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  • 1. TRANSITIONAL FUNDING MECHANISM (TFM)INFORMATION NOTE Issue Date: 12 December 2011 IMPORTANT NOTICE: Funding under the Transitional Funding Mechanism (TFM) will be dependent on the resources available at the time the Board will approve TRP recommended TFM applications. Available resources depend on several factors over which the Global Fund has no direct control, in particular the receipt of funding anticipated from donors. The timing of receipt of donor funding will also influence the ability of the Global Fund to commit resources in a timely manner to minimize the disruption of essential services. At this time, the Global Fund cannot guarantee the amount of resources or the timing commitments. Given this, in accordance with its recent decision, the Board will approve applications on a rolling basis and stagger the timing of commitments (and if necessary vary the duration of commitments) to apply available resources to minimize the disruption of services. Introduction This information note explains the recent decision by the Global Fund Board to replace Round 11 with the Transitional Funding Mechanism because of inadequate resources and to establish a very limited Transitional Funding Mechanism (TFM) to help countries that might otherwise face a service interruption. In particular, the note guides applicants in the development of a proposal for continuation of essential prevention, treatment and/or care services under TFM. This note should be read along with the revised application materials available on the Global Fund website. Important decisions were also taken by the Board to modify the eligibility and application processes for grant renewals. More detailed information on the revised grant renewals process is available on the Global Fund website. Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 1
  • 2. 1. ContextAt its recent September and November 2011 meetings, the Global Fund Boardacknowledged the severe economic and resourcing environment and the resultinglikelihood that there would be inadequate funding to support proposals under Round 11.As a result, the Board decided to take immediate and exceptional action to ensure whatlimited resources are available are used to safeguard gains made through essentialprevention, treatment, and care services presently supported by the Global Fund. TheBoard therefore replaced Round 11 with the Transitional Funding Mechanism for programsthat:  Face disruption of essential services, currently supported by the Global Fund; and  For which no alternative sources of funding can be secured.This decision has important implications on the eligibility of applicants, the application,review and approval process and the allowable scope and duration of a TFM fundingrequest. These implications are introduced in this Information Note and explained in moredetail in the Guidelines.During 2012, the Secretariat will also undertake the development of a new funding modelconsistent with the new Global Fund 2012-2016 Strategy approved by the Board at itsTwenty-Fifth Board Meeting in Accra. This new approach should be operational in early2013 with funding approvals made in early 2014 when new resources become available,and should replace the annual rounds system used up until now.2. Application Process for TFMRevised application materials and guidance for TFM are now available and can bedownloaded from the TFM website. The date of submission for TFM requests is 31 March2012.3. Application of eligibility, counterpart financing and prioritization requirements to TFMEligibility for TFMThe Eligibility, Counterpart Financing and Prioritization (ECFP) policy approved by theBoard in May 2011 will apply to TFM, with some modifications. Please refer to the ECFPinformation note and to the new Eligibility list applicable for TFM which has been revisedto reflect the following:  Given the timing of TFM, the eligibility list is now based on World Bank income classifications as of July 2011 and updated disease burden data and OECD-DAC list of ODA recipients;  As a result of the 31 March 2012 deadline for submission of applications to TFM, revisions have been made regarding the recent funding rule1;1 The eligibility list reflects the “implementation window” defined by the recent funding rule that applies fromthe program start date to the deadline for submission of TFM applications set at 31 March 2012 by the Board.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 2
  • 3.  Consistent with the recent Board decision, the one-year grace period for changes in country income classification no longer applies;  G20 upper-middle income countries with less than an extreme disease burden are not eligible to apply, however the NGO rule included in the ECFP policy still applies; and  Because stand-alone cross-cutting HSS proposals will not be permitted under TFM, the HSS eligibility information no longer appears on the list.Counterpart financing and “focus of proposal” requirementsApplicants must demonstrate that their TFM request complies with both the counterpartfinancing and “focus of proposal” requirements. The “focus of proposal” requirementapplies to the incremental demand in the TFM request.Resources allocated to each funding poolThe separate General and Targeted Funding Pools will be maintained under TFM. Ninetypercent of resources available will be allocated to the General Funding Pool and tenpercent to the Targeted Funding Pool (subject to an upper limit). Due to uncertainties inthe current resource forecast, it is not possible to estimate the funding allocated to eachfunding pool.In addition, in the General Funding pool, funding for UMI countries will not exceed 10percent of the total proposal value (two-year incremental) of this Funding Pool.PrioritizationIf demand for TFM requests recommended by the Technical Review Panel (TRP) exceedsavailable resources, then the Board (or a Committee of the Board) will provide guidance onhow to prioritize funding. The