The document discusses the Global Fund's Sustainability, Transition and Co-Financing (STC) policy. It aims to provide a coherent approach to delivering long-term sustainability of health systems and disease responses in countries receiving Global Fund support. The key principles of the policy are predictability, differentiation based on country income level, alignment with national systems, and flexibility. The policy is designed to address sustainability and transition challenges. It emphasizes early transition planning and preparation, particularly for upper-middle income countries and lower-middle income countries with low/moderate disease burdens. Co-financing requirements are scaled up as countries develop to gradually increase domestic funding of national disease programs.

1. The Global Fund policy on Sustainability, Transition and Co-financing and the
Funding Cycle Process

2. Webinar Objectives & Key Focus Areas
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Core Principles of the STC Policy
STC Policy and Sustainability and
Transition
1
2
3 Transition Projections and
Preparedness
4 Understanding Co-Financing
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Transition Planning and Assessments
Main Objectives:
• Review the Global Fund’s STC Policy, and
the way it affects sustainability, transition
preparedness, and transition
• Understand the linkages between the STC
Policy and the upcoming Funding Cycle,
including Co-Financing
• Discuss the core aspects of a Transition
Tailored Review Application for funding
• Review the basic concepts and thematic
areas of transition planning
Transition Tailored Review
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Questions and Answers
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3. What is the Sustainability, Transition and Co-Financing
Policy?
The Sustainability, Transition and Co-Financing Policy (STC Policy)
brings together three inter-related themes to provide a coherent
approach to delivering the long-term sustainability of health
systems and national disease responses for HIV, TB, and Malaria.
2

4. The S, the T, and the C
3
Sustainability
Transition
Co-financing
a process Desired outcome
one of the tools
Investing to
End Epidemics
BUILD
RESILIENT
&
SUSTAINABLE
SYSTEMS FOR
HEALTH
MAXIMIZE IMPACT
AGAINST
HIV, TB AND
MALARIA
PROMOTE &
PROTECT
HUMAN RIGHTS
AND
GENDER
EQUALITY
MOBILIZE
INCREASED
RESOURCES
Goal

5. Sustainability and Transition in a Global Fund Context
Transition
The process by which a country moves
towards fully funding and implementing its
health programs independent of Global
Fund support while continuing to sustain
the gains and scaling up as appropriate
4
Sustainability
The ability of a health program or
country to both maintain and scale up
service coverage to a level, in line
with epidemiological context, that will
provide for continuing control of a
public health problem and support
efforts for elimination of the three
diseases, even after the removal of
external funding by the Global Fund
and other major external donors.
Relevant to all countries
Transition preparedness should be a
priority for all LMI countries with ‘low’
and ‘moderate’ disease burden and all
UMI countries

6. How does the STC Policy relate to the 2017-2022
Strategy?
The Global Fund Strategy 2017-2022
places a strong emphasis on the need to
support sustainable responses for epidemic
control and successful transitions away
from direct grant support.
It also stresses the need to support
countries to use existing resources more
efficiently and to increase domestic
resource mobilization.
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BUILD RESILIENT
& SUSTAINABLE
SYSTEMS FOR
HEALTH
MAXIMIZE IMPACT
AGAINST
HIV, TB AND
MALARIA
PROMOTE & PROTECT
HUMAN RIGHTS AND
GENDER EQUALITY
MOBILIZE INCREASED
RESOURCES

7. What is it designed to do?
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RISK
Financial
Programmatic
Alignment
Governance
The policy takes a proactive approach
to addressing the sustainability
challenges and transition risks faced by
a broad range of countries and grant
components

8. STC Policy
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Predictability
Of time and resources to plan
Differentiation
By income level
Alignment
With existing systems or processes
Flexibility
To adapt to particular contexts
What principles is it based on?

