Existing HSS grant to South Sudan re-programmed
The Global Fund Board has approved funding in the amount of € 16.4 million ($18.4 million) for a malaria grant to Guinea-Bissau. The Board also approved additional funding for an existing health services strengthening grant to South Sudan. The Board was acting on recommendations from the Technical Review Panel and the Grant Approval Committee.
Guinea-Bissau is considered a challenging operating environment and has been under the Additional Safeguard Policy since 2012. The grant aims to
increase the proportion of pregnant women attending antenatal clinics who received three or more doses of intermittent preventive treatment for malaria from 18% in 2014 to 55% in 2017;
reduce annual inpatient malaria deaths per 1,000 population from 30 in 2012 to 25 in 2017;
reduce the malaria test positivity rate from 31% in 2014 to 21% in 2017; and
increase the proportion of health facilities reporting no stock-outs of essential drugs from 81% in 2014 to 92% in 2017.
Among the strategies to reach these targets is the scale-up of integrated communicate case management interventions.
According to the GAC, as an interim measure, the budget includes funds for the payment of incentives for key staff members of the national malaria control program who are critical to successful grant implementation. At the Secretariat's request, the GAC said, the CCM submitted a proposal in December 2015 for the harmonization of incentives across Global Fund grants. Discussions are being held with the CCM to ensure that the payment of incentives is linked to the performance of the grant and that a phase-out plan is provided. Furthermore, the GAC said, a condition has been included in the grant confirmation to ensure that incentives are paid only upon the Secretariat's approval of the CCM's proposal.
The Board approved $0.6 million in funding to support re-programming of an existing HSS grant (SSD-910-G12-S) that dates from the round-based period. The reprogramming will support a public reference library to improve diagnosis and blood bank services; allow for renovating and equipping regional medical stores; address the shortage of skilled human resources by supporting training, and providing scholarships and salary support for tutors; and strengthen community systems (which was not part of the existing grant). The grant was given a one-year no-cost extension to allow for the new initiatives to be implemented.
Actually, South Sudan submitted an HSS concept note to implement these initiatives in October 2014. The TRP did not consider the note strategically focused or technically sound, so it sent it back for reiteration. Subsequently, it was revealed that there was no money set aside for HSS in the approved program split for South Sudan. Hence, the decision to reprogram an existing HSS grant instead.
In November 2015, the Secretariat informed South Sudan that it would continue to fund grants in that country under a non-CCM approach, meaning that the CCM was not able to operate effectively. The United Nations Development Programme is the principal recipient for the HSS grant. Non-CCM countries are not required to meet counterpart financing and willingness-to-pay requirements. However, the GAC decided that the WTP requirements would not be waived for South Sudan, as a way of encouraging the government to sustain its investments in the heath sector.
The Board also approved additional funding of $2.4 million for a malaria grant and a TB grant to Eritrea that had previous been approved for funding. The additional funding comes from in-country cash balances from two rounds-based grants. The GAC said that the additional amounts are "within the allocation." While the amount of the original allocation for Eritrea and the suggested program split are known publicly, the Global Fund has not released the final approved program split for Eritrea (or for any other country).
The information for this article is taken from GF34-ER09-EDP12-13, the GAC report to the Board for February 2016. This document is not available on the Global Fund website.