Iryna Reshevska Catherine Severo Melinda Ojermark Mark Eldon-Edington

1. with the Global Fund to Fight AIDS,TB and Malaria Global Fund Country Coordinating Mechanisms: Providing Oversight and Leadership during the Transitional Funding Period Iryna Reshevska Catherine Severo Melinda Ojermark Mark Eldon-Edington XIX International AIDS Conference 2012 Non-Commercial Satellite Session July 22, 2012

2. Funding under the Transitional Funding Mechanism (TFM) • Proposals for continuation of essential prevention, treatment and/or care services • Harmonization with other donor programs • No alternative sources of funding • Eligibility of applicants - ECFP Policy - WB classification

3. TFM Process • General vs Targeted Funding Pools (90/10%) • Combined disease burden and country income level scores • Prioritization of proposals within the Targeted Pool • Objective to avoid disruption of essential services • Approval of applications on a rolling basis

4. Evaluation criteria

5. TFM Current Status • 48 applicants: 3 non CCMs, 2 RCMs and 43 CCMs (all are compliant, some with management actions underway) Status of the Process: • Board endorsement of Technical Review Panel’s recommendations - July 20th • Way forward….Board funding decisions (after grant negotiations) – 2012/2013

6. Applicants needed to demonstrate compliance with all requirements TFM requirements 1 Current grantee Applicants must have a current grant and be eligible for new funding (i.e. on the 2012 eligibility list). At risk of disruption Applicants’ grants must face significant program disruption between 1 January 2012 and 31 March 2014 (does not equate to the ending of a grant) 1 Continuation of essential services Funding requests are restricted to the continuation of essential prevention, treatment and care services financed by the Global Fund at existing scale at time of disruption 2-year funding request Applicants must limit their funding request to two years. 2 No alternative sources of funding • Applicants must demonstrate that there are no alternative sources of funding available to finance the proposed activities; including reprogramming is not possible.

7. TFM review 1 Objective: To avoid disruption Element of review Technical merit Assessment of proposal against technical review criteria O u t c o m e s TFM requirements Real disruption, scope, funding sources, etc. ECFP requirements Proposal focus, counterpart financing, special assessments

8. Two-year demand (in US$)* 1 US$ 606.6 million (61 proposals) Breakdown by Disease Breakdown by WHO Region Malaria 38% 232 mil US$ 14 proposals Malaria 38% 232 mil US$ 14 proposals HIV 41% US$ 253 m 26 proposals TB 21% 130 mil US$ 21 proposals * Figures using the EUR/US$ exchange rate of 1 July 2012

9. Role of CCMs under TFM • Conformity with Eligibility Criteria • Needs Evaluation • Assistance to PR(s) in Re-programming • Consideration of Changing PR(s)/SRs • Counter-signing of grant agreement • Routine oversight activities, including site visits

10. What Is CCM Oversight? • Oversight is a CCM responsibility! • Oversight is not micro-management: It is a scanto identify cross-cutting problems of implementation • It is strategic! Focus is on broad objectives and service delivery approaches • It is cyclic! Follows reporting cycles to review: • The performance of the Principal Recipient as manager, • The timely execution of the work plan and • The technical results compared to quarterly and annual targets

11. CCM oversight: A national responsibility SR SR SR SR LFA CCM PR The Country

12. Oversight: The Big Picture

13. Five Key Questions for Every Grant • Where is the money? • Where are the drugs, supplies and equipment? • Are sub recipients receiving funds and resources as planned? • Are grants being implemented as planned? • What are the results?

14. CCM oversight => improved grant performance • The CCM should help the PR identify problems and bottlenecks hindering implementation. • The CCM should help the PR definesolutions. • The CCM should help implement solutions where the PR does not have sufficient authority or capacity alone.

