The New Funding Model

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2. The New Funding Model Key features and implementation

3. Principles of the new funding model • Greater alignment with country schedules, context, and priorities • Focus on countries with the highest disease burden and lowest ability to pay, while keeping the portfolio global • Simplicity for both implementers and the Global Fund • Predictability of process and financing levels • Ability to elicit full expressions of demand and reward ambition Principles of the new funding model

4. The new funding model changes the way applicants apply for funding, get approval of their proposals and then manage their grants Key features Predictable funding • Applicants are given an indicative funding range over a 3-year period • The Secretariat will hold indicative amounts for applicants until they apply • Applicants apply for funding when they want • Applicants can submit different disease or HCSS requests at different times • Applicants can use in-country planning cycles Timing of requests Length of grants • Three years Early feedback • Applicants submit a funding request through a “Concept Note” • Early feedback from the Secretariat and the TRP = higher success rate Incentive funding • Competitive funding in addition to indicative range • Rewards high impact, well-performing programs • Encourages full expression of demand • Upfront risk and capacity assessments • Differentiated processes to ensure disbursement-ready grants • Funding requests negotiated before Board approval Grant-making

5. Overview of the new funding model Determination of split between diseases & HCSS Unfunded quality demand NSP support Grant Approval Committee Board approval TRP review Country dialogue Concept Note Determine / approve adjusted funding amount Grant-making NSP Indicative funding Incentive funding Band allocation Allocation formula 1 2 3 4 5 6 7

6. Events leading up to the Board’s decision and implementation When Outcome Key event 2011 New Global Fund Strategy approved Established the framework to replace“Rounds” with a substantially changed funding model 2012 Decisions on New funding model Design and Agreementon all key features of the new model, with timelines for implementation 2013 Create grants for a limited number of countries based on funds available Implementation 2014 Full implementation of the new funding model after replenishment

7. In new funding model, disease programs fall into one of three categories How they receive funding What they do Early Applicants New grant: eligible for indicative and incentive funding. All steps of the new funding model process – country dialogue, submitting a concept note, TRP review, grant-making. 1 Interim Applicants Renewals and extensions of existing grants, and redesigns to access funding in 2013. Country dialogue 2 Country dialogue Standard Applicants Prepare for applications to be submitted in late 2013 or in 2014. 3

8. Implementation Timelines 2013 2014 2015 Early Selection of early applicants Application plus real time learning New grants signed 1 Interim Selection of interim applicants Interim funding through renewals, grant extensions and redesigned programs 2 Standard In-country preparation and national strategy development New grants signed 3 Application, review and grant-making

9. How were applicants selected for funding? Purpose of the transition This enabled... • Investment of available funds, for early impact • Focus on those most in need (e.g. underfunded or facing disruption) • Implementing elements of the new model Board approved immediate launch of the transition to the new funding model

10. How were applicants selected for funding? Participation in the transition Countries positioned to achieve rapid impact Who was invited to participate? Countries at risk of service interruptions Countries receiving less than they would under the new funding model principles

11. Country Dialogue • Builds upon existing, on-going mechanisms & dialogue in health and development, not only with Global Fund • Brings together Governments, donors, partners and civil society and key affected populations / MARPs • Provides inputs into the concept note development: • Strategic investment guidance from technical partners • Info and analysis on Global Fund grants • Amount of indicative funding available • Concept notes and Global Fund funding request developed from these discussions, based on national strategy/investment case Country dialogue Indicative funding

12. Preparing for the NFM: All applicants All applicants could consider the following actions... Strengthen national health/disease strategies • During 2013, or according to their national planning cycle, countries can assess the strength of their National Health Strategy and their National Disease-specific Strategies for HIV, TB and malaria, and, if necessary, take steps to strengthen them. 1 • They can identify programmatic and funding gaps in these strategies. They could organize joint reviews of their strategies (e.g. Joint Assessment of National Strategies (JANS)), if needed. • As an alternative, they can develop an investment case to be included in the Concept Note. Identify programmatic and funding gaps 2 • CCMscan review eligibility requirements for themselves and the Global Fund’s Minimum Standards for PRs, to assess potential issues and make any necessary improvements before 2014. Review CCM eligibility requirements 3

