UPDATE July 2011: Now includesEnsuring Equality: A Guide to Addressing and Eliminating Stigma and Discrimination in the Health Sector (pdf), 2011 health system strengthening addition to Global Fund Round 11.
To support applicants in including health systems strengthening interventions in their proposals, PHR and the Health Workforce Advocacy Initiative, an international civil society-led coalition supported by the Global Health Workforce Alliance, in collaboration with Health Systems 20/20, have developed this Health Systems Strengthening Toolkit for Global Fund Round 10 Proposals. A reference guide (pdf) on the Global Fund’s support for health systems strengthening provides a basic orientation on why and how to use the Global Fund to support health systems strengthening.
Continue reading in English, or see this page in French or Spanish.
The current funding round of the Global Fund to Fights AIDS, Tuberculosis, and Malaria provides applicants with an excellent opportunity to secure funds for critically needed health systems strengthening. The Global Fund is committed to supporting health system strengthening interventions that are necessary to overcome health system constraints to improved outcomes in combating any or all of its three priority diseases. Applicants should review the exact criteria in the Global Fund's Guidelines for Proposals for Round 10, which launched on May 20, 2010. The Guidelines are available on the Global Fund's website, TheGlobalFund.org.
PHR strongly encourages countries to take advantage of this opportunity, using Round 10 to overcoming fundamental human resource and other health system constraints to successful and sustained scale-up of HIV, TB, and malaria interventions, including as appropriate, by using Round 10 to fund portions of national health workforce strategies.
The Global Fund also encourages health system strengthening activities that, in the process of improving outcomes for HIV, TB, and/or malaria, will also improve women’s and children’s health. This Round, the Global Fund is also giving special emphasis to community systems strengthening, which can include support to civil society organizations engaged in advocacy, health promotion and monitoring, and service delivery aimed at developing more equitable and accountable health systems. The Global Fund encourages an integrated, cross-cutting approach to health system strengthening that can contribute to achieving the Millennium Development Goal (MDG) on AIDS, malaria, TB, and other major diseases and to achieving the MDGs focused on improving women’s and children’s health.
This toolkit includes more detailed information on how to use the Global Fund to support health systems strengthening, key opportunities that the Global Fund presents, technical support providers to assist applicants in developing proposals, background information on health systems and the health workforce, as well as information on community systems strengthening. The toolkit also includes PHR's Guide to Using Round 10 of the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening. Information is also available to support countries in developing approaches to their health workforce and health systems that are grounded in human rights.
Health Systems Strengthening Toolkit for Global Fund Round 10 Proposals
- Frequently Asked Questions on the Global Fund and Health Systems Strengthening
- Overview of Health Systems Strengthening in the Context of Global Fund
- Background on Health Systems Strengthening
- Community Systems Strengthening and the Global Fund
- Human Resources for Health (HRH)
- Country Specific Examples
- Technical Support Providers
Frequently Asked Questions on the Global Fund and Health Systems Strengthening
- Health Workforce Advocacy Initiative & Health Systems 20/20. May 2010. Global Fund’s Support for Cross-Cutting HSS Interventions: A Reference Guide (pdf) (French) (Spanish).
This document provides an orientation to the Global Fund to Fight AIDS, Tuberculosis and Malaria and its support for cross-cutting health systems strengthening (HSS). It answers such questions as why to use to Global Fund to support HSS, what activities the Global Fund will support and has supported in the past, what factors contribute to successful proposals, and where to find information needed for developing HSS-related proposals.
Overview of Health Systems Strengthening in the Context of Global Fund
- Eric A. Friedman (Physicians for Human Rights). May 2010. Guide to Using Round 10 of the Global Fund to Fight AIDS, Tuberculosis and Malaria to Support Health Systems Strengthening (pdf) (French) (Spanish).
The Global Fund holds much potential for advancing health systems strengthening (HSS) efforts in the international community, including supporting cross-cutting HSS interventions that benefit more than one of the Global Fund’s three target diseases. This Guide provides information on how to use the Global Fund to support HSS, key opportunities that the Global Fund presents for HSS, advice on developing a strong HSS-related proposal, and more. It is intended for use by Country Coordinating Mechanisms (CCMs), other people and organizations involved in proposal development, and governmental and non-governmental health system advocates who are encouraging their countries to use the Global Fund to support HSS.
- Global Fund to Fight AIDS, TB and Malaria. November 2007. Strategic Approach to Health Systems Strengthening: Decision Point GF/B16/DP10 (pdf) (French) (Spanish).
This document, from the Global Fund Sixteenth Board Meeting, outlines the Board’s decision to provide funding for health systems strengthening actions within the overall framework of funding technically sound proposals focused on HIV/AIDS, tuberculosis and malaria.
- World Health Organization. 2010. The Global Fund and Health System Strengthening: How to Make the Case, in a Proposal for Round 8, 9 and 10? Working Draft (pdf) (French).
This brief paper summarizes some critical points that proposals with HSS activities should make to have a strong chance of success. Country examples from Tanzania, Malawi, Kenya, and Rwanda illustrate credible lines of argument.
- Global Fund to Fight AIDS, TB and Malaria. May 2010. Excerpts on Health Systems Strengthening from Guidelines for Proposals – Round 10 (pdf) (French) (Spanish).
The Guidelines are an official Global Fund document to support proposal development. Portions that focus on HSS (as well as the Technical Review Panel’s review criteria) are included here. Applicants should be sure to review the full Guidelines for Proposals (pdf), not only those excerpts included here.
- Global Fund to Fight AIDS, TB and Malaria. May 2010. The Global Fund’s Approach to Health Systems Strengthening (HSS): Information Note (pdf) (French) (Spanish).
This information note includes an explanation of HSS in the context of the Global Fund’s mandate. Applicants are encouraged to incorporate responses to health system constraints and gaps within their proposals. The information note provides direction for applicants on how to clearly include HSS interventions in proposals and how to develop strong requests for funding. It also explains the different ways in which HSS cross-cutting interventions can be included and provides some lessons from the Technical Review Panel on HSS-related proposals.
- Global Fund to Fight AIDS, TB and Malaria. February 2009. Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening, 3rd Edition (pdf) (French) (Portuguese).
This is the HSS piece of The Global Fund’s full Monitoring and Evaluation Toolkit. This HSS section presents select process, output, and outcome indicators for HSS, and descriptions of these indicators.
Background on Health Systems Strengthening
- World Health Organization. 2007. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action (pdf).
This document provides valuable background information on health systems, as it seeks to promote a common understanding of health systems and what constitutes health system strengthening. It defines and explains six building blocks of health systems, and provides insights into major health system challenges and opportunities. It also provides a framework for WHO’s own current and increasing role in improving the performance of health systems.
- Paul Hunt. January 2008. Promotion and protection of all human rights, civil, political, economic and cultural rights: Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (pdf).
The right to the highest attainable standards of health provides important guidance on developing an effective and integrated health system. There is an increasing acknowledgement that strong health systems are essential to a healthy and equitable society. Taking into account good health practices as well as the right to the highest attainable standards of health, this report identifies general approaches to strengthening health systems. These approaches should be applied consistently and systemically across a set of "building blocks," which together constitute a functioning health system.
Community Systems Strengthening and the Global Fund
- Global Fund to Fight AIDS, TB and Malaria. May 2010. Community systems strengthening: Information Note (pdf) (French) (Spanish).
Community systems strengthening (CSS) encompasses activities to develop and sustain key populations and communities, and community organizations and networks, in their efforts to design, deliver, and monitor and evaluate services aimed at improving health outcomes. As the information note explains, along direct health service delivery, CSS is “aimed at increased community engagement (meaningful and effective involvement as actors as well as recipients) in health and social care, advocacy, health promotion and health literacy, health monitoring, home-based and community based care and wider responses to ensure an enabling and supportive environment for such interventions.” Ensuring the role of communities and strengthening the capacity and reach of civil society organizations is a critical component of countries’ responses to three diseases and other health issues. CSS will help ensure the responsiveness of health systems to people’s needs, provide a continuity of care between health facilities and communities, enable health systems to better reach marginalized populations, and strengthen the accountability of health systems. The Global Fund is placing a high priority on CSS in Round 10. This information note provides a basic overview of community systems strengthening and related terminology, explains its importance and the core components of CSS, and offers advice on how to incorporate CSS into Global Fund proposals.
- Global Fund to Fight AIDS, Tuberculosis and Malaria. May 2010. Community Systems Strengthening Framework (pdf) (French) (Spanish).
This framework aims to define and explain core areas of CSS, which should assist in the process of determining what resources are needed to strengthen community action. The framework also explains the importance of CSS, the strategies that underlie a CSS approach, and the connections between CSS and health systems. The framework includes a comprehensive discussion on indicators for CSS activities. Summary versions of an earlier draft of this document are available through the International HIV/AIDS Alliance.
- Global Fund to Fight AIDS, TB and Malaria and International HIV/AIDS Alliance. September 2008. Civil society success on the ground: community systems strengthening and dual-track financing (pdf).
This report aims to increase understanding of the range of ways in which the Global Fund can support – and has supported – civil society activities, including those of community-based organizations. To outline the many different models of community systems strengthening, this report includes case studies from civil society organizations in Cambodia, India, Mongolia, Peru, Senegal, Somalia, Thailand, Ukraine and Zambia. All nine case studies examine HIV grants, but the examples have broader applicability. For instance, examples address processes of civil society engagement in the Global Fund, providing services to marginalized populations, and partnership development. The report also addresses topics including civil society activities to integrate HIV services with sexual and reproductive health services.
Human Resources for Health (HRH)
- Maggie Cooper & Eric A. Friedman (Physicians for Human Rights). August 2008. The Right to Health and Health Workforce Planning: A Guide for Government Officials, NGOs, Health Workers and Development Partners (pdf) (French) (Spanish part 1) (Spanish part 2); and Health Workforce Advocacy Initiative. November 2009. Incorporating the Right to Health into Health Workforce Plans: Key Considerations (pdf) (French).
The health workforce, improved health outcomes, and human rights are inextricably linked. Not only is a strong health workforce needed for improved health and fulfilling human rights, but human rights are needed to develop the workforce that can lead to overall better health. The guide explains why it is necessary to ground health workforce planning in human rights, and how to develop a plan that does just that. The Key Considerations document is a practical, easy-to-use tool that succinctly lays out the many connections between the health workforce and the right to health. Health and other government ministry officials, civil society, health workers, and development partners can use these documents as they develop or revise health workforce plans. The strategies they contain can also inform interventions, approaches, and priorities in health workforce development that can be incorporated into Global Fund proposals.
- Health Workforce Advocacy Initiative. 2008. Guiding Principles on National Health Workforce Strategies (pdf) (French) (Spanish).
The guidelines are intended primarily for the policymakers and other people involved in developing and evaluating these plans, including ministry of health officials, health workers, civil society advocates, development partners, and technical advisors. What should these plans – which should be country-developed and country-led – contain? How should they be developed to give them the best chance of significantly improving health outcomes and moving countries as rapidly as possible towards universal access to essential health interventions? The guidelines should serve as overarching principles that will promote the success of health workforce plans, while ensuring that they are consistent with human rights.
- Global Health Workforce Alliance. 2010. Human Resources for Health: Good Practices in ‘Country Coordination and Facilitation’ (CCF) (draft) (pdf).
This document provides good practices in the process of bringing together all stakeholders to develop country-level alliances on human resources for health, and describes key areas to be addressed by and functions of such alliances. These mechanisms, which exist in many countries in various forms (such as Human Resources for Health Working Groups), have a critical role in developing the consensus, strategy, and political will needed for resolving critical shortages and other weaknesses in the health workforce. Members of these mechanisms should actively engage in assessing how the Global Fund can be used to support the health workforce, and in developing health workforce interventions to be included in Global Fund proposals. Annex 1 provides a valuable list of key stakeholders.
- Ummuro Adano & James McCaffery (Capacity Project). October 2008 (UPDATED July 2011). Global Fund Round 11 Opportunity to Build Human Resource Management Capacity: the central pillar in health systems strengthening initiatives (pdf)
Many countries do not have adequate capacity to manage their current health workforce, let alone to effectively manage increased numbers of health workers and new funding for human resources, or to effectively develop and implement health workforce strategies and policies. Round 10 of the Global Fund provides an opportunity to build human resource management capacity to enable countries to effectively use expanding funds for the health workforce and to successfully implement health workforce strategies and policies at the national, district, and facility levels. This short document outlines ways in which the Global Fund can be used to build this capacity.
Country Specific Examples
- (Based on) Lesotho Country Coordinating Mechanism. 2008. Summary of Cross-Cutting Activities from Lesotho’s Proposal from Round 8 (pdf) (French) (Spanish).
This is a short summary of the cross-cutting health systems strengthening activities that Lesotho included as part of its Round 8 HIV/AIDS proposal. This summary illustrates ways that HSS activities can be integrated into proposals. The Technical Review Panel has recommended this proposal for approval.
- Physicians for Human Rights. 2010. Summaries of cross-cutting HSS sections of 3 successful Round 9 Global Fund proposals: Eritrea, Tanzania, and Cambodia (pdf).
This document summarizes the cross-cutting HSS sections of successful Round 9 proposals from Eritrea, Tanzania, and Cambodia. Eritrea submitted one of the few Round 9 proposals, and the only one with a cross-cutting HSS section, that the Technical Review Panel gave its highest rating. Tanzania included a particularly ambitious set of health workforce interventions. Cambodia included important community system strengthening interventions and measures to strengthen maternal health services.
- Health Workforce Advocacy Initiative. 2010. Examples of the Global Fund and Health Workforce Strengthening: Rounds 5 and 8 (pdf) (French) (Spanish).
This one-page document provides a highlights of ways in which Malawi (Round 5), Lesotho (Round 8), Mozambique (Round 8), and Zambia (Round 8) have used the Global Fund to strengthen their health workforces.
- Health Workforce Advocacy Initiative. 2010. Global Fund Round 9 Proposals with Successful Cross-Cutting HSS Sections (pdf).
This document lists the 17 successful Global Fund proposals from Round 9 that included cross-cutting HSS sections, and lists the health systems areas covered in each interventions. Reviewing past proposals can provide an understanding of the HSS support countries have sought from the Global Fund and how successful proposals make their cases. However, reviewing successful proposals from other countries does not remove the necessary work of applicants to determine their own health system needs for improving AIDS, TB, malaria, and other health outcomes, and to undertake the analysis and consensus-building exercises to develop strategies that will work in their particular contexts to build equitable, accountable, and effective health systems.
*Please see reference #4 for additional country examples from Tanzania, Malawi, Kenya, and Rwanda.
- Health Workforce Advocacy Initiative. 2010. Technical Support for Health Systems Strengthening Global Fund Round 10 (pdf) (French) (Spanish).
This document lists organizations and agencies that are able to provide technical support for developing HSS-related proposals. It includes several organizations able to provide support for developing proposals with community systems strengthening activities as well.
Additional Website References
In addition to the materials included in the toolkit, the following websites are additional references to support inclusion of health systems strengthening activities in Round 10 proposals.
- Human Resources for Health (HRH) Action Framework The HRH Action Framework has been developed as an initiative of the Global Health Workforce Alliance (GHWA) and represents a collaborative effort between the U.S. Agency for International Development (USAID) and the World Health Organization (WHO). The HRH Action Framework provides a way to comprehensively conceptualize and address the health workforce by engaging in six main areas (Human Resource Management Systems, Leadership, Partnership, Finance, Education and Policy). The website provides links to numerous tools in these areas to support country action.
- Support for the Global Fund Round 10 call on health system strengthening (HSS) – specific resources on HSS This WHO website lists a number of resources that provide helpful technical guidance for preparing health system strengthening (HSS) activities as part of a proposal to the Global Fund, Round 10.
- WHO and UNAIDS resource kit for writing Global Fund HIV proposals for round 10 – includes several HSS resources This resource kit was jointly developed by WHO and UNAIDS to provide specific guidance in planning for and writing Global Fund HIV proposals for Round 10. The kit is primarily intended for use by WHO, UNAIDS and other UN staff and consultants as they support country teams in developing Round 10 HIV proposals. The resource kit consists of technical guidance notes, reference documents, practical tools for proposal development, Global Fund Round 10 forms and guidelines, and Aidspan guides and other resources.
- The Aidspan Guide to Round 10 Applications to the Global Fund – Volumes 1 and 2 This guide provides extensive information to support Global Fund applicants, including guidance on filling out the Round 10 proposal form. Note that Volume 1 of Aidspan’s guide to Round 8, available through the same website, includes an extensive analysis of the strengths and weaknesses of proposals submitted in previous rounds of funding.