9. Why is it important? Challenges and lessons learned
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Service
Continuation Governance
Programmatic
Risks
Data Risks Financial
Dependency

10. Why is it important? Successes and lessons learned
Aligning
program design
with
government
systems
Political will and
government
leadership
Investing in
health systems
and
local capacity
Early start
and clarity on
transition details
Planned,
multi-stage,
gradual timelines
Investing in
transition
Accounting for
human rights
and gender
Monitoring
programs
after transition

11. The STC Policy and Sustainability
Sustainability is a key aspect of development and health financing, and all
countries, regardless of their economic capacity and disease burden, should be
planning for and embedding sustainability considerations within national
strategies, program design, grant design, and implementation.
Key aspects of sustainability planning:
• Strengthening of National Strategic Plans
• Development of health financing strategies
• Alignment and integration of systems
• Identifying efficiencies and enhancing optimization of disease responses
• Increased domestic financing of national disease response and interventions
financed by the Global Fund, including via co-financing
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12. STC Policy, Transition, and Transition Preparedness
Early and proactive engagement with countries is essential to enhance transition
preparedness (encourages planning 10 years out). Transition is a process – it depends
both on eligibility, but is also affected by changes in allocation (and the ability to finance the
national disease response with that allocation)
Key Aspects of Transition Planning:
• All sustainability planning, plus:
• Development of Transition Readiness Assessments, Transition Strategies, and/or Sustainability Plans
• Progressive and accelerated government financing of key interventions
• Enhanced focus on key populations and structural barriers to health access (including human rights)
• Enhanced focus in grants on thematic areas that could represent sustainability and transition gaps,
including: contracting of non-state actors, strengthening of M&E and procurement systems, reduction
of dependence on Global Fund for purchasing commodities, etc.
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13. Fully
transitioned
Funding
request
based
on
Transition
Work-plan
Co-Financing requirements along the development continuum work towards enhancing program sustainability
and eventual transitions
LICs
LMICs
with high disease
burden
LMICs
with low/moderate
disease burden
/ UMICs
Ineligible
Focus on long-term sustainability planning by
supporting the development of robust national
health strategies, disease specific strategic plans
and health financing strategies
• National Strategic
Plans
• Health Financing
Strategies
• Alignment with country
systems
Focus on sustainability
and transition
preparedness,
particularly for countries
projected to transition
All sustainability activities +
Preparedness Measures:
• Transition Readiness
Assessments and
Transition Strategies
• Addressing transition
challenges in grant and
program design
Max.3 years
funding to
implement
transition
activities
“Final Grant”

14. 13
From Eligibility…
• Global Fund Eligibility is
based on income level
and disease burden.
• The 2017 Global Fund
Eligibility List identifies
disease components
(HIV, tuberculosis or
malaria) which are eligible
and may receive an
allocation.
• A country may be eligible
for one component (due to
its heavy burden) but not
another.
…to Ineligibility
• A country moves to high income status (*and
are not eligible for transition funding);
• A country moves to upper-middle income (UMI)
status and disease burden for a component is
low or moderate;
• Disease burden for a component decreases to
low or moderate in a country classified as UMI;
• A country is a member of the Group of 20 (G20)
countries and moves to UMI status, and the
disease burden for a component is less than
extreme;
• A country joins the Organization for Economic
Co-operation and Development’s (OECD)
Development Assistance Committee (DAC)
…to
transition
Once a country
component
becomes
ineligible, it may
receive
transition
funding under
the stc policy

15. LICs
LMICs
with high disease
burden
LMICs
with low/moderate
disease burden
/ UMICs
Ineligible
Max.3 years
funding to
implement
transition
activities
• As a country moves along the development continuum, its possible that there are
reductions in the size of the Global Fund allocation
• Reductions in the size of the allocation may require a country to progressively assume
key parts of the national disease response, even multiple allocation cycles prior to
transition because of ineligibility
• Countries are encouraged to plan early, and work to increase financing of all key
interventions of the national disease response as they move along the continuum
• The Global Fund review of funding applications for UMICs and LMICs with
low/moderate disease burden will include considerations around how transition
preparedness is incorporated in the national disease response
Modifications in allocation during this process

16. • All UMICs and LMICs with ‘low’ and ‘moderate’ disease burden
should proactively enhance transition preparedness
• This does not mean that all UMICs and LMICs with low and moderate
disease burden are exiting Global Fund financing. But it does mean that
planning for eventual transition should be a priority and considerations for
transition should be built into co-financing commitments, grant design, and
program design
• There are 14 disease components “transitioning” in the 2017-2019
allocation cycle (i.e., may receive transition funding due to ineligibility)
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Where should transition preparedness be a focus?

