Reaching TB patients among high risk groups, remote populations and people living with HIV and AIDS

Transcription

1 ! Hanoi, 8 March 2002 GFATM/B1/6A PROPOSAL ON TUBERCULOSIS CONTROL IN VIETNAM FOR THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA For the use of the Global Fund Secretariat: Date Received: ID No: SECTION A: OVERVIEW INFORMATION A.1. Country (or region): Vietnam A.2. Proposal Title: Reaching TB patients among high risk groups, remote populations and people living with HIV and AIDS A.3. Spell out which of the three health problems or combination of them this proposal aims to address (HIV/AIDS, TB and/or malaria) : The proposal concerns the expansion of the DOTS strategy to control tuberculosis among the entire population of Vietnam. The project gives high priority to reaching out to the populations living in the remote areas of Vietnam as well as patients at special risk to develop TB such as the home-less, IV drug abusers, prisoners, patients in homes for mentally retarded and homes for the elderly. Particular focus is given to patients with co-infection of HIV and TB. The proposal includes special efforts in developing a joint strategy of the AIDS and TB program in providing a continuum of preventive and care activities to both HIV positive TB patients and PLWHA. A.4 What are the additional outcomes expected from this proposal? Long term objectives of the NTP are: 1. Reducing the existing number of tuberculosis cases by 50% by 2010 and the number of annual new tuberculosis cases by Reducing the risk for developing drug resistance tuberculosis to the minimum by maintaining a high cure rate of over 85% through nationwide implementation of the DOTS strategy. Application Form for Proposals to the Global Fund 1

2 The additional outcomes expected from this proposal are: 1. Implementation of a network for diagnosis and treatment of TB covering all ethnic minorities living in the remote areas of Vietnam 2. Implementation of a special program to reach the urban poor such as the homeless and temporary workers 3. Implementation of a special program for diagnosis and treatment of TB for people in correctional facilities, institutions for the elderly and mentally ill. 4. Development and implementation of a joint TB/HIV strategy addressing the needs of PLWHA 5. Development of improved diagnostic facilities to enable high standard diagnosis of sputum negative tuberculosis nationwide 6. Improved quality of diagnosis and treatment of TB by private health sector. A.5. Total Amount Requested from the Global Fund: (in million US$, by year) Components (described in Section C) Year 1 Year 2 Year 3 Year 4 Year 5 Component 1 Component 2 1,0 1,5 2,5 2,5 2,5 Component 3 TOTAL (outlined in Section B) A.6. Disease burden (Refer to official documentation or sources of epidemiological data on the prevalence and magnitude of HIV/AIDS, TB and/or malaria in the country/region/area) or potential disease burden (indicators such as incidence of new infections etc) Vietnam ranks 12 th among the 23 countries which together carry 80% of the global burden of TB (WHO ). It is estimated by WHO that in Vietnam each year about 145,000 persons develop TB, i.e. 189 cases per 100,000 population. Among those 65,000 are infectious sources, i.e. 85 per 100,000 population. The estimated prevalence of TB is 221,000, among which 78,000 patients are smear positive. TB prevalence surveys show that the tuberculosis problem is particularly severe among ethnic minorities living in remote areas and among the less privileged in urban settings and in certain institutions. The prevalence in these groups is as high as 200 to 500 infectious cases per 100,000. Drug resistant tuberculosis is an issue of grave concern. In % of new cases had TB resistant against at least one drug. Primary multi drug resistance was observed in 2.3% of the cases. An important cause for the development of resistant TB is treatment of TB by the private practitioners and pharmacies, which are not well controlled at present.. The evolving HIV epidemic is a serious threat to the TB situation in Vietnam, as a high proportion of the population is already infected with tuberculosis. Results from sentinel surveillance in 30 provinces show that the HIV infection rate among TB patients has increased dramatically in recent years with 20 50% per year. A.7. Economic situation: (Refer to official indicators such as GNP per capita, HDI or other information on resource availability) Application Form for Proposals to the Global Fund 2

