Supporting Community Responses to Malaria€¦ · 5/1/2010 · Malaria (GFATM)‘, conducted in...

Supporting Community Responses to Malaria

A Training Manual to Strengthen Capacities of Community Based Organizations in Application Processes of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

Acknowledgements

This training manual is a product of the STOP MALARIA NOW! advocacy campaign and aims

to support community responses to malaria. In particular, this manual aims to improve know-

ledge and skills of Community Based Organizations (CBOs) in application processes of the

Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

The contents are based on results of the needs assessment ‘Capacity Needs of CBOs in Ke-

nya in Terms of Application Processes of the Global Fund to Fight HIV/AIDS, Tuberculosis and

Malaria (GFATM)‘, conducted in June and July 2009.

The study can be downloaded from www.stopmalarianow.org

The contents of the manual were compiled by Dr. Maurice Odindo, Chief Executive Officer,

Community Capacity Building Initiative (CCBI) in Nairobi and Antje Mangelsdorf, Project Co-

ordinator, STOP MALARIA NOW! in Germany.

Appreciation is also expressed for technical input from Ms. Rubina Adhiambo, Programme

Manager, CCBI and Esther Suchanek, Project Manager, STOP MALARIA NOW! The authors

also appreciate the comments and information on community-owned responses to malaria

as well as on national policies and strategies for Global Fund applications provided by Mr.

Edward Mwangi, CEO, KeNAAM.

Contents

Abbreviations ....................................................................................................

List of Figures and Tables ................................................................................

Introduction .......................................................................................................

Why this manual? .....................................................................................................

Who is this manual for? ............................................................................................

How is this manual organized? .................................................................................

MODULE 1: Structure and Work of the Global Fund to Fight HIV/AIDS,

Tuberculosis and Malaria (GFATM)

1.1 Module objectives ...............................................................................................

1.2 What is the Global Fund? ...................................................................................

1.3 Core structures of the Global Fund ....................................................................

1.3.1 Decision-making ..........................................................................................

1.3.2 Operating .....................................................................................................

1.4 Financial resources of the Global Fund .............................................................

1.4.1 Financial Resources .....................................................................................

1.4.2 Current Funding Gap of the GFATM ............................................................

MODULE 2: The Global Fund and Community Based Organizations


2.2 The importance of civil society within Global Fund processes ..........................

2.3 Delivering key services on the ground – CBOs and malaria control ..................

2.4 Possibilities for CBOs to apply for Global Fund grants ......................................

2.4.1 Strengths and gaps of CBOs ......................................................................

2.4.2 Community Systems Strengthening (CSS) .................................................

2.5 Challenges for CBO participation in Global Fund grants ...................................

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MODULE 3: The Global Fund grant-making process


3.2 The Global Fund grant-making process .............................................................

3.3 Actors within the grant-making process of the GFATM ......................................

3.3.1 Country Coordinating Mechanisms (CCMs) ..............................................

3.3.2 Principal-Recipients (PR) and Sub-Recipients (SR) ....................................

3.3.3 Local Fund Agents ......................................................................................

3.3.4 Technical Review Panel ...............................................................................

MODULE 4: How to Apply for Global Fund grants – a roadmap for CBOs


4.2 How to apply for a Global Fund grant .................................................................

4.2.1 Choosing the right strategy - guiding principles of the Global Fund ..........

4.2.2 Minimum prerequisites for a recommendation for funding .........................

4.3 National Strategy Applications ...........................................................................

4.4 Common mistakes in proposals .........................................................................

4.5 Application checklist ...........................................................................................

4.6 Sources of information .......................................................................................

Recommendations for Advocacy ....................................................................

Imprint ...............................................................................................................

6

Abbreviations

ACT Artemisinin-Based Combination Therapy

ANC Antenatal Care

CBO Community Based Organization

CCM Country Coordinating Mechanism

C-IMCI Community-based Integrated Management of Childhood Illness

CORP Community Owned Resource Person

CSO Civil Society Organization

CSS Community Systems Strengthening

DHMT District Health Management Team

DOMC Division of Malaria Control

FBO Faith Based Organization

GFATM Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

HSS Health Systems Strengthening

INGO International Non Governmental Organization

IPTp Intermittent Preventive Treatment of malaria during pregnancy

ITN Insecticide Treated Net

LFA Local Fund Agent

LLIN Long Lasting Insecticide treated Net

MIS Malaria Indicator Survey

MoH Ministry of Health

NGO Non Governmental Organization

NMSP National Malaria Strategic Plan

NSA National Strategy Application

PSO Private Sector Organisation

PR Principal Recipient

SR Sub Recipient

TRP Technical Review Panel

TOR Terms of Reference

ToT Trainer of trainers

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List of Figures and Tables

Fig. 1. Structures of the Global Fund ........................................................................

Fig. 2. Major donors of the Global Fund ....................................................................

Fig. 3. Development of total and disease-specific funding .......................................

Fig. 4. Distribution of funding after seven rounds (HIV/AIDS, TB and Malaria) .........

Fig. 5. CBO participation in Global Fund processes .................................................

Fig. 6. Global Fund grant-making process ................................................................

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25

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Introduction

8

Malaria is a preventable and treatable infectious disease, which is transmitted by mosquitoes

and kills more than one million people each year, most of them in Sub-Saharan Africa, where

malaria is the leading cause of death for children under five. Malaria is a global emergency

that affects half of the world’s population and perpetuates a vicious cycle of poverty in the

developing world.

Scaling up malaria control interventions to prevent and treat malaria is key for Community

Based Organizations (CBOs) in particular, since access to health facilities and awareness

among community members is still quite low in rural areas. This requires increased capacities

and funding for CBOs, enabling them to submit competitive proposals and ensures satisfac-

tory implementation of their projects.

As part of its program, the African-European malaria campaign STOP MALARIA NOW! con-

ducted a needs assessment in Kenya in order to identify capacity needs of CBOs working in

malaria control. The focus of this assessment was on identifying the needs and capacities of

CBOs in terms of resource mobilization, with particular regard to access grants from the Glo-

bal Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) as the world’s largest donor

for malaria control interventions.

The needs assessment was conducted in close collaboration with Community Capacity Buil-

ding Initiative (CCBI), a Kenyan NGO. Within the framework of this needs assessment, 214

organizations were interviewed (190 CBOs, ten local NGOs, nine FBOs and five INGOs) in 24

districts in western, central, northern and coastal Kenya classified as malaria endemic, high-

land epidemic or malaria epidemic.

Major findings of the assessment

CBOs in Kenya play a vital role in attaining universal coverage of malaria control •

tools.

CBOs’ malaria control activities are mainly focused on advocacy and community mo-•

bilization, followed by training in malaria control interventions.

Lack of contacts to and information from relevant authorities are major barriers for •

CBOs when applying for and acquiring funds for running their projects (low information

flow).

Knowledge about the Global Fund and its structures in particular is limited at CBO •

level.

IntroductionWhy this manual?

9

Moreover, the results of the needs assessment show evidence that many CBOs:

Lack ownership in project design and planning.•

Lack financial resources due to dependency on membership fees (87,6% of the inter-•

viewed CBOs have an annual budget below KES 1 million/10,000 EUR).

Have no qualified staff and are mostly dependant on local volunteers.•

Lack adequate access to transport facilities as well as necessary materials and equip-•

ment for community action in the field of malaria control.

Often lack project management skills, including project planning, proposal writing, •

project monitoring and evaluation, financial management and reporting.

Find the Global Fund application process lengthy, complex and distressful – 94,9% of •

the interviewed organizations had not yet applied for GFATM grants.

Are in need of training in application procedures, proposal writing, work plan and bud-•

get development for activities financed through Global Fund grants.

Lack effective representation in the Kenyan Country Coordination Mechanism (CCM).•

The Global Fund provides around 60% of international

funding for malaria. It regards Civil Society Organizations

(CSOs) as core partners for the successful implementation

of its grants. For this reason, the Global Fund stipulates that

at least 40% of all financial resources allocated in a particular

country should go to CSOs, including CBOs and FBOs.

Sadly enough, at least in Kenya, there appear to be various

impediments and bottlenecks in the way of CBO participation

in Global Fund funded programs. Recognizing these bottle-

necks, as well as the comparative advantages that CBOs have in ensuring universal coverage

of malaria control interventions, this training manual is designed to improve knowledge and

capacities of CBOs in terms of Global Fund application and grant management mechanisms,

thereby ensuring that international support reaches the people most in need.

10

Who is this manual for?This manual formed the basis of two 5–day trainings, conducted from November 23-27, 2009

in Kisumu and from December 7-11, 2009 in Malindi. About 50 Community Owned Resource

Persons (CORPs) of the two major malaria-prone areas of Kenya participated in the training,

which aimed to improve the capacity of CBOs in Kenya to apply for funding from the GFATM,

a donor which these grassroots organizations would usually not access. It empowered CBOs

to engage in GFATM processes in order to extend and increase their ability to effectively im-

plement programs as much as possible at the grassroots level. The training also gave partici-

pants the opportunity to network with other CBOs and share examples of good practice, thus

strengthening coordination on the ground. The objective of the trainings was also to increase

the project management as well as monitoring and evaluation skills of CBOs.

The objectives of this training manual are:

To provide Community Owned Resource Persons (CORPs)/CBOs with comprehensive •

information about the GFATM.

To show them a way to become effective partners in malaria programs financed by the •

GFATM.

