Challenging Operating Environments Global Health Cluster - April 2017 Montreux, Switzerland
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Challenging Operating Environments Global Health Cluster April 2017 Montreux, Switzerland
COE POLICY
1
2 4
Maximize 3
Impact
In line with the first objective of the 2017-2022 Strategy, the Global Fund Against HIV,
CONTEXT developed a policy to improve effectiveness in Challenging Operating TB and
Malaria
Environments through innovation, increased flexibility and partnership
Countries or unstable parts of countries, or regions, characterized by weak governance, poor
COEs access to health services, limited capacity and fragility due to man-made or natural crisis
Use new approaches and Apply policy exceptions to Strengthen in-country
mechanisms, e.g. in reduce administrative burden & governance by optimizing
procurement, service delivery, increase agile response to partnerships and coordination;
etc. building on lessons changes in contexts, through foster integrated service
learned to address or contingency planning and delivery; and improve
circumvent challenges reprogramming technical assistance
2OBJECTIVE & FOCUS
COEs must strive to achieve the best possible outcomes and impact within their given setting
PRIORITIES
The ‘priority’ or minimum focus for Global Fund investment would depend on the type of COE
ACUTE EMERGENCY CHRONIC INSTABILITY
Deliver essential services, avoid Build resilient and sustainable systems
program regressions, and support for health and maintain or scale up
maintenance/ strengthening of health effective coverage of services
system where feasible
Allocation
COEs will submit a funding requests (where applicable) to access their allocation
Allocations may be reprogrammed at any time to respond to crises or changing context.
FINANCING Other Sources of Funding
Global Fund allocations may be complemented by financing from the Emergency Fund
The Emergency Fund supports activities that cannot be funded through the reprogramming of
existing grants during emergency
3COE CLASSIFICATION
The Global Fund The COE list is based on the countries classified under the “very high risk”
classifies COEs category of the ERI.
based on an
external risk index (ERI),
updated annually by the The ERI is a composite index that is derived by compiling data from 10
Risk Department. The ERI authoritative indices (e.g. Fragile States Index, UN’s Safety & Security
methodology derives the Index…).
classification of countries
as ‘Very High’, ‘High’,
‘Medium’ and ‘Low’ risk. The COE list is based on the countries classified under the “very high risk”
category of the ERI.
Ad-hoc adjustments can be made depending on emerging needs: The list of COEs is determined
- Post-crisis countries may remain categorized as COEs for one for every allocation period and
additional allocation period, in order to allow for restoration of reviewed annually with the
weakened health systems; and possibility to add countries
- Countries that face sudden emergency situations or disease based on updates to the ERI
outbreaks may be considered on a case-by-case basis and and emergency status by the
categorized as COEs. EGMC.
42017-2019 COE LIST
FOCUSED CORE HIGH IMPACT
• Iraq • Afghanistan • Liberia • Congo (Democratic
• Lebanon • Burundi • Mali Republic)
• Central African • Niger • Nigeria
• Mauritania
Republic • Sierra Leone • Pakistan
• Palestine
• Chad • Somalia • Sudan
• Syrian Arab
• Eritrea • South Sudan
Republic
• Yemen • Guinea
• Ukraine
• Guinea-Bissau
5COE OPN
Operationalizes the COE Policy
The COE OPN operationalizes the policy approved by the Board in April 2016 ( GF/B35/DP09).
Provides guidance
Guides future Global Fund engagement in COE contexts and provides guidance to CTs in managing their portfolios.
OPN Emphasizes stronger Country Team engagement
Stronger CT engagement is emphasized to define an operational strategy for the portfolio, tailored to achieving impact
within the context, needs and prevailing risks and challenges, including any required flexibilities.
COE classified as ‘High Impact’ are managed differently
High Impact COE portfolios will be managed following standard approach for High Impact portfolios.
COE will generally Categorization as a Additional flexibilities, Additional flexibilities,
follow the defined COE does not not provided in the not described in the
approaches for the automatically the OPN may be the OPN may be
portfolio category; guarantee eligibility requested and requested and
however they may for a flexibility granted through 000
granted through
FLEXIBILITIES access flexibilities to EGMC normal EGMC normal
ensure an agile approval channels approval channels
management of the
grant
6EMERGENCY FUND
Quick access to funds to enable the Global Provide and continue prevention and
1 Fund to fight the three diseases in emergency 2 treatment and other essential services on
situations. three diseases during emergencies
• For activities that cannot be funded through
Not for general humanitarian purposes
the reprogramming
2014-2017: US$ 30 million that go beyond the Global Fund mandate
• UN** classified L2 and L3 emergencies of
(HIV, TB and Malaria)
2017-2019: US$ 20 million WHO*** classified Grade 2 and 3 emergencies
Short-term and time-bound (up to 1 year) funding for:
provision/ distribution of drugs/ commodities (primary use)
supporting risk and situation assessments specific to the three diseases.
