Board Decisions

GF/B16/DP10

Approved by the Board on: 13 November 2007

Strategic Approach to Health Systems Strengthening

The Board refers to the principles set forth in its decision GF/B15/DP6 and reaffirms that the Global Fund should continue to support the strengthening of public, private and community health systems by investing in activities that help health systems overcome constraints to the achievement of improved outcomes in reducing the burden of HIV/AIDS, tuberculosis and malaria ("ATM").

The Board decides that the Global Fund shall provide funding for health systems strengthening ("HSS") actions within the overall framework of funding technically sound proposals focused on the three diseases and that such funding shall be based on the following principles:

1. The Global Fund shall allow broad flexibility regarding HSS actions eligible for funding, such that they can contribute to system-wide effects and other programs can benefit. With this principle in mind, the Global Fund shall develop guidance with few prescriptions for applications for HSS funding, which may take the form of the following:
   1. the specification of categories of HSS actions that the Global Fund recommends applicants consider when developing applications for funding;
   2. the specification of principles to guide applicants in deciding which categories of HSS actions to apply for; and
   3. the specification of any category of HSS actions that may not be financed by the Global Fund.
2. The Global Fund shall encourage applicants, wherever possible, to integrate requests for funding for HSS actions within the relevant disease component(s). Such HSS actions will be assessed by the Technical Review Panel ("TRP") as part of its review of that disease component.
3. Recognizing that some HSS actions ("cross-cutting HSS actions") may significantly benefit more than one disease, the Global Fund shall allow applicants to request funding for such HSS actions by completing a distinct but complementary section (a "cross-cutting HSS section") within a disease component, provided that:
   1. An application shall not contain more than one cross-cutting HSS section.
   2. Where cross-cutting HSS actions are proposed, the applicant shall articulate how they address identified health systems constraints to the achievement of improved ATM outcomes.
4. In reviewing a disease component which contains a cross-cutting HSS section, the TRP may recommend for funding either:
   1. The entire disease component, including the cross-cutting HSS section;
   2. The disease component excluding the cross-cutting HSS section; or
   3. Only the cross-cutting HSS section if the interventions in that section materially contribute to overcoming health systems constraints to improved ATM outcomes.
5. The Global Fund shall also:
   1. Recommend that proposals containing material HSS actions be based on the results of a recent assessment (the coverage of which need not be limited to ATM) identifying health systems constraints to the achievement of improved outcomes in reducing the burden of HIV/AIDS, tuberculosis and malaria; and
   2. Recommend that applications provide evidence of the involvement of relevant HSS stakeholders in the Country Coordinating Mechanism - including at least one non-government in-country representative with a focus on HSS and one government representative with responsibility for HSS planning.

The Board requests the Portfolio Committee to modify future application forms and guidelines (including for the Rolling Continuation Channel), effective from 1 March 2008, to incorporate the above principles and propose for approval at the Seventeenth Board Meeting any modifications to the Terms of Reference of the TRP (including with respect to the composition of the TRP) that are required in light of the strategic approach reflected in this decision point

The Board requests the Secretariat to provide to the TRP information on the principles that are set forth in this decision. The Board also requests the Secretariat to communicate clearly, working closely with relevant partners, to country stakeholders the Global Fund's amended strategic approach to HSS - including the flexibilities inherent within it.

The Board requests the Secretariat and the TRP to review the results of the Round 8 proposals with regard to HSS actions, and to report to the Eighteenth Board Meeting on the impact of this decision on the application and review process. The report should discuss the quality of proposals that include HSS actions, the proportion recommended by the TRP for approval, and the extent to which applicants have articulated how cross-cutting HSS actions address identified health systems constraints to the achievement of improved ATM outcomes.

Budgetary Implications

The budgetary implications of this decision point in 2008 amount to US$ 235,000.