Wave 2 of the National Strategy Application (NSA) funding channel will probably involve joint assessments of national disease strategies rather than just assessment by the Global Fund, but the form that these assessments will take is not yet decided.

In Issue 122, GFO reported that the Global Fund Board decided that Wave 2 of NSAs would be launched in time for funding decisions to be made by the Board at its meeting in the final quarter of 2011. This article provides additional information.

When the Global Fund developed the NSA concept, it was assumed that national strategies would be reviewed jointly by the Global Fund and other donors, and that countries would then submit proposals to the Global Fund (and, presumably, other donors) based on their national strategies.

In April 2008, a Working Group on National Strategies was convened under the auspices of the International Health Partnership (IHP+) to make recommendations on how to do joint assessments of national strategies (JANS). The Global Fund participated, along with a wide variety of partners.

The deliberations of the IHP+ Working Group were still ongoing in 2009 when the Global Fund decided to proceed with Wave 1 (the "First Learning Wave" (FLW)). The FLW did not involve joint assessments; instead, members of the Global Fund's Technical Review Panel (TRP) assessed the national strategies.

In July 2009, the IHP+ decided to disband the Working Group, and move instead to a pilot phase to "learn by doing" how to carry out the JANS process. This work is ongoing; to date, one joint assessment has been carried out (in Nepal). The Global Fund Secretariat says that a number of fundamental issues remain unresolved, including the following:

• the focus so far appears to be on national health strategies rather than national disease strategies;
• it remains unclear how the principles of credibility, independence and consistency will be implemented in the IHP+ JANS process; and
• there is a lack of solid mechanisms to ensure multi-stakeholder involvement in the JANS.

The Global Fund Secretariat says that its "medium-term vision" for the NSA approach (over the next 3-10 years) still depends on the availability of a solid, credible, accepted joint assessment strategy. However, it is not clear whether the IHP+ process will produce such a strategy. Therefore, the Secretariat says that it needs flexibility in Wave 2 to pursue approaches to joint assessments that are appropriate to the country context and consistent with the Global Fund's principles.

At its meeting on 28-30 April, the Global Fund Board said that Wave 2 applications should be "based on a national disease strategy that has been jointly assessed using a credible, joint assessment approach for national disease strategies that accords with the fundamental principles ... [of] country ownership, independence, consistency, adequate expertise, transparency, and multi-stakeholder involvement." This decision appears to leave the door open for the Secretariat to pursue a variety of approaches to joint assessment.

The FLW was limited to a small number of countries, mainly because of logistical constraints. Countries were identified on the basis of a set of criteria, and then invited to participate. The Secretariat said that for Wave 2, the intent is to move closer to a more open process, but that it is not yet logistically feasible to have a completely open process.

The Secretariat says that Wave 2 will retain the features of multi-stakeholder involvement that applied in the FLW, but would also seek to enhance such involvement through three supplementary measures:

• requiring that there be at least one expert from civil society or the private sector in the team that reviews the national strategy;
• encouraging systematic consultation of civil society and private sector stakeholders by the Review Team; and
• requiring that the Review Team include an assessment of the level of multi-stakeholder involvement in the information it considers when deciding whether a strategy is sufficiently sound to form the basis of an NSA.

The Global Fund Secretariat says that in Wave 2, all NSA funding requests will have to be made using a consolidated proposal form. (A consolidated proposal is one that clearly demonstrates how new funding will be added to programmes already being funded by the Global Fund for that disease.) The Secretariat also says that all grants signed as a result of Wave 2 NSAs will be single-stream-of-funding grants.

The Secretariat points out that the NSA concept already fits very well with the concept of a single stream of funding per disease per PR, and it says that four of the five FLW grants will be signed as single-stream grants. Furthermore, it says, these will be some of the first Global Fund single-stream grants.

This article is primarily based on "Analysis of Lessons from the National Strategy Application First Learning Wave and Proposed Further Investment Through National Strategy Applications," a report referred to in Decision Point 4 at the April 2010 Board meeting. The report has not been posted on the Global Fund website.