Supporting Community Responses to Malaria

Transcription

1 Supporting Community Responses to Malaria A Training Manual to Strengthen Capacities of Community Based Organizations in Application Processes of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

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3 Acknowledgements This training manual is a product of the STOP MALARIA NOW! advocacy campaign and aims to support community responses to malaria. In particular, this manual aims to improve knowledge and skills of Community Based Organizations (CBOs) in application processes of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The contents are based on results of the needs assessment Capacity Needs of CBOs in Kenya in Terms of Application Processes of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), conducted in June and July The study can be downloaded from The contents of the manual were compiled by Dr. Maurice Odindo, Chief Executive Officer, Community Capacity Building Initiative (CCBI) in Nairobi and Antje Mangelsdorf, Project Coordinator, STOP MALARIA NOW! in Germany. Appreciation is also expressed for technical input from Ms. Rubina Adhiambo, Programme Manager, CCBI and Esther Suchanek, Project Manager, STOP MALARIA NOW! The authors also appreciate the comments and information on community-owned responses to malaria as well as on national policies and strategies for Global Fund applications provided by Mr. Edward Mwangi, CEO, KeNAAM.

4 Contents Abbreviations... List of Figures and Tables... Introduction... Why this manual?... Who is this manual for?... How is this manual organized? MODULE 1: Structure and Work of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) Module objectives What is the Global Fund? Core structures of the Global Fund Decision-making Operating Financial resources of the Global Fund Financial Resources Current Funding Gap of the GFATM MODULE 2: The Global Fund and Community Based Organizations Module objectives The importance of civil society within Global Fund processes Delivering key services on the ground CBOs and malaria control Possibilities for CBOs to apply for Global Fund grants Strengths and gaps of CBOs Community Systems Strengthening (CSS) Challenges for CBO participation in Global Fund grants

5 MODULE 3: The Global Fund grant-making process Module objectives The Global Fund grant-making process Actors within the grant-making process of the GFATM Country Coordinating Mechanisms (CCMs) Principal-Recipients (PR) and Sub-Recipients (SR) Local Fund Agents Technical Review Panel MODULE 4: How to Apply for Global Fund grants a roadmap for CBOs Module objectives How to apply for a Global Fund grant Choosing the right strategy - guiding principles of the Global Fund Minimum prerequisites for a recommendation for funding National Strategy Applications Common mistakes in proposals Application checklist Sources of information Recommendations for Advocacy Imprint... 53

6 Abbreviations ACT ANC CBO CCM C-IMCI CORP CSO CSS DHMT DOMC FBO GFATM HSS INGO IPTp ITN LFA LLIN MIS MoH NGO NMSP NSA PSO PR SR TRP TOR ToT Artemisinin-Based Combination Therapy Antenatal Care Community Based Organization Country Coordinating Mechanism Community-based Integrated Management of Childhood Illness Community Owned Resource Person Civil Society Organization Community Systems Strengthening District Health Management Team Division of Malaria Control Faith Based Organization Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria Health Systems Strengthening International Non Governmental Organization Intermittent Preventive Treatment of malaria during pregnancy Insecticide Treated Net Local Fund Agent Long Lasting Insecticide treated Net Malaria Indicator Survey Ministry of Health Non Governmental Organization National Malaria Strategic Plan National Strategy Application Private Sector Organisation Principal Recipient Sub Recipient Technical Review Panel Terms of Reference Trainer of trainers 6

7 List of Figures and Tables Fig. 1. Structures of the Global Fund... Fig. 2. Major donors of the Global Fund... Fig. 3. Development of total and disease-specific funding... Fig. 4. Distribution of funding after seven rounds (HIV/AIDS, TB and Malaria)... Fig. 5. CBO participation in Global Fund processes... Fig. 6. Global Fund grant-making process

8 Introduction Why this manual? Malaria is a preventable and treatable infectious disease, which is transmitted by mosquitoes and kills more than one million people each year, most of them in Sub-Saharan Africa, where malaria is the leading cause of death for children under five. Malaria is a global emergency that affects half of the world s population and perpetuates a vicious cycle of poverty in the developing world. Scaling up malaria control interventions to prevent and treat malaria is key for Community Based Organizations (CBOs) in particular, since access to health facilities and awareness among community members is still quite low in rural areas. This requires increased capacities and funding for CBOs, enabling them to submit competitive proposals and ensures satisfactory implementation of their projects. As part of its program, the African-European malaria campaign STOP MALARIA NOW! conducted a needs assessment in Kenya in order to identify capacity needs of CBOs working in malaria control. The focus of this assessment was on identifying the needs and capacities of CBOs in terms of resource mobilization, with particular regard to access grants from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) as the world s largest donor for malaria control interventions. The needs assessment was conducted in close collaboration with Community Capacity Building Initiative (CCBI), a Kenyan NGO. Within the framework of this needs assessment, 214 organizations were interviewed (190 CBOs, ten local NGOs, nine FBOs and five INGOs) in 24 districts in western, central, northern and coastal Kenya classified as malaria endemic, highland epidemic or malaria epidemic. Major findings of the assessment CBOs in Kenya play a vital role in attaining universal coverage of malaria control tools. CBOs malaria control activities are mainly focused on advocacy and community mobilization, followed by training in malaria control interventions. Lack of contacts to and information from relevant authorities are major barriers for CBOs when applying for and acquiring funds for running their projects (low information flow). Knowledge about the Global Fund and its structures in particular is limited at CBO level. 8

9 Moreover, the results of the needs assessment show evidence that many CBOs: Lack ownership in project design and planning. Lack financial resources due to dependency on membership fees (87,6% of the inter- viewed CBOs have an annual budget below KES 1 million/10,000 EUR). Have no qualified staff and are mostly dependant on local volunteers. Lack adequate access to transport facilities as well as necessary materials and equipment for community action in the field of malaria control. Often lack project management skills, including project planning, proposal writing, project monitoring and evaluation, financial management and reporting. Find the Global Fund application process lengthy, complex and distressful 94,9% of the interviewed organizations had not yet applied for GFATM grants. Are in need of training in application procedures, proposal writing, work plan and budget development for activities financed through Global Fund grants. Lack effective representation in the Kenyan Country Coordination Mechanism (CCM). The Global Fund provides around 60% of international funding for malaria. It regards Civil Society Organizations (CSOs) as core partners for the successful implementation of its grants. For this reason, the Global Fund stipulates that at least 40% of all financial resources allocated in a particular country should go to CSOs, including CBOs and FBOs. Sadly enough, at least in Kenya, there appear to be various impediments and bottlenecks in the way of CBO participation in Global Fund funded programs. Recognizing these bottlenecks, as well as the comparative advantages that CBOs have in ensuring universal coverage of malaria control interventions, this training manual is designed to improve knowledge and capacities of CBOs in terms of Global Fund application and grant management mechanisms, thereby ensuring that international support reaches the people most in need. 9

10 Who is this manual for? This manual formed the basis of two 5 day trainings, conducted from November 23-27, 2009 in Kisumu and from December 7-11, 2009 in Malindi. About 50 Community Owned Resource Persons (CORPs) of the two major malaria-prone areas of Kenya participated in the training, which aimed to improve the capacity of CBOs in Kenya to apply for funding from the GFATM, a donor which these grassroots organizations would usually not access. It empowered CBOs to engage in GFATM processes in order to extend and increase their ability to effectively implement programs as much as possible at the grassroots level. The training also gave participants the opportunity to network with other CBOs and share examples of good practice, thus strengthening coordination on the ground. The objective of the trainings was also to increase the project management as well as monitoring and evaluation skills of CBOs. The objectives of this training manual are: To provide Community Owned Resource Persons (CORPs)/CBOs with comprehensive information about the GFATM. To show them a way to become effective partners in malaria programs financed by the GFATM. The intended users of this manual include: CORPs serving as focal points for CBOs in Kenya and other countries. NGOs, INGOs and public authorities working in the area of Community Systems Strengthening and malaria control in Kenya and other countries. This manual is the start of the journey, not its end. We hope it will help to enable Community Based Organizations to raise funds from donors they do not usually access and specifically to apply for and manage Global Fund grants. This can only be achieved if willpower is transformed into action by: Using this manual as a training tool within local communities. Developing the capacity of organizations in terms of project management, disease control strategies, GFATM application procedures as well as networking. Demanding and developing training courses to strengthen capacity across the region. Providing us with feedback to keep the manual current and on target. We wish you every success in your endeavors. 10

