The Global Fund

New Funding Mechanism

Experience of Myanmar

Eva Nathanson

Regional Meeting of NTP Managers and Partners

Bangkok, Thailand, 23-27 September 2013

Presentation outline

TB situation in Myanmar

Governance and technical/

financial collaboration

History of the Global Fund in

Myanmar

From Round 9 to the New

Funding Mechanism

New Funding Mechanism

experiences

Funding for TB control

Conclusions and next steps

TB situation in Myanmar, 2011

0

100

200

300

400

500

600

Mortality Prevalence Incidence

Ra

te p

er

10

0,0

00

po

pu

lati

on

Myanmar WHO Southeast Asian Region Global

240,000 prevalent cases

180,000 incident cases

10% HIV co-infected

9,000 with MDR-TB

Context

During the last 10 years funding for TB control has

increased dramatically

The government spent 2% of its GDP on health in 2011

but commitments are increasing

Majority of funding comes from out-of-pocket payment by

households and external partners

Despite the increase in funding there are huge gaps to

reach universal access to TB services

Myanmar is among the lowest recipients of Official

Development Assistance in the world receiving a fraction

of what neighboring countries receive

Universal access to TB care is hampered by the weak

health system and infrastructure/communication

Governance

Myanmar Health Sector Coordinating Committee - Chaired by the Minister of Health

- Evolved from the CCM

Technical and Strategic Groups - Focusing on policy and coordination of

national response

- Established groups: HIV, TB and Malaria

- New groups: HSS, MNCH & RH, M&E/research and health emergencies

TB Technical and Strategic Group - Coordinated by the Department of Health

- WHO serves as secretariat

- Quarterly and ad hoc meetings

Technical and financial collaboration

0

20000

40000

60000

80000

100000

120000

140000

160000

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

TB

no

tifi

ca

tio

ns

History of the Global Fund in

Myanmar Rounds 2 and 3 (US$ 98 million): started in March 2005, interrupted in

August 2005

Establishment of Three Diseases Fund to cover major gaps

Round 9, agreed in 2009, covers 2011-2015:

– Based on underestimated TB disease burden

– Covers only basic DOTS with limited support for MDR-TB and TB/HIV

– Additional safeguards, zero cash-flow to government

Update of National Strategic Plan in 2012, based on:

– Prevalence survey conducted in 2009-2010

– External review (Nov. 2011)

From Round 9 to the

New Funding Mechanism (I) Application to Round 11: – “Proposal Concept” submitted in July 2011 to be eligible for Round 11

– August 2012: green light for applying to Round 11

– Round 11 proposal drafted

– Round 11 cancelled in November 2011

Transitional Funding Mechanism: not eligible

Round 9 Phase 2: Request for Renewal submitted in

August 2012

Global Fund Secretariat informs to develop concept notes

with different scenarios for max. 100% additional funding to

top up Phase 2 – Concept Note submitted in October 2012 and discussed with a Global Fund

panel in January 2013 with positive results

From Round 9 to the

New Funding Mechanism (II)

Round 9 Phase 1: extended till June 2013, incorporating

first two quarters of Phase 2

Invitation to apply to New Funding Mechanism in February

2013 – New Concept Note submitted in April 2013 (2013-2016)

– Feedback received in May 2013

– For TB, US$ 82 million approved and committed out of US$ 106 million

requested

– Grant signed in June 2013

New Funding Mechanism

opportunities

Alignment with national health strategies

Fostering in-country partnerships between three disease communities (joint submission)

Predictability on amount and timeframe

Significant input from the Global Fund country team and Technical Review Panel

Short and intensive preparations

Advocacy for increased health funding by the Government (co-financing)

Emphasis on rights-based care

New Funding Mechanism

challenges

Concept Note is almost like full proposal

Slow down of Phase II and need to accelerate for second half of 2013

No possibility to select new SRs due to short timeframe

Disease split, PR split and SR split negotiations due to fixed ceiling

Two different budgets – indicative and incentive

Uncertainty about incentive funding amount

Next funding opportunity only in 2017

Funding gaps for TB control, 2011-2015

• Total needs for

2011-2015 are

US$ 186 million

• The funding gap is

US$ 48 million

• BUT: updates are

needed for infection

control and

laboratory

strengthening

• The most important

shortfall is for

MDR-TB

management

Conclusions

Country could benefit from previous concept notes and proposals

Engagement with the Technical Review Panel (through the Global

Fund Secretariat) was based on mutual respect and “equal” partners

– TRP suggestions were duly considered and incorporated

– Global Fund Secretariat was informed where the country

disagreed with the TRP comments. Justification for non-

compliance with TRP suggestions was provided and accepted

Role of WHO at country level

– Importance of pro-active approach

– Bringing stakeholders together

– Need for continuous consultation and dialogue

– Keep HQ and RO in the loop

Fund Portfolio Manager is key contact person in the Global Fund

– Link to Global Fund Country Team and Secretariat

Next steps

Strengthen capacity of the Government to

become Principal Recipient

Advocating for the current Principal

Recipients to start handing over to the

Government and national NGO Princial

Recipient

Increase absorption capacity to ensure

access to all TB patients in all parts of the

country

Accelerate resource mobilization

Thank you very much!