13. Despite tight timelines, there has been significant progress to date • All 50 CCMs accepted the invitation to participate in the NFM • Three early applicants - El Salvador, Myanmar and Zimbabwe - have submitted their Concept Notes and aim to sign grants by June Board • Country dialogue was well received and considered a significant improvement • Simpler Concept Note said to focus CCMs on strategic areas to drive impact • Greater work needed on the budget and performance reporting tool • Another three - DRC, Philippines and the Mekong Artemisinin Resistance Initiative - aim to complete Concept Notes by October • Learnings from the first early applicants will improve the NFM process • Interim applicants are moving forward rapidly to access funding • One country – Pakistan – submitted its funding request in March • Five countries planning to submit funding requests in May

14. Investing for Impact Global Fund results and impact

15. Contents Update on results in numbers Coverage and Impact Challenge and Opportunity Impact evaluation plan

16. Rapid increase in results (Reported numbers from GF supported programmes)

17. Coverage of key interventions % % 56 5 %

18. ART Coverage 2011 2009 People on ART : 310,000 (2004)  3.8 mil (2009)  6.1 mil (2011) ART coverage : N/A (2004)  41 % (2009)  56 % (2011) Source: UNAIDS 2012

19. ITN Coverage 2002 2011 2006 Average coverage increased: 3% (2000)  53% (2011) Source: WHO 2012

20. Malaria prevalence in Tanzania 2008 2012 Tanzania Every week 500 children saved from malaria deaths

21. Coverage supported by Decreasing unit costs Domestic financing in 3 diseases in GF eligible countries Estimated costs of common First Line Adult Anti-Retroviral Regimens Source: UNAIDS, Stop TB, GMP Source: Global Fund Price & Quality Reporting System

22. Challenge and opportunity to maintain and invest in increased coverage • Major challenge: to maintain coverage • e.g.) Malaria cases have rapidly increased when Zambia and Rwanda faced a funding gap. • Major opportunity : multiplier effects when achieving universal access • e.g.) Rwanda and Ethiopia achieving universal access show great impact on MDG 4,5 and 6, and potential to control 3 diseases epidemics.

23. Health/Community system strengthening (HCSS) • Challenge and opportunity to fight 3 diseases • GF HSS funding (TRP-recommended ) • Amount of funding: USD 2.4 billion • Number of proposals funded: 107 • Number of Countries: 69

24. Example: Ethiopia – 20% towards HSS Out of total disbursements 1.2 billion (2003-2012) • Increased coverage • MDG Impact

25. Evaluation plan Program review with partners in high impact countries to assess impact and others Data quality assessment Thematic review on cross-cutting issues like MDG 4&5, fragile states Synthesis report of GF on results for mid-term and end-term of the new strategy 2012-16

26. Impact reviews and Inputs to grants Country/ Disease Grant Recommendations Key Findings • Scale up routine contact investigation among elderly and children • Increase government contribution, improve efficiencies and cost savings, and expand TB/ HIV collaboration - TB prevalence reduced by 43%, but mainly among young adults - Funding beyond 2013 uncertain Cambodia/TB - Decreased morbidity and mortality - Inaccessible areas - Majorrisk of artemisinin resistance - Target hard-to-reach townships while maintaining nation-wide intervention efforts - Strengthen drug resistance monitor and encourage regional approach to counter artemisinin resistance Myanmar/Malaria - Increase in HIV prevalence - Inadequate prevention - Moderate ART and PMTCT coverage - Strengthen targeted combination prevention approaches - Prioritize quality and coverage of ART and PMTCT programs Uganda/HIV

27. Conclusions • Rapid increase in access to key services, especially last five years • Improved coverage of key interventions • Challenge to sustain coverage of key interventions • Returns of impact if reach universal access • Impact evaluation plan: underway and contributing to focus on impact in grants