prioritization process will be adapted to recognize:  Funding priority afforded to Continuity of Services interventions, under existing Global Fund policy;  The combined disease burden and country income level scores of applicants, as defined in the ECFP Policy (and included in the Eligibility list) as a relative indicator of country need;  The prioritization of proposals within the Targeted Pool by the TRP; and  The objective of avoiding disruption of essential services.4. Scope of applications under TFMUnder TFM, applicants with current Global Fund grants facing significant programdisruption between 1 January 2012 and 31 March 2014 can request the minimum amount offunding needed for the continuation of essential prevention, treatment and/or careservices. Applicants must also show that there are no alternative sources of fundingavailable to fund the activities proposed, including through reprogramming.Essential prevention, treatment and care servicesThe applicant must demonstrate that the proposed interventions/services presented withina TFM request represent essential services for the national response to the relevantdisease. What is permissible within an application will be specific to countryGlobal Fund Information Note: Transitional Funding Mechanism (12 December 2011) 3
  • 4. epidemiological and funding context, and for this reason no definitive list is provided.However the following guidance will help define what is likely to be considered under TFM.TFM is intended to support requests that continue at the existing scale2 core interventionsthat: (i) protect the gains achieved (e.g. interventions whose interruption would mean a significant rebound in transmission); and (ii) save lives; and (iii) are high impact, evidence-based, targeted to most appropriate populations and represent good value for money in a resource-constrained environment.TFM would typically not support interventions that: (i) Scale up3 services (including essential interventions) beyond the levels of patients, geographic areas or populations that will be reached at time of disruption; (ii) Continuation of interventions that are not high impact, have not been evaluated and demonstrated to be effective, are not targeted to appropriate populations, and/or do not demonstrate adequate value for money in a resource-constrained environment; (iii) Introduction of new interventions (except for certain essential interventions as explained in the footnote4).The Global Fund will support continuation of early diagnosis/detection where it is deemedan essential component of disease programs. However, early diagnosis could result inconsiderable increase in the number of people requiring treatment. Countries that decideto maintain existing scale of early diagnosis should demonstrate how alternate sources offunding (domestic or from other donors) will be deployed to cover the costs of placingadditional people on treatment, in particular for those requiring life-long treatment. TFMwill not support scale up beyond current levels of reach.Please refer to Annex 1 to this document for examples of essential prevention, treatmentand care services for each of the three diseases.Alternative sources of fundingApplicants must show that there are no alternative sources of funding available to fund theactivities proposed. Applicants are therefore expected to review existing and newresources that could be accessed. Sources may include:2 In the context of TFM, at the “existing scale” refers to a restriction to the same number of patients receivinga service at time of imminent disruption, in the same geographical area, in the same target population andwith a similar or lower budget.3 Scale up in the context of TFM refers to an absolute increase in the number of people receiving a service, theexpansion of geographical coverage and extension of services beyond the initially defined target population.4 In some cases, countries may change the content of the service package offered to epidemiologicallyimportant populations currently being served, provided: i) continuation of service to this population is essentialto avoiding substantial transmission rebound or deaths; ii) the proposed package is more cost-effective thanthe package previously funded by the Global Fund that it would replace, and provided there is no scale-up interms of (iii) the number of people receiving the service at any particular time, (iv) geographic coverage, and(v) finances; (vi) the target population should also remain the same. These will not be considered “newinterventions” under TFM. However, applicants will be expected to demonstrate that all of the aboveconditions have been met.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 4
  • 5.  Government budgets or other domestic sources;  other donors; or  funds from other Global Fund same-disease grants, which may be reprogrammed.Continuity of ServicesThe TFM request form asks applicants to provide information on proposed interventionsthat fall within the Global Fund Continuity of Services (CoS) policy, which is far morelimited in scope. The funding request and identification of CoS interventions are requiredto support a potential prioritization of demand should available resources be below theoverall TRP-recommended demand.5. Duration of fundingThe maximum proposal term permitted is two years. In order to avoid program disruption,the start date will be the date from which incremental funding will be required, which willbe at (or shortly prior to) the anticipated date of program disruption. The disruption (forexample, the end date of an existing grant) must fall between 1 January 2012 and 31March 2014.The Board approval of applications and commitment of funds will occur on a rollingbasis. The duration of commitments may also be varied and could, for example, belimited to one year at a time.6. Special considerations for NSAs and HSFPNSA Second-Wave participantsCountries participating in the Second Wave of NSAs are affected by the recent Boarddecisions. The NSA funding request