed activities
which are strategically focused on the key affected populations most affected by the HIV epidemic in
Uruguay. The goal of the proposal is to reduce transmission of HIV among identified most-at-risk
16 Aidspan
(June 2011). Guide to Round 11 Applications to the Global Fund. Volume 1: Getting a Head Start.
http://aidspan.org/documents/guides/aidspan-round-11-applying-guide-volume-1-en.pdf
62 | P a g e
populations (MSM and transsexuals – including sex workers and people deprived of their liberty),
promote access to health and social services for these groups, promote social inclusion and the
acceptance and implementation of recently passed non-discriminatory laws. The epidemiological
profile notes that second generation surveillance identified these key affected populations as key
affected populations relatively recently. Qualitative and quantitative studies have been referenced
along with data from the Ministry of Health, the National Survey on HIV/AIDS and the Public Health
Laboratory Department, to add context and detail to the profile information. (see Appendix 4B).
13.2.3 Example 4C, Round 10 Macedonia proposal
The main weaknesses in the implementation of current HIV strategies and the existing gaps and
inequities in the delivery of services to target populations are well defined. The extract (see
Appendix 4C) highlights one activity area (the scale-up of drug substitution treatment) to illustrate
the flow and sound linkages demonstrated between gap analysis, goal, objective and activity.
The Macedonia Round 10 proposal also highlights the evidence base for proposed interventions. For
example, “... interventions suggested for injecting drug users follow the recommendations of the
“comprehensive package of interventions for IDUs” for prevention, treatment and care as
recommended by UNAIDS, WHO and UNODC”.
13.2.4 Example 4D, Round 10 Panama proposal
Each proposed cluster of activities is introduced after a summary of the analysis of need in section
4.4.1. on Interventions. Further, a number of the activities proposed are introduced as ‘best practice’
models with overview descriptions (including the Relational Outreach and Engagement Model,
Patient Navigation and a range of client centres evidence based interventions). (see Appendix 4D)
Resources



Matching resources to need: opportunities to promote equity. Global fund information note.
http://www.theglobalfund.org/en/application/infonotes/?lang=en Discusses the use the
most recently available evidence to understand which population groups face barriers and
why, and how Global Fund financing can be most effectively used to address them.
UNAIDS, WHO (2010). Guidelines on Estimating the Size of Populations Most at Risk to HIV.
http://www.aidsdatahub.org/dmdocuments/guidelines_popnestimationsize_en.pdf
Not specifically for Global Fund proposals, this guideline can be used to conduct population
size estimate studies to measure and understand the populations most at risk.
The Global Fund, WHO and UNAIDS (2009). Synthesis of Results from Multiple Data Sources
for Evaluation and Decision-Making: HIV Triangulation Resource Guide.
http://www.aidsdatahub.org/dmdocuments/20090915_hiv_triangulation_resource_guide_e
n0.pdf triangulation This method seeks to strengthen interpretations and improve decisions
based on available evidence.
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14 Guarantee that actions harmonize with aims and objectives
A notable weakness in Round 10 proposals was “incoherent proposal strategy with proposed
activities not reflecting the goals and objectives of the program”.17
14.1 Action Point 12: Ensure that activities reflect goals and objectives of the
programme
For Round 11, applicants will be required to include a log frame with each application. The log frame
will provide a consolidated summary of the proposed programmes. It will help guide applicants
through the structure of the goals, objectives, service delivery areas and key activities. The Global
Fund will release more information on the log frame at or before the time of the launch.18
14.2 Examples from Round 10 proposals highlight how activities can appropriately
reflect programme goals and objectives.
14.2.1 Example 5A, Round 10 Macedonia proposal
The activity areas are well described and flow logically from the goal and objectives. The goal,
objectives and activity areas are set out together with an example extract of objective, SDA and
activity description (for Prevention of HIV transmission among sex workers). (see Appendix 5A).
Sequencing and logical flow from goal to objectives, service delivery areas and proposed activities
are self-evident.
14.2.2. Example 5B, Round 10 Peru proposal
Activities and objectives are well detailed along with the description of the interventions planned.
The example extract highlights the fifth objective (Generate and institutionalize the evidence
necessary to improve access to comprehensive healthcare for transsexual and gay/MSM
populations) to demonstrate the linkages to activity areas (Support the study of epidemiological
surveillance on incidence, prevalence, population size and risk behaviour in Transsexual Gay and
MSM populations; Study of mid-term and final evaluations of the program to help transsexual, gay
and MSM populations access comprehensive healthcare, and: Present evidence on Gay/MSM and
transsexuals). It is evident that each activity feeds carefully into the overarching objective, which, in
turn, plays a role (by producing evidence to improve and adjust intervention strategies for access to
comprehensive healthcare for the transsexual and Gay/MSM populations) in moving towards the
goal of reducing HIV incidence in the target populations.
Resources
17
AIDS Projects Management Group (APMG) for UNAIDS (June 2011). Assisting Countries to Develop Global Fund
Targeted Pool Proposals: Recommendations for Revisions to the MARPS/Targeted Pool Toolkit.
18
Aidspan (June 2011). Guide to Round 11 Applications to the Global Fund. Volume 1: Getting a Head Start.
http://aidspan.org/documents/guides/aidspan-round-11-applying-guide-volume-1-en.pdf
64 | P a g e
No Global Fund-specific resources were identified. However, there are a range of websites that
might be of value to applicants who seek guidance on ensuring that activities reflect goals and
objectives. See, for example:

How to Write Goals and Objectives for Your Grant Proposal. Outcomes vs Steps
http://nonprofit.about.com/od/foundationfundinggrants/a/goalsobjectives.htm
 Proposal Writing Guide. 2008. pp9-13
http://www.toolsforcommunitybuilding.ca/propwrit/prwritgd/prwritgd.pdf
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15 Showing that plan will enhance, not duplicate, previous grants
For Round 10 proposals (unlikely to be changed substantially for Round 11), the TRP looks for
proposals that demonstrate that Global Fund financing will be additional to existing efforts to
combat HIV/AIDS rather than replacing them.19 A weakness identified by the TRP in Round 10 MARPs
proposals was inadequate demonstration of complementarity and synergy with previous similar
Global Fund grants.20 Where the proposal is similar to a previous grant, there must be sufficient
information to justify funding of proposed interventions, emphasising how they complement and
add value to previous Global Fund grants.
15.1 Demonstrate the synergies and complementarity of the proposed program
with any previous Global Fund grants
New to Round 11 is an additional eligibility rule relating to recent history of funding. If an applicant
has an existing Global Fund grant which has been implemented for less than 12 months, that
applicant will not be able to submit a proposal for the same disease or HSS component. This rule is
subject to two exceptions:


the proposal has a different geographical coverage; and,
the proposal calls for the roll-out of new technical guidance.
To have been considered for one of the exceptions, a brief summary or ‘proposal concept’ of the
planned scope of the proposal had to be presented prior to full proposal development (before July
22, 2011). A proposal concept form would have been be provided by the Global Fund and obtained
by contacting: recentfunding@theglobalfund.org.
In the Round 10 form, applicants were asked to describe the links between their proposal and other
Global Fund grants under section 4.4.7.
15.2 Examples from Round 10 proposals highlight how synergies and
complementarity between proposed programme with any previous Global
Fund grants can be demonstrated
15.2.1 Example 6A. Round 10 Peru proposal
The additionality of the Round 10 proposal in relation to previous approved proposals was well
addressed. The rationale for new related human resource training activities was explained to be
differentiating between key affected populations and thus strengthening capacity building efforts. A
stigma reduction activity area proposed consolidation of public policy (developed under a previous
Global Fund grant) through new activity to introduce policy regulation. It was also proposed that a
surveillance system started through the previous proposal be expand to additional geographical
areas (see Appendix 6A).
19
Aidspan (June 2011). Guide to Round 11 Applications to the Global Fund. Volume 1: Getting a Head Start.
http://aidspan.org/documents/guides/aidspan-round-11-applying-guide-volume-1-en.pdf
20 AIDS Projects Management Group (APMG) for UNAIDS (June 2011). Assisting Countries to Develop Global Fund Targeted
Pool Proposals: Recommendations for Revisions to the MARPS/Targeted Pool Tool Kit.
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15.2.2 Example 6B. Round 10 Panama proposal
Synergies of objectives and activities with the regional project of HIV prevention among uniformed
personnel (approved in Round 9 and being negotiated by the same Principal Recipient) are well
described. Coordination to maximise opportunities emerging from previous grant activity are
proposed (see Appendix 6B).
15.2.3 Example 6C. Round 10 Macedonia proposal
A number of sections in the proposal refer to complementarity with previous Global Fund grants
however this is most systematically expressed in section 4.4.7. In each case, linkages are captured
and described to demonstrate that Round 10 funding would contribute to scaling up (including
expansion to new geographical areas), continuation and/or strengthening of service provision.
Synergies are expressed where pre-existing activity areas are supported towards strengthening and
additional capacity building themes. For example, in Activity 1.1, harm-reduction efforts are
strengthened by adding training on overdose. (see Appendix 6C)
Resources
For more examples on additionality, see relevant sections of:


Aidspan (2006). An Analysis of the Strengths and Weaknesses of Proposals Submitted to the
Global Fund in Rounds 3-6. Based on comments by the Technical Review Panel.
http://aidspan.org/documents/guides/aidspan-strengths-and-weaknesses-guide-extract.pdf;
Aidspan (2011). Key Strengths of Rounds 8, 9 and 10 Proposals to the Global Fund.
http://aidspan.org/documents/aidspan/aidspan-round-8-10-strengths-report-en.pdf
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16 Cross-Cutting Issues
16.1 Health-System Strengthening
Situational, response and gap analysis guide for HSS
Resources:
 The Global Fund (2008). HSS Fact Sheet
 WHO (2010). HSS How to Make the Case in a Proposal for Rounds 8, 9 and 10
 WHO. HSS Round 10 support materials
16.2 Civil Society Strengthening
Resources:
 The Global Fund (2008). NGO Participation in the Global Fund: Report on the Screening




Review Panel Round 7
Aids Alliance (2010). NGO/CBO Support and Organisational Development Tools
Aids Alliance (2008). A Framework for analysing and organising data regarding civil society
strengthening in Round 8
Aids Alliance (2007). CBO Capacity Analysis toolkit
Aids Alliance (2007). Network Capacity Analysis: Rapid Assessment Guide
16.3 Gender
Resources:












The Global Fund (2008). Fact sheet: Ensuring a Gender Sensitive Approach
The Global Fund (2008). Fact sheet: Sexual Minorities in the context of the HIV epidemic
The Global Fund (2010). Gender Equality Strategy
UNAIDS (2003). Seven fact sheets on gender and HIV
UNAIDS (2009). Operational plan for UNAIDS Action Framework: Addressing women, girls,
gender equality and HIV
WHO (2009). Integrating gender into HIV/AIDS programmes in the health sector: Tool to
improve responsiveness to women’s needs
UNAIDS (2005). Operational Guide on Gender and HIV: A Rights-Based Approach
UNAIDS (2009). Action Framework: Addressing Women, Girls, Gender Equality and HIV
UNDP (2009). Developing … Services to Reduce HIV among MSM and Transgender Populations
in Asia and the Pacific
UNAIDS (2009). Action Framework: Universal Access for MSM and Transgender People
UNDP (2009). HIV Vulnerabilities Faced by Women Migrants: from Asia to the Arab States
UNAIDS (2009). Gender guidance for national AIDS responses
16.4 TB/HIV
Resources:
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WHO Tuberculosis/HIV Web Portal
 WHO (2008): Policy guidelines for collaborative TB and HIV services for injecting and
other drug users: an integrated approach.
 Technical paper
 Policy brief
 WHO Stop TB Department (June 2010). Workshop to build the capacity of civil society
for people who use drugs. Liverpool.
o
o
o
o
o
o
TB/HIV: Why is it important?
TB Basics: Understanding TB and the immune response
Policy guidelines for collaborative TB and HIV services for injecting and other drug
users: an integrated approach
Four country study on implementation of TB/HIV and drug use services
Key issues: prisons and access to services – the Ukraine example
Developing TB Services for Homeless People - the Toronto Example
 UNAIDS, WHO, PEPFAR (2009). A guide to monitoring and evaluation for collaborative
TB/HIV activities
 WHO (2007). Tuberculosis care with TB-HIV co-management
 WHO (2005). TB/HIV research priorities in resource-limited settings
 WHO, UNAIDS (2004). Guidelines for HIV surveillance among tuberculosis patients
 WHO (2004). Interim policy on collaborative TB/HIV activities
16.6. Private Sector
UNAIDS (2008). Public Private Partnerships in the AIDS Response
16.7 Greater Involvement of People living with HIV/AIDS
UNAIDS, APCASO, APN+, AusAID (2005). “Valued Voices” GIPA Toolkit
16.8 HIV/AIDS and the Media
UNDP, Population Foundation of India (2005). HIV-AIDS in News – Journalists as Catalysts
16.9 Human Rights Approaches
UNHCR, UNAIDS (2006). International Guidelines on HIV/AIDS and Human Rights
UNDP (2008). Human Rights & HIV: Advocacy Tools
UNDP (2007). Guide to an effective human rights response to the HIV epidemic
HARPAS (2007). Towards the Protection of the Universal Human Rights of People Living with HIV
AIDSLEX (2008). A new Web resource on HIV, the law and human rights
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17 Annex
17.1 Glossary of Key Terminology Used in HIV/AIDS Programming
This glossary provides the definitions of key terms used in HIV/AIDS programming, with a
special focus on Global Fund terminology. It is not exhaustive, and has been developed by
synthesizing information from different sources – namely UNAIDS and the Global Fund (see
references section). Please note that not all definitions provided are those used by the Fund,
so where possible applicants should make sure to always consult whether the Global Fund
has defined any new terminology or issued any updated guidance material.
