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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
1. Context

At its recent September and November 2011 meetings, the Global Fund Board
acknowledged the severe economic and resourcing environment and the resulting
likelihood 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 what
limited resources are available are used to safeguard gains made through essential
prevention, treatment, and care services presently supported by the Global Fund. The
Board therefore replaced Round 11 with the Transitional Funding Mechanism for programs
that:
       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 funding
request. These implications are introduced in this Information Note and explained in more
detail in the Guidelines.

During 2012, the Secretariat will also undertake the development of a new funding model
consistent with the new Global Fund 2012-2016 Strategy approved by the Board at its
Twenty-Fifth Board Meeting in Accra. This new approach should be operational in early
2013 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 TFM

Revised application materials and guidance for TFM are now available and can be
downloaded from the TFM website. The date of submission for TFM requests is 31 March
2012.



3. Application of eligibility, counterpart financing and prioritization requirements to
   TFM

Eligibility for TFM

The Eligibility, Counterpart Financing and Prioritization (ECFP) policy approved by the
Board in May 2011 will apply to TFM, with some modifications. Please refer to the ECFP
information note and to the new Eligibility list applicable for TFM which has been revised
to 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 from
the 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
    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” requirements

Applicants must demonstrate that their TFM request complies with both the counterpart
financing and “focus of proposal” requirements. The “focus of proposal” requirement
applies to the incremental demand in the TFM request.

Resources allocated to each funding pool

The separate General and Targeted Funding Pools will be maintained under TFM. Ninety
percent of resources available will be allocated to the General Funding Pool and ten
percent to the Targeted Funding Pool (subject to an upper limit). Due to uncertainties in
the current resource forecast, it is not possible to estimate the funding allocated to each
funding pool.

In addition, in the General Funding pool, funding for UMI countries will not exceed 10
percent of the total proposal value (two-year incremental) of this Funding Pool.

Prioritization

If demand for TFM requests recommended by the Technical Review Panel (TRP) exceeds
available resources, then the Board (or a Committee of the Board) will provide guidance on
how 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 TFM

Under TFM, applicants with current Global Fund grants facing significant program
disruption between 1 January 2012 and 31 March 2014 can request the minimum amount of
funding needed for the continuation of essential prevention, treatment and/or care
services. Applicants must also show that there are no alternative sources of funding
available to fund the activities proposed, including through reprogramming.

Essential prevention, treatment and care services

The applicant must demonstrate that the proposed interventions/services presented within
a TFM request represent essential services for the national response to the relevant
disease. What is permissible within an application will be specific to country



Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)            3
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 interventions
that:
    (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 deemed
an essential component of disease programs. However, early diagnosis could result in
considerable increase in the number of people requiring treatment. Countries that decide
to maintain existing scale of early diagnosis should demonstrate how alternate sources of
funding (domestic or from other donors) will be deployed to cover the costs of placing
additional people on treatment, in particular for those requiring life-long treatment. TFM
will not support scale up beyond current levels of reach.

Please refer to Annex 1 to this document for examples of essential prevention, treatment
and care services for each of the three diseases.

Alternative sources of funding

Applicants must show that there are no alternative sources of funding available to fund the
activities proposed. Applicants are therefore expected to review existing and new
resources 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 receiving
a service at time of imminent disruption, in the same geographical area, in the same target population and
with 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, the
expansion 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 epidemiologically
important populations currently being served, provided: i) continuation of service to this population is essential
to avoiding substantial transmission rebound or deaths; ii) the proposed package is more cost-effective than
the package previously funded by the Global Fund that it would replace, and provided there is no scale-up in
terms 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 “new
interventions” under TFM. However, applicants will be expected to demonstrate that all of the above
conditions have been met.




Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)                                 4
   Government budgets or other domestic sources;
       other donors; or
       funds from other Global Fund same-disease grants, which may be reprogrammed.

Continuity of Services
The TFM request form asks applicants to provide information on proposed interventions
that fall within the Global Fund Continuity of Services (CoS) policy, which is far more
limited in scope. The funding request and identification of CoS interventions are required
to support a potential prioritization of demand should available resources be below the
overall TRP-recommended demand.



5. Duration of funding

The 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 will
be at (or shortly prior to) the anticipated date of program disruption. The disruption (for
example, the end date of an existing grant) must fall between 1 January 2012 and 31
March 2014.

The Board approval of applications and commitment of funds will occur on a rolling
basis. The duration of commitments may also be varied and could, for example, be
limited to one year at a time.


