23 January 2016    3264    news    0   

GF/B34/EDP02: Decision on Additional Funding and GF/B34/EDP03 on Grant Extensions

As already formally confirmed to the Board, on 24 December 2015, the
Board confirmed the following decisions through electronic vote:

GF/B34/EDP02: Decision on the Secretariat’s Recommendation on
Additional Funding from the 2014 Allocation
GF/B34/EDP03: Decision on the Secretariat’s Recommendation on Grant Extensions

The Secretariat acknowledges the comments received. Operational
observations and comments on individual grants have been shared with
relevant country teams. The Secretariat remains available for further
clarifications and details.

In response to comments with strategic implications, the Secretariat offers additional information as follows.

Intermittent preventive treatment in pregnancy for malaria

The recent meeting of the Malaria Policy Advisory Group (more
information can be found here) in November 2015 reiterated that
intermittent preventive treatment in pregnancy with
sulfadoxine-pyrimethamine still remains highly cost-effective in
preventing adverse maternal and fetal outcomes from malaria, including
where sulfadoxine-pyrimethamine resistance is high. In addition, it
does not recommend intermittent screening and treatment as comparative
studies to intermittent preventive treatment in pregnancy resulted in
higher maternal infections and clinical malaria during pregnancy as
well as being less cost-effective.

Botswana TB/HIV Grants (BWA-C-ACHAP and BWA-C-BMOH)

The Secretariat will review the TB targets with Botswana stakeholders
within the first 12 months of implementation. New 2014 WHO TB data
(released after the submission of the concept note) indicate that the
TB treatment success rates for all cases are actually lower than the
2013 data used as the baseline. Thus, the targets are more ambitious
than anticipated.

Chad Malaria Grant (TCD-M-UNDP)

Considering the challenges of the operating environment, a phased
implementation has been put in place by the Ministry of Public Health,
taking into account quality of services concerns. It was therefore
agreed during grant-making with national stakeholders and technical
partners that the initial targets would be revised and the percentage
and number of malaria cases managed at community level would be
reduced, with gradual increases each year in an ambitious yet
realistic manner. The agreed upon strategy is to start with one
regional health delegation in the first year of implementation, and
based on lessons learned, expand the interventions to a second region
in the second year.

Malaria interventions through the private sector are limited mainly to
the capital city, N'Djamena. Analysis of the data on the contribution
of the private sector to the management of malaria has not yet been
completely analyzed by the national malaria program and its partners.
It was agreed that this grant will support private sector activities,
including identification, training of personnel/staff and provision of
monitoring and evaluation tools.

Djibouti TB/HIV Grant (DJI-C-UNDP)

With regards to the interventions accompanying the proposed target
coverage of 100 percent of ART for HIV, this target is envisaged for
the HIV positive pregnant women attending antenatal clinics that
provide services as detailed in the grant documents.

To overcome, prevent and mitigate fraud situations, Djibouti has been placed under the Additional Safeguard Policy since December 2010, with the nomination and installation of UNDP as Principal Recipient in 2012 and sub-recipients being managed accordingly under UNDP policies.
Following the 2010 OIG investigation, a protocol of reimbursement was agreed upon with the country in July 2014 and the instalments are being paid by the country as per the set deadlines.


On the proposed plan to engage private health and non-NTP healthcare
providers for TB diagnosis and management: specific strategies for
addressing under-notification, delayed diagnosis and under-diagnosis
have been developed, as already detailed in the TRP Clarifications
Form. The Secretariat have included an additional requirement in the
grant to provide targets and timelines for the engagement of private
providers in program delivery and reporting by 28 February 2016.

The “upper funding ceiling” refers to funds available for 2016 and
2017 both from the original allocation and the incentive funding
rewarded, after considering program expenditures in 2014 and 2015. The
TRP recommended $25 million in incentive funding for this program.
During grant-making, a number of efficiencies were identified (for
example, MDR-TB drug price and quantity had been overestimated and
adjustments were made accordingly). At the end of grant-making, the
Secretariat considered that essential targets and components were
covered and absorptive capacity reached, with a remaining balance from
the upper funding ceiling of US$9 million. Therefore, the grants
represent full utilization of the original allocation with an
additional US$16 million of incentive funding (subtracting US$9
million from the initially awarded incentive funding amount of US$25
million). The program has scaled up its absorptive capacity by 100
percent this grant cycle and the Secretariat does not perceive the
amount being returned to the funding pool as the result of an
absorptive capacity issue. The US$3 million investment for technical
cooperation is intended to support sustainability and transition
planning by engaging with the World Bank and possibly other technical
partners to support transition of TB funding through the expansion of
the national health insurance program. This requires a level of
engagement outside of the existing grants and Principal Recipients,
and will better position the country to ensure eventual domestic
financing through health insurance or other budgetary channels.

