Twentieth Board Meeting

Eiji Yamamoto from the constituency of Japan is designated as Rapporteur for the Twentieth Board Meeting.

The agenda for the Twentieth Board Meeting (GF/B20/1, Revision 2), as amended, is approved.

The report of the Nineteenth Board Meeting (GF/B20/2, Revision 1) is approved.

<p>The Board acknowledges the collaborative efforts undertaken by the Global Fund with the World Bank and the Global Alliance for Vaccines and immunizations (GAVI), with technical support and facilitation from the World Health Organization (WHO), to develop a proposal for a common platform for joint Health Systems Strengthening (HSS) funding and programming to respond to country needs and to accelerate achievements in the fight against the three diseases and improve immunization coverage.</p><p>The Board requests the Secretariat, in close consultation with the Policy and Strategy Committee, to continue collaboration with the partner agencies to elaborate in an inclusive manner the operational, financial and policy implications for joint HSS funding and programming based on but not limited to the proposed Option 1 (Single HSS Funding Application) and Option 2 (Funding on the Basis of Jointly Assessed National Health Strategies) described in the Policy and Strategy Committee's Report to the Board (GF/B20/4).</p><p>The Board asks the Secretariat to propose to the PSC, based on consultations at country level with key stakeholders, how a joint HSS platform could be operationalized and funded, for recommendation to the Board at its Twenty-First Meeting.</p>

The Board requests the Executive Director to invite Dr Dorothy Kinde-Gazard, Dr Stein-Erik Kruse, Dr Vasanthapuram Kumaraswami, Dr Ruth Levine, Dr Maria Ines Nemes and Dr Wim Van Damme to become members of the Technical Evaluation Reference Group (TERG) for a period of two years, subject to the revision of the TERG Terms of Reference.

The Board notes the Secretariat's continued focus on strengthening the Global Fund's relationship with its key partners in the fight against the three diseases. In this context, the Board expresses its satisfaction with and endorsement for the principles of the revised memorandum of understanding with the Roll Back Malaria Partnership (the "RBM MoU") set out in Attachment 3 of the Policy and Strategy Committee's Report to the Board (GF/B20/4), and requests the Executive Director to finalize and sign the RBM MoU.

<p>The Global Fund's constituency based governance model is core to the organization's identity as a public private partnership. The Board reiterates its support for this model and stresses that its effective functioning requires active and informed engagement by all constituencies. </p><p>To further facilitate the engagement of the Board constituencies of the implementing voting group in the Global Fund's governance processes, the Board decides to make available, on an annual basis, funds to these constituencies for communication, meeting, travel and staff costs incurred for intra-constituency functions, as specified in the Board Constituency Funding Policy (GF/B20/4 Annex 3).</p><p>The Board decides that each implementing constituency application in accordance with paragraph 8 of GF/B20/4 Annex 3 should be limited to US$ 80,000 for 2010. Exceptions to this ceiling may be permitted by the Secretariat, in consultation with the Chair of the Policy and Strategy Committee, and within the overall funding ceiling approved by the Board.</p><p>The Board delegates oversight of the Board Constituency Funding Policy to the Policy and Strategy Committee and requests the Secretariat to provide that committee with periodic reports on its impact on constituency participation, particularly in view of possibilities for joint action with UNAIDS and other relevant partners in this area. The first such report to the PSC should be at its first meeting in 2011. </p>

<p>The Board amends the Committee Rules and Procedures, Section C. paragraph 1 a. and b. as follows:</p><p>C. Size</p><p>Committees will be limited to a maximum membership as follows:</p><p>a. Policy and Strategy: 20 members (plus one representative of each of the World Bank, the World Health Organization, the Partners constituency and UNAIDS in a consultative, non-voting role)</p><p>b. Portfolio and Implementation: 12 members (plus one representative of each of UNAIDS, the Partners constituency and the World Health Organization in a consultative, non-voting role).</p>

<p>With respect to Round 9 and National Strategy Applications (NSAs), the Board recognizes that:</p> <p>i. currently a large proportion of funding commitments made by the Global Fund are for a three year period, with the entire funding commitment being made at the time of grant signature; </p> <p>ii. it is preferable to make three-year funding commitments in two tranches of an initial two-year period and an additional one-year period;</p> <p>iii. commitment of the additional one-year period can be undertaken in a manner that minimizes funding uncertainty and additional transaction costs; and</p> <p>iv. certain other measures are required to be put into effect in order to fund the current demand for funding. </p> <p>Therefore, the Board decides as follows:</p> <p>1. The Board approves the addition of paragraph 3.c. of the Comprehensive Funding Policy (approved at the Sixth Board Meeting and amended at the Thirteenth Board Meeting and Fifteenth Board Meeting (GF/B15/DP27)) as presented in Annex 5 Version 2 to the Report of the Working Group on Managing the Tension Between Supply and Demand (GF/B20/12).</p> <p>2. Round 9 proposals, National Strategy Applications: </p> <p>a. The Round 9 proposals and National Strategy Applications shall be subject to an overall 10% adjustment for efficiency, resulting in a maximum limit of 90% of the TRP-recommended amount for the first two years of implementation.</p> <p>b The Secretariat shall commit funds for Round 9 and NSAs limited to 90% of the approved funding (an "Initial Commitment") and an anticipated financial commitment for the remaining year of the approved additional funding, to be committed not earlier than 12 months after the starting date of the Initial Commitment, conditional upon the availability of funding (a "Continuing Commitment"). Continuing Commitments shall have the first funding priority under paragraph 8 of the Comprehensive Funding Policy.</p> <p>3. Round 9 and National Strategy Application additional commitments: Approval by the Board of additional commitments for Round 9 proposals and National Strategy Applications shall be subject to a collective maximum limit of US$2,852 million (being 75% of the amounts requested in Round 9 proposals for the third, fourth and fifth year </p> <p>of implementation and 75% of the amounts requested in NSAs for implementation periods beyond the first two years). These limitations, as well as the limitations placed on Round 8 Phase 2 in the decision entitled "Funding Decisions" made at the 18^th Board meeting (GF/B18/DP13, paragraph 2) shall be increased from 75% to 90% when new resources become available, subject to approval by the Board at that time.</p> <p>4. Due to the measures outlined in this decision, which increase the amount of funding available in 2011, the last sentence of paragraph 4 of Decision GF/B18/DP13 is deleted.</p>

