Gaps mark several of the NFM's first concept note submissions
The technical review panel (TRP) has sent five of the first ten concept notes to be submitted under the new funding model (NFM) back for review, asking for better priority-setting based on epidemiological data and a more integrated approach to health systems strengthening.
Ten concept notes were submitted in the first applications window for the NFM: the new allocations methodology aiming to target the greatest number of resources to the countries with the least ability to pay. An additional 24 concept notes were submitted in June, and two other windows -- in August and October -- remain in 2014.
The first 10 concept notes revolved primarily around funding for malaria programs.
Table 1: Concept notes submitted by eligible applicants under the NFM by June 15, 2014
Congo (Democratic Republic)
Papua New Guinea
According to the Global Fund's July News Flash, countries will have the opportunity to revise and re-submit their application.
A series of guidance materials has also been prepared by the Secretariat for CCMs whose concept notes are in process, or who are preparing to begin the process. The materials include a letter that was sent to CCMs and a slide presentation that fund portfolio managers (FPMs) can use when meeting with CCM representatives. It is hoped that the materials will improve the quality of future submissions, including the 23 concept notes sent to the Fund for the June 15 window.
The TRP identified a number of areas where countries needed to strengthen their concept notes. These areas were:
Some applicants failed to adequately prioritize interventions in their concept notes. Priority-setting should be based on sound epidemiological data and emphasize activities targeting key populations for each of the disease components: HIV, TB and malaria. Strategic choices must be made to "maximize the impact of Global Fund investments" and those strategic choices must be founded on sound evidence.
According to the letter sent to CCMs, one of the major reasons the TRP requested a second iteration of a concept note was the lack of an "evidence-based prioritization" for the allocation amount, derived from sub-national and sub-population epidemiological data. Costed interventions that target specific demographics -- either behavior-based or geographically -- were more favorably reviewed by the TRP than generalized concept notes.
Separation of allocation from above-allocation request
Countries that failed to adequately distinguish between interventions to be covered by the base allocation -- the envelope announced on 12 March by the Fund -- were asked to resubmit a more nuanced concept note. Critical program components -- such as commodity purchase and distribution -- must be included in any allocation request, if the allocation is large enough to cover them. Not to do so, according to the TRP, "is inappropriate and risky because incentive funding is not guaranteed".
The point, Aidspan understands from the Secretariat, is that all forecasted activities must have a dollar amount attached to them, and prioritized to ensure the highest possible impact and maximized investment.
Incentive funding -- the above allocation portion that some components assigned to bands 1-3 are eligible for -- should be reserved for "additional interventions beyond the minimum level, such as expanding geographic coverage or scaling up services,” the Secretariat said.
Within the above-allocation request, the letter from the Secretariat noted, there needs to be a costed prioritization of activities so that the TRP can make recommendations for incentive funding that distribute those resources as strategically as possible.
Health systems strengthening
In general, the Secretariat said, there was insufficient focus on cross-cutting HSS initiatives in the concept notes, even though it was clearly stated in the allocation letters received by countries in March that HSS funds would be incorporated into each of the disease components. The TRP recommended that where there is a need to strengthen HSS, countries should set aside funding for this during the program split discussions which precede the submission of the concept notes. The TRP said that the cross-cutting HSS modules in concept notes should explain how these interventions will help to maximize the impact of the investments in the three diseases.
If health systems are weak in a country, and there are no cross-cutting HSS interventions included in the concept note, or if there is no clear explanation of how these interventions will support the disease programs, the Secretariat said, “the TRP may question whether investments in treatments and prevention will have an impact…. If concept notes don’t include requests for HSS from the Global Fund, then applicants need to explain how HSS is otherwise being addressed.”
Lessons from past experience
The TRP advised countries to include historical information about past Global Fund investments into the various disease programs, specifically related to the impact of those past investments.
These lessons learned should feed the narrative of the concept note, demonstrating that the allocation will not represent business as usual but an innovative case of investment for impact.
"Programs should be adjusted to focus more strongly on the most effective approaches used in the past," the letter to the CCMs advised.
Duration of concept notes
The Secretariat said that barring exceptional circumstances, all concept notes should cover the period at least through the end of 2017 due to the anticipated 12 months countries will be devoting to the development and review of concept notes and the grant-making process. Although the allocation period was announced as 2014-2016, the implementation period will now run through 2017. Some countries appeared not to understand this requirement, which led to them the submitting a two-year concept note rather than a three-year one.