Global Fund Board Makes Decisions on Health Funding. 17/12/10

The main decisions made at the meeting, in chronological order, were as follows.

AllAfrica

At its just-completed 22^nd meeting, the Global Fund Board made decisions on, among other things, which Round 10 proposals to approve; the timing of Round 11 and the second wave of national strategy applications; funding for health systems strengthening; the status of the Board chair and vice-chair; quality assurance policies; the Comprehensive Funding Policy; and the re-appointment of the Fund's Executive Director.

On 13-15 December 2010, the Global Fund Board held its 22^nd meeting in Sofia, Bulgaria. GFO was present, with observer status. The main decisions made at the meeting, in chronological order, were as follows. (For precise wording of what the Board agreed, see the decision points document here Background documentation will also, in time, be posted by the Fund at the same location.)

HSS funding requests: The Board approved a change to the funding architecture that will allow cross-cutting health systems strengthening (HSS) funding requests to be submitted separately in the rounds-based funding stream - i.e., they will no longer have to be attached to a disease proposal. (Previously, "stand alone" HSS requests were only permitted in Round 5.) The Board also approved some minor modifications to existing policies to allow cross-cutting HSS activities to be consolidated into single streams of funding.

The Board decided that the requirement that all HSS proposals be consolidated proposals will be phased in. (Previously, the Board had decided that, starting in Round 11, all proposals have to be consolidated proposals. However, because a consolidated HSS proposal is more complicated than a consolidated disease proposal, the Board is exempting HSS proposals from this deadline.) Finally, the Board asked one of its working groups to develop eligibility and prioritisation criteria for cross-cutting HSS proposals in time for Round 11. [See Decision Point 4.]

Health systems funding platform: The Board approved modifications to some existing policies to allow for a pilot project to proceed.The pilot will involve the submission by 4-5 countries of health systems strengthening (HSS) proposals based on an assessment of a country's national health plan conducted jointly by the Global Fund and the Global Alliance for Vaccines and Immunisation (GAVI).

It is very similar to the way that the Global Fund's national strategy applications (NSAs) work. The Portfolio and Strategy Committee (PSC) has already approved a design for the pilot. Applicants will be able to submit joint or separate funding requests to the Global Fund and GAVI. Requests to the Global Fund will have to emanate from a CCM. [See Decision Point 5.] The pilot will be launched in early 2011.

Board chair and vice-chair: The Board decided that in future, the Board chair and vice-chair will serve in an ex-officio capacity with no voting rights; and any individual may be nominated for chair or vice-chair (not just existing Board members, as at present). For further details, see Article 2 below. [See Decision Point 6.]

Technical Evaluation Reference Group (TERG): The Board approved revised terms of reference for the TERG; extended the terms of two TERG members for a few months; mandated the Secretariat to seek nominations for new TERG members; and asked the TERG to assess its own independence and the independence of its support team, and to make recommendations for changes, if required. [See Decision Point 7.]

Eligibility, cost sharing and prioritisation criteria: The Board recognised the complexity of the review currently underway, acknowledged that further work needs to be undertaken, and asked the PSC and the Portfolio and Implementation Committee (PIC) to present recommendations for the next Board meeting. [See Decision Point 8.]

QA policy for pharmaceutical products: The Board approved a change to the quality assurance (QA) policy that would allow the Global Fund to continue to approve certain life-saving medicines that are not already prequalified by the World Health Organization (WHO) or a stringent regulatory authority, or for which applications for review have not been accepted by these agencies.

The interim exception policy that had allowed for this was set to expire at the end of this year. The Board asked the Secretariat to explain in writing to grant recipients the implications of the termination of the interim exception policy, and the changes to the QA policy approved at this meeting. [See Decision Point 9.]

QA policy for diagnostic products: The Board approved a policy on quality assurance for diagnostics. The policy sets minimum standards for the quality of the diagnostics and use of the diagnostics, including product-specific requirements for HIV and malaria immunoassays. Product-specific requirements for CD4, viral load and TB molecular tests will be phased in as adequate review mechanisms become available.

The Board asked the Secretariat to work with the WHO to (a) conclude an agreement under which the WHO will manage the technical evaluation of diagnostic products, including, if relevant, the establishment of an Expert Review Panel for Diagnostics; and (b) explore measures to ensure that PRs procure good quality malaria rapid diagnostic tests. [See Decision Point 10.]

Artemisinin-based combination therapy (ACT): The Board referred to guidance from the WHO to the effect that fixed-dose combination formulations (FDCs) of ACTs are strongly preferred to co-blistered formulations, and asked its Market Dynamics and Commodities Ad-Hoc Committee to recommend ways in which recipients of Global Fund money can best transition from FDCs to ACTs. [See Decision Point 11.]

Affordable Medicine Facility - malaria (AMFm): The Board extended Phase 1 of the AMFm by six months, to November 2012, due to delays experienced in getting Phase 1 underway. [See Decision Point 13.]

Tribute to Richard Holbrooke: The Board expressed its "shock and deep sorrow" at the recent death of U.S. Ambassador Richard C. Holbrooke. The Board said that i n his position as U.S. Ambassador to the U.N., and later as the founding President of the Global Business Coalition against AIDS, Ambassador Holbrooke "played a ground-breaking role in ensuring that the world accepted HIV and AIDS as a threat to international security and global business, as well as being a humanitarian catastrophe." [See Decision Point 14.]

Maternal, newborn and child health (MNCH): Referring to its decision at a prior Board meeting to accelerate funding for MNCH, the Board said that it encourages countries to strengthen the MNCH content of their programmes financed by the Global Fund; and it asked the Secretariat to develop clear guidance (Including indicators) for countries on how best to do this. [See Decision Point 15.]