<p>The Board refers to its decision made at the Nineteenth Board Meeting establishing a working group to examine the tension between demand and supply in a resource-constrained environment (GF/B19/DP26) (the "Working Group").</p> <p>The Board commends the Working Group on its recommendations to the Board contained in its report (GF/B20/12) and endorses the broad lines of thought contained in the recommendations contained in the report. In particular, the Board notes that the measures outlined for Area B in the report need to be discussed by the Board and requests the Chair and Vice Chair of the Board to urgently establish the appropriate process, including some recommendations to the Board before the launch of the next Funding Round.</p> <p>The Board requests that this process takes forward the Working Group's effort to improve prioritization for funding amongst proposals. The Board recognizes that significant progress has been made and that further work is necessary to assist the Board to make difficult prioritization decisions.</p> <p>With reference to the Working Group's suggestions on the need for more sophisticated strategies, tools and mechanisms for identifying efficiencies in grant proposals and implementation, the Board requests the Chair and Vice Chair, together with appropriate committees, to make recommendations to the Board at its next meeting.</p> <p>This should specifically address key areas where efficiency gains can and should be made, including a focus on commodity pricing, procurement and supply chain management, optimizing country level collaboration and partnerships, as well as budgeting, planning and implementation processes in line with best practices in efficient and quality service delivery.</p>

<p>1. The Board approves, in principle, all the Round 9 proposals and National Strategy Applications (NSAs) recommended for funding by the Technical Review Panel (TRP).</p> <p>2. The Board approves for funding, subject to Decision GF/B20/DP9, for an initial two years those Round 9 proposals and NSAs recommended for funding by the TRP as 'Category 1' and 'Category 2' as listed in LIST A in GF/B20/18, subject to paragraphs 4 to 5 below.</p> <p>3. The remaining Round 9 proposals and NSAs recommended for funding by the TRP as 'Category 2B' will be approved for funding for an initial two years (subject to Decision GF/B20/DP9) and paragraph 4 and 5 below):</p> <p>a. through Board confirmation by email (or, if appropriate, at the Twenty-First Board Meeting), as funds become available under the terms of the Comprehensive Funding Policy; and</p> <p>b. based on the composite ranking of such proposals in compliance with the Comprehensive Funding Policy.</p> <p>4. The applicants whose proposals are recommended for funding as 'Category 1' (as indicated in Annex 1 of GF/B20/9 and Annex 1 of GF/B20/11) shall conclude the TRP clarifications process, as indicated by the written approval of the Chair and/or Vice Chair of the TRP, not later than eight weeks after the applicant's receipt of: </p> <p>a. notification in writing from the Secretariat of the Board's decision; or</p> <p>b. the findings of the independent budget review, in cases where the TRP has requested an independent budget review as part of the clarifications process.</p> <p>5. The applicants whose proposals are recommended for funding as 'Category 2', including the subset of proposals identified as 'Category 2B' (as indicated in Annex 1 of GF/B20/9, and Annex 1 of GF/B20/11), shall:</p> <p>a. provide an initial detailed written response to the requested TRP clarifications and adjustments by not later than eight weeks after the applicant's receipt of :</p> <p>i. notification in writing by the Secretariat to the applicant of this Board decision; or</p> <p>ii. the findings of the independent budget review, in cases where the TRP has requested an independent budget review as part of the clarifications process; and</p> <p>b. conclude the TRP clarifications process, as indicated by the written approval of the Chair and Vice Chair of the TRP, not later than three months from the Secretariat's receipt of the applicant's initial detailed response to the issues raised for clarification and/or adjustment.</p> <p>6. The Board declines to approve for funding those proposals recommended by the TRP as 'Category 3' as indicated in Annex 1 of GF/B20/9 and Annex 1 of GF/B20/11. These applicants are encouraged to re-submit a proposal in a future funding round after major revision of the proposal. </p> <p>7. The Board declines to approve for funding those proposals recommended by the TRP as 'Category 4', as indicated in Annex 2 of GF/B20/9.</p> <p>8. The Board notes the TRP's request to have additional financial analysis support as part of the clarifications process and requests the Secretariat to make the necessary arrangements. </p>

<p>The Board delegates authority to the Portfolio and Implementation Committee (PIC) to approve changes to the "Guidelines and Requirements for Country Coordinating Mechanisms". </p><p>However, if the PIC considers that material changes to any of the six CCM eligibility requirements are needed, the PIC will make a recommendation to the Board for approval.</p>

