The Board recognizes that, in exceptional circumstances, there may be a need to provide funding for the continuation of treatment in grants where funding ends.
The Board wishes to revise its policy on continuity of services for treatment (as amended at the Twelfth and Thirteenth Board Meetings) to reflect the differing circumstances of grants that end because of suspension, force majeure situations, a decision not to provide Phase 2 funding, or other unforeseen causes ("unanticipated terminations") and grants which reach the end of their term ("anticipated expirations").
The Board accordingly revokes the Continuity of Services decision, as amended at the Thirteenth Board Meeting (GF/B14/2) and replaces it with this decision:
The Board adopts the following system for addressing continuity of services following both unanticipated termination and anticipated expiration of grants:
i. A recipient (typically a CCM) whose funding has ended may submit an Extraordinary Request for Continued Funding for Treatment.
ii. The Extraordinary Request will be limited to expenses directly related to the continuation of courses of treatment (including medicines [which, in the case of discontinuation of anti-retroviral therapy, includes drugs for HIV-related opportunistic infections], diagnostics, and, as appropriate, costs for medical staff and other personnel directly involved in care of the patients on treatment) for those people already placed on courses of treatment under the existing proposal at the time of the Extraordinary Request. "Courses of treatment" includes treatment that is for a limited duration (such as for tuberculosis), or is life-long (such as for antiretroviral therapy).
iii. The Extraordinary Request will be limited to the amount required to provide services directly related to the continuation of courses of treatment for up to two years (taking into account any amount which remains available under the existing grant).
iv. The Extraordinary Request shall contain a description of the steps taken to find sustainable sources of financing for the people on courses of treatment, and to ensure the recipients are delivering courses of treatment effectively. To be eligible for funding under this provision, the CCM (or, in the case of non-CCM proposals, the grant applicant) must demonstrate that it has used its best efforts to identify other sources of funding to provide continuity of services, but has been unsuccessful.
v. The Secretariat will review the Extraordinary Request, and provide a funding recommendation to the Board for its approval. The Secretariat will take into account performance issues, as appropriate, and shall make any adjustments to existing implementation arrangements necessary to ensure the effective use of Global Fund financing.
vi. Throughout the process, the Secretariat will encourage CCMs and PRs to actively engage with technical partners to identify mechanisms to ensure continuity of services.
vii. In a resource-constrained environment, the Global Fund shall prioritize Extraordinary Requests for Continued Funding for Treatment for anticipated expiration and Extraordinary Requests for Continued Funding for Treatment for unanticipated termination at the same level as Phase 2 renewals.
The following additional conditions shall apply in cases of anticipated expiration:
viii. CCMs that submit an Extraordinary Request must provide evidence of compliance with Global Fund counterpart financing requirements during the period for which they make the request.
ix. In addition to the merit of the request, the primary factor affecting the Secretariat's recommendation to the Board with respect to the amount and duration of funding for the continuity of treatment shall be the income level of the country of the applicant (as defined by the World Bank income classification of the applicant in the year of application of an Extraordinary Request); the Secretariat may also take into account other relevant considerations such as the size of the treatment program (in terms of cost or number of patients).