ROUND 10 – Tuberculosis

PROPOSAL FORM – ROUND 10 SINGLE COUNTRY APPLICANT
SECTIONS 3-5: Tuberculosis

3. PROPOSAL SUMMARY

Option 1: Transition to a single stream of funding by submitting a consolidated disease proposal
 go to section 3.1 (b)

Relevant sections are marked in RED throughout the proposal form

3.1Transition to a single stream of funding
(a) Select only one of the three options:

Option 2: Transition to a single stream of funding during grant negotiation
 go to section 3.1 (b)

Relevant sections are marked in RED throughout the proposal form Option 3: No transition to a single stream of funding in Round 10 Relevant sections are marked in RED throughout the proposal form (b) For options 1 or 2, list the grant numbers.
 insert relevant grant numbers

3.2 Duration of Proposal
Month and year:

Planned Start Date 1 July 2011

To 1 July 2016

3.3 Alignment to in-country cycles
Describe: (a) how the proposal duration was selected in section 3.2 and how it contributes to alignment with the national fiscal cycle(s), programmatic reporting, or in-country program reviews; and (b) the systems in place for regular national program reviews and evaluations (including Operations and Implementation research). (a) The current proposal envisages starting the activities on 1 July 2011 and after when the round five proposal ends. The national TB control programme reports her annual activities by end April of each year to the Ministry of Health. The planning of the National
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Revenue and Expenditure Budget starts in the middle of the year. Starting the new grant by July would permit the programme finalize its annual report and progress report of the round five and prepare adequately for launching the round 10 activities. (b) National Program is reviewed externally by WHO EMRO every five years. On a quarterly basis, NTP supervises the program through governorate TB coordinators. Annual internal review of the programme is conducted by NTP and CCM representatives. PR informs CCM members on achievements and challenges of the programme on a quarterly basis. With the support of WHO EMRO and international experts operational research studies (Research and Training in Tropical Diseases: TDR) are being conducted on TB among migrants and TB in the poverty pockets. Preliminary results of these studies have helped NTP develop this proposal so that the vulnerable population may receive improved services.

3.4 Summary of Round 10 Proposal Provide a summary of the tuberculosis proposal.
The objectives and activities of the current proposal are in line with the national TB strategic plan to control TB 2011-2015 (annex1). Proposed activities are complementing the interventions funded by the Ministry of Health and implemented by the national TB control program. The National TB Control Program under GFATM round five grant has improved TB control particularly in major cities and most rural areas, however experience in implementing the round five grant has shown that there are significant gaps in terms of quality of services for the most vulnerable groups of patients particularly the non- Jordanian nationals (about one fifth of residents of Jordan). There are barriers surrounding access to and use of services for some of the most vulnerable population particularly the labor migrants (from high incidence countries), the refugees and the very poor in remote rural areas. The current proposal will improve detection, treatment and care for these vulnerable populations. With its dual track nature, tThe current proposal envisages wider involvement of civil society and communities with strong component of community system strengthening and emphasizes on introducing and monitoring the progress towards implementing patientcentered approaches. The proposed activities are built up on the lessons learned from implementation of the round five grant which comes to an end in June 2011. The pilot project on Practical Approaches to Lung health (PAL) under round five will be scaled up and followed up with strengthened supervision, monitoring and evaluation. The proposal empowers communities affected by TB particularly women and youth association to improve social awareness and combat stigma. The latter will be conducted with increasing the capacity of and empowering NGOs and community members who will work in proximity to the vulnerable population. Jordanian Anti-TB Association with long history of involvement in TB control will be empowered to assist with social awareness and providing services to refugees. NGOs will be involved in social mobilization, provision of DOT and home visit to eligible patients. Based on the result of study of NTP which is under publication, labor migrants are prone to developing TB since they often come from high TB incidence countries and are often lost to follow-up mainly because they are not aware of their rights and responsibilities. Language and cultural barriers play an important role. Peer educators from migrant communities will be trained and supported to overcome these barriers. The proposal envisages establishing pilot collaboration with private sector and factories to strengthening TB services in workplace for early detection and management of TB among vulnerable groups. The proposal continues and expands the round five MDR-TB activities with the support of GLC mechanism and under WHO technical assistance. NTP will work with Annoor Sanatarium (FBO) to improve quality of and access to MDR-TB services including: improving infection control measures, strengthening ambulatory DOT, providing quality-assured second line drugs to all MDR-TB patients. The proposal continues and expands the round five MDR-TB activities with the support of GLC mechanism and under WHO technical
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assistance. The capacity of National Mycobacteriology Reference Laboratory will be improved to address the increasing need for quality assured timely diagnosis of drug resistant TB including improved biosafety measures and molecular tests for timely detection of drug resistant TB. The lessons learnedresults of an operational research have have shown it is important to improveaddress the cross border TB control to ensure appropriate care. In an innovative intervention and with involvement of International Organization for Migration (IOM), civil society representatives and other national and international partners, the proposal is ensuring timely diagnosis of TB and continuity of treatment (throughcare) across the borders. The pilot project on Practical Approaches to Lung health (PAL) under round five will be scaled up and followed up with strengthened supervision, monitoring and evaluation. With the support of round five During R5 grant, NTP implemented PAL in 200 PHC units out of existingabout 700 units. Under the current proposal, NTP now will scale up PAL to provide nationwide coverage toof all PHC units and ensure a robust follow up system. NTP will ensure fFurther advocacy ting for PAL implementation and raising awareness among all stakeholders and decision makers ais aan initial necessary step to improve cross-cutting approach and full understanding and ownership of PAL. Theis advocacy meetings will should include representatives of MOH, NTP, local health directories of all governorates, members of national PAL working group, United Nations Relief and Working Agency for Palestine Refugees in Near East, (UNRWA),, key staff involved in health management information system (HMIS), essential drug list and Integrated management of Childhood Illnesses (IMCI). The meeting group is expected to nominate 8 personnel that constitute the PAL planning group responsible for of a PAL expansion. This group is responsible for elaborating a draft ofA national working group will develop a strategic national expansion plan of PAL. In addition, this meeting should also nominate the operationalization group of national strategic PAL expansion plan, a group which is responsible for producing specific implementation and training plan specifying roles and responsibilities of local district level including supervision of PAL relevant quality implementation. This also encompasses the widely agreed introduction of PAL indicators and the harmonization of PAL relevant R&Rrecording and reporting with the existing HMIS. (health management and information system). After the national strategic PAL expansion plan has been operationalized, the Participants of advocacy meeting should endorse it. developed and