15. Four essential elements of oversight Better dialogue with principal recipients Timely problem identification & resolution Enhanced grant performance

16. Challenges to Grant Oversight • No time for oversight – CCM members are very busy people! • Getting information too late to provide real oversight • Increasing number of grants and PRs – too much information! • Too many details in the quarterly reports, not enough details in verbal or narrative reports

17. Enhancing Importance of the Oversight Function • This is how CCMs demonstrate ‘Country Ownership’ during grant implementation. • This is the only way for them to ensure that their strategy is on track. • Evidence confirms that strong oversight practices lead to good grant performance. • This is so important that the Global Fund is working on ‘Minimum Standards’ for CCMs (to be monitored on a yearly basis)

18. GMS Tools for Successful Oversight • Rapid Assessment of CCM Oversight Capacity • Conflict of Interest Diagnostic Tool • Oversight Plan • Work Plan & Calendar • Oversight Committee TOR • Site Visit Tools • Grant Dashboards

19. For more information: Visit: http://www.theglobalfund.org/en/ccm/support/oversight/

20. Grant Dashboard Video…

21. Oversight priorities for 2012-2014 • How to provide quality oversight for continuity of treatment and effective use of resources ? • Evaluating your portfolio: which grants need what type of oversight • SSF, consolidated, R10: normal • Late phases, COS, bridge, • FM: intensified oversight

22. Continuity of Service (COS) • Interventions proposed under the TFM should fall within the COS Policy • Up to two years of funding to continue certain courses of treatment • No increase in number of people on treatment, no introduction of new interventions • Funding under COS is available in both unanticipated and anticipated closures

23. Services covered under the COS Policy • Medicines: - ARVs - Opportunistic Infections • PMTCT activities • Medicated Assisted Therapy for IDUs • Diagnostic tests • Human Resources directly linked to delivery of services for existing patients • Other ongoing direct costs (e.g. delivery & storage of drugs) • Limited and critical operational costs

24. Peculiarities of COS applications under the TFM • Both COS and TFM are for a maximum of two years • COS continues only treatment activities for existing patients, but does not cover prevention activities and is essentially limited to HIV grants   • TFM continues all essential activities at the same scope and scale that were being financed through Global Fund grants as of the disruption date • TFM is applicable to all three diseases and integrated HSS grants

25. Special information needs to oversee COS: HIV • Epidemiological situation and trends • Number of patients on ART and estimated needs in ARVs • Waiting list, if any • TB screening and treatment needs among PLWH • PMTCT needs and OVC challenges • Prevention and treatment interventions among key populations ATTENTION! • No scale up of ARVs • No untargeted population approaches to prevention • No general population testing in concentrated epidemics • No generalized nutrition support • No blood safety or pre-exposure prophylaxis • No infrastructure development • No general education programs, BCC approaches

26. Special information needs to oversee COS: TB • Epidemiological situation and the trends • Number of patients on treatment • Diagnosis and treatment needs among DS/MDR TB patients • Needs for high impact interventions that ensure early case detection • HIV testing and treatment needs among TB patients ATTENTION! • No scale up of DOTS • No scale up of DS/MDR TB services • No food support for TB patients • No infrastructure development • TB screening needs among high risk populations • TB infection control needs (TB transmission in health facilities)

27. Special information needs to oversee COS: Malaria • Epidemiological situation and trends, seasonal data • Vector control activities • Case management = combination of diagnostics and appropriate treatment • Intermittent preventive treatment in pregnant women in high burden settings ATTENTION! • No scale up of vector control activities and case management • Intermittent preventive therapy for infants and children • Infrastructure development

28. Closer oversight of drug stocks and deliveries For better oversight of storage facilities for medical products, it is incumbent on CCMs to: 1. Organize site visits (central and peripheral storage facilities and treatment sites) 2. Analyze available stock, security stock and orders, and make contingency plans for stock-outs 3. Analyze the distribution system and make contingency plans for bottlenecks 4. Ensure that regional stocks are balanced to ensure relocation if needed

29. Intensified harmonization with other donor programs • National Disease Strategic Plans - to avoid duplication of efforts • Gap analysis and assessment of demand for programs, HSS and CSS investments • Re-examination of the services package content offered to epidemiologically important populations • Work with government, donor partners to align resources to ensure adequate response

30. Questions and discussion

31. Case Study: Ferrovia Grant Portfolio Grant Performance Last Quarter Current Quarter

32. Case Study Discussion Questions • Which figures will guide you in determining your oversight objectives? • What are the key grant events to include in the oversight calendar for 2012-2014? • What might be done to better coordinate the efforts of the two AIDS PRs and the two TB PRs? • What might be done to ensure a successful Phase 2 review of the HIV/AIDS grant? • What might be done to better plan the transition from the COS to the TFM support for tuberculosis?

33. Sample oversight calendar