Sustainability Transition Cofinancing STC Progress Ongoing Challenges CSO

Sustainability, Transition & Co-financing (STC): Progress & Ongoing Challenges CSO CCM DIALOGUE FORUM, ANGLOPHONE AFRICA 1 OCTOBER 2019 NAIROBI, KENYA GEMMA OBERTH, REGIONAL PLATFORM COORDINATOR, STRATEGIC INITIATIVE

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An integrated approach 04 Enabling Environment 01 Planning Insufficient domestic investments to address human rights related barriers, and continued legal and policy environments that restrict access to services 05 Civil Society Strengthen the ability of civil society to continue providing services, engaging in advocacy, and mobilizing sufficient additional resources to ensure a robust continued role in disease responses 06 Efficiency Sub-optimal use of external and national resources, and need for ongoing integration of vertical disease programs into health systems Need for greater, early, robust identification of country specific bottlenecks and transition and sustainability planning, aligned with broader country planning and budgeting Efficiency Civil Society 05 06 02 Financing Planning 04 Enabling environ ment 01 03 Health Systems *The list is not exhaustive and will always be determined by country context 02 Financing Insufficient domestic financing and cofinancing of GF supported interventions, with a particular focus on services for key and vulnerable populations; ongoing treatment financing concerns 03 Health Systems • Limited service integration and need to engage with health system related reforms • Need for strengthening and aligning monitoring, evaluation, and data systems • Challenges to ensure continued access to quality-assured health products with domestic finance, including sufficient capacity of domestic procurement systems

Strengthening Public Financing of Civil Society Service Provision (i. e. , “Social Contracting”) • • Strengthening public financing of service provision to key and vulnerable populations is essential to efforts to control the epidemics; particularly since a significant percentage of these programs are still dependent on external financing across the GF portfolio Enhanced efforts in 2017 -2019 to support effective transition to domestic financing and management, but need for scale up in 2020 -2022 DIALOGUE v Global consultation on government financing of programs implemented by civil society with partners, civil society and governments (October, 2017) v “Latin America and Caribbean regional meeting on public financing of CSO for the delivery of services: progress, challenges and lessons learned” (June 2018) DESIGN Foster global, regional and country dialogue, with partners v Regular engagement and joint country work with partners, including UNAIDS, USAID, UNDP, others v Aligning GF grants (SR contracting, M&E) to public procedures and systems Leverage grant design and A 2 F cycle v Using GF grant funds to pilot contracting mechanisms v Strengthening CSO linkages with government services v Supporting capacity building for government and CSOs v Negotiating co-financing commitments for absorption of interventions for KVP implemented by CSOs v Strengthening CSO cost-efficiency & communication of their contributions to national responses v Inclusion of thematic area in regional and global meetings (ie, WHO meeting on transition to domestic financing) v Supporting accountability mechanisms (i. e. patients scorecards, community-led monitoring) KNOWLEDGE v Inclusion of module within internal STC Course focused on enhancing capacity for key GF Secretariat stakeholders v Collection of and development of best practices and lessons learned Improved capacity and knowledge Technical assistance TECHNICAL ASSISTANCE v Development of Diagnosis tool on Public financing for CSO health service delivery, to strengthen analytics alongside sustainability and transition planning. v In-depth analysis on domestic mechanisms available to publicly fund delivery of services via STE-SI. v Step-by-step support to organizing public procurement of health services delivered by CSOs (from technical 4 specifications, to contracts, to M&E)

Strengthening Public Financing of Civil Society Service Provision (i. e. “Social Contracting”) Illustrative Examples MONTENEGRO, SERBIA, GEORGIA, UKRAINE: alignment of unit costs for HIV prevention services of key population for improved efficiency and basis of domestic takeover of services. KAZAKHSTAN, TAJIKISTAN: strengthening of CSOs capacity to deliver services + advocacy towards long-term sustainability DOMINICAN REPUBLIC, PANAMA, COSTA RICA: UKRAINE, BELARUS: grant support multiple pilots to setco-financing commitments+ key milestones up and strengthen CSO contracting at municipal, set in performance framework to ensure regional and national level institutional follow-up BELIZE: Support the setting up of an umbrella CSO network that helps coordinate smaller CSOs to represent them in accessing public funding. PANAMA, ALBANIA, KOSOVO: comprehensive TA to set up policy and procedures for public procurement of health services delivered by CSOs. GUYANA: coordinated support with partners to advocate and support development of procedures and implementation of public funding for CSOs + costing of CSOs services. Launch of first public call for proposals in Q 2 2019. PERU, BOLIVIA, PARAGUAY, SURINAME, HONDURAS, ECUADOR: Conducted Diagnosis tool on Public financing for CSO health service delivery COLOMBIA: grant designed to allow replication of the public contracting of CSO after GF exit MONTENEGRO, SERBIA: GF and domestic funds are managed together through national CSO contracting mechanisms. MOROCCO: manual outlining the modalities of engagement of CSOs with the MOH + trainings for CSOs on social contracting BOTSWANA: along with partners supported government to define a roadmap to put social contracting in place + support to develop the mechanisms. MULTI-COUNTRY GRANTS IN AELAC & MENA: grants focused on the sustainability of services for key and vulnerable populations, including increasing of domestic funding for interventions targeting KVP, strengthening/expanding CSO contracting mechanisms.

Strengthening CCM engagement in Sustainability & Transition priorities, including via CCM Evolution Approach: § Recognizing the importance of STC to the GF’s strategic goals and the key role of CCMs, the CCM evolution is working to strengthen a strategic approach to sustainability, transition, and co-financing across the four key Evolution areas (linkages, engagement, oversight, functioning). Greater emphasis of STC elements in core CCM requirements and guidelines, including (but not limited to): CCM membership (ensuring engagement of key players); monitoring co-financing compliance as part of strategic oversight, and strengthening CCM alignment with other governance bodies in the national health landscape. § Linkages § Developing roadmaps for the CCM strategic repositioning within the national health landscape. § Fostering on-going country dialogue and strengthening alignment with relevant in-country stakeholders to contribute towards a sustainable health response. Engagement § Strengthening meaningful participation of all stakeholders, particularly civil society to engage more effectively. § Enhancing synergies between Community Based Monitoring organisations and oversight committees for purposes of data triangulation, sustainability and quality responses. Strategic Oversight § Oversight of alignment of grants with national strategic investment and priorities. § Strengthening data-driven divisions to better track and influence co-financing commitments. § Strengthening CCM Oversight Committees to engage in broader health systems and health sector discussions. CCM Functioning § Strengthening ethical leadership and governance to anchor CCMs’ mandate to lead and/or contribute towards good governance for health, and encouraging necessary representation on CCMs, such as the Minister of Finance, Minister of Planning, etc. § Instituting a robust results-based management system for CCM secretariats that ensures accountable and sustainable structures. 6