<p>The Board recognizes that, as described in the Portfolio and Implementation Committee's Report to the Board (GF/B20/5), there are challenges with identifying sources for certain essential and long-established multi-source treatments that meet the requirements of the Global Fund's revised Quality Assurance Policy for Pharmaceutical Products ("QA Policy"). In order to avoid disruption to treatment of patients, but without compromising the fundamental quality assurance principles of the QA Policy, the Board therefore decides to revise the QA Policy to expand the eligibility criteria for a risk/benefit review of products by the Expert Review Panel (ERP) by adding the following interim provision at the end of paragraph 13 of the QA Policy: </p><p>"Provided that the criterion in paragraph (ii) above is met, certain multi-source [8] FPPs for malaria and first-line tuberculosis treatment that do not meet the criteria in paragraph (i) above are also eligible for review by the ERP for associated potential risks/benefits in accordance with paragraph 10 of this Policy. The list of ERP-recommended FPPs that is made publicly available will indicate which of the ERP-recommended FPPs were eligible for review as a result of this paragraph. </p><p>Footnote 8: For these purposes, "multi-source" means a pharmaceutical product for which the monograph of the finished dosage form was published in the International, U.S. or U.K. Pharmacopeia before 10 October 2002"</p><p>The Board requests the Market Dynamics and Commodities Committee to review this amendment to the QA Policy, with special attention to the working, transparency and reporting requirements of the ERP review process, and to report to the Board at its last meeting in 2010.</p><p>The Board notes that it will take some time for dossiers for these multi-source FPPs to be prepared and submitted to the next set of ERP reviews and that an interim exception is necessary to avoid disruption in essential treatment. The Board decides that, on an exceptional basis and for the period up to 31 December 2010 only, grant funds may be used to procure certain multi-source FPPs for malaria and first-line tuberculosis treatment, provided that:</p><p>a. there are no other FPPs for that product formulation available (as defined in the QA Policy) that are WHO-prequalified or SRA-authorized or ERP-recommended;</p><p>b. the site at which such FPP is being manufactured must, at the time of the procurement, be in compliance with the relevant GMP standards as verified by the WHO Prequalification Program, or an SRA or a regulatory authority participating in PIC/S; </p><p>c. the FPP has been selected for procurement by relevant UN procurement agencies; and</p><p>d. the notification/confirmation and testing processes described in paragraphs 9 and 31 of the QA Policy will apply to such procurement.</p><p>The Board requests the MDC to consider, as a matter of urgency, contingency plans regarding the recently notified disruption of funding for certain life-saving medicines (e.g. artemisinin intra-rectal and injectable medicines) in situations where no FPPs for such medicines meet the criteria in paragraph 7 of the QA Policy and to make recommendations to the Board at the earliest opportunity.</p>

The Board approves the 2010 Operating Expenses Budget in the amount of USD 274 million as set out in Annex 1 to the Report of the Finance and Audit Committee (GF/B20/6).

The Board endorses the Risk Management Framework of the Global Fund as set out in Attachment 3 to the Finance and Audit Committee Report to the Board (GF/B20/6).

The Board requests the Secretariat to continue to gather information regarding in-kind donations, in particular research into the donation of non-health products and for this purpose authorizes the Secretariat to undertake the facilitation of donations of non-health products to Global Fund grant recipients on a trial basis. The trials shall be in a limited number of countries and will be conducted in line with the guidelines for service donations developed by the Secretariat. Specific attention shall be paid to donations of non-health products by health companies. The Board requests the Secretariat to report to the Finance and Audit Committee, regarding the outcome of the trials, with the aim of making recommendations to the Board, at the Board's second meeting in 2011.

<p>The Board notes the progress and positive experience of the pilot phase of the Debt2Health mechanism. The Board decides to incorporate the Debt2Health mechanism as an additional means of resource mobilization for the Global Fund. There will be no limit on the number of creditor and debtor countries that may participate and due diligence on the original purpose of the debt will be undertaken. </p><p>The Board authorizes the Secretariat to amend the Global Fund's Policy for Restricted Financial Contributions to allow restricted contributions from implementing countries for counterpart funds under Debt2Health swaps which are attributed at the country level.</p><p>The Board requests the Secretariat to report to the Board annually on the implementation of Debt2Health.</p>

The Board delegates its authority to the Finance and Audit Committee to deal with all matters related to the Global Fund Provident Fund.

<p>The Board notes the concepts set out in the Letter of Intent (GF/FAC13/20, Annex 2) to be signed with a property developer, and requests the Secretariat to engage in further negotiations for the construction of a building to be leased by the Secretariat. </p><p>The Board notes the importance for the Secretariat to identify a suitable entity that, at the time the Secretariat signs a lease agreement, provides a binding commitment to share the rent for space in this office building, in the case where the building contains more space than what would be necessary to house the Fund at that time. The Board also encourages the Secretariat to minimize the Fund's financial exposure for the costs of the building prior to occupancy, and to provide additional information about interim arrangements between the date of the expiration of the current lease and the expected date of occupancy of the new space. </p><p>The Board requests the Finance and Audit Committee to oversee the arrangements for the Secretariat's future office space.</p>

<p>We, the Board, express our deep gratitude to Barry Greene for his long service to the Global Fund. We are indebted to him for his dedication and loyalty and the tireless efforts he has made to forward the cause of the Global Fund. We are also grateful for Barry's sense of humour and his ability to maintain congeniality and compassion at all times. His integrity and ability to inspire trust are unrivalled. He represents what is best about the Global Fund. Barry will be much missed by the Board, by the FAC members in particular and by the Secretariat staff. </p><p>We wish Barry all the best, and look forward to continuing to work with him in his new role. <b><i>Go raibh</i></b> <b><i>mile</i></b> <b><i>maith agat</i></b> (Irish for a thousand thank yous)!</p>

<p>The Board notes the reports of the Office of the Inspector General (OIG), in particular the OIG Report on Lessons Learned (TGF-OIG-09-002), and the Secretariat's response contained in such reports. The Board stresses the need to ensure that the response to the findings and recommendations of the OIG will be prioritized and fed into the overall planning and work of the Global Fund, including grant operations. </p><p>The Board notes that the Secretariat is responsible for monitoring and reporting on the progress made in following up on findings and recommendations of OIG reports to the Finance and Audit Committee (FAC). The OIG, in turn, separately provides assurance on the progress made to the FAC. The Board requests that these reports are provided to the Board at its 21^st meeting and that the Secretariat also provides a report to the Board describing the process that is followed to address the findings and recommendations of the OIG reports, including (i) a description of the protocols on coordination between the OIG and the Secretariat and (ii) considerations on the roles of implementers, partners, CCMs and LFAs. </p>

The Board notes that the approach adopted by the OIG to develop its annual audit plan is an important strategic matter that reflects the Global Fund's risk management policy. The Board approves the approach for setting the annual OIG audit plan as described in Annex C of the OIG Progress Report (GF/B20/14).