11 How is this manual organized? The manual is divided into four modules. At the beginning of each module, learning objectives are described. Each module is divided into several chapters. The Key Points provided at the end of each module are to be used as a checklist by the trainer. This will ensure that all key issues have been covered and will help the trainer monitor participants learning progress. Key Reading is suggested for each module. This may form part of the participants exercises or serve as an additional information source on the topics presented. Additional Information and Definitions of particular terms are provided in every module. The rationale behind this structure is to allow flexible use of the manual. Depending on the demand and need of the participants, modules can be added or taken out. We want to encourage trainers to adapt the material to each individual training situation and to the informational needs and demands of the participants. It is important to show participants, from the beginning, that the training approach is based on the mutual sharing of knowledge and information. Moreover, the participants and trainers knowledge is equally respected and valued throughout the training. A brief outline of the four modules can be found below: MODULE 1 MODULE 2 MODULE 3 MODULE 4 introduces structures and work of the GFATM. focuses on the role of CBOs in malaria control and their possibilities to apply for GFATM grants. highlights the grant making process of the GFATM. provides a roadmap for CBOs how to apply for a GFATM grant. Recommendations for Advocacy that can be used by CBOs, NGOs and INGOs at various levels form the final part of the manual. 11

12 1 Module 1 Structure and work of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) 1.1 Module objectives By the end of this module, the participants will: Know what the Global Fund is. Describe some achievements of the Global Fund. Be aware of the decision-making and operating structures of the Global Fund. Have information about the financial resources of the Global Fund. 1.2 What is the Global Fund? The Global Fund: Was created in 2002 and is an independent global public/private partnership dedicated to raising funds from governments, businesses and individuals around the world and disbursing these additional resources into grant programs to prevent and treat HIV/AIDS, tuberculosis and malaria. Is a financing instrument, not an implementing entity. Forms a partnership between governments, civil society, the private sector and affected communities and therefore represents a new approach to international health financing. Has become the main source of financing for programs to fight AIDS, tuberculosis and malaria, providing a quarter of all international financing for AIDS globally, as well as two-thirds for TB and malaria. The Global Fund has now (after nine funding rounds) approved a total funding of USD 18.4 billion for 144 countries since it was created in Finances Health Systems Strengthening (HSS) and Community Systems Strengthening (CSS) as program components. Supports programs which deliver services to hundreds of millions of people. As a result, more than four million lives have been saved. 3,000 deaths are averted every day. Main results include: The distribution of 88 million bed nets to protect families from the transmission of malaria, thus becoming the largest financier of insecticide-treated bed nets in the world (730 million LLINs needed to reach universal coverage by 2010). The delivery of 74 million malaria drug treatments (228 million doses of ACTs required annually to reach universal coverage by 2010). 91 million people have been reached with community outreach services. 12

13 Module Core structures of the GFATM Decision-making The Global Fund is an independent organization, governed by an international Board that consists of representatives from donor and recipient governments, nongovernmental organizations (NGOs), the private sector (including businesses and philanthropic foundations) and affected communities. Moreover, the Global Fund consists of a Secretariat, a Technical Review Panel and Local Fund Agents. The Global Fund Board is composed of representatives from donor and recipient governments, civil society, the private sector, private foundations, and communities living with and affected by the diseases. The Board is responsible for the organization s governance, including establishing strategies and policies, making funding decisions and setting budgets. The Board also works to advocate and mobilize resources for the organization. It meets at least twice a year and consists of 26 members (20 with voting rights, six without voting rights) and one elected Chair. The Global Fund Secretariat manages the grant portfolio, including screening proposals, issuing instructions to disburse money to grant recipients and implementing performance-based funding of grants. Therefore, the Secretariat is tasked with executing Board policies, mobilizing resources, providing strategic, political, financial, legal and administrative support and overseeing monitoring and evaluation of grants. It is based in Geneva, Switzerland, and has no staff located outside its headquarters. The Technical Review Panel (TRP) is an independent group of international experts in the three diseases and cross-cutting issues such as health systems. It meets regularly to review proposals based on technical criteria and provide funding recommendations to the Board. The TRP consists of a maximum of 40 experts. Each expert is appointed by the Board for a period of up to four funding rounds. Since the Global Fund does not have staff at country level, it contracts firms to act as Local Fund Agents (LFAs) to monitor implementation. LFAs are responsible for providing recommendations to the Secretariat on the capacity of the entities chosen to manage Global Fund grants and on the soundness of regular requests for the disbursement of funds and result reports submitted by Principal Recipients (PRs). 13

14 Module Operating At country level, the Country Coordinating Mechanism (CCM) is an entity composed of key stakeholders in a country s response to the three diseases. The CCM should preferably be an already-existing body, but a country can instead decide to create a new entity to serve as CCM. Country Coordinating Mechanisms are central to the Global Fund s commitment to local ownership and participatory decision-making. These country-level partnerships develop and submit grant proposals to the Global Fund based on priority needs at the national level. After grant approval, they oversee progress during implementation. Country Coordinating Mechanisms consist of representatives from both, the public and private sectors, including governments, multilateral or bilateral agencies, nongovernmental organizations, academic institutions, private businesses and people living with the diseases. For each grant, the Country Coordinating Mechanism nominates one or a few public or private organizations as accountable entities to administer funding (Principal Recipients). Global Fund Trustee The World Bank 4. Disbursement of Grant Funds 3. Instructions to Disburse CCM Principal Recipient 5. Disbursement Sub- Recipient 1. Request for Disbursement with Documented Results 2. Data Verification & Advice of Release of Funds LFA The Global Fund signs a legal grant agreement with a Principal Recipient (PR), which is designated by the CCM. The PR receives Global Fund financing directly, and then uses it to implement prevention, care and treatment programs or passes it on to other organizations (Sub-Recipients) who provide those services. Secretariat Fig. 1 Structures of the Global Fund Many PRs not only make sub-grants with other entities, but implement program components themselves. There can be multiple PRs in one country. The PR also makes regular requests for additional disbursements from the Global Fund based on demonstrated progress towards the intended results. 14

15 Module Financial resources of the Global Fund Financial Resources Around fifty countries have pledged USD 21.1 billion to the Global Fund so far (from 2001 to 2009), mostly western and middle-eastern nations, but also countries directly affected by the three diseases, individuals and private enterprises , , , ,418 1,406 1,270 USA Sweden France European Commission Japan Germany Amount pledged ( ) in billion USD Fig. 2. Major donors of the Global Fund The Global Fund publishes funding needs, but does not dictate the origin and amount of donations. Pledges are made on a goodwill basis. The Global Fund also now has a system of periodic replenishments, which enables more accurate forecasting of available resources. This replaces a more ad hoc and flexible system of replenishment that was used earlier. Round 1 (April 2002) Round 6 (November 2006) Round 7 (November 2007) Round 8 (November 2008) Total approved USD 565 million (including USD 55m for HIV/TB; USD 20m for integrated programs) USD 846 million in 63 countries USD 1,119 billion in 66 countries USD 2,753 billion 110 programs countries approved of a maximum amount of HIV/AIDS USD 326 million (26 programs) USD 453 million USD 537 million (26 programs) USD 1,164 billion (37 countries) Tuberculosis USD 96 million (12 programs) USD 190 million USD 111 million (19 programs) USD 327 million (29 countries) Malaria USD 68 million (12 programs) USD 202 million USD 471 million (28 programs) USD 1,568 billion (28 countries) Fig. 3. Development of total and disease-specific funding 15

16 Module 1 Geographic Region Expenditure Target 6% 8% 8% 10% 3% 9% 9% 12% 57% 10% 23% 45% Sub-Saharan Africa East Asia & the Pacific Eastern Europe & Central Asia Latin America & the Caribbean South Asia Middle East & North Africa Drugs Commodities Products Human Resources Other Administration Infrastructure & Equipment Monitoring & Evaluation Sector Represented Disease 12% 11% 17% 60% 25% 14% 61% Government NGO/Private Sector Multilateral Not Signed HIV/AIDS Malaria Tuberculosis Fig. 4. Distribution of funding after seven rounds (HIV/AIDS, TB and Malaria) Current Funding Gap of the GFATM USD 13.5 billion are needed between 2008 and 2010 to fully fund all proposals recommended for funding. Due to the continuously rising number of high-quality proposals, the Global Fund currently (2009) faces a financing gap of USD 3 billion. Between USD billion are projected to be needed for , whereas to-date pledges for later than 2010 are only USD 1.8 billion. 16

