Board Decisions

GF/B44/EDP18

Approved by the Board on: 30 March 2021

Second Extension of C19RM Timeline and Operational Flexibility for COVID-19

The Board acknowledges its previous decision establishing the Global Fund COVID-19 Response Mechanism (C19RM) and agrees that the COVID-19 pandemic continues to have a devastating impact on global health systems, jeopardizing the fight against HIV, tuberculosis, and malaria and progress towards 2030 goals for the three diseases. Recognizing the acute needs at country-level, and the threat of diversion of resources towards COVID-19, the Board agrees that additional funding to support country responses to COVID-19 is necessary to safeguard the USD 14 billion raised through the 6th replenishment for HIV, tuberculosis, and malaria (HTM) programs. The Board further acknowledges that certain public donors wish to make significant additional pledges to the Global Fund to provide further support for country responses to COVID-19 and that this decision does not preclude further discussion and Board decisions within the Strategy development process on the future role and scope of Global Fund support for pandemic preparedness and response.

The Board agrees that C19RM should leverage existing Global Fund processes, controls, and frameworks, while acknowledging that modifications may be necessary to ensure the level of speed and agility necessary for an emergency response. The Board further agrees on the need for greater transparency on the operationalization and implementation of C19RM, to facilitate and ensure an appropriate degree of oversight from, and accountability to, the Board.

The Board therefore approves the following:

1. Timelines:

1. C19RM is a temporary, timebound mechanism established to address the current global emergency related to the COVID-19 pandemic;
2. The Secretariat will, through 31 December 2021, continue to mobilize additional funds from public donors and, pursuant to existing policies, private donors, which will be used to support C19RM;
3. C19RM funds may be awarded through 31 March 2022;
4. C19RM will continue to finance interventions across the 5th and 6th replenishment periods; and
5. While C19RM funding is expected to be used rapidly for emergency needs, the final deadline for use of C19RM funds will be 31 December 2023, to reduce the additional cost and burden associated with establishing and monitoring an independent deadline within core grants.

2. Use of funding:

1. C19RM funding will finance interventions consistent with applicable World Health Organization (WHO) guidance, including on COVID-19;
2. C19RM funding must be aligned with national Strategic Preparedness and Response Plans;
3. C19RM funding may be used for the following types of interventions:
   1. COVID-19 control and containment interventions, including personal protective equipment, diagnostics, treatment, communications and other public measures as specified in WHO guidance;
   2. COVID-19-related risk mitigation measures for programs to fight HTM (including, but not limited to, support for COVID-19 interventions needed to safely implement campaigns, community and health facility level HTM programs, and additional delivery and procurement costs for HTM programs where related to addressing COVID-19 disruptions); and
   3. iii. Expanded reinforcement of key aspects of health systems, such as laboratory networks, supply chains, and community-led response systems, to address advocacy, services, accountability, and human rights based approaches;
4. C19RM funds may be used to procure COVID-19 products approved under the WHO Emergency Use and Listing procedures or under other emergency procedures set up by any Stringent Regulatory Authorities as defined under the Quality Assurance Policy for Pharmaceutical Products and Quality Assurance Policy for Diagnostic Products; and
5. The Secretariat will develop detailed technical guidance on eligible C19RM interventions for countries, in consultation with relevant partners, as described in paragraphs 27.a and 44 of GF/B44/ER12 – Revision 2.

3. Allocations:

1. C19RM funding awards will use countries’ 2020-2022 allocations as a starting basis; and
2. C19RM funding awards will be qualitatively adjusted to better reflect countries’ COVID-19 needs using the following factors: (i) COVID-19 burden; (ii) level of disruption to systems of health, including HTM services; (iii) availability of other sources of funding; and (iv) utilization of funds already awarded.

4. Funding requests:

1. C19RM funding requests must be endorsed by Country Coordinating Mechanisms;
2. C19RM funding requests must be developed through appropriate, multisectoral consultation, and fully-inclusive decision-making, which must engage communities and civil society, and ensure coordination with the national COVID-19 response coordinator;
3. C19RM funding request development must include consideration of appropriate community, rights, and gender-related interventions, in alignment with the Global Fund’s underlying principles of gender equity and human rights, and funding requests must articulate national HTM program adaptation needs and how these needs will be covered (e.g. through C19RM funding, grant funding, or other sources); and
4. The Board calls on partners to support countries at the country, regional and global levels to develop robust, technically-sound C19RM funding requests.