Applicants requiring assistance with other terminology may consult the list of resources at
this end of document, though accuracy of the information provided cannot be guaranteed.
17.2 HIV/AIDS programming terminology
Advocacy - Is a method and a process of influencing decision-makers and public perceptions
about an issue of concern, and mobilising community action to achieve social change,
including legislative and policy reform, to address the concern. (WHO)
Aid effectiveness - Refers to principles outlined within the aid effectiveness agenda that aim
to improve the quality of the delivery, management, and use of development aid in order to
increase the probability of obtaining sustainable, high-quality results that achieve maximum
development impacts. (AusAID; Global Fund)
Behaviour Change Communication - Behaviour change communication promotes tailored
messages, personal risk assessment, greater dialogue and an increased sense of ownership.
Behaviour change communication is developed through an interactive process, with its
messages and approaches using a mix of communication channels in order to encourage
and sustain positive, healthy behaviours. (UNAIDS)
Concentrated epidemic - In the context of HIV, a concentrated epidemic is typically
characterized by an HIV prevalence higher than 5% in any subpopulation at higher risk of
HIV infection, but less than 1 percent in the total population. (UNAIDS)
Counselling - Counselling is an interpersonal, dynamic communication process between a
client and a trained counsellor, who is bound by a code of ethics and practice, to resolve
personal, social, or psychological problems and difficulties. When counselling in the context
of an HIV diagnosis, the objective is to encourage the client to explore important personal
issues, identify ways of coping with anxiety and stress, and plan for the future (keeping
healthy, adhering to treatment, and preventing transmission). When counselling in the
context of a negative HIV test result, the focus is exploring the client’s motivation, options,
and skills to stay HIV-negative. (UNAIDS)
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Discrimination - HIV-related discrimination refers to the unfair and unjust treatment (act or
omission) of an individual based on his or her real or perceived HIV status. Discrimination in
the context of HIV also includes unfair treatment of key affected populations, such as sex
workers, people who use drugs, LGBTI people, prisoners, and in some social contexts
women, young people, migrants, refugees and internally displaced people. Discrimination
can be institutionalised through existing laws, policies and practices that negatively target
people living with HIV and marginalized groups. (UNAIDS, WHO)
Enabling environment - There are different kinds of enabling environments in the context of
HIV. An enabling legal environment is one in which laws and policies against discrimination
on the basis of HIV status, risk behaviour, occupation, and gender are in place and are
monitored and enforced. An enabling social environment is one in which social norms
support healthy behaviour choices. (UNAIDS)
Epidemic - An unusual increase in the number of new cases of a disease in a human
population. The population may be all the inhabitants of a given geographic area, the
population of a school or similar institution, or everyone of a certain age or sex, such as the
children or women of a region. (UNAIDS)
Evaluation - The systematic collection of information about programme activities,
characteristics, and outcomes that determines the merit or worth of a specific programme.
It is an episodic assessment of the change in targeted results that can be attributed to the
programme, project or project intervention. Evaluation attempts to link a particular output
or outcome directly to an intervention after a period of time has passed. (UNAIDS; Global
Fund)
Faith-based organization - A faith-based organization is a non-governmental agency owned
by religiously affiliated entities such as (1) individual churches, mosques, synagogues,
temples or other places of worship; or (2) a network or coalition of churches, mosques,
synagogues, temples, or other places of worship. (CDC)
Generalized epidemic- A generalized HIV epidemic is an epidemic that is self-sustaining
through heterosexual transmission. In a generalized epidemic, HIV prevalence usually
exceeds 1% among pregnant women attending antenatal clinics. (UNAIDS)
Harm reduction - Policies, programmes, and approaches that seek to reduce the harmful
health, social, and economic consequences associated with the use of psychoactive
substances. For example, people who inject drugs are vulnerable to blood-borne infections
such as HIV if they use non-sterile injecting equipment. Therefore, ensuring adequate
supplies of sterile needles and syringes helps to reduce the risk of blood-borne infections.
Harm reduction is a comprehensive package of evidence-informed programming for people
who use drugs. The nine components in the package are: opioid substitution therapy; HIV
testing and counselling; HIV care and antiretroviral therapy for injecting drug users;
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prevention of sexual transmission; outreach (information, education, and communication
for people who inject drugs and their sexual partners); hepatitis diagnosis, treatment, and
vaccination (where applicable); and tuberculosis prevention, diagnosis, and treatment.
(UNAIDS; Global Fund)
Health system - A health system consists of all organizations, people, and actions whose
primary intent is to promote, restore, or maintain health. It involves the broad range of
individuals, institutions, and actions that help to ensure the efficient and effective delivery
and use of products and information for prevention, treatment, care, and support to people
in need of these services. (WHO; UNAIDS)
Health systems strengthening - The term ‘health systems strengthening’ refers to a process
that empowers a health system to deliver effective, safe, and high-quality interventions to
those who need them. Areas that require strengthening are typically the service delivery
system, health workforce, health information system, systems to guarantee equitable
access to health products and technologies, and health financing systems, as well as
leadership, governance, and accountability. (UNAIDS; Global Fund)
Information, Education and Communication (IEC) - Information, Education and
Communication (IEC), comprises a range of approaches, activities and outputs to raise
awareness about HIV/AIDS for behaviour change. (WHO)
Intervention - A specific activity (or set of activities) intended to bring about change in some
aspect of the status of the target population (e.g. HIV risk reduction, improving the quality
of services) using a common strategy. An intervention has distinct process and outcome
objectives and a protocol outlining the steps of the intervention. (UNAIDS)
Logic model - A logic model is a graphic representation of a programme that describes the
programme’s essential components and expected accomplishments and conveys the logical
relationship between these components and their outcomes. (EMCDDA)
Monitoring - The routine tracking and reporting of priority information about a programme
and its intended outputs and outcomes. (UNAIDS)
Mother-to-child transmission (MTCT) - Is the transmission of HIV from an HIV-positive
mother to her child during pregnancy, labour, delivery or breastfeeding. Some countries
prefer to use the term ‘parent-to-child transmission’ or ‘vertical transmission’ in order to
avoid stigmatizing pregnant women and to encourage male involvement in HIV prevention.
(WHO; UNAIDS)
MSM – This is an abbreviation used for ‘men who have sex with men’ or ‘males who have
sex with males’. The term ‘men who have sex with men’ describes males who have sex with
males, regardless of whether or not they have sex with women or have a personal or socially
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gay or bisexual identity. This concept is useful because it also includes men who self-identify
as heterosexual but have sex with other men. (UNAIDS)
Needle and syringe exchange programmes (NSP) - Needle and syringe exchange
programmes describe the provision of sterile syringes and hypodermic needles as well as
further injecting paraphernalia to injecting drug users. (EMCDDA)
Opioid substitution therapy (OST) - Opioid substitution therapy is the recommended form
of drug dependence treatment for people who are dependent on opioids. It has proved to
be effective in the treatment of opioid dependence, in the prevention of HIV transmission,
and in improving adherence to antiretroviral therapy. (UNAIDS)
Opportunistic infections (OI) - Opportunistic infections are illnesses caused by various
organisms, many of which usually do not cause disease in persons with healthy immune
systems. Persons living with advanced HIV infection may have opportunistic infections of
the lungs, brain, eyes, and other organs. Tuberculosis is the leading HIV-associated
opportunistic infection in developing countries. (UNAIDS)
Outreach work - Community-based activities with the aim of getting in touch with persons
who are not effectively reached by existing services. One key element is active contactmaking with high-risk groups in a setting in which they are comfortable, and keeping in close
contact with them, instead of waiting for these people to approach services. Activities range
from prevention to health care and advice for untreated persons. (EMCDDA)
Parent-to-child transmission (PTCT) - The term ‘parent-to-child transmission’ is preferred to
‘mother-to-child transmission’ in some countries (see ‘mother-to-child transmission’)
because it is less stigmatising to women and may encourage male involvement in HIV
prevention. (UNAIDS)
Risk behaviours - Behaviours that can directly expose individuals to HIV or transmit HIV, if
virus is present (e.g. unprotected sex, sharing unclean needles). Risk behaviours are actual
behaviours in which HIV can be transmitted. Risk behaviours are those in which a single
instance can result in a transmission. (CDC)
Scaling-up - Refers to the different strategies used to expand the scope, reach and impact of
responses to HIV/AIDS. This can involve expanding the geographical or population reach of
HIV/AIDS-specific programmes and integrating HIV/AIDS-specific interventions within other
health programming, such as sexual and reproductive health and child and maternal health
programmes. It is also refers to mainstreaming of HIV/AIDS within development and
humanitarian programming. (WHO)
Sex worker – Refers to female, male and transgender adults, aged 18 years and over, who
receive money or goods in exchange for sexual services, either regularly or occasionally. Sex
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workers may or may not openly state they sell sex. All children under the age of 18 years
who sell sex are victims of commercial sexual exploitation and are not sex workers.
(UNAIDS)
Social networking - A recruitment strategy in which a chain of referrals is based on
individuals at higher risk of HIV exposure using their personal influence to enlist their peers
they believe to be also at higher risk of HIV exposure. (CDC)
Stigma - HIV-related stigma refers to the negative beliefs, feelings and attitudes towards
people living with HIV as well as those groups suspected of being infected by HIV, affected
by HIV by association, such as the families of people living with HIV, or those most at risk of
HIV transmission, such as people who inject drugs, sex workers, lesbians, gay men,
transgender and intersex people (LGBTI). (UNAIDS; WHO)
Substitution/maintenance treatment - Treatment of drug dependence by prescription of a
substitute drug (agonists and antagonists) for which cross-dependence and cross-tolerance
exists, with the goal to reduce or eliminate the use of a particular substance, especially if it
is illegal, or to reduce harm from a particular method of administration, the attendant
dangers for health (e.g. from needle sharing), and the social consequences (EMCDDA)
Target populations - Groups of people who are to benefit from the result of the
intervention. (UNAIDS)
Targeted interventions - Programmes or activities targeted to specific populations groups to
achieve specific objectives, such as increasing the use of condoms among truck drivers or
reducing STD rates. (WHO)
Technical Assistance (TA) - The delivery of expert programmatic, scientific, and technical
support to organizations and communities in the design, implementation, and evaluation of
HIV prevention interventions and programmes. (CDC)
Transgender people - are individuals whose gender identity and/ or expression of their
gender differ from social norms related to their gender of birth. The term transgender
people describes a wide range of identities, roles and experiences, which can vary
considerably from one culture to another. (UNAIDS)
17.3 Terminology specific to Global Fund programmes
(as defined by the Global Fund)
Alignment - This refers to setting the dates for the Component Implementation Period to be
in line with the most relevant in-country cycle. For example, Global Fund reporting and
reviews can be aligned with country systems for reporting and review, and Global Fund
grant renewals can be aligned with national fiscal cycles.
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(Global Fund) Board - Body responsible for overall governance of the organization, and
determines policies, objectives and strategies of the Global Fund.
Budget and Workplan - The budget and workplan outline programme implementation and
the activities of any sub-recipients along with the associated costs.
Collaborative TB/HIV activities - Aim to: (1) establish the mechanisms for collaboration
between tuberculosis and HIV/AIDS programmes; (2) decrease the burden of tuberculosis in
people living with HIV/AIDS; and (3) decrease the burden of HIV in tuberculosis patients.
Community systems - Community systems are community-led structures and mechanisms
used by community members and community-based organizations and groups to interact,
coordinate and deliver their responses to the challenges and needs affecting their
communities.
Community Systems Strengthening (CSS) - An approach that promotes the development
and sustainability of communities and community organizations and actors, and enables
them to contribute to the long-term sustainability of health and other interventions at
community level. The goal is to develop the role of key affected populations and
communities, and community organizations, networks and other actors, in the design,
delivery, monitoring and evaluation of services and activities aimed at improving health
outcomes.
Component - A component is a disease area within a proposal. Within the Global Fund
architecture, disease components are AIDS, tuberculosis (TB) and malaria.
Component implementation period - The cyclical period of up to three years to which all
Principal Recipients for a disease or cross-cutting health system strengthening programme
in a given country will align their Single Stream of Funding and thus financial commitments.
This period is aligned to an in-country cycle (e.g. national fiscal or national programmatic
reporting). The alignment is decided by the Country Coordinating Mechanism together with
the Principal Recipients implementing in the disease or cross-cutting health system
strengthening programme.
Consolidated proposal - is different to grant consolidation. They provide a complete
programmatic picture of the entire disease or cross-cutting health system strengthening
programme for which the applicant is requesting funding for the duration of the proposal
term (i.e. up to five years). Consolidated proposals give applicants the opportunity to reflect
on the progress made towards addressing the disease with their existing Global Fund grants
and propose a revised strategy based on the most relevant epidemiological or
programmatic country context. This strategy should also build on lessons learned and adjust
for any weaknesses or gaps identified in the course of implementation. For applicants with
existing Global Fund grants, the consolidated proposal should include information (i.e.
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objectives, service delivery areas, activities, targets and costs) for the disease or HSS
programme for both:
 existing activities from ongoing grants that applicants would like to continue under the
new proposal; and,
 new initiatives or activities for which additional funding is being requested.
Counterpart financing - Refers to the Global Fund’s requirements regarding a country’s
government contribution (see definition below) to the national disease programme and to
the health sector.
Country Coordinating Mechanism (CCM) - This is a country-level multi-stakeholder
partnership that has overall ownership of and responsibility for proposal development and
grant oversight.