The intended users of this manual include:

CORPs serving as focal points for CBOs in Kenya and other countries.•

NGOs, INGOs and public authorities working in the area of Community Systems •

Strengthening and malaria control in Kenya and other countries.

This manual is the start of the journey, not its end. We hope it will help to enable Community

Based Organizations to raise funds from donors they do not usually access and specifically

to apply for and manage Global Fund grants. This can only be achieved if willpower is trans-

formed into action by:

Using this manual as a training tool within local communities.•

Developing the capacity of organizations in terms of project management, disease •

control strategies, GFATM application procedures as well as networking.

Demanding and developing training courses to strengthen capacity across the regi-•

on.

Providing us with feedback to keep the manual current and on target.•

We wish you every success in your endeavors.

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How is this manual organized?The manual is divided into four modules. At the beginning of each module, learning objectives

are described. Each module is divided into several chapters.

The Key Points provided at the end of each module are to be used as a check-

list by the trainer. This will ensure that all key issues have been covered and will

help the trainer monitor participants’ learning progress.

Key Reading is suggested for each module. This may form part of the parti-

cipants’ exercises or serve as an additional information source on the topics

presented.

Additional Information and Definitions of particular terms are provided in every

module.

The rationale behind this structure is to allow flexible use of the manual. Depending on the

demand and need of the participants, modules can be added or taken out. We want to en-

courage trainers to adapt the material to each individual training situation and to the infor-

mational needs and demands of the participants. It is important to show participants, from

the beginning, that the training approach is based on the mutual sharing of knowledge and

information. Moreover, the participants’ and trainers’ knowledge is equally respected and

valued throughout the training.

A brief outline of the four modules can be found below:

MODULE 1 introduces structures and work of the GFATM.

MODULE 2 focuses on the role of CBOs in malaria control and their possibilities to

apply for GFATM grants.

MODULE 3 highlights the grant making process of the GFATM.

MODULE 4 provides a roadmap for CBOs how to apply for a GFATM grant.

Recommendations for Advocacy that can be used by CBOs, NGOs and INGOs at various

levels form the final part of the manual.

Module 1

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1.1 Module objectives

By the end of this module, the participants will:

Know what the Global Fund is.•

Describe some achievements of the Global Fund.•

Be aware of the decision-making and operating structures of the Global Fund.•

Have information about the financial resources of the Global Fund.•

1.2 What is the Global Fund?

The Global Fund:

Was created in 2002 and is an independent global • public/private partnership dedica-

ted to raising funds from governments, businesses and individuals around the world

and disbursing these additional resources into grant programs to prevent and treat

HIV/AIDS, tuberculosis and malaria.

Is a • financing instrument, not an implementing entity.

Forms a partnership between governments, civil society, the private sector and af-•

fected communities and therefore represents a new approach to international health

financing.

Has become the main source of financing for programs to fight AIDS, tuberculosis and •

malaria, providing a quarter of all international financing for AIDS globally, as well as

two-thirds for TB and malaria. The Global Fund has now (after nine funding rounds)

approved a total funding of USD 18.4 billion for 144 countries since it was created in

2002.

Finances Health Systems Strengthening (HSS) and Community Systems Strengthe-•

ning (CSS) as program components.

Supports programs which deliver services to hundreds of millions of people. As a re-•

sult, more than four million lives have been saved. 3,000 deaths are averted every day.

Main results include:

The distribution of • 88 million bed nets to protect families from the transmission of ma-

laria, thus becoming the largest financier of insecticide-treated bed nets in the world

(730 million LLINs needed to reach universal coverage by 2010).

The delivery of • 74 million malaria drug treatments (228 million doses of ACTs required

annually to reach universal coverage by 2010).

91 million• people have been reached with community outreach services.

Module 1Structure and work of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM)

Module 1

13

1.3 Core structures of the GFATM

1.3.1 Decision-making

The Global Fund is an independent organization, governed

by an international Board that consists of representatives

from donor and recipient governments, nongovernmental

organizations (NGOs), the private sector (including busi-

nesses and philanthropic foundations) and affected com-

munities. Moreover, the Global Fund consists of a Secreta-

riat, a Technical Review Panel and Local Fund Agents.

The Global Fund Board is composed of representatives

from donor and recipient governments, civil society, the

private sector, private foundations, and communities living

with and affected by the diseases. The Board is respon-

sible for the organization’s governance, including establishing strategies and policies, making

funding decisions and setting budgets. The Board also works to advocate and mobilize re-

sources for the organization. It meets at least twice a year and consists of 26 members (20

with voting rights, six without voting rights) and one elected Chair.

The Global Fund Secretariat manages the grant portfolio, including screening proposals, issu-

ing instructions to disburse money to grant recipients and implementing performance-based

funding of grants. Therefore, the Secretariat is tasked with executing Board policies, mobili-

zing resources, providing strategic, political, financial, legal and administrative support and

overseeing monitoring and evaluation of grants. It is based in Geneva, Switzerland, and has

no staff located outside its headquarters.

The Technical Review Panel (TRP) is an independent group of international experts in the

three diseases and cross-cutting issues such as health systems. It meets regularly to review

proposals based on technical criteria and provide funding recommendations to the Board.

The TRP consists of a maximum of 40 experts. Each expert is appointed by the Board for a

period of up to four funding rounds.

Since the Global Fund does not have staff at country level, it contracts firms to act as ‘Local

Fund Agents‘ (LFAs) to monitor implementation. LFAs are responsible for providing recom-

mendations to the Secretariat on the capacity of the entities chosen to manage Global Fund

grants and on the soundness of regular requests for the disbursement of funds and result

reports submitted by Principal Recipients (PRs).

Module 1

14

1.3.2 Operating

At country level, the Country Coordinating Mechanism (CCM) is an entity composed of key

stakeholders in a country’s response to the three diseases. The CCM should preferably be

an already-existing body, but a country can instead decide to create a new entity to serve as

CCM.

Country Coordinating Mechanisms are central to the Global Fund‘s commitment to local ow-

nership and participatory decision-making. These country-level partnerships develop and

submit grant proposals to the Global Fund based on priority needs at the national level.

After grant approval, they oversee progress during implementation. Country Coordinating

Mechanisms consist of representatives from both, the public and private sectors, including

governments, multilateral or bilateral agencies, nongovernmental organizations, academic in-

stitutions, private businesses and people living with the diseases. For each grant, the Country

Coordinating Mechanism nominates one or a few public or private organizations as accoun-

table entities to administer funding (Principal Recipients).

The Global Fund signs a

legal grant agreement with

a Principal Recipient (PR),

which is designated by the

CCM. The PR receives Glo-

bal Fund financing directly,

and then uses it to imple-

ment prevention, care and

treatment programs or pas-

ses it on to other organiza-

tions (Sub-Recipients) who

provide those services.

Many PRs not only make

sub-grants with other enti-

ties, but implement program

components themselves.

There can be multiple PRs in

one country. The PR also makes regular requests for additional disbursements from the Glo-

bal Fund based on demonstrated progress towards the intended results.

Fig. 1 Structures of the Global Fund

Module 1

PrincipalRecipient

Sub-Recipient

LFA

CCM

5. Disbursement

4. Disbursementof Grant Funds

1. Request forDisbursement withDocumented Results

2. Data Verification &Advice of Releaseof Funds

3. Instructions to Disburse

Secretariat

Global Fund TrusteeThe World Bank

15

1.4 Financial resources of the Global Fund

1.4.1 Financial Resources

Around fifty countries have pledged USD 21.1 billion to the Global Fund so far (from 2001 to

2009), mostly western and middle-eastern nations, but also countries directly affected by the

three diseases, individuals and private enterprises.

The Global Fund publishes funding needs, but does not dictate the origin and amount of

donations. Pledges are made on a goodwill basis. The Global Fund also now has a system

of periodic replenishments, which enables more accurate forecasting of available resources.

This replaces a more ‘ad hoc’ and flexible system of replenishment that was used earlier.

Module 1

1

2

3

4

5

6

Amount pledged (2001-2010) in billion USD

1,2701,4061,418

2,470

3,860

5,430

USA Sweden France EuropeanCommission

Japan Germany

Total approved USD 565 million (including USD 55m for HIV/TB; USD 20m for integrated programs)

USD 846 million in 63 countries

USD 1,119 billion in 66 countries 110 programs

countries approved of a maximum amount of

USD 2,753 billion

HIV/AIDS

Tuberculosis

Malaria

USD 326 million(26 programs)

USD 453 million USD 537 million (26 programs)

USD 1,164 billion (37 countries)

USD 96 million (12 programs)

USD 190 million USD 111 million (19 programs)

USD 327 million (29 countries)

USD 68 million (12 programs)

USD 202 million USD 471 million(28 programs)

USD 1,568 billion (28 countries)

Round 1 (April 2002)

Round 6 (November 2006)



Fig. 2. Major donors of the Global Fund

Fig. 3. Development of total and disease-specific funding

16

Fig. 4. Distribution of funding after seven rounds (HIV/AIDS, TB and Malaria)

1.4.2 Current Funding Gap of the GFATM

USD 13.5 billion are needed between 2008 and 2010 to fully fund all proposals recommen-

ded for funding. Due to the continuously rising number of high-quality proposals, the Global

Fund currently (2009) faces a financing gap of USD 3 billion. Between USD 20-36 billion are

projected to be needed for 2011-2013, whereas to-date pledges for later than 2010 are only

USD 1.8 billion.

