1. Roll-Back Malaria Board Meeting 10 November 2008 Professor Rifat Atun
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

2. 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
GMAP= Global Malaria Action Plan
PBF= Performance Based Funding

3. 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%

4. Acceleration of scale up

5. Increasing country evidence of malaria impact
Declining malaria in health facilities after intervention: Rwanda,
Other evidence of impact on malaria:
Pilot trials of ITNs in Kenya showed child mortality improvement and economic benefits. Southern Africa showed the benefits of integrating spraying and effective treatment.
National declines: Global Fund-supported programs now show similar evidence of national declines in malaria and child mortality in Burundi, Eritrea, Swaziland, Kenya, Mozambique and Zanzibar, with initial signs of decline in Ethiopia and Zambia.
Incidence↓~64%
2001
2002
2003
2005
2007
2006
2004
Year

6. Malaria Grants – Rounds 1 to 7
West Pacific
Andean
Situation in current grants.
Total lifetime budget is US$ 3.2 bn
Linking money to results - ITNs distributed:
Mid 2007: 30 million
Mid 2008: 59 million (% of target met: ITN - 118% )
% increase since mid 2007: 97%
Note for Bill: During the PC you were asked: Do we have indicators on net use?  If so, what is it? And if no, what are the constraints with respect to collecting such data?
Answer: Many, but not all, grants have outcome indicators on net use within the performance framework. This data are obtained through surveys (most commonly DHS [Demographic health Survey] or MICS [Multiple Indicator Cluster Survey]) which are usually conducted every two or three years, and often it takes nearly a year to make the results available. For those without outcome indicators there is a need for capacity to conduct surveys and budget it appropriately. Consequently, many grants were yet to report on results, until the World Malaria Report, 2008, was launched in September – it provides such data by country and survey.
RMCC
Total lifetime budget (million USD)
Less than 20
20-50
More than 50

7. Performance rating at 18 months
On average TB grants are performing better that HIV and malaria grants at Phase 2 evaluation, that is almost two year from the beginning of implementation.
This slide illustrates that TB grants perform better than Malaria and HIV grants in phase 2 evaluation: 33% of TB grants received A rating compared to 23% of HIV/AIDS grants and 13% of malaria grants
Possible reasons: maturity and strength of TB programs, efficient international technical assistance provided by Who and STB Partnership, including international procurement mechanisms
* Includes HIV/TB grants 7

8. 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
Percent of 5
Year Upper
Ceiling
37 of 76
49%
1,196
38%
3,416
46%
29 of 57
51%
344
11%
960
13%
28 of 41
68%
1,623
3,014
41%
94 of 174
54%
3,163
100%
7,390
Disease Proposal
HIV (including HSS requests)
Tuberculosis (including HSS requests)
Malaria (including HSS requests)
TOTAL

9. Round 8: TRP Recommendations

10. Category 2B Proposals: Composite Index 3
No.
Country
Disease 88
Bulgaria
Tuberculosis 89
Bolivia
Malaria 90
Fiji
Tuberculosis, incl CCHSS 91
Guyana 92
Kazakhstan 93
Sri Lanka 94
Tunisia

11. 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)

12. 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

13. Funding Decision
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
Round 8 Phase 2: Collectively be subject to a maximum limit of $3.087Bn* (75% of the P2 amounts in the R8 recommended proposals).
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.
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
Round 9: deadline for submission of proposals extended to 6/2009.
*Limit may be partially or fully relaxed If new resources become available

14. 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

15. Category 1 No. Country Disease 1 Afghanistan Tuberculosis 2 Armenia 3
Belarus
HIV, incl. CCHSS 4
Gabon
HIV 5
Mauritius 6
Moldova 7
West Bank and Gaza 8
Peru 9
Ethiopia
Malaria, incl. CCHSS 10
Indonesia 11 12
Mauritania
HIV, CCHSS only 13
Sao Tome and Principe 14
Swaziland
Malaria 15
Thailand 16
Zambia

16. Category 2: Proposals with Composite Index 8
No.
Country
Disease 17
Burkina Faso
Malaria 18
Central African Republic 19
Chad
HIV 20
Côte d'Ivoire 21
Mali
HIV, disease part only 22
Tajikistan 23
Togo 24
Bangladesh
TB, incl. CCHSS 25
Democratic Republic of Congo 26 27
Eritrea 28
Ghana 29
Malaria, disease part only 30
Lao People's Democratic Republic
HIV, incl. CCHSS 31
Liberia 32
Mozambique
HIV, CCHSS only 33
Nigeria 34
Pakistan
Tuberculosis 35
United Republic of Tanzania 36
Vietnam 37
Zimbabwe

17. 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 42
Lesotho
HIV, incl. CCHSS 43
Swaziland 44
Tuberculosis 45
Thailand

18. Category 2: Proposals with Composite Index 5
No.
Country
Disease 46
Comoros
Malaria, disease part only 47
Democratic People's Republic of Korea
Malaria 48
Gambia
HIV, incl. CCHSS 49
Guinea-Bissau
Tuberculosis, CCHSS only 50
Tajikistan 51
Tuberculosis, incl. CCHSS 52
Zanzibar
Malaria, incl. CCHSS 53
Kyrgyz Republic 54
Madagascar
HIV 55
Papua New Guinea 56
Rwanda 57
Somalia 58
United Republic of Tanzania 59
Zimbabwe

19. 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):
through Board confirmation by (or, if appropriate, at the 19th Board Meeting), as funds become available under the terms of the Comprehensive Funding Policy; and
based on the composite ranking of such proposals in compliance with Board’s decision entitled ‘Prioritization in Resource Constrained Environments’