Cross-cutting-health systems strengthening (CC-HSS) interventions - Health systems and
community systems strengthening interventions that, within the country context, improve
programme outcomes for underserved populations in two or more of the diseases by
improving equitable coverage and uptake addressing availability of services, access to
services, utilization of services and/or quality of services; AND are not funded adequately.
Dual-track financing - Is the inclusion of both government and non-government Principal
Recipients (PRs) in proposals for Global Fund financing.
Equity - In the context of the Global Fund, health equity means that those in need are able
to access the services they require in relation to age, sex, sexual orientation or gender
identity, socio-economic status, geographical location or other factors. It means that
services are delivered to the right people in the right places and that most-affected
populations are involved in the planning and delivery of these services.
Gender identity - refers to each person’s deeply felt internal and individual experience of
gender, which may or may not correspond with the sex assigned at birth, including the
personal sense of the body. This may involve, if freely chosen, modification of bodily
appearance or function by medical, surgical or other means and other expressions of
gender, including dress, speech and mannerisms.
General funding pool - Is the Global Fund pool to which applicants can apply for funding for
HIV and AIDS, tuberculosis and malaria, as well as cross-cutting health systems
strengthening activities. In this pool, there is no predefined budget ceiling on proposals,
however, there are conditions regarding focus of the proposal depending on income of the
country.
Government contribution - refers to all public resources specifically allocated to the
national disease programme and the health sector from government revenues; government
borrowings from external sources or private creditors; and debt relief proceeds. With the
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exception of loans and debt relief, all other forms of external assistance, even when routed
through government budgets are not counted as government contribution.
Grant consolidation - This is the:
 Merging of an approved proposal with an existing grant(s) for that Principal Recipient for
the same disease or cross-cutting health system strengthening programme, OR
 Merging of two or more existing grants for the same Principal Recipient and disease or
cross-cutting health system strengthening programme into a Single Stream of Funding
agreement.
Grant consolidation happens at the level of the individual Principal Recipient. The focus of
grant consolidation is on streamlining the management and reporting burden associated
with a Principal Recipient managing multiple grants for the same disease/HSS programme.
Health products - These are pharmaceuticals, other health products (e.g. insecticide-treated
nets, laboratory and radiology equipment, and supportive products such as painkillers) and
single-use health products (such as condoms, rapid and non-rapid diagnostic tests,
insecticides and injection syringes)
Highest-impact interventions within a defined epidemiological context - Evidence-based
interventions that:
 Address emerging threats to the broader disease response; AND/OR,
 Lift barriers to the broader disease response and/or create conditions for improved
service delivery; AND/OR,
 Enable the roll-out of new technologies that represent best practice; AND,
 Are not adequately funded at present.
Implementation window - refers to the period from the programme start date (as set out in
the grant agreement with the Principal Recipient) to the closing date for submission of
proposals.
In-country stakeholders - These include the Principal Recipients, Country Coordinating
Mechanisms, sub-recipients, in-country development partners, civil society organizations,
the private sector, and other entities engaged in the fight against AIDS, TB and/or malaria.
Local Fund Agent (LFA) - Local Fund Agents are entities contracted by the Global Fund in
countries with active grants to provide independent information, advice and
recommendations to the Global Fund.
Non-health products - are all products other than ‘health products’ as described above.
They include vehicles, computers, construction materials and services, such as technical
assistance.
Partners - can be drawn upon throughout the grant process to help develop proposals,
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implement programmes and evaluate programme performance. Partners include
multilateral and bilateral agencies, nongovernmental organizations, civil society
organizations, private sector entities, and other development organizations that address
AIDS, TB and malaria.
Performance-based funding - is a mechanism that links funding to the achievement of clear
and measurable results. It promotes accountability and transparency, and provides
incentives for recipients to use funds efficiently and effectively.
Performance framework - This is the formal statement of the performance expected over
the grant period, which contains key indicators and targets, and is used to measure
programme outputs, coverage, outcomes and impact.
Periodic Review - Looks at the entirety of Global Fund funding for a disease or cross-cutting
health system strengthening programme in a given country. All Principal Recipients
implementing in the programme will be reviewed at the same time. The Periodic Review
replaces the Phase 2 review, and is an in-depth assessment of programmatic performance
and public-health impact of activities supported by the Global Fund. A Periodic Review of
the disease or cross-cutting health system strengthening programme is required prior to the
end of each Component Implementation Period.
Pharmacovigilance - This refers to the detection, assessment, understanding and
prevention of adverse effects, particularly long-term and short-term side effects of
medicines.
Principal Recipient (PR) - A Principal Recipient is a legal entity that is responsible for the
implementation of a grant, including oversight of sub-recipients, grant funds, and
communications with the Local Fund Agent, fund portfolio manager and Country
Coordinating Mechanism on grant progress.
Procurement and Supply Management Plan - is a document prepared by the Principal
Recipient which provides information on the health products required by the programme. It
describes how the Principal Recipient will adhere to the Global Fund’s procurement and
supply management policies and related provisions of the grant agreement. It also describes
the systems and structures that will be used for managing these products under the grant.
Proposal - is made up of an application form and supporting documents. It is submitted to
the Global Fund by Country Coordinating Mechanisms or other eligible entities in response
to the Global Fund Board’s call for proposals. Proposals request funding for prevention, care
and treatment of people and communities living with, affected by, or at risk from AIDS, TB
and/or malaria.
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Recent funding - Refers to when an applicant has completed less than 12 months of
implementation of funding for a particular component (disease or cross-cutting –HSS) at the
closing date of submission of proposals to the Global Fund.
(Global Fund) Secretariat - is responsible for carrying out the day-to-day operations of the
Global Fund, under the guidance of the Global Fund Board.
Sexuality - is a central aspect of being human throughout life and encompasses sex, gender
identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.
Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes,
values, behaviours, practices, roles and relationships. While sexuality can include all of these
dimensions, not all of them are always experienced or expressed. Sexuality is influenced by
the interaction of biological, psychological, social, economic, political, cultural, ethical, legal,
historical, religious and spiritual factors.
Sexual orientation - Sexual orientation refers to each person’s capacity for profound
emotional and sexual attraction to, and intimate and sexual relations with, individuals of a
different sex (heterosexual) or the same sex (homosexual) or more than one sex (bisexual).
Single Stream of Funding - A core feature of the new grant architecture is the single stream
of funding per Principal Recipient per disease or cross-cutting health system strengthening
programme. Each Principal Recipient will have one grant agreement only per disease and/or
cross-cutting health system strengthening programme, which will be amended each time
additional funding is approved and at the time of Periodic Review
Sub-Recipient (SR) - These are entities (government or nongovernment, big or small)
receiving Global Fund financing through a Principal Recipient for the implementation of
programme activities. They are usually selected among stakeholders involved in the
response to AIDS, TB and malaria.
Targeted funding pool - Is the Global Fund funding pool to which applicants can apply for
funding for HIV and AIDS, tuberculosis and malaria only. In addition, in this pool, proposals
must entirely focus on specific populations and/or interventions (see definition below), and
there is predefined proposal budget ceiling of US$5 million for the first two years, and
US$12.5 million over five years.
Underserved and most-at-risk populations - Subpopulations within a defined and
recognized epidemiological context that have significantly higher levels of risk, mortality
and/or morbidity, AND whose access to, or uptake of, relevant services is significantly lower
than the rest of the population. In HIV, these populations may include - but are not limited
to:
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 Women and girls (including pregnant women, trafficked women and children, and those
who are disadvantaged, abused and neglected);
 Men who have sex with men;
 Transgender persons;
 People who use drugs;
 Male, female and transgender sex workers and their clients;
 Prisoners;
 Refugees,
 Migrants or internally displaced populations;
 Adolescents and young people;
 Vulnerable children and orphans;
 Ethnic minorities; and
 People in low-income groups; or people living in rural or geographically isolated settings.
Value for money - The Global Fund defines value for money as being characterized by three
main elements:
 Effectiveness, i.e. that proposed activities represent the best way to achieve the desired
impact, outcomes, and sustainability given the prevailing conditions within the country
context;
 Efficiency, i.e. that desired outputs of proposed activities are obtained at least cost in
terms of inputs; and
 Additionality, i.e. that requested Global Fund support is additional to existing efforts
and will not substitute for other resources (national, private sector, or international)
17.4 Monitoring and Evaluation terminology
Activity - Actions taken to produce specific outputs from inputs such as funds, technical
assistance, and other resources. (UNAIDS)
Baseline - The status of services and outcome related measures, such as knowledge,
attitudes, norms, behaviours, and conditions before an intervention. (UNAIDS)
Coverage - The extent to which a programme reaches its intended target population,
institution, or geographical area. (UNAIDS)
Effectiveness - The extent to which a programme or project has achieved its objectives
under normal conditions in a field setting. (UNAIDS)
Efficacy - The extent to which an intervention produces the expected results under ideal
implementation conditions in a controlled environment. (UNAIDS)
Efficiency - A measure of how well inputs (resources such as funds, expertise, and time) are
converted into outputs. This term is also used more specifically in economic evaluation to
mean the cost value of producing a given product or service. (UNAIDS)
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Goal - The higher order aims of the programme or project, to which the intervention is
intended to contribute. (UNAIDS)
Impact - The longer range, cumulative effect of programmes over time on what they
ultimately aim to change. Often, this effect will be a population-level health outcome, such
as a change in HIV infection, morbidity, and mortality. (UNAIDS)
Impact Evaluation - A scientifically rigorous methodology to establish a causal association
between programmes and what they aimed to achieve beyond the outcomes on individuals
targeted by the programme(s). Impact evaluation looks at the rise and fall of impacts, such
as disease incidence and prevalence or quality of life as a function of HIV/AIDS programmes.
(UNAIDS)
Incidence - HIV incidence (sometimes referred to as cumulative incidence) is the number of
new cases arising in a given period in a specified population. UNAIDS normally refers to the
number of adults aged 15-49 years or children (aged 0-14 years) who have become infected
during the past year. (UNAIDS)
Indicator - A quantitative or qualitative variable that provides simple and reliable means to
measure achievement, monitor performance, or to reflect changes connected to an
intervention. (UNAIDS)
Input - A resource used in a programme, including monetary and personnel resources from
a variety of sources, as well as curricula and materials (UNAIDS)
Objective - A statement of desired programme results. A good objective meets the criteria
of being specific, measurable, achievable, realistic, and time-based. (SMART). (UNAIDS)
Objectives describe the intention of the proposal and provide a framework through which
services are delivered in order to achieve the goals of the programme. An example is: “to
improve survival rates in people with advanced HIV infection in four provinces”. (Global
Fund)
Outcome - The changes that a programme aims to effect on target audiences or
populations, such as change in knowledge, attitudes, beliefs, skills, behaviours, access,
policies, and environmental conditions. (UNAIDS)
Output - The results of programme activities. This term relates to the direct products or
deliverables of programme activities, such as the number of counselling sessions completed,
the number of people reached, and the number of materials distributed. (UNAIDS)
Prevalence - HIV prevalence refers to the number of infections at a particular point in time,
no matter when infection occurred, and is expressed as a percentage of the population.
(UNAIDS)
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Sentinel surveillance - Systematic, continuing collection and analysis of data from certain
sites (e.g. hospitals, health centres, and antenatal clinics) selected for their geographic
location, medical specialty, and populations served, and considered to have the potential to
provide an early indication in the changes in the level of disease. (UNAIDS)
Service Delivery Area (SDA) - This refers to a collection of key services to be delivered in
order to achieve a specific objective. There may be one or more service delivery areas per
objective. For example, antiretroviral treatment and monitoring are separate service
delivery areas aimed at achieving an improvement in survival rates among people with
advanced HIV infection in a number of provinces. (Global Fund)
Surveillance - The ongoing, systematic collection, analysis, interpretation, and dissemination
of data regarding a health-related event for use in public health action to reduce morbidity
and mortality and to improve health. These data can help predict future trends and target
needed prevention and treatment programmes. (UNAIDS)
Target - An objective, which is time-limited and can be measured. Targets are set for a
baseline and successive measurement over five years. (UNAIDS)
Technical Review Panel - An independent, impartial team of disease-specific and crosscutting health and development experts, appointed by the Global Fund Board to guarantee
the integrity and consistency of an open and transparent proposal review process.
Term (also cycle) - This refers to the duration of a grant. The usual term of a grant is five
years, made up of two phases (Phase 1: two years, and Phase 2: three years).
17.5 Other glossaries
The following HIV/AIDS glossaries may also be useful. Please note that UNAIDS cannot verify
the accuracy of information on these sites and accepts no responsibility for the information
provided there.
AIDSinfo Glossary
http://www.aidsinfo.nih.gov/glossary/glossarydefaultcenterpage.aspx
Global HIV M&E Glossary
http://www.globalhivmeinfo.org/Pages/Glossary.aspx?Paged=TRUE&p_Title=Population%2
dbased%20surveys&p_ID=53&View=%7bBD9525B9%2dDE08%2d4F2B%2dBE58%2dAA17FE
BEB67D%7d&PageFirstRow=51
World Health Organization Terms Commonly Used in HIV/AIDS
http://www.searo.who.int/LinkFiles/Publications_terms.pdf
17.6 References used in this glossary:
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1. Centres for Disease Control and Prevention (CDC). Attachment 1: Glossary of HIV
prevention terms. Available online:
http://www.cdc.gov/hiv/topics/funding/PS111113/pdf/Attachment%20_1_Glossary%20of%20Terms.pdf
2. European Monitoring Centre for Drugs and Drug Addiction. EMCDDA Online Glossary.
Available online: http://www.emcdda.europa.eu/publications/glossary
3. Global HIV M&E information (provides definitions used by the prepared by the Evaluation
Technical Working Group of the Joint United Nations Programme on HIV/AIDS (UNAIDS)
Monitoring and Evaluation Reference Group in June 2008). Available online:
http://www.globalhivmeinfo.org/Pages/Glossary.aspx?Paged=TRUE&p_Title=Population%2
dbased%20surveys&p_ID=53&View=%7bBD9525B9%2dDE08%2d4F2B%2dBE58%2dAA17FE
BEB67D%7d&PageFirstRow=51
4. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). Addressing Sex Work,
MSM, and Transgender People in the Context of the HIV Epidemic Information Note.