3 Though in recent years, the Vietnamese economic situation has developed favorably (6.8% growth in 2001), the country is still among the poorest countries in the world and certainly in the region. The economic indexes in 2000 were as following: GDP per capita: 380 USD (5,716,640 VND) Health care budget per capita: 4 USD (65,600 VND) HDI (1999): Life expectancy: 67 years old IMR: 36.7o/oo Literacy rate: 91.1% (Reference: Annual Health Statistics 2000) A.8 Political commitment: (government contribution to the financing of the proposal or public spending on health or existence of supportive national policies or presence of a national counterpart in the proposal, or other indicator). 1. The supportive policy of the government for the task of tuberculosis control From the beginning the government of Vietnam has paid due attention to the fight against tuberculosis. In 1985, the Ministry of Health formally established the National Tuberculosis Control Program. The NTP is a modern tuberculosis program implementing the strategy of the International Union Against Tuberculosis and Lung Disease (IUATLD) and the World Health Organization (WHO). The NTP has implemented the DOTS strategy step by step covering gradually all provinces, districts, communes, villages and hamlets as an integral part of the primary health care system. In 1995, the Vietnamese government decided to invest in tuberculosis prevention and control as a priority health care activity with direct impact on development. To that effect the government took a 23 million USD loan from the World Bank. The government counterpart funding amounts to 4 million USD. The government of Vietnam also cooperates closely with the global anti tuberculosis program. Ministers of Health, Finance and Planning and Investment participated in the Ministerial Meetings organized by Stop TB in 2000 and 2001 and expressed the government commitment to control tuberculosis in Vietnam. The commitments to the national tuberculosis control are also strongly expressed by the administrations at various levels (province, district, and village) and by other Ministries and branches in carrying out the DOTS strategy. 2. The government corresponding expenditure for the project In this project, direct contribution from the government budget is 37,463,954 USD (57.2% of the total budget). An additional amount of 6,745,704 USD (10% of the total budget) is provided by the government through the World Bank loan. 3. The government participation in the project: Application Form for Proposals to the Global Fund 3

4 The project is developed and managed by the Ministry of Health, a government agency with the participation of the government offices from the central to the local areas. A.9 Links with existing activities: (What links are there between this proposal and other current activities supported, for example, through, national health strategies, Poverty Reduction Strategies and Sector-Wide Approaches? Provide copies of these as supporting documentation, noting them in Attachment 1) The project is developed in line with the general socio-economic objective - the direction of the government. This project is part of Hunger Elimination and Poverty Reduction Strategy of the country and one of the first development priority. By applying the proven high economic effective strategy of DOTS, the project will contribute in reducing economic loss caused by diseases and will achieve economic benefits by improving the community health. The project also contributes to improve the socio economic condition in the difficult areas such as in the remote areas and for ethnic minority community. This project is further closely associated with the overall development of the health care sector by: Contributing to the development of the primary health care system at large Consolidating the basic health care network by focusing on community-oriented activities Socializing health care through educational broadcasting providing information and knowledge to the community. Developing health information based on data derived from the tuberculosis surveillance system Application Form for Proposals to the Global Fund 4