6. Special considerations for NSAs and HSFP

NSA Second-Wave participants
Countries participating in the Second Wave of NSAs are affected by the recent Board
decisions. The NSA funding request must comply with the same guidance regarding focus
on the continuation of essential prevention, treatment and/or care services and other
criteria applicable to TFM.

Recognizing that Second Wave countries have conducted a joint assessment of their
national disease strategy, they will be able to use the jointly-assessed strategy as the basis
for their funding request for the continuation of essential services. Furthermore, the
funding request will be submitted using a special TFM form for Second Wave participants.

Health Systems Funding Platform (new funding requested through the Common HSS
proposal form and HSS request template)

Health systems strengthening (HSS) requests through the “common proposal form” or
through “funding requests based on jointly assessed national health strategies” (the HSFP
Pilot) are not permitted under TFM.

Applicants are permitted to integrate relevant HSS activities within their disease-specific
TFM requests. Support requested must be exclusively for those HSS activities that are
crucial to preventing program disruption (such that the absence of these HSS activities will
adversely 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 must
directly and clearly contribute to sustaining the availability, utilization and quality of


Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)              5
essential high-impact prevention, treatment and/or care services and ensure their
equitable distribution and coverage for the target populations. HSS interventions must be
defined in such a way that they will be supportive to and not undermine the wider health
system. One example of such activity is strengthening of procurement and supply chain
management systems for essential commodities.

The Global Fund remains a committed partner to HSFP and continues its cooperation with
the other HSFP partners in the areas of harmonization and alignment of existing HSS
funding, as well as in the technical cooperation around developing joint frameworks for
Monitoring & Evaluation, Financial Management and Pharmaceutical Health Product
Management.



7. Review and approval processes

Following 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 the
Global Fund Secretariat will provide data and contextual information on existing grant
programs and disruptions and provide feedback on applicants’ TFM proposals. Partner
input may also be requested.

The TRP review will recognize that TFM applications seek to avoid disruption of essential
services. Consequently, following its initial review, the TRP may decide that it requires
further information and clarifications in relation to the application prior to finalizing its
recommendation to the Board. This phase of clarifications is likely to include engagement
of partners and the Secretariat staff managing country portfolios.

Noting the purpose of TFM, the normal TRP review outcomes may be varied. The TRP
review will be within the context that TFM is strictly intended for the continuation of
programs, which if interrupted, would cause disruption of essential services and
recommendation categories will be used to reflect the level of clarification and/or
modification of proposals that is required. TFM applications may be recommended in full or
in 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 rolling
basis. The timing of making commitments will depend on available resources and
therefore may be staggered to mitigate the impact of services/programs imminently
facing disruption. The duration of commitments may also be varied and could, for
example, be limited to one year at a time.




Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)             6
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 Services

A limited Bridge funding facility will be designed for TFM applicants whose programs face
disruption before funds become available under TFM. More information on this facility will
become available in due course.

As explained in section 4, applications that include Continuity of Services should separately
identify these elements within their TFM proposal. This will facilitate prioritization of
these services should this be necessary. Certain countries that are not eligible to submit a
request under TFM may also be eligible for funding under the Global Fund’s Continuity of
Services policy. These countries should consult their Fund Portfolio Manager.



9. Looking Ahead

The decision point also directs the Secretariat to work with countries and partners to
develop full expressions of demand for programs for the three diseases and related health
systems and community systems strengthening (CSS) investment that are consistent with
the 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 partners
should begin using national disease strategic plans, draft Round 11 applications, and other
documents to develop these expressions of demand. The Secretariat and partners will
provide guidance in early 2012.




Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)             7
Annex 1: Examples of essential prevention, treatment and care services


Under TFM, applicants with current Global Fund grants facing significant program
disruption between 1 January 2012 and 31 March 2014 can request the minimum amount of
funding needed for the continuation of essential prevention, treatment and/or care
services. Applicants must also show that there are no alternative sources of funding
available to fund the activities proposed, including through reprogramming. What is
permissible within an application will be specific to country epidemiological and funding
context, and for this reason no definitive list is provided. The examples described below
are only indicative.


HIV and AIDS
The investment framework for HIV5 and the UNAIDs strategy 2011-20156 set out the key
evidence-based program elements which when implemented in combination, as
determined by respective epidemiological context, will maximize impact.