The Board approves the amendments to the Charter and Terms of Reference of the Office of the Inspector General and the Policy for Disclosure of Reports Issued by the Inspector General as set out in the Annexes 2 and 3 of the Report of the Finance and Audit Committee to the Board (GF/B20/6).

<p>The Board refers to its earlier decisions regarding the Affordable Medicine Facility - malaria ("AMFm") and clarifies its intent that the Global Fund will only expand from Phase 1 (the pilot phase) of AMFm to a global scale-up on the basis of evidence gathered during the pilot phase that the initiative is likely to achieve its four stated objectives: (i) increased ACT affordability, (ii) increased ACT availability, (iii) increased ACT use, including among vulnerable groups, and (iv) "crowding out" oral artemisinin monotherapies, chloroquine and sulfadoxine-pyrimethamine by gaining market share. The Board further clarifies that it will consider evidence that the AMFm will achieve these four objectives more cost-effectively than other financing models that aim to achieve similar objectives solely or principally through the expansion of public sector services (i.e., public health facilities and community health workers only).</p> <p>The Board requests the AMFm Ad Hoc Committee to review the findings of the independent evaluation of AMFm Phase 1 against the four objectives and to make a recommendation to the Board at its first meeting in 2012 on whether to expand, accelerate, modify, terminate or suspend the AMFm business line in countries participating in the pilot. The Board notes that, in addition, it may decide to extend the pilot phase beyond its first meeting in 2012, if necessary. Any such extension would be subject to available funding and the Board reiterates that AMFm Phase 1 is currently funded as a 24-month program and countries should plan accordingly.</p> <p>The Board decides that, in addition to the AMFm 'identifier', all AMFm co-paid ACTs should bear a logo that is universal for all countries participating in AMFm. During implementation of AMFm Phase 1, based on lessons learned and discussions with participating countries and with due regard to the independent evaluation, other donors should be encouraged and permitted to use the logo on ACTs procured directly by such donors, provided that such ACTs meet the Global Fund's quality assurance policy. The Board requests RBM to work with participating countries, donors and all partners to coordinate the progress towards a universal logo for all quality-assured ACTs.</p> <p>The Board approves the revised AMFm Phase 1 Policy attached as Annex 1 to the Report of the AMFm Ad Hoc Committee to the Board (GF/B20/7).</p>

<p>The Board approves those AMFm Phase 1 applications recommended for approval by the Technical Review Panel (TRP) as 'Category 1' and 'Category 2', as listed in Annex 1 to the Report of the Technical Review Panel and Secretariat on AMFm Applications (GF/B20/10), subject to paragraphs 2-3 below. The Board's approval is for re-programmed and new grant funding (as the case may be) for a full two<b>-</b>year period for each AMFm Phase 1 application and is not subject to prioritization.</p><p>The applicants whose applications are recommended for approval as 'Category 2' shall:</p><p>a. provide an initial detailed written response to the requested TRP clarifications and adjustments by not later than four weeks after receipt of notification in writing by the Secretariat of the Board's funding decision; and</p><p>b. conclude the TRP clarifications process, as indicated by the written approval of the Chair and Vice Chair of the TRP, not later than 31 January 2010.</p><p>For those applications recommended for approval as 'Category 2', if the TRP clarification process is not concluded to the satisfaction of the TRP by the deadline stipulated in paragraph b above, the AMFm application in its entirety will be deemed not approved.</p><p>The Board declines to approve for funding those applications recommended by the TRP as 'Category 3' as indicated in Annex 1 in GF/B20/10. </p>

<p>The Board:</p> <p>i. acknowledges its previous decisions (GF/B15/DP17 and GF/B18/DP20) concerning the need for and value of a National Strategy Applications ("NSAs") procedure; and</p> <p>ii. recognizes the ongoing learning process with partners from the launch of the First Learning Wave of NSAs ("FLW").</p> <p>Therefore, the Board requests the Secretariat to prepare appropriate in-depth analyses and recommendations, taking into account:</p> <p>i. the feedback from the Technical Review Panel and other relevant partners on the FLW; and</p> <p>ii. the new architecture approved at this Board meeting;</p> <p>for further investment on the basis of NSAs; and present it to the Policy and Strategy Committee for further consideration at its next meeting.</p>

The Board approves "The Global Fund Partnership Strategy" (GF/B20/4 - Attachment 2) and requests the Secretariat to report on progress of implementation of the strategy to the Policy and Strategy Committee at its next meeting.

<p>The Board stresses the need to ensure that Global Fund governance processes reflect the multi-lingual nature of both the organization and of its Board constituencies. To ensure these processes remain open and transparent to all constituencies it decides to adopt the measures outlined in GF/B20/4 Attachment 4, in an incremental manner, limited initially to two languages in addition to English.</p><p>The Board wishes to emphasize that in implementing this decision a pragmatic approach should be taken, with the provision of any increased interpretation and translation at the Board and committee level being based on a proactive needs assessment of Board and committee members, carried out by the respective Chair and Vice-Chair, prior to committee / Board meetings. </p>

<p>The Board recognizes that:</p><p>i. the Round 3 Russian Federation HIV/AIDS grant to Open Health Institute entitled "Stimulating an Effective National Response to HIV/AIDS in the Russian Federation" (RUS-304-G01-H) (the "OHI Grant") expired on 31 August 2009;</p><p>ii. in addition to provision of treatment services, the OHI Grant has provided support for lifesaving prevention services for populations in the Russian Federation that are vulnerable to HIV/AIDS through the work of non-governmental organizations;</p><p>iii. under the current income eligibility policies of the Global Fund, the Russian Federation is not eligible for funding for HIV/AIDS funding; </p><p>iv. the income eligibility policies of the Global Fund will be reviewed by the Portfolio and Implementation Committee in 2010 for approval by the Board at its second meeting in 2010; and</p><p>v. the Russian Federation has contributed USD$ 225,852,403 to the Global Fund, and has supported other programs for HIV in Russia.</p><p>The Board recognizes the role of the Russian government leadership in developing efficient national policies and providing a long term, sustainable response to HIV, and calls on the Russian Federation to expand investment in these life-saving, evidence-based services to vulnerable populations.</p><p>In recognition of the emergency situation of the lifesaving prevention activities supported by the OHI Grant being discontinued, the Board approves:</p><p>a. an extension, on an extraordinary basis, to 31 December 2011 of the term of the OHI Grant (the "Extension Term"); and</p><p>b. continued emergency funding for lifesaving prevention services in an amount of up to USD$ 24 million for the Extension Term, in order to continue the same activities as currently being implemented under OHI Grant. </p><p>The Board requests that the Secretariat continues discussions with the government of the Russian Federation on the HIV epidemic in Russian and their role as a donor to the Global Fund. </p>