5. C19RM Funding Request Review and Approval:

1. GAC:
   1. C19RM funding requests will be shared with partners on the Grant Approvals Committee (GAC) for review and input;
   2. C19RM funding requests will also be shared with a technical advisory group composed of relevant ACT-Accelerator partners with technical COVID-19 expertise (CTAG) for review and input;
   3. iii. The Secretariat will consider input from GAC partners and CTAG in determining C19RM funding awards or recommendations; and
   4. The Secretariat will convene regular GAC review of C19RM to discuss awards made, emerging thematic issues relating to C19RM and Global Fund programs, and concerns and observations from partners. CTAG partners will be invited to participate in these reviews.
2. TRP:
   1. The TRP will be requested to input into upfront technical guidance relating to HTM adaptations/risk mitigation as referenced in paragraph 2.e above; and
   2. The TRP will also be requested to conduct an expedited review of HTM program adaptation/risk mitigation elements of C19RM funding requests that entail material changes to existing Global Fund programs.
3. Fast-track investments: The Secretariat may award countries up to USD 900 million of C19RM funding on an accelerated basis to support urgent needs for COVID-19 commodities (including personal protective equipment, diagnostics, and therapeutics) and costs relating to the effective deployment of such commodities.
4. Board approval:
   1. The Board must approve any C19RM awards exceeding USD 35 million, as measured in aggregate by country and not including any funding awarded pursuant to paragraph 5.c above or previously awarded C19RM funding;
   2. Commodity orders relating to paragraph 5.d.i above may be placed pending Board approval; and
   3. iii. For C19RM awards approved by the Board, the Secretariat will have delegated authority to increase such awards by up to USD 10 million, in order to avoid the need for repeated Board approvals for increases to the same grants. This authority will be limited to increases that scale up interventions previously approved by the Board.

6. Reporting, Monitoring and Evaluation:

1. The Board emphasizes the need for comprehensive reporting, monitoring and evaluation of C19RM investments, while acknowledging the challenges of measuring results within an emergency response to a rapidly evolving pandemic. The Secretariat and TERG will further develop an evaluation approach for C19RM, as described in paragraphs 50 - 56 of GF/B44/ER12 – Revision 2. This approach will be presented to the Strategy Committee at its 16th meeting (July 2021) for review and input;
2. The Board emphasizes the need for enhanced transparency on C19RM. The Secretariat will provide monthly detailed reporting to the Board on C19RM operationalization, as described in paragraph 21 of GF/B44/ER12 - Revision 2. This reporting will also be available on the Global Fund’s external website to increase transparency of investments and support coordination of external support for COVID-19; and
3. The Secretariat will continue to provide updates through regular Board and Committee engagements.

7. Centrally Managed Investments

1. Up to 2.5% of C19RM funding may be used for centrally managed investments to address needs that are not well addressed through awards to individual countries, as described in paragraph 57 of GF/B44/ER12 – Revision 2; and
2. The Secretariat will develop any centrally managed investments under this provision in coordination with GAC and CTAG, and will report all such investments to the Board and its relevant Committees.

8. Management and Operating costs

1. Up to 3% of C19RM funds may be used by the Secretariat to cover additional management and operating costs relating to C19RM. These costs may include (i) additional Secretariat resources and expertise, (ii) additional assurance costs, (iii) additional costs relating to enhanced reporting and monitoring and evaluation of C19RM investments, and (iv) additional costs to support CCMs;
2. Management and operating costs under this provision are timebound, reflecting the temporary nature of C19RM, and will not form part of the Secretariat’s annual budget for operating expenditures;
3. The Audit and Finance Committee will review the Secretariat’s plan for costs under this provision; and
4. The Secretariat will provide regular reporting on any costs under this provision to the Audit and Finance Committee and the Board.

9. Additional changes:

1. The Board will monitor C19RM on an ongoing basis to determine whether any changes are required as the pandemic continues to evolve; and
2. The Secretariat will return to the Board, through its Committees, as relevant, for additional consideration and approval of any further modifications to C19RM.

10. Limited exceptions to Quality Assurance Policies:

1. The Secretariat may continue to grant limited exceptions to the Quality Assurance Policies to waive the requirement for pre-shipment sampling and testing (as originally approved under paragraph 3 of GF/B42/EDP10) through 31 March 2022.

Budgetary Implications

Incremental management and operating costs directly attributable to the proposed extension of C19RM will be covered from any additional funds made available for C19RM, pursuant to paragraph 8.a above. Such costs will not exceed 3% of any C19RM funding.