For HIV and AIDS, the following are examples of essential prevention, treatment and care
services in the context of TFM: antiretroviral therapy; TB screening and treatment among
PLWHA; PMTCT; prevention and treatment targeted at key populations with high levels of
incidence (including evidence-based programs reaching men who have sex with men,
people who inject drugs, prisoners and sex workers); and male circumcision where
indicated (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 concentrated
epidemics, generalized nutritional support, blood safety, universal precautions, pre-
exposure prophylaxis, infrastructure development, procurement of vehicles, and
generalized/untargeted trainings.


TB
The following are examples of essential prevention, treatment and care services in the
context of TFM: high impact interventions that ensure early case detection; diagnosis and
treatment of patients with drug-susceptible or multidrug-resistant TB, including
interventions targeted at vulnerable populations; HIV testing and treatment among TB
patients; TB preventive therapy among PLWHA and TB screening among high risk
populations; interventions to strengthen systems to ensure access for communities and
people 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; food
support for TB patients; Practical Approach to Lung health (PAL); infrastructure
development; 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

http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/JC2034_UNAIDS_
Strategy_en.pdf


Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)                      8
Malaria
For malaria, the following are examples of essential prevention, treatment and care
services in the context of TFM: vector control activities (including long lasting insecticidal
nets OR indoor residual spraying7); case management composed of a combination of
diagnostics and appropriate treatment; and intermittent preventive treatment in pregnant
women 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 routine
information systems; elimination programs8; intermittent preventive therapy for infants
and    children,   infrastructure  development,    procurement     of   vehicles,  and
generalized/untargeted trainings.

Critical enablers Critical enablers (such as stigma reduction, gender equality and
community mobilization) and program efforts in relation to wider development sectors
(health systems, social protection, gender-based violence, etc.), as applicable to each
disease, will only be considered where they are deemed by the Global Fund as essential for
the continuation of delivery of essential treatment, prevention and care services based on
clear and precise justification by the applicant.




7
  Please note that proposals requesting continuation for both LLINS and IRS combined in the same area are
discouraged.
8
  Activities aimed at malaria elimination will be considered only in specific contexts where there is sufficient
evidence of substantial risks, e.g. loss of significant gains, immediate threat of disease outbreak and risk of
spread of artemisinin resistance.


Global Fund Information Note: Transitional Funding Mechanism (12 December 2011)                               9
Annex 2: Continuity of Services

The Global Fund’s Continuity of Services (CoS) policy provides funding to continue certain
courses of treatment (whether the treatment is for a limited duration or is lifelong) for HIV
and TB grants that are coming to an end. This policy provides up to two years of funding
to continue certain courses of treatment.

Relevant HIV and TB applicants should present the CoS part of their request, if any, in this
section. 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

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13 tfm request-info_note_en1