<p>The Board:</p><p>a. recognizes the continued need for countries to maintain and scale-up their national programs to fight HIV/AIDS, tuberculosis and malaria; and</p><p>b. recognizes the need to improve the effectiveness, simplicity, efficiency, alignment and harmonization and other fundamental aspects of the Global Fund's operating model.</p><p>Therefore the Board requests the Chair and Vice Chair to convene a retreat of the Board in January or early February of 2010 to discuss and determine priority areas for further changes in its operating model and strategic architecture, address key issues such as prioritization for funding amongst proposals; leading to decisions at its next Board meeting and a broader reform agenda timeline, as well as informing substantially the structure of Round 10.</p><p>The Secretariat will call for proposals to launch Round 10 on or about 1 May 2010, with a submission due date of 1 August 2010; and confirmation of this launch will be made at the Board's first meeting in 2010 based primarily on progress on incorporating the new strategic architecture.</p><p>The Board requests the Secretariat and Technical Review Panel (TRP) to review the Round 10 proposals in time for approval at a meeting of the Board (either regular or special) between November 2010 and January 2011, as determined by the Chair and Vice Chair. It would be preferable if the TRP review was completed before the second Replenishment meeting, scheduled for October 2010.</p>

<p>The Board refers to its decision made at the Eighteenth Board Meeting on the Global Fund Architecture (GF/B18/DP19) and recognizes that:</p> <p>i. the Global Fund was established to provide significant additional financing to fight AIDS, tuberculosis and malaria; </p> <p>ii. over time, with the increase in its funding to countries and the resulting multiplicity of funding streams from the Global Fund to Principal Recipients ("PRs"), the funding architecture has become complex; </p> <p>iii. the funding architecture of the Global Fund requires simplification; and</p> <p>iv. the Board has already endorsed the Single Stream of Funding per PR per disease as the foundation for a new funding architecture.</p> <p>Therefore, in order to simplify Global Fund support to current and future implementers of national disease-fighting and health systems strengthening programs, the Board decides as follows:</p> <p>1. The Secretariat shall, at the appropriate time as determined by the Secretariat in collaboration with CCMs:</p> <p>a. consolidate approved grants to one PR supporting a program to fight one of HIV/AIDS, tuberculosis or malaria (which may include any health systems strengthening elements) into one grant agreement (a "Single Stream Agreement") with an initial commitment period of up to three years, by, as appropriate, combining budgets, workplans and targets; and</p> <p>b. align the financial commitment periods for each of the Grant Agreements with different PRs for a particular disease in a country by adjusting the durations and commitment amounts (in accordance with paragraph 2 below).</p> <p>2. In order to facilitate the activities described in paragraph 1 above, the Board delegates to the Secretariat the authority to:</p> <p>a. make reasonable adjustments to: </p> <p>i. the duration of the funding commitment period for the resulting Single Stream Agreement (including both extensions and truncations); </p> <p>ii. the implementation activities contained in the proposals; and </p> <p>iii. the time periods for reaching performance targets contained in proposals; and,</p> <p>b. commit additional funding to the Single Stream Agreement the equivalent of 12 months of grant funds requested in an approved proposal (including a National Strategy Application ("NSA")), but as yet uncommitted (from Phase 2 Renewals or RCC II Renewals) which shall be committed by the Secretariat in accordance with paragraph 3c of the Comprehensive Funding Policy, as presented in Annex 5 Version 2 to GF/B20/12 Report of the Working Group on Managing the Tension Between Demand and Supply in a Resource-Constrained Environment.</p> <p>3. Consolidation of existing grants and alignment of commitment periods of all grants that support a disease program will enable the Secretariat to make recommendations for additional financial commitments under the Periodic Reviews and Commitments Policy attached as Annex 2a Version 2 to GF/B20/4 "Report of the Policy and Strategy Committee", which will be operational not earlier than 1 January 2011. The Board requests the Secretariat to conduct further work on a mechanism to allow for additional funding on the basis of demonstrated strong performance at the time of the requests for and approval of Additional Commitments under the Periodic Reviews and Commitments Policy. In undertaking this work, the Secretariat shall analyze and further describe its feasibility, financial implications and mechanics, and present it to the Policy and Strategy Committee and its next meeting, for its consideration and recommendation to the Board.</p> <p>4. The issue of the Round 10 call for proposals provides an early opportunity for countries to begin transition to the new architecture. To this end, transition to single streams of funding per PR per disease will be possible on a voluntary basis. To facilitate this, the Board delegates authority to the Secretariat to make adjustments to the Round 10 proposal form and guidelines.</p> <p>5. Commencing with Round 11:</p> <p>a. all proposals submitted to the Global Fund shall require the applicant to present a consolidated request for funding incorporating current Global Fund support to the country for the disease, including health systems strengthening support. The consolidated proposal shall identify previously committed and approved funds included within the consolidated request; </p> <p>b. following the approval of a new proposal by the Board, any incremental grant funds for an existing PR shall be included in the PR's existing Single Stream Agreement for that disease, rather than resulting in a new separate Grant Agreement; and</p> <p>c. the Secretariat shall present to the Board for approval, with respect to the proposals recommended for funding by the Technical Review Panel, the amount of the additional financial commitment covering the time remaining in the single stream's then-current commitment period. The revised Comprehensive Funding Policy, as presented in Annex 5 Version 2 to GF/B20/12 "Report of the Working Group on Managing the Tension between Demand and Supply in a Resource-Constrained Environment" shall be applicable to such approvals. All continuing financial commitments to a country's disease-fighting program shall be made in compliance with the Periodic Reviews and Commitments Policy attached as Annex 2a Version 2 to GF/B20/4 "Report of the Policy and Strategy Committee".