Global Fund New Funding Model – Mock TRP Workshop Johannesburg, South Africa 22 – 25 July 2014

Strengthening Health and Community Systems

Dr Martin Ekeke

Dr Rene Adzoodo

Dr Prosper Tumusiime

Presentation Outline

• Objectives, principles and approaches to HSS in ATM and RMNCH programs

• Lessons from TRP

OBJECTIVES, PRINCIPLES AND APPROACHES TO HSS IN ATM & RMNCH PROGRAMS

For the NFM to be successful ATM and RMNCH programs must be able to receive critical inputs from the health system

(1) SERVICE DELIVERY INFRASTRUCTURE

(2) HEALTH WORKFORCE

(3) MEDICAL PRODUCTS AND TECHNOLOGIES

(4) FINANCING

(5) INFORMATION Equity, more life years, better life experience, efficiency,…

(6) LEADERSHIP AND GOVERNANCE

DELIVERY OF SPECIFIC SERVICES

IN THE HEALTH SECTOR

GF objectives in HSS

–To address health system constraints that hinder the effective and efficient delivery of (HTM + MNCH) disease programs

–To ensure sustainability of the gains made by the three programs.

GF expectations for HSS

• Strengthen performance of priority health system components

• Foster synergies by promoting integrated approaches to planning and programming

• Improve health of mothers and children • Allow for the scale up of services and improve their

quality, equity, efficiency and sustainability • Support community and civil society actors to

enhance their engagement in health systems and disease programs

• Ensure that gender inequalities and human rights barriers to accessing services are addressed

Principles

• HSS investment must be aligned to national health sector strategy and relevant program strategies

• Justify how the proposed interventions contribute to achievement of proposed objectives with effectiveness , quality and sustainability in mind

• Put emphasis on key populations

• Justify the existence of a funding gap & show complementarity with other funding sources

What is Cross-cutting HSS?

The notion refers to cross-cutting interventions, which contribute to maximizing the impact of more than one of the HIV, TB and malaria programs and may also bring spill-over effects to health outcomes beyond the three diseases. Cross cutting HSS is that which • Contributes to strengthening performance of a priority

health system component, • Has a direct linkage to improving HIV, TB and/or malaria

outcomes, • Benefits more than one disease program (including HIV,

tuberculosis, malaria and beyond), and • Benefits the health outcomes of women and children.

Analysis Matrix for Cross-cutting Elements Why is

GFATM the

appropriate

funding

source?

What are the

priorities?

What should

be done first?

Which are the

gaps and

weaknesses

constraining the

ATM programs?

Gaps and priority constraints

linked to weakness of the

health system

Health System

Component

Others

R

M

N

C

H

M

A

L

T

U

B

HIV/

AID

S

Management of supplies

NHIS

Community

health

Service

delivery

Financing

Available approaches to request HSS support • Two options for HSS funding request:

– Include cross-cutting HSS into a disease funding request; or

– Develop a separate concept note for a stand-alone cross-cutting HSS grant using the HSS concept note template

• A country’s income level also defines the required focus of cross-cutting HSS requests:

– LMICs must focus 50% of HSS funding on addressing the needs of underserved populations. UMICs 100%. No restriction for LICs.

• Community systems strengthening (CSS) interventions are envisaged to be funded primarily through relevant disease grants

• The approximate allocation of HSS funding by country Bands in the Global Fund’s portfolio has been: 11% for Band 1, 8% for Bands 2 and 3, and 5% for Band 4.

Needs Assessment and Gap Analysis

Robust needs and gap analysis is critical to inform HSS concept note: • Through review of national strategy priorities, identify

program objectives that can be addressed by health system interventions

• Gaps and weaknesses in health system components relevant to program related objectives

• Mapping of domestic and donor funding for HSS to identify areas of complementarity for GF

• Review of current program investments & identification of HSS requirements, e.g. PSM

• Linkage of identified HSS priorities with MNCH outcomes

Steps in Developing Good Quality HSS Funding Request

Core Components of Community Systems

1. Enabling environments and advocacy –policy, legal, and governance environments, and for social determinants of health;

2. Community networks, linkages, partnerships and coordination – enabling coordinated, collaborative working relationships;

3. Resources and capacity building – strengthening technical, organizational and institutional capacities;

4. Community activities and service delivery – improving access to all who need them;

5. Organizational and leadership strengthening –management, accountability and leadership for organizations and community systems;

6. Monitoring and evaluation and planning –M&E systems, situation assessment, evidence-building and research, learning, planning and knowledge management.

HSS Modules

1. Scale-up availability, increase accessibility and improve quality of service delivery

2. Produce, distribute and retain skilled health workforce

3. Strengthen procurement & supply chain management system

4. Strengthen health information systems 5. Create enabling legal, policy and regulatory

environments 6. Ensure adequate financing 7. Protect and promote human rights

LESSONS FROM TRP

Lessons from TRP (1)

• HSS must be clearly presented as being auxiliary to, and flowing from, a national health strategy.

• HSS requests must demonstrate their benefit in addressing the three diseases

• Health sector reform leadership and governance issues were often inadequately addressed in proposals

• A good proportion of proposals sought significant salary support that was not based on salary structures within national human resource development strategies or other fiscal planning frameworks, with potential distortion.

Lessons from TRP (2)

• HSS proposals should be effectively aligned with other grants that countries had received from the Global Fund and with other sources of funding.

• The TRP values careful analysis of the health system, particularly as relevant to the proposal (evidence based).

• Need to justify how proposed strategies would succeed in achieving the set objectives.

• The TRP is sceptical of proposals that focus too heavily on activities that do not directly benefit patients or strengthen the health system, such as workshops, meetings, consultants, and research

THANK YOU