Health Action AIDS

Toolkit for Using Round 9 of the Global Fund for Health Systems Strengthening

The current funding round of the Global Fund to Fights AIDS, Tuberculosis and Malaria provides applicants with an excellent opportunity to secure funds for critically needed health systems strengthening. The Fund is committed to supporting health system strengthening interventions that are necessary to overcome health system constraints to improved outcomes in combating any or all of its three priority diseases. Applicants should review the exact criteria in the Global Fund's Guidelines for Proposals for Round 9, which launched on October 1, 2008. The Guidelines are available on the Global Fund's website, TheGlobalFund.org.

PHR strongly encourages countries to take advantage of this opportunity, using Round 9 to overcoming fundamental health system and human resource constraints to successful and sustained scale-up of HIV, TB, and malaria interventions, including as appropriate by using Round 9 to fund portions of national health workforce strategies.

To support applicants in including health systems strengthening interventions in their proposals, PHR and the Health Workforce Advocacy Initiative, in collaboration with Health Systems 20/20, have developed a Health Systems Strengthening Toolkit for Global Fund Round 9 Proposals. This toolkit includes information on how to use the Global Fund to support health systems strengthening, key opportunities that the Global Fund presents, technical support providers (French) (Spanish) to assist applicants in developing proposals, background information on health systems and the health workforce, as well as information on community systems strengthening. The packet includes PHR's Guide to Using Round 9 of the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening. The packet also contains information to support countries in developing approaches to their health workforce and health systems that are grounded in human rights.

Please Note: The deadline for Round 9 proposals has been extended to June 1, 2009.

Health Systems Strengthening Toolkit for Global Fund Round 9 Proposals

• Introduction to Toolkit (French) (Spanish)
• Overview of Health Systems Strengthening in the Context of Global Fund
• Background on Health Systems Strengthening
• Community Systems Strengthening and the Global Fund
• Human Resources for Health (HRH)
• Country Specific Examples

Overview of Health Systems Strengthening in the Context of Global Fund

1. Friedman, Eric A. October 2008. Guide to Using Round 9 of the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening. Washington, DC: Physicians for Human Rights. (French) (Spanish)
   
   The Global Fund to Fight AIDS, Tuberculosis and Malaria holds much potential for advancing health systems strengthening (HSS) efforts in the international community, including supporting cross-cutting HSS interventions that benefit more than one of the Global Fund’s three target diseases. This Guide provides information on how to use the Global Fund to support HSS, key opportunities that the Global Fund presents for HSS, advice on developing a strong HSS-related proposal, and more. It is intended for use by Country Coordinating Mechanisms (CCMs) as well as other who will be involved in proposal development.
   
2. Global Fund to Fight AIDS, TB and Malaria. November 2007. Strategic Approach to Health Systems Strengthening: Decision Point GF/B16/DP10. Geneva, Switzerland. (French) (Spanish)
   
   This document, from the Global Fund Sixteenth Board Meeting, outlines the Board’s decision to provide funding for health systems strengthening actions within the overall framework of funding technically sound proposals focused on HIV/AIDS, tuberculosis and malaria.
   
3. World Health Organization. The Global Fund and Health System Strengthening: How to Make the Case, in a Proposal for Round 8? Working Draft. Geneva, Switzerland. (French)
   
   This brief paper summarizes some critical points that proposals with HSS activities should make to have a strong chance of success. Country examples from Tanzania, Malawi, Kenya, and Rwanda illustrate credible lines of argument.
   
4. Global Fund to Fight AIDS, TB and Malaria. October 2008. Excerpts on Health Systems Strengthening from Guidelines for Proposals - Round 9 and Global Fund, Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis and Malaria (2nd ed.) Addendum March 2008 (March 2008). Geneva, Switzerland. (French) (Spanish)
   
   The Guidelines for Proposals is the official Global Fund document that guides applicants through the proposal development process. These HSS excerpts include portions of the Guidelines that are focused on HSS, as well as the HSS section of the Global Fund’s Monitoring & Evaluation Toolkit. Applicants should be sure to review the full Guidelines for Proposals, not only those excerpts included here.
   