</p> <p>6. The Rolling Continuation Channel (RCC) procedure for grant application will be discontinued immediately. The Board requests the Secretariat to continue to process all RCC proposals that will be submitted in accordance with existing RCC policies contained in GF/B14/DP9 (Establishment of a Rolling Continuation Channel): GF/B14/DP10 (Technical Reviews for the Rolling Continuation Channel); GF/B15/DP18 (Duration of Grants Eligible for the Rolling Continuation Channel); GF/B15/DP 19 (Board Decision-Making Procedure for the Rolling Continuation Channel); and GF/B16/DP7 (Revision of the Rolling Continuation Channel for Strongly-performing Grants).</p> <p>7. During the period in which the grant portfolio is transitioning to single streams of funding using the methods described in paragraph 1, all funding commitments for grants under the RCC and the Rounds-based Channel (Phase 2 Renewals, RCC proposals and RCC Renewals) and NSA grants, other than incremental requests for funding included in new proposals, shall be considered as "Additional Commitments" in paragraph 9 of the Comprehensive Funding Policy.</p> <p>8. As soon as all of the grants for a particular disease in a country have the characteristics described in paragraph 1 above, the extensions to grant terms available under the Phase 2 Decision-Making Policies and Procedures (GF/B14/8, Annex 3b revision 2, as amended by GF/B15/DP48) and Decision GF/B14/DP27 will no longer be available for the grants for that disease in that country and paragraph 17 of the Periodic Reviews and Commitments Policy attached as Annex 2a Version 2 to GF/B20/4 "Report of the Policy and Strategy Committee", will apply.</p> <p>9. In order to facilitate the implementation of this decision, if a CCM elects to consolidate an approved Round 8, Round 9, Round 10 and/or NSA grant with other existing grants for the same PR:</p> <p>a. as an exception to point 2 of the decision made at the 8^th Board meeting entitled "Timeframes for Grant Agreements", a Single Stream Agreement must be signed not later than 18 months after Board approval of the funding of the proposal, failing which the Board's approval is no longer valid; and</p> <p>b. as an exception to Decision GF/B19/DP19 entitled "Flexibilities to Set Grant Start Dates", the Secretariat may set the start date for the commitment in the Single Stream Grant Agreement up to 24 months after Board approval.</p> <p>The Board notes that the exceptions in paragraph a and b shall only be available if requested by a CCM in order to give CCMs and PRs the time necessary to consolidate grants and set start dates for alignment purposes.</p> <p>10. The Board recognizes that the new grant architecture has the potential to further empower CCMs in their essential roles of developing programs and funding requests, selecting Principal Recipients, and in overseeing implementation of programs funded by the Global Fund. The Board reaffirms the importance of the minimum eligibility criteria contained in the "Guidelines and Requirements for Country Coordinating Mechanisms." The Board further recognizes that the Portfolio and Implementation Committee (PIC) is currently overseeing a number of CCM strengthening initiatives being implemented by the Secretariat and will undertake a comprehensive revision of the "Guidelines and Requirements for Country Coordinating Mechanisms," taking into account the architecture changes, in time for the second Board meeting in 2010.</p> <p>11. The Board requests the Secretariat to revise the Terms of Reference of the Technical Review Panel, for approval by the Board, prior to the launching of Round 11 in order to give effect to this decision.</p> <p>12. This decision revokes and replaces the Board's previous decisions on Rollout of Grant Consolidation (GF/B16/DP9).</p>

<p>The Board emphasizes the urgency of providing more room for youth leadership and involvement in the response to HIV/AIDS, tuberculosis and malaria. The Board recognizes the diversity and special needs of young people and stresses the importance of protecting young people's health and human rights, especially for the 5.4 million young people who are living with HIV and the millions who are at risk, in particular young women and girls; but also those who are marginalized, including but not limited to young sex workers and people who use drugs; lesbian, gay, bisexual and transgender youth; and young migrants. </p><p>The Board asks constituencies and the Secretariat to consider how they can better include young people, facilitate youth-led action at global and national level and ensure that their ideas and perspectives are better reflected in the work of the Global Fund and the Board and report back to the Board within 2 years.</p>

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard.</p><p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p><p>See attached tabledetailing total recommended funding amount of US$ 42,907,127 for the following grants: ZAR-506-G04-T ; ZAR-607-G05-T ; ERT-607-G05-M ; RWN-607-G08-H ; SYR-607-G01-T</p>

<p>The Board approves additional funding for two years for the Continuity of Services for the proposal listed in Schedule B and described in Annex 1, with the clear understanding that the amount approved is an upper ceiling rather than a final funding amount, and based on the understanding that the Secretariat shall pursue implementation arrangements for such proposal consistent with the recommendation set forth in Annex 1.</p> <p>See attached tabledetailing total recommended funding amount of 413,096 US$ for the following grant: HTI-304-G04-T</p>

<p>The Board approves additional funding for the Phase 2 period of the Round 6 Mozambique Malaria grant (MOZ-607-G06-M) as a Conditional Go in the amount of up to US$ 7,762,108, subject to TRP clarifications and conditions within a limited timeframe, and also subject to possible additional conditions to be cleared by the Secretariat.</p><p>The Board reaffirms that the maximum funding amount for Phase 2 of this grant shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p>

