Technical Guidance for Global Fund HIV Proposals

Technical Guidance for Global Fund HIV Proposals FINAL DRAFT DOCUMENT The document will remain in a final draft form for Round 9 and will be finalized for the Round 10 Resource Toolkit. If you would like to add your contribution to the current guidance please forward your suggestions to UNICEF New York HQ before June 30, 2009 (Please contact Dr. Mariam Jashi at mjashi@unicef.org) ANALYSING PROGRAMMATIC AND RESOURCE GAPS Working document - 21 April 2009 Introduction A robust analysis of both programmatic and financial gaps is one of the fundamental prerequisites for the country applications to be recommended by the Technical Review Panel (TRP) for approval by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). A well articulated gap analysis in its turn provides a basic skeleton of the country proposal, as clearly defined disease-specific and systems bottlenecks guide both identification of the programme and financial gaps in the overall national response and prioritization of the additional programme and funding support needs for the GFATM applications. Purpose and the intended audience The current technical note intends to provide consolidated guidance to the country teams and consultants involved in the writing of the GFATM applications regarding how to analyze the existing programmatic and financial gaps of the national HIV & AIDS responses and how to best reflect the results of the gap analysis into the HIV proposals to the GFATM. The guidance was drafted in response to the TRP observation, that insufficient analysis of the situational gaps and selection of inappropriate approaches/activities were the most commonly identified weaknesses across the category 3 and 4 proposals from the Round 8 submissions. Structure of the guidance note In efforts to avoid duplication of already available instructions and guidance from different sources and to facilitate better coherence of the gap analysis to the structure of the GFATM applications, the note: 1. Summarizes the major recommendations and guiding principles relevant for the programmatic and financial gap analysis from the GFATM Round 9 Proposal Guidelines. 2. Spells out a step wise process for a comprehensive gap analysis of the national response frameworks (hereafter referred as the NATIONAL PROGRAMME). 3. Provides practical recommendations and proposes a framework for undertaking a comprehensive gap analysis of the overall NATIONAL PROGRAMME and how to link the results of the analysis to the specific sections/subsections of the GFATM applications, and 4. Summarizes a set of evidence-based interventions in HIV/AIDS prevention, treatment, care and support programmes described in the major reference documents from the GFATM, UNAIDS and cosponsor agencies. Major References used for the guidance 1. Guidelines for Proposals Round 9 (single country applications). The Global Fund to fight AIDS Tuberculosis and Malaria, 2008 2. HIV Proposal Form (sections 3, 4, 5 and Annex A) for Round 9. The Global Fund to fight AIDS Tuberculosis and Malaria, 2008 3. A handbook for Planning and Managing for HIV/AIDS Results. IBRD/The World Bank. 2007 4. Practical Guidelines for Intensifying HIV Prevention, Towards Universal Access. UNAIDS, 2007 5. Monitoring and Evaluation Toolkit. HIV/AIDS, Tuberculosis and Malaria. February 2009. Third Edition. GFATM, MEASURE Evaluation, PEPFAR, PMI, RBM, Stop TB Partnership, UNAIDS, UNICEF, USAID, WHO, World Bank. 6. Global Health-Sector Strategy for HIV/AIDS 2003-2007. WHO. 2003 1

