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FAQ on Single Concept Note Submission For Joint HIV And TB Programming

1. What is the Global Fund Board decision?

Countries with high co-infection rates of TB and HIV will have to submit a single concept note that presents integrated and joint programming for the two diseases, unless the Secretariat determines that extraordinary circumstances warrant separate concept note submissions; and
The Secretariat and partners should facilitate the development of such TB and HIV concept notes through the country dialogue process to present integrated programs to the Board for approval.

2. What is the aim of the decision of the Global Fund Board on submission of a single concept note for TB and HIV?

The aim is to maximize the impact of Global Fund investments to make an even greater contribution towards the vision of a world free of the burden of AIDS and tuberculosis. Enhanced joint HIV and TB programming will allow to better target resources, to scale up services and to increase their effectiveness and efficiency, quality and sustainability. Completing a single concept note for TB and HIV entails systematic and ongoing country level dialogue between TB and HIV programs and stakeholders prioritizing the alignment of planning and strategic investments, including for cross-cutting areas like health systems strengthening and community systems strengthening.

3. What was the impetus behind the Global Fund Board’s decision?

The Board of the Global Fund provided suggestions in the past on how to improve the programmatic response to the diseases, which has not yielded the expected results. Separate programming and lack of adequate and systematic dialogue between the two programs continued. As a result, patients do not benefit from the services they need. For example, by the end of 2012

  • TB contributed to 20 percent of 1.6 million AIDS deaths
  • HIV caused 25 percent of 1.3 million TB deaths
  • Only 57 percent of TB patients received ARV therapy, the most powerful intervention for preventing HIV and TB illness, death and transmission; this is despite the recommended 100 percent coverage.

The evidence base for the WHO-recommended collaborative TB/HIV activities is compelling. While some progress is being demonstrated, acceleration for joint programming is urgent. In addition, TB/HIV services need to be considered as critical components of quality care for TB and HIV.

4. Which countries should submit a single TB and HIV concept note?

The decision primarily applies to the 41 countries which the World Health Organization (WHO) considers as the TB/HIV priority countries that have the highest estimated number of people living with HIV who develop TB. These countries represent 92 percent of the global burden of HIV- associated TB in 2012. The WHO list of countries is in the Annex of this document. An exact list of the countries among these 41 that will be eligible for funding for HIV and TB under the new funding model will be released by the Global Fund in the first quarter of 2014.
The Global Fund Secretariat, along with technical partners of respective countries, will work closely with the Country Coordinating Mechanism in each country to help ensure a single concept note is submitted for the two diseases. Other countries (particularly countries with concentrated and increasing HIV epidemics e.g. in Central Asia and Eastern Europe) are also encouraged to consider joint planning and concept note submission. At a minimum, other countries which plan to request funding for HIV and TB should include TB/HIV collaborative activities in their concept notes, in line with the instructions provided in the new funding model tools and guidance materials.

5. What is the process to develop a single concept note?

Concept note development is embedded in the country dialogue in which stakeholders from TB and HIV programs should participate. The steps that are identified for concept note development under the new funding model are also applicable for the development of single TB and HIV concept note. This includes epidemiological and impact assessment, program reviews, development or update of national strategic plans, and gap analysis. Applying strategic investment thinking throughout the concept note development process is critical to targeting investments on the interventions and populations where they will have maximum impact. During all these steps meaningful engagement and the voice of key affected populations and civil society organizations equally representing TB and HIV should be ensured.

The concept note will also include cross-cutting activities such as health systems strengthening, community systems strengthening, program management, monitoring and evaluation, and human rights, which offer great opportunities for identifying synergies between the TB and HIV programs.
The single concept note template and instructions for completion will be available at the beginning of 2014 on the Global Fund new funding model website: http://www.theglobalfund.org/en/about/grantmanagement/fundingmodel/

6. What does this decision mean to TB and HIV program reviews as part of the new funding model?

In high TB/HIV burden countries HIV and TB program reviews should be aligned and conducted jointly. In cases where these cannot be conducted jointly, TB/HIV collaboration should be a mandatory part of each disease program review or the health sector reviews with participation from both disease programs. The timing of the submission of the joint TB and HIV concept notes should be aligned such that recommendations from the two program reviews are available and can be addressed in the concept note to the Global Fund. Where program reviews are not planned in time for application due to the national cycle, epidemiological and impact analysis should be conducted to inform national strategic plan development, investment case and concept notes

7. What does this decision mean to national strategic plans as part of the new funding model?

There may be advantages to working towards alignment of national strategic plans for TB and HIV in terms of strategies and timeframes. For example, both programs would have the most up-to-date data and analysis to draw upon when developing a single concept note. The Global Fund Secretariat will assess how best to support development of a single concept note that builds on national planning processes.
Where the quality of a national strategic plan is considered low or not up-to-date the anticipated application to the Global Fund could be used by countries to identify opportunities for a more focused and effective use of the resources available for HIV and TB. The country could engage in a process to update their strategy and/or to align the HIV and TB national strategic plans. Comprehensive, investment-oriented and coordinated strategies will provide a solid basis for application to the Global Fund.

8. What does the single concept note mean for management of HIV and TB programs?

With regards to the requested submission of a single concept note for HIV and TB, the Global Fund will follow a similar approach to how it manages its broader grant portfolio, recognizing that there is not a one-size-fits-all and country context is essential. In this, the single TB and HIV concept note is intended to stimulate a country-led dialogue and related decision-making leading to an optimization of HIV and TB programming, service delivery and health outcomes achieved. This might also entail structural adjustments where needed. The Global Fund recognizes that the situation might be different for each country that is submitting a single concept note. Countries will therefore determine their own scope and areas of joint programming depending on their local context including the epidemiology of TB and HIV.

9. What does this decision mean to the technical support my country receives?

Technical support can be given to help countries make stronger linkages across the disease programs. Coordinating technical support in relation to Global Fund processes is the overall responsibility of the Country Coordinating Mechanisms. In-country technical partners and stakeholders are expected to coordinate in support of the Country Coordinating Mechanisms and harmonize their approach to supporting joint concept note development.
The following mechanisms can be accessed in addition to technical support from domestic sources, in-country technical partners and bilateral donors:

For preparation of concept notes

  • Except for writing of concept notes:

o Use of existing technical support budgets from Global Fund grants.
o Alternatively, Country Coordinating Mechanisms can utilize up to US$150,000 of existing grants (in the manner of a non-material reprogramming) towards strengthening of national strategic plans or strategic investment planning including for example: epi-analysis, national strategic plan strengthening/development, costing, etc.

  • For writing of concept notes it is recommended to reach out to technical partners.

Throughout program implementation

Technical partners will be available to support countries in relevant stages during program implementation. A number of mechanisms for technical assistance during grant implementation exist through which countries can access technical support providers. More details will be available on the Global Fund website or through the email address, both of which are provided in section 10 below.

10. Where can I obtain additional information?

  • A letter from the Chair of the Global Fund Board was sent to the ministers of health of countries to which this decision applies.
  • At the beginning of 2014 the Global Fund Secretariat is publishing on its website (http://www.theglobalfund.org/en/about/grantmanagement/fundingmodel/) guidelines and tools for the new funding model, which take into consideration the Board decision on the single TB and HIV concept note.
  • Send an e-mail to HIV_TB@theglobalfund.org or contact your Fund Portfolio Manager
  • These frequently asked Questions will also be disseminated by WHO, UNAIDS, Stop TB Partnership and PEPFAR to all in-country partners to ensure coordination and understanding.