Transcript Document

Malaria Round 8 Lessons Learned & Outcomes of 18th Global Fund Board
Meeting
Roll-Back Malaria Board Meeting
10 November 2008
Professor Rifat Atun
Director, Strategy, Policy and Performance Cluster
The Global Fund
Global Fund is committed to impact on malaria
• Dedicated to targets of GMAP
• Working with partner on prevention, scaling up effective
treatment & on TA in areas such as procurement
• Providing flexible financing while adhering to PBF for
impact
Round 8 represents a significant step in increasing value of
funds – GF is integral to the fight against malaria
Results: people reached with services
Mid 2007
Mid 2008
% increase
since mid 2007
HIV:
People on ART
1.1 million
1.75 million
59%
TB:
DOTS treatment
2.8 million
3.9 million
39%
Malaria:
ITNs distributed
30 million
59 million
97%
Indicator
Acceleration of scale up
Accelerating Results
4.5
60
55
4
DOTS
50
3.5
ITNs
45
3
40
35
2.5
30
2
25
1.5
20
15
1
10
0.5
5
0
-
Dec-04
Jun-05
Dec-05
Jun-06
Dec-06
Jun-07
Dec-07
Jun-08
ITNs (millions)
ARVs and DOTS (millions)
ARVs
500
0
Jan-01
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Nov-01
Dec-01
Jan-02
Feb-02
Mar-02
Apr-02
May-02
Jun-02
Jul-02
Aug-02
Sep-02
Oct-02
Nov-02
Dec-02
Jan-03
Feb-03
Mar-03
Apr-03
May-03
Jun-03
Jul-03
Aug-03
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
May-04
Jun-04
Jul-04
Aug-04
Sep-04
Oct-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
May-05
Jun-05
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Malaria in-patient and out-patient laboratory-confirmed
cases
4,500
3,000
2,500
4,000
2,000
3,000
1,500
Malaria in-patient cases
Out-patient confirmed cases
Non-malaria in-patient cases
2001
2002
2003
2004
Month
2005
2006
2007
Non-malaria in-patient cases
Increasing country evidence of malaria impact
Declining malaria in health facilities after intervention: Rwanda, 2001-2007
7,000
Interventions
4,000
6,000
3,500
5,000
2,000
1,000
1,000
Incidence↓~64%
0
Year
Malaria Grants – Rounds 1 to 7
West Pacific
Andean
RMCC
Total lifetime budget (million USD)
Less than 20
20-50
More than 50
Performance rating at 18 months
Performance:
Malaria
17%
TB
A - good
B1 - adequate
52%
32%
HIV/AIDS*
31%
54%
24%
0%
50%
20%
40%
15%
27%
60%
% of phase 2 grants, per disease
* Includes HIV/TB grants
B2/C - poor
80%
100%
Round 8: TRP Recommendations
2 Year Upper
Number
Within disease
Disease Proposal
5 Year Upper
Percent of 5
Ceiling all
Year Upper
Recommended
Ceiling
(US$ millions)
Budget
Percent of 2 Year
Ceiling all
recommended
Upper Ceiling
success rate
Recommended
for funding
Budget
(US$ millions)
HIV (including HSS requests)
37 of 76
49%
1,196
38%
3,416
46%
Tuberculosis (including HSS requests)
29 of 57
51%
344
11%
960
13%
Malaria (including HSS requests)
28 of 41
68%
1,623
51%
3,014
41%
94 of 174
54%
3,163
100%
7,390
100%
TOTAL
Round 8: TRP Recommendations
Cumulative 2 Year
Upper Ceiling (US$
millions)
EURO amount as part of
US$ ** (millions)
Funding Category
Number of Proposals
2 Year Upper
Ceiling US$
(millions)
1
16
460
460
49
2
51
1,928
2,388
433
2B Total
27
Composite index 8
6
446
2,834
15
Composite index 6
4
87
2,921
52
Composite index 5
8
133
3,054
48
Composite index 3
9
109
3,163
12
2B Sub-total
775
94
3,163
All recommended
127
3,163
609
Category 2B Proposals: Composite Index 3
No.
Country
Disease
88
Bulgaria
Tuberculosis
89
Bolivia
Malaria
90
Fiji
Tuberculosis, incl CCHSS
91
Guyana
Tuberculosis
92
Kazakhstan
Tuberculosis
93
Sri Lanka
Malaria
94
Tunisia
Tuberculosis
Round 8: Key Outcomes - Number of Proposals
Overall success rate: 54% (94 of 174, highest to date)
• Within the Diseases:
– Malaria:
– Tuberculosis:
– HIV:
68%
51%
49%
Health systems strengthening 'parts' fared well
• Overall success rate: 56% (25 of 45, as part of 174)
Board Decision Point GF/B18/DP7 on AMFm
• Policy Framework and Implementation Plan approved
• GFATM to host and manage the AMFm in Phase 1 in a
limited number of countries
– Pre launch overseen by AMFm Ad Hoc Committee
– 19th Board meeting: decision on the Governance structure for the
oversight and performance monitoring of implementation of Phase 1
• Independent technical evaluation of AMFm roll-out
• Work and support of the RBM Task Force, UNITAID and
other partners acknowledged and their support requested
to develop and implementation of AMFm
Funding Decision
1. Round 8 Phase 1: proposals to be approved for funding—collectively
subject to a 10% efficiency adjustment: max. limit of $2.753Bn for P1
– Category 1’ and ‘Category 2’ with composite indices 8, 6, and 5
2. Round 8 Phase 2: Collectively be subject to a maximum limit of
$3.087Bn* (75% of the P2 amounts in the R8 recommended
proposals).
3. New Rolling Continuation Channel (RCC): RCC 1 approved by the
Board each be subject to a limit of 140% of the amount of the
incremental funding approved for the P2 period of the relevant expiring
grant.
4. Phase 2 and RCC: Efficiency savings of 10% (US$0.5Bn) until 31
December 2010, in P2 renewals of existing grants and upcoming RCC
renewals
5. Round 9: deadline for submission of proposals extended to 6/2009.
– *Limit may be partially or fully relaxed If new resources become available
Decision: Approval of Round 8
• The Board approves for funding for an initial two
years those Round 8 proposals recommended for
funding by the Technical Review Panel (TRP) as
‘Category 1’ and ‘Category 2’ with composite indices
8, 6, and 5
Category 1
No.
Country
Disease
1
Afghanistan
Tuberculosis
2
Armenia
Tuberculosis
3
Belarus
HIV, incl. CCHSS
4
Gabon
HIV
5
Mauritius
HIV
6
Moldova
Tuberculosis
7
West Bank and Gaza
Tuberculosis
8
Peru
Tuberculosis
9
Ethiopia
Malaria, incl. CCHSS
10
Indonesia
HIV
11
Indonesia
Tuberculosis
12
Mauritania
HIV, CCHSS only
13
Sao Tome and Principe
Tuberculosis
14
Swaziland
Malaria
15
Thailand
Tuberculosis
16
Zambia
HIV, incl. CCHSS
Category 2: Proposals with Composite Index 8
No.
Country
Disease
17
Burkina Faso
Malaria
18
Central African Republic
Malaria
19
Chad
HIV
20
Côte d'Ivoire
Malaria
21
Mali
HIV, disease part only
22
Tajikistan
HIV
23
Togo
HIV
24
Bangladesh
TB, incl. CCHSS
25
Democratic Republic of Congo
HIV
26
Democratic Republic of Congo
Malaria
27
Eritrea
HIV, disease part only
28
Ghana
HIV
29
Ghana
Malaria, disease part only
30
Lao People's Democratic Republic
HIV, incl. CCHSS
31
Liberia
HIV, incl. CCHSS
32
Mozambique
HIV, CCHSS only
33
Nigeria
HIV, CCHSS only
34
Pakistan
Tuberculosis
35
United Republic of Tanzania
HIV, disease part only
36
Vietnam
HIV
37
Zimbabwe
HIV
Category 2: Proposals with Composite Index 6
No.
Country
Disease
38
Armenia
HIV, CCHSS only
39
China
HIV
40
Paraguay
HIV, disease part only
41
Guyana
HIV, CCHSS only
42
Lesotho
HIV, incl. CCHSS
43
Swaziland
HIV, CCHSS only
44
Swaziland
Tuberculosis
45
Thailand
HIV
Category 2: Proposals with Composite Index 5
No.
Country
Disease
Comoros
Malaria, disease part only
Democratic People's Republic of Korea
Malaria
Gambia
HIV, incl. CCHSS
Guinea-Bissau
Tuberculosis, CCHSS only
Tajikistan
Malaria
Tajikistan
Tuberculosis, incl. CCHSS
52
Zanzibar
Malaria, incl. CCHSS
53
Kyrgyz Republic
Malaria
54
Madagascar
HIV
55
Papua New Guinea
Malaria
Rwanda
Malaria, disease part only
57
Somalia
HIV, incl. CCHSS
58
United Republic of Tanzania
Malaria
59
Zimbabwe
Malaria, incl. CCHSS
46
47
48
49
50
51
56
Category 2 Composite Index 3 and Category 2B
Round 8 proposals recommended for funding by the TRP and
identified as ‘Category 2’ proposals with composite index 3
and ‘Category 2B’ will be approved for funding for an initial
two years (subject to):
(i) through Board confirmation by email (or, if appropriate, at
the 19th Board Meeting), as funds become available under
the terms of the Comprehensive Funding Policy; and
(ii) based on the composite ranking of such proposals in
compliance with Board’s decision entitled ‘Prioritization in
Resource Constrained Environments’
Category 2: Proposals with Composite Index 3
No.
60
61
62
63
64
65
66
67
Country
Disease
Brazil
Malaria
Colombia
Malaria
Serbia
HIV
Cape Verde
HIV
Dominican Republic
Malaria
Ecuador
Malaria
Indonesia
Malaria
Nicaragua
HIV
Category 2B Proposals: Composite Index 8
No.
Country
Disease
68
Burkina Faso
Tuberculosis, incl. CCHSS
69
Chad
Tuberculosis
70
Burundi
HIV
71
Nigeria
Malaria
72
Sudan, Northern Sector
Tuberculosis, incl CCHSS
73
Zimbabwe
Tuberculosis
Category 2B Proposals: Composite Index 6
No.
Country
Disease
74
China
Tuberculosis
75
Congo (Republic of)
Malaria
76
Congo (Republic of)
Tuberculosis
77
Moldova
HIV
78
Iran
HIV
79
Lesotho
Tuberculosis
Category 2B Proposals: Composite Index 5
No.
80
Country
Afghanistan
Democratic People's Republic of Korea
81
Disease
Malaria, incl CCHSS
Tuberculosis
82
Haiti
Malaria
83
Madagascar
Tuberculosis
84
Solomon Islands
HIV CCHSS only
85
Solomon Islands
Tuberculosis
86
Uzbekistan
Malaria
87
Uzbekistan
Tuberculosis
Malaria Grants – Round 8
Total 5-year ceiling amount (million USD)
Less than 20
20-50
More than 50
HSS component
Malaria Grants – Round 8
Total 5-year ceiling amount (million USD)
Less than 20
20-50
More than 50
HSS component
Malaria – proposal support working well
80%
Success Rate by Round by Disease Components
68%
70%
62%
62%
60%
57%
51%
49%
50%
50%
45%
47%
44%
41%
42%
39%
40%
41%
38%
36%
46%
46%
41%
39%
37%
32%
32%
30%
30%
25%
20%
23%
17%
10%
10%
0%
0%
0%
0%
0%
Round 1
Round 2
Round 3
Round 4
Round 5
HIV/AIDS
Tuberculosis
Malaria
Poly. (HIV/AIDS)
Poly. (Tuberculosis)
Poly. (Malaria )
Round 6
Round 7
Integrated/HSS
Round 8
Round 8 – specific malaria outcomes
1800
70%
1600
Proposal success rate
60%
5
50%
6
7
40%
8
30%
20%
10%
0%
Success Rate
Total 2-year ceiling amount (million USD)
80%
1400
1200
5
1000
6
7
800
8
600
400
200
0
2-year ceiling amount
Topics of discussion (1)
• Gender
– Overall, fewer proposals were 'gender
transformative'
– However, more diversity (and strength) when
included
– No proposal 'not recommended' if did not include
gender
– Opportunity for 'case studies' to be released for R9
Topics of discussion (2)
• Health Systems Strengthening:
– Cross-cutting HSS requests 'possible' in Rd 8 formulation
– Yet, WHO Building Blocks not optimal as 'operational framework'
on which to prepare integrated responses to constraints, leading
to 'formulaic' elaborations of HSS needs
(Note: Few requests in Financing; Leadership/Governance)
• Community Systems Strengthening
– Most proposals included some level of CSS activity
– Covered the full range of activities
– However, not easily 'extracted' for analysis/proof of concept
Extract of specific recommendations
•
Delay applying for funding if no track record for
performance: Especially when applicants are requesting
'scaling up' of activities from an earlier grant that has not
started/not signed, or just beginning
•
Value for money: pre-TRP financial review of 'large
budgets'
•
Health workforce salary requests: recommendation for
Global Fund to identify principles that guide requests for
salary support – with particular focus on National HR plans
•
Eligibility for multi-country proposals: Reduce
proposals that 'select' eligible countries rather than
focusing on epidemiological/social/political issues
Indexing