Major Recommendations and Guiding Principles from the GFATM Round 9 Proposal Guidelines and relevance to the programmatic and financial gap analysis Guiding Principles and Recommendations from the GFATM R9 Guidelines As far as possible, Round 9 proposals should be developed in the context of national health sector development plans and strategic plans, and/or national disease control programs and strategic plans Proposals submitted to the Global Fund should seek additional support for programs that address gaps and needs identified by the countries The Global Fund aims to ensure that funding is available to support universal access to comprehensive prevention, treatment, and care and support services by all members of affected communities women and men of all ages, key affected populations and sexual minorities Relevance of the Principles and Recommendations to the Gap Analysis The gap analysis should assess the gaps and constraints towards attainment of the overall goals and targets of the NATIONAL PROGRAMMES. The analysis should make reference to any recent SWOT analysis i.e. response analysis of the national AIDS programmes, health system or health sectoral reviews. Where no formal analysis exists, the SWOT analysis should be undertaken in a broad consultative process as part of the GFATM proposal development. The main purpose of the Gap Analysis is to identify these additional programmatic and financial support needs based on the situational and response analysis and analysis of the remaining challenges and barriers towards reaching the overall NATIONAL PROGRAMME targets for Universal Access. A comprehensive analysis should assess the gaps and constraints towards reaching ambitious, but realistic Universal Access targets set by the countries for prevention, treatment, care and support. And the Global Fund encourages that the countries submit proposal that would be able to bridge the gaps between the current level of the response and the ambitious Universal Access targets. However, a sound analysis will also guide the country teams in their decisions whether the GFATM application should address all gaps that have been revealed (taking into consideration the absorptive capacity of the national systems and other factors) or whether the application should include only a select number of disease-specific, community- and/or health system strengthening interventions. Based on the synthesis of the different resources, we could recommend the following 9 steps both for a comprehensive analysis of the programmatic and financial gaps within the overall national responses and identification of the appropriate additional interventions and funding requests for the GFATM applications: Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8: Step 9: Analyzing the overall national contexts Identifying the overall NATIONAL PROGRAMME framework Reviewing the goals and objectives of the NATIONAL PROGRAMME Analyzing the broad programmatic objectives, SDAs, output targets and the core interventions spelled out in the NATIONAL PROGRAMME Assessing the level of engagement and the capacities of the governmental and nongovernmental partners in implementation of the NATIONAL PROGRAMME Assessing the systems capacities in implementation and tracking the progress of the NATIONAL PROGRAMME Compiling information on the existing and pledged resources from the domestic and external sources for the NATIONAL PROGRAMME, including the previous GFATM grants. Summarizing the response gaps and areas for additional programmatic and financial support needs within the overall NATIONAL PROGRAMME, and Agreeing on the list of the additional programmatic and financial needs to be included in the GFATM applications 2

STEP 1 Link to the GFATM Application ANALYZING THE OVERALL NATIONAL CONTEXT This step will provide data for sections 4.2.1 (b) and 4.2.2. The specific target population groups will be selected based on the agreement of the GFATM proposal content (Step 9) The first step in the process is to know your epidemic to define the current epidemiological, behavioural situation and context, the populations, geographic locations, and risk settings of the groups most in need of HIV services. In order to identify the key affected populations and drivers of the epidemic summarize the latest demographic and epidemiological data available in the country through the first and second generation surveillance. Look into the dynamics and the drivers of the epidemic: - Where and among whom are HIV infections happening? 1 What are the populations with high HIV prevalence, where are those populations being exposed to HIV? What is the trend of the HIV prevalence in these groups? Consider how the epidemic differently affects men vs. women, rural vs. urban populations, adult vs. children, high risk or marginalized population groups compare the current statistics to any trend data available from the 1 st or 2 nd generation surveillance for the last 3-5 year periods. - Why are HIV infections happening in these population groups? What are the risk behaviours (i.e. injecting drug use with use of unsterile equipment, unprotected casual sex contacts), what are the high-risk situations and what factors limit the ability of those who are vulnerable to reduce their risk behaviours? Use any available data from biomarker and behavior surveys, sentinel surveillance, etc. - How fast are infections moving? 1 HIV may move through a network of exposures. For example, from client to sex worker, who may then infect other clients, who transmit the virus to their regular partners. - What are the drivers of the epidemic? 1 Apart from the risk behaviours, what are the sociocultural and policy factors which act as drivers of the epidemic? i.e. stigma and discrimination against people living with HIV or to most-at-risk populations, gender inequality (lack of sexual autonomy and power of decision-making among women and girls). The possible resources of the strategic information 2 for the analysis: - Health facility-based statistics - Community-based program reports - Surveillance studies - National representatives, population/based sample surveys such as Demographic and Health Survey (DHS and DHS+, AIS, Multiple Indicator Cluster Surveys (MICS)) - Schools, health facility and workplace surveys - Specially designed surveys and questionnaires i.e. targeted surveys of most-at-risk populations, National Composite Policy Index questionnaire. Many countries will already have the data synthesized into a structured framework (or a table) for the national programme analysis, UNGASS-related report or other formats, and the country teams are encouraged to use any available synthesis reports for the context analysis. Otherwise, the GFATM proposal writing teams could use the following table. 1 Practical Guidelines for Intensifying HIV Prevention, Towards Universal Access. UNAIDS. 2007 2 Practical Guidelines for Intensifying HIV Prevention, Towards Universal Access. UNAIDS, 2007 Monitoring and Evaluation Toolkit. HIV/AIDS, Tuberculosis and Malaria. February 2009. Third Edition. GFATM, MEASURE Evaluation, PEPFAR, PMI, RBM, Stop TB Partnership, UNAIDS, UNICEF, USAID, WHO, World Bank. 3