17 Module 1 Key Points The GFATM was created in 2002 and is an independent global public/private part- nership dedicated to raising funds from governments, businesses and individuals around the world and disbursing these additional resources into grant programs to prevent and treat HIV/AIDS, tuberculosis and malaria. The Global Fund is a financing instrument, not an implementing entity. The Global Fund has become the main source of finance for programs to fight AIDS, tuberculosis and malaria, providing a quarter of all international financing for AIDS globally, as well as two-thirds for TB and malaria. Core structures of the Global Fund encompass the Global Fund Board, the Global Fund Secretariat, the Technical Review Panel and Local Fund Agents (Decision- Making) as well as Country Coordinating Mechanisms, Principal and Sub-Recipients (Operating). Financial contributions to the Global Fund are made on a voluntary basis. Key Reading

18 2 Module 2 The Global Fund and Community Based Organizations 2.1 Module objectives By the end of this module, the participants will: Define the term civil society. Understand the role civil societies play within Global Fund processes. Understand why community involvement is key for effective malaria control. Understand the challenges of CBOs. Know about Community Systems Strengthening (CSS). Understand the types of organizations benefiting from CSS initiatives. Describe the capacity development needs of CBOs. Understand the incorporation of CSS into Global Fund proposals. Know about the role of CORPs. 2.2 The importance of civil society within Global Fund processes Civil society has been an important and vital partner to the GFATM since the financing mechanism was first conceived. CSOs contributed to the design and structure of the GFATM, and have encouraged governments to commit more resources to support its work. Therefore, CSOs play a fundamental role in resource mobilization for the Global Fund. But civil society is not only an advocate for the GFATM, it plays an essential role in the oversight and implementation of GFATM grants. Civil society Civil society is composed of the totality of voluntary civic and social organizations and institutions that form the basis of a functioning society as opposed to the force-backed structures of a state and commercial institutions. (Wikipedia) Examples of civil society organizations: Mass organizations (such as organizations of peasants, women or retired people). Trade unions. Professional associations. Social movements. Indigenous people s organizations. Religious and spiritual organizations. Academic and public benefit nongovernmental organizations. 18

19 Module 2 Roles and comparative advantages of local civil society organizations Local CSOs: Serve and reflect local communities. Are often uniquely placed to determine whether and how the resources reach and benefit affected communities. Play an effective role in targeting hard-to-reach communities and in improving prevention and treatment literacy. Advocate and promote policies that will lead to adoption of effective control strategies for the three diseases. Are far more likely than international organizations to provide training and information in ways that are culturally, economically and politically appropriate. Ensure that grants and programs are implemented effectively, efficiently, and for the benefit of the entire society and affected countries in particular. Often lead the way in identifying and implementing innovative strategies and initiatives that are included in Global Fund programs. Have the ability to influence GFATM proposals when directly involved in drafting applications. 2.3 Delivering key services on the ground CBOs and malaria control Why community involvement for malaria control? The Alma-Ata Declaration of 1978 underscored the need for concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. Community participation is critical to the success and sustainability of health programs because involving people actively in the planning and implementation of activities encourages the development of skills, institutionalizes appropriate decisionmaking capacities within communities, and creates a sense of ownership. Local knowledge, values, and practices may determine acceptability of facilities meant to help the community. Continued interaction and communication with the beneficiaries of social projects are thus important. Article VI Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. (Declaration of Alma-Ata) 19

20 Module 2 Community action for malaria control is based on the premise that long-term change in several key behavioral patterns can be implemented in partnership with communities and families for the control of the disease. Such change in specific behaviors can lead to early, appropriate recognition and treatment of malaria in addition to undertaking preventive and promotion activities. Elements of community participation The basic objectives of involving communities in malaria control are to: Ensure ownership of malaria control activities by communities. Improve quality of home care. Build capacity for communities for implementation and sustainability of activities. Link malaria control with other development activities. Broaden the resource base at community level by facilitating community based financing initiatives to ensure sustainability of malaria activities. Mobilize all segments of society for relevant activities. Link community actions with national malaria efforts to control the disease. Enhancing community participation in malaria programs To enhance participation in malaria control activities, the roles and responsibilities at the various levels (community, district and national) need to be clearly spelt out. These should include at least the following: At community level Planning and implementation of activities. Mobilizing resources and community financing. Supervision, monitoring and evaluation of planned activities. At district level Advocacy. Strategy formulation, planning, partnership building. Coordination of activities of the different partners and stakeholders. Guide implementation. At national level Develop enabling policies supportive of community actions. Mobilize and allocate resources. Strengthen existing institutions and human resources. Monitor and evaluate implementation of activities. 20

21 Module 2 Challenges for community participation The major challenges of ensuring effective community participation lie in: Ensuring full participation by communities in the assessment of needs, management and evaluation of activities. Ensuring that mothers/caretakers and family members are able to recognize malaria and take immediate and appropriate action. Maintaining preventive actions especially among vulnerable groups. Making appropriate and effective antimalarials close to communities. Strengthening health systems (both formal and non-formal) to respond effectively to the needs of individuals and communities in the management of malaria. Establishing a collaborative network of interested government sectors, NGOs, and districts to enable sharing of approaches. Developing appropriate organizational mechanisms for collaboration and for fostering political commitment and will. Building capacities of local communities in all areas of malaria control as well as project management. Mobilizing adequate resources to support community initiatives. 21

22 Module 2 The role of Community Owned Resource Persons in malaria control Community Owned Resource Persons (CORPs) are individuals that reside within a community and have acquired skills that can be passed on to the community to initiate behavioral change. Due to their permanent residence within the community, they form an important part of the human resource base of the community and are available for advice and information. Most CORPs are retired professionals such as nurses, clinical officers, teachers and administrators, but many youths who are keen to see change in their communities can be trained to serve as CORPs thus ensuring sustainability of change initiatives. The strength of CORPs lies in the fact that they are continuously available within their respective communities, providing continued support to those in need of it. Community Owned Resource Persons can play a major role in: Giving advice on disease prevention and treatment at household level. Providing information on critical issues that concern the community. Training the community in disease interventions. Mobilizing communities. Advocating for policy change at community level. Advocating for behavior change among community groups such as youths, wo- men, men, administration, etc. Linking health administration such as DHMTs and communities. Giving communities a voice at forums and meetings at regional or national level. Linking major disease control programs and funding agencies such as the Global Fund, RBM, PEPFAR, TOWA, etc. with local communities. 22

23 Module Possibilities for CBOs to apply for Global Fund grants Strengths and gaps of CBOs The vast majority of registered CBOs are based in rural areas or urban slums, which are less developed and bear the burden of poverty. Few people have access to education and health facilities. Many of the workers and conveners of CSOs, despite entirely noble intentions and the strongest links to the community, are themselves victims of poverty and, as such, are often lacking the ability and capacity to mobilize and utilize resources efficiently. Nevertheless, CBOs have many strengths that can form the basis of their Global Fund proposals: Advocacy and mobilization of communities on use of LLINs Community Based Organizations (CBOs), by definition, are based within areas where they provide community services. Therefore, CBOs are uniquely placed to mobilize community members to use LLINs and enhance their use at community level. CBOs can also play an important role in training Community Owned Resource Persons (CORPs) on net use and enabling them to act as linkage points between communities and medical facilities, as well as DHMTs. Epidemic preparedness and response among communities A key area in epidemic preparedness is indoor residual spraying (IRS). This is an effective intervention to mitigate malaria epidemics, and has been conducted by the Ministry of Health in Kenya. If combined with ITNs, IRS reduces the population of mosquitoes drastically and has been a key player in the reduction of mosquito populations and malaria incidence. Community organizations role here would cover the sensitization of communities for IRS, and advocacy for support of IRS programs among the target groups. Early recognition of malaria and access to effective case management and accurate malaria diagnosis Communities need to support the efforts of malaria home management programs. Major constraints to this are inadequate stocks of ACTs as well as poor prescription practices by health workers not yet trained on the application of new treatment guidelines. A new malaria treatment policy in Kenya aims at taking health services to Level One (grassroots), which was approved in 2005 and officially launched in late Since the program began in 2006, many health workers, particularly from the nongovernmental sectors, were not reached with this government-initiated training. The DOMC estimates that half of all health workers have not been trained to date. As a result, case management in accordance with the new treatment guidelines remains weak. This offers an opportunity for the better-placed CBOs, and NGOs to follow the approach used by DOMC, which is to conduct three-day trainings through a cascade approach employing trainers of trainers (ToTs) at the community level. 23