<p>The Board recognizes the importance of States granting to the Global Fund such privileges and immunities as necessary for the effective exercise of its functions and efficient use of its resources. The Board recommends that States consider granting privileges and immunities to the Global Fund by:</p><ul><li>applying domestic legislation that specifically confers on the Global Fund status, capacities, privileges and immunities equivalent to those enjoyed by <span style="font-size: 12px; line-height: 1.5;">international organizations within their respective legal systems, and/or<br/><br/></span></li><li>adhering to the Agreement on Privileges and Immunities of the Global Fund to Fight AIDS, Tuberculosis, and Malaria set out in Attachment 1 - Revision 1 of the Policy and Strategy Committee’s Report to the Board (GF/B20/4), <span style="font-size: 12px; line-height: 1.5;">pursuant to Article 8 of that Agreement;</span></li></ul><p>and requests the Secretariat to report back to the Board periodically on what measures states have taken in response to this decision.</p>

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard.</p><p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p><p>See attached tabledetailing total recommended funding amount of US$ 100, 337, 574 for the following grants: BUL-607-G02-T ; CUB-607-G02-H ; GEO-607-G06-H ; MOL-607-G03-H ; PKS-607-G06-T ; PKS-607-607-T ; PHL-607-G07-M ; TGO-607-G06-M ; TGO-607-G07-T ; VTN-607-G04-H ; VTN-607-G05-T</p>

<p>The Board approves additional funding for two years for the Continuity of Services for the proposal listed in Schedule B and described in Annex 1, with the clear understanding that the amount approved is an upper ceiling rather than a final funding amount, and based on the understanding that the Secretariat shall pursue implementation arrangements for such proposal consistent with the recommendation set forth in Annex 1.</p><p>See attached tabledetailing total recommended funding amount of 12, 492,000 Euros = US$ 18,830,441 for the following grant: CMR-304-G01-H</p>

<p>The Board approves additional funding for the Phase 2 period of the Round 6 Mozambique HIV grant (MOZ-607-G05-H) as a Go in the amount of up to US$ 47,292,469, subject to TRP clarifications and conditions within a limited timeframe, and <span style="font-size: 12px; line-height: 1.5;">also subject to possible additional conditions to be cleared by the Secretariat.</span></p><p>The Board reaffirms that the maximum funding amount for Phase 2 of this grant shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p>

<p>The Board approves the appointment of the following persons as Chairs of the following Committees:</p><ul><li>Dr. Suwit Wibulpolprasert for the Policy and Strategy Committee;</li><li>Mr. Peter van Rooijen for the Finance and Audit Committee;</li><li>Ms. Michele Moloney-Kitts for the Portfolio and Implementation Committee;</li><li>Dr. Bobby John for the Ethics Committee; and</li><li>Dr. Lesley Ramsammy for the Affordable Medicines Facility for Malaria (AMFm) Ad Hoc Committee.</li></ul><p>The Chair of each Committee is appointed for the period from the date of this decision until the adjournment of the first Board meeting of 2011.</p>

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard. Approval is also subject to paragraph 3.c. of the revised Comprehensive Funding Policy (GF/B20/DP9).⁴</p> <p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p> <p>See attached tabledetailing total recommended funding amount of US$ 56,401,349 for the following grants: CAM-607-G10-M ; MAW-607-G01-H ; HL-607-G08-H ; SLE-607-G04-H</p>

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard. Approval is also subject to paragraph 3.c. of the revised Comprehensive Funding Policy <span>(GF/B20/DP9).</span>⁵</p> <p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p> <p>See attached tabledetailing total recommended funding amount of US$ 53,026,371 for the following grants: BTN-607-G03-H ; BTN-607-G04-T ; IND-607-G06-M ; ZIM-509-G10-H ; ZIM-509-G08-T</p>

<p>The Board approves additional funding for the Continuity of Services for the proposals listed in Schedule B and described in Annex 1, with the clear understanding that the amount approved is an upper ceiling rather than a final funding amount, and based on the understanding that the Secretariat shall pursue implementation arrangements for such proposal consistent with the recommendation set forth in Annex 1.</p><p>See attached tabledetailing total recommended funding amount⁶ of US$ 1,579,508 for the following grants: BOL-307-G07-H ; COM-304-G02-H ; SUR-305-G01-H</p>

<ol><li>The Board approves the following Round 9 proposals recommended for funding by the Independent Appeal Panel in its report dated 8 February 2010, subject to paragraph 2 below: <ol><li type="i">Pakistan (HIV disease component only) – USD 11,856,124; and</li><li type="i">Ukraine (Tuberculosis) – USD 34,584,205.</li></ol></li><li>These Appeal Panel-recommended Round 9 proposals are approved for funding by the Board as ‘Category 2’ proposals, for an initial two years, under the terms of the Comprehensive Funding Policy and subject to the following: <ol><li type="a">Satisfactory completion by the applicants of the Technical Review Panel <span style="font-size: 12px; line-height: 1.5;">(TRP) clarifications as set out in paragraph 3 below;</span></li><li type="a">the measures associated with funding of Round 9 proposals and national <span style="font-size: 12px; line-height: 1.5;">strategy applications set out in Decision GF/B20/DP9; and</span></li><li type="a">The clear understanding that the amounts indicated are upper ceilings <span style="font-size: 12px; line-height: 1.5;">subject to adjustment through TRP clarifications and grant negotiations, </span><span style="font-size: 12px; line-height: 1.5;">rather than final approved Phase 1 grant amounts.</span></li></ol></li><li>The applicants for the proposals referred to in paragraph 1 above shall: <ol><li type="a">provide an initial detailed written response to the clarifications and adjustments requested by the Independent Appeal Panel not later than six weeks after the receipt of either: <ol><li type="i">notification in writing by the Secretariat to the applicant of this Board <span style="font-size: 12px; line-height: 1.5;">decision; or</span></li><li type="i">the findings of the independent budget review (in the case where the Independent Appeal Panel has requested an independent budget review as part of the clarifications process); and</li></ol></li><li type="a">complete any further clarifications or adjustments, as required by the Chair or <span style="font-size: 12px; line-height: 1.5;">Vice-Chair of the TRP, not later than three months from the Secretariat’s receipt </span><span style="font-size: 12px; line-height: 1.5;">of the applicant’s initial detailed response to the issues raised for clarifications or </span><span style="font-size: 12px; line-height: 1.5;">adjustments (if applicable).</span></li></ol></li><li>The Board notes the Independent Appeal Panel’s request to have additional Financial analysis support as part of the clarifications process and requests the Secretariat to make the necessary arrangements.</li></ol>