must comply with the same guidance regarding focuson the continuation of essential prevention, treatment and/or care services and othercriteria applicable to TFM.Recognizing that Second Wave countries have conducted a joint assessment of theirnational disease strategy, they will be able to use the jointly-assessed strategy as the basisfor their funding request for the continuation of essential services. Furthermore, thefunding request will be submitted using a special TFM form for Second Wave participants.Health Systems Funding Platform (new funding requested through the Common HSSproposal form and HSS request template)Health systems strengthening (HSS) requests through the “common proposal form” orthrough “funding requests based on jointly assessed national health strategies” (the HSFPPilot) are not permitted under TFM.Applicants are permitted to integrate relevant HSS activities within their disease-specificTFM requests. Support requested must be exclusively for those HSS activities that arecrucial to preventing program disruption (such that the absence of these HSS activities willadversely affect the continuation of essential prevention, treatment and/or care services)and should not represent a scale up of HSS activities.Such activities may vary across programs, but generally any supported HSS activities mustdirectly and clearly contribute to sustaining the availability, utilization and quality ofGlobal Fund Information Note: Transitional Funding Mechanism (12 December 2011) 5
  • 6. essential high-impact prevention, treatment and/or care services and ensure theirequitable distribution and coverage for the target populations. HSS interventions must bedefined in such a way that they will be supportive to and not undermine the wider healthsystem. One example of such activity is strengthening of procurement and supply chainmanagement systems for essential commodities.The Global Fund remains a committed partner to HSFP and continues its cooperation withthe other HSFP partners in the areas of harmonization and alignment of existing HSSfunding, as well as in the technical cooperation around developing joint frameworks forMonitoring & Evaluation, Financial Management and Pharmaceutical Health ProductManagement.7. Review and approval processesFollowing screening, TFM applications will be reviewed by the TRP to:  Assess the technical merit of the proposal in accordance with existing review criteria;  Determine whether applicants have demonstrated a risk of disruption of essential prevention, treatment and/or care services; and  Assess whether the activities for which funding is sought cannot be funded by alternate sources of funding.As an input to the TRP review, the Fund Portfolio Managers and Country Teams of theGlobal Fund Secretariat will provide data and contextual information on existing grantprograms and disruptions and provide feedback on applicants’ TFM proposals. Partnerinput may also be requested.The TRP review will recognize that TFM applications seek to avoid disruption of essentialservices. Consequently, following its initial review, the TRP may decide that it requiresfurther information and clarifications in relation to the application prior to finalizing itsrecommendation to the Board. This phase of clarifications is likely to include engagementof partners and the Secretariat staff managing country portfolios.Noting the purpose of TFM, the normal TRP review outcomes may be varied. The TRPreview will be within the context that TFM is strictly intended for the continuation ofprograms, which if interrupted, would cause disruption of essential services andrecommendation categories will be used to reflect the level of clarification and/ormodification of proposals that is required. TFM applications may be recommended in full orin part. If the TRP finds that technical and scope criteria applicable to TFM are not met,the proposal may not be recommended.The Board approval of applications and commitment of funds will occur on a rollingbasis. The timing of making commitments will depend on available resources andtherefore may be staggered to mitigate the impact of services/programs imminentlyfacing disruption. The duration of commitments may also be varied and could, forexample, be limited to one year at a time.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 6
  • 7. TFM timelines Stage Dates Proposal development period 12 December 2011 – 31 March 2012 Screening process April – May 2012 TRP review meeting June 2012 Board (or Board Committee) endorsement of TRP initial July 2012 (anticipated) recommendations Board funding decisions (after further clarifications and From July 2012/2013, on a rolling basis grant negotiations)8. Provision of bridge funding and Continuity of ServicesA limited Bridge funding facility will be designed for TFM applicants whose programs facedisruption before funds become available under TFM. More information on this facility willbecome available in due course.As explained in section 4, applications that include Continuity of Services should separatelyidentify these elements within their TFM proposal. This will facilitate prioritization ofthese services should this be necessary. Certain countries that are not eligible to submit arequest under TFM may also be eligible for funding under the Global Fund’s Continuity ofServices policy. These countries should consult their Fund Portfolio Manager.9. Looking AheadThe decision point also directs the Secretariat to work with countries and partners todevelop full expressions of demand for programs for the three diseases and related healthsystems and community systems strengthening (CSS) investment that are consistent withthe new Global Fund Strategy 2012-2016 approved at the Twenty-Fifth Board Meeting.While the information note focuses on the limited scope of TFM, countries and partnersshould begin using national disease strategic plans, draft Round 11 applications, and otherdocuments to develop these expressions of demand. The Secretariat and partners willprovide guidance in early 2012.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 7