  • 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. Context At its recent September and November 2011 meetings, the Global Fund Board acknowledged the severe economic and resourcing environment and the resulting likelihood 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 what limited resources are available are used to safeguard gains made through essential prevention, treatment, and care services presently supported by the Global Fund. The Board therefore replaced Round 11 with the Transitional Funding Mechanism for programs that:  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 funding request. These implications are introduced in this Information Note and explained in more detail in the Guidelines. During 2012, the Secretariat will also undertake the development of a new funding model consistent with the new Global Fund 2012-2016 Strategy approved by the Board at its Twenty-Fifth Board Meeting in Accra. This new approach should be operational in early 2013 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 TFM Revised application materials and guidance for TFM are now available and can be downloaded from the TFM website. The date of submission for TFM requests is 31 March 2012. 3. Application of eligibility, counterpart financing and prioritization requirements to TFM Eligibility for TFM The Eligibility, Counterpart Financing and Prioritization (ECFP) policy approved by the Board in May 2011 will apply to TFM, with some modifications. Please refer to the ECFP information note and to the new Eligibility list applicable for TFM which has been revised to 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 from the 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” requirements Applicants must demonstrate that their TFM request complies with both the counterpart financing and “focus of proposal” requirements. The “focus of proposal” requirement applies to the incremental demand in the TFM request. Resources allocated to each funding pool The separate General and Targeted Funding Pools will be maintained under TFM. Ninety percent of resources available will be allocated to the General Funding Pool and ten percent to the Targeted Funding Pool (subject to an upper limit). Due to uncertainties in the current resource forecast, it is not possible to estimate the funding allocated to each funding pool. In addition, in the General Funding pool, funding for UMI countries will not exceed 10 percent of the total proposal value (two-year incremental) of this Funding Pool. Prioritization If demand for TFM requests recommended by the Technical Review Panel (TRP) exceeds available resources, then the Board (or a Committee of the Board) will provide guidance on how 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 TFM Under TFM, applicants with current Global Fund grants facing significant program disruption between 1 January 2012 and 31 March 2014 can request the minimum amount of funding needed for the continuation of essential prevention, treatment and/or care services. Applicants must also show that there are no alternative sources of funding available to fund the activities proposed, including through reprogramming. Essential prevention, treatment and care services The applicant must demonstrate that the proposed interventions/services presented within a TFM request represent essential services for the national response to the relevant disease. What is permissible within an application will be specific to country Global 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 interventions that: (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 deemed an essential component of disease programs. However, early diagnosis could result in considerable increase in the number of people requiring treatment. Countries that decide to maintain existing scale of early diagnosis should demonstrate how alternate sources of funding (domestic or from other donors) will be deployed to cover the costs of placing additional people on treatment, in particular for those requiring life-long treatment. TFM will not support scale up beyond current levels of reach. Please refer to Annex 1 to this document for examples of essential prevention, treatment and care services for each of the three diseases. Alternative sources of funding Applicants must show that there are no alternative sources of funding available to fund the activities proposed. Applicants are therefore expected to review existing and new resources 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 receiving a service at time of imminent disruption, in the same geographical area, in the same target population and with 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, the expansion 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 epidemiologically important populations currently being served, provided: i) continuation of service to this population is essential to avoiding substantial transmission rebound or deaths; ii) the proposed package is more cost-effective than the package previously funded by the Global Fund that it would replace, and provided there is no scale-up in terms 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 “new interventions” under TFM. However, applicants will be expected to demonstrate that all of the above conditions 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 Services The TFM request form asks applicants to provide information on proposed interventions that fall within the Global Fund Continuity of Services (CoS) policy, which is far more limited in scope. The funding request and identification of CoS interventions are required to support a potential prioritization of demand should available resources be below the overall TRP-recommended demand. 5. Duration of funding The 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 will be at (or shortly prior to) the anticipated date of program disruption. The disruption (for example, the end date of an existing grant) must fall between 1 January 2012 and 31 March 2014. The Board approval of applications and commitment of funds will occur on a rolling basis. The duration of commitments may also be varied and could, for example, be limited to one year at a time. 6. Special considerations for NSAs and HSFP NSA Second-Wave participants Countries participating in the Second Wave of NSAs are affected by the recent Board decisions. The NSA funding request must comply with the same guidance regarding focus on the continuation of essential prevention, treatment and/or care services and other criteria applicable to TFM. Recognizing that Second Wave countries have conducted a joint assessment of their national disease strategy, they will be able to use the jointly-assessed strategy as the basis for their funding request for the continuation of essential services. Furthermore, the funding request will be submitted using a special TFM form for Second Wave participants. Health Systems Funding Platform (new funding requested through the Common HSS proposal form and HSS request template) Health systems strengthening (HSS) requests through the “common proposal form” or through “funding requests based on jointly assessed national health strategies” (the HSFP Pilot) are not permitted under TFM. Applicants are permitted to integrate relevant HSS activities within their disease-specific TFM requests. Support requested must be exclusively for those HSS activities that are crucial to preventing program disruption (such that the absence of these HSS activities will adversely 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 must directly and clearly contribute to sustaining the availability, utilization and quality of Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 5