17. 16
Source: Global Fund Eligibility List 2016
UMICs and LMICs with Low / Moderate Disease Burden
Low and Middle Income Countries (LMICs) with at least one
disease component with low /moderate DB
Upper Middle Income Countries (UMICs)
Please note that this is based on 2016 data and not
currently updated with the 2017 eligibility list.

18. Transition Preparedness Priorities: Upper Middle Income countries
(regardless of disease burden) and lower middle income countries with low or
moderate disease burden:
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19. Who is transitioning now, and who is projected to
transition?
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20. Co-Financing - Why is it important?
As they increase fiscal capacity, countries are also expected to increase contributions
to disease programs and health systems
Domestic funding should progressively absorb costs of key program components, including
but not limited to:
• human resources
• procurement of essential drugs and commodities
• programs that address human rights and gender related barriers and programs for key
and vulnerable populations.
STC Policy includes a co-financing policy aimed at incentivizing increased domestic
resources for health, and progressively focused investments along the development
continuum as a country prepares for transition.
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21. Revised Co-Financing Policy
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No restriction
Minimum 50% in
disease programs
Focused on
disease program
and systems to
address
roadblocks to
transition;
minimum 50% in
key and
vulnerable
populations
75% in disease
programs*
Minimum 15% Co-Financing
Incentive
* ‘low’ or ‘moderate’ burden country components are encouraged to
show a greater share of domestic contributions that will address
systemic bottlenecks for transition and sustainability.
Progressive
absorption
of
key
program
costs
(all
countries)
Upper-Middle
Income
Countries
Low Income
Countries
Lower-LMI
Countries
Upper-LMI
Countries
Progressive
government
expenditure
on
health
(all
countries)
• Engagement with Ministries of Finance
and or relevant bodies for confirmation
of domestic commitments
• Continued support for public finance
management systems and health
expenditure tracking
• Co-financing incentive of at least 15%
of the allocation:
 Focus on broader health systems at lower
end of the development continuum
 More targeted focus on disease programs,
key and vulnerable populations, and
transition and sustainability priorities as
countries along development continuum

22. Upper-Middle
Income
Countries
Income
Level
Low Income
Countries
Lower-LMI
Countries
Upper-LMI
Countries
Severe, High
or Extreme
Extreme
(G-20)
Disease
Burden
Focus of
application
No restriction
50% focus on
key and
vulnerable
populations/
interventions
100% focus on
interventions
that maintain or
scale-up
evidence-based
interventions
for key and
vulnerable
populations
No
restriction
No
restriction
No
restriction
No restriction
Minimum 50%
in disease
programs
Focused on
disease program
and systems to
address
roadblocks to
transition;
minimum 50% in
key and
vulnerable
populations
Minimum 75%
in disease
programs**
Co-Financing
UMICs with low/moderate DB, G-20 UMIs with less than extreme DB, and High Income Countries are ineligible
Incentive
for
Strategic
Investment:At
Atleast
15%
Requirements
Progressive
government
expenditure
on
health
(all
countries)
Progressive
absorption
of
key
program
costs
(all
countries)
Parameters
Sustainability: Focus of Applications and Co-financing

23. Applying the STC principles into the funding cycle process
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Differentiation
By income level
Alignment
With existing systems or
processes
Flexibility
To adapt to particular
contexts
Predictability
Of time and resources to
plan