Available online:
http://www.theglobalfund.org/en/application/infonotes/
5. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011) Aid Effectiveness
Information Note. Available online:
http://www.theglobalfund.org/en/application/infonotes/
6. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). Community Systems
Strengthening (CSS) Information Note. Available online:
http://www.theglobalfund.org/en/application/infonotes/
7. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). Dual-Track Financing
Information Note. Available online:
http://www.theglobalfund.org/en/application/infonotes/
8. Global Fund to Fight AIDS, Tuberculosis and Malaria (2010). Glossary of Terms in
Operational Guide: The Key to Global Fund Policies and Processes. Geneva. Available online:
http://www.theglobalfund.org/en/lfa/documents/
9. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). Matching Resources to
Need: Opportunities to Promote Equity Information Note. Available online:
http://www.theglobalfund.org/en/application/infonotes/
10. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). New Grant Architecture
Glossary. Available online: http://www.theglobalfund.org/en/application/infonotes/
11. The Global Fund to Fight AIDS, Tuberculosis and Malaria. 2011. Value for Money
Information Note. Available online:
http://www.theglobalfund.org/en/application/infonotes/
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12. UNAIDS (2011). UNAIDS Terminology Guidelines (January 2011). Available online:
http://data.unaids.org/pub/Manual/2008/jc1336_unaids_terminology_guide_en.pdf
13. UNAIDS and WHO (2010), Technical Guidance Note for Global Fund HIV Proposals –
Reduction of HIV Stigma and Discrimination.
http://www.who.int/entity/hiv/pub/toolkits/HIVstigma_Technical_Guidance_GlobalFundR1
0_June2010.pdf
14. World Health Organization (2004). Interim policy on collaborative TB/HIV activities.
WHO/HTM/TB/2004.330. Available online:
http://www.who.int/tb/publications/tbhiv_interim_policy/en/index.html
15. World Health Organization (1998). Terms commonly used in HIV/AIDS. South-East Asia
Regional Office. Available online:
http://www.searo.who.int/LinkFiles/Publications_terms.pdf
16. World Health Organization NGO Glossary. Available online:
http://www.who.int/3by5/partners/NGOglossary.pdf
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18 Appendices
18.1 Appendix 1A
Round 10 MENAHRA proposal
4.5.3 Improving value for money
Explain how the proposal represents good value for money. Specifically, given the context of the
regional epidemic and the definition of value for money provided in the Guidelines, describe how the
key interventions in the proposal represent the best balance of costs and effectiveness, with
consideration to the desired achievement of both the short and long term to achieve desired impacts.
The evidence of effectiveness of harm reduction interventions in preventing, slowing or even reversing HIV
epidemics among injecting drug users is well established. The cost effectiveness of OST and NSP is also well
established. Therefore, the subject of this proposal is by definition of a great value for money.
In spite of the commitment of the global fund to funding evidence-based interventions, and specifically to harm
reduction, global demand for funding such interventions has been very low. According to the IHRA Global Harm
Reduction report, 3 cents are spent by the Global Fund per IDU per day. The lack of spending and demand for
resources to fund harm reduction in the countries included in this proposal is well illustrated in table 4.3.2.1. The
cost of inaction in IDU epidemics is much higher than any investment in the field. Experience from countries like
Bangkok, New York and Karachi have shown an increase of more than 40% in HIV prevalence among IDU within
two years.
Proving value for money in advocacy and capacity building is not easy to demonstrate, however the previous
experience of MENAHRA in similar activities as in those described in the present proposal has demonstrated their
importance in creating a momentum for harm reduction among CSOs as well as among governmental
organizations. It is believed that the cost invested in this proposal will pay off once harm reduction is scaled up in
the region and HIV epidemics among IDU are averted. The effectiveness of this proposal and, hence, of the money
invested in it is believed to stem from the following features:
-
-
The proposal provides a forum for uniting and empowering civil society organizations to advocate for and to
implement harm reduction; which otherwise, country by country advocacy will take much costlier efforts and
longer times to build.
The proposal seeks uniting efforts and sharing expertise in a region which is lacking those expertise
The effects of the strategies used under this proposal are sustainable as they rely mostly on empowerment,
capacity building and technical assistance.
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18.2 Appendix 1B
From Macedonia Round 10 proposal
4.5.4 Improving value for money
Explain how the program that the proposal contributes to represents good value for money.
Specifically, given the context of the epidemic in the country and the definition of value for money
provided in the Guidelines, describe how the key interventions in the proposal represent the best
balance of costs and effectiveness, with consideration to the desired achievement of both short and
long term impacts.
The process for identification of the weaknesses and future challenges in the area of HIV response
including development of this proposal was done through evident ownership and accountability of all
national key stakeholders and wide participation of key beneficiaries. As it has been the case with the
previous GFATM grants, proposed interventions and the procedures for management of this grant are
fully aligned with national systems and procedures as well as harmonization and coordinated with all
national and other development partners present in the country.
Given the context of the low HIV epidemic in the country, this proposal has unique focus on HIV
prevention interventions targeting the MARPs in the country. The present investment in prevention
activities among MARPs are expected to prevent the HIV transition among these groups as the most
cost effective and efficient way for prevention of further HIV transmission into the general population.
Interventions included in this proposal are carefully selected following the international and proven
evidence based practice, as the most cost effective and recommended interventions with globally
proven and evident impact on the HIV epidemic. For example, interventions suggested for injecting drug
users follow the recommendations of the “comprehensive package of interventions for IDUs” for
prevention, treatment and care as recommended by UNAIDS, WHO and UNODC.
In 2008 the country has gone through an exercise for costing of the National HIV/AIDS Strategy 20072011. During this exercise, individual costs per clients per services have been estimated, thus further
used for preparation of the detailed budget for this proposal. At the same time, process of the planning
and budgeting of this proposal has been very carefully performed in order to achieve the highest and
best possible result for a lowest possible price. For example, in order to reduce the cost and increase
efficiency of already planned operational research studies, the population size estimation studies will be
conducted in conjunction with the bio-behavioural survey and RDS surveys. Through this study the
representative samples from MARPs needed for the population size estimates will be obtained for the
same cost instead of repeating the same study.
Other important value for money aspect of this proposal is its focus on strengthening existing national
capacity and links to broader development frameworks. It is expected that this will support the
sustainability of impact of the proposal interventions and increase the likelihood of sustainable impact
in the HIV prevention in general.
In the final year, this proposal envisages external evaluation of the program in order to assess not only
the possible gaps and areas for its improvement but at the same time to assess its impact and
effectiveness.
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18.3 Appendix 2A
Round 10 MENAHRA proposal
CLARIFIED SECTION
5.4.1 Overall budget context
Describe any significant variations in cost categories by year, or significant five year totals for those
categories.
Significant variations in the cost categories involve the following areas:
1. Human resources
Human resource cost varies little across the years except in year 3 where it increases by approximately
250%. This is due to the initiation of the work in the drama series which involves high-cost personnel
such as actors, film directors’ crew, etc. The cost of those personnel is temporary only for the drama
series. Cost of human resources comes back to normal spending in the following year.
2. Technical and management assistance
In years 1 and 2 the cost is higher due to an assessed need for MENAHRA’s capacity strengthening. This
technical and management assistance will be provided by WHO and IHRA and will end by the end of
year 2 and remains partial in year 3. Technical and management assistance cost in years 3 and 4 is
mainly provided by MENAHRA to CSOs in the region.
3. Pharmaceutical products (medicines)
The cost incurred under this category comes mainly due to OST. It is assumed that in year 1 the NGOs
providing OST will start gradually to reach full capacity by the end of the year. In Year 2 they will be
operating in full capacity and hence, reach their full target number of beneficiary on OST. This explains
the increase in budgeted cost from year 1 to year 2. In order to ensure sustainability, the NGOs should,
by year 3, start gradually mobilizing other sources to keep their clients on OST. This explains the
decrease in this cost in years 3, 4 and 5.
4. Infrastructure and Other Equipment
In year 1 and 2, the cost of infrastructure is high in order to set up the premises and infrastructure of the
MENAHRA secretariat, SR-KHs and model programmes. This includes the purchase of premises for
MENAHRA which is paid in three instalments (US$100,000, US$100,000 and US$300,000 in years 1, 2
and 3 respectively). With that, infrastructure would be complete and no more spending on
infrastructure is envisioned in years 4 and 5.
5. Planning and Administration
This cost category shows more or less no variations across the years, except in year 2 and 3 where it
increases by approximately 3 times. This is due to the planning and administration cost of the drama
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series which starts in year 2 and ends in year 3.
5.4.2 Human resources
(a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or top-ups
will be consistent with agreed in-country salary frameworks, such as national salary or inter-agency
frameworks for those countries included in the proposal.
 Attach supporting information as evidence, including draft documents where applicable
Human resources represent almost 42% of the budget. In such a proposal, the value of human
resources cannot be underestimated as they are the sole developers of the activities, providers of
services, deliverers of training and technical assistance and managers of the structures described
here within.
As the proposal presented in this document involves little services for end use, and thus very
limited expenditure on procurement of expensive items such as ARVs or expensive health
equipment, it becomes understandable that the cost of human resources would occupy a large
chunk of the budget.
In Year 3, there is a major scale up in the human resource cost and this is due to the production of
the drama series where the cost of actors and film crews are high.
(b) In addition, in cases where human resources represents an important share of the budget,
summarize: (i) the basis for the budget calculation over the initial two years; (ii) the method of
calculating the anticipated costs over years three to five; and (iii) to what extent human resources
spending will strengthen service delivery.
 Attach supporting information as evidence, including draft documents where applicable
The current proposal is about strengthening the capacities of civil society organizations, among
which is the MENAHRA Network Secretariat. The Network Secretariat, after thorough review of its
capacities to play the PR role, has received solid recommendations for staffing and for establishing a
grant management unit. Thus contributing highly to the cost of human resources.
The staffing cost proposed in this proposal will result in the enhancement of the technical,
managerial and financial capacities of the following institutions:
1) MENAHRA Network Secretariat
2) 3 MENAHRA SR-KHs Ar-Razi, SIDC and INCAS
3) NGO Skoun
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4) NGO FDIS
5) NGO SIDC
6) NGO AJEM
These institutions are distributed in 4 countries of the region covered in this proposal and their
capacity will be transferred to many others across the region through trainings and capacity
building.
18.4 Appendix 2B
Round 10 Macedonia proposal
5.4.2 Human resources
(a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or top-ups
will be consistent with agreed in-country salary frameworks, such as national salary or inter-agency
frameworks.
 Attach supporting information as evidence, including draft documents where applicable
Effective services regarding HIV/AIDS prevention among MARPs are being delivered by NGOs,
including outreach activities for hard-to-reach populations. This includes major involvement of
outreach workers delivering services on the field supported by different professionals managing the
outreach work and the work within the offices and various drop-in centres. In order to provide high
quality of services offered by NGOs, large number of professionals will be included in their delivery.
In order to achieve the planned outcomes with this proposal dedicated work and constant presence
on the field is required in order to maintain linkages with final beneficiaries already developed under
the current Global Fund HIV grant and also establishment of new ones. In line with this, the present
partnerships will be strengthened and new ones will be established between the government
agencies and NGOs using the positive experiences from the current Global Fund HIV grant, e.g. VCT
and bio-behavioural surveillance.
The proposed financing of salaries, fees and compensations were agreed by using the historical
amounts used in the Round 3 and Round 7 approved grants, also considering the scope, scale and
range of work. The entire proposed amount in the category human resources was also agreed with
the implementers themselves during the consultative process of developing the Round 10
application and based upon their initial proposals (including their proposed budgets) considering the
national salary framework. All the salaries and fees for this category are calculated as gross amount.
(b) In cases where human resources represents an important share of the budget, summarize: (i) the
basis for the budget calculation over the initial two years; (ii) the method of calculating the
anticipated costs over years three to five; and (iii) to what extent human resources spending will
strengthen service delivery.
 Attach supporting information as evidence, including draft documents where applicable
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As to provide the necessary and high-quality outreach services and well-managed programme (as
outlined in the section 5.4.2.a) adequate financing is required and therefore all human resources in
this proposal contribute to 28.27% of the total proposed budget. Provision of sustainability in terms
of financing of human resources will be achieved through increased domestic financing of the NGO
sector as defined in newly endorsed Strategy for collaboration between the Government and NGOs
(ANNEX 8).
5.4.3 Other large expenditure items
8.5.1
If ‘other’ cost categories represent important amounts in the summary in table 5.4, (i) explain the
basis for the budget calculation of those amounts; and (ii) explain how this contribution is
important to implementation of the national HIV program.
8.5.2
 Attach supporting information as evidence, including draft documents where applicable
All necessary categories of other key expenditure items will contribute to greater achievement of
goals and objectives of this proposed program.
The biggest portion of the budget goes to Medicines and Pharmaceutical products (31.01%) and
relates to provision of treatment for hepatitis C infection among IDUs.
Expenditures for trainings contribute with 4.69% of total requested budget.
Provision of infrastructure and other equipment contributes with 2.10% of total planned budget.