  • 8. Annex 1: Examples of essential prevention, treatment and care servicesUnder TFM, applicants with current Global Fund grants facing significant programdisruption between 1 January 2012 and 31 March 2014 can request the minimum amount offunding needed for the continuation of essential prevention, treatment and/or careservices. Applicants must also show that there are no alternative sources of fundingavailable to fund the activities proposed, including through reprogramming. What ispermissible within an application will be specific to country epidemiological and fundingcontext, and for this reason no definitive list is provided. The examples described beloware only indicative.HIV and AIDSThe investment framework for HIV5 and the UNAIDs strategy 2011-20156 set out the keyevidence-based program elements which when implemented in combination, asdetermined by respective epidemiological context, will maximize impact.For HIV and AIDS, the following are examples of essential prevention, treatment and careservices in the context of TFM: antiretroviral therapy; TB screening and treatment amongPLWHA; PMTCT; prevention and treatment targeted at key populations with high levels ofincidence (including evidence-based programs reaching men who have sex with men,people who inject drugs, prisoners and sex workers); and male circumcision whereindicated (i.e. in settings with high prevalence and low rates of male circumcision).The following are examples of interventions that are unlikely to be funded under TFM:scale up of antiretroviral therapy, untargeted population approaches to HIV prevention(including mass media campaigns), general population HIV testing in concentratedepidemics, generalized nutritional support, blood safety, universal precautions, pre-exposure prophylaxis, infrastructure development, procurement of vehicles, andgeneralized/untargeted trainings.TBThe following are examples of essential prevention, treatment and care services in thecontext of TFM: high impact interventions that ensure early case detection; diagnosis andtreatment of patients with drug-susceptible or multidrug-resistant TB, includinginterventions targeted at vulnerable populations; HIV testing and treatment among TBpatients; TB preventive therapy among PLWHA and TB screening among high riskpopulations; interventions to strengthen systems to ensure access for communities andpeople affected by TB; TB infection control related to TB transmission in health facilities.The following are examples of interventions that are unlikely to be funded under TFM:scale up of DOTS, scale up of drug-susceptible and multidrug-resistant TB services; foodsupport for TB patients; Practical Approach to Lung health (PAL); infrastructuredevelopment; procurement of vehicles; and generalized/untargeted trainings.5 Schwartländer B et al, Towards an improved investment approach for an effective response to HIV/AIDS.Lancet. 2011 Jun 11;377(9782):2031-41.6 Fund Information Note: Transitional Funding Mechanism (12 December 2011) 8
  • 9. MalariaFor malaria, the following are examples of essential prevention, treatment and careservices in the context of TFM: vector control activities (including long lasting insecticidalnets OR indoor residual spraying7); case management composed of a combination ofdiagnostics and appropriate treatment; and intermittent preventive treatment in pregnantwomen in high burden settings.The following are examples of interventions that are unlikely to be funded under TFM:scale up of vector control and case management; large investments in improving routineinformation systems; elimination programs8; intermittent preventive therapy for infantsand children, infrastructure development, procurement of vehicles, andgeneralized/untargeted trainings.Critical enablers Critical enablers (such as stigma reduction, gender equality andcommunity mobilization) and program efforts in relation to wider development sectors(health systems, social protection, gender-based violence, etc.), as applicable to eachdisease, will only be considered where they are deemed by the Global Fund as essential forthe continuation of delivery of essential treatment, prevention and care services based onclear and precise justification by the applicant.7 Please note that proposals requesting continuation for both LLINS and IRS combined in the same area arediscouraged.8 Activities aimed at malaria elimination will be considered only in specific contexts where there is sufficientevidence of substantial risks, e.g. loss of significant gains, immediate threat of disease outbreak and risk ofspread of artemisinin resistance.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 9
  • 10. Annex 2: Continuity of ServicesThe Global Fund’s Continuity of Services (CoS) policy provides funding to continue certaincourses of treatment (whether the treatment is for a limited duration or is lifelong) for HIVand TB grants that are coming to an end. This policy provides up to two years of fundingto continue certain courses of treatment.Relevant HIV and TB applicants should present the CoS part of their request, if any, in thissection. This will allow prioritization if necessary due to limited resources.The services covered under the CoS policy include: (i) Medicines (which, in the case of discontinuation of anti-retroviral therapy (ARV), include drugs for HIV-related opportunistic infections), PMTCT activities (for mothers already placed on courses of treatment at the time of the application) and Opioid Substitution Therapy; (ii) Diagnostic tests for patients currently under ARV and TB therapy; (iii) Human resources directly linked to the delivery of services for existing patients; (iv) Other ongoing direct costs (e.g. delivery and storage of drugs); Limited and critical operational costs to deliver and store drugs and comply with Global Fund reporting requirements during the COS period.Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 10