24. Context: Overview of Differentiated Application and Review Modalities
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• Country components requiring material change in defined programmatic area(s); or
• Country components receiving Transition Funding or otherwise using a transition work plan as basis for their
funding request (TBD)
• Challenging operating environments (COE) country components with material change; or
• Innovative approaches, learning opportunities or results-based financing modalities (RBF)
Tailored Review: tailored to the objective and to the applicant type
• Focused and Core country components with less than 2 years of implementation (High Impact considered on
case-by-case basis); or
• Focused and Core country components with demonstrated performance and no material change needed (High
Impact considered on case-by-case basis);
Note: To maximize impact against the diseases, program continuation components may in addition reprogram at any time (during grant making or grant
implementation) & OPN on reprogramming will apply.
Program continuation: streamlined process for program continuation
• High Impact country components
• Focused and Core country components referred to full review
• Country components not reviewed by the TRP in the previous allocation period
Full Review: comprehensive overall review of investment approach and strategic priorities

25. What is the Transition Tailored Review?
Approach: Disease components receiving their final round of transition
funding and those projected to become high income countries will apply for
funding using the Tailored Transition Review.
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• Application materials completely tailored to transition activities
• Funding request based on country-level activities in the Transition Work Plan
• Identification of gaps and challenges based on Transition Readiness
Assessment and National Strategic Plan
• Proactive approach to transferring service provision and key interventions to
national authorities before the grant ends
• Funding should focus on priority needs and investments that address
transition and sustainability bottlenecks, as well as for key and vulnerable
populations

26. Who will use the Transition Tailored Review?
16 disease components
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Ineligible since 2014-2016;
May receive transition funding for 2017-2019
•Albania (HIV, TB)
•Algeria (HIV)
•Belize (TB)
•Botswana (malaria)
•Bulgaria (TB)
•Cuba (HIV)
Projected to become
ineligible in 2017-2019
•Malaysia (HIV)
•Panama (HIV)
*Please note that there may be additional circumstances when a country may use
the “transition-tailored approach” given country context

27. What about all the other components in UMICs and
LMICs with low and moderate disease burden?
• Although not all countries will be applying through a transition tailored
review, the GF encourages all UMICs and LMICs with low and moderate
disease burden to integrate considerations regarding transition
preparedness into their funding requests
• Given that successful transitions take time, the Global Fund encourages
countries to plan in advance
• Early analysis of sustainability gaps and transition challenges can help
countries address the problems before transition
• All funding requests to the Global Fund will be reviewed, to some extent,
with a sustainability and transition lens
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28. What are key thematic areas in transition planning?
While this depends heavily on country context, some key areas to consider are:
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Key area What to consider
- Program for Key and Vulnerable Populations
- Capacity and Role of Non-State Actors in
Service Provision
- Implementation of Global Fund grants
- Ownership of key interventions and
integration into national systems
How reliant on the Global Fund is the country for
interventions for key populations?
Can non-state actors contract with
implementers to provide key services as part of
the health system?
Are implementers of Global Fund grants
integrated fully into the national health system,
and can they manage the transition process?
Are all key interventions co-financed by
national authorities, and are all systems
aligned?

29. What are key thematic areas in transition planning?
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Key area What to consider
- Salaries, operational costs and trainings
- Strong monitoring and evaluation (M&E)
systems
- Reliable and efficient health products
procurement and supply chain systems
- Governance during and after transition
Are key operating costs and trainings still
covered by the Global Fund, and to what
extent?
To what extent do M&E systems capture the
key data needed, particularly around key and
vulnerable populations?
To what extent are these able to deliver key
commodities without GF support?
Are there mechanisms for long term inclusion
of all key stakeholders in the national disease
response?
While this depends heavily on country context, some key areas to consider are:

30. Additional Thematic Areas in Transition Planning:
• Epidemiological context: the drivers of infection and any key and vulnerable populations that might be
disproportionately affected as well as age and gender related disparities and vulnerabilities.
• Economic situation: the country’s macroeconomic outlook and the fiscal capacity of the government to increase public
sector financing.
• Political context: the term of the current government and its commitment to financing the disease program.
• Policy and legal environment: the policy and legal issues that may impact on the transition.
• Human rights and gender: human rights and gender related barriers in access to services including
• Disease Program: the current interventions being implemented, service delivery coverage, across the dimensions of
gender and age, and including for key and vulnerable populations, and an analysis of where scale-up is needed to achieve
policy objectives.
• Health systems: the current capacity for health systems planning, monitoring and evaluation; procurement system
management including how first-line drugs are procured; what reforms are happening in the health sector and their potential
relevance for the sustainability of the disease program; the enabling factors required for transition and what systems
components present roadblocks to transition.
• Financing: who are the major funders, how the public financial management system is structured, whether key services of
the disease program are included in the national health insurance.
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31. Clarifying Terminology: TRAs, Strategies, Work-Plans
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• Transition Readiness Assessment (TRA): Refers to the different tools, both developed in cooperation with
the Global Fund and developed by technical partners, that identify existing gaps in the domestic system that
may hamper effective transition from Global Fund financing and that facilitate identification and prioritization of
policy solutions towards maintaining existing levels and quality of service delivery
• Transition Strategy / Approach: A high-level plan for progressive domestic take-up of Global Fund financed
activities. A solid transition strategy or approach establishes early the priorities and estimated sequencing of
key steps that may foster a successful exit from Global Fund (and other donor) financing. Ideally, a transition
strategy that considers the future of all donor financing would be part of the NSP or other existing disease
plans. A transition strategy may take many forms – it does not need to be a document or separate plan.
• Transition Work plans: A transition work-plan is the specific, time-bound, costed plan that will guide a
country’s transition from Global Fund financing, while at the same time ensuring that key interventions are
maintained. A transition work-plan is required for all “transition grants”.
• GF Transition Funding Request: This funding request may include all, or a sub-set of the key activities
identified in-country in the Transition Work plan, depending on the level of funding available, and must
rationalize this prioritization.

32. How do various tools support transition planning and
the funding request?
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Transition Readiness Assessment,
Sustainability Analysis, Sustainability
and Transition Strategies
Transition
Readiness
Assessment
Tool
Allocative
Efficiency
Models
Health
Systems
Financing
Assessment
Transition
Work plan
Global
Fund
Funding
Request
*Countries should use the tools they believe will best help them enhance
sustainability, strengthen transition, and manage the transition process

33. How can CCMs lead in transition?
Country Coordinating Mechanisms (CCMs) can play a key role in
the transition process
• Central to the principal of local ownership and participatory decision-making
• Play important role as country-level partnerships focusing on national
priorities
• CCMs have access to the strategic information about the program
performance
• Able to coordinate with national governments and across sectors
• Can help ensure inclusive, multi-stakeholder and country-owned process
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34. Country Dialogue and STC Considerations:
• Sustainability should be a part of country dialogue discussions for all
countries. Transition Preparedness should be a part of country dialogue for
all UMICs and LMICs with low / moderate disease burden
• Country Dialogue is a unique opportunity to ensure all actors in the national
disease responses are engaged in a discussion on strengthening
sustainability and preparing for transition, particularly people affected by the
diseases and key and vulnerable populations
• For countries currently in transition and or projected to transition in the next
allocation cycle (based on the transition projections list), country dialogue is
an excellent opportunity to shape the country-level dialogue regarding how
maintaining key interventions will be achieved without Global Fund financing
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35. What additional resources does the Global Fund have?
Published Documents and Resources:
• STC Policy – Available here [link]
• Transition Projections Document – Available here [link]
• Global Fund Eligibility List – Available at [link]
Forthcoming Documents:
• STC Technical Guidance Note – forthcoming
• Questions and Answers about the STC Policy – forthcoming
Early Engagement with Country Teams:
• Engage your FPM and Country Team Members Early in the STC Discussion
• For Latin America, EECA, and Southeast Asia, Sustainability and Transition specialists are
now built into country teams
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