Proposed sample of a table to summarize the priority groups of the populations and the size of the target populations for the NATIONAL PROGRAMMES Population groups Population - all ages Total Estimated number /size of the group Female Male Urban Rural Estimated number of people living with HIV in the group Total Female Male Urban Rural Estimated HIV prevalence in the group Total Female Male Urban Rural Year & Source of the data. Or indicate no data Summary of the Priority Populations for the NATIONAL HIV and AIDS RESPONSE Identify the population groups to be prioritized and describe why? i.e. comment on latest HIV trend in the group or the HIV disease burden attributable to the group Indicate risk behaviors and other driving factors that contribute to higher HIV rates in the selected priority groups Indicate specific geographic locations for the priority groups, if applicable Population > 25 years Population 19 24 years Population 15 18 years Population 0-14 years Pregnant women (annual #of births) Migrant population Drug Users (including injecting drugs) Sex workers (female) Men who have sex with men Orphans Add additional lines for other population groups as relevant to country context 4

STEP 2 IDENTIFYING THE OVERALL NATIONAL PROGRAMME FRAMEWORK Ling to the This step provides narrative inputs for Section 4.1 GFATM Application This step intends to identify the overall NATIONAL PROGRAMME framework the document that best reflects the comprehensive scope, priorities and the strategic interventions set by the national HIV and AIDS programmes and plans. Most of the countries would have in place health sector or disease-specific programmes and strategic plans that will reflect the overall framework of the national HIV and AIDS response, like National Health Sector Development Plan National HIV and AIDS Action Framework Strategic and operational Plans for HIV and AIDS, etc. The NATIONAL PROGRAMMES, even where they exist, should be considered 'as living documents that can and should be adjusted as needed during implementation, based on the real-time data from programme monitoring, studies, evaluations and other emerging response priorities 3. If there is no comprehensive NATIONAL PROGRAMME, the application should be built on the Logframes and national priorities spelled out in any existing draft plan 4. If no official or draft documents exist, the subject of the Global Fund application may be referred as the PROGRAMME 4. Thus the GFATM proposal development will serve as a catalyst for defining the current epidemiological and programmatic contexts, formalizing the national programme targets for meeting the most vulnerable and affected population needs, and establishing a costed strategic framework for action. STEP 3 Link to the GFATM Application Reviewing the goals and objectives of the NATIONAL PROGRAMME The goals and objectives to be reflected in sections 4.1 and attachment A The existing NATIONAL PROGRAMMES (sectoral or HIV and AIDS Action Frameworks) will be defining the overarching goals and objectives of the national response to HIV and AIDS. Goal(s) are the broad statements of a desired, long-term effect of the NATIONAL PROGRAMMES. The goal(s) are usually defined by a set of Impact-level targets aiming at reduction of HIV/STI incidence and prevalence, HIV related mortality, impact mitigation or changes of the social norms leading to reduced vulnerability and risk settings for HIV. Each goal should also have a set of related, more specific programme objectives that will permit the Program to reach the stated goal(s). The programme objectives are usually expressed by Outcomelevel targets, the intermediate effects that the NATIONAL PROGRAMMES target to achieve. The outcome-level targets are related to the desired changes in behaviors, services utilization, clinical outcomes and quality of life of the affected population groups. How to analyze the relevance of the NATIONAL PROGRAMME goals and objectives? - Look at the results of the context analysis that identifies the key target populations and the drivers of the epidemic (Step 1). - Analyze whether the national goals and objectives through the impact and outcome level targets prioritize the desired changes in the health outcomes, behavior changes and other relevant indicators among the priority population groups identified through the context analysis (Step 1) - If any of the priority population groups are missed out identify as a gap and discuss with stakeholder the need for revision of the NATIONAL PROGRAMME goals and objectives. Below we summarize the set of the Impact and Outcome indicators described in the multi-agency M&E toolkit 5, that could be a useful reference for the analysis of the NATIONAL PROGRAMME goals and objectives. 3 A handbook for Planning and Managing for HIV/AIDS Results. IBRD/The World Bank. 2007, and 4 Guidelines for Proposals Round 9 (single country applications). The Global Fund to fight AIDS Tuberculosis and Malaria. 2008 5

Impact-level indicators Outcome-level indicators 1. Young women and men aged 15-24 who are HIV infected (percentage) (UNGASS #22) 2. Most-at-risk populations who are HIV-infected (percentage) (UNGASS #23) 3. Adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy (percentage) (UNGASS #24) 4. Infants born to HIV-infected mothers who are infected (percentage) (UNGASS #25) 5. Children under age 18 who are orphans (Percentage) (Additional Recommended Indicator #10) 6. Newly registered TB patients who are HIV positive (percentage) 1. Young women and men aged 15 24 years who have had sexual intercourse before the age of 15 years (percentage) (UNGASS#15) 2. Never married young men and women aged 15 24 years who have never had sex (percentage) (Additional recommended indicator #12) 3. Women and men aged 15 49 years who have had sexual intercourse with more than one partner in the last 12 months (percentage) (UNGASS #16) 4. Women and men aged 15 49 years who have had more than one sexual partner in the past 12 months reporting the use of a condom during their last sexual intercourse (percentage) (UNGASS #17) 5. Female and male sex workers reporting the use of a condom with their most recent client (percentage) (UNGASS #18) 6. Men reporting the use of a condom the last time they had anal sex with a male partner (percentage) (UNGASS #19) 7. Injecting drug users reporting the use of a condom the last time they had sexual intercourse (percentage) (UNGASS #20) 8. Injecting drug users reporting the use of sterile injecting equipment the last time they injected (percentage) (UNGASS #21) 9. Current school attendance among orphans and among non-orphans (percentage) (UNGASS #12) 10. Women and men aged 15 49 years expressing accepting attitudes towards people living with HIV (percentage) (Additional recommended indicator #14) Note: Please consult the multi-agency M&E toolkit for further details on the reporting schedules and the data measurement tools for the indicators. The same indicators are included in the Attachment A of the GFATM Round 9 Applications HIV Performance Framework, and The Global Fund encourage the use of the proposed standard indicators. However, if appropriate for the local situation, one can overwrite the drop-down box in the HIV Performance Framework to include country specific indicators in line with the NATIONAL PROGRAMME and its respective M&E plan. STEP 4 Analyzing the broad programmatic objectives, SDAs, output targets and the core interventions spelled out in the NATIONAL PROGRAMME Where NATIONAL PROGRAMME is already in place, the goals and objectives (with respective impact and outcome targets) will define the Broad Programmatic Objectives, or Programmatic Areas for the overall national response to HIV and AIDS. The programmatic objectives sometimes are also referred as the Strategic Directions of the national response. Each of the broad programmatic objectives of the NATIONAL PROGRAMME will be defining a set of Service Delivery Areas (SDAs) with expected results (Outputs) and the list of major interventions (activities) as the process of attaining the planned results. The interventions and the output targets of the SDAs should be adequate in the content and scale to ensure that collectively they contribute towards attainment of the broader objectives (outcomes) and goals (impact level targets) of the NATIONAL PROGRAMMES. Thereby selection of relevant intervention for the specific country contexts is a key to the overall soundness of the NATIONAL PROGRAMME and to ensuring a strong logical chain from the identified interventions (process) to the output targets and the broader outcome and impact level targets. In Step 3 we already noted that for countries that have no official or draft NATIONAL PROGRAMMES, the subject of the Global Fund application may be referred as the PROGRAMME 4. Thus the GFATM proposal development shall define the results-based framework of the goals, objectives, programmatic areas and and corresponding impact, outcome and output targets How to assess if the selected Service Delivery Areas and interventions within the NATIONAL PROGRAMMES are appropriate? Consider the following 3 questions: Are we targeting the right population groups? Are we doing the right things? Are we doing the things on a large enough scale? 6 Q1. Are we targeting the right populations groups? Once again the country teams should refer to the context analysis for the population groups and the size of the target population identified as the priority focus for the NATIONAL PROGRAMME (Step 1). Are the Service Delivery Areas prioritizing prevention, treatment, care and support interventions among the key priority populations identified through the context analysis (both men & women, girls & boys, rural and urban populations; poor and affluent; adults and children; children in and out of school; migrant vs. native born; most-at risk and marginalized groups, including sexual minorities; and various combinations 6 A handbook for Planning and Managing for HIV/AIDS Results. IBRD/The World Bank. 2007, and 6

of these). If any of the population groups are missed out identify as the programmatic gap and discuss with stakeholders the need to add relevant SDA/interventions. Q2. Are we doing the right things? This question looks at the technical soundness and appropriateness of the selected SDAs and the planned interventions whether they correspond to the best international practices, as defined by the WHO Global Health-Sector Strategy for HIV/AIDS and other WHO and UNAIDS strategies and guidance 7. As there is no one list of the proven evidence-based interventions that the countries could review, we recommend that the country teams take a look through the following four references: 1. The Global Health-Sector Strategy for HIV/AIDS 2003-2007 (WHO) summarizing the core components of a Health Sector Response to HIV/AIDS. Please see the Appendix A to the current note for the list of these core components. 2. Monitoring and Evaluation Toolkit for HIV, Tuberculosis and Malaria (February 2009, Third Edition, Part 2, Table 11) provides a list of SDAs and the output level indicators. The list can serve as a useful guide to the country teams to assess the technical soundness of the approaches that are currently applied by the NATIONAL PROGRAMMES. The same SDAs are provided in the drop-down boxes of the HIV Performance Framework of the GFATM Application form and for easy reference we are summarizing the SDAs and the Output Indicators in the Appendix B to the current note. 3. Practical Guidelines for Intensifying HIV Prevention (UNAIDS). This document is useful for checking appropriateness of the prevention interventions that are currently implemented within the NATIONAL PROGRAMMES. The Guidelines spell out the building blocks of the prevention approaches and recommended prevention interventions for general population and the key affected populations in different epidemic scenarios (low-level, concentrated, generalized and hyperendemic). For easy reference the tables from the guidance are included in the current note as Appendix C. 4. Finally, the country teams could refer to Annex 3 of the GFATM Round 9 Guidelines for the list of the disease focused and HSS interventions that Global Fund will support. If any of the proven interventions for preventive, treatment, care and support that needs to be provided in the specific epidemiological context to the target population groups are not yet considered identify as the gap and discuss with stakeholders what additional interventions are essential to be included in the overall NATIONAL PROGRAMME frameworks. Q3. Are we doing the things on a large enough scale? This question looks at both geographic and population-based access to and uptake of the needed services by all affected populations and whether the access and the existing service delivery systems are adequate to reach the ambitious coverage targets for Universal Access. Look at the population-based coverage targets of the specific prevention, treatment, care and support interventions. Are they ambitious enough to reach the overall national goals and objectives? If no identify as the gap and revise the targets in agreement with the stakeholders. If the population-based coverage targets of the SDA interventions are ambitious, and no changes are needed, assess the current trend of the SDA coverage. Is the country on track towards meeting the set output targets for prevention, treatment, care and support under the NATIONAL PROGRAMME? If no identify the coverage gap and discuss with the stakeholders the essential measures to accelerate the scale up of the interventions. Are there differences in equity of access to services between men vs. women, rural vs. urban populations, poor vs. affluent, adults vs. children, children in and out of school, migrant vs. native born, etc. If yes identify the coverage gap and discuss how to accelerate equity in access. Identify the geographic areas where progress in implementation of the SDA intervention is stagnating or off the track to meet the output targets. Also based on the latest epidemiological data identify the new geographic locations where the priority services under the SDAs have to be expanded to reach the most in need groups. If any geographic location where the key affected populations need to access the services are not included in the NATIONAL PROGRAMME or if the current coverage of the intervention in any priority geographic locations is not adequate identify as the gap and discuss with stakeholders the strategies how to accelerate or expand the services in those priority geographic locations. 7 Guidelines for Proposals Round 9. The Global Fund to fight AIDS Tuberculosis and Malaria. 2008 7

STEP 5 Assessing the level of engagement and the capacities of the governmental and non-governmental partners in implementation of the NATIONAL PROGRAMME Comprehensive NATIONAL PROGRAMMES are designed to be implemented through a multi-sectoral approach to create demand for, access to and uptake of services at national, sub-national and community levels. List all governmental and non-governmental partners engaged in implementation of the SDAs/ interventions under the NATIONAL PROGRAMME at the national, sub-national and community levels. Does the implementation plan consider all relevant stakeholders both governmental and nongovernmental sectors (NGOs, FBOs, CBOs, networks of people living with HIV, organizations representing key affected populations, private sector, and education/academic sector) to implement the interventions at targeted scale? If any of the key sectors or players have been missed out identify as the gap and discuss with stakeholders how to engage the stakeholders Assess the management and operational capacity of the governmental and non-governmental partners in implementing the interventions at the targeted scale. If any of the capacities need to be strengthened identify as the gap and discuss with stakeholders how to strengthen the partners capacities. STEP 6 Assessing the health and community systems capacity in delivering and tracking progress in implementation of the NATIONAL PROGRAMME This step intends to reveal major bottlenecks in the national health systems and the community systems that impedes demand for, access to and delivery of the prevention, treatment, care and support interventions identified within the NATIONAL PROGRAMMES. Countries are encouraged to use any available SWOT analysis of the national health systems from the national health sectoral or system reviews. The detailed guidance on Health System Strengthening component is available from the Physicians for Human Rights (http://www.physiciansforhumanrights.org/hiv-aids/globalfundround9.html) and we recommend the countries to refer to the document for detailed guidance. Similarly a technical guidance on Community System Strengthening is available from UNAIDS and the International HIV/AIDS Alliance and here too we recommend the countries to consult the document (web-link tbc). Based on review of the above documents and the results of the analytical work summarize the current gaps across the health systems and the community-level services and discuss the potential approaches to overcome the current bottlenecks with the stakeholders Though the M&E review would be an integral part of the health system review, we would like to reiterate the need for paying a special attention to M&E system capacities in monitoring the output, outcome and impact level indicators identified within the NATIONAL PROGRAMMES, to ensure that the relevant capacities are in place to track the progress in the overall national response. Are all indicators included in the established M&E plans and systems in the country? Are measurement tools and systems in place to track the indicators? If not identify as the M&E system gap and discuss with the stakeholders the additional needs for closing the gaps STEP 7 Compiling information on the existing and pledged resources from the domestic and external sources for the NATIONAL PROGRAMME, including the previous GFATM grants List all existing or pledged resources (both financial and technical) available from the domestic and external sources, including the previous GFATM grants for implementation of the current SDAs/interventions under the national programmes. If any of the SDA interventions remain unfunded within the NATIONAL PROGRAMMES identify as the financial gap within the current response. For each of the additional programmatic gaps identified by the country team through Steps 2-6 of the gap analysis, indicate any potential resources (domestic or external) for covering these additional programmatic interventions. If no potential source of funding can be identified identify as the financial gap for the additional programme interventions. It is imperative to demonstrate that any funding requested for the GFATM is additional to the country's own contributions to the disease both from domestic and external support, and is not displacing existing 8

or known funding streams. And analysis of the financial gaps within the overall NATIONAL PROGRAMMES is the first step towards defining the funding requests to GFATM. STEP 8 SUMMARIZING THE PROGRAMMATIC GAPS AND AREAS FOR ADDITIONAL PROGRAMMATIC AND FINANCIAL SUPPORT WITHIN THE OVERALL NATIONAL PROGRAMME Link to the Summarize the results in sections 4.3.1, 4.3.2 and 4.3.3 GFATM Application Summarize all gaps identified through the steps 2 to 7: 1. Any revisions that need to be made to the current goal and objectives of the NATIONAL PROGRAMME and the corresponding impact and outcome targets. 2. The key affected population groups (men vs. women, rural vs. urban, etc) that have been left out of the current national response or the groups that need additional focused attention based on the latest dynamics of the epidemics. 3. The additional evidence-based interventions across the preventive, treatment, care and support areas that need to be included in the NATIONAL PROGRAMMES based on the latest dynamics of the HIV epidemic in the country or in light of the newly emerged scientific evidence. 4. Any revisions of the output targets for prevention, treatment, care and support interventions in order to reach the ambitious Universal Access targets of the NATIONAL PROGRAMME. 5. Geographic areas where the prevention, treatment, care and support services need to be scaled up or expanded to ensure equal access by all affected populations, including the new locations prioritized by the latest context analysis. 6. The governmental and/or non-governmental sector partners that need to be more actively engaged at the national, sub-national and community levels 7. The capacity building needs of the major partners already involved or to be engaged in the implementing of the NATIONAL PROGRAMME. 8. Health system bottlenecks impeding demand for, access to and uptake of the health system based prevention, treatment, care and support interventions both for the interventions already underway and the additional interventions to be included in the NATIONAL PROGRAMME 9. Community system bottlenecks impeding demand for, access to and uptake of the prevention, treatment, care and support interventions both interventions already underway and the additional interventions to be included in the NATIONAL PROGRAMME 10. Gaps in M&E tools and systems to adequately track the progress in impact, outcome and output level indicators both under the current response and the additional interventions to be included in the NATIONAL PROGRAMME 11. Interventions that remain unfunded under the current NATIONAL PROGRAMME, and the 12. The additional programmatic interventions for attainment of the national Universal Access targets that has not potential source of funding. In efforts to facilitate comprehensive analysis of the programmatic and financial gaps, we are proposing a table that could assist the proposal writing teams in visualizing all major components of the analysis and reflection of the requested information in the specific sections/sub-sections of the GFATM proposal forms through the special links. 9

PROPOSED FRAMEWORK FOR THE COMPREHENSIVE GAP ANALYSIS OF THE NATIONAL PROGRAMMES AND PRIORITIZATION OF SDAS/INTERVENTIONS FOR THE GLOBAL FUND APPLICATIONS Summarize the data of the populations groups to be prioritized by the NATIONAL PROGRAMMES, based on the context analysis Ref.: Step 1. Key populations to be prioritized by national programmes/plans General population Size of the target population Total Female Male Whole Country Geographic Location of the population Specific Region(s) Please specify Why this group? Comment on the latest HIV trends in the group or the HIV disease burden attributable to the group Risk behaviors and other Driving factors that contribute to higher HIV rates in this groups Additional comments Population sub-groups. Please specify i.e. youth, pregnant women Most-at-risk population (MARP) please specify i.e. IDUs Orphans and Vulnerable Children (OVCs) Please add additional lines as necessary List the broader overarching goal(s) and objectives of the NATIONAL PROGRAMME National Goals and Objectives Please copy from the NATIONAL PROGRAMME frameworks Impact and Outcome Indicators Please select from the NATIONAL PROGRAMME Targets set by the NATIONAL PROGFRAMME Baseline for the selected indicator (2008) Are these targets adequate for reaching the desired health outcomes and behavior changes in the priority populations? M&E system and tools in place to track the progress in impact and outcome indicators? Goal 1: Target by end of the NATIONAL PROGRAMME Targets by 2014 (if later than the final year of the NATIONAL PROGRAMME) If no suggest revisions of the Impact/Outcome Targets If No, Indicate the existing M&E System Gap Goal 2: Goal 3: Copy additional lines for the Goal(s) as needed The national programme goals and the impact/outcome targets should be copied into the HIV Performance Framework - Attachment A of the GFATM Applications. If any of the goals or impact/outcome targets are changed, the changed statements should be copied into the HIV Framework. 10

List the Broad Programmatic Objectives (also referred as the Broad Programmatic Areas or Strategic Directions) of the NATIONAL PROGRAMME Copy the current page for each of the Broad Programmatic Objectives and the SDAs identified in the NATIONAL PROGRAMME framework and number accordingly Broad Programmatic Objective 1: SDA 1.1. Copy from the National Programme Copy from the National Programme Output Indicators Output Indicator 1.1 Output Indicator 1.2 Output Indicator 1.3 Output Indicator 1.4 Output Indicator 1.5 (State 2-5 core output indicators under the SDA as reflected in the national programme) Baselines (State 2008 or the most recent baseline estimates for the 2-5 core output indicators) Targets (State output targets for the 2-5 core indicators by end of the national programme or by 2014, if the national programme ends earlier) 1. Are we targeting the right populations? If NOT, specify the groups missing out. 2. Are we targeting equally the population groups - men vs. women, urban vs. rural, etc.? If NOT, specify which group is missing out. 3. Is the interventions evidence based? If NOT, what additional interventions should be included in the NATIONAL PROGRAMME? Ref.: Appendixes A-C 4. Is the scale of the intervention large enough to meet ambitious UA targets? If NOT suggest needed revisions 5. Is the intervention reaching all affected geographic locations? If NOT, specify regions were the interventions need to be expanded 6. If the country on track of meeting the output targets? If NOT, specify geographic locations where the interventions should be accelerated 7. List key Government, private and NGO sector partners engaged in implementation of the SDA intervention 8. What are the operational and technical capacities that the current partners need to strengthen? 9. Is there a need to engage other sectors or players in implementation of the SDA intervention 10. What are the operational and technical capacities that the new partners will need to strengthen? 11. Summarize HSS challenges impeding implementation of the SDA interventions 12. Summarize CSS challenges impeding implementation of the SDA interventions 13. Are M&E tools and mechanisms in place to track progress in the current SDA interventions or the additional interventions that need to be included (ref.: Question 3). If NOT, specify the M&E gaps 14. Summarize resources available for the SDA from Government and nongovernmental partners, including the previous Global Fund grants. 15. Is the SDA fully funded as planned under the current NATIONAL PROGRAMME? If NOT indicate the interventions that remain unfunded. 16. Can any of the partners fund the additional interventions identified through Questions 3-6 and 8-13? If NOT indicate the additional interventions that has no potential source of funding? 17. Discuss with the CCM partners and country proposal writing teams, which of the identified GAPS should be included in the GFATM Applications. 11

STEP 9: Agreeing on additional programmatic and financial needs to be included into the GFATM applications Based on the information compiled through the Steps 2-8 agree which of the additional programmatic interventions (both disease specific, HSS and CSS) and the associated additional financial needs will be prioritized for the GFATM applications. The discussions should involve all concerned partners from governmental and non-governmental sectors through a broad and inclusive consultation. Summary of the programme and financial gaps that will be included into the GFATM application Link to the Global Fund APPLICATION FORM The evidence-based interventions that will be included in the GFATM application. These will include: - Priority intervention under the current NATIONAL PROGRAMME both disease-specific and HSS to be scaled up or that remain unfunded till 2014 - The additional evidence based interventions both disease specific and HSS - that should be prioritized by the NATIONAL PROGRAMMES and that have no identified source of funding Each of the intervention to be described in section 4.5.1. Additionally reflect all interventions targeting M&E system improvements in s 4.8.3 Additionally reflect all capacity building activities for government & nongovernmental partners in s 4.7.1 and 4.9.1 for PRs If partners agree to apply for cross-cutting HSS application relevant inputs to be included in the s 4B For each of the activity identify any available co-funding: - From GOV and other non-global Fund source s4.6.2 - From other Global Fund sources s4.6.1 - From private sector s4.6.3. - Co-funding from all domestic sources in s5.1line B - Co-funding from all external non-gf resources s5.1 line C - Co-funding from all other Global Fund grants s5.1 line D Three to six of the core interventions to be summarized in s 4.4. Indicators for the major SDA interventions to be reflected in Attachment A HIV Performance framework Target populations of the interventions to be supported within the GFATM application Geographic coverage of the interventions to be supported by the GFATM application The key affected population groups (men vs. women, rural vs. urban, etc) that have been missed out from the current national response that will receive additional focused attention in the GFATM application. Reflect in s 4.2.1 (b) and s 4.2.2. Reflect in s 4.2.1 (a) s4.5.4 reflecting how the application will contribute to the social and gender equity 12

Annexes to the Technical Guidance for Round 9 Global Fund HIV Proposals DRAFT for Comment ANALYSING PROGRAMMATIC AND RESOURCE GAPS Appendix A Core components of a Health Sector Response to HIV/AIDS Ref.: WHO Global Health-Sector Strategy for HIV/AIDS 13

Appendix B Ref.: MONITORING AND EVALUATION TOOLKIT HIV/AIDS, TUBERCULOSIS AND MALARIA. Third Edition February 2009, Part 2 14

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Appendix C Prioritized HIV Prevention Measures for Key Audiences Ref.: Practical Guidelines for Intensifying HIV Prevention. UNAIDS. 2007 17

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