To help ensure high quality PAL implementation, supervisory teams should will be trained and enabled.be guaranteed. Travel allowances for depending on the average distance traveled and the frequency of supervisory visits are also important to ensure maintenance of these supervisory visits. Members of the national working group plus representatives of academia, Jordanian thoracic association, army, primary health care, pediatricians, and health safety directorate of MOH will work on updating the current national PAL guideline, the training materials and production of posters that can help using the guideline in PHC units. For control of patients with bronchial asthma and COPD, some equipment are needed to be present at the level of the PHC units and referral TB chest units. NTP, intend to provide 2000 peak flow meters for PHC units and 12 spirometers to every TB chest unit in every governorate as a referral centers. A team of trainers will be prepared;, this will include 12 members from the chest NTP centers at governorate level, 12 heads of health governorate directorates or their appointees, plus 12 heads of comprehensive health centers of different governorates. This team of trainers will engage in cascade training as outlined in the operationalized national PAL expansion plan. It is intended that training session would cover 1000 physicians of all PHC and partners., e.g. UNRWA, over three years Participants will receive updated guidelines, wall display posters and peak flow meters. ‘VAN’ WILL ADD IN ACTIVITIES THE
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GUIDELINES FOR NURSES AND HOSPITALS.
The objectives of the proposal are to improve quality of TB care for the most vulnerable population particularly the non-Jordanian nationals, to scale up MDR-TB management, control and care control and strengthen health system response to TB Control.

The main service delivery areas are:
Community System Strengthening (CSS), Advocacy, Communication and Social Mobilization (ACSM), MDR-TB, TB infection control, TB in children, Improving diagnosis, TB in workplace

The main outputs of the programme will be: Please note that aAlthough the number of patients ese numbers may seem small little comparing with other high TB burden countries prevalence countries, however the humanitarian and public health impacts of proposed interventions are noteworthy for Jordan with its relatively small size and population and restricted resources.The main outputs of the program will be: considering the size of the country and vulnerability of these population, impact of the current proposal will be significant from humanitarian and public health point of view: 200 migrant TB patients will receive continuum of care per year, PAL will be expanded to all primary health care centers and its monitoring process will be re-enforced. • 20 X/MDR-TB patients receive adequate treatment per year with the support of Faith-based organization Annoor Sanitarium and NTP • 200 eligible patients particularly from poor urban and south Jordan will benefit from patients’ support to complete their treatment successfully. • Four Community-based organizations will be strengthened and enabled to contribute in fighting stigma, improve adherence and implement patient-centered approach. • 150 TB/MDR-TB patients will be provided continuums of care across the borders until the national program of corresponding countries are taking care of them. • Three pilot models of private-public partnership for TB in workplace are will be developed and tested and successful model(s) of TB in workplace is/arewill be expanded to 15 more factories. • 30 Media representatives will be trained on TB information, education and communication.

4. PROGRAM DESCRIPTION 4.1 National program Describe: (a) current tuberculosis national prevention, treatment, and care and support strategies; (b) how these strategies respond comprehensively to current epidemiological situation in the country; and (c) the improved tuberculosis outcomes expected from implementation of these strategies.
(a) The National TB Control Strategic Plan has been drafted in 2009 and finalized in a workshop organized by WHO EMRO in Cairo in May 2010. The strategic plan covers the period 2010-2015. The overall goal is to decrease the burden of Tuberculosis. The goal is in line with the Global Plan to Stop TB 2011-2015, to achieve the Stop TB Partnership and the MDG targets of halving TB prevalence and deaths compared with 1990 levels by 2015 and to have halted and begun to reverse the incidence of TB by 2015 by ensuring access to quality diagnosis and treatment for all, respectively. The objectives of the strategic plan are: 1) Pursuing, optimizing and sustaining quality DOTS, 2) Adapting DOTS to respond to TB-HIV, MDR-TB, and other special
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challenges, 3) engaging all care providers, 4) empowering patients and communities, 5) enabling and promoting operational research and 6) strengthening health system response to TB. (b) Jordanian national TB control strategy address the challenges of TB control in a comprehensive manner with improving national partnership and intersectoral collaboration. However there are lack of funds to involve civil society, strengthen community system and fulfill adequate advocacy, communication and social mobilization. (c) Under the national strategic plan the following outcomes are foreseen: improved and maintaining treatment success for sputum smear positive patients (at least 90%), new sputum smear positive TB case detection (above 95%) by 2012, diagnose at least 85% of estimated MDR-TB cases and treat at least 70% of them successfully.

TWO PAGE MAXIMUM

4.2 Epidemiological profile of target populations (a) Describe the current epidemiological profile of the target populations, and how this profile is changing with respect to tuberculosis.
Dr Nadia please add some line from the latest annual or quarterly reports thanks. ONE PAGE MAXIMUM (b) Do the activities in the proposal target: Whole country
 Paste map here if relevant (see Guidelines)

Specific geographic region(s)

Specific population group(s)

(c) Size of population group(s)
 If national data is disaggregated differently then type over the categories proposed

Population Groups Total country population (all ages) Females > 25 years

Population Size 5850000

Source of Data Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook

Year of Estimate 2008 2008

1162440

Females 20 – 24 years

2008

298420

Females 15 – 19 years 311890 Males > 25 years 1242500

2008

2008

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(c) Size of population group(s)
 If national data is disaggregated differently then type over the categories proposed

Population Groups

Population Size 2008

Source of Data

Year of Estimate

Males 20 – 24 years 321100 Males 15 – 19 years 330440 Females 0 – 14 years

Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Jordan Department of Statistics, Statistical Yearbook 2008 Ministry of Labour, 2008

