Optimizing GFATM contribution to HTM in WPR: Role of Technical Assistance

1. Optimizing GFATM contribution to HTM in WPR:Role of Technical Assistance GFATM Working Group WHO-WPRO

2. Outline • Background • HTM goals, strategies and progress • GFATM support in the WPR • Role of TA in optimizing GFATM results • WHO role (TA and coordination of TA) • Issues and challenges in the provision of TA

3. Western Pacific Region

4. HTM goals, strategies, progress

5. GFATM Funding Support (WPR) • Overview GFATM grants in WPR (Round 1-6) • Total of US$ 982 million • 52 grants from Round 1-6

6. GFATM Funding Support (WPR) Most countries have multiple grants within disease components

7. GFATM Funding Support (WPR) • Majority of funding are in the bigger countries

8. Round 7 Proposals (WPR) • 7 countries+ Pacific multi-country • Total value of proposal – US$ 322.6 million

9. RCC Proposals (WPR) • 6 grants are so far eligible (China, Mongolia, Lao PDR, Philippines, Solomon+Vanuatu) • Proposals submitted so far: • Mongolia TB (US$ 8.5 m) • Solomon and Vanuatu Malaria (US$ 40 m) • China TB (US$ 70.3 m)

10. Projected size of GFATM support in the WPR (incl. successful Round 7) • More than US$ 1 billion in grants • Close to 70 grants for HTM • 7 countries + most of Pacific island countries and areas We have the money and strategies. HOW TO MAKE OPTIMAL USE OF THESE RESOURCES?

11. Role of Technical Assistance (TA) Why do we need TA?

12. Role of Technical Assistance (TA) What type of TA is needed?

13. Proposal management Grant negotiation Phase 2 renewal Proposal management Grant negotiation Term 2 renewal Implementation (performance-based) Implementation (Performance-based) Demand for TA for GFATM Round-based (yearly*) RCC (quarterly**) Proposal development (incl strategic planning) Agreements, incl. prep. M&E and PSM plans Activity implementation, technical guidance, management Review, planning and budgeting, agreement negotiations

14. Role of Technical Assistance (TA) TB example: Round 6 approval rate • Approvals: • 89 of 205 (overall) • 35 of 55 (TB) • 44 of 114 (HIV) • 19 of 59 (malaria)

15. Role of Technical Assistance (TA) TB example: TA behind the success • Coordinated TA provision (HQ, RO, CO) • RO/HQ coordinate with CO (WHO staff country missions, recruitment of consultants, desk reviews by RO and HQ focal points • Country-based or mission series (not one-off) • Sound Regional Strategic Plan and national TB control plans • Streamlined/well-focused TA • TA based on needs of countries • Planning frameworks/guides prepared (E.g. Stop TB/HQ) • Support from existing TWGs • Intensive communication

16. Key Issues and Bottlenecks in TA • Insufficient recognition of importance of TA • Countries often forget or reluctant to include TA • Late identification of TA needs • Countries request TA after plan is developed/or already experience severe bottlenecks • Lack of coordination of TA among partners • no coordination mechanism among partners • Perception that somebody else is paying for TA • perception that TA is not a direct support to countries with direct (tangible) outcome • TA is not FREE and quality TA is expensive!

17. WHO-WPRO and TA WHO-WPRO’s inputs so far? • Technical assistance to Member States – WHO core function and mandate • WHO-WPRO is already active in providing TA for most grants • WHO TA is not FREE! TA provided is mostly funded from WHO resources, incl. own regular budget; mostly staff-time (technical and managerial) • WHO/CO is a member in all CCMs and all TWGs in the Region

18. Key Issues for WHO in TA • Limited or overstretched capacity • Decreasing WHO staff numbers = increasing work load remaining staff • Uncertainty of long-term financing • Limited number of qualified consultants to meet increasing complexity of TB control • Consultancy fee policies

19. Limited or overstretched capacity TB example: Increasing GFATM Grants Globally Grants in US$ Number of grants

20. Limited or overstretched capacity But less regional and country WHO TB Staff

21. Key Issues for WHO 2. Synergy of TA delivered by WHO & partners • More effective coordination needed among at least 15 technical partners • Competition for funding rather than sharing • Exchange of technical expertise and experience • Existing mechanisms often insufficient

22. STB Partnership ICC Technical Partners NTP WHO STB Partnership ICC Financial Partners Financial Partners STB Technical Working Groups Stop TB Partnership Technical Partners Technical Partners WHO WHO • Synergy of TA • Country-based support and external missions • Capacity-building workshops • Regional coordination and support TB TEAM – model for better coordinated TA CCM Structure Financial Partners Country Global Regional

23. Key Issues for WHO 3. Difficulties in mobilizing funds for TA TB Example: Comparison of NTP TB budgets (incl. GFATM) and WPRO TB budget between 2002 and 2007

24. Key issues for WHO 4. Building and utilizing local capacity • Limited capacity of local partners • Limited involvement local partners in technical issues • Low credibility of local partners • Local partners frequently not involved in Technical Working Groups • Complexity of requirements of funding donors (E.g. GFATM)

25. 5. Issues in including TA in Global Fund grants • Including TA in the GFATM grant • WHO is in all CCMs, MOH is often the PR in WPR • Now included in a few grants • PNG (HIV: US$1.3 m) • Philippines (Malaria: US$150,000) • Lao PDR (Malaria: US$ 240,000) • Cambodia (TB: US$ 104,000) • Advocating TA at higher level in WHO and GFATM • Separate agreement between WHO and GFATM (E.g. Funding for GLC services)

26. Conclusions • TA is important to ensure resources are optimized to achieve HTM goals • Quality TA is needed in every step of the GFATM “life cycle”. Need for TA should be identified and requested early. • TA is not free. Quality TA is expensive. • Country-based TA is crucial. External TA can contribute • Mechanism should be in place to better coordinate TA in countries. • Mechanism should be in place to ensure TA is available for all GFATM grants (imbedded in GFATM grants + separate from it)