Module 1

Sub-Saharan AfricaEast Asia & the PacificEastern Europe & Central AsiaLatin America & the CaribbeanSouth AsiaMiddle East & North Africa

6%8%

8%

9%

12%57%

Geographic Region

Disease

61%

14%

25%

HIV/AIDSMalariaTuberculosis

Drugs Commodities ProductsHuman ResourcesOtherAdministrationInfrastructure & EquipmentMonitoring & Evaluation

3%9%

10%

10%

23%

45%

Expenditure Target

GovernmentNGO/Private SectorMultilateralNot Signed

11%

12%

17% 60%

Sector Represented

17

Module 1

Key Points

The GFATM was created in 2002 and is an independent global public/private part-•

nership dedicated to raising funds from governments, businesses and individuals

around the world and disbursing these additional resources into grant programs to

prevent and treat HIV/AIDS, tuberculosis and malaria.

TheGlobalFundisafinancinginstrument,notanimplementingentity.•

TheGlobalFundhasbecome themain sourceof finance forprograms tofight•

AIDS,tuberculosisandmalaria,providingaquarterofallinternationalfinancingfor

AIDSglobally,aswellastwo-thirdsforTBandmalaria.

CorestructuresoftheGlobalFundencompasstheGlobalFundBoard,theGlobal•

Fund Secretariat, the Technical Review Panel and Local Fund Agents (Decision-

Making)aswellasCountryCoordinatingMechanisms,PrincipalandSub-Recipi-

ents (Operating).

FinancialcontributionstotheGlobalFundaremadeonavoluntarybasis.•

Key Reading

www.theglobalfund.or• g

www.aidspan.or• g

www.avert.org/global-fund.ht• m

Module 2

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Define the term • ‘civil society‘.

Understand the role civil societies play within Global Fund processes. •

Understand why community involvement is key for effective malaria control.•

Understand the challenges of CBOs.•

Know about Community Systems Strengthening (CSS).•

Understand the types of organizations benefiting from CSS initiatives.•

Describe the capacity development needs of CBOs.•

Understand the incorporation of CSS into Global Fund proposals.•

Know about the role of CORPs.•

2.2 The importance of civil society within Global Fund processes

Civil society has been an important and vital partner to the GFATM since the financing

mechanism was first conceived. CSOs contributed to the design and structure of the GFATM,

and have encouraged governments to commit more resources to support its work. Therefore,

CSOs play a fundamental role in resource mobilization for the Global Fund.

But civil society is not only an advocate for the GFATM, it plays an essential role in the over-

sight and implementation of GFATM grants.

Module 2The Global Fund and Community Based Organizations

Civil society

“Civilsocietyiscomposedofthetotalityofvoluntarycivicandsocialorganizationsand

institutionsthatformthebasisofafunctioningsocietyasopposedtotheforce-backed

structures of a state and commercial institutions.” (Wikipedia)

Examplesofcivilsocietyorganizations:

Massorganizations(suchasorganizationsofpeasants,womenorretiredpeople).•

Trade unions.•

Professional associations.•

Social movements.•

Indigenouspeople’sorganizations.•

Religiousandspiritualorganizations.•

Academicandpublicbenefitnongovernmentalorganizations.•

Module 2

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Roles and comparative advantages of local civil society organizations

Local CSOs:

Serve and reflect local communities. •

Are often uniquely placed to determine whether and how the resources reach and •

benefit affected communities.

Play an effective role in targeting hard-to-reach communities and in improving preven-•

tion and treatment literacy.

Advocate and promote policies that will lead to adoption of effective control strategies •

for the three diseases.

Are far more likely than international organizations to provide training and information •

in ways that are culturally, economically and politically appropriate.

Ensure that grants and programs are implemented effectively, efficiently, and for the •

benefit of the entire society and affected countries in particular.

Often lead the way in identifying and implementing innovative strategies and initiatives •

that are included in Global Fund programs.

Have the ability to influence GFATM proposals when directly involved in drafting •

applications.

2.3 Delivering key services on the ground – CBOs and malaria control

Why community involvement for malaria control?

The Alma-Ata Declaration of 1978 underscored the need for concrete and effective commu-

nity action in setting priorities, making decisions, planning strategies and implementing them

to achieve better health. Community participation is critical to the success and sustainabi-

lity of health programs because involving people actively in the planning and implementati-

on of activities encourages the development of skills, institutionalizes appropriate decision-

making capacities within communities, and creates a sense of ownership. Local knowledge,

values, and practices may determine acceptability of facilities meant to help the community.

Continued interaction and communication with the beneficiaries of social projects are thus

important.

Module 2

Article VI

Primaryhealthcareisessentialhealthcarebasedonpractical,scientificallysoundand

sociallyacceptablemethodsandtechnologymadeuniversallyaccessibleto individu-

alsandfamiliesinthecommunitythroughtheirfullparticipationandatacostthatthe

communityandcountrycanaffordtomaintainateverystageoftheirdevelopmentinthe

spirit of self-reliance and self-determination. (Declaration of Alma-Ata)

20

Community action for malaria control is based on the

premise that long-term change in several key behavi-

oral patterns can be implemented in partnership with

communities and families for the control of the disease.

Such change in specific behaviors can lead to early, ap-

propriate recognition and treatment of malaria in additi-

on to undertaking preventive and promotion activities.

Elements of community participation

The basic objectives of involving communities in malaria control are to:

Ensure ownership of malaria control activities by communities.•

Improve quality of home care.•

Build capacity for communities for implementation and sustainability of activities.•

Link malaria control with other development activities.•

Broaden the resource base at community level by facilitating community based finan-•

cing initiatives to ensure sustainability of malaria activities.

Mobilize all segments of society for relevant activities.•

Link community actions with national malaria efforts to control the disease.•

Enhancing community participation in malaria programs

To enhance participation in malaria control activities, the roles and responsibilities at the vari-

ous levels (community, district and national) need to be clearly spelt out. These should include

at least the following:

At community level

Planning and implementation of activities.•

Mobilizing resources and community financing.•

Supervision, monitoring and evaluation of planned activities.•

At district level

Advocacy.•

Strategy formulation, planning, partnership building.•

Coordination of activities of the different partners and stakeholders.•

Guide implementation.•

At national level

Develop enabling policies supportive of community actions.•

Mobilize and allocate resources.•

Strengthen existing institutions and human resources.•

Monitor and evaluate implementation of activities.•

Module 2

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Challenges for community participation

The major challenges of ensuring effective community participation lie in:

Ensuring full participation by communities in the assessment of needs, management •

and evaluation of activities.

Ensuring that mothers/caretakers and family members are able to recognize malaria •

and take immediate and appropriate action.

Maintaining preventive actions especially among vulnerable groups.•

Making appropriate and effective antimalarials close to communities.•

Strengthening health systems (both formal and non-formal) to respond effectively to •

the needs of individuals and communities in the management of malaria.

Establishing a collaborative network of interested government sectors, NGOs, and •

districts to enable sharing of approaches.

Developing appropriate organizational mechanisms for collaboration and for fostering •

political commitment and will.

Building capacities of local communities in all areas of malaria control as well as pro-•

ject management.

Mobilizing adequate resources to support community initiatives.•

Module 2

22

The role of Community Owned Resource Persons in malaria control

CommunityOwnedResourcePersons(CORPs)areindividualsthatresidewithinacom-

munity and have acquired skills that can be passed on to the community to initiate

behavioralchange.Duetotheirpermanentresidencewithinthecommunity,theyform

animportantpartofthehumanresourcebaseofthecommunityandareavailablefor

advice and information. Most CORPs are retired professionals such as nurses, clinical

officers, teachers andadministrators, butmany youthswhoare keen to seechange

in their communities can be trained to serve asCORPs thus ensuring sustainability

ofchangeinitiatives.ThestrengthofCORPsliesinthefactthattheyarecontinuously

available within their respective communities, providing continued support to those in

need of it.

CommunityOwnedResourcePersonscanplayamajorrolein:

Giving advice on disease prevention and treatment at household level.•

Providinginformationoncriticalissuesthatconcernthecommunity.•

Trainingthecommunityindiseaseinterventions.•

Mobilizingcommunities.•

Advocatingforpolicychangeatcommunitylevel.•

Advocatingforbehaviorchangeamongcommunitygroupssuchasyouths,wo-•

men, men, administration, etc.

Linking health administration such as DHMTs and communities.•

Giving communities a voice at forums and meetings at regional or national level.•

LinkingmajordiseasecontrolprogramsandfundingagenciessuchastheGlobal•

Fund,RBM,PEPFAR,TOWA,etc.withlocalcommunities.

Module 2

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2.4 Possibilities for CBOs to apply for Global Fund grants

2.4.1 Strengths and gaps of CBOs

The vast majority of registered CBOs are based in rural areas or urban slums, which are less

developed and bear the burden of poverty. Few people have access to education and health

facilities. Many of the workers and conveners of CSOs, despite entirely noble intentions and

the strongest links to the community, are themselves victims of poverty and, as such, are

often lacking the ability and capacity to mobilize and utilize resources efficiently. Neverthe-

less, CBOs have many strengths that can form the basis of their Global Fund proposals:

Advocacy and mobilization of communities on use of LLINs

Community Based Organizations (CBOs), by definition, are based within areas where they

provide community services. Therefore, CBOs are uniquely placed to mobilize community

members to use LLINs and enhance their use at community level. CBOs can also play an

important role in training Community Owned Resource Persons (CORPs) on net use and

enabling them to act as linkage points between communities and medical facilities, as well

as DHMTs.

Epidemic preparedness and response among communities

A key area in epidemic preparedness is indoor residual spraying (IRS). This is an effective

intervention to mitigate malaria epidemics, and has been conducted by the Ministry of Health

in Kenya. If combined with ITNs, IRS reduces the population of mosquitoes drastically and

has been a key player in the reduction of mosquito populations and malaria incidence. Com-

munity organizations’ role here would cover the sensitization of communities for IRS, and

advocacy for support of IRS programs among the target groups.

Early recognition of malaria and access to effective case management and accurate malaria diagnosis

Communities need to support the efforts of malaria home management programs. Major

constraints to this are inadequate stocks of ACTs as well as poor prescription practices by

health workers not yet trained on the application of new treatment guidelines. A new malaria

treatment policy in Kenya aims at taking health services to Level One (grassroots), which was

approved in 2005 and officially launched in late 2006. Since the program began in 2006,

many health workers, particularly from the nongovernmental sectors, were not reached with

this government-initiated training. The DOMC estimates that half of all health workers have

not been trained to date. As a result, case management in accordance with the new treat-

ment guidelines remains weak. This offers an opportunity for the better-placed CBOs, and

NGOs to follow the approach used by DOMC, which is to conduct three-day trainings through

a cascade approach employing trainers of trainers (ToTs) at the community level.

Module 2

24

Module 2

Limitations of Kenyan CBOs in applying for Global Fund grants

Community organizations in Kenya have

not realized thebreadthofopportunities

that are available for them to apply for

GlobalFundgrants.ThemajorityofCBOs

inKenya focusonadvocacy,community

mobilization, net distribution and vector

control. In a recent community assess-

ment,about90%ofthe201organizations

thatrespondedtoasurveyontheirareasofactivitysaidthattheirorganizationswork

intheareaofadvocacyandcommunitymobilization,while58%saidtheyworkinthe

areaoftrainingandcapacitybuildingofmalariacontrol.About52%oftheCBOssaid

theyworkintheareaofITN/LLINdistribution,51%intheareaofmalariatreatmentand

case management. Another 41% work in the vector control area. The review brought

outtheprecariouspositioninwhichtheKenyanCBOfindsitselftoday.Severalfactors

stoodoutclearly.

CBOs are low in capacity inmost areas - including financial resources, trained•

personnel, materials and equipment.

CBOs lackknowledge inspecificareasofprojectmanagement, includingappli-•

cationprocesses,monitoringandevaluation,financialmanagementskills,andre-

porting.

CBOsarekeentolearnnewtechniquesandmethodsonmalariacontrolandhow•

to manage disease.

CBOsareenthusiasticandreadyandwillingtoparticipateincommunitydevelop-•

ment and lifting the standard of living of their members and their communities.

CBOsdonotgetsufficientcontactandinformationfromrelevantauthoritiesthat•

wouldenablethemtoapplyforandacquirethefundsforrunningtheirprojects.

SomeCBOshavetakentheinitiativetoapplyforGFfunds,butlacksupportfrom•

the local authorities has discouraged them to the point of never attempting to ap-

plyagain.

25

Involvement of CBOs in management of malaria and anemia in pregnancy

There is a strong need to involve community organizations in the management of malaria and

anemia in pregnancy and antenatal care (ANC). The groups would be involved in enrollment

and advocacy for IPTp. Currently there is a low uptake of IPTp among the target groups. Alt-

hough there is high ANC attendance (87%) as well as high awareness about the IPTp strategy

in Kenya, only 24% of pregnant women had received two or more doses of IPTp according to

the MIS 2007. This level is far less than the 60% Abuja target, and communities will have to

be involved in behavior change strategies to attain this goal. In this context, CBOs can play

an essential role in mobilizing their members to pass appropriate messages to their commu-

nities.

Other areas that offer opportunities for CBOs and other CSOs to apply for GFATM funding

include:

Sensitization of communities on appropriate health-seeking behavior related to •

malaria prevention and treatment.

Management of stagnant water and other mosquito breeding sites in the community.•

Community participation in effective management of malaria.•

Monitoring and evaluation of community-owned responses to malaria.•

Identification of malaria as a priority for local action and development of a local malaria •

action plan.

Promotion of behavior change induced through social change communication.•

Ensuring timely referral of severe malaria cases.•

Data collection to inform procurement and service delivery, e.g. mapping LLIN needs, •

IRS coverage, malaria morbidity and mortality.

Module 2

Fig. 5. CBO participation in Global Fund processes

Preditable Financing

C

oord

inat

ion alignment & advocacy

Community Based Organisations

Training and Capacity Building

• Capacity development programmes accompany finance• Mentoring younger community organisations• Human resource training and planning

• Partner to reduce financing barrier• Distribute Finance according to capacity• Accountability

• Partner for Avocacy & information sharing• Community program framework of services

26

Identification of candidates for Community-based Integrated Management of Child-•

hood Illnesses (C-IMCI) and/or training for community-based management of

malaria.

Community organizations face gaps that pose major obstacles in applying for GFATM grants,

which can be classified as follows:

Gaps in project management skills.•

Gaps in logistics management.•

Gaps in administration and governance.•

Gaps in linkage with district health services.•

Gaps in infrastructure.•

2.4.2 Community Systems Strengthening (CSS)

The Global Fund recognizes that the presence of strong, sustainable community-based orga-

nizations is an important element of ensuring good governance, policy coherence, program

impact, sustainability, and results for HIV, tuberculosis and malaria prevention, treatment and

care and support efforts.

The GFATM therefore supports smaller implementing organizations in becoming stronger and

more effective implementers. To fulfill this goal, the GFATM encourages CCM members to

identify national gaps and constraints for scale-up within the context of developing capacities

of CBOs. These interventions, known as Community Systems Strengthening (CSS), are incre-

asingly becoming a core part of the Global Fund’s preferred strategy across its programs.

CSS:

Is a program of the GFATM to strengthen CBOs while acknowledging the unique role •

they play in maximizing health results through advocacy and mobilization.

Aims to foster the generation of quality demand for services through an increased role •

of the community in design, delivery and monitoring and evaluation of services.

Relies on community-based needs assessments.•

To maximize these community-based responses, CSS is needed in order to:

Expand coverage of service delivery.•

Provide emergency responses to the epidemics at community level.•

Achieve service coverage for hard to reach and marginalized groups.•

Inform and improve public policy, including policy analysis, advocacy and leadership •

development.

Mobilize members of society as actors in the fight against the three diseases.•

Module 2

27

Module 2

Types of organizations benefiting from CSS initiatives

A broad range of NGOs can benefit from CSS initiatives, such as:

Organizations of people living with and/or affected by the diseases.•

Community-based advocacy groups.•

Home-based care organizations.•

Faith-based Organizations.•

Women’s organizations.•

Youth organizations.•

Vulnerable groups organizations.•

Community centers.•

Private sector organizations.•

Incorporating CSS into Global Fund proposals

The Global Fund continues to support Community Systems Strengthening initiatives as part

of the overall framework for improving health outcomes for HIV, tuberculosis and malaria.

Starting with Round 8, the Global Fund is encouraging applicants to include measures to

strengthen community systems relevant to in-country contexts on a routine basis in proposals

for new and continuing funding.

Applicants are encouraged to consider Community Systems Strengthening needs in:

The overall program implementation strategy, including strengthening of sub-recipient •

or other implementing partner systems and capacities to improve the quality and sus-

tainability of services delivered throughout the community.

Their assessment of disease programs and health system weaknesses and gaps to •

ensure that identification of program needs considers the community systems that are

necessary to improve the scope and quality of service delivery, particularly to those

without current access.

The Global Fund’s revised Guidelines for Proposals include a non-exhaustive reference to

areas of work that may be supported by the Global Fund to improve access to and/or the

quality of services, such as:

Initiatives to improve community-based program implementation and service delivery, •

including strengthening core institutional capacity through physical infrastructure de-

velopment, and organizational and systems strengthening.

Partnership building at the community level, focusing on the building of systematized •

relationships among and between community-based organizations to improve coor-

dination.

28

2.5 Challenges for CBO participation in Global Fund grants

Not all governments recognize the valuable sup-

port civil society can bring in scaling-up health

interventions. The critical nature of government-

civil society interface therefore often hinders ef-

forts. In many countries, government reluctance

to work with civil society has been a significant

barrier to the effective design of proposals and,

equally, to the managing of bottlenecks and chal-

lenges in obtaining grants.

However, even those barriers are less significant

overall than the lack of knowledge and aware-

ness among civil society, particularly at the local level, of possibilities available for support,

funding, and participation through the Global Fund.

Ultimately, the responsibility for increasing civil society engagement lies within civil

society itself. As civil society continues to engage in Global Fund processes, other stake-

holders will increasingly come to recognize the comparative advantage these organizations

bring, particularly in reaching vulnerable and marginalized populations. CSOs need to coordi-

nate and develop networks to increase their representation within these processes. Funding

from the Global Fund is a key opportunity for civil society to strengthen relationships with

other entities as well as to pave the way for sustainable responses to the three diseases in

the long term.

Module 2

Key Points

CivilsocietyhasbeenanimportantandvitalpartnertotheGFATM.•

Communityinvolvementiskeyforeffectivemalariacontrol.•

Therearechallengesforeffectivecommunityparticipationinmalariacontrol.•

CBOscanbenefitfromGFATMgrantsthroughCSSprograms.•

The responsibility for increasing civil society participation in Global Fund and •

diseasecontrolprocesseslieswithincivilsocietyitself.Nevertheless,manybarriers

for CSOs remain.

29

Module 2

Key Reading

Joint UnitedNations Programme onHIV/AIDS (UNAIDS) (2009): SUPPORTING•

COMMUNITYBASEDRESPONSESTOAIDS:AguidancetoolforincludingCom-

munitySystemsStrengtheninginGlobalFundproposals.

TheGlobalFund(2007):Anevolvingpartnership:TheGlobalFundandCivilSoci-•

etyintheFightagainstAIDS,TuberculosisandMalaria.

TheGlobalFund/InternationalHIV/AIDSAlliance(2009):CivilSocietySuccesson•

theGround:CommunitySystemsStrengtheningandDualTrackFinancing:Nine

Illustrative Case Studies.

CSSindicatorscanbefoundonthefollowingwebsite: •

http://www.theglobalfund.org/documents/me/M_E_Toolkit_P2-HSS_en.pdf

Module 3

30



Describe how the GFATM grant-making process works.•

Understand the role of CCM, its structure and composition.•

Understand the minimum requirements for Grant Eligibility for CCMs. •

Describe the Civil Society Representation in CCMs. •

Know about the difference between Principal and Sub-Recipients.•

Understand how to become a Sub-Recipient.•

Understand the minimum requirements for Sub-Recipients.•

Describe the role of the LFA.•

Describe the role of the TRP.•

3.2 The Global Fund grant-making process

Every nine to twelve months, the Global Fund Board holds a funding round and invites CCMs

to submit proposals. The funding process is explained with the example of a fictitious country

called Mubamba:

Module 3The Global Fund grant-making process

Academic/Educational Sector

Country Coordinating Mechanism

- Prepares an submits proposals

- Selects Principal Recipient(s)

- Oversees implementation Requests continued funding from the Global Fund for years 3-5

Provides technical and capacity building support

GovernmentGlobal Funds Local

Fund Agent

AdviceReports

Instructionto disburse

FundsFunds

Assessment

Reports

Global Funds Trustee(World Bank)

Global FundSecretariat

PrincipalRecipient(s)

Sub-Recipients

NGOs/CBOs

PLW DiseasesGrant agreement

(2 years)

Private Sector

Multi-/Bilateral De-velopment Partners

Religous/Faith-Based Organizations

Fig. 6. Global Fund grant-making process

Module 3

31

The Governmental Health Authority in Mubamba identifies a need for malaria prevention and

treatment interventions. There are already a number of organizations working in that area in

Mubamba. But they are tremendously under-funded. The Mubambian Health Authority works

with these organizations through the Country Coordinating Mechanism (CCM) to prepare a

proposal to the Global Fund to fund malaria control interventions.

The CCM submits the proposal to the Technical Review Panel (TRP) for assessment. The TRP

found it satisfactory and worth for funding without any conditions. This recommendation is

passed on to the Global Fund Board.

The Global Fund Board approves grants based on availability of funds, and appoints the

Mubambian Health Authority as the Principal Recipient (PR). The Global Fund Secretariat then

contacts a Local Fund Agent (LFA) to oversee progress and ensure that the Health Authority

have sufficient systems to administer funding properly.

The Global Fund Secretariat negotiates a two-year grant agreement with the Health Authority

and both parties sign the grant. The Secretariat then instructs the World Bank (as trustee) to

make the first disbursement.

The Health Authority receives the first portion of the grant and, overseen by the LFA, distribu-

tes it to the agreed organizations in the country.

After a few months more money is needed. The Health Authority applies for second disbur-

sement at the Secretariat. As sufficient progress has been made and the LFA has agreed, the

second disbursement is made.

The initial two-year period comes to an end and the Global Fund Board makes a successful

assessment of progress. They find that the Mubambian Health Authority has been using the

money wisely and that the organizations receiving it were making good progress in tackling

malaria. The grant is therefore renewed for a further three years, to the full five-year period.

Module 3

32

Module 3

3.3 Actors within the grant-making process of the GFATM

3.3.1 The Country Coordinating Mechanisms (CCMs)

Country Coordinating Mechanisms are central to the Global Fund’s commitment to local

ownership and participatory decision-making. These country-level partnerships develop and

submit grant proposals to the Global Fund based on priority needs at the national level. After

grant approval, they oversee progress during implementation.

Country Coordinating Mechanisms include representatives from both the public and private

sectors, including governments, multilateral or bilateral agencies, nongovernmental organi-

zations, academic institutions, private businesses and people living with the diseases. For

each grant, the Country Coordinating Mechanism nominates one or a few public or private

organizations to serve as Principal Recipient.

Structure of the CCMs

Each CCM should elect a Chair and a Vice Chair in accordance with the election procedures

determined by its members. It is recommended that Chair and Vice are from different sectors

as well as from domestic entities.

Composition of the CCMs

The Global Fund recognizes the importance of

national contexts, customs and traditions, and

therefore does not intend to prescribe specific

CCM compositions. However, in accordance

with its guiding principles, the Global Fund

expects CCMs to be broadly representative

of all national stakeholders in the fight against

the three diseases. In particular, the Global

Fund encourages CCMs to aim at a gender

balanced composition. The CCM should therefore be as inclusive as possible and seek repre-

sentation of all key stakeholders that are relevant in the fight against the three diseases in the

national context. The membership of the CCM should comprise a minimum of 40% represen-

tation of the non-government sectors such as NGOs/community based organizations, people

living with the diseases, key affected populations, religious/faith-based organizations, private

sector and academic institutions.

33

Civil Society representation in CCMs

The CCM is a cornerstone of the Global Fund’s architecture, where

innovative public/private partnerships are built to rapidly disburse

funds in the battle against AIDS, TB, and malaria. The CCM was

designed to mirror the structure of the Global Fund Board, where-

by all relevant sectors would play a key role in determining how the

Global Fund should be governed. In many countries, Kenya inclu-

ded, governments, private sector and civil society are collabora-

ting together to decide crucial programmatic and policy outcomes.

This has not only become a strong factor in a country’s potential

sustainability of disease-fighting efforts, but – equally as important – a catalyst for democratic

processes where vulnerable and marginalized groups acquire a key voice in national policy.

Nevertheless, in many countries, the voice of civil society in CCMs is perceived as weak and

in need of strengthening.

Module 3

The Six Minimum Requirements for Grant Eligibility of Country Coordinating

Mechanisms

The Global Fund Secretariat applies a screening process before a proposal submitted

byaCCMisreferredtotheTechnicalReviewPanelasawaytoensurethatallrequire-

ments for a functional CCM are met.

CCM members representing the non-government sectors must be selected/elec-•

tedbytheirownsector(s)basedonadocumented,transparentprocess,develo-

ped within each sector.

The Global Fund requires all CCMs to show evidence of membership of people •

livingwithand/oraffectedbythediseases.

CCMs are required to put in place and maintain a transparent, documented pro-•

cessto:solicitandreviewsubmissionsforpossibleintegrationintotheproposal.

CCMs are required to put in place and maintain a transparent, documented process •

to:ensuretheinputofabroadrangeofstakeholders,includingCCMmembersand

non-members, in the proposal development and grant oversight process.

CCMs are required to put in place and maintain a transparent, documented pro-•

cess to nominate the Principal Recipient(s) and oversee program implementation.

WhenthePRsandChairorViceChairsoftheCCMarethesameentity,theCCM•

musthaveawrittenplaninplacetomitigateagainstthisinherentconflictofinte-

rest.

34

Module 3

Structural obstacles to strengthened civil society participation in CCMs

Technical Capacity: The capacity of civil society organizations – particularly those in •

isolated or rural areas - to develop technically sound proposals is quite limited, as

compared with government or international civil society organizations.

Access to information: Civil society organizations often find it difficult to access critical •

information.

Difficulties interacting with constituencies: Civil society organizations, especially •

in countries covering large areas and/or with underdeveloped communications and

transportation infrastructures, often face serious challenges to interactions with their

constituencies.

Poor CCM organization: Poor information sharing – a responsibility of CCM leader-•

ship – often disadvantages civil society members by not allowing enough time for the

review of documents critical to an upcoming meeting when they are circulated at the

last minute.

3.3.2 Principal-Recipients (PR) and Sub-Recipients (SR)

PRs are country-based organizations legally responsible for the programmatic results and

financial accountability of Global Fund grants. PRs are suggested by the CCM and appointed

by the Board. Sub-recipients are organizations sub-contracted by the PR to deliver program-

related services. In April 2005, the Global Fund Board approved a revision of the CCM Gui-

delines requiring, among other changes, that CCMs nominate PRs using transparent and

documented processes as a condition of funding eligibility.

Moreover, the Board recommends the submission of proposals with both government and

non-government PRs (Dual-Track Financing).

Civil society representation in CCMs – The example of Kenya

IneffectiveCBOrepresentationattheCCMinKenyanegativelyaffectstheparticipation

in and performance of Global Fund programs. Poor communication and information

sharingincombinationwithless-than-satisfactorymonitoring,evaluationandreporting,

whichisdelayingdisbursements,arethemainchallengesidentifiedbyCCMmembers

thusaffectingcivilsocietyparticipationintheCCM.CBOsinKenyacomplainbitterly

of being left out of decision-makingprocessesby theCCM, and in the selectionof

proposals submitted to the TRP. Stringent rules for prospective sub-recipients, lack of

knowledge on application processes, and poor communication to hard-to-reach rural

communitiesaremajorbarriersforpotentialapplicantsinruralareas.

35

Module 3

Selection and Role of Sub-Recipients (SRs)

After having received the grant, the PR should develop a detailed annual work plan with •

potential areas for SRs involvement and share with GFATM secretariat for approval.

Subsequently, the PR should call for proposals for SRs activities as per approved work •

plan.

The CCM oversees and monitors progress during implementation. •

The SRs should provide programmatic and financial quarterly progress reports to the •

PR as per agreement signed with the PR.

The PR submits periodic disbursement requests with updates on programmatic and •

financial progress to the Global Fund trough the LFA. The SR should submit fiscal year

progress reports and annual audits of program financial statements to the PR. Regular

disbursement requests from SRs and program updates continue, with future disburse-

ments tied to ongoing progress.

LFA verifies PR/SRs information submitted and paves the way for further disburse-•

ments.

Before entrance into agreement, a nominated SR should have a detailed work plan and •

budget for the intended period of the agreement.

A clearly defined and transparent process for sub-recipient selection

InKenya,acallforexpressionsofinterestinproposaldevelopmentwasplacedinnati-

onalnewspapersandontheCCMwebsite,andannouncedviacivilsocietynetworks.

Interestedorganizationswereinvitedtosubmitaprojectproposalbasedonspecified

priorityareas,togetherwithanorganizationalcapacityprofile.Acapacityassessment

questionnaire,aprojectproposaltemplateandworkplanandbudgetformats,aswellas

guidelines for their completion were provided. The CCM then set up an independent re-

viewpaneltoassesstheexpressionsofinterestbasedoncriteriapreviouslydeveloped.

Thiswasafour-stageprocess-Screeningapplicationsforadmissibility:

Compliance with application guidelines.1.

Assessmentoforganizationalcapacitybasedonagreedcriteria.2.

Evaluationofprojectproposal,workplanandbudget.3.

Assessment of comparative advantages of organizations in addressing specific 4.

issuesorreachingspecificvulnerablegroups.

Of the 412 organizations that expressed interest, 34 submitted proposals that were

deemedeligibleforinclusioninthecountryproposalandwerenominatedassub-reci-

pients.

36

Module 3

Minimum requirements for sub-recipients

In order to successfully assume quality and timely implementation and accountability for pro-

jects’ proceeds, Sub-Recipients (SRs) need certain minimum institutional and technical capa-

city requirements before signing a Project Cooperation Agreement with the Global Fund.

Institutional and technical capacity requirements include:

Legal status.•

Management and organization. •

Infrastructure and information systems. •

Health (HIV/AIDS, TB and/or malaria) and cross-functional expertise (finance, procure-•

ment, legal, M&E).

In detail, that means:

Legal Status

The applicant SR should be a currently legally registered organization.•

Management and Organization

The applicant (potential) SR should preferably have a good track record for timely and •

results based implementation of project activities.

If the applicant SR is a civil society organization, it should have a board that meets •

regularly and has statutes for its function.

The applicant SR should have sufficient management capacity (quality and quantity) to •

implement the proposed program.

The applicant SR is preferably required to have a clear organizational leadership with •

clear accountability system to implement the proposed project.

The applicant SR should coordinate and participate in/seek advice from the relevant •

national program and technical committees related to the project.

The applicant SR has the administrative capacity to forecast, recruit, select, and retain •

human resources effectively.

The applicant SR should have written personnel policies and procedures. •

The applicant SR should make available performance reports (e.g. audit reports) for •

external review by stakeholders including the public.

The key individuals who will be responsible for implementing the program should have •

written job descriptions that incorporate responsibilities associated with the Project.

The applicant SR should have a current budget sufficient to support key positions and •

organizational functions not related to Global Fund activities. This budget is expected

to remain in place for the duration of the project.

37

Module 3

The applicant SR should be able to demonstrate commitment to gender, equity and •

non-discrimination/principles.

The applicant SR should be able to demonstrate the acceptance within the local com-•

munities where the intervention is proposed, or a plan to ensure they will obtain local

leaders and communities support.

Infrastructure and Information Systems

The applicant SR should have a functional IT system for internal and external commu-•

nication.

The applicant SR should have the ability to work in targeted areas (geographical •

coverage) where proposed field activities will be implemented.

The applicant SR’s management should meet periodically to review/analyze perfor-•

mance and share performance outcomes with internal and external stakeholders

(e.g. CCM, partners, etc.).

The applicant SR should have adequate physical facilities, office equipment, minimum •

logistical arrangements, etc. to implement current programs.

Technical Expertise

The applicant SR should recruit full time (within its organization) personnel with the •

required, HIV/AIDS, malaria or TB expertise necessary to implement the project.

The applicant SR should have the required, specialized staff in finance and M&E •

necessary to implement the project and to recruit other necessary staff (legal etc.).

38

Module 3

3.3.3 Local Fund Agents (LFAs)

Following its core principles of ensuring country

ownership of programs and maintaining a lean

and efficient Secretariat, the Global Fund does

not have offices outside of Geneva. Instead the

Secretariat relies on LFAs, which are selected

through a competitive bidding process to assess

implementation capacities and verify grant im-

plementation progress at the country level. LFA

responsibilities include the following:

Assess the PR’s capacity to implement approved proposals by reviewing budgets and •

work plans and otherwise assisting the Global Fund in grant negotiations.

Independently oversee program performance and the accountable use of funds (known •

as Verification of Implementation). This includes reviewing the PR’s periodic requests

for funds, undertaking site visits to verify results and reviewing the PR’s annual audit

report.

Review grant performance as it approaches Phase 2.•

Assist with grant closure.•

Conduct ad hoc assignments at the request of the Global Fund, such as investigations •

related to the suspected misuse of funds.

The LFA is not the Global Fund’s representative within the country nor does it speak on behalf

of the Global Fund unless expressly authorized to do so on a case-by-case basis. It is not

empowered to make decisions on grants – the LFA recommends and the Global Fund deci-

des. Neither does it participate in the design or implementation of a Global Fund proposal, nor

provide technical support to grantees.

3.3.4 Technical Review Panel

The Technical Review Panel (TRP) reviews eligible grant proposals for technical merit (sound-

ness of approach, feasibility and potential for sustainability). Based on this review the TRP

recommends proposals for funding to the Board. The TRP consists of a maximum of 40 ex-

perts. Each expert is appointed by the Board for a period of up to four funding rounds.

39

Module 3

Key Points

CCMsareacornerstoneoftheGlobalFundarchitectureandplayanessentialrole•

in proposal development.

CSO representation in CCMs often remains weak.•

PRsarecountry-basedorganizations legallyresponsibleforprogramresultsand•

financialaccountability.

SRsareorganizationssub-contractedbyPRstodeliverprogram-relatedservices.•

Tobecome aSR certain institutional and technical capacity requirementsmust •

be met.

LFAsverifygrantimplementationprogressatcountrylevel.•

The TRP reviews eligible grant proposals.•

Key Reading

TheGlobalFund(2007):Anevolvingpartnership:TheGlobalFundandCivilSoci-•

etyintheFightagainstAIDS,TuberculosisandMalaria.

TheGlobalFund(2008):AcceleratingtheEfforttoSaveLives.•

TheGlobalFund/InternationalHIV/AIDSAlliance(2009):CivilSocietySuccesson•

theGround:CommunitySystemsStrengtheningandDualTrackFinancing:Nine

Illustrative Case Studies. http://www.globalfundkccm.or.ke/

Further information on the issues covered in this module can be found in the following

publications:

www.aidspan.org/publication• s-Aidspan:ABeginner’sGuidetotheGlobalFund.

www.theglobalfund.org/documents/rounds/8/R8DTF_Factsheet_en.pdf•

Global Fund Factsheet on Dual Track Financing.

http://www.theglobalfund.org/documents/ccm/Clarifications_CCM_Require-•

ments_en.pdf - CCM Requirements.

http://www.theglobalfund.org/en/ccm/guidelines• /

Contact informationforCCMmembers isalsoavailableoneachcountrypageofthe

Global Fund website.

Module 4

40



Know the application process of the Global Fund. •

Have the capacity to follow the format provided by the CCM for Global Fund applica-•

tions.

Know the minimum prerequisites for recommendation of proposals.•

Be aware of national strategy applications.•

Know about common mistakes in applications and how to avoid them.•

Have gone through the application checklist.•

Know where to get relevant information and support for their proposals.•

4.2 How to apply for a Global Fund grant

In order to apply for a Global Fund grant, the applying CBO must follow a format that is

prescribed by the national CCM and strictly adhere to the regulations set by the CCM. The

application must be submitted to the national CCM after the CCM publishes a Call for Propo-

sals. It is strongly recommended to consult the CCM and other relevant stakeholders such as

governmental and nongovernmental organizations in order to demonstrate that the applica-

tion corresponds with national contexts and initiatives.

The format requires applicants to:

Describe its organizational structure and areas of operation as well as its capacity to •

implement the proposed project activities using the appropriate forms.

Prove that it is experienced in the proposed field. •

Show evidence that the medical authorities in the planned project site are aware of the •

organizations existence and its activities.

Provide a detailed description of activities, a concrete work plan and a realistic •

budget.

Moreover, the proposal should clearly draw on the national strategy to describe (and request

funding for) gaps in terms of intervention coverage to ensure a comprehensive response to

the diseases.

Module 4How to apply for Global Fund grants – a roadmap for CBOs

Module 4

41

Module 4

Implementation of transparent inclusive proposal development process

TheGlobalFundGuidelines forproposalsemphasize thatallCCMdeliberationsand

decisionsshouldbetransparentanddisseminatedwidely.ItoutlinestheCCMrespon-

sibilitiesforproposaldevelopmentasfollows:

Disseminatewidely toall interestedparties in thecountryall informationrelated•

totheGlobalFund,suchasCallsforProposals,decisionstakenbytheCCMand

detailed information on approved proposals for funding.

Treat all members as equal partners in the proposal development process with full •

rights of participation, expression and involvement in decision-making in line with

their areas of expertise.

BuildinsufficienttimeduringtheproposaldevelopmentprocesstoallowallCCM•

members to review and provide input for the drafts of a proposal.

CCMsareencouragedtosubmittheirproposalstoathoroughqualityreview/en-•

hancementprocesspriortofinalsubmission.

AllCCMmemberstosigntheproposaltoindicatethattheyhaveparticipatedin•

theproposaldevelopmentprocess.Ifinsufficientconsultationhasoccurredinthe

course of preparing a proposal, CCM members who have not been involved should

not sign the proposal.

ForNon-CCMproposals:

IforganizationsoutsideoftheCCMprocesssubmitproposalsfortheCCM’sconside-

ration,theCCMshouldprovidethereasonswhyitdecidedtoincludeornottoinclude

suchproposalsinthefinalsubmission.

42

Introduction of application formats – the example of Kenya

Instructions for prospective applicants (Sub-Recipients)

In 2009, the DOMC in Kenya distributed guidelines for CSOs and PSOs intending to apply for

malaria components for GFATM funding Round 9. Those guidelines are reproduced below for

the purpose of this training, and may change from round to round. Specific Terms of Refe-

rence (TOR) were developed for identified areas where private and nongovernmental sectors

may have a comparative advantage in implementation.

These included:

Malaria Behavior Change Communication.•

Training of health workers on case management. •

LLIN distribution through mass campaigns. •

Home Management of Malaria in selected districts. •

Community systems strengthening.•

Diagnostic quality assurance. •

Prospective Sub-Recipients were to apply under a specific TOR and could apply for more

than one. Interested applicants were required to provide the following:

Completed organizational profile. •

Completed concept note under the defined TOR.•

Completed work plans under each of the defined TOR.•

Completed budgets under each of the defined TOR.•

Templates were provided in order to allow for consistency in applications and ease of •

consolidation. Applicants were disqualified if they did not use these templates.

Organizational Profile Template

Name of organization: •

Address and contact details of organization (including email and telephone number): •

Year of registration (Attach a copy of your registration document): •

Current geographic operational areas (districts and divisions): •

Current programmatic operational areas related to malaria (tick the ones you are cur-•

rently involved in):

ITN distribution: •

Malaria BCC:•

Training on malaria (specify in which areas):•

Home Management of Malaria:•

Community systems strengthening (specify areas):•

Governance and management structure (attach organigram):•

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Financial capacity:•

Current budget using the table below:•

(Please provide information on your accounting system and internal controls. Attach a copy

of your annual audit report to the application)

Moreover, each application had to be based on a concept note on the planned project activi-

ties, which had to be submitted. The outline of the concept note is given below:

Concept Note Template

Organizational experience working in malaria control:•

Organizational experience working under the specific TOR:•

Value added or comparative advantage that your organization has in relation to the •

TOR:

Experience in gender sensitive programming related to the specific TOR:•

Description of the activities proposed under the specific TOR (including implementa-•

tion strategy):

Target groups and final beneficiaries:•

Expected results:•

Other stakeholders and their anticipated roles: •

Risk analysis and contingency plan:•

Sustainability (describe how systems will be strengthened to ensure improved malaria •

service delivery and outcomes):

Work plan (using provided template):•

Budget (using provided template):•

Selection of proposals

Applicants were selected based upon their organizational comparative advantage: The

appropriateness of proposed activities in relation to meeting the goals and objectives of the

National Malaria Strategic Plan (NMSP) as well as cost effectiveness. The Concept Note(s)

should have four to six pages.

Risk Likelihood Contingency

Program or project including geographic coverage Donor Amount (KSh) Duration

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4.2.1 Choosing the right strategy – guiding principles of the Global Fund

The Global Fund will finance programs that address the three diseases in ways that will •

contribute to strengthening health systems.

In making its funding decisions, the Global Fund will support proposals which:•

Contribute to substantially scaling up and increasing coverage of proven »

and effective interventions against the three diseases for the prevention,

treatment, care and support of the infected and directly affected.

Build on, complement and coordinate with existing regional and national »

programs in support of national policies, priorities and partnerships.

Focus on performance by linking resources to the achievement of clear, »

measurable and sustainable results.

Highlight the creation, development and expansion of country government/ »

private/nongovernmental organization partnerships, building on existing

coordination mechanisms, and promoting new and innovative partnerships

where none exist.

Strengthen the participation of communities and people, particularly those »

infected with and directly affected by the three diseases, in the develop-

ment of proposals.

4.2.2 Minimum prerequisites for a recommendation for funding

Although the prerequisites listed below have not been adopted as formal Global Fund policy,

they nevertheless constitute important guidance for applicants preparing proposals for Round

9 (and beyond) because they provide insight into the way the TRP evaluates proposals. The

following criteria apply for evaluation of proposals:

A disease proposal that is based upon and responds directly to the current, documen-•

ted, epidemiological situation.

A coherent strategy that flows in a consistent order throughout the proposal – with the •

implementation plans having the same objectives, program areas (‘Service Delivery

Areas’), and interventions/activities as are stated in the budget, the work plan, the

‘Performance Framework’.

A robust gap analysis, both programmatic and financial, that accounts for the full extent •

of existing resources (including those planned and/or reasonably anticipated based on

past practice) and not merely signed arrangements.

Clear and realistic analysis of implementation and absorptive capacity constraints •

(whether disease specific or broader health systems) that relate directly to the in-coun-

try social, environmental and other contexts.

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Logical strategies to address capacity constraints, whether through the existing fun-•

ding application, or through other domestic or partner supported initiatives (which are

also subject to performance assessments and adjustments).

Implementation arrangements that recognize and respond to the need to broaden ser-•

vice delivery channels to multiple sectors to achieve universal access to prevention,

treatment, and care and support services for people most affected.

Demonstrated effort to address the more challenging drivers of, especially, the HIV •

epidemic in ways that will have a meaningful impact on preventing further infections.

A clear plan for how to monitor activities and evaluate the impact of interventions.•

A budget that is sufficiently detailed to allow the costs of activities to be assessed.•

A work plan that makes clear the timing and sequencing of activities and responsibili-•

ties for each activity.

Planned outcomes (included as indicators in the ‘Performance Framework’) that •

address and respond to current epidemiological data, and demonstrate that the incre-

mental investment of additional Global Fund resources will improve disease specific

and broader health outcomes for those most at risk.

By dealing effectively with all these prerequisites, an applicant will demonstrate to the TRP

that it has a clear need for the additional resources, and has planned its funding request in a

way that will supplement and strengthen in-country responses to the three diseases.

4.3 National Strategy Applications - A new way of applying for Global Fund

financing

Importance of National Strategies

Experience has shown that robust national strategies can improve the success of grants.

They provide an effective framework for donors and implementers to adapt disease-specific

and basic health care projects and programs to national contexts. National strategies also

enable all stakeholders to agree on national priorities and work for common results.

In recent years, many countries have made significant efforts to develop national disease and

broader health strategies. However, to finance implementation of these strategies, they have

usually had to prepare multiple, separate proposals to different donors. This involves high

transaction costs and may not always be fully consistent with national planning and reporting.

As part of its commitment to aid effectiveness principles and in response to country requests

for streamlined processes, the Global Fund has committed to introducing a new way to apply

for Global Fund resources - known as National Strategy Applications (NSAs).

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This involves submitting a national strategy itself rather than a Global Fund-specific proposal

form – as the primary basis of the application for Global Fund financing. NSAs will be introdu-

ced through a phased rollout, beginning in 2009 with a limited number of countries.

The anticipated benefits of NSAs are:

Improved alignment of Global Fund financing with country priorities, national program-•

matic and budgetary timeframes.

Reduced transaction costs and paperwork for countries.•

Improved harmonization with other donors that have agreed to use the same criteria •

for reviewing national strategies.

A focus on managing for results and accountability within national strategies.•

In the longer term, improved quality, consistency and credibility of national strategic •

frameworks.

NSAs will be an alternative approach to access resources from the Global Fund and countries

will still have the opportunity to apply through the regular round-based system if they so wish.

Although NSAs are not yet standard and are still tested out by a limited number of countries

(first learning wave), it is important for CSOs to be aware that their planned activities have

to be in line with the Kenya National Malaria Strategic Plan (2009 – 2017). Therefore they

have to fit their proposals to the strategic plan, and although this requirement has not been

announced by the CCM, it is likely that once adopted, applications outside that plan are not

likely to be accepted by the CCM.

Challenges

To date, while the Global Fund has encouraged applicants to base funding proposals on na-

tional strategies and to attach these to their proposal, it has still required CCMs to complete

a long Global Fund proposal form. Furthermore, even when national strategies have been

attached to the proposal, the review of the TRP does not provide an assessment that could

be useful to other potential funders. This is because the review’s prime focus is on the con-

tents of the proposal, rather than on the national strategy itself. National strategies attached

to Global Fund proposals have in any case tended to lack detailed budgets, information

about financial contributions to national efforts by all funding sources, sufficient inclusion of

civil society or the private sector, or appropriate mechanisms to ensure accountability. These

elements are all necessary if national strategies are to serve as the primary basis of a rigorous

funding decision. According to the new strategic regulations, applications to the Global Fund

will in future be linked to the national strategy. This approach will create an incentive for coun-

try stakeholders to develop robust national strategies and eliminate parallel planning efforts.

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4.4 Common mistakes in proposals

Recent assessments of the epidemiological situation in the country do not exist.•

Many proposals lack coherence and logic between objectives, program areas, budget, •

a separate detailed work plan and the Performance Framework.

Work plan and budget are repeatedly not clearly separated. This makes it difficult to •

prove whether activities are linked to the timing of the intended outputs, outcomes and

impact.

Budgets are unrealistic (salaries and equipment) and not well structured.•

Poor grammar and sentence construction makes it difficult to understand the intended •

rationale for programming.

Poor linkage between objectives and activities.•

Mentioned objectives can not be achieved within the project life.•

A large number of proposed activities are difficult to implement.•

Lack of objectively verifiable indicators.•

Lack of outputs/outcomes with milestones for achievement.•

4.5 Application checklist

Access information on announcements of new funding rounds. This information is pu-•

blished in newspapers as well as on the website of the national CCM.

Read the announcement and the requirements for the application carefully.•

Note the deadlines for application.•

Access and carefully read the guidelines for applicants as outlined by the CCM.•

Access the required background on the areas of your interest.•

Note any special conditions and requirements such as number of pages, letters of •

recommendations, signatures, etc.

Note that certain requirements need time, e.g. letters from MoH at district level, func-•

tional bank accounts, bank statements, etc.

Start preparations early, prepare fully.•

Prepare the documents as indicated in the guidelines, making sure that ALL require-•

ments are complied as listed in the guidelines.

Prepare the number of copies required. Remember that original copies are to be sub-•

mitted to with your application to the CCM.

Keep copies of each document in your file. You will need them for project verification, •

implementation, monitoring and evaluation.

Submit your application early - Do not wait until the last minute. Take the required period for

postage into consideration.

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4.6 Sources of information

Community organizations in Kenya can access information needed for preparing a proposal

from the following sources:

Websites of (internet):•

CCM »

Global Fund »

Division of Malaria Control »

Ministry of Health »

Aidspan »

KeNAAM »

WHO »

Local DHMT through the District Medical Officer for Health.•

Local daily newspapers.•

NGOs working in your area.•

Make phone calls to DOMC, KeNAAM, AMREF or local district hospital to enquire about sub-

mission dates and other requirements. The key words are: If you are not sure, ask.

Key points

The application processes forGlobal Funds requires thatCBOs keenly observe and

complywith the requirementsasannouncedby theCCM.Strictattentionshouldbe

paid to timelines and deadlines. Last minute rush to prepare concept notes, write pro-

posals, or obtain letters of recommendations will result in poor proposals that will not

pass the rigorous evaluation process! For a successful application for the Global Fund,

itmaybenecessarythatseveralCBOsteamupandcollaborateintheapplicationand

implementationprocess.Ifthis isthelineyoutake,thenmakesurethateachpartner

knowsitsroleandspecifywhichactivitywillbecarriedoutbywhichpartner.Similarly,

agreeonthesharingofresources(money,equipment,officespace,personnel)andres-

ponsibilities well before the implementation period.

Accessinginformationiskey.•

Proposals should be aligned to the Global Fund guiding principles and need to •

meet certain criteria.

NationalStrategyApplicationscouldbe tomorrow’sstandard.Beawareofyour•

national disease control strategies.

BeawareofcommonmistakesinGlobalFundapplicationsandtrytoavoidthem•

inyourownapplication.

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Module 4

Key Reading

Aidspan(January2008):TheAidspanGuidetoRound8ApplicationstotheGlobal•

Fund–Volume1:GettingaHeadStart.

RepublicofKenyaMinistryofHealth,NationalMalariaControlProgramme(2001):•

NationalMalariaStrategicPlan(2001-2010).

TheGlobalFund(2006):ReportoftheGlobalFundPartnershipForumCelebrating•

Successes&OvercomingChallengesDurban,SouthAfrica(1-3July,2006).

TheGlobalFund(2006):TheRoleofthePrivateSectorintheGlobalFund.•

TheGlobal Fund (2009): Faith-BasedOrganizations asPrincipalRecipients and•

sub-recipients.In“ReportontheInvolvementofFaith-BasedOrganizationsinthe

Global Fund”.

TheGlobalFund (2009):Malariacontrol,communitysystemsstrengtheningand•

community-ownedresponse:Consensusonbestpracticeforuseinthedevelop-

mentofGlobalFundRound9malariaproposalsandNationalStrategyApplica-

tions.

www.globalfundkenya.or• g

www.theglobalfund.org/documents/publications/other/Strategy/Innovate.pdf•

NationalStrategyApplications.

UNDPSudan (July,2007): ImplementationManual forGlobalFundGrantsSub-•

Recipients.

Recommendations

50

In order to strengthen the role of CSOs, and CBOs in particular, in terms of involvement in

Global Fund operating structures and implementation of grants, the following recommenda-

tions are made:

Recommendations to the Global Fund

The funding gap for technical assistance must be met and support for technical agen-•

cies should be scaled up. The Consolidated United Nations (UN) Technical Support

plan should be fully funded to enhance support to CSOs where huge gaps in technical

capacities have resulted in poor proposal development, monitoring, evaluation and

reporting – both programmatic and financial.

Technical support needs to be provided to CBOs, particularly in terms of project cyc-•

le management, financial management and disease control interventions in order to

create more technically sound proposals and ensure a stronger implementing role for

CBOs.

Performance-based funding is proving to be a positive tool, which is improving grant •

implementation. Technical support should be available to community organizations so

as to increase their compliance for continual funding.

The application process needs to be further simplified for CSOs and CBOs in particu-•

lar, in order to reduce barriers to submitting applications.

The Board should modify the grant proposal process and create separate streams for •

government and civil society (including FBOs) funding.

Reporting requirements of the Global Fund remain a challenge for CSOs, in terms of •

the depth and frequency. For stable grants, grant reporting should not be required

more often than every six or twelve months to allow CSOs to come up with concrete

results and outcomes.

CBOs are an important constituency in the implementation of Global Fund grants. At •

country level, their participation in the CCM is minimal and their voice is unheard. Ade-

quate representation of CBOs needs to be ensured in all Global Fund decision-making

and operating structures.

The Secretariat should improve information sharing and communication: (1) among •

countries (civil society and government) and (2) between the Secretariat and civil soci-

ety to address communication gaps between CSOs and the GF especially in resource

availability.

Recommendations

Recommendations

51

Easily accessible and digestible information should be made available to CSOs and •

CBOs, also in local languages. This should encompass information on:

CCM membership, roles, responsibilities and contacts. »

National priorities on disease control. »

Deadlines and process for application submission to the CCM. »

How to obtain technical assistance and how to participate in civil society »

consultations.

How to apply for CCM membership and timelines and processes for »

applying.

Recommendations to the Donor Community

The current funding gap of approximately USD 4 billion for 2008-2010 as identified by •

the Global Fund Secretariat should be urgently filled by donor nations in order to save

more lives and respond to the funding demand as well as to ensure predictable and

sustainable funding.

Recommendations to Civil Society and Community Based Organizations

Ensure advocacy impact through building strong coalitions. •

Recognize and exploit the crucial “watchdog function” of civil society in order to moni-•

tor the application and implementation processes of Global Fund grants.

Increase efforts to engage in and access information on Global Fund grant application •

and implementation processes.

Strive to improve the level of civil society and community participation within the •

Global Fund.

Increase efforts to improve communication between the board and civil society repre-•

sentatives, among civil society representatives and with and within CCMs.

Organize yourselves into national systems that advocate for your needs within and •

outside the CCM framework.

List CSOs and grassroots organizations in your country and make this list publicly •

accessible in order to facilitate communication.

53

ImprintImprint

Publisher: STOP MALARIA NOW!

c/o action medeor e.V.

Gertrudenstrasse 9 | 50667 Cologne | Germany

Phone: +49 (0) 221/29970236

E-Mail: [email protected]

Web: www.stopmalarianow.org

Editors: Antje Mangelsdorf, Esther Suchanek (STOP MALARIA NOW!)

Dr. Maurice Odindo (Community Capacity Building Initiative)

Layout and Design: Die Medienarchitekten - Goedecke & Wruck GbR

Kirschallee 11 | 53115 Bonn | Germany

Web: www.medienarchitekten.eu

Support for the development of this manual was provided by Community Capacity Building

Initiative (CCBI) and Kenya NGO Alliance Against Malaria (KeNAAM), both based in Nairobi.

To request copies of this manual, please contact:

Kenya NGOs Alliance Against Malaria (KeNAAM),

On AMREF KCO Building

Along Wilson Airport, off Langata Road.

P. O. Box 30125

GPO, 00100 Nairobi | Kenya

E-Mail: [email protected]

Or download the manual from www.stopmalarianow.org

Photos: action medeor e.V. (Cover, pages 20, 24, 28, 32, 33, 38, 52)

Medicines for Malaria Venture (Cover, pages 9, 13, 21, 22, 37, 49)

Icons: istockphoto.com

November 2009

STOP MALARIA NOW! is organized with financial assistance from the European Union. The contents of this

publication are the sole responsibility of action medeor e.V. and can in no way be taken to reflect the views of

the European Union.

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