2008

2008

1062250

2008

Males 0 – 14 years

1120960

2008

Other: labour migrants

303325

 use "Tab" key to add extra rows if needed

(d) Tuberculosis epidemiology of target population(s) Indicators (see the footnote under this table for the references) Number or rate or percentage
Best estimate 441 24 29 7 135 2 534 9 46 1 [a/population*100 000] (1) [c/population*100 000] (1) [e/population*100 000] (1) [g/population*100 000] (1) [i/population*100 Low estimate High estimate

[Calculation] or (reference)

TB estimates, 2008 (available on http://www.who.int/entity/tb/dots/table4_2_2_gfatm.xls)
a Estimated number of new TB cases (all forms) Male 0-14 (5.4% of total number) Female 0-14 (6.5% of total number) b c d e f g h Estimated number of new TB cases (all forms) per 100 000 population Estimated number of new smear-positive cases Estimated number of new smear-positive cases per 100 000 population Estimated prevalence of TB cases (all forms) Estimated prevalence of TB cases (all forms) per 100 000 population Estimated number of deaths due to TB (all forms) among HIV-negative people Estimated number of deaths due to TB (all forms) among HIV-negative people per 100 000 population Estimated number of HIV-positive new TB cases (all forms) Estimated number of HIV-positive new TB (1)

i j

0 0

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cases (all forms) per 100 000 population k1 k2 Estimated % of MDR-TB among new TB cases Estimated % of MDR-TB among previously treated TB cases 5.4% 40.0% 2.5% 24.6% 11.3% 57.7% 000] (2) (2)

Indicators (see the footnote under this table for the references)
TB notifications, 2008 l1 Number of new TB cases (ss+, ss-/unknown, extra pulmonary) notified in 2008

Number or rate or percentage
Best estimate Low estimate High estimate

[Calculation] or (reference)

337 (including 101 TB among foreigners) (plus 140 TB cases among migrants who preferred to return to their home countries) 356

(3)

l2

Number of new TB cases (ss+, ss-, extra pulmonary) and retreatment TB cases (relapse, after failure, after default, other) notified in 2008 Number of new TB cases (all forms) notified per 100 000 population % of estimated new TB cases (all forms) notified Number of new smear-positive TB cases notified Male 0-14 Male, 15-44 Male, 45 and more Female 0-14 Female 15-44 Female, 45 and more 337/441=76 ,1%

(3) [l1/population*100 000] [l1/a*100] (3)

m n o

5.74 76,1% 104 0 26 23 0 41 14 1.7 104/135=77% 337 100% 0

p q

Number of new smear-positive TB cases notified per 100 000 population % of estimated new smear-positive TB cases notified - Case detection rate of new smear positive TB Number of TB cases all forms (new and retreatment) that were tested for HIV % of TB cases all forms (new and retreatment) that were tested for HIV Number of notified TB cases all forms (new and retreatment cases) that were found or known to be HIV-positive % of all estimated HIV-positive TB cases that were found or known to be HIV-positive - case detection of HIV+ TB Number of notified HIV-positive TB cases (new and retreatment) started or continued on CPT % of all notified HIV-positive TB cases (new and retreatment) started or continued on CPT Number of notified HIV-positive TB cases new and retreatment) started or continued on ART % of all notified HIV-positive TB cases (new and retreatment) started or continued on ART Number of TB cases (new and retreatment) 0%

[o/population*100 000] [o/c*100] (3)

r s t

[r/l2*100] (3)

u

[t/i*100] 0% 0% 0% 0% 62 (3) [v/t*100] (3) [x/t*100] (3)

v w x y z

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received diagnostic DST aa Number of multi-drug resistant TB (MDR-TB) cases notified among new and re-treatment cases Number of new smear-positive cases registered for treatment in 2007 Number of new smear-positive cases notified in 2007 % of all notified new smear-positive TB cases that were registered for treatment Number of new smear-positive TB cases that were successfully treated (2007 cohort) % of all new smear-positive TB cases registered for treatment that were successfully treated (2007 cohort) Number of new smear positive TB cases that failed their treatment % of all new smear-positive TB cases registered for treatment who failed their treatment (2007 cohort) Number of new smear positive TB cases who died while on TB treatment % of all new smear-positive TB cases registered for treatment who died while on TB treatment (2007 cohort) Number of new smear positive TB cases who defaulted % of all new smear-positive TB cases registered for treatment who defaulted (2007 cohort) 6 (3)

Treatment outcome, 2007 ab ac ad ae af 109 109 100% 94 94/109= 86.2% 0 0% 5 5/109=4.5% 10 10/109=9% (3) (3) [ab/ac*100] (3) [ae/ab*100] (3) [ag/ab*100] (3) [ai/ab*100] (3) [ak/ab*100]

ag ah

ai aj

ak al

Other:  specify
1.

 use "Tab" key to add extra rows if needed

Global tuberculosis control: a short update to the 2009 report. WHO/HTM/TB/2009.426

2. Multidrug and extrensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
WHO/HTM/TB/2010.3 – See Annex 6: Estimates of MDR-TB, by WHO region, 2008 3. Data from country TB routine recording and reporting system.

4.3

Major constraints and gaps in disease, health, and community systems

4.3.1 Tuberculosis program
Describe: (a) the main weaknesses in the implementation of current tuberculosis strategies; (b) existing gaps and inequities in the delivery of services to target populations; and (c) how these weaknesses affect achievement of planned national tuberculosis outcomes. The National TB control progamme with the support of GFATM round five grant has made considerable improvement in TB control and DOTS implementation in Jordan (improved TB case detection and sustaining treatment outcome among Jordanian nationals), however there are significant gaps and constraints for which involvement of civil society and other stakeholders are crucial to provide equitable access to quality services and improve care for the most vulnerable populations particularly non Jordanians.;