The budget for planning and administration contributes to 3.89% of the total budget, and the
majority counts for expenses related to audit of the grant that will take place each year of the
programme.
Overheads contribute with 7.42% of total requested budget and includes all costs related with
scaling-up of established services and setting up of new ones.
Communication materials contribute with 5.2% of total requested budget.
For details see detailed budgets (ANNEX 35)
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18.5 Appendix 2C
Round 10 Sao Tome and Principe proposal
5.4.1 Overall budget context
Describe any significant variations in cost categories by year, or significant five year totals for
those categories.
HALF- PAGE MAXIMUM
Human resources represents a large proportion of Sao Tomé and Principe’s proposed Round 10
budget (18 %). The main raison is a personal staff cost of the new second PR. The technical and
management assistance cost category represents an important amount because during the proposal
considerable amount of budget is needed to coordinate all international technical assistance of all
four Global Fund Grant in the country by new recruited staff from SR-OMS.
Clarified Section 5.4.2 (b)
5.4.2 Human resources
(a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or top-ups
will be consistent with agreed in-country salary frameworks, such as national salary or interagency frameworks.
The Salary to volunteers which will implement outreach activities among high-risk groups and
PLWHA. Volunteer’s fee was calculated based on target group size and planned coverage and also
previous experience of GFATM, Round 5. The Salary level was indicated based on minimum level of
existing salaries in Sao Tomé and Principe for volunteers (US$150). The functional obligations of
volunteers will include:
1) motivation of high risk group representatives to utilize HIV prevention
services;
2) motivation of high risk group representatives to utilize harm reduction
services;
3) Strengthening of Adherence to ARVT;
4) Strength of PMTCT coverage;
5) Distribution of condoms, IEC materials;
6) Inter Personal communications on Behaviour Change Communications;
7) Consulting and Testing services;
8) Referral to STI diagnostic and treatment
Other salaries:
Salary of coordinators and accountants of NGOs implementing the project. The functional
obligations of volunteers will include:
1) Realization of HIV prevention programmes;
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2) Control and Monitoring of work of volunteers;
3) Reporting system to PR;
4) Reporting for materials received to be distributed among vulnerable groups;
5) Salary of Managers of NGO which will work about strengthening capacity of their institution;
6) Salary of M&E specialists;
7) Also salaries of consultants on development of educational manuals, conduction of trainings,
establishment of computer programmes, implementation of M$E projects, Project
Implementation Unit, and International Technical Assistance were included and determined
being calculated in accordance with NAP and National HIS.
(b) In cases where human resources represents an important share of the budget,
summarize:
(i) the basis for the budget calculation over the initial two years;
(ii) the method of calculating the anticipated costs over years three to five; and
(iii) to what extent human resources spending will strengthen service delivery.
(c) This budget calculation over the initial two years is based on the salary and
subsidy paid in HIV Grant STP-506-G02-H. But in this proposal we established a
harmonization with others Global Fund Grants in STP relative salaries and subsidies.
Attached you can see copies of staff contracts and vouchers of subsidy paid to NAP
staffs;
(d) the method of calculating the anticipated costs over years three to five is the
same in the initial two years; and,
(e) extent of human resources spending on the NAP staffs will give them more
motivation. This motivation will contribute to better service delivery based on
performance. This motivation will also contribute to better organization of services
and their monitoring at central level, health districts level and central hospital.
5.4.3 Other large expenditure items
If ‘other’ cost categories represent important amounts in the summary in table 5.4, (i) explain the
basis for the budget calculation of those amounts; and (ii) explain how this contribution is important
to implementation of the national HIV program. Apart from reference documents proposed by
GFATM-Geneva, we have used the financial data of GF projects management unit (PMU) for unity
cost of certain items in the budget. Rehabilitations, human resources cost, training costs and
consultancy costs estimates. Is presently implementing round 5 Sao Tomé and Principe Global Fund
HIV/AIDS projects, we therefore used these information for certain budget lines.
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18.6 Appendix 3A
Round 10 Georgia proposal
4.6.1 Impact and outcome measurement systems
Describe the impact and outcome measurement systems, including strengths and weaknesses, used
to measure achievements of the national disease program at impact and outcome level.
Currently, there are many organizations involved in collection, analysis, dissemination and use of
HIV/AIDS related data. However, data are not always collected in a systematic and well-coordinated
way. Programmatic M&E data collection mainly focuses on activities and fails to address programme
impact and outcomes (e.g. behaviour change, coverage and utilization of services). Rapid assessment
of the M&E system in Georgia undertaken in 2008 with the UNAIDS support identified the lack of
outcome and impact measurement system as one of the main weaknesses.
Since 2007, considerable progress has been made in terms of the development of the HIV/AIDS
surveillance system that along with routine monitoring and sentinel surveillance incorporates Biobehavioural surveillance studies among high-risk groups. The National Centre for Disease Control
and Public Health has been identified as an agency responsible for coordinating HIV/AIDS
surveillance.
The national surveillance plan was elaborated, accompanied by the standard data collection forms
and a methodological manual for data analysis. The new system has successfully been piloted with
the TGF support. The Ministerial decree #217/o as of July 23, 2010 was issued to support
institutionalization of this arrangement. However, concerns around limited allocation to the
surveillance system from the state budget and reliance on donor support remain valid and require
further consideration.
It is worth mentioning that BSS surveys undertaken for the last few years with TGF grants and other
donor support have successfully been utilized in decision making and planning the national
strategies for 2011-2016. Hence, it is extremely important to make the system fully operational and
ensure that outcome and impact related date is generated regularly. The CCM together with the
NCDCPH and the National AIDS Centre is in the process of developing an effective national M&E
system that would allow for tracking the outcomes and impact of all HIV interventions. The national
HIV/AIDS M&E framework and operational manual, currently being elaborated upon with UNAIDS is
supporting articulate organizational structures, linkages, reporting relationships and indicators to
measure inputs, outputs, outcomes and impact of HIV/AIDS national response. BSS surveys and
operational research are identified as key elements of the M&E system that should receive adequate
technical and financial support and implemented in a systematic way. The NSP for 2011-2016 offers
the national agenda of studies in priority areas to guide M&E processes and avoid ad hoc and
episodic measurement of the HIV programme impact and outcomes.
1. Indicators
 HIV Prevalence among IDUs, MSM, FSM, prisoners
 Percentage of CSWs reporting the use of a condom with their most recent client
 Percentage of men reporting the use of a condom the last time they had anal sex with a male
partner
 Percentage of IDUs reporting the use of a condom the last time they has sex with paid for sex
partners
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 Percentage of IDUs reporting the use of sterile injecting equipment the last time they injected
Method: BSS surveys among MARPs combines with population size estimation studies in 6 cities
2. Indicators
 Level of stigma among health care workers
Method: Operational research on measuring HIV stigma level among health-care workers
3. Indicators
 Percentage of adults and children with HIV known to be on treatment 12 months after
initiation of antiretroviral therapy
 Percentage of IDUs with HIV known to be on treatment 12 months after initiation of
antiretroviral therapy
Method: Routine program data/HIV/AIDS Clinical database.
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18.7 Appendix 3B
Round 10 Macedonia proposal
4.6.1 Impact and outcome measurement systems
Describe the impact and outcome measurement systems, including strengths and weaknesses, used
to measure achievements of the national disease program at impact and outcome level.
Following the UNAIDS “the ones” principle, in 2004 the Republic of Macedonia has developed the
National M&E System and Plan (ANNEX 18) for the National HIV/AIDS Strategy 2003-2006. This M&E
system and plan was aligned with the grant specific M&E system and plan used for the HIV Round 3
and Round 7 grant.
The latest National Strategy for HIV/AIDS 2007-2011 (ANNEX 1) and the action plans for the
upcoming National Strategy on HIV/AIDS 2012-2017 envisages further strengthening and
implementation of the National M&E System on HIV/AIDS. In parallel with the national process for
target setting on the Universal Access to prevention, treatment and care for PLHIV by the end of
2011, the National M&E System will be revised and updated with National M&E plan as per its
strategic action areas within the National AIDS Strategy for 2012-2017 upon its endorsement by the
Government of the Republic of Macedonia. The impact and outcome measurement system for this
program will be scaled–up from the existing M&E system for the current R7 HIV grant.
The HIV/AIDS/STI surveillance system, as well as the surveillance systems for other communicable
diseases in the Republic of Macedonia is regulated by laws and programmes. The epidemiological
surveillance is obligatory for all Regional Centre of Public Health – on a regional level, for their
Organization Units – on local level, as well as for the Institute of Public Health – on national level.
Until 2005, epidemiological data in the country were purely based on the data from the passive case
reporting on HIV cases and there were very limited data on knowledge, attitudes and risk behaviours
among the general and most-at-risk populations. The second generation surveillance system in the
country has been gradually developed, starting with the first bio-behavioural study carried out in
2005. Data on the prevalence and risk behaviours from this study have been used as baseline for
measurement of the progress in the following years. The surveillance system has been further
strengthen with the same type of studies repeated in 2006 and 2007 and particularly the latest
studies in carried out in 2010 using improved study methodology. It is expected that with the latest
study in 2010 using Respondent Driven Methodology for the sample selection, the results and data
will be less biased and more accurate and representative for the MARPs.
Baseline data for outcome and impact indicators in this proposal comes from the latest available
results from the bio-behavioural studies conducted in 2007. The same data has been used for the
country UNGASS Report in 2008 and 2010. Once the results from the ongoing BBS studies among
IDUs, SW, MSM and Prisoners in 2010 is made available, will be used as updated baselines for this
proposal after its possible approval. Within Round 7, one more round of BBS studies among same
groups are planned in the last year that will correspond with the second year of Round 10. Hence,
data for outcome and impact targets in Y2 of this proposal will derive from the studies budgeted
under Round 7. In Round 10 proposal, one more round of bio-behavioural studies (one per target
group) are planned to be conducted and these results will be used for reporting on outcome and
impact indicators in Y4 and Y5 respectively.
At the same time, the M&E system and outcome and impact data used for this proposal are fully
aligned with all national and international reporting requirements such as UNGASS reporting and the
forthcoming reporting on the Universal Access to HIV prevention, treatment and care in 2010.
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Along with bio-behavioural studies, and further strengthening of the second generation system for
HIV in the country in general this proposal envisages activities for human resources capacity building
for operational research on community level as well.
The process of M&E for all activities anticipated with the proposal will be managed and organized by
the Project Implementation Unit within the PR in coordination with the National M&E Group.
Further details on the management and reporting on the performance against planned impact and
outcomes of this proposal are presented in the M&E plan (ANNEX 19) of this proposal. Note: The
submitted M&E plan (ANNEX 19) and MESST action plan (ANNEX 21) within this application refer to
the M&E activities of the R7 HIV application and were revised for the needs of the request for
continuous funding for the Phase 2 of the R7 HIV grant. Due to overlapping of 18 months of R7 and
R10 HIV grants, these M&E documents will be revised accordingly and using GF recommended tools
(MESST) after the termination of R7 HIV grant.
The process of M&E for all activities anticipated with the proposal will be managed and organized by
the Project Implementation Unit within the PR in coordination with the National M&E Group
established for the purposes of the M&E system in the country (ANNEX 20).
During the current Global Fund HIV Grant, at the end of Phase 1, PIU performed an assessment on
the capacity of the existing M&E System and identified weaknesses and gaps using the Global Fund`s
M&E System Strengthening Tool (MESST). In accordance with the results, M&E Team from PIU
developed a three-year action plan in linkage with MESST action plan that includes M&E system
strengthening measures (ANNEX 21). This action plan is currently being implemented both on
national and programme level and plans to further strengthen its capacity with the proposed
application.
Indicators
1) % of most-at-risk population (sex workers) who are HIV infected;
2) % of most-at-risk population (men who have sex with men) who are HIV infected;
3) % of most-at-risk population (injecting drug users) who are HIV infected;
4) % of most-at-risk population (prisoners) who are HIV infected;
5) % of injecting drug users reporting the use of sterile injecting equipment the last time
they injected;
6) % of injecting drug users reporting the use of a condom the last time they had sexual
intercourse;
7) % of female and male sex workers reporting the use of a condom with their most
recent client;
8) % of men reporting the use of condom the last time they had anal sex with a male
partner;
9) % of prisoners reporting use of condom during last sex (with regular, out of prison,
sexual partner during visits)
Measurement method
(BSS – funded with R7 HIV proposal)
Indicators
1) % of most-at-risk population (men who have sex with men) who are HIV infected;
2) % of most-at-risk population (injecting drug users) who are HIV infected;
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3) % of injecting drug users reporting the use of sterile injecting equipment the last time
they injected;
4) % of injecting drug users reporting the use of a condom the last time they had sexual
intercourse;
5) % of men reporting the use of a condom the last time they had anal sex with a male
partner;
Method
(Respondent driven sample – survey and size estimation study among MSM and IDUs)
Indicators
1) % of most-at-risk population (sex workers) who are HIV infected;
2) % of most-at-risk population (prisoners) who are HIV infected;
3) % of female and male sex workers reporting the use of a condom with their most
recent client;
4) % of prisoners reporting use of condom during last sex (with regular, out of prison,
sexual partner during visits)
Method
(Respondent-driven sample survey and size estimation study among SW and bio-behavioural survey
among prisoners)
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18.8 Appendix 4A
Round 10 Kazakhstan proposal
4.2 Epidemiological profile of target populations
(a) Describe the current epidemiological profile of the target populations, and how this profile is
changing with respect to HIV.