24 Module 2 Limitations of Kenyan CBOs in applying for Global Fund grants Community organizations in Kenya have not realized the breadth of opportunities that are available for them to apply for Global Fund grants. The majority of CBOs in Kenya focus on advocacy, community mobilization, net distribution and vector control. In a recent community assessment, about 90% of the 201 organizations that responded to a survey on their areas of activity said that their organizations work in the area of advocacy and community mobilization, while 58% said they work in the area of training and capacity building of malaria control. About 52% of the CBOs said they work in the area of ITN/LLIN distribution, 51% in the area of malaria treatment and case management. Another 41% work in the vector control area. The review brought out the precarious position in which the Kenyan CBO finds itself today. Several factors stood out clearly. CBOs are low in capacity in most areas - including financial resources, trained personnel, materials and equipment. CBOs lack knowledge in specific areas of project management, including application processes, monitoring and evaluation, financial management skills, and reporting. CBOs are keen to learn new techniques and methods on malaria control and how to manage disease. CBOs are enthusiastic and ready and willing to participate in community development and lifting the standard of living of their members and their communities. CBOs do not get sufficient contact and information from relevant authorities that would enable them to apply for and acquire the funds for running their projects. Some CBOs have taken the initiative to apply for GF funds, but lack support from the local authorities has discouraged them to the point of never attempting to apply again. 24

25 Module 2 Involvement of CBOs in management of malaria and anemia in pregnancy There is a strong need to involve community organizations in the management of malaria and anemia in pregnancy and antenatal care (ANC). The groups would be involved in enrollment and advocacy for IPTp. Currently there is a low uptake of IPTp among the target groups. Although there is high ANC attendance (87%) as well as high awareness about the IPTp strategy in Kenya, only 24% of pregnant women had received two or more doses of IPTp according to the MIS This level is far less than the 60% Abuja target, and communities will have to be involved in behavior change strategies to attain this goal. In this context, CBOs can play an essential role in mobilizing their members to pass appropriate messages to their communities. Community Based Organisations Training and Capacity Building Capacity development programmes accompany finance Mentoring younger community organisations Human resource training and planning Preditable Financing Partner to reduce financing barrier Distribute Finance according to capacity Accountability Partner for Avocacy & information sharing Community program framework of services Coordination alignment & advocacy Fig. 5. CBO participation in Global Fund processes Other areas that offer opportunities for CBOs and other CSOs to apply for GFATM funding include: Sensitization of communities on appropriate health-seeking behavior related to malaria prevention and treatment. Management of stagnant water and other mosquito breeding sites in the community. Community participation in effective management of malaria. Monitoring and evaluation of community-owned responses to malaria. Identification of malaria as a priority for local action and development of a local malaria action plan. Promotion of behavior change induced through social change communication. Ensuring timely referral of severe malaria cases. Data collection to inform procurement and service delivery, e.g. mapping LLIN needs, IRS coverage, malaria morbidity and mortality. 25

26 Module 2 Identification of candidates for Community-based Integrated Management of Childhood Illnesses (C-IMCI) and/or training for community-based management of malaria. Community organizations face gaps that pose major obstacles in applying for GFATM grants, which can be classified as follows: Gaps in project management skills. Gaps in logistics management. Gaps in administration and governance. Gaps in linkage with district health services. Gaps in infrastructure Community Systems Strengthening (CSS) The Global Fund recognizes that the presence of strong, sustainable community-based organizations is an important element of ensuring good governance, policy coherence, program impact, sustainability, and results for HIV, tuberculosis and malaria prevention, treatment and care and support efforts. The GFATM therefore supports smaller implementing organizations in becoming stronger and more effective implementers. To fulfill this goal, the GFATM encourages CCM members to identify national gaps and constraints for scale-up within the context of developing capacities of CBOs. These interventions, known as Community Systems Strengthening (CSS), are increasingly becoming a core part of the Global Fund s preferred strategy across its programs. CSS: Is a program of the GFATM to strengthen CBOs while acknowledging the unique role they play in maximizing health results through advocacy and mobilization. Aims to foster the generation of quality demand for services through an increased role of the community in design, delivery and monitoring and evaluation of services. Relies on community-based needs assessments. To maximize these community-based responses, CSS is needed in order to: Expand coverage of service delivery. Provide emergency responses to the epidemics at community level. Achieve service coverage for hard to reach and marginalized groups. Inform and improve public policy, including policy analysis, advocacy and leadership development. Mobilize members of society as actors in the fight against the three diseases. 26

27 Module 2 Types of organizations benefiting from CSS initiatives A broad range of NGOs can benefit from CSS initiatives, such as: Organizations of people living with and/or affected by the diseases. Community-based advocacy groups. Home-based care organizations. Faith-based Organizations. Women s organizations. Youth organizations. Vulnerable groups organizations. Community centers. Private sector organizations. Incorporating CSS into Global Fund proposals The Global Fund continues to support Community Systems Strengthening initiatives as part of the overall framework for improving health outcomes for HIV, tuberculosis and malaria. Starting with Round 8, the Global Fund is encouraging applicants to include measures to strengthen community systems relevant to in-country contexts on a routine basis in proposals for new and continuing funding. Applicants are encouraged to consider Community Systems Strengthening needs in: The overall program implementation strategy, including strengthening of sub-recipient or other implementing partner systems and capacities to improve the quality and sustainability of services delivered throughout the community. Their assessment of disease programs and health system weaknesses and gaps to ensure that identification of program needs considers the community systems that are necessary to improve the scope and quality of service delivery, particularly to those without current access. The Global Fund s revised Guidelines for Proposals include a non-exhaustive reference to areas of work that may be supported by the Global Fund to improve access to and/or the quality of services, such as: Initiatives to improve community-based program implementation and service delivery, including strengthening core institutional capacity through physical infrastructure development, and organizational and systems strengthening. Partnership building at the community level, focusing on the building of systematized relationships among and between community-based organizations to improve coordination. 27

28 Module Challenges for CBO participation in Global Fund grants Not all governments recognize the valuable support civil society can bring in scaling-up health interventions. The critical nature of governmentcivil society interface therefore often hinders efforts. In many countries, government reluctance to work with civil society has been a significant barrier to the effective design of proposals and, equally, to the managing of bottlenecks and challenges in obtaining grants. However, even those barriers are less significant overall than the lack of knowledge and awareness among civil society, particularly at the local level, of possibilities available for support, funding, and participation through the Global Fund. Ultimately, the responsibility for increasing civil society engagement lies within civil society itself. As civil society continues to engage in Global Fund processes, other stakeholders will increasingly come to recognize the comparative advantage these organizations bring, particularly in reaching vulnerable and marginalized populations. CSOs need to coordinate and develop networks to increase their representation within these processes. Funding from the Global Fund is a key opportunity for civil society to strengthen relationships with other entities as well as to pave the way for sustainable responses to the three diseases in the long term. Key Points Civil society has been an important and vital partner to the GFATM. Community involvement is key for effective malaria control. There are challenges for effective community participation in malaria control. CBOs can benefit from GFATM grants through CSS programs. The responsibility for increasing civil society participation in Global Fund and disease control processes lies within civil society itself. Nevertheless, many barriers for CSOs remain. 28

29 Module 2 Key Reading Joint United Nations Programme on HIV/AIDS (UNAIDS) (2009): SUPPORTING COMMUNITY BASED RESPONSES TO AIDS: A guidance tool for including Community Systems Strengthening in Global Fund proposals. The Global Fund (2007): An evolving partnership: The Global Fund and Civil Society in the Fight against AIDS, Tuberculosis and Malaria. The Global Fund/International HIV/AIDS Alliance (2009): Civil Society Success on the Ground: Community Systems Strengthening and Dual Track Financing: Nine Illustrative Case Studies. CSS indicators can be found on the following website: 29

