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
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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
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94
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98
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99
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12
TB
no
tifi
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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!