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(a)The main weaknesses of implementation of current tuberculosis strategies are: 1. Improvements of health services have not been associated with improved access to care for migrants. Interventions have not been fully tapered to patients’ needs. The limited ACSM activities have not yet so far resulted in comprehending and addressing the barriers to use services by migrants 2. The results of KAP survey that NTP conducted in 2007 by involving 275 patients diagnosed with TB in rural areas and poor urban showed that there are serious barriers for patients to go through daily direct observation of treatment in health care facilities. These barriers are mainly stigma, physical burden to refer to services on a daily basis, family responsibilities to take care of the children at home by mothers and fear of losing the work. The survey tried to look into the percentage of patients who were not ensuring compliance to treatment (not taking medication for 7 or more consecutive days). While default rate (being lost to follow-up for more than two months) is 9% among Jordanian nationals, this rate varies in urban and rural areas. In some rural areas default rate is as high as ???. According to the results of this survey, 36.4% of the patients were non-compliant and the highest number of such patients was from south Jordan. Many of the knowledge and behavior aspects including perceived stigma, long duration of treatment, being busy, living far away from facility and fear of losing job were among the causes of this non-compliance reported by the patients. 3. Up to now, tuberculosis infection control measures have been largely neglected, this is largely due to low suspicion of TB among patients with respiratory symptoms and lack of know-how on how to decrease the risk of nosocomial transmission of TB. A survey conducted in 2006 and repeated in 2007 showed xx% of health care staff have turned PPD skin positive. This means infection control needs to be addressed. 4. In the last three years on average 21% of peripheral laboratories have failed to show satisfactory results for TB microscopic examination on the external quality assurance. This has been resulted mainly from high turnover of staff. During the last three years, seven out of existing 13 peripheral laboratories have changed their staff responsible for direct sputum microscopy. The Programme has trained staff however the staff need time to improve their skills. 5. Capacity of National Reference Laboratory in timely and accurate diagnosis of drug resistant TB, particularly among migrant population is limited. In the last three years, the efforts of NRL to contact a supranational reference laboratory and be externally quality assessed have not led to any result. The main problem has been mentioned by SNRL were lack of funding and unavailability of specimen. The NRL is functioning without external quality assessment by any SNRL. 6. Health care staff of prisons is not fully aware of how to diagnose and/or treat TB. Existing gaps and inequities in the delivery of services to target populations 1. There are estimated 1.5 million migrants with limited access to TB care due to lack of awareness, stigma, and lack of ability of services to reach out to these groups of population. According to the latest census, there were 303,325 officially registered labor migrants including about 60,000 house-maids (mainly from Indonesia, Sri Lanka and The Philippines) with average annual turnover of 40%. The Ministry of Health provides free of charge services to migrants and they are screened on entry; however follow-up screening and provision of treatment for detected TB patients are largely lacking for several reasons namely the fear of being deported and stigma associated with TB, lack of awareness of migrants on their rights and responsibilities and psychosocial and cultural/language barriers. For this reason, treatment outcome among non Jordanian residents is strikingly low. Due to high mobility of these population and based on agreement with WHO EMRO, NTP enters these patients in a separate register. In 2007, 313 sputum smear positive patients were detected

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among 390,618 migrants, however only 91 of them are evaluated for treatment, the rest were lost to follow-up, either have returned to their home country or can not be identified to ensure treatment. Although this number seems small, however comparing with the number of TB cases among Jordanian during the same period (244 TB cases) and small population, this considers an important portion. In 2006 treatment success rate for new sputum smear positive for Jordanians was 85,7% while the rate is 32% for non Jordanians, In 2007 92,7% for Jordanian and 65,3% and in 2008 this indicator for was 93% for Jordanians and for non-Jordanians 64%. There are more than 200 large factories in Jordan mostly preparing men suits with labour migrant mainly from Asia (more than 500 workers mainly from high TB incidence countries). TB in work place does not exist and once diagnosed with TB after a short intensive phase treatment, these workers are often sent back to their home countries by the recruiting companies. 2. There are indications that drug resistant TB is becoming a growing problem among migrants (numbers??). With security problem in the neighboring countries (Iraq and Palestine) and importance of providing care for patients irrespective of their nationality, religious or ethnic background, Jordan needs consolidated actions to improve services and access of services for refugees and migrants. Annoor sanitarium a Christian Faith-based organization is providing care for MDR-TB patients under GLC monitoring and financial support of round five for procurement of second line drugs, with round five GFATM proposal ending in June 2011, there is a need for continuous procurement of quality assured concessionally-priced second line drugs through GLC. Technical assistance of WHO/GLC is needed to ensure moving from project and hospital based approach to a programmatic approach of management of drug resistant TB. 3. There is a need for strengthening cross border TB control with communication system between NTPs and involving other stakeholders particularly the IOM to assist with linking the moving population to NTPs and civil society for improved TB diagnosis and care among people coming in from Iraq who have to live in overcrowded camps. Collaboration with UNRWA (The United Nations Relief and Works Agency for Palestine Refugees in the Near East) needs to be expanded to cater for the Palestinian refugees. How these weaknesses affect achievement of planned national tuberculosis outcomes. Poor treatment success among non Jordanian nationals, whether these patients are returned back to their home country or are residing in Jordan and avoiding referring to health centers for the fear of being deported will lead to TB transmission in the communities and continued reservoir of TB. Should NTP include the non Jordanians in her national register, treatment outcome would substantially decrease. With almost 200 TB patients travelling back to their home countries without adequate treatment or infection control measures in international airports, transit zones and airplanes, in addition to huge physical, financial and mental burden to patients and their families, is a threat to international public health. Should some of these patients opt to stay in the country, inadequate or selfadministered treatment may lead to development of drug resistant TB. Poor TB infection control measures will lead to staff being infected and ultimately develop the disease (as the result of NTP operational research in 2007 showed that xxx number of staff were infected in one year period). Screening methods for industrial and domestic workers coming from other countries are not satisfactory leading to diagnosis of TB in them only when they have landed in Jordan. The health facilities make maximum efforts to treat these patients but many a times these patients are sent back to their country of origin by their employers. This can result in loss to the follow-up and an inadequate contact management. Low performance of one fifth of peripheral laboratories can lead to under-diagnosis of TB and continuous transmission of the disease in the society. There is a need to strengthen
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on-site supervision by NRL.