5 A.10 Profile of the Country Co-ordinating Mechanism (CCM) If not submitted by a CCM, please move directly to A.14. Various agencies and partners (including NGOs and Research Institutions) that are supporting this proposal are co-ordinated and organised through a country co-ordinating mechanism which is referred to in this document as CCM. 1. Name of the CCM: National Coordination Committee for the GFATM 2. Date of constitution of the current CCM : March 6th, Organizational structure (e.g., secretariat, sub-committee, stand-alone): Chair of the National Coordination Committee : Prof. Le Ngoc Trong, MD, PhD Vice Minister of Health Vice-chairs of the National Coordination Committee : Duong Huy Lieu, MD, PhD - Director of the Planning Department, MOH Trinh Quan Huan, MD, PhD - Director of the Preventive Department, MOH Members of the of the National Coordination Committee : Nguyen Dinh Thuong, MD Deputy Director of the Planning Department MOH A. Prof. Chung A, MD, PhD Director of the National AIDS Bureau Prof. Nguyen Viet Co, MD, PhD Director, National Institute of TB and Resp. Disease Prof. Le Dinh Cong, MD, PhD Director, National Institute of Malaria, Parasite and Entomology Le Thu Ha, MPH Deputy Director, International Coorperation Department MOH Tran Thu Thuy, MD, PhD Director, Therapy Department, MOH Prof. Hoang Thuy Long, MD, PhD Director, National Institute of Epidemiology and Hygiene Prof. Le Dang Ha, MD, PhD, Director, Institute of Clinical Reasearch & Tropical Medicine Prof. Nguyen Cong Khanh, MD, PhD-Director, Institute of Pediatric Prof. Do Trung Phan, MD, PhD-Director, Institute of Hematology and Transfusion Prof. Pham Van Hien, MD, PhD-Director, Insitute Dermatology Nguyen Duc Vy, MD, PhD-Director, Institute for Protection Mother and Newborns Trinh Thi Le Tram, MD, BA-Deputy Director, Legislation Department, MOH Representative of the Ministry of Plan and Insvestment Representative of the Department of Trade and Industrial Representative of the Ministry of Financial Representative of Vietnam Red Cross Representative of the National Religious Committee Representative of the Youth Union Representative of the Women Union Secretariat : Nguyen Van Nhuan, MD, Planning Department, MOH Nguyen Thanh Long, MD, MSc, Preventive Department, MOH Nguyen Hoang Long, Planning Department, MOH Representative of the International Corporation Department, MOH Bureau, National Institute of Tuberculosis and Respiratory Disease, National Institute of Malaria, Parasite and Entomology, National AIDS Bureau. 4. Frequency of meetings : quarterly 5. Major functions and responsibilities of the CCM: 1. Preparing and supporting domestic & international organizations in Vietnam in building up projects for grant aids from the GFATM 2. Co-ordinating and managing the implementation of HIV/AIDS, tuberculosis and malaria projects under the sponsorship of the GFATM 3. Organizing meetings to consider and approve projects for grant aids from the GFATM 4. Managing and using grant aid in accordance with the regulations of the GFATM and Vietnamese government 5. Assessing the projects efficiency, sending reports to agencies and aid organizations concerned, in accordance with existing regulations. 6. Major strategies to enhance CCM s role and functions in the next 12 months: Application Form for Proposals to the Global Fund 5

6 A.12. Signatures: Members of the Country Coordinating Mechanism (CCM see following page) sign below to endorse this proposal. Endorsement of this proposal does not imply any financial (or legal) commitment on the part of the partner agency or individual: Signature, Chair of the National Coordination Committee : Prof. Le Ngoc Trong, MD, PhD Vice Minister of Health Ministry of Health, S.R. Vietnam 138A Giang vo Str. Hanoi, Vietnam (Signed) Vice-chairs of the National Coordination Committee : Duong Huy Lieu, MD, PhD - Director of the Planning Department, MOH Trinh Quan Huan, MD, PhD - Director of the Preventive Department, MOH (Signed) Members of the of the National Coordination Committee : Nguyen Dinh Thuong, MD Deputy Director of the Planning Department MOH (signed) A. Prof. Chung A, MD, PhD Director of the National AIDS Bureau Prof. Nguyen Viet Co, MD, PhD Director, National Institute of TB and Resp. Disease (signed) Prof. Le Dinh Cong, MD, PhD Director, National Institute of Malaria, Parasite and Entomology (Signed) Le Thu Ha, MPH Deputy Director, International Coorperation Department MOH (Signed) Tran Thu Thuy, MD, PhD Director, Therapy Department, MOH (Signed) Prof. Hoang Thuy Long, MD, PhD Director, National Institute of Epidemiology and Hygiene Prof. Le Dang Ha, MD, PhD, Director, Institute of Clinical Reasearch & Tropical Medicine (Signed) Prof. Nguyen Cong Khanh, MD, PhD-Director, Institute of Pediatric (Signed) Prof. Do Trung Phan, MD, PhD-Director, Institute of Hematology and Transfusion Prof. Pham Van Hien, MD, PhD-Director, Insitute Dermatology (signed) Nguyen Duc Vy, MD, PhD-Director, Institute for Protection Mother and Newborns (Signed) Trinh Thi Le Tram, MD, BA-Deputy Director, Legislation Department, MOH (signed) Representative of the Ministry of Plan and Insvestment (signed) Representative of the Department of Trade and Industrial (signed) Representative of the Ministry of Financial (signed) Representative of Vietnam Red Cross (signed) Representative of the National Religious Committee (signed) Application Form for Proposals to the Global Fund 6

7 Representative of the Youth Union Representative of the Women Union Secretariat : Nguyen Van Nhuan, MD, Planning Department, MOH (Signed) Nguyen Thanh Long, MD, MSc, Preventive Department, MOH (Signed) Nguyen Hoang Long, Planning Department, MOH (Signed) Representative of the International Corporation Department, MOH Bureau, National Institute Application Form for Proposals to the Global Fund 7

8 A.13. In case the Global Fund Secretariat has queries on this submission, please contact: Name: Nguyen Viet Co Title/Address: Professor, Medical Doctor, Director. National Institute of Tuberculosis and Respiratory Diseases National Tuberculosis Control Programme Manager 463 Hoang Hoa Tham Str., Badinh, Hanoi, Vietnam Tel.No.: / / Fax No.: nitrd@netnam.org.vn A.14. If submitting not under a CCM, but as an individual or a partnership of non-governmental organizations (NGOs) or from private sector, please explain clearly the circumstances, conditions and/or reasons why not applying under a CCM. SECTION B: OVERALL PROPOSAL B.1 Summary of overall proposal: (Synopsis of proposal, describing overall objectives, who will be involved, the beneficiaries, listing the major health components and the synergies between the different components. [more detail on separate components is sought in section C]). The National Tuberculosis Control Program plans to use the finances of the Global Fund to fight AIDS, Tuberculosis and Malaria to finance planned activities of the program in the period 2002 to 2006 for which so far no funds had been secured from other sources.the GFATM funds will thus be additional to funds from the government budget, from the WB loan and grant money from the Government of the Netherlands. The overall objectives of this proposal are supporting the general NTP objectives of casedetection and treatment by: 1. Expansion of the DOTS strategy and network in all mountainous provinces, districts communes, villages and hamlets. The expansion will be undertaken in collaboration with the district and commune health authorities. In view of the local circumstances the DOTS strategy will be adapted to the local needs in a consultative process with direct involvement of the ethnic minority groups. The DOTS package will be part of a broader health care package addressing the needs of the populations in the remote areas. 2. Development and implementation of a specific DOTS model to reach the urban poor and least privileged. The project will be part of the overall strategy of the Government for poverty reduction and be developed in close collaboration with the municipalities. Where possible local communities and NGO s will be directly involved in the process. 3. Specific strategies addressing the TB problem in institutionalized populations. Depending on the type of institution the program will be developed in collaboration with the Ministry of Justice, Ministry of Health and Ministry of Social Welfare. 4. With priority developing a joint HIV/TB strategy to address the need of PLWHA. The strategy will be developed in collaboration with the National AIDS program and relevant local organizations and NGO s. As the NTP has established good collaboration with mass Application Form for Proposals to the Global Fund 8

9 organizations, such as the women and youth associations, during the expansion phase of DOTS it has been planned to involve the same groups in information campaigns about the link between HIV and TB. Efforts will primarily focus on geographical areas with elevated HIV prevalence levels, such as districts bordering China in the North and districts bordering Cambodia in the West. Special attention will be given to the problem of HIV positive IV drug abusers in the major cities, building on already existing projects, such as the project for TB control in IVDU s in Ho Chi Minh City. The main purpose of the new strategy is to reduce the incidence of TB in PLWHA by early detection and treatment of disease and provision of preventive therapy. 5. Development of improved diagnostic facilities to enable high standard diagnosis of sputum negative tuberculosis nationwide will contribute to reduction of TB transmission by identification of sputum negative but culture positive TB patients. The NTP is in the process of equipping several provincial TB units with culture facilities, but much more is needed. This proposal would accelerate the development of the culture network by training of staff, equipping facilities, provision of materials, development of guidelines and a quality control system for cultures. Part of the project would be to establish a monitoring and evaluation system to guide the countrywide implementation of the services. 6. Improved quality of diagnosis and treatment of TB by private health sector. The proposal builds on earlier research in HCM City on the role of the private sector in diagnosing and treating TB. The NTP aims at developing a private/public partnership with the private sector to safeguard the quality of TB control by private practitioners and pharmacies. Activities would involve developing materials, capacity building, quality control and a surveillance system. Areas and population benefited The subject of the project will be all people who are living in Vietnam, especially people from remote and difficult areas and special groups of people such as prisoners, the old, the mental patients are more benefited. B.2 Programmatic monitoring and evaluation: (The proposal needs to include an outline of the monitoring and evaluation process that will be followed in relation to the overall proposal, including timelines, and baseline data, responsibility for collection, proposed/anticipated use of the information to be collected and involvement of target population with monitoring and evaluation. [Section C requests monitoring and evaluation information on major components]) The NTP has well-established mechanisms to monitor and evaluate program operations, program results, distribution and use of anti-tb drugs and financial expenditures. The NTP operates a system to ascertain the quality of the services by field visits to all program levels by as follows: The national team supervises the provincial level four times a year. The provincial staff supervises district level quarterly and district staff supervises villages monthly. The NTP organizes coordination and planning meetings on half-yearly basis and monitoring and evaluation meetings on annual basis. Every 5-year the NTP organizes a 5-year program review meeting. Under the agreement with the Government of the Netherlands the program receives technical assistance by experts of the Royal Netherlands Tuberculosis Association and the Medical Committee Netherlands Vietnam. Twice yearly the NTP is visited by two consultants of these Application Form for Proposals to the Global Fund 9

10 organizations to assist the NTP in the monitoring and evaluation of the implementation of the DOTS strategy as well as the special projects described earlier. The NTP has planned a Mid term evaluation in March April 2004 and a End term evaluation November 2006 B.3. Financial management (Describe arrangements in place for financial management, including suggested disbursement mechanisms and plans) Current NTP funds derive from several sources: Direct government of Vietnam funds, funds from the World Bank, funds from the Government of the Netherlands and funds from KNCV and MCNV. The NTP operates different accounting procedures depending on the requirements of the donor. For example in the case of the funds from the government of the Netherlands the NTP has opened a bank account to receive the Dutch funds. The Management Board of the NTP needs to ask for approval of the Embassy to incur expenditure on the basis of detailed annual plans. The Dutch funds are subject to external audits either at the spending level, e.g. at the provincial level or at the national level where the account is administered and funds are disbursed. Similar arrangements could be used for the use of GFATM funds. To account for expenditures at the different program levels the NTP uses the official accounting books and ledgers, which are maintained in accordance with the financial, accounting and management rules and regulations of the government of Vietnam. The account office of the NTP has the responsibility to keep all vouchers, books, and documents concerning to the accounting of the project. Units send expenditure report and other reports to the central level. B.4 Statement of Budget Requirements, Financial Commitments and Unmet Needs 2002 (Demonstrate the additionally of the proposal) BUDGET REQUIREMENT S (US$) Budget Categories (please fill in according to your plan) Human Logistics Training & Outreach Commodities or education information Health Data & TOTAL Resources And Supervision Services supplies Products* system 32,341,556 7,409,415 3,397,244 6,785,610 12,231,572 1,033, ,500 63,587,897 Financial commitments by source Government 32,341,556 1,560,000 1,371, , ,000 35,670,956 WB 140, ,130 6,000,000 6,424,480 Ned 2,116, ,594 2,143, ,250 4,956,527 WHO 67,500 13,000 10,000 59, ,000 CDC 118,000 25, ,000 Total Commitments 32,341,556 2,116,949 2,106,844 2,666,864 6,000, ,250 84,500 47,344,963 Unmet needs 3,732,466 1,310,900 4,131,746 6,231, , ,000 16,299,434 *Including drugs Application Form for Proposals to the Global Fund 10

11 B.5 Duration (provide an estimate): Beginning and end dates: From: 2002 To: 2015 Period to be covered by this request for financing: From: 2002 To: 2006 SECTION C: MAJOR COMPONENTS PROPOSAL COMPONENT : TUBERCULOSIS (Number separate components 1) Application Form for Proposals to the Global Fund 11

12 C.1 Description: (Describe this component of the proposal (e.g. disease-specific intervention), what it seeks to accomplish, who are the beneficiaries, who will be the implementing partners and strategies for implementation). With malaria tuberculosis is a major public health problem in Vietnam. Annually more the infectious cases occur. Without proper treatment most patients would die. Moreover, these patients infect annually more than 1 million Vietnamese citizens. Facing this reality the Ministry of Health in line with WHO s new global program against tuberculosis strengthens its efforts to control tuberculosis nationwide. The Ministry has developed a new national tuberculosis program in order to prevent the mortality caused by the disease and to reduce transmission, so that the enormous burden of tuberculosis will gradually be reduced. Thus the ministry executes the new government policy formulated in March 1993 to improve the detection of infectious cases, to strengthen the PHC network to diagnose and cure infectious cases, and to improve the regular supply of drugs, in order to control the transmission of tuberculosis.. Tuberculosis control activities started on a small scale in 1957 and the collaboration in this field between the Netherlands and Vietnam exists already 25 years. At that time the country was divided into two parts. In the northern part the fight against tuberculosis was carried out by the National Institute of Tuberculosis in Hanoi, the southern part of the country was covered by the Tuberculosis control Program in Saigon. Since the reunification of the country in 1975, the National Institute of Tuberculosis and Respiratory Diseases (NITRD) in Hanoi is in charge of the coordination of the NTP. The Pham Ngoc Thach Hospital in Ho Chi Minh city is responsible for the supervision of the tuberculosis control activities in the southern provinces. The Vietnamese National Tuberculosis Control Program (NTP) is modeled after the successful IUATLD assisted program in other third world countries. From the onset, the major elements of the program consisted of the recommendations of the World Health Organization (WHO) of that time (e.g. emphasis on the diagnosis of smear- positive patients, standard chemotherapy and ambulatory treatment) and IUATLD s practical solutions to monitor and improve the results of case-finding and treatment (monitoring of treatment results by bacteriology, evaluation of case finding and treatment results of quarterly patients cohorts, the introduction of a retreatment regimen for relapse and failure patients and the introduction of a program manual). Application Form for Proposals to the Global Fund 12

13 C.2 Objectives and indicators (Provide information on objectives for this component.) Main objective (Describe the expected end situation) The overall aim of the NTP is to reduce the prevalence of tuberculosis in order to prevent the physical and psycho -social suffering of the population and the economic loss for the nation, caused by tuberculosis, in such a way that tuberculosis no longer remains a public health problem. Therefore the incidence of new infections, caused by transmission of the TB bacillus must be controlled during a relatively long period of time. Effective control of tuberculosis is defined as the situation wherein the annual risk of infection and the incidence of smear-positive tuberculosis cases per population aged years decline with 5% per year or more Long term Objectives: By the year 2015, the incidence of tuberculosis is halved compared with the 2001 values Specific objectives: 1) In the , the number of detected cases continues to be 67 new smear- positive cases per population. 2) Outcome of treatment for new smear - positive cases is a cure rate of more than 87% Strategy: The WHO recommended DOTS strategy INDICATORS Baseline: 100% DOTS coverage in 2002 At least 75% Case Detection Rate (Notified cases/estimated cases by WHO) At least 85% Cure rate in new smear-positive cases Targets: DOTS coverage 100% 100% 100% 100% 100% CDR 87% 88% 89% 90% 90% Cure rate 89% 90% 91% 92% 92% Development of network for remote populations 25% 50% 75% 100% 100% Coverage of the urban poor and less privileged 25% 50% 75% 100% 100% Program coverage of institutionalized patients 50% 75% 100% 100% 100% Coverage HIV/TB Strategy for PLWHA 25% 40% 55% 75% 100% Development of diagnostic culture network for smear-negative TB 10% 25% 50% 75% 100% Public/private sector collaboration 10% 25% 50% 75% 100% Application Form for Proposals to the Global Fund 13

14 C.3 Programmatic monitoring and evaluation plans: (An outline of the monitoring and evaluation process that will be followed for this component.) Next to the routine services the NTP will establish special projects addressing the 6 areas of the proposal. For each of the projects special teams will be created. The projects will monitor the progress of implementation based on baseline data gathered through initial surveys of the current size of the problem and routine service coverage. Detailed implementation plans will be developed for 5-year periods. Case-finding and treatment results will be monitored using the standard HMIS package of the NTP. C.4 Duration: (provide an estimate) Beginning and end dates: From: 2002 To: 2015 Period to be covered by this request for financing: From: 2002 To: 2006 C5. Statement of budget requested financial commitment and unmet needs in 2002 Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 6,554, , ,840 32,000 32,000 7,447,335 WB 105, ,130 3,000,000 3,355,880 Ned 1,171,659 4, ,896 52,750 1,799,143 WHO 47,000 46,500 93,500 CDC 78,000 17, Total Commitments 6,554,495 1,171, , ,026 3,000,000 52,750 63,500 12,790,858 Unmet needs 644, , , ,750 93,000 1,789,513 *Including drugs Statement of budget requested financial commitment and unmet needs in 2003 Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 6,513, , ,990 53,000 4,000 7,525,976 WB 34,600 34,000 3,000,000 3,068,600 Ned 477, , ,096 94,500 1,266,983 WHO 20,500 13,000 10,000 13,000 56,500 CDC 40,000 8,000 48,000 Total Commitments 6,513, , , ,096 3,000, ,500 21,000 11,966,059 Unmet needs 761, , , , ,000 2,080,681 *Including drugs Application Form for Proposals to the Global Fund 14

15 Statement of budget requested financial commitment and unmet needs in 2004 Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 6,471, , ,190 47,000 30,000 6,960,006 WB Ned 258,434 94, ,796 49, ,130 WHO CDC Total Commitments 6,471, ,434 94, , , ,130 Unmet needs 757, , ,500 2,068, ,500 70,000 4,017,960 *Including drugs Statement of budget requested financial commitment and unmet needs in 2005 Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 6,418,943 90, ,190 47,000 53,000 6,885,133 WB Ned 209,425 94, ,946 89, ,271 WHO CDC Total Commitments 6,418, ,425 94, , , ,271 Unmet needs 848, , ,000 2,111,371 53,500 25,000 3,936,860 *Including drugs Statement of budget requested financial commitment and unmet needs in 2006 Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 6,382,316 90, ,190 47,000 53,000 6,852,506 WB Ned WHO CDC Total Commitments 6,382,316 90, ,190 47, , ,852,506 Unmet needs 720, ,400 1,285,946 2,051, ,500 25,000 4,474,420 *Including drugs Application Form for Proposals to the Global Fund 15

16 C.6 Implementation Plans including resource allocations to partners Financial commitments by source Human Resources Budget Categories (please fill in according to your plan) Logistics And supplies Training & Supervision Outreach Services Commodities or Products* Health education Data & information system TOTAL Government 32,341,556 1,560,000 1,371, , ,000 35,670,956 WB 140, ,130 6,000,000 6,424,480 Ned 2,116, ,594 2,143, ,250 4,956,527 WHO 67,500 13,000 10,000 59, ,000 CDC 118,000 25, ,000 Total Commitments 32,341,556 2,116,949 2,106,844 2,666,864 6,000, ,250 84,500 47,344,963 Unmet needs 3,732,466 1,310,900 4,131,746 6,231, , ,000 16,229,434 *Including drugs Application Form for Proposals to the Global Fund 16

17 Attachment 1: List of Supporting Documents Please note which documents are being included with your proposal by indicating a document number General documentation: Attachment # 1. Poverty Reduction Strategy Paper (PRSP) 2. Medium Term Expenditure Framework 3. Sector strategic plans 4. Any reports on performance HIV/AIDS specific documentation: Attachment # 5. Situation analysis 6. Baseline data for tracking progress 1 7. National strategic plan for HIV/AIDS, with budget estimates 8. Results-oriented plan, with budget and resource gap indication (where available) TB specific documentation: Attachment # 9. Multi-year DOTS expansion plan and budget to meet the global targets for TB control 10. Documentation of technical and operational policies for the national TB programme, in the form of national manuals or similar documents 11. Most recent annual report on the status of DOTS implementation, expansion, and financial planning (routine annual WHO TB Data [and Finance] Collection Form) 12. Most recent independent assessment/review of national TB control activities Malaria specific documentation: 1 copy 1 copy 1 copy 3 copies Attachment # 13. Situation analysis 14. Baseline data for the tracking of progress 15. Country strategic plan to Roll Back Malaria, with budget estimates 16. Result oriented plan, with budget and resource gap indication (where available) Crosscutting documents/activities Attachment # 1 Where baselines are not available, plans to establish baselines should be included in the proposal. Application Form for Proposals to the Global Fund 17