Limited incremental operational costs of service delivery and staffing
Flexible Emergencies usually involve cross border movement.
interpretation of Emergency Fund allows ineligible countries being affected by
the flow of refugees could thus receive funding (e.g. Syrian
the Global Fund refugees in ‘ineligible’ neighboring countries like Lebanon,
Eligibility Policy Jordan could still be covered by the Emergency Fund)
* Emergency Fund Guidelines were developed and approved by EGMC in August 2015, revised in November 2015.
** The UN uses the Inter-Agency Standing Committee (IASC) emergency classifications.
*** This grading relates to the health impact of the emergency situation. 7IMPLEMENTATION ARRANGEMENTS
• PR of existing grants (top-up) or pre-qualified implementers (new grant)
• Fast-track Reprogramming: This should be the first option, prior to
submitting proposals to the EF. The CT should liaise with partners
responding to the emergency to determine the best course of action
Pre-Qualified Implementers
• IOM • Save the Children • IRC
• WFP • Catholic Relief Services • UNDP
• UNICEF • IFRC • UNOPS
• World Vision • PSI • UNHCR
• GIZ • International Medical Corps • Plan International
• Purpose: Maintain a pool of experienced organizations that can be mobilized
quickly
AIM • 2 rounds of prequalification: 15 pre-qualified implementers
• Pre-qualified status must be renewed in 2018
8EMERGENCY FUND
Review and approval process: top-up arrangements
Country EGMC Amend
Dialogue with PR revises
Team reviews & Grant
in-country grant
reviews approves Agreement
partners documents
documents
Country Team PR revises the Country Team EGMC reviews Country Team
discusses with in- grant documents: reviews the and approves the issues an
country partners on performance documents and emergency amendment to
the emergency framework; makes a funding request. the Grant
response, the need detailed and recommendation Agreement.
for emergency summary budget; through a memo to
funding and the most and list of health EGMC based on the
appropriate products (as criteria set for
implementation relevant). Emergency Fund.
arrangements,
associated risk and
mitigation measures.
* Country Team comprises the relevant Fund Portfolio Manager, Program Officer, Finance Officer, M&E Officer, Procurement Officer and Legal
Officer.
** Applications assessed against the following criteria: a) Situation adequately described; b) Interventions proposed are appropriate to the
emergency situation; c) Suitability of selected implementer; d) No duplication of efforts; e) sustainability and exit strategy.
*** The Executive Grant Management Committee (EGMC) of the Global Fund is the approval authority of Emergency Fund grants.
9EMERGENCY FUND
Review and approval process: new grants
Implementer Implementer
submits EGMC Final
prepares
Dialogue with Concept reviews and Approval and
documents
In-country Proposal and approves a Signature of
and Country
partners Country Team funding Grant
Team
prepares memo ceiling Confirmation
for EGMC reviews
Country Team Following the EGMC reviews the Selected EGMC provides
discusses with in- Concept review, memo provided by implementer final approval for
country partners on Country Team the Country Team, prepares the the funding
the emergency prepares a makes a funding request, request,
response, the need summary memo to recommendation to based on the following which
for emergency EGMC on the proceed with the parameters agreed the Country
funding and the proposed detailed request by the EGMC after Team proceeds
most appropriate implementer; and sets the their review of the with the
implementation response and funding ceiling. Concept Proposal, preparation of
arrangements, strategy to address and submits to the the grant
associated risk and the situation; and Country Team for documents and
mitigation the estimated review and signature.
measures. funding request. approval.
10EMERGENCY FUND
Progress on the Emergency Fund
$ 30 million for Allocation Period 2014-2016
$ 21.3 million committed
• Procurement of 448,084 LLINs to complement the Liberia mass campaign LLIN gap due to a change in the distribution strategy
Liberia linked to the Ebola emergency.
(US$ 1.62 M) • Top-up to existing grant implemented by Ministry of Health and Social Welfare
(November 2014)
• Financing of the ACT gap as part of the Mass Drug Administration campaign in the context of the Ebola crisis.
Sierra Leone
• Top-up to the existing malaria grant implemented by the Ministry of Health
(US$ 1.63 M)
(November 2014)
• To enhance tuberculosis prevention, diagnosis and treatment among Syrian refugees in Lebanon and Jordan.