4.3.2

Health Systems

Describe the main weaknesses of and/or gaps in health systems that affect tuberculosis outcomes. Lack of continuum of care for migrants diagnosed with TB is a major weakness of health system. The practical Approaches to Lung Health has started officially in 2006 after a feasibility study 190 physicians were trained, however there have not been supervisory visits planned. just limited to few health services. The PAL monitoring has not been included in the reporting system. Despite decrease of TB among general population, latent TB infection and active TB is being reported among health care staff particularly in services where TB is not suspected. Up to now no infection control risk assessment has been conducted, staff is not trained on TB-IC, effective use of natural ventilation and personal protection equipment (respirators) are not introduced. Limited education on cough etiquette is provided to patients. TB infection control is one of the areas which needs improvement both in terms of laboratory biosafety and development of facility standard operating procedures as well measures to decrease the risk of TB infection in health care services, particularly in Annoor Sanitarium where MDR-TB, potentially XDR-TB and at time drug sensitive TB patients are admitted together.

4.3.3

Community Systems

Describe the main weaknesses of and/or gaps in community systems that affect tuberculosis outcomes. Stigma is a major barrier in involving communities in TB control. The results of KAP survey that NTP conducted in 2007 by involving 275 patients diagnosed with TB showed that 36.4% of the patients interrupted their treatment for 7 or more consecutive days and the highest number of such patients was from south Jordan. Many of the knowledge and behavior aspects including perceived stigma, long duration of treatment, being busy, living far away from facility and fear of losing job were among the causes of this non-compliance reported by the patients. There are no community activities among migrants and refugees. The communities of migrants are by large under-powered and self-restricted due to their fear of being deported. TB among these groups continues to flare-up after their arrival most probably due to stress of new environment and their wish to save all their incomes for their families and saving on housing and food costs. These individuals do not get any specific community support.

4.3.4 Efforts to resolve weaknesses and gaps
Describe what is being done, and by whom, to respond to health and community system weaknesses and gaps that affect tuberculosis outcomes, as outlined in sections 4.3.2 and 4.3.3. PAL is being piloted. Round five proposal has helped improving TB infection control in the national reference laboratory. In order to destigmatise TB, a celebrity is recruited as a TB Ambassador is recruited. In collaboration with WHO EMRO and STOP TB, a high level visit of President Goergio Sampaio was arranged to sustain commitment to TB control despite financial restrictions of the government. ACSM activities are conducted but with limited resources. In response to poor performance of some peripheral laboratories conducting direct sputum smear microscopy, the programme has introduced parallel preparation and reading of sputum samples at NRL at the same time in the low performance centers. The lessons learned shows that at least two training courses shall be organized per year to address the
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high turnover of staff. The programme has translated in Arabic and distributed the patient charter to highlight patients’ right and responsibilities.

4.4

Proposal strategy
Complete this version of section 4.4.1 if the applicant selected option 2 or 3 in section 3.1 of the Proposal Form

Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

4.4.1 Interventions
 This section should be completed in parallel with the Performance Framework and detailed budget and work plan

Describe the objectives, service delivery areas (SDA), and activities of the proposal. The description must be organized in that exact order and the numbering system must match the Performance Framework, detailed budget and work plan. The description must identify: (a) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other implementer); and (b) the targeted population(s). The proposal is structured in three objectives in line with StopTB strategy and The National TB Control Strategic Plan 2007-2011

Objective 1: To ensure quality DOTS for the most vulnerable population particularly the non-Jordanian residents
Vulnerable populations in Jordan are mainly immigrants including refugees and labor migrants, nomads and people living in poor urban and remote rural areas. There are about 1.5 million immigrants in Jordan (one in every fifth resident). Activities under this objective will supplement the services provided by the Ministry of health and will improve accessibility and acceptability of services for the most vulnerable populations particularly the nonJordanian nationals who are the most vulnerable population and face multiple barriers to access and use services. The proposed activities will be mainly implemented mainly by civil society, NGOs, communities and NTP partners who have proximity to the population. In designing the community system strengthening (CSS) and patient-centered approaches, the latest guidelines of GFATM, WHO and UNAIDS have been used to classify the SDAs with inputs of NGOs and migrants.

SDA 1.1 Community System Strengthening: Human resources (skills building for service delivery, advocacy and leadership)
Target population: Migrant population, people living below poverty line, women and youth Indicators:

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Principle activities: Activity 1.1.1 Conduct quality of care workshops with patient’s and communities’ representatives - NTP, JATA and representatives of migrants, patients and/or ex-TBs and communities will take part in round table consultation meetings under a national committee to discuss patient-centered approaches, patient default prevention and tracing mechanism and adapt the models of TB care in Jordan. Activity 1.1.2 Conduct training of TB health educators who are targeting women, nomads, rural areas and poor urban – JATA will train six health educators embedded in women’s groups, Youth NGOs and faith-based organizations to conduct TB health education among women, rural areas and poor urban to fight stigma and improve case detection and referrals.

SDA1.2 Community System Strengthening: Community based activities and services – delivery, use, quality
Target population: Migrant population, people living below poverty line, other vulnerable population including single mothers Indicators: Principle activities: Activity 1.2.1 Develop peer support network for migrant communities – JATA will
identify and train five migrant peer- supporters per year. Peer supporters conduct monthly lectures and distribute TB health education materials in their respective communities to combat stigma and promote patients’ right. Their main task is to be focal contact for migrants particularly housemaids.

Activity 1.2.2 Provide Direct Observation of Treatment (DOT) via community treatment supporters – JATA will contract four NGOs to improve DOT with patient-centered
approaches including home visits and/or DOT by treatment supporters for eligible patients (single mothers, disabled patients, nomads and migrants with difficulty to access health care services; 200 per year) in poor urban, remote rural and migrant communities.

Activity 1.2.3 Provide food supplements as an incentives and reimbursement of travel expenses as enablers for most vulnerable patients – JATA will identify eligible

patients based on an already-developed national selection criteria (annex XX) of the social status (including low income, unemployment, single mothers, migrants and patients from rural remote areas) and provide them with incentives and enablers to improve their adherence to treatment. To confirm the social status, a social nurse will visit patient’s domicile. JATA will provide food supplements (35 USD per month) and reimbursement of patients’ transport cost of 15 USD per month (200 socially eligible patients per year).

SDA: 1.3 Advocacy, Communication and Social Mobilization
Target population: general population, policy makers, migrants Indicators: Principle activities: Activity 1.3.1 Conduct training for mass media on TB control – NTP in collaboration with
the communication department of Ministry of Health will organize Media training workshops (Yrs 2 and 4) for media representatives in order to educate them on the current TB issues and provide them with up-to-date TB resource kits.