30 3 Module 3 The Global Fund grant-making process 3.1 Module objectives By the end of this module, the participants will: Describe how the GFATM grant-making process works. Understand the role of CCM, its structure and composition. Understand the minimum requirements for Grant Eligibility for CCMs. Describe the Civil Society Representation in CCMs. Know about the difference between Principal and Sub-Recipients. Understand how to become a Sub-Recipient. Understand the minimum requirements for Sub-Recipients. Describe the role of the LFA. Describe the role of the TRP. Academic/ Educational Sector Government Country Coordinating Mechanism Assessment Global Funds Local Fund Agent NGOs/CBOs - Prepares an submits proposals - Selects Principal Recipient(s) Reports Advice PLW Diseases - Oversees implementation Requests continued funding from the Global Fund for years 3-5 Principal Recipient(s) Grant agreement (2 years) Global Fund Secretariat Private Sector Reports Sub-Recipients Funds Funds Instruction to disburse Religous/Faith- Based Organizations Global Funds Trustee (World Bank) Multi-/Bilateral Development Partners Provides technical and capacity building support Fig. 6. Global Fund grant-making process 3.2 The Global Fund grant-making process Every nine to twelve months, the Global Fund Board holds a funding round and invites CCMs to submit proposals. The funding process is explained with the example of a fictitious country called Mubamba: 30

31 Module 3 The Governmental Health Authority in Mubamba identifies a need for malaria prevention and treatment interventions. There are already a number of organizations working in that area in Mubamba. But they are tremendously under-funded. The Mubambian Health Authority works with these organizations through the Country Coordinating Mechanism (CCM) to prepare a proposal to the Global Fund to fund malaria control interventions. The CCM submits the proposal to the Technical Review Panel (TRP) for assessment. The TRP found it satisfactory and worth for funding without any conditions. This recommendation is passed on to the Global Fund Board. The Global Fund Board approves grants based on availability of funds, and appoints the Mubambian Health Authority as the Principal Recipient (PR). The Global Fund Secretariat then contacts a Local Fund Agent (LFA) to oversee progress and ensure that the Health Authority have sufficient systems to administer funding properly. The Global Fund Secretariat negotiates a two-year grant agreement with the Health Authority and both parties sign the grant. The Secretariat then instructs the World Bank (as trustee) to make the first disbursement. The Health Authority receives the first portion of the grant and, overseen by the LFA, distributes it to the agreed organizations in the country. After a few months more money is needed. The Health Authority applies for second disbursement at the Secretariat. As sufficient progress has been made and the LFA has agreed, the second disbursement is made. The initial two-year period comes to an end and the Global Fund Board makes a successful assessment of progress. They find that the Mubambian Health Authority has been using the money wisely and that the organizations receiving it were making good progress in tackling malaria. The grant is therefore renewed for a further three years, to the full five-year period. 31

32 Module Actors within the grant-making process of the GFATM The Country Coordinating Mechanisms (CCMs) Country Coordinating Mechanisms are central to the Global Fund s commitment to local ownership and participatory decision-making. These country-level partnerships develop and submit grant proposals to the Global Fund based on priority needs at the national level. After grant approval, they oversee progress during implementation. Country Coordinating Mechanisms include representatives from both the public and private sectors, including governments, multilateral or bilateral agencies, nongovernmental organizations, academic institutions, private businesses and people living with the diseases. For each grant, the Country Coordinating Mechanism nominates one or a few public or private organizations to serve as Principal Recipient. Structure of the CCMs Each CCM should elect a Chair and a Vice Chair in accordance with the election procedures determined by its members. It is recommended that Chair and Vice are from different sectors as well as from domestic entities. Composition of the CCMs The Global Fund recognizes the importance of national contexts, customs and traditions, and therefore does not intend to prescribe specific CCM compositions. However, in accordance with its guiding principles, the Global Fund expects CCMs to be broadly representative of all national stakeholders in the fight against the three diseases. In particular, the Global Fund encourages CCMs to aim at a gender balanced composition. The CCM should therefore be as inclusive as possible and seek representation of all key stakeholders that are relevant in the fight against the three diseases in the national context. The membership of the CCM should comprise a minimum of 40% representation of the non-government sectors such as NGOs/community based organizations, people living with the diseases, key affected populations, religious/faith-based organizations, private sector and academic institutions. 32

33 Module 3 The Six Minimum Requirements for Grant Eligibility of Country Coordinating Mechanisms The Global Fund Secretariat applies a screening process before a proposal submitted by a CCM is referred to the Technical Review Panel as a way to ensure that all requirements for a functional CCM are met. CCM members representing the non-government sectors must be selected/elected by their own sector(s) based on a documented, transparent process, developed within each sector. The Global Fund requires all CCMs to show evidence of membership of people living with and/or affected by the diseases. CCMs are required to put in place and maintain a transparent, documented process to: solicit and review submissions for possible integration into the proposal. CCMs are required to put in place and maintain a transparent, documented process to: ensure the input of a broad range of stakeholders, including CCM members and non-members, in the proposal development and grant oversight process. CCMs are required to put in place and maintain a transparent, documented process to nominate the Principal Recipient(s) and oversee program implementation. When the PRs and Chair or Vice Chairs of the CCM are the same entity, the CCM must have a written plan in place to mitigate against this inherent conflict of interest. Civil Society representation in CCMs The CCM is a cornerstone of the Global Fund s architecture, where innovative public/private partnerships are built to rapidly disburse funds in the battle against AIDS, TB, and malaria. The CCM was designed to mirror the structure of the Global Fund Board, whereby all relevant sectors would play a key role in determining how the Global Fund should be governed. In many countries, Kenya included, governments, private sector and civil society are collaborating together to decide crucial programmatic and policy outcomes. This has not only become a strong factor in a country s potential sustainability of disease-fighting efforts, but equally as important a catalyst for democratic processes where vulnerable and marginalized groups acquire a key voice in national policy. Nevertheless, in many countries, the voice of civil society in CCMs is perceived as weak and in need of strengthening. 33

34 Module 3 Structural obstacles to strengthened civil society participation in CCMs Technical Capacity: The capacity of civil society organizations particularly those in isolated or rural areas - to develop technically sound proposals is quite limited, as compared with government or international civil society organizations. Access to information: Civil society organizations often find it difficult to access critical information. Difficulties interacting with constituencies: Civil society organizations, especially in countries covering large areas and/or with underdeveloped communications and transportation infrastructures, often face serious challenges to interactions with their constituencies. Poor CCM organization: Poor information sharing a responsibility of CCM leadership often disadvantages civil society members by not allowing enough time for the review of documents critical to an upcoming meeting when they are circulated at the last minute. Civil society representation in CCMs The example of Kenya Ineffective CBO representation at the CCM in Kenya negatively affects the participation in and performance of Global Fund programs. Poor communication and information sharing in combination with less-than-satisfactory monitoring, evaluation and reporting, which is delaying disbursements, are the main challenges identified by CCM members thus affecting civil society participation in the CCM. CBOs in Kenya complain bitterly of being left out of decision-making processes by the CCM, and in the selection of proposals submitted to the TRP. Stringent rules for prospective sub-recipients, lack of knowledge on application processes, and poor communication to hard-to-reach rural communities are major barriers for potential applicants in rural areas Principal-Recipients (PR) and Sub-Recipients (SR) PRs are country-based organizations legally responsible for the programmatic results and financial accountability of Global Fund grants. PRs are suggested by the CCM and appointed by the Board. Sub-recipients are organizations sub-contracted by the PR to deliver programrelated services. In April 2005, the Global Fund Board approved a revision of the CCM Guidelines requiring, among other changes, that CCMs nominate PRs using transparent and documented processes as a condition of funding eligibility. Moreover, the Board recommends the submission of proposals with both government and non-government PRs (Dual-Track Financing). 34

