In May 2014, countries submitted concept notes in the first review window of the new approach to grant-making approved by the Board for full implementation just two months earlier. By the end of the year, the Technical Review Panel (TRP) had reviewed 111 concept notes, approximately 43% of all expected country submissions for the 2014-2016 allocation period and representing nearly 60% of the entire allocation amount.
The concept notes submitted for TRP review during the four 2014 review windows accounted for US$ 8.58 billion of the total allocation, divided between diseases as follows:
- Joint TB/HIV: US $4.67 billion
- Malaria: US $2.85 billion
- Tuberculosis: US $497 million
- HIV/AIDS: US $443 million
- Health Systems Strengthening: US $127 million
Although progress has been steady – with 80% of grants reviewed by the TRP in 2014 progressing into the grant-making stage and 20 concept notes totaling US$ 1.2 billion approved in full by the Board – there are also indications that the new process has been challenging. The deferral rate of countries delaying submission to a later date than originally communicated was roughly 30%. The Secretariat has emphasized that these delays should allow the development of more robust concept notes and the signing of “disbursement-ready grants.” A steady stream of grant extensions over the course of the year has also been approved to help mitigate potential service gaps as countries prepare concept notes.
Read more about the first year of implementation under the Global Fund’s new grant-making model, including challenges and lessons learned, progress on regional programs, progress on the Global Fund Emergency Fund and other special initiatives below.
Regional Programs and Special Initiatives
In addition to country-specific allocations, at the full launch of the model, the Board also approved US$ 200 million for regional programs and US$ 100 million for special initiatives.
Funding for regional programs will be divided between two application windows. During the first deadline in May 2014, regional applicants submitted 43 expressions of interest with a total request of US$ 689 million, indicating strong demand for regional approaches. Following TRP review, 16 applicants were given indicative envelopes and invited to submit fully developed concept notes by January 2015. These 16 applicants will compete for US$ 120 million in available funding for the first window, compared to a maximum funding request of approximately US$ 235 million. The Fund will need to decide whether to full fund only a few proposals or partially fund a larger number.
The second window for regional expressions of interest will fall in April 2015, with US$ 80 million in available funding.
Of the US$ 100 million set aside for special initiatives, the largest strategic investment went to a US$ 30 million Emergency Fund, intended to provide quick access to financing to avoid treatment disruptions in emergency situations. In November 2014, the Global Fund tapped into the Emergency Fund for the first time, allocating US$ 1.6 million to expand a mass distribution campaign of mosquito nets in areas severely affected by the Ebola outbreak in Liberia. In December 2014, the Fund again accessed the Emergency Fund to provide US$ 3.3 million in emergency TB funding to Syrian refugees in Lebanon and Jordan.
Other approved special initiatives and progress through the end of 2014 included:
- US$ 29 million for a technical assistance partnership agreement with WHO (and including Roll Back Malaria and Stop TB Partnership) to assist concept note preparation, including program reviews, gap analysis, strategic planning, development of investment cases and epidemiological analysis – 236 requests from 73 countries received in 2014.
- US$ 17 million for catalytic investments in country data systems to address key data gaps and help inform the upcoming midterm review of the Global Fund Strategy 2012-2016 – approximately US$ 6 million disbursed by year end.
- US$ 15 million to provide technical assistance and capacity building to key populations, community and civil society groups to ensure meaningful engagement in country dialogue and support the inclusion in concept notes of technical-sound interventions to address human rights, gender equality and community systems strengthening – RFPs issued and assignments underway across three main pillars of work.
- US$ 8.5 million to improve value for money and financial sustainability of Global Fund-supported programs through investments in optimizing prioritization of funding requests and national plans, measuring and analyzing program spending data, and tracking and maximizing domestic spending – projects in at least 12 countries were underway by the end of the year.
- US$ 0.5 million to help build capacity and expedite the grant-making process for new Principal Recipients – no applications for funding yet received.
Stakeholder Feedback and Future Challenges
Overall feedback from countries has been positive, with 77% of country participants in one Global Fund survey saying they had a “good” or “very good” experience with the model and 78% agreeing that the new process was an improvement over the former system. The focus on inclusivity in the country dialogue also received strong feedback. Eighty-eight percent of respondents agreed that it helped improve engagement with key stakeholders, and 89% said that civil society and key affected populations were represented during concept note development. Although statistics on the strength of private sector involvement have not been captured, the country dialogue process is designed to be a multi-sector collaboration, and private sector representatives serve on Country Coordinating Mechanisms (CCMs), the key in-country bodies who formulate concept notes and supervise grants, in a number of countries across the Global Fund portfolio.
Though there are signs of positive progress, questions have been raised about some elements of the model that may need revision. The allocation methodology created inconsistencies in some situations, especially among malaria allocations and countries in Band 4 (higher income/lower burden). The methodology also did not fully account for continuity of services, leaving some countries with lower allocations than in the past grappling with how to maintain existing coverage levels for essential interventions.
One option offered to countries by the Board was to structure shorter grant durations and maximize disbursement rates in exceptional cases where there was a strong rationale and need. However, implementing this decision has proved complex, with the TRP raising concerns about challenges from an equity standpoint and about using unfunded quality demand to fill gaps between the end of the shortened grant and the next allocation cycle. Under the newly-approved revisions to the Fund’s earmarking policy, private sector donors have the opportunity to play a role in helping to fill some of these gaps in future.
The incentive funding stream, which gives countries an opportunity to compete for additional money above their indicative allocation, has also been the subject of debate. According to the TRP, incentive funding has not fulfilled its purpose of encouraging full expressions of demand and the formulation of ambitious and strategic funding requests; on the contrary, the TRP claimed that the most strategic requests with the strongest prioritization have tended to come from countries ineligible for incentive funding.
It is unclear whether this is a result of a flaw in the design of incentive funding itself or of other, interrelated factors, such as the fact that many of the most successful countries under the previous model, who may also have had stronger existing capacity to formulate robust requests, were among those ineligible. The TRP has also argued that incentive funding poses an undue burden on countries, although over two-thirds of applicants surveyed midway through 2014 felt that the level of effort to formulate incentive funding requests was appropriate.
Over the course of 2015, the Private Sector Delegation and other Board constituencies will have the responsibility of helping to guide the Fund in considering lessons and making adjustments as needed to continue to strengthen the Global Fund’s impact. Read more here about how your company can add your expertise to help solve these challenges as a PSD member.