Syria
• Two grants (Lebanon: US$ 3,813,432; Jordan: US$ 2,464, 509; Pre-financing for MER: US$ 272,256) are being implemented by
(US$ 6.55 M )
IOM (January 2015, Costed Extensions approved in March 2016 and August 2016)
• To respond to HIV following the earthquake in Nepal.
Nepal
• Top-up to the existing HIV grant implemented by Save the Children.
(US$ 2.13 M)
(May 2015)
• To prevent disruptions in the delivery of essential HIV-related commodities and services to Donetsk and Lugansk regions of
Ukraine Ukraine, which are affected by the military conflict and are out of the control of the Government of Ukraine.
(US$ 7.27 M) • The grant is managed by UNICEF as a new grant.
(July 2015, No-Costed Extension approved in June 2016, Costed extension approved in December 2016)
• To support Burundian refugees’ access to services in all 3 diseases, incl. HIV Testing and Counselling; PMTCT; ART and
treatment for opportunistic infections; IRS at Mahama Camp and Reception Centres; Screening, investigation and treatment
Rwanda
services to patients with TB.
(US$ 2.09 M)
• The grant is managed by UNHCR as a new standalone grant.
(December 2016)
11EMERGENCY FUND
Emergency Fund: Snapshot
UKRAINE (US$ 7.27 M)
Objective: Prevent disruptions in delivery of essential HIV-related commodities and services to
Donetsk and Lugansk regions of Ukraine, affected by the military conflict and are out of the control of
the Government of Ukraine.
Implementer: UNICEF; stand-alone grant
(New Grant in July 2015; No-Costed Extension approved in June 2016; Costed extension approved in December 2016)
Activities:
Procurement of HIV-related commodities and supplies;
International air transport of health products to Kiev;
Establishment of a supply chain management system for the effective delivery of health supplies
Monitoring and delivery of health products to NGCAs
Partnerships: Health Sub-Cluster for HIV/TB (including PEPFAR); MSF (logistics)
SYRIA (LEBANON: US$3.8M & JORDAN: US$2.5M; pre-financing MER: US$272,256)
Lebanon is UMI and wasn’t eligible; Jordan had not had prior GF grants
Objective: To enhance tuberculosis prevention, diagnosis and treatment among Syrian refugees in
Lebanon and Jordan.
Implementer: IOM (approved in January 2015, Costed Extensions approved in March 2016 and August 2016)
Activities:
TB surveillance via CHVs;
TB treatment;
Web TBS and cross border notification;
IEC, training, screening, support lab tests, hospitalization costs
Training for NTP and staff engaged
Partnerships: WHO (SR); NTP; UNHCR (consulted)
12MER
MIDDLE EAST REGIONAL INITIATIVE
• Total budget: USD 34.5 million (balance of funds from the Syria and Yemen 2014 – 2017
allocation)
• Grant Duration: 1 Jan 2017 – 31 Dec 2018
• Prioritized interventions for 9 disease components taking into account feasibility factors in light of
the challenging operating environments and focusing on:
• Ensuring continuity of services, and prioritization of testing, treatment and prevention
• Vulnerable and key populations in Yemen and Syria, including IDPs and hard to reach areas
• Refugees in Jordan and Lebanon, with a focus on geographical regions where high density
• Health products procurements through GDF and PPM
• Flexible programming:
• Capitalize on IOM’s in-country presence and technical capacity to support the national programs, and improved coordination on the
grounds through field coordinators to facilitate implementation and monitoring.
• IOM is currently operationalizing the grant work plan to further refine grant activities and define corresponding implementation
modalities to ensure service delivery in hard to reach areas.
• Budget for service delivery in hard to reach areas through non-governmental partners once identified through the situational
assessments for Yemen and Syria to operationalize the grant work plan.
• IOM to develop contingency plans for each country to ensure flexibility in essential service delivery, including to populations in hard to
reach areas.
• Iraq TB Transition Funding Grant ended 31 Dec. 2016. Eligible in 2017-2020. Interim 1 year funding managed by IOM (1
Jan. – 31 Dec. 2017) approved by the Board in December 2016, to ensure continuity of services. Board approved
budget ceiling: USD 3 million. To be signed by 15 Feb. 2017.
• Palestine: Available funding (2014 – 2017): USD 5.5 million. Inclusion of essential TB and HIV services in the MER still
in discussion with MOH. Deadline: 31 March 2017. Any funding moving forward to be managed under the MER grant
management platform.
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