5. Global Fund to Fight AIDS, TB and Malaria. September 2008. Global Fund Fact Sheet Series, 5 of 6: The Global Fund's approach to health systems strengthening. Geneva, Switzerland. (French) (Spanish)
   
   This factsheet includes an explanation of HSS in the context of the Global Fund’s mandate. Applicants are encouraged to incorporate responses to Health System constraints and gaps within their proposals. The factsheet provides direction for applicants on how to clearly include HSS interventions in proposals and how to develop strong requests for funding. It also depicts the different ways in which HSS cross-cutting interventions can be included.
   

Background on Health Systems Strengthening

6. World Health Organization. 2007. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland.
   
   This document provides valuable background information on health systems, as it seeks to promote a common understanding of health systems and what constitutes health system strengthening. It defines and explains six building blocks of health systems, and provides insights into major health system challenges and opportunities. It also provides a framework for WHO’s own current and increasing role in improving the performance of health systems.
   
7. Hunt, Paul. January 2008. Promotion and protection of all human rights, civil, political, economic and cultural rights: Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. New York, NY: United Nations General Assembly.
   
   The right to the highest attainable standards of health provides important guidance on developing an effective and integrated health system. There is an increasing acknowledgement that strong health systems are essential to a healthy and equitable society. Taking into account good health practices as well as the right to the highest attainable standards of health, this report identifies general approaches to strengthening health systems. These approaches should be applied consistently and systemically across a set of "building blocks," which together constitute a functioning health system.
   

Community Systems Strengthening and the Global Fund

8. Global Fund to Fight AIDS, TB and Malaria. September 2008. Global Fund Fact Sheet Series, 2 of 6: Community systems strengthening. Geneva, Switzerland. (French) (Spanish)
   
   ‘Community systems strengthening’ (CSS) refers to initiatives that contribute to the development and/or strengthening of community-based organizations in order to improve knowledge of, and access to, improved health service delivery. The mounting scale of HIV, TB and malaria, and the more recent availability of significant financial resources to respond to these diseases, has increased pressure on national systems to scale-up and improve the quality of implementation efforts. Scaling up the response to the three diseases will not be successful without strengthened community systems. The Global Fund encourages applicants to include measures to strengthen community systems relevant to in-country contexts on a routine basis in proposals for new and continuing funding. This factsheet provides a basic overview of community systems strengthening, its importance, and how to incorporate CSS into Global Fund proposals.
   
9. International HIV/AIDS Alliance. 2008. A framework for analysing and organising data regarding community system strengthening in Round 8. Brighton, United Kingdom. (French) (Spanish)
   
   This framework aims to help with assessing community systems strengthening (CSS) needs and organizing data and costs for integrating CSS into proposals. The Global Fund has given a broad description of CSS and this framework provides focus for consultation and planning by proposing further details of core processes that may be considered for strengthening.
   
10. Global Fund to fight AIDS, TB and Malaria and International HIV/AIDS Alliance. September 2008. Civil society success on the ground: community systems strengthening and dual-track financing. Geneva, Switzerland and Brighton, United Kingdom.
    
    This report aims to increase understanding of the range of ways in which the Global Fund can support – and has supported – civil society activities, including those of community-based organizations. To outline the many different models of community systems strengthening, this report includes case studies from civil society organizations in Cambodia, India, Mongolia, Peru, Senegal, Somalia, Thailand, Ukraine and Zambia. All nine case studies examine HIV grants, but the examples are also illustrative of tuberculosis and malaria grants. The report also illustrates a range of examples of dual track financing, and addresses topics including civil society activities to integrate HIV services with sexual and reproductive health services.
    

Human Resources for Health (HRH)

11. Adano, Ummuro and James McCaffery. October 2008. Global Fund Round 9 Opportunity to Build Human Resource Management Capacity: the central pillar in health systems strengthening initiatives. Washington DC: Capacity Project (funded by USAID). (French) (Spanish)
    
    Many countries do not have adequate capacity to manage their current health workforce, let alone to effectively manage increased numbers of health workers and new funding for human resources, or to effectively develop and implement health workforce strategies and policies.. Round 9 of the Global Fund provides an opportunity to build human resource management capacity to enable countries to effectively use expanding funds for the health workforce and to successfully implement health workforce strategies and policies at the national, district, and facility levels. This short document outlines ways in which the Global Fund can be used to build this capacity.
    
