Round 6 of the Global Fund comes on the heels of WHO's World Health Report 2006, which identified 57 countries with health worker shortages that will severely impede their ability to achieve the Millennium Development Goals (MDGs). The MDGs include reversing the spread of AIDS, tuberculosis, and malaria. A few weeks after the launch of Round 6, world leaders at UNGASS committed to universal access to comprehensive prevention, care, and treatment by 2010, a goal requiring massive scale up of health workforces and strengthening of health systems. In light of these important developments, it is vital that Round 6 make a significant contribution to health workforce and health system strengthening.

To facilitate applicants' efforts in these areas, Physicians for Human Rights (PHR) has produced a Guide to Using the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening in Round 6, available at www.phrusa.org/campaigns/aids/pdf/guide_hs.pdf. Even though Round 6 does not have a separate Health System Strengthening category, as Round 5 had, applicants still may use the Global Fund for a very wide range of health system strengthening activities which may be system-wide. That is, countries may seek funds to strengthen basic health system elements, as long as the system-strengthening activities are needed to reduce the spread and impact of at least one of the three diseases. This round, these activities must be integrated into an HIV, tuberculosis, or malaria component of the application, rather than placed in a separate category.

Much of the new PHR Guide is based on analysis of the three successful Health System Strengthening proposals in Round 5 and the Technical Review Panel's comments on the thirty Health System Strengthening Proposals submitted in that round. The Guide describes the benefits of using the Global Fund to support health system strengthening. It also analyzes features of successful proposals on health system strengthening and shares several innovative approaches to addressing the health worker shortage.

The key lessons include:

• Round 5's successful Health System Strengthening proposals had a discrete focus on one or several health system elements; addressed major obstacles; made strong links to reducing the spread and impact of the target diseases; included strong health system analyses; lodged health system activities within national commitments and strategies; demonstrated that they had a strong chance of success; included considerable benefits for poor and rural populations; and supplemented support being received from other development partners.
• Proposals must have strong links between the health system activities and at least one of the three diseases. The successful Round 5 Health System Strengthening proposals of Malawi and Rwanda indicate that this entails presenting data on the severity of the health system problem being addressed, providing qualitative descriptions of how the problem impacts the target disease, using data to demonstrate this link, and employing impact indicators for the target diseases.
• Proposals should include detailed budgets and work plans, including, for example, providing clear descriptions of incentives. A proposal that includes incentives for health worker retention or deployment to rural or deprived areas should describe the nature of the incentives, explain who will be eligible for them, and if possible, provide evidence that the incentives will work.