20. Category 2: Proposals with Composite Index 3
No.
Country
Disease 60
Brazil
Malaria 61
Colombia 62
Serbia
HIV 63
Cape Verde 64
Dominican Republic 65
Ecuador 66
Indonesia 67
Nicaragua

21. 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

22. Category 2B Proposals: Composite Index 6
No.
Country
Disease 74
China
Tuberculosis 75
Congo (Republic of)
Malaria 76 77
Moldova
HIV 78
Iran 79
Lesotho

23. Category 2B Proposals: Composite Index 5
No.
Country
Disease 80
Afghanistan
Malaria, incl CCHSS 81
Democratic People's Republic of Korea
Tuberculosis 82
Haiti
Malaria 83
Madagascar 84
Solomon Islands
HIV CCHSS only 85 86
Uzbekistan 87

24. Malaria Grants – Round 8 Total 5-year ceiling amount (million USD)
[Round 8 map including the 2B]
Situation in Round 8
Total 5.year ceiling amount for recommended grants (including 2b) is US$ 2.9 bn – for Round 7 the amount was about US$ $1bn
[Note: Phase 1 amount in R8 was US$1,6bn (about half of recommended Upper Ceiling request); Phase 1 amount in R7 was US$ 469 million (42% of recommended Upper Ceiling request)]
Round 8 represents a significant step towards increasing value for money.
Total 5-year ceiling amount (million USD)
Less than 20
20-50
HSS component
More than 50

25. Malaria Grants – Round 8 Total 5-year ceiling amount (million USD)
[Round 8 map without the 2B]
Situation in Round 8
Total 5.year ceiling amount for recommended grants (excluding 2b) is US$ 2.1 bn – for Round 7 the amount was about US$1bn
[Note: Phase 1 amount in R8 was US$1,1 bn (about half of recommended Upper Ceiling request); Phase 1 amount in R7 was US$ 469 million (42% of recommended Upper Ceiling request)]
Round 8 represents a significant step towards increasing value for money.
Total 5-year ceiling amount (million USD)
Less than 20
20-50
HSS component
More than 50

26. Malaria – proposal support working well
This slide displays the success rate of proposals.
Malaria is the component that is by far the most successful now.

27. Round 8 – specific malaria outcomes
80%
1800
1600
70%
1400
60%
1200
50% 5 6 7 8 5
1000 6
40%
Proposal success rate 7
800
Total 2-year ceiling amount (million USD) 8
30%
600
20%
400
These charts illustrate the high success rate for round 8 compared to other rounds as well as the MUCH larger total amount approved for Round 8.
First time malaria has exceeded HIV upper ceiling (R8,US$ 1.2b)
AFRO outcomes especially:
Equals 50% of all malaria proposals recommended.
Internal AFRO success rate of 78% (14 of 18).
78% of these 14 (n=11) have not had a malaria proposal approved since Round 5 or earlier.
HSS part: internal success of HSS inside Malaria: 50%.
4 parts recommended: Ethiopia, Zanzibar, Zimbabwe, Afghanistan [Afghanistan is 2b – revise if necessary]
4 parts not recommended: Comoros, Rwanda, Ghana, SADC (multi-country)
10%
200 0%
2-year ceiling amount
Success Rate

28. 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

29. 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
All Round 8 Proposals[1] Received
78% of the 230[2] Round 8 proposals received included CSS activities.
Low income applicants included CSS activities more often in their proposals (82%) than either lower-middle (77%) or upper-middle income countries (70%).
Proposals from SEARO included CSS activities most often (95%), followed by WPRO, AFRO and EMRO (80-90%), and EURO and AMRO least often (65%).
Category 1, 2 or 2B Recommended Proposals
84% of the 108 proposals recommended for funding by the TRP as Category 1, 2 or 2B included CSS activities.
Proposals from AFRO, SEARO and WPRO were 10-20% more likely to include CSS activities then proposals from AMRO, EMRO, and EURO.
Malaria and HIV proposals included CSS activities 15-25% more often than Tuberculosis or section 4B HSS cross-cutting proposals.
[1] For the purposes of this analysis, section 4B health systems strengthening cross-cutting interventions were analyzed and included as separate proposals.
[2] Not including non-CCM proposals.

30. 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
TRP Report has a number of 'headline issues' in Part 5 of the main body of the Report. As a snap shot:
HIV – positive innovation, including introduction of at least one 'go to scale' male circumcision program. However, too many proposals coming without a recent epidemiological study to base funding request.
Tuberculosis – concern over the 'formulaic' use of the StopTB planning tool. People including "the full list" of recommended interventions, and not focusing on their country, their priorities, and their capacity to implement.
Malaria – strong entomology and epidemiological basis for proposals. Malaria: AFRO is 50% of all malaria recommended, and 14 of 18 malaria proposals from AFRO supported. Most hadn't been funded since Round 5 or earlier.
Existing Global Fund grants & grant consolidation – TRP recommending more of a focus on bringing 'the national approach'. SIE data that enables the TRP to know what 'the Global Fund', and not what each grant brings is preferred. Applicants need to reflect more fully on additionality of future funding requests.
HIV/TB co-infection: Role for Partners to emphasize more
Infant feeding – requests for broad scale distribution of funding for infant formula. Role for partners to be more robust in explaining when not appropriate.
Sub-national proposals – need to require better demonstration of avoiding duplication, and also working with CCM (unless situation renders difficult).
Accelerate architecture review

31. Indexing