The HIV epidemic in Kazakhstan continues to be driven by unsafe practices related to drug use and
sexual practices. As of July 1, 2010, a cumulative number of 14 812 HIV cases were registered by the
Republican AIDS Centre, with a national prevalence of 77.4 per 100,000 population. The 5 most affected
geographic regions are Pavlodar (161.9), Qaraghandy (134.5), East Kazakhstan region (102.4), Qostanay
(91.7) and South Kazakhstan region (62.0). The HIV epidemic continues to be concentrated among IDUs,
with 67.1% of HIV cases being transmitted through syringe sharing and 24.4% through heterosexual
mode of transmission, mostly males (71.9%) and age group of 20-40 years (77.7%). (Annex 17. AIDS
Centre Epidemic Update, July 2010).
According to country estimations, the Republic of Kazakhstan has the highest number of people who use
drugs compared to the rest of Central Asian countries. It is estimated that the country has an overall IDU
prevalence over 1.1% of the total population with age over 15 years and an estimated number of
124,500 IDU population in the country (Annex 18 BBSS Report 2009), while the national statistics
registered a total number of 36,123 IDUs by January 1, 2010 (3.4 times lower than the current
estimates). According to Bio-Behavioural Sero-Surveillance (BBSS) 2009 results, the country has been
successful in containing the HIV epidemic thus far to an overall 4.2% prevalence among drug users in
2008 and 2.9% in 2009, the HIV knowledge indicator reached 78.0% in 2009, yet sustained safe practices
have not been adopted yet fully: over a third (37%) of the IDUs reported did not use sterile syringe use
at last injection, less than a half (44%) reported condom use at last sex and even less (37%) used
condoms consistently in the past 6 months. Female IDUs have somewhat higher HIV prevalence (3.63%)
compared to males (2.75%), with a regional variation from 0% to 22.2%. Hepatitis C and STI prevalence,
markers of unsafe injecting and sexual behaviours, are also high: 60.3% of IDUs (61.2% men and 56.0%
women) have Hepatitis C markers and 10.9% (9.8% men and 16.6% women) have antibodies to Syphilis.
(Annex 18 BBSS Report 2009).
The CCM proposes GF R10 implementation of the five most affected regions in Kazakhstan, East
Kazakhstan, Qostanay, Qaraghandy, Pavlodar and South Kazakhstan regions, where HIV prevalence
among IDUs is more than 5% (6.8% in year 2008 and 5.2% in year 2009). These regions are home to 53%
of total population, 58% of registered number of PLWH and 54% of the estimated number of IDUs.
The HIV situation in prisons is alarming. A cumulative number of 4,108 HIV cases were registered in
prisons, accounting for 28% of all HIV cases registered in the country, of which 96% has been
transmitted through injecting drug use (AIDS Centre Epidemic Update, July 2010). As of January 2010, a
total number of 2,416 HIV-positive prisoners were detained in Kazakh prisons, a 3.4 fold increase from
some 705 HIV-positive detainees in year 2005 (AIDS Centre Epidemic Update, January 2010). Due to a
change in HIV testing policy in 2006 based on opt-out approach, detained people are tested at the time
of entry into pre-trial detention centre, after conviction at the time of transfer from pre-trial detention
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to prison and after six months of stay in prison. This policy allows to document HIV outbreaks in prisons
in pre-trial detention and prisons. In year 2009 alone some 532 new HIV cases were registered among
prisoners, of which 59% were registered at the stage of entry in pre-trial detention, capturing HIV cases
coming from the civilian sector, while 41% were registered in prisons, new cases of HIV transmission in
pre-trial detention and prisons. In the period 2006-2009 a total number of 324 of in-prison transmission
of HIV have been documented through epidemiologic investigation, of which 77.8% in years 2008-2009
alone, showing a sign of worsening HIV epidemic in prisons. The BBSS 2009 results show an overall HIV
prevalence of 2.6% (2.4% in men and 6.5% in women). Drug use is criminalized in Kazakhstan, thus a
high number of active drug users are detained. Based on BBSS 2009 results, it is estimated that an
average 46% (43% to 60%) of prisoners use drugs in prisons. Unsafe injecting and sexual behaviours are
highly prevalent among prisoners, as 43.3% of prisoners have HCV markers (42.9% among men and
50.2% among women) and 11.3% (9.7% men and 37.2% women) have Syphilis antibodies, 46.5% are
estimated to share syringes and some 28.2% used condoms at their last sex. Current prevention
interventions seem to be ineffective at containing the epidemic, as 93.2% prisoners have been covered
by HIV educational sessions and 69.6% have correct knowledge about HIV transmission, 74.8% have
access to condoms, 83.5% have access to disinfectants, while only 32.2% of prisoners said they could get
a sterile syringe. (Source: BBSS 2009)
The CCM proposes to select six regions (Almaty, Qostanay, East Kazakhstan, Qaraghandy, Pavlodar and
South Kazakh regions) where the HIV situation in prisons is the most alarming and select prisons where
HIV prevalence is over 5%. A total of 22 prison sites with an HIV prevalence of 6.8% are included in the
current proposal. The 22 prison sites comprise a total prison population of 18,725 (35% of total prison
population), accounting for 54% of all HIV cases (Source: Ministry of Justice 2010).
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18.9 Appendix 4B
Round 10 Uruguay proposal
4.2 Epidemiological profile of target populations
(a) Describe the current epidemiological profile of the target populations, and how this profile is
changing with respect to HIV.
General profile. After the first case of HIV reported in Uruguay in 1983, the HIV/AIDS epidemic has
maintained a prevalence under 1% in the general population and is concentrated in the populations
most exposed and vulnerable, where figures exceed the 5%. These characteristics of the prevalence of
the HIV infection define the epidemic as a type II or concentrated epidemic. The accumulated cases
reported from 1983 to December 31, 2009 reach a total of 12,852 persons with HIV/AIDS, 3,884 of
whom have developed AIDS, with 2,250 deaths4.
Geographical distribution. There are evidences of territorial distribution of HIV, with the highest rates
seen in Montevideo, tourist and ports departments and border regions.
Age and gender. The accrued figures show a mean age of 34 years, with a mode at 26 years, highlighting
that the transmission of HIV/AIDS –other than the vertical transmission – occurs in the early
adolescence. The age of onset of new cases of HIV infection have dropped in recent years, increasing the
weight of the epidemic in the young. On the other hand, 66% of the cases occur in males and 34% in
women. HIV testing is available for women, because all pregnant women are offered the test since 1997,
with informed consent.
Populations most exposed. Although Uruguay suffers a concentrated epidemic, the epidemiological
study of the populations most exposed was not started until recently. Throughout 2008-2009, second
generation tests (based on knowledge, practices complemented with the active screening of cases) were
conducted on male sex professionals and Trans genders, as well as on MSM.
Males sex professionals and Transgender. The 2006 and 2007 census of the street male sex
professionals (PP STI/AIDS, ATRU, PAHO) identified 1,721 sex professionals. Based on the results
of the census, a second generation study was conducted in the population of male sex
professionals and Trans, including HIV serology, and a Survey on Behaviours, Attitudes and
Practices (Annex 17). There were 313 cases in street male sex professionals and Trans genders.
The study shows the vulnerability to HIV and the disproportionate impact of the epidemic in this
population, i.e., the young (30-year-old mean, with a standard deviation of 10 years; one third
were homeless; low educational level (one out of five had completed high school); high
prevalence of drug consumption; consistent use of condoms during the commercial intercourse
(84%); difference in the prevalence of HIV/AIDS between the two subpopulations: 37% in Trans
and 8% in taxi-boys (male sex workers).
Men who have sex with men (MSM). The 2007 “National Survey on HIV/AIDS- HIV/AIDS related
Behaviours, Attitudes and Practices of Uruguayans”. The results show that 2% of the individuals
report having intercourse with persons of the same sex, and 1% declare having intercourse with
persons of both sexes5. During the year 2008-2009, a specific epidemiological study was
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conducted in the population of males that have sexual intercourse with males. It consisted of a
Survey on Behaviours, Attitudes and Practices, as well as serology HIV testing. It is essential to
know this population if the national epidemic is to be successfully handled. The study included a
sample of 309 cases contacted on the streets and discos. The methodology used was similar to
that used in the survey on male sex professionals and trans genders. The results also show that
the subjects in the sample were young (mean 26 years of age; SD 8 years), with an education level
that did not differ from that of the general population of reference; 43% reported occasional or
frequent heterosexual sexual relations; 44% were tested for HIV at least once in their lifetime, and
the prevalence of HIV was 9%.
Persons deprived of their liberty. There is evidence that the persons deprived of liberty are more
vulnerable to acquiring HIV. A second-generation study conducted in 2007 at a men’s prison in the
Department of Canelones found a 5.5% prevalence of HIV; undetermined cases were not
recorded. And in the case of the prevalence of Hepatitis B, 8.5% of them had presented the
infection before, presenting AbHBc (+) serology reactivity. The type of sexual partners was
statistically significant for the risk of HBV, with a five-fold increase in men that have sex with men
(MSM), showing a relative prevalence of 5.8%in heterosexuals and 23.8% in MSM. (Instituto IDESMinistry of the Interior- PP STI/AIDS-MOH- Virology Unit. Public Health Laboratory Department /
MOH 2007 (Annex 23)
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18.10 Appendix 4C
Round 10 Macedonia proposal
4.3 Gap analysis stated: The last UNGASS progress country report from 2010 (Annex 3) identified the
key weaknesses of current HIV programme, including:
Establishment of new centres for substitution treatment in the capital city – although, 10 new
centres for substitution treatment have been established throughout the country, the substitution
services offered in the capital city remained centralized and provided by only two centres, out of
which only one new addition to the programme, though contributing to the already high rate of
deaths in IDUs as well as overdose cases. The main unforeseen problem is the public resistance and
disagreement on the location for the new centres in the capital. This proposal offers alternative
solution for introduction of drug substitution therapy to IDUs through establishment of publicprivate partnership between the public health system and private psychiatrists (Objective #1; SDA
#1).
Goal:
To keep low HIV-prevalence using an integrated and community-oriented approach in order to
secure sustainability of services and uninterrupted implementation of preventive interventions
among most-at-risk populations.
Objectives and Service Delivery Areas (SDAs):
1. Prevention of HIV transmission among most-at-risk populations
SDA #1: Prevention of HIV transmission among injecting drug users, including the activity to
Continue and scale-up the work of established centres for Drug Substitution: this activity will
provide support and ensure quality control to all drug substitution centres in Macedonia. By March
2010, 2354 IDUs were reached with drug substitution program; and by the end of the grant 800 new
clients will be included in the drug substitution program. The capacities of these centres to provide
high quality services will be strengthened through two trainings for the personnel at these centres
annually, covering a total of 60 professionals over five years. Additionally, monitoring of drug
substitution treatment will be improved through regular supervision visits and Annual Reports
derived from them, providing recommendations based upon lessons learned will be developed and
distributed to key stakeholders. In order to provide unified data collection and management, with R7
HIV grant, a software was developed and networking of all drug substitution cenrtes. The software is
operated by professionals at the centres, taking into consideration privacy and confidentiality of
clients following the Law on Personal Data Protection which was introduced in 2006.
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18.11 Appendix 4D
Round 10 Panama proposal
4.4.1 Interventions
This section should be completed in parallel with the Performance Framework and detailed budget
and work plan
Describe the objectives, service delivery areas (SDA), and activities of the proposal. The
description must be organized in that exact order and the numbering system must match the
Performance Framework, detailed budget and work plan.
The description must reference:
 who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other
implementer); and
 the targeted population(s).
The Panama Collaborative MARPs Initiative is a comprehensive project that will use evidence-based
interventions and promising practices to effectively reach members of most at risk populations
(MARPs). The MARPs to be targeted by this Initiative will be MSM, FSW and people of transgendered
experience. HIV infection in Panama, as in many countries, is primarily concentrated among MARPs,
with MSM, FSW and Trans groups bearing the greatest burden of infection.
Unfortunately, health and social service leaders in the public as well as private sectors remain
unclear as to how best reach, engage, link and retain MARPs in prevention and care services. As a
result of stigma, discrimination, and marginalization, members of MARPs have long been
disconnected from the mainstream, including healthcare and social services. There is a great lack of
knowledge of how to access services or even distrust in government and civil society, which further
alienates MARPs from prevention and care services. However, a great deal of progress has been
made, and there are several evidence-based and practice-based interventions and best practices
that have demonstrated efficacy in reaching, engaging, linking and retaining MARPs in prevention
and care. The Panama Collaborative MARPs Initiative will use a comprehensive, multi-component
approach and use a combination of these interventions and best practices to reach MARPs with HIV
prevention and services. An important strategy will to build the capacity of NGOs and MARPs groups;
increase collaboration with government and civil society, in order to build a sustainable national HIV
prevention program for MARPs.
The key interventions of the Panama Collaborative MARPs Initiative include the following:
Outreach and Education – General outreach and education, which is usually conducted in the form
of distributing educational materials to individuals while providing one-on-one education is core
strategy for providing basic information on HIV prevention to members of the target population. This
activity can be
Enhanced Outreach – This is a best practice model designed for effectively reaching “hard-to-reach”
populations. It is based on the Relational Outreach and Engagement Model (ROEM)6, which provides
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a framework for understanding the outreach and engagement process. There are four phases of
ROEM: approach, companionship, partnership and mutuality. Each phase is marked by a
predominant quality in the emerging relationship as seen from the perspective of the outreach
worker or Health Advocate and the experience of the target individual. The relational field in which
the outreach worker and the targeted individual move is extraordinarily complex and filled with
many subtleties and unknowns. Outreach is necessary precisely because the more general and
generic processes by which people come into care (referral, appointment, walk-in, screening, intake
etc.) have not proven successful in leading to treatment. Outreach and engagement practice seeks
to build a relationship of trust and care with those who present unusual challenges and are the most
difficult to serve. The process takes time and the outreach worker must be present in a variety of
ways with the individual, in brief moments and over long hours, on an unpredictable schedule, as
the person is ready.