<p>The Board refers to its Decision GF/B20/DP11 regarding approval of Round 9 proposals and approves for funding for an initial two years those Round 9 proposals recommended for funding by the Technical Review Panel (TRP) and identified as ‘Category 2B’ proposals and as listed in the following table. Such approval is subject to the Comprehensive Funding Policy, satisfactory completion by the applicants of the Technical Review Panel (TRP) clarifications as set out in paragraph 5 of Decision GF/B20/DP11 and the measures associated with funding of Round 9 proposals and national strategy applications set out in Decision GF/B20/DP9.</p> <p>See attached tabledetailing total TRP recommended Phase 1 Upper Ceiling (2 years) funding amount of US$ 719,921,434 for the Category 2B grants.</p>

The Board approves the membership of the Board Committees as set out in Annex 1 (Revision 1) attached to this decision. The members of each Committee are appointed for the period from the date of this decision until the adjournment of the first Board meeting of 2011.

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard. Approval is also subject to paragraph 3.c. of the revised Comprehensive Funding Policy <span>(GF/B20/DP9).</span>⁷</p> <p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p> <p>See attached tabledetailing total recommended funding amount⁸ of US$ 56,930,178 for the following grants: CIV-607-G07-T ; ETH-607-G06-T ; EGY-608-G03-H ; GNB-607-G04-M ; MKD-708-G03-H ; SRL-607-G09-H ; SRL-607-G07-T ; ZIM-509-G09-M</p>

<ol><li>The Board approves, subject to paragraph 2 below, the Rolling Continuation Channel proposals recommended for funding by the Technical Review Panel (TRP) as ‘Category 2’ which are listed in Annex 1 to the Report of the TRP and the Secretariat on Funding Recommendation for Wave 8 Rolling Continuation Channel Proposals (the “Wave 8 RCC Report”). The Board approves funding for up to three years for each proposal (indicated as “Total 3 Years” in Annex 1 to the Wave 8 RCC Report). The Board’s approval is made with the clear understanding that the grant amounts requested are upper ceilings subject to TRP clarifications and grant negotiations rather than final approved grant amounts. For <br/>further clarity, this decision is subject to the revised Comprehensive Funding Policy approved at the Twentieth Board meeting.</li><li>The applicants whose proposals are recommended for funding as ‘Category 2’ shall: <ol><li type="i">provide an initial detailed written response to the requested TRP clarifications and adjustments by no later than four weeks after notification in writing by the Secretariat to the applicant of the Board’s decision; and</li><li type="i">conclude the TRP clarifications process, as indicated by the written approval of the Chair and Vice Chair of the TRP, not later than two months from the Secretariat’s receipt of the applicant’s initial detailed response to the issues raised for clarification and/or adjustment.</li></ol></li><li>The Board declines to approve for funding those proposals categorized by the TRP as ‘Category 3A’ as indicated in Annex 1 to the Wave 8 RCC Report, however such applicants are strongly encouraged to resubmit a revised proposal, taking into account the issues raised by the TRP, for consideration in the final resubmission wave of Rolling Continuation <span style="font-size: 12px; line-height: 1.5;">Channel review.</span></li><li>The Board declines to approve for funding proposals categorized by the TRP as ‘Category 3B’ as indicated in Annex 1 to the Wave 8 RCC Report, however such applicants are encouraged to resubmit the proposal through the Rounds-Based Channel following major revision.</li></ol>

<p>The Board approves additional funding for the Phase 2 period for the proposals listed in Schedule A in the amounts indicated for each proposal, with the clear understanding that the amounts approved are upper ceilings rather than final funding amounts, and based on an understanding that the Secretariat shall pursue ongoing implementation arrangements for each proposal consistent with the recommendations set forth in its Grant Scorecard. Approval is also subject to paragraph 3.c. of the revised Comprehensive Funding Policy (GF/B20/DP9).</p> <p>The Board reaffirms that the maximum funding amount for Phase 2 of each proposal shall be the sum of the amount approved by this decision and the amount of any funds approved for Phase 1 which have not been disbursed by the Global Fund at the end of the Phase 1 period.</p> <p>See attached tabledetailing total recommended funding amount⁹ of US$ 55,170,462 for the following grants: BUR-708-G07-M ; SAF-607-G06-H ; TNZ-607-G09-T ; ZAN-607-G05-H</p>

The Board acknowledges that the special condition upon which the Board approved the Togo Round 4 Malaria grant to the United Nations Development Programme (UNDP) of the delivery at the end of year 3 of a detailed assessment of program progress and performance was fulfilled later than anticipated in the grant agreement. Although the revised timeline for the program assessment has delayed confirmation that the condition has been fulfilled, in recognition of the subsequent improved program performance of the grant the Board decides to retrospectively approve continued funding for years 4 and 5 of the Togo Round 4 Malaria grant (TGO-405-G05-M).

The Board acknowledges that the special condition upon which the Board approved continued funding to the Zambia Round 4 HIV grant to the Ministry of Finance and National Planning of the Government of Zambia required the Principal Recipient to utilize at least fifty per cent (50%) of the funds disbursed from the Global Fund during Year 3 of the Program Term and that an overall rating of B1 or above would be achieved during Year 3 of the Program Term. In recognition that the special condition was not met, the Board decides to discontinue funding for years 4 and 5 of the Zambia Round 4 HIV grant (ZAM-405-G12-H).