  • 6. essential high-impact prevention, treatment and/or care services and ensure their equitable distribution and coverage for the target populations. HSS interventions must be defined in such a way that they will be supportive to and not undermine the wider health system. One example of such activity is strengthening of procurement and supply chain management systems for essential commodities. The Global Fund remains a committed partner to HSFP and continues its cooperation with the other HSFP partners in the areas of harmonization and alignment of existing HSS funding, as well as in the technical cooperation around developing joint frameworks for Monitoring & Evaluation, Financial Management and Pharmaceutical Health Product Management. 7. Review and approval processes Following 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 the Global Fund Secretariat will provide data and contextual information on existing grant programs and disruptions and provide feedback on applicants’ TFM proposals. Partner input may also be requested. The TRP review will recognize that TFM applications seek to avoid disruption of essential services. Consequently, following its initial review, the TRP may decide that it requires further information and clarifications in relation to the application prior to finalizing its recommendation to the Board. This phase of clarifications is likely to include engagement of partners and the Secretariat staff managing country portfolios. Noting the purpose of TFM, the normal TRP review outcomes may be varied. The TRP review will be within the context that TFM is strictly intended for the continuation of programs, which if interrupted, would cause disruption of essential services and recommendation categories will be used to reflect the level of clarification and/or modification of proposals that is required. TFM applications may be recommended in full or in 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 rolling basis. The timing of making commitments will depend on available resources and therefore may be staggered to mitigate the impact of services/programs imminently facing disruption. The duration of commitments may also be varied and could, for example, 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 Services A limited Bridge funding facility will be designed for TFM applicants whose programs face disruption before funds become available under TFM. More information on this facility will become available in due course. As explained in section 4, applications that include Continuity of Services should separately identify these elements within their TFM proposal. This will facilitate prioritization of these services should this be necessary. Certain countries that are not eligible to submit a request under TFM may also be eligible for funding under the Global Fund’s Continuity of Services policy. These countries should consult their Fund Portfolio Manager. 9. Looking Ahead The decision point also directs the Secretariat to work with countries and partners to develop full expressions of demand for programs for the three diseases and related health systems and community systems strengthening (CSS) investment that are consistent with the 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 partners should begin using national disease strategic plans, draft Round 11 applications, and other documents to develop these expressions of demand. The Secretariat and partners will provide 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 services Under TFM, applicants with current Global Fund grants facing significant program disruption between 1 January 2012 and 31 March 2014 can request the minimum amount of funding needed for the continuation of essential prevention, treatment and/or care services. Applicants must also show that there are no alternative sources of funding available to fund the activities proposed, including through reprogramming. What is permissible within an application will be specific to country epidemiological and funding context, and for this reason no definitive list is provided. The examples described below are only indicative. HIV and AIDS The investment framework for HIV5 and the UNAIDs strategy 2011-20156 set out the key evidence-based program elements which when implemented in combination, as determined by respective epidemiological context, will maximize impact. For HIV and AIDS, the following are examples of essential prevention, treatment and care services in the context of TFM: antiretroviral therapy; TB screening and treatment among PLWHA; PMTCT; prevention and treatment targeted at key populations with high levels of incidence (including evidence-based programs reaching men who have sex with men, people who inject drugs, prisoners and sex workers); and male circumcision where indicated (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 concentrated epidemics, generalized nutritional support, blood safety, universal precautions, pre- exposure prophylaxis, infrastructure development, procurement of vehicles, and generalized/untargeted trainings. TB The following are examples of essential prevention, treatment and care services in the context of TFM: high impact interventions that ensure early case detection; diagnosis and treatment of patients with drug-susceptible or multidrug-resistant TB, including interventions targeted at vulnerable populations; HIV testing and treatment among TB patients; TB preventive therapy among PLWHA and TB screening among high risk populations; interventions to strengthen systems to ensure access for communities and people 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; food support for TB patients; Practical Approach to Lung health (PAL); infrastructure development; 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 http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/JC2034_UNAIDS_ Strategy_en.pdf Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 8
  • 9. Malaria For malaria, the following are examples of essential prevention, treatment and care services in the context of TFM: vector control activities (including long lasting insecticidal nets OR indoor residual spraying7); case management composed of a combination of diagnostics and appropriate treatment; and intermittent preventive treatment in pregnant women 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 routine information systems; elimination programs8; intermittent preventive therapy for infants and children, infrastructure development, procurement of vehicles, and generalized/untargeted trainings. Critical enablers Critical enablers (such as stigma reduction, gender equality and community mobilization) and program efforts in relation to wider development sectors (health systems, social protection, gender-based violence, etc.), as applicable to each disease, will only be considered where they are deemed by the Global Fund as essential for the continuation of delivery of essential treatment, prevention and care services based on clear and precise justification by the applicant. 7 Please note that proposals requesting continuation for both LLINS and IRS combined in the same area are discouraged. 8 Activities aimed at malaria elimination will be considered only in specific contexts where there is sufficient evidence of substantial risks, e.g. loss of significant gains, immediate threat of disease outbreak and risk of spread of artemisinin resistance. Global Fund Information Note: Transitional Funding Mechanism (12 December 2011) 9
  • 10. Annex 2: Continuity of Services The Global Fund’s Continuity of Services (CoS) policy provides funding to continue certain courses of treatment (whether the treatment is for a limited duration or is lifelong) for HIV and TB grants that are coming to an end. This policy provides up to two years of funding to continue certain courses of treatment. Relevant HIV and TB applicants should present the CoS part of their request, if any, in this section. 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