35 Module 3 Selection and Role of Sub-Recipients (SRs) After having received the grant, the PR should develop a detailed annual work plan with potential areas for SRs involvement and share with GFATM secretariat for approval. Subsequently, the PR should call for proposals for SRs activities as per approved work plan. The CCM oversees and monitors progress during implementation. The SRs should provide programmatic and financial quarterly progress reports to the PR as per agreement signed with the PR. The PR submits periodic disbursement requests with updates on programmatic and financial progress to the Global Fund trough the LFA. The SR should submit fiscal year progress reports and annual audits of program financial statements to the PR. Regular disbursement requests from SRs and program updates continue, with future disbursements tied to ongoing progress. LFA verifies PR/SRs information submitted and paves the way for further disbursements. Before entrance into agreement, a nominated SR should have a detailed work plan and budget for the intended period of the agreement. A clearly defined and transparent process for sub-recipient selection In Kenya, a call for expressions of interest in proposal development was placed in national newspapers and on the CCM website, and announced via civil society networks. Interested organizations were invited to submit a project proposal based on specified priority areas, together with an organizational capacity profile. A capacity assessment questionnaire, a project proposal template and work plan and budget formats, as well as guidelines for their completion were provided. The CCM then set up an independent review panel to assess the expressions of interest based on criteria previously developed. This was a four-stage process - Screening applications for admissibility: Compliance with application guidelines. Assessment of organizational capacity based on agreed criteria. Evaluation of project proposal, work plan and budget. Assessment of comparative advantages of organizations in addressing specific issues or reaching specific vulnerable groups. Of the 412 organizations that expressed interest, 34 submitted proposals that were deemed eligible for inclusion in the country proposal and were nominated as sub-recipients. 35

36 Module 3 Minimum requirements for sub-recipients In order to successfully assume quality and timely implementation and accountability for projects proceeds, Sub-Recipients (SRs) need certain minimum institutional and technical capacity requirements before signing a Project Cooperation Agreement with the Global Fund. Institutional and technical capacity requirements include: Legal status. Management and organization. Infrastructure and information systems. Health (HIV/AIDS, TB and/or malaria) and cross-functional expertise (finance, procure- ment, legal, M&E). In detail, that means: Legal Status The applicant SR should be a currently legally registered organization. Management and Organization The applicant (potential) SR should preferably have a good track record for timely and results based implementation of project activities. If the applicant SR is a civil society organization, it should have a board that meets regularly and has statutes for its function. The applicant SR should have sufficient management capacity (quality and quantity) to implement the proposed program. The applicant SR is preferably required to have a clear organizational leadership with clear accountability system to implement the proposed project. The applicant SR should coordinate and participate in/seek advice from the relevant national program and technical committees related to the project. The applicant SR has the administrative capacity to forecast, recruit, select, and retain human resources effectively. The applicant SR should have written personnel policies and procedures. The applicant SR should make available performance reports (e.g. audit reports) for external review by stakeholders including the public. The key individuals who will be responsible for implementing the program should have written job descriptions that incorporate responsibilities associated with the Project. The applicant SR should have a current budget sufficient to support key positions and organizational functions not related to Global Fund activities. This budget is expected to remain in place for the duration of the project. 36

37 Module 3 The applicant SR should be able to demonstrate commitment to gender, equity and non-discrimination/principles. The applicant SR should be able to demonstrate the acceptance within the local communities where the intervention is proposed, or a plan to ensure they will obtain local leaders and communities support. Infrastructure and Information Systems The applicant SR should have a functional IT system for internal and external communication. The applicant SR should have the ability to work in targeted areas (geographical coverage) where proposed field activities will be implemented. The applicant SR s management should meet periodically to review/analyze performance and share performance outcomes with internal and external stakeholders (e.g. CCM, partners, etc.). The applicant SR should have adequate physical facilities, office equipment, minimum logistical arrangements, etc. to implement current programs. Technical Expertise The applicant SR should recruit full time (within its organization) personnel with the required, HIV/AIDS, malaria or TB expertise necessary to implement the project. The applicant SR should have the required, specialized staff in finance and M&E necessary to implement the project and to recruit other necessary staff (legal etc.). 37

38 Module Local Fund Agents (LFAs) Following its core principles of ensuring country ownership of programs and maintaining a lean and efficient Secretariat, the Global Fund does not have offices outside of Geneva. Instead the Secretariat relies on LFAs, which are selected through a competitive bidding process to assess implementation capacities and verify grant implementation progress at the country level. LFA responsibilities include the following: Assess the PR s capacity to implement approved proposals by reviewing budgets and work plans and otherwise assisting the Global Fund in grant negotiations. Independently oversee program performance and the accountable use of funds (known as Verification of Implementation). This includes reviewing the PR s periodic requests for funds, undertaking site visits to verify results and reviewing the PR s annual audit report. Review grant performance as it approaches Phase 2. Assist with grant closure. Conduct ad hoc assignments at the request of the Global Fund, such as investigations related to the suspected misuse of funds. The LFA is not the Global Fund s representative within the country nor does it speak on behalf of the Global Fund unless expressly authorized to do so on a case-by-case basis. It is not empowered to make decisions on grants the LFA recommends and the Global Fund decides. Neither does it participate in the design or implementation of a Global Fund proposal, nor provide technical support to grantees Technical Review Panel The Technical Review Panel (TRP) reviews eligible grant proposals for technical merit (soundness of approach, feasibility and potential for sustainability). Based on this review the TRP recommends proposals for funding to the Board. The TRP consists of a maximum of 40 experts. Each expert is appointed by the Board for a period of up to four funding rounds. 38

39 Module 3 Key Points CCMs are a cornerstone of the Global Fund architecture and play an essential role in proposal development. CSO representation in CCMs often remains weak. PRs are country-based organizations legally responsible for program results and financial accountability. SRs are organizations sub-contracted by PRs to deliver program-related services. To become a SR certain institutional and technical capacity requirements must be met. LFAs verify grant implementation progress at country level. The TRP reviews eligible grant proposals. Key Reading ety in the Fight against AIDS, Tuberculosis and Malaria. The Global Fund (2008): Accelerating the Effort to Save Lives. The Global Fund/International HIV/AIDS Alliance (2009): Civil Society Success on the Ground: Community Systems Strengthening and Dual Track Financing: Nine Illustrative Case Studies. The Global Fund (2007): An evolving partnership: The Global Fund and Civil Soci- Further information on the issues covered in this module can be found in the following publications: - Aidspan: A Beginner s Guide to the Global Fund. Global Fund Factsheet on Dual Track Financing. - CCM Requirements. Contact information for CCM members is also available on each country page of the Global Fund website. 39

40 4 Module 4 How to apply for Global Fund grants a roadmap for CBOs 4.1 Module objectives By the end of this module, the participants will: Know the application process of the Global Fund. Have the capacity to follow the format provided by the CCM for Global Fund applica- tions. Know the minimum prerequisites for recommendation of proposals. Be aware of national strategy applications. Know about common mistakes in applications and how to avoid them. Have gone through the application checklist. Know where to get relevant information and support for their proposals. 4.2 How to apply for a Global Fund grant In order to apply for a Global Fund grant, the applying CBO must follow a format that is prescribed by the national CCM and strictly adhere to the regulations set by the CCM. The application must be submitted to the national CCM after the CCM publishes a Call for Proposals. It is strongly recommended to consult the CCM and other relevant stakeholders such as governmental and nongovernmental organizations in order to demonstrate that the application corresponds with national contexts and initiatives. The format requires applicants to: Describe its organizational structure and areas of operation as well as its capacity to implement the proposed project activities using the appropriate forms. Prove that it is experienced in the proposed field. Show evidence that the medical authorities in the planned project site are aware of the organizations existence and its activities. Provide a detailed description of activities, a concrete work plan and a realistic budget. Moreover, the proposal should clearly draw on the national strategy to describe (and request funding for) gaps in terms of intervention coverage to ensure a comprehensive response to the diseases. 40