Regarding TB targets:

Targets for the TB prevalence and incidence in the grant are based on
the national strategic plan for TB 2015-2019 and the latest prevalence
study results, which found TB cases to be three times higher than the
previous estimates, which encouraged the country to intensify the case
finding efforts to find the missing cases from a baseline of 39
percent in 2014. In addition, to strengthen TB surveillance, the
Ministry of Health as a TB Principal Recipient will conduct an
inventory study to measure magnitude of under-reporting of TB cases
and drug resistance survey to be completed in 2016, after which
revision of the estimates and projections will be done if deemed
necessary. Please refer to the Performance Framework enclosed in the
Grant Confirmation for further details.

Paraguay Malaria Grant (PRY-M-OIM)

The US$2.3 million being returned to the pool is the result of the
Paraguay malaria program allocation amount exceeding the amount needed
for activities considered strategic investments for highest impact and
critical to the prevention of reintroduction of malaria, and that are
not already covered by domestic resources being included in the final
grant. This is in line with TRP recommendations. The possible award
related to the certification of malaria elimination in Stage 2 of the
grant would be conditioned to the applicability of a new results-based
financing policy still being developed in line with the 2017-2020
Strategy and Allocation. Lastly, the eligibility of Paraguay in its
current epidemiological state in the upcoming allocation period is
dependent on the eligibility list not yet released.

Senegal HSS Grant (SEN-S-MOH)

Senegal has been chosen as a pilot country to test the implementation
of the Financial Shared Service Approach, which is a common unit that
performs a mutualized management of financial services for several
entities within a group. In the context of Senegal, this unit is the
financial division of the Ministry of Health, which will deliver a
harmonized level of services through the same processes and the same
systems and will mutualize resources. This division of the Ministry of
Health also works with other donors/partners to increase coordination
among different departments within the Ministry of Health of Senegal.

Sierra Leone TB/HIV Grants (SLE-T-MOHS and SLE-H-NAS)

To address the increased needs of active and meaningful engagement of
civil society organizations, the TB/HIV request a range of activities,
as detailed in the Grant Confirmation.

Sri Lanka HIV Grants (LKA-H-FPA and LKA-H-MOH)

The audit referred to in the report is that published the Office of
the Inspector General (OIG) on 31 October 2011. As noted in the Report
of the Secretariat’s Grant Approvals Committees (GF/B34/ER02), only a
portion of the ineligible expenditures identified in this country
audit have been repaid to date. The Secretariat has made repeated
demands for the repayment of the ineligible expenditures identified
under all disease components. As noted in the Report of the
Secretariat’s Grant Approvals Committees (GF/B34/ER02), the
Secretariat’s decision to withhold an amount to be determined from the
country’s allocation for the implementation period was reached as an
exceptional measure after these prior efforts were only partially
successful – in line with management decision, reported to the Board
at its 33rd meeting (GF/B33/24, Report of the 33rd Board Meeting, 31
March-1 April 2015), providing for such reductions as an exceptional
measure to resolve difficult recoveries cases. In order to prevent
such situations in the future, the Secretariat has implemented a
number of risk mitigation measures, applicable to all disease
components, not solely HIV, including:

The discontinuation of implicated Principal Recipients
The move of finance staff working for the disease component program
premises from a program management unit to on-site
The hiring of procurement officers to ensure all regulations are
followed and to build capacity among disease program staff

Tunisia HIV Grant (TUN-H-ONFP)

The Secretariat notes that the very ambitious targets are in line with
the Tunisia HIV national strategic plan. The expected contribution of
the grant was agreed upon at grant making stage and strategies to
scale-up services to key populations were further defined with
national stakeholders. Detailed mapping of key populations, including people who inject drugs conducted in 2015, new dependence treatment site with progressive introduction of substitution therapy, planned introduction of community testing and enhanced outreach activities by peer-educators will enable program implementers to gradually reach the set objectives. In addition, epidemiological data is based on routine mandatory reporting, hospital statistics and 2009, 2011 and 2014 bio behavioral surveys for each key population. Population size estimates are currently based on Spectrum data and the mapping-based size
estimation will be completed first year of grant implementation.
Results of the 2015 mapping of key populations offered the basis to
inform prevention programs activities per geographical zones. The
Secretariat initiated discussions on increasing domestic funding of
the national response and the development of a long-term
sustainability plan is a condition to the grant confirmation


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