Activity 1.3.2 Produce and distribute TB information and education materials

– A national working group (NTP, NGOs, IOM and JATA) will develop and distribute TB health education materials in different languages to increase knowledge among refugee and cross border populations and

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other population groups in the year one. Information and education materials will include 1000 flip charts and 50,000 posters to be distributed through NGO partner networks. Additionally, 1000 footballs will also be purchased and branded with TB control messages to be disseminated through youth associations, schools, rural communities and migrant worker groups.

SDA 1.4 Community System Strengthening: Monitoring and documentation of community and government interventions
Target population: Communities affected by TB Indicators: Principle activities: Activity 1.4.1 Monitoring implementation of Community System Strengthening activities – A subgroup appointed by CCM with representatives of CBO, FBO and PR will oversight
implementation of community system strengthening activities. The subgroup will conduct desk review of the implementation reports and conduct quarterly site visits. The subgroup will report back their findings and recommendations to CCM Oversight Committee.

SDA 1.5 Cross border TB care
Target population: Migrant population, asylum seekers, refugees Indicators: Principle activities:
International Organization of Migration (IOM) is dealing with pre-entry screening of migrants, refugees and asylum seekers. Once in Jordan, Iraqi refugees and asylum seekers are receiving services from IOM clinic. Labor migrants with TB may be returned home by the company recruiting them. Under SDAs 1.1, 1.2 and 1.3, the program attempts to provide care and support for these patients until they fully recover, however some patients may opt to return to their home country while on TB treatment. These patients need to have immediate access to treatment and care across the borders. Previous NTP efforts to reach other countries’ NTP for transfer of patients have not resulted in any feedback from countries receiving patients. As the result NTP has created a separate register for temporary residents. Under this SDA, the program will work with IOM as a sub-recipient to ensure continuity of care for patients across the borders using IOM offices in different countries and regions. IOM has offices in Iraq as well as high TB incidence countries the patients are coming from and therefore will expand its services to provide continuation of care to TB patients internationally (150 estimated TB patients per year).

Activity 1.5.1 Train IOM clinicians – NTP will train five staff of IOM clinics in Jordan to transfer
TB suspects to NTP and follow their treatment if residing in Jordan in year 1 and year 3.

Activity 1.5.2 Strengthen cross border referral system – NTP and IOM will prepare referral
and transfer forms for TB patients and ensuring treatment outcomes are reported back to NTP Jordan in year 1.

Activity 1.5.3 Contract IOM to deliver services to migrants – IOM will ensure effective health pre-screening of labor migrants (including TB screening) through appointed health centers in home country of migrants, provide DOT for asylum seekers and Iraqi refugees with TB in Jordan and ensure transfer of data if patients are transferred to their home country: (60,000 USD per year from every 1 onwards).

SDA 1.6 TB laboratory network
Target population: TB suspects, TB patients Indicators:

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Principle activities: Activity 1.6.1 Improve external quality control assurance of direct microscopy – TB laboratories in the periphery and laboratories in refugee camps and IOM will send randomly selected slides to NRL for double checking of slides and quality control (according to WHO EQA system) on a quarterly basis (transport cost of 1000 USD per year). Activity 1.6.2 Conduct supportive supervisory visits to peripheral laboratories – NRL will conduct supervisory visits to peripheral laboratories on a quarterly basis to conduct on the job training of staff and improve the quality of direct sputum examination.

Objective 2: To scale up MDR-TB management, control and care
Under this objective, NTP in collaboration with Annoor sanitarium will scale-up national MDR-TB response and provide treatment and care for all MDR-TB patients who are residents of Jordan irrespective of their ethnic, race, religion or nationality. Annoor Sanitarium is a Faith-based organization who has been providing treatment and care for patients with TB and respiratory diseases in the past four decades. The center has a bilateral partnership agreement with NTP and provides care for MDR-TB patients under the GLC agreement. Under round 10 proposal, the support to procure second line drugs from GLC/GDF will be continued and with WHO technical assistance, NTP will scale up programmatic management of MDR-TB with providing ambulatory treatment of patients. The capacity of National Mycobacteriology Reference Laboratory will be improved to timely detect drug resistance for all residents of Jordan.

SDA 2.1 Improving diagnosis
Target population: TB and MDR-TB suspects Indicators: Principle activities: Activity 2.1.1 Establish external quality assessment Activity 2.1.2 Improve infection control in NRL
– NTP will establish an external quality assurance system for mycobacteriology services by NRL with panel testing of SNRL on an annual basis. – The program will refurbish the NRL to improve TB infection control. (procurement of two class II laminar Biosafety cabinets (18,000 USD), maintenance of biosafety cabinets (4000 USD every other year), four Ultra-Violet Germicidal Irradiation (UVGIs) (4x680 USD), physical separation of clean and dirty zones and negative pressure ventilation (60,000 USD) in year 1.

Activity 2.1.3 Transport safely sputum samples from peripheries

– NTP will arrange safe transport of sputum samples for culture and DST from district laboratories, refugee camps and work places every quarter from year 1 onwards (1000 USD per year).

Activity 2.1.4 Train NRL staff on liquid culture – Three NRL staff will be trained at SNRL on
liquid culture/DST in year II and year IV.

Activity 2.1.5 Procure laboratory equipment and supply for liquid culture – PR will
procure MGIT equipment for liquid culture and supplies for 120 tests per year from 2011 onwards.

Activity 2.1.5 Establish Drug susceptibility testing to second line drugs

– NRL in close collaboration with SNRL will introduce drug susceptibility testing to second line anti-TB drugs from 2013 onwards.

Activity 2.1.6 Provide external technical assistance – An external laboratory consultant will
visit NRL and provide technical assistance on an annual basis.

SDA 2.2 Provision of quality assured second line drugs
Target population: MDR-TB patients
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Indicators: Principle activities: Activity 2.2.1 Procure second line drugs – PR will procure second line drugs from GLC/GDF
mechanism for 20 X/MDR-TB patients per year.

SDA 2.3 Programmatic management of Drug resistant TB
Target population: MDR-TB suspects, MDR-TB patients Indicators: Principle activities: Activity 2.3.1 Provide external technical assistance – PR will ensure technical assistance
from WHO/GLC appointed expert on annual basis (one visit per year).

