Ukraine TB/HIV Concept Note

Outcomes of TRP GAC and Grant Making

Place Day Month Year 1

Overview of Allocation Request • Technically sound and overall well balanced Concept Note.

– Builds on achieved results and strong experience in a difficult programming environment.

– The funding request aims to scale-up and ensure equitable access to prevention, care, treatment and support for key populations and vulnerable groups, and to strengthen health and community systems that enable integrated and sustainable interventions for key populations.

– The CN builds on gains of previous investment in HIV and TB control, and is aligned with the National TB Program 2012-2016.

• A number of strategic, technical and operational issues to be addressed.

CONGRATULATIONS•Hard work, tight deadlines, 3 consecutive proposals, limited funding!!!

•Very difficult country circumstances!

•In previous TRP window, 50% of proposals referred back to country.

Overview of Allocation Request • Recommendation on allocation amount:

• Budget ceiling for NFM period (2015-2017): USD 130,489,741, incl. USD 128,828,095 (est. budget ceiling prior to TRP review) + USD 1,661,646 (additional savings in signed grant identified after TRP review).

• Partially, “above-allocation” request can be covered from the allocated funds (based on savings identified), but no additional/above-allocation funding.

• Since TRP/GAC, Country Team has approved reallocation of some savings (ca. USD 1.2 m) to cover unfunded activities for Red Cross and emergency gap in MDR medicines.

  Amount (USD)

CCM request within allocation amount (A) 123,693,062

Savings achieved in 2014 within existing grants (B)* 6,796,679

Total budget amount available for NFM (2015-2017) (A+B) 130,489,741

Additional savings found in NFM proposal (C) 7,419,400

Total amount available for reinvestment within the allocated funds (B+C) 14,216,079

Total proposed reinvestment at the time of submission to TRP (D) (12,554,433)

Additional savings available for reinvestment 1,661,646*$5,135,033 of savings identified before submission to TRP + $1,661,646 identified after finalizing all Annual Funding Decisions, after submission to TRP.

Budget analysis – Confirmed savings

Geneva 16 May 2014 4

Intervention/justification Amount – US$

Savings achieved in 2014 within existing grants 6,796,679

MDR-TB treatment

•Latest GDF prices were not used (US$ 2.5m) and •Funds that will have been provided in 2014, that partially cover need for 2015, were not considered (US$ 4.6m).

7,105,927

OST and other drug dependence treatment

•Funds that will have been provided in 2014, that partially cover needs for 2015-2016, were not considered.

203,473

OST and other drug dependence treatment

The Global Fund is not willing to invest in additional procurement of methadone dispensing machines (electronic and manual) at this stage.

110,000

TOTAL 12,554,433

Budget analysis – Potential savings and proposed allocation

Place Day Month Year 5

Budget analysis – Proposed reallocation

Place Day Month Year 6

Intervention/justification Amount proposed (USD) Amount confirmed (USD)

Procurement of medicines to treat Opportunistic Infections in 2015 and 2016

2,231,678 2,519,086

Increased unit cost for PWIDs 1,203,546 1,203,546

Legal barriers 50,000 50,000

Stigma Index Survey 50,000 50,000

Introduction of OST in prisons 47,000 47,000

Activities in Crimea (across all proposed interventions) 1,884,954 1,884,954

Activities in Crimea (across all proposed interventions) 1,395,046

Procurement of additional ARV stock 3,251,902 3,251,90

Procurement of BACTEC and Hain reagents in 2017 1,190,307 1,190,307

Lubricants as part of programs for sex workers and their clients

600,000 0

STI testing as part of programs for sex workers and their clients

250,000

POC CD4 testing as part of programs for PWID and their partners

150,000 150,000

Strengthening TB and TB/HIV routine reporting systems

150,000

STI testing as part of programs for MSM and TGs 100,000

12,554,433 10,346,795

Use of additional savings

Items Amount (USD)

Care and support 912,000

OST medical support 1,085,000

Advocacy 350,000

UCDC administration 1,200,000

OST (drugs, logistic) 715,000

Drugs for MDR-TB treatment side-effects 500,000

MSM, SW unit cost increase 450,000

Place Day Month Year 7

Concept Note Review - Recommendations • Proposed strategic approaches remain unclear:

– social contracting mechanism for the HIV prevention package,

– scale-up of VCT in key populations to twice a year and ART in people who inject drugs,

– regionalisation approach,

– approach to integration of services,

– sustainability plan.

• Technical issues to resolve:

– Optimize to ensure value for money for packages for MARPs, CD4 and treatment monitoring and different forms of methadone.

– ARV treatment – 3FDC vs 2FDC +EFV – to follow the country decision

– Strengthen rapid diagnosis of rifampicin resistance and quinolone-resistant MDR-TB by the Xpert and LPA.

– Strengthen patient-centered approach to improve treatment outcomes for TB.

– How to address low access to medical and social services in prison.

Geneva 16 May 2014 8

Concept Note Review - Recommendations• Operational issues require negotiation:

– Crimea – to invest and seek for the solutions.

– How we work in conflict-affected regions and what can be done for IDPs.

– Implementation arrangements, including central level functional unit, need to be clarified: efficiency, effectiveness, coordination, relevance/expertise, effect on quality of service for end users.

Next steps• In cooperation with technical partners agree on reinvestment of savings and

address the remaining challenges.

• Develop and agree on grant making work plan and its implementation modalities.

• One week before November 13, 2014 – ready-to-sign grant documents have to be submitted for GAC2.

• GAC2 on November 13 followed by the board approval.

• WE HAVE 7 WEEKS TO FINALISE GRANT MAKING!

Geneva 16 May 2014 10

Grant Making

• Process of translating the funding request based on the TRP and GAC1 recommendations into disbursement-ready grants for Board approval and signature.

Geneva 16 May 2014 11

Disbursement-ready grant: • all required grant making outputs are in final form and agreed with PR(s)

• adequate risk mitigation measures are agreed and in place

• all significant issues to be resolved prior to first disbursement are addressed

Grant Making

Geneva 16 May 2014 12

Workstream Expected outputs Responsibility

Development and negotiation of grant documents

Performance Framework M&E PlanDetailed Budget List of Health Products, Quantities and Related Costs

CCM and PRs

Negotiation of implementation arrangements, identification and mitigation of capacity gaps and risks

Completed capacity assessment toolCompleted implementer mapping

CT – LFA, PRsCCM and PRs

Finalisation of administrative documents to enable grant signing

PR master data and bank account details Grant agreement

PRs

We need to develop a work plan for the deliverables of these workstreams.

Deadlines• Grant documents:

– 1st draft: 26 September (with turn around by 3 October)

– 2nd draft: 10 October (with turn around by 17 October)

– Final submission: 24 October

• Implementation mapping:

– Grant signing requirement

– Half day macro-level planning tomorrow

– Regional mapping – understanding of regionalisation approach, but regional mapping should be started and finished by end of year.

• CAT:

– CT will work with PRs and LFA. Final deadline is 31 October, but need support.

• Grant agreement documents:

– PRs to begin populating information.

– Government framework agreement needs to be worked on right away.

Place Day Month Year 13

During review, please do not

change the documents.

Your questions...

Place Day Month Year 14