Navigation – Patient Navigation is a best practice that has been used in both chronic and infectious
disease program models to improve client retention in care, kept appointment rates, and access to
referrals and support services.7 It was developed particularly in an attempt to address racial/ethnic
and socioeconomic health disparities. It has long been used in cancer care programmes, and has also
been used as an effective strategy in HIV/AIDS for getting people from hard-to-reach and vulnerable
communities linked to care and services quickly. Navigation will be used in conjunction with
enhanced outreach, VCT, and EBIs to reach and bring members of MARPs into services.
Male and Female Condom Distribution – Condoms, both male and female, are a key component of
all HIV-prevention activities. Condoms continue to be the most effective method of protection from
HIV infection during sexual encounters. Correct and consistent condom use is crucial for effective
protection, so condom distribution activities require the following: availability of free condoms that
are easily accessible by members of the target groups; education (usually delivered by a peer) on
correct and consistent condom use, and social marketing and promotional campaigns to promote
condom use.
Mobile, Community-Based Voluntary Counselling and Testing – VCT has been recognized by such
agencies as the World Health Organization and UNAIDS as an important HIV prevention strategy. For
many, it serves as an entry point to care, treatment and support for HIV infected individuals. Mobile,
Community-Based VCT has been shown to be highly effective in reaching targeted populations with
basic HIV/AIDS education.8 The major factors for it success are: 1) the provision of free services; and,
2) convenience of rapid testing (same day results) and having the VCT operations come to local
communities.
Referrals to Services and Follow-up – In addition to VCT and ARVs, it is important to address the
overall health and social service needs of PLWHA, such as mental health needs, substance abuse,
housing, and other services. Failure to address the overall health and social conditions in an
individual’s environment, will increase the likelihood that an individual will be lost from care.
Evidence-Based Interventions – NGOs and MARPs groups will receive training and assistance on
implementing EBIs as part of the HIV prevention services they provide to MARPs. Three EBIs that
have either been used successfully with MARPs in other countries are described below. Additional
EBIs and promising practices will be included as NGOs and MARPs groups build capacity.
Motivational Interviewing (MI) – MI is an evidence based practice designed to increase intrinsic
motivation and elicit behaviour change. It is a directive, client-centred counselling approach that
recognizes that clients who need to make changes in their lives are at different levels of readiness to
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change. MI proposes that, through a process of motivational strategies, providers can actively
increase intrinsic motivation which results in clients moving towards behaviour change. This
approach, which can be used in tandem with most interventions, has been found to be particularly
effective with clients often viewed as “ambivalent”, “challenging” or “resistant”. MI will be used in
combination with other interventions with MSM, FSW and transgendered individuals.
SISTA – Sista is a peer-led group-level HIV prevention intervention originally designed for sexually
active African-American women. It consists of five sessions that focus on increasing gender and
ethnic pride, HIV knowledge, and skills to implement risk reduction behaviours and decision-making.
Sista is based on the theory of gender and power, a social structure theory which proposes that a
woman’s HIV risk behaviours are impacted by gender-based power differences such as economic
factors, division of power and gender based socialization of behavioural norms within a sexual
relationship. The intervention uses gender and culturally appropriate materials to develop HIV
prevention skills while enhancing pride and addressing cultural and gender-related barriers related
to safer sex practices. Sista will be adapted for use mostly with FSWs and the transgender
population.
Focus on the Future (FOF) – FOF is a single-session, individual-level, intervention originally designed
for African-American men who have been newly diagnosed with an STD. The intervention is
conducted immediately after diagnosis and treatment and is usually delivered by a trained peer. It is
a client centred approach that allows the client to explore and address his barriers to condom use.
FOF increases knowledge and skills to help clients implement safer sex practices. In addition,
motivation for behaviour change is enhanced through discussions on how to make condoms
compatible with sexual pleasure and how to actively prevent future STD infections. This intervention
will be used in clinic settings with MSM. It may be adapted for use in non-clinical settings, if
appropriate.
The Panama Initiative has the following goals and objectives:
Goal 1 – To reduce the sexual transmission of HIV through the use of evidence-based interventions
(EBIs) and promising practices for the most at-risk populations (MARPs), specifically men who have
sex with men (MSM), people of transgendered experience (trans) and female commercial sex
workers (FSW); and,
Objective 1.1: To promote behaviour change among MARPS populations regarding HIV prevention,
stigma and discrimination, human rights, and gender equity, through the implementation of
evidence-based interventions
Objective 1.2: Increase access to and utilization of condoms to prevent HIV infection and
transmission among MARPS populations.
Objective 1.3: Increase access to and uptake of VCT services by MARPS populations through linkages
and coordination with MOH, NGOs and civil society.
Objective 1.4: Increase access to and utilization of HIV/AIDS care and support services among
MARPS populations.
Goal 2 – To increase the organizational capacities of MARP groups to ensure a comprehensive
response to the HIV epidemic and guarantee protection of human rights through promotion of
public policies.
Objective 2.1: To develop a Human Rights coalition to advocate for MARPS rights
Objective 2.2: To strengthen the organizational capacity of MARPS groups in program management,
fiscal management, and monitoring and evaluation of HIV AIDS programmes.
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18.12 Appendix 5A
Round 10 Macedonia proposal
Goal: To keep low HIV prevalence using an integrated and community-oriented approach in order to
secure sustainability of services and uninterrupted implementation of preventive interventions
among most-at-risk populations.
Achievement of the main goal of the proposal is planned through definition of 4 project objectives:




Objective#1: Prevention of HIV transmission among most-at-risk populations
Objective#2: Establishing models, mechanisms and activities for community system
strengthening
Objective#3: Strengthening HIV surveillance among most-at-risk populations
Objective#4: Increasing capacity and coordination of the focused response to HIV among mostat-risk populations
Objectives and Service Delivery Areas:
1. Prevention of HIV transmission among most-at-risk populations
SDA #1: Prevention of HIV transmission among injecting drug users
SDA #2: Prevention of HIV transmission among sex workers
SDA #3: Prevention of HIV among men who have sex with men
SDA #4: Prevention of HIV among prisoners
SDA #5: Testing and counselling
SDA #6: Condom distribution
SDA #7: Sexually Transmitted Infections (STI) diagnosis and treatment
2. Establishing models, mechanisms and activities for community system strengthening (CSS)
SDA # 1: CSS: Advocacy, communication and social mobilization
SDA # 2: Community based activities and services - delivery, use and quality
3. Strengthening HIV surveillance among most-at-risk populations
SDA # 1: Information system and operational research
4. Increasing capacity and coordination of the focused response to HIV among most-at-risk
populations
SDA # 1: Supportive environment: Institutional capacity building and coordination
SDA # 2: Strengthening institutional capacities
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SDA #2 Prevention of HIV transmission among SWs
With the support of previous GFATM grants, HIV prevention activities among SWs and their clients
were supported primarily in the capital, Skopje. During the implementation of R7 Grant, these
activities have been expanded in 3 new cities: Strumica, Ohrid and Gostivar.
With the R10 Grant, preventive community outreach activities will continue with condom and
lubricant distribution as well as distribution of IEC materials among SWs and their clients.
Four drop-in centres, currently operational in Skopje, Ohrid, Gostivar and Strumica will continue
offering services such as laundry, showers and free meals. In addition to these services, health/social
and legal assistance available to clients will be enhanced.
Furthermore, the need for 3 new outreach teams for HIV/AIDS prevention among sex workers has
been identified and these centers will be established in Bitola, Tetovo and Gevgelija.
In effort to further improve available services, capacity building trainings for operational teams in
selected locations covering topics such as administrative and financial management, outreach
interventions and empowerment strategies, advocacy and fund-raising will be organized.
Furthermore, these trainings will work on communication and negotiation skills of outreach workers.
The proposed activities are non-restrictive to access, offering equal scope of services to both female
and male sex workers.
By March 31, 2010, a total of 578 SWs were reached. The current estimated number of SWs in the
country is 2,500-3,500 [source: NGOs and Ministry of Interior]. Under these estimates, the coverage
rate with the current GFATM-HIV grant is 12.8% (low end 11%, high end 15.4%). The target set for
R10 HIV Grant during Y1-Y5 is to expand coverage of these preventative activities to approximately
1,265 new SWs. The increased coverage of SW from those already reached with the current GFATMHIV grant will raise the total number of SW reached to 1,723, which corresponds with a coverage
rate of 61.4% (low end 52.6%, high end 73.7%).
The following activities for this SDA are proposed:
1. Outreach work among SEX WORKERS’- In order to prevent transmission of HIV within this target
group, services for promotion of safe sex practices and street safety have been successfully
implemented and will continue. These services include: a) free distribution of condoms and
lubricants b) distribution of hygiene materials c) distribution of informational materials on safe
sexual practices including street safety and d) initial and follow-up training for outreach teams.
The activities involve outreach work in Skopje, Strumica, Ohrid and Gostivar and will be
expanded to surrounding rural areas. During the period of Y1-Y5 a projected 980 new SWs will
be reached with SW preventive activities, 515,900 condoms and 146,298 lubricants will be
distributed.
2. Scaling-up of services for HIV prevention among sex workers – In order to scale-up the HIV
prevention initiative among SWs, 3 new programmes for HIV/AIDS prevention among sex
workers in Bitola, Tetovo and Gevgelija will be established during Y2. For this reason 3 local
NGO’s will be selected to implement the preventive programmes for sex workers in their
respective locations. Over the course of the grant, it is projected that 105 new sex workers will
be reached with targeted intervention in Bitola; 105 new SW`s in Gevgelija and 75 new sex
workers reached with the program in Tetovo, 60,000 additional condoms and 48,000 lubricants
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distributed, 3 offices will be established and 12 staff members will be trained on principles of
outreach work among sex worker’s.
3. Provision of services within drop-in centres for sex workers – within the existing drop-in
centres for sex workers in Skopje, Ohrid, Gostivar and Strumica, wide range of services for sex
workers such as laundry, showers and free meals will be offered. It will also include a provision
of range of professional services such as social, legal and medical assistance, as well as referrals
to STI counselling and testing to STI centres and outreach STI services supported under this
proposal (see SDA 7 of this objective; act. No 1 and 2), including treatment and gynaecological
check-ups. Therefore, the drop-in centres in Ohrid, Strumica and Gostivar, will be additionally
equipped upon the examples of existing drop-in centres in Skopje in order to provide unified
approach and same scope of services for sex workers. Over the course of the 5-year grant, a
projected 950 services will be delivered to sex workers within drop-in centres per year and 1250
medical/social/legal services will be provided per year. Note: sex workers targeted for this
activity are a sub-set of those reported under activity No. 1 and 2 of this SDA.
4. Strengthening of the organizational and operational capacities of the existing programmes for
sex workers Capacity building of staff members offering services to sex workers throughout the
country will be provided via three trainings in year 1 and 2, for administrative and financial
management, outreach interventions and social mobilization strategies, advocacy and fundraising where 25 staff members will be trained. In addition, three international study
visits/conference participation will be organized for staff members for experience exchange and
improvement of the preventive programmes for sex workers.
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18.13 Appendix 5B
Round 10 Peru proposal
The goal of the proposal is to contribute to the reduction of HIV incidence in the transsexual and
MSM populations.
Objective 1: Strengthen the capacity of community-based organizations (CBOs) for transsexuals, gay
men and men having sex with men to respond to HIV and exercise community surveillance.
1. Census of CBOs and their needs to strengthen their organizational and financial management,
infrastructure, monitoring and evaluation in order to carry out prevention, treatment, health care,
support and incident response services, and a mid-term study.
2. Support to improve the organizations’ infrastructure and equipment according to the analysis of
the needs census
3. Technical support for program management, planning, budgeting, monitoring services and legal
support for selected CBOs working to help gay men/men having sex with men.
4. Technical support for program management, planning, budgeting, and legal support for selected
CBOs working with transsexuals.
5. Training new leaders in human rights of transsexuals in order to enforce human rights, promote
advocacy and have a ripple effect on replication.
6. Training new leaders in human rights of gay men and men having sex with men, in order to
enforce human rights, promote advocacy and have a ripple effect on replication.
7. Training CBO community agents on quality care; new approaches in counselling and prevention,
human rights, educational techniques on how to use condoms, social support, nutrition, etc.,
including assistance and mentoring.
8. Strengthening the mechanisms for representation and participation in decision-making spaces.
9. Decentralization and implementation of the community surveillance system for healthcare and
human rights in regions, in coordination with the Ombudsman’s Office.
10. Strengthening capabilities through cooperation between CBOs for men having sex with men and
transsexuals, sharing experiences and good practices and developing a common agenda.
Objective 2: Intensify prevention and care efforts aimed at transsexuals and gay men/men having
sex with men, expanding community service coverage and strategies to reach other men who have
sex with men.
1. Establish a referral and counter-referral system that includes contributions from community
groups and basic community centres in addition to contribution from other sectors.
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2. Establish community centres with a basic package to deliver healthcare services (counselling,
rapid testing and health-care education on HIV prevention) to men having sex with men and the
transsexual population.
3. Design, validation and institutionalization of a Comprehensive Community Health-care Model
(MAIC) for transsexuals and men having sex with men that incorporates community centres.
4. Counselling information campaign and voluntary HIV tests in coordination with centres
specializing in sexual and reproductive health through social networks and web pages (internet), free
confidential telephone line.
5. Strengthening the monitoring and evaluation (M&E) systems for the Sexually Transmissible
Diseases (STD) Reference Centres (CERITs) and Periodic Medical Attention Units (UAMPs) and the
CBOs to support community system management and MAIC.
6. Operational research on the effectiveness of the community healthcare system with regards to
men having sex with men and the transsexual population: 1) MAIC model, 2) referral and counterreferral system, and 3) innovative strategies to supply condoms in populations with high prevalence.
Objective 3: Support CBOs for gay men/men having sex with men in the fight to end homophobia,
stigma and discrimination to reduce barriers to comprehensive healthcare.
1. Develop public policy that includes specific activities and budget dedicated to preventing
homophobia and transphobia.
2. Programmes to raise awareness focusing on key sectors to fight homophobia, stigma and
discrimination.
3. Implementation of a social audit system designed to verify compliance with and give
recommendations on human rights norms on sexual diversity.
4. Integration of hate crimes into the Public Ministry’s Crime Observatory.
Objective 4: Support CBOs for transsexuals in the fight against HIV, on behalf of gender identity
recognition and against transphobia.
1. Study of factors that increase HIV vulnerability, risks of feminization and educational and labor
needs of the transsexual population in the regions of intervention.
2. Develop public policy that includes specific activities and budget dedicated to preventing
homophobia and transphobia.
3. Multi-sector roundtables on the issue of gender identity, equal opportunities for the transsexual
population and HIV prevention.
4. Program focusing on key sectors to build awareness in the fight against transphobia.
5. Program to raise awareness of the fight against transphobia among the general population.
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6. Program for access to equal employment opportunities for transsexuals.
7. Programme to help transsexuals access equal educational opportunities.
8. Filing hallmark cases that will generate case law to effectively protect the human rights of people
based on sexual orientation and gender identity.
Objective 5: Generate and institutionalize the evidence necessary to facilitate access to
comprehensive healthcare for transsexual and gay men/men having sex with men populations.
1. Support the study of epidemiological surveillance on incidence, prevalence, population size and
risk behaviour among transsexual, gay and men having sex with men populations.
2. Study of mid-term and final evaluations of the program to help transsexual, gay and men having
sex with men populations’ access comprehensive healthcare.
3. Present evidence on men having sex with men, gay and transsexual populations.
GOAL 5: Generate and institutionalize the evidence necessary to improve access to comprehensive
healthcare for transsexual and gay/MSM populations
The anticipated outcome of the fifth goal is to have a strengthened epidemiological surveillance
system for the gay/MSM and transsexual population by the end of the second year of
implementation. The goal is aimed at strengthening and institutionalizing epidemiological research
studies done by the General Directorate of Epidemiology and operational studies that are needed to
improve and adjust intervention strategies for access to comprehensive health care for the
transsexual and Gay/MSM populations.
SDA CSS: Information systems
5.1 Support the study of epidemiological surveillance on incidence, prevalence, population size
and risk behaviour in Transsexual Gay and MSM populations
The proposal aims to help the General Directorate of Epidemiology (DGE) in an epidemiological
surveillance study about incidence and behaviour of the transsexual and gay/MSM population,
considering the different risk characteristics for each population. The recommended methodology is
Respondent-Driven-Sampling, which is a sampling method based on a chain of references similar to
the snowball effect technique, with the difference that this one generates a final sample
independent of the individuals recruited at the beginning of the study, in addition to being
reasonably representative of the population it studied. The plan is to support the study done in two
cities, complementing the DGE programme.
Sub-activities are the following:
 5.1.1 Work plan for evaluation study
 5.1.2 Studying the evaluation study
The outcome is a report of the completed study
Responsible party: Coast sub-recipient
SDA CSS: Monitoring and evaluation, evidence building
5.2 Study of mid-term and final evaluations of the programme to help transsexual, gay and MSM
populations access comprehensive healthcare
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This study is aimed at evaluating the results of the proposal’s implementation. It will feed the
programme indicators that were implemented in the communities and will be carried out twice in
the selected regions.
Sub-activities are the following:
 5.2.1 Work plan for evaluation study
 5.2.2 Studying the evaluation study
Outcome is the report of the completed study
Responsible party: Coast sub-recipient
SDA CSS: Monitoring and documentation of community and government interventions
5.3 Present evidence on Gay/MSM and transsexuals
Finally, there will be national forums for 400 people (leaders from the public sector, communitybased organizations, academia, etc.) every two years to present the evidence generated by the
studies done in the project on the transsexual and gay/MSM population. This opportunity will be
used to analyze the problem and present attainable solutions.
Sub-activities are the following:
 5.3.1 Disseminate up-to-date information from studies on evidence for transsexual
and MSM populations
 5.3.2 Macro-regional and national forums to disseminate information from studies on
transsexual and MSM populations as part of Global Fund programmes
The outcome is 400 people who participated in forums where evidence was presented
Responsible party: Coast sub-recipient
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18.14 Appendix 6A
Round 10 Peru proposal
4.4.7 Links to other Global Fund resources
Describe in the table below the linkages between this Round 10 proposal and existing Global Fund
resources. It is important to list the SDAs and activities as outlined in the current proposal in the left
hand column, add a description as to how they relate to previous grants in the middle two columns,
and then outline how the Round 10 proposal specifically addresses this in the right-hand column.
SDAs and key activity, according to
Round 10 proposal
Existing grants
PER-607-GO5-H
Round 10 Proposal
[Insert Round number]
1. SDA CSS: Human Resources: capacity building for service delivery, advocacy and leadership
1.1 Activity
Training new transsexual leaders in
Human Rights, mechanisms to
demand those rights, advocacy and
ripple effect on replication
Workshops on situation analysis
and negotiation strategies for
LTGB/MSM and sex worker leaders
The activity seeks to complement
training for new leaders by
differentiating between the
transsexual and gay men/MSM
populations, taking into
consideration the different
agendas they need to address.
2. SDA Reduction of stigma under all circumstances
2.1 Activity
Develop public policy that includes
specific activities and budget
dedicated to preventing
homophobia and transphobia
Develop coordinated plans to
promote and defend human rights
among LTGB and sex workers’
organizations
The aim is to regulate policies
already achieved in the previous
proposal and formulate new ones
in regions where there are none
3. SDA CSS: Monitoring and documentation of community and government interventions
3.1 Activity
Decentralization and
implementation of the regional
healthcare and human rights
community surveillance system in
coordination with the
Ombudsman’s Office and following
the incident plans
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Strengthen the coordination,
surveillance and participation
system
The aim is to strengthen the
surveillance system started in the
previous proposal and expand it to
regions where there isn’t one
18.15 Appendix 6B
Round 10 Panama proposal
4.4.7 Links to other Global Fund resources
Describe in the table below the linkages between this Round 10 proposal and existing Global Fund resources.
It is important to list the SDAs and activities as outlined in the current proposal in the left hand column, add a
description as to how they relate to previous grants in the middle two columns, and then outline how the
Round 10 proposal specifically addresses this in the right-hand column.
Key SDA and activity as proposed in
the Round 10 proposal
Round 9
Existing grants
Round 10 Proposal
[insert Round #]
1. Stigma reduction in all settings
1.1 Activity Develop agreements
with the private sector to enforce
rights for MARP groups in the
workforce
Avanzada COPRECOS LAC, Round 9
Avanzada includes activities for
reducing stigma and discrimination
against MARPs by uniformed
services personnel. Because
MARPs, in particular FSW, are
commonly found in communities
around military and police bases,
the project will need to coordinate
activities with those of Avanzada to
maximize outcomes. Avanzada
includes opportunities for joint
projects between military/police
and community NGOs or MARPs
groups, which will be opportunities
to coordinate activities.
Avanzada COPRECOS LAC, Round 9
Avanzada includes opportunities
for joint projects between
military/police and community
NGOs or MARPs groups, which will
be opportunities to coordinate
activities, particularly condom
distribution to uniformed services
personnel and MARPs.
1.2 Activity
2. SDA Condoms
2.1 Activity 1.2.3 Condom
education and distribution to
MARPs with male and female
condoms
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18.6 Appendix 6C
Round 10 Macedonia proposal
4.4.7
4.4.7 Links to other Global Fund resources
Describe in the table below the linkages between this Round 10 proposal and existing Global Fund resources. It is
important to list the SDAs and activities as outlined in the current proposal in the left hand column, add a
description as to how they relate to previous grants in the middle two columns, and then outline how the Round
10 proposal specifically addresses this in the right-hand column.
Describe in the table below the linkages between this Round 10 proposal and existing Global Fund resources. It is
important to list the SDAs and activities as outlined in the current proposal in the left hand column, add a description
as to how they relate to previous grants in the middle two columns, and then outline how the Round 10 proposal
specifically addresses this in the right-hand column.
Key SDA and activity as proposed in
the Round 10 proposal
Existing grants
Round 10 Proposal
Round 7
1. Obj.1 SDA 1 Behavioural change communication - community outreach – IDUs
Two new HR/NE
programmes were
established in Tetovo
and Gevgelija; 1239
IDUs and 107 key
stakeholders were
reached during phase
1.
The new Grant will scale-up
the coverage of the existing
10 HR/NE programmes to
reach 2,779 new IDUs, 285
IDUs and 215 professionals in
total will be trained on
principles of overdose during
Y1-Y5
1.2 Continuation and scale-up of the
work of established centres for Drug
Substitution
11 drug substitution
centres offered
treatment to 851
IDUs, 60 staff were
re-trained during
phase 1. Government
took over the
procurement of
methadone.
By the end of the grant 800
new clients will be included in
the drug substitution
program. Refresh trainings for
60 staff members will
continue on annual basis
during the course of the
Grant.
1.5 Sharing experience of Harm
reduction best practices
The previous Grant
targeted 1 harm reduction
conference held nationally.
6 health care professionals
visited other HR
programmes.
Six professionals will participate
at international study tours and
one conference will be organized
under the new Grant.
1.1 Building-up upon best practices
from the work of the existing Harm
Reduction-Needle Exchange
Programmes
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2. Obj1.SDA 2: Behavioural change communication – community outreach – sex workers
2.1 Outreach work among SW’s
cruising at open scenes
2.2 Scaling-up of services for HIV/AIDS
prevention among sex workers
2.3 Provision of services within drop-in
centre for sex workers
The Grant targeted
reach of 386 new
SWs cruising at open
scenes by the end of
phase 1.
The new Grant will increase
the number of SWs to 980
new clients cruising at open
scenes.
The Grant supports
establishment and
functioning of 3 new
programmes for SWs
in Gostivar, Ohrid and
Strumica.
Additional 3 new programmes
for HIV prevention among
SWs in Bitola, Tetovo and
Gevgelija will be established
reaching 285 new SWs; 12
staff members will be trained
for outreach activities.
The Grant supports
the functioning of 4
drop-in centers for
SWs in Skopje,
Gostivar, Ohrid and
Strumica offering
facilities such as
laundry, showers and
free meals, as well as
medical, social and
legal services
Existing 4 drop-in centers will
continue to offer services to
SWs. It is planned 950 services
provided within drop-in
facilities and 1,250
medical/social/legal services
will be provided on annual
basis. (Y1-Y5)
3. Obj.1 SDA 3 Behavioural change communication - community outreach – MSM
3.1 Further pursue of services offered
in the LGBT centres
As of phase 1 two
new LGBT centres
were established in
Bitola and Strumica
The new Grant targets to
reach 1,395 new MSM with
services offered within LGBT
centres
3.2 Expansion of outreach work
among MSM
With outreach
activities, 1182 new
MSM were reached
during phase 1.
The new Grant will increase
the number of new MSM
reached to 1,495 with
outreach work.
4. Obj.1 SDA 4 Behavioural change communication - community outreach – prisoners
4.1 Educational sessions on HIV/AIDS
in prisons
The Grant targeted
reach of 2,697
prisoners with HIV
prevention sessions
during the phase 1
and 8 staff trained as
educators.
The new Grant aims to reach
2250 prisoners with HIV
education sessions held from
teams of two: prison staff and
NGO member. Trainings for 8
staff and 8 NVO educators will
be organized.
4.2 Continuation of drug substitution
The Grant supports
The new Grant will continue
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programme for prisoners.
opening of one drug
substitution centre
within Jail “Sutka” in
Skopje. As of phase 1,
total of 247 prisoners
were included in
MMT.
to monitor drug substitution
program in two biggest
prisons in Skopje, targeting
250 prisoners reached with
MMT.
During phase 1 of the
Grant 448.362 male
condoms were
distributed to IDUs,
SWs, MSM, prisoners
The new Grant will increase
the target to 1,549,700 male
condoms distributed to
MARPs and PLHIV over the
course of five years.
6. Obj.1 SDA 6 Condom distribution
6.1 Condom distribution
9. Obj.2 SDA 2: Community based activities and services - delivery, use and quality
9.2 Community oriented interventions
for IDUs and networking with existing
drug substitution centres
During the phase 1,
the Grant targeted
reach of 376 IDUs
and their family
members with
psychosocial support.
The new Grant targets to
reach 375 IDUs with
counselling services. It also
aims to strengthen the
cooperation between
community-based
organization for IDUs and
centres for drug substitution
through trainings on principles
for delivery of community
oriented interventions
reaching 45 IDUs and 45
service providers from existing
DS
10. Obj.4 SDA 1: Information system and operational research
10.1 Behavioural and serological
surveys among most-at-risk
population
The Grant targeted
conduction of 2
national biobehavioural studies,
introducing RDS
methodology for
hard-to-reach
populations.
The new Grant will increase
the number of studies to
additional 4 bio-behavioural
studies among MARPs (IDUs,
SWs, MSM and prisoners)
over the course of the Grant.
10.2 Estimation of size of most-at-risk
populations (IDUs, MSM and SW)
The Grant supported
a survey for
determination of size
of MARPs
The new proposal, two
surveys on estimation of size
of populations (MARPs) will be
conducted in Y3 and Y4.
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