Activity 2.3.2 Develop Standard Operating Procedures for MDR-TB case management
– In consultation with WHO, GLC and Annoor Sanitarium, NTP will finalize standard operating procedure for ambulatory care for MDR-TB patients in year 1.

Activity 2.3.3 Train staff responsible for ambulatory care of MDR-TB patients – NTP
will train 15 staff of MDR-TB ambulatory units per year on case holding, side effect management and follow-up of MDR-TB patients.

Objective 3: To improve health system response to TB control
SDA 3.1 TB in workplace
Target population: Workers working in manufacturing factories (mainly labor migrants from high TB incidence countries) Indicators: Principle activities: Activity 3.1.1 Map the potential sites for TB in workplace – NTP and governorate TB
coordinators will map the factories with more than 500 workers where mainly labor migrants are working in year two. The mapping exercise includes the following variables: number of workers, percentage of labor migrants, health care and health insurance status of workers and identify contact persons in each workplace. (2000 USD per governorate).

Activity 3.1.2 Study visit to successful models of TB in workplace – Three staff (NTP and
JATA) will participate in a study visit to a country with successful models of TB in workplace year 1.

Activity 3.1.3 Develop feasible model of TB in workplace – A working group from NTP, NGO

and private sector responsible for workplace will establish a model of collaboration (modus operandi) in year 2.

Activity 3.1.4 Train TB in workplace Focal Persons – In collaboration with the private sector,
JATA, NTP and IOM will select and train TB focal persons in each workplace (three people in each workplace) in year 2.

Activity 3.1.5 Conduct TB health education campaigns in workplace – TB Focal Persons
in workplace emphasis on patients on emphasizing

in collaboration with the private sector will conduct TB health education campaigns with early referral of TB suspects, importance of timely start of treatment and full treatment of a quarterly basis. TB focal persons will provide TB patients with patients’ charter, on their right and responsibilities regardless of race, ethnic group, nationality or

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background.

Activity 3.1.6 Establish DOT in workplace or via appointed private sector – In
collaboration with three major workplaces, NTP will pilot directly-observed treatment of workers with TB including the labor migrants in the year 2. Treatment will be provided by the private sector appointed by the factory or the trained focal person on a home-based care.

Activity 3.1.7 Assess the pilot DOT in workplace – A team of national and international
consultants will assess the pilot models of TB in workplace in year 3.

Activity 3.1.8 Organize national orientation workshop – NTP will organize a national
orientation workshop to share the results of TB in work place pilot implementation with other factory managers in year 3.

Activity 3.1.9 Expand TB in workplace model – NTP will expand the model of TB in workplace
to 15 more factories from year 3 to 5.

SDA 3.2 TB in Children
Target population: children (below 12 years old) Indicators: Principle activities:
Using the existing national team on Integrated Management of Childhood Illnesses (IMCI), the GFATM project will include TB in the curriculum and train the trainers.

Activity 3.2.1 Include TB in Integrated Management of Childhood Illnesses – NTP will
include TB in the curriculum of Integrated Management of Childhood Illnesses (IMCI) and adapt the necessary recording and reporting forms and monitor the referral of TB suspects (latent TB and active TB) from NTP and non NTP treatment providers in year 2.

Activity 3.2.2 Train national IMCI trainers – NTP will train national IMCI trainers (11 trainers)
and four trainers from UNRWA in year 2.

Activity 3.2.3 Train health care providers on TB in children – Trainers will conduct two-day
training courses of staff of public health care units (150 staff per year) from year 2 onwards.

Activity 3.2.4 Monitor progress of improved TB case detection and management among children – NTP will conduct quarterly follow-up supervisory visits to primary health care
centers and UNRWA from year 2 onwards.

SDA 3.3 Practical Approaches to Lung Health
Target population: Individuals above five years of age with respiratory symptoms Indicators: number of primary health care facilities with at least one physician trained in PAL over total number of PHC facilities in Jordan TO ADD HERE (VAN AND NADIA) Principle activities: NTP will scale up PAL started under round 5 and ensure a robust follow up system. Activity 3.3.1. A national awareness and advocacy and expansion planning one day meeting – Participants: representatives: (2) form MOH, (2) from NTP, (12) from governorate health
directorates, (12) from supervisory officers from health directorates, members of national PAL working group, (1) representative from UNWRA, (1) from Health Management Information System (HMIS), (1) from responsible from pharmaceuticals and one from IMCI. (Year 1, Q1). The outcome of this meeting is nomination of the PAL planning group and operationalization group.

Activity 3.3.2 meetings of PAL planning group – Group is composed of 8 members as
nominated by the meeting under 3.3.1. Meetings should hold three times, two meetings in two months. The outcome should be an elaborated draft of a strategic national expansion PAL (end of Q1 beginning

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Q2 of first year).

Activity 3.3.3 National meeting to operationalize and discuss the draft of strategic PAL expansion plan – Participants: (2) from NTP, (2) from MOH, (12) TB governorates coordinators

and (12) primary health care appointees (appointed by the head of the general directorate, as in 3.3.1). The outcome will be a specific implementation and training plan specifying roles and responsibilities of local district level including supervision of PAL relevant quality implementation. This also encompasses the widely agreed introduction of pal indicators and the harmonization of pal relevant R&R with the existing HMIS (health management and information system). To help ensure high quality PAL implementation, travel allowances for supervisory teams should be guaranteed. The actual allowance depends on the average distance traveled and the frequency of supervisory visits (Q2 of first year).