41 Module 4 Implementation of transparent inclusive proposal development process The Global Fund Guidelines for proposals emphasize that all CCM deliberations and decisions should be transparent and disseminated widely. It outlines the CCM responsibilities for proposal development as follows: Disseminate widely to all interested parties in the country all information related to the Global Fund, such as Calls for Proposals, decisions taken by the CCM and detailed information on approved proposals for funding. Treat all members as equal partners in the proposal development process with full rights of participation, expression and involvement in decision-making in line with their areas of expertise. Build in sufficient time during the proposal development process to allow all CCM members to review and provide input for the drafts of a proposal. CCMs are encouraged to submit their proposals to a thorough quality review/enhancement process prior to final submission. All CCM members to sign the proposal to indicate that they have participated in the proposal development process. If insufficient consultation has occurred in the course of preparing a proposal, CCM members who have not been involved should not sign the proposal. For Non-CCM proposals: If organizations outside of the CCM process submit proposals for the CCM s consideration, the CCM should provide the reasons why it decided to include or not to include such proposals in the final submission. 41

42 Module 4 Introduction of application formats the example of Kenya Instructions for prospective applicants (Sub-Recipients) In 2009, the DOMC in Kenya distributed guidelines for CSOs and PSOs intending to apply for malaria components for GFATM funding Round 9. Those guidelines are reproduced below for the purpose of this training, and may change from round to round. Specific Terms of Reference (TOR) were developed for identified areas where private and nongovernmental sectors may have a comparative advantage in implementation. These included: Malaria Behavior Change Communication. Training of health workers on case management. LLIN distribution through mass campaigns. Home Management of Malaria in selected districts. Community systems strengthening. Diagnostic quality assurance. Prospective Sub-Recipients were to apply under a specific TOR and could apply for more than one. Interested applicants were required to provide the following: Completed organizational profile. Completed concept note under the defined TOR. Completed work plans under each of the defined TOR. Completed budgets under each of the defined TOR. Templates were provided in order to allow for consistency in applications and ease of consolidation. Applicants were disqualified if they did not use these templates. Organizational Profile Template Name of organization: Address and contact details of organization (including and telephone number): Year of registration (Attach a copy of your registration document): Current geographic operational areas (districts and divisions): Current programmatic operational areas related to malaria (tick the ones you are currently involved in): ITN distribution: Malaria BCC: Training on malaria (specify in which areas): Home Management of Malaria: Community systems strengthening (specify areas): Governance and management structure (attach organigram): 42

43 Module 4 Financial capacity: Current budget using the table below: Program or project including geographic coverage Donor Amount (KSh) Duration (Please provide information on your accounting system and internal controls. Attach a copy of your annual audit report to the application) Moreover, each application had to be based on a concept note on the planned project activities, which had to be submitted. The outline of the concept note is given below: Concept Note Template Organizational experience working in malaria control: Organizational experience working under the specific TOR: Value added or comparative advantage that your organization has in relation to the TOR: Experience in gender sensitive programming related to the specific TOR: Description of the activities proposed under the specific TOR (including implementation strategy): Target groups and final beneficiaries: Expected results: Other stakeholders and their anticipated roles: Risk analysis and contingency plan: Risk Likelihood Contingency Sustainability (describe how systems will be strengthened to ensure improved malaria service delivery and outcomes): Work plan (using provided template): Budget (using provided template): Selection of proposals Applicants were selected based upon their organizational comparative advantage: The appropriateness of proposed activities in relation to meeting the goals and objectives of the National Malaria Strategic Plan (NMSP) as well as cost effectiveness. The Concept Note(s) should have four to six pages. 43

44 Module Choosing the right strategy guiding principles of the Global Fund The Global Fund will finance programs that address the three diseases in ways that will contribute to strengthening health systems. In making its funding decisions, the Global Fund will support proposals which:»» Contribute to substantially scaling up and increasing coverage of proven and effective interventions against the three diseases for the prevention, treatment, care and support of the infected and directly affected.»» Build on, complement and coordinate with existing regional and national programs in support of national policies, priorities and partnerships.»» Focus on performance by linking resources to the achievement of clear, measurable and sustainable results.»» Highlight the creation, development and expansion of country government/ private/nongovernmental organization partnerships, building on existing coordination mechanisms, and promoting new and innovative partnerships where none exist.»» Strengthen the participation of communities and people, particularly those infected with and directly affected by the three diseases, in the development of proposals Minimum prerequisites for a recommendation for funding Although the prerequisites listed below have not been adopted as formal Global Fund policy, they nevertheless constitute important guidance for applicants preparing proposals for Round 9 (and beyond) because they provide insight into the way the TRP evaluates proposals. The following criteria apply for evaluation of proposals: A disease proposal that is based upon and responds directly to the current, documented, epidemiological situation. A coherent strategy that flows in a consistent order throughout the proposal with the implementation plans having the same objectives, program areas ( Service Delivery Areas ), and interventions/activities as are stated in the budget, the work plan, the Performance Framework. A robust gap analysis, both programmatic and financial, that accounts for the full extent of existing resources (including those planned and/or reasonably anticipated based on past practice) and not merely signed arrangements. Clear and realistic analysis of implementation and absorptive capacity constraints (whether disease specific or broader health systems) that relate directly to the in-country social, environmental and other contexts. 44

45 Module 4 Logical strategies to address capacity constraints, whether through the existing fun- ding application, or through other domestic or partner supported initiatives (which are also subject to performance assessments and adjustments). Implementation arrangements that recognize and respond to the need to broaden service delivery channels to multiple sectors to achieve universal access to prevention, treatment, and care and support services for people most affected. Demonstrated effort to address the more challenging drivers of, especially, the HIV epidemic in ways that will have a meaningful impact on preventing further infections. A clear plan for how to monitor activities and evaluate the impact of interventions. A budget that is sufficiently detailed to allow the costs of activities to be assessed. A work plan that makes clear the timing and sequencing of activities and responsibilities for each activity. Planned outcomes (included as indicators in the Performance Framework ) that address and respond to current epidemiological data, and demonstrate that the incremental investment of additional Global Fund resources will improve disease specific and broader health outcomes for those most at risk. By dealing effectively with all these prerequisites, an applicant will demonstrate to the TRP that it has a clear need for the additional resources, and has planned its funding request in a way that will supplement and strengthen in-country responses to the three diseases. 4.3 National Strategy Applications - A new way of applying for Global Fund financing Importance of National Strategies Experience has shown that robust national strategies can improve the success of grants. They provide an effective framework for donors and implementers to adapt disease-specific and basic health care projects and programs to national contexts. National strategies also enable all stakeholders to agree on national priorities and work for common results. In recent years, many countries have made significant efforts to develop national disease and broader health strategies. However, to finance implementation of these strategies, they have usually had to prepare multiple, separate proposals to different donors. This involves high transaction costs and may not always be fully consistent with national planning and reporting. As part of its commitment to aid effectiveness principles and in response to country requests for streamlined processes, the Global Fund has committed to introducing a new way to apply for Global Fund resources - known as National Strategy Applications (NSAs). 45

46 Module 4 This involves submitting a national strategy itself rather than a Global Fund-specific proposal form as the primary basis of the application for Global Fund financing. NSAs will be introduced through a phased rollout, beginning in 2009 with a limited number of countries. The anticipated benefits of NSAs are: Improved alignment of Global Fund financing with country priorities, national program- matic and budgetary timeframes. Reduced transaction costs and paperwork for countries. Improved harmonization with other donors that have agreed to use the same criteria for reviewing national strategies. A focus on managing for results and accountability within national strategies. In the longer term, improved quality, consistency and credibility of national strategic frameworks. NSAs will be an alternative approach to access resources from the Global Fund and countries will still have the opportunity to apply through the regular round-based system if they so wish. Although NSAs are not yet standard and are still tested out by a limited number of countries (first learning wave), it is important for CSOs to be aware that their planned activities have to be in line with the Kenya National Malaria Strategic Plan ( ). Therefore they have to fit their proposals to the strategic plan, and although this requirement has not been announced by the CCM, it is likely that once adopted, applications outside that plan are not likely to be accepted by the CCM. Challenges To date, while the Global Fund has encouraged applicants to base funding proposals on national strategies and to attach these to their proposal, it has still required CCMs to complete a long Global Fund proposal form. Furthermore, even when national strategies have been attached to the proposal, the review of the TRP does not provide an assessment that could be useful to other potential funders. This is because the review s prime focus is on the contents of the proposal, rather than on the national strategy itself. National strategies attached to Global Fund proposals have in any case tended to lack detailed budgets, information about financial contributions to national efforts by all funding sources, sufficient inclusion of civil society or the private sector, or appropriate mechanisms to ensure accountability. These elements are all necessary if national strategies are to serve as the primary basis of a rigorous funding decision. According to the new strategic regulations, applications to the Global Fund will in future be linked to the national strategy. This approach will create an incentive for country stakeholders to develop robust national strategies and eliminate parallel planning efforts. 46

47 Module Common mistakes in proposals Recent assessments of the epidemiological situation in the country do not exist. Many proposals lack coherence and logic between objectives, program areas, budget, a separate detailed work plan and the Performance Framework. Work plan and budget are repeatedly not clearly separated. This makes it difficult to prove whether activities are linked to the timing of the intended outputs, outcomes and impact. Budgets are unrealistic (salaries and equipment) and not well structured. Poor grammar and sentence construction makes it difficult to understand the intended rationale for programming. Poor linkage between objectives and activities. Mentioned objectives can not be achieved within the project life. A large number of proposed activities are difficult to implement. Lack of objectively verifiable indicators. Lack of outputs/outcomes with milestones for achievement. 4.5 Application checklist Access information on announcements of new funding rounds. This information is published in newspapers as well as on the website of the national CCM. Read the announcement and the requirements for the application carefully. Note the deadlines for application. Access and carefully read the guidelines for applicants as outlined by the CCM. Access the required background on the areas of your interest. Note any special conditions and requirements such as number of pages, letters of recommendations, signatures, etc. Note that certain requirements need time, e.g. letters from MoH at district level, functional bank accounts, bank statements, etc. Start preparations early, prepare fully. Prepare the documents as indicated in the guidelines, making sure that ALL requirements are complied as listed in the guidelines. Prepare the number of copies required. Remember that original copies are to be submitted to with your application to the CCM. Keep copies of each document in your file. You will need them for project verification, implementation, monitoring and evaluation. Submit your application early - Do not wait until the last minute. Take the required period for postage into consideration. 47

48 Module Sources of information Community organizations in Kenya can access information needed for preparing a proposal from the following sources: Websites of (internet):»» CCM»» Global Fund»» Division of Malaria Control»» Ministry of Health»» Aidspan»» KeNAAM»» WHO Local DHMT through the District Medical Officer for Health. Local daily newspapers. NGOs working in your area. Make phone calls to DOMC, KeNAAM, AMREF or local district hospital to enquire about submission dates and other requirements. The key words are: If you are not sure, ask. Key points The application processes for Global Funds requires that CBOs keenly observe and comply with the requirements as announced by the CCM. Strict attention should be paid to timelines and deadlines. Last minute rush to prepare concept notes, write proposals, or obtain letters of recommendations will result in poor proposals that will not pass the rigorous evaluation process! For a successful application for the Global Fund, it may be necessary that several CBOs team up and collaborate in the application and implementation process. If this is the line you take, then make sure that each partner knows its role and specify which activity will be carried out by which partner. Similarly, agree on the sharing of resources (money, equipment, office space, personnel) and responsibilities well before the implementation period. Accessing information is key. Proposals should be aligned to the Global Fund guiding principles and need to meet certain criteria. National Strategy Applications could be tomorrow s standard. Be aware of your national disease control strategies. Be aware of common mistakes in Global Fund applications and try to avoid them in your own application. 48

49 Module 4 Key Reading Aidspan (January 2008): The Aidspan Guide to Round 8 Applications to the Global Fund Volume 1: Getting a Head Start. Republic of Kenya Ministry of Health, National Malaria Control Programme (2001): National Malaria Strategic Plan ( ). The Global Fund (2006): Report of the Global Fund Partnership Forum Celebrating Successes & Overcoming Challenges Durban, South Africa (1-3 July, 2006). The Global Fund (2006): The Role of the Private Sector in the Global Fund. The Global Fund (2009): Faith-Based Organizations as Principal Recipients and sub-recipients. In Report on the Involvement of Faith-Based Organizations in the Global Fund. The Global Fund (2009): Malaria control, community systems strengthening and community-owned response: Consensus on best practice for use in the development of Global Fund Round 9 malaria proposals and National Strategy Applications. National Strategy Applications. UNDP Sudan (July, 2007): Implementation Manual for Global Fund Grants Sub- Recipients. 49

50 Recommendations Recommendations In order to strengthen the role of CSOs, and CBOs in particular, in terms of involvement in Global Fund operating structures and implementation of grants, the following recommendations are made: Recommendations to the Global Fund The funding gap for technical assistance must be met and support for technical agencies should be scaled up. The Consolidated United Nations (UN) Technical Support plan should be fully funded to enhance support to CSOs where huge gaps in technical capacities have resulted in poor proposal development, monitoring, evaluation and reporting both programmatic and financial. Technical support needs to be provided to CBOs, particularly in terms of project cycle management, financial management and disease control interventions in order to create more technically sound proposals and ensure a stronger implementing role for CBOs. Performance-based funding is proving to be a positive tool, which is improving grant implementation. Technical support should be available to community organizations so as to increase their compliance for continual funding. The application process needs to be further simplified for CSOs and CBOs in particular, in order to reduce barriers to submitting applications. The Board should modify the grant proposal process and create separate streams for government and civil society (including FBOs) funding. Reporting requirements of the Global Fund remain a challenge for CSOs, in terms of the depth and frequency. For stable grants, grant reporting should not be required more often than every six or twelve months to allow CSOs to come up with concrete results and outcomes. CBOs are an important constituency in the implementation of Global Fund grants. At country level, their participation in the CCM is minimal and their voice is unheard. Adequate representation of CBOs needs to be ensured in all Global Fund decision-making and operating structures. The Secretariat should improve information sharing and communication: (1) among countries (civil society and government) and (2) between the Secretariat and civil society to address communication gaps between CSOs and the GF especially in resource availability. 50

51 Easily accessible and digestible information should be made available to CSOs and CBOs, also in local languages. This should encompass information on:»» CCM membership, roles, responsibilities and contacts.»» National priorities on disease control.»» Deadlines and process for application submission to the CCM.»» How to obtain technical assistance and how to participate in civil society consultations.»» How to apply for CCM membership and timelines and processes for applying. Recommendations to the Donor Community The current funding gap of approximately USD 4 billion for as identified by the Global Fund Secretariat should be urgently filled by donor nations in order to save more lives and respond to the funding demand as well as to ensure predictable and sustainable funding. Recommendations to Civil Society and Community Based Organizations Ensure advocacy impact through building strong coalitions. Recognize and exploit the crucial watchdog function of civil society in order to monitor the application and implementation processes of Global Fund grants. Increase efforts to engage in and access information on Global Fund grant application and implementation processes. Strive to improve the level of civil society and community participation within the Global Fund. Increase efforts to improve communication between the board and civil society representatives, among civil society representatives and with and within CCMs. Organize yourselves into national systems that advocate for your needs within and outside the CCM framework. List CSOs and grassroots organizations in your country and make this list publicly accessible in order to facilitate communication. 51

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53 Imprint Publisher: STOP MALARIA NOW! c/o action medeor e.v. Gertrudenstrasse Cologne Germany Phone: +49 (0) 221/ info@stopmalarianow.org Web: Editors: Antje Mangelsdorf, Esther Suchanek (STOP MALARIA NOW!) Dr. Maurice Odindo (Community Capacity Building Initiative) Layout and Design: Die Medienarchitekten - Goedecke & Wruck GbR Kirschallee Bonn Germany Web: Support for the development of this manual was provided by Community Capacity Building Initiative (CCBI) and Kenya NGO Alliance Against Malaria (KeNAAM), both based in Nairobi. To request copies of this manual, please contact: Kenya NGOs Alliance Against Malaria (KeNAAM), On AMREF KCO Building Along Wilson Airport, off Langata Road. P. O. Box GPO, Nairobi Kenya kenaam@amref.org Or download the manual from Photos: action medeor e.v. (Cover, pages 20, 24, 28, 32, 33, 38, 52) Medicines for Malaria Venture (Cover, pages 9, 13, 21, 22, 37, 49) Icons: istockphoto.com November 2009 STOP MALARIA NOW! is organized with financial assistance from the European Union. The contents of this publication are the sole responsibility of action medeor e.v. and can in no way be taken to reflect the views of the European Union. 53

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