12. Cooper, Maggie and Eric A. Friedman. August 2008. The Right to Health and Health Workforce Planning: A Guide for Government Officials, NGOs, Health Workers and Development Partners. Washington, DC: Physicians for Human Rights. (French, part 1) (Spanish, part 1) (French, part 2) (Spanish, part 2)
    
    The health workforce, improved health outcomes, and human rights are inextricably linked. Not only is a strong health workforce needed for improved health and fulfilling human rights, but human rights are needed to develop the workforce that can lead to overall better health. This guide explains why it is necessary to ground health workforce planning in human rights, and how to develop a plan that does just that. Health and other government ministry officials, civil society, health workers, and development partners can use this tool as they develop or revise health workforce plans. The strategies contained in this guide can also inform interventions, approaches, and priorities in health workforce development that can be incorporated into Global Fund proposals.
    
13. Association of Nurses in AIDS Care & Physicians for Human Rights. 2008. Statement on the rights of nurses to health and safety – a global call to action. Akron, OH and Washington, DC. (French) (Spanish)
    
    This statement is a global call to action that draws attention to the need for workplace health and safety measures for nurses and other health care workers. It has been widely endorsed by organizations and individuals from around the world. Global Fund applicants should consider how they might incorporate these measures into their proposals.
    
14. Health Workforce Advocacy Initiative. 2008. Guiding Principles on National Health Workforce Strategies. (French) (Spanish)
    
    The guidelines are intended primarily for the policymakers and other people involved in developing and evaluating these plans, including ministry of health officials, health workers, civil society advocates, development partners, and technical advisors. What should these plans – which should be country-developed and country-led – contain? How should they be developed to give them the best chance of significantly improving health outcomes and moving countries as rapidly as possible towards universal access to essential health interventions? The guidelines should serve as overarching principles that will promote the success of health workforce plans, while ensuring that they are consistent with human rights.
    

Country Specific Examples

15. Lesotho Country Coordinating Mechanism. 2008. Summary of Cross-Cutting Activities from Lesotho’s Proposal from Round 8. (French) (Spanish)
    
    This is a short summary of the cross-cutting health systems strengthening activities that Lesotho included as part of its Round 8 HIV/AIDS proposal. This summary illustrates ways that HSS activities can be integrated into proposals. The Technical Review Panel has recommended this proposal for approval.

*Please see reference #3 for additional country examples from Tanzania, Malawi, Kenya, and Rwanda.

Additional Website References

In addition to the materials included in the toolkit, please refer to the following websites for additional references to support inclusion of health systems strengthening activities in Round 9 proposals.

• Human Resources for Health (HRH) Action Framework.
  
  The HRH Action Framework has been developed as an initiative of the Global Health Workforce Alliance (GHWA) and represents a collaborative effort between the U.S. Agency for International Development (USAID) and the World Health Organization (WHO). The HRH Action Framework provides a way to comprehensively conceptualize and address the health workforce by engaging in six main areas (Human Resource Management Systems, Leadership, Partnership, Finance, Education and Policy). The website provides links to numerous to tools in these areas to support country action.
  
• Support for the Global Fund Round 9 call on health system strengthening (HSS) – specific resources on HSS.
  
  This WHO website lists a number of resources that provide helpful technical guidance for preparing health system strengthening (HSS) activities as part of a proposal to the Global Fund, Round 9.
  
• WHO and UNAIDS resource kit for writing Global Fund HIV proposals for round 8 (includes several HSS resources).
  
  This resource kit was jointly developed by WHO and UNAIDS to provide specific guidance in planning for and writing Global Fund HIV proposals for Round 8. The kit is primarily intended for use by WHO, UNAIDS and other UN staff and consultants as they support country teams in developing Round 8 HIV proposals. The resource kit consists of technical guidance notes, reference documents, practical tools for proposal development, GFATM Round 8 forms, guidelines and key tools and Aidspan Round 8 guides.
  
• The Aidspan Guide to Round 8 Applications to the Global Fund – Volumes 1 and 2.
  
  This guide provide extensive information to support Global Fund applicants, including extensive analysis of the strengths and weaknesses of proposals submitted in previous rounds of funding and a step-by-step guide on filling out the Round 8 proposal form (much of which is identical to the Round 9 proposal form).