Activity 3.3.4 national PAL expansion plan endorsement meeting: Participants: representatives: (2) form MOH, (2) from NTP, (12) from health directories, (12) from supervisory officers from health directories, members of national PAL working group, (1) representative from UNWRA, (1) from HMIS, (1) from essential drug list and one from IMCI. One-day meeting in Q3 of year one to endorse the operationalized plan. Activity 3.2. Updating the PAL national guideline, the PAL training materials and developing PAL posters Members of the national working group plus representatives of: academia, Jordanian thoracic association, army, primary health care, pediatricians, health safety directorate of MOH (year 1 Q3, after endorsement of the expansion plan see, activity 3.3.4) To consider external TA for 3.2 activity Activity 3.2.1 printing the updated PAL guideline in sufficient number (2000 copies, end of Q3 and beginning of Q4, year 1). Activity 3.2.2 printing of PAL posters in sufficient number (1000 copies, end of Q3 and beginning of Q4, year 1) Activity 3.2.3 procuring PAL equipment: peak flow meters (2000), spirometers (12), to cover primary health facilities with peak flow meters and TB centers with spirometers. (Q1, year1). Activity 3.3 PAL training i. Trainer of trainers: training of additional trainers conducted by the NTP: 12 from the chest NTP centers at governorate level, 12 heads of health governorate directorates or their appointees, plus 12 heads of comprehensive health centers of different governorates. (one session in Q4 year1 and the second session in Q1 year2). ii. Cascade training by trainers (continuation of 3.3.1) as outlined in national PAL expansion plan (endorsed under activity 3.3.4). To train 1000 physicians in three years (years 2 to year 4 inclusive). Participants will receive updated guidelines, wall display posters and peak flow meters, which were developed under activities 3.2.1 to 3.2.3. Activity 3.3.1 Conduct supervisory visits – NTP will conduct supportive supervisory visits to centers to monitor the progress of implementation on a quarterly basis.

Activity 3.3.2 Improve recording and reporting system – NTP will integrate the PAL recording and reporting to the national health information system in year I.

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Activity 3.3.3 Train newly recruited staff – NTP trainers and Chest Physician association will train other physicians to scale up PAL (120 staff per year).

SDA 3.4 TB in prisons
Target population: prisoners Indicators: Principle activities: Activity 3.4.1 Introduce TB health education materials for prisoners – NTP in
collaboration with the Ministry of Interior will develop and distribute health education materials for prisoners.

Activity 3.4.2 Train health care staff and wardens – Every year NTP will train 10 prison health staff on TB infection control, early referral of TB suspects, sputum collection and Direct Observation of Treatment every year and train 20 wardens per year on TB infection control and communication skills with patients. Activity 3.4.2 Conduct supervisory visits – NTP will conduct supportive supervisory visits to prisons to monitor the progress of implementation on a quarterly basis.

SDA 3.5 TB Infection control
Target population: General population, health care staff, prisoners and prison wardens Indicators: Principle activities: Under this SDA, the program will introduce modern infection control policies and practices, the latest WHO and CDC guidelines will be used. Activity 3.4.1 Develop National guidelines on TB Infection control – A national working group will develop national guidelines for TB-IC for Jordan based on the 2009 WHO guidelines in the year I. Activity 3.4.2 Establish TB surveillance among health care staff – NTP will introduce surveillance of TB among health care workers from year I onwards. Activity 3.4.3 Train staff on TB-IC – WHO will conduct training of three national trainers on TB-IC, trainers will train 2 staff per governorate on TB-IC risk assessment and different levels of TB-IC from year II onwards Activity 3.4.4 Conduct facility TB-IC risk assessments – governorate TB coordinators will conduct facility TB-IC risk assessment in their respective governorates from year II onwards and recommend measures to decrease the risk of TB infection in health care facilities. Activity 3.4.5 Procure TB-IC related equipment and supplies – PR will procure equipment to measure airflow and air changes per hour and 20 shielded UVGI (14 for TB centers+ 6 for MDR-TB patient facility Annoor), respirators (N95 or FFPII certified, 3 respirators per staff working with TB patients per month) and qualitative respiratory fit testing kit (five) in year I and III.

Complete this version of section 4.4.1(a) (b) and (c) if the applicant selected option 1 in section 3.1 of the Proposal Form Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal
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4.4.1 Interventions
 This section should be completed in parallel with the Consolidated Performance Framework and detailed budget and work plan

(a) Overview of programmatic activities Describe the objectives, service delivery areas (SDA), and activities of the consolidated disease application. The description must be organized in that exact order and the numbering system must match the Consolidated Performance Framework, detailed budget and work plan. The narrative description of the Round 10 interventions should reflect all objectives, service delivery areas (SDAs), and activities in the Round 10 consolidated disease proposal, but distinguish between what programming is being continued from existing grants versus new programming for Round 10. The description must identify: (1) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other implementer); (2) the targeted population(s); (3) what changes in implementation and/or the targeted population(s) have occurred, if any, for those elements which are from existing grants and continuing in this consolidated disease proposal; (4) any links between the existing grant activities to be continued in the consolidated disease proposal, as these activities previously existed in separate grants; (5) any links between the proposed activities and existing Global Fund grants for other diseases or HSS; and (6) how duplication will be avoided if there are linkages identified in points (4) and (5) above. FOUR - EIGHT PAGE MAXIMUM (b) Changes to existing SDAs, programmatic activities, indicators and targets In the table below, list the SDAs and activities of existing grants consolidated within the Round 10 consolidated disease proposal. Explain whether each SDA and activity from an existing grant will be included in the Round 10 consolidated disease proposal by indicating an increase in scale, decrease in scale, continuation without change, or discontinuation. Provide justification for any proposed changes or discontinuation.
 The proposed changes should be clearly and systematically reflected in the Consolidated Performance Framework
Servi ce Deliv ery Area (SDA )

Ro un d#

Act ivit y

Propose d change

Justification for change

 use “T ab ” key to ad d ext ra ro ws

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(c) Changes to existing impact or outcome indicators and targets Describe any major changes in indicators and targets that may have occurred due to the programming described above in sections (a) and (b) and that is supported by the Consolidated Performance Framework. In particular, if there has been discontinuation or change in indicators or if targets have been changed between previous grants and the Round 10 proposal, describe why this has occurred. ONE PAGE MAXIMUM

4.4.2 Addressing weaknesses from a previous category 3 proposal
If relevant describe how the weaknesses identified in the TRP Review Form of a previous category 3 proposal have been addressed. TWO PAGE MAXIMUM

4.4.3 Lessons learned from implementation experience
How do the implementation plans and activities described in 4.4.1 above draw on lessons learned from program implementation (from either Global Fund financed or non-Global Fund financed programs)? Implementation of round five grant has shown that there is a need for a sound cