Malaria Round 8 Lessons Learned & Outcomes of 18 th Global Fund Board Meeting Roll-Back Malaria Board Meeting 10 November 2008 Professor Rifat Atun Director,

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

Indicator 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%

Acceleration of scale upAccelerating Results

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Dec-04 Jun-05 Dec-05 Jun-06 Dec-06 Jun-07 Dec-07 Jun-08

AR

Vs a

nd

DO

TS (m

illions)

-

5

10

15

20

25

30

35

40

45

50

55

60

ITN

s (millions)

DOTS

ARVs

ITNs

Increasing country evidence of malaria impact

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Jan

-01

Fe

b-0

1M

ar-

01

Ap

r-0

1M

ay-

01

Jun

-01

Jul-

01

Au

g-0

1S

ep

-01

Oct

-01

No

v-0

1D

ec-

01

Jan

-02

Fe

b-0

2M

ar-

02

Ap

r-0

2M

ay-

02

Jun

-02

Jul-

02

Au

g-0

2S

ep

-02

Oct

-02

No

v-0

2D

ec-

02

Jan

-03

Fe

b-0

3M

ar-

03

Ap

r-0

3M

ay-

03

Jun

-03

Jul-

03

Au

g-0

3S

ep

-03

Oct

-03

No

v-0

3D

ec-

03

Jan

-04

Fe

b-0

4M

ar-

04

Ap

r-0

4M

ay-

04

Jun

-04

Jul-

04

Au

g-0

4S

ep

-04

Oct

-04

No

v-0

4D

ec-

04

Jan

-05

Fe

b-0

5M

ar-

05

Ap

r-0

5M

ay-

05

Jun

-05

Jul-

05

Au

g-0

5S

ep

-05

Oct

-05

No

v-0

5D

ec-

05

Jan

-06

Fe

b-0

6M

ar-

06

Ap

r-0

6M

ay-

06

Jun

-06

Jul-

06

Au

g-0

6S

ep

-06

Oct

-06

No

v-0

6D

ec-

06

Jan

-07

Fe

b-0

7M

ar-

07

Ap

r-0

7M

ay-

07

Jun

-07

Jul-

07

Au

g-0

7S

ep

-07

Oct

-07

No

v-0

7

Month

Mal

aria

in

-pat

ien

t an

d o

ut-

pat

ien

t la

bo

rato

ry-c

on

firm

ed

case

s

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

No

n-m

alar

ia i

n-p

atie

nt

case

s

Malaria in-patient cases

Out-patient confirmed cases

Non-malaria in-patient cases

Interventions

Incidence↓~64%

20042001 2002 2003 2005 20072006 Year

Declining malaria in health facilities after intervention: Rwanda, 2001-2007

Malaria Grants – Rounds 1 to 7

Andean

West Pacific

RMCC

Less than 2020-50

More than 50

Total lifetime budget (million USD)

Performance rating at 18 months

24%

32%

17%

50%

54%

52%

27%

15%

31%

0% 20% 40% 60% 80% 100%

HIV/AIDS*

TB

Malaria

% of phase 2 grants, per disease

A - good B1 - adequate B2/C - poorPerformance:

* Includes HIV/TB grants

Round 8: TRP Recommendations

Number

recommended

for funding

Within disease

success rate

2 Year Upper

Ceiling all

Recommended

(US$ millions)

Percent of 2 Year

Upper Ceiling

Budget

5 Year Upper

Ceiling all

Recommended

(US$ millions)

Percent of 5

Year Upper

Ceiling

Budget

37 of 76 49% 1,196 38% 3,416 46%

29 of 57 51% 344 11% 960 13%

28 of 41 68% 1,623 51% 3,014 41%

94 of 174 54% 3,163 100% 7,390 100%

Disease Proposal

HIV (including HSS requests)

Tuberculosis (including HSS requests)

Malaria (including HSS requests)

TOTAL

Round 8: TRP Recommendations

Number of Proposals2 Year Upper Ceiling US$

(millions)

Cumulative 2 Year Upper Ceiling (US$

millions)

EURO amount as part of US$ ** (millions)

16 460 460 49

51 1,928 2,388 433

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 775 127

94 3,163 3,163 609

Funding Category

All recommended

1

2

2B Total

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: 68%– Tuberculosis: 51%– HIV: 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 1No. 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 5No. Country Disease

46Comoros Malaria, disease part only

47Democratic People's Republic of Korea Malaria

48 Gambia HIV, incl. CCHSS

49Guinea-Bissau Tuberculosis, CCHSS only

50 Tajikistan Malaria

51Tajikistan Tuberculosis, incl. CCHSS

52 Zanzibar Malaria, incl. CCHSS

53 Kyrgyz Republic Malaria

54 Madagascar HIV

55 Papua New Guinea Malaria

56Rwanda Malaria, disease part only

57 Somalia HIV, incl. CCHSS

58 United Republic of Tanzania Malaria

59 Zimbabwe Malaria, incl. CCHSS

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. Country Disease

60Brazil Malaria

61Colombia Malaria

62Serbia HIV

63Cape Verde HIV

64Dominican Republic Malaria

65Ecuador Malaria

66Indonesia Malaria

67Nicaragua 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. Country Disease

80 Afghanistan Malaria, incl CCHSS

81Democratic People's Republic of Korea

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

Less than 2020-50

More than 50

Total 5-year ceiling amount (million USD)

HSS component

Malaria Grants – Round 8

Less than 2020-50

More than 50

Total 5-year ceiling amount (million USD)

HSS component

Malaria – proposal support working well

25%

45%

41%

38% 37%39%

41%

49%

30%

39%36%

47% 46%

62%

46%

51%

44%

62%

68%

0% 0% 0% 0%

57%

32%

42% 41%

23%

32%

17%

50%

10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Round 1 Round 2 Round 3 Round 4 Round 5 Round 6 Round 7 Round 8

HIV/AIDS Tuberculosis Malaria Integrated/HSS

Poly. (HIV/AIDS) Poly. (Tuberculosis) Poly. (Malaria )

Round 8 – specific malaria outcomes

0%

10%

20%

30%

40%

50%

60%

70%

80%

Success Rate

Pro

po

sal

succ

ess

rate

0

200

400

600

800

1000

1200

1400

1600

1800

2-year ceiling amount

To

tal

2-ye

ar c

eili

ng

am

ou

nt

(mil

lio

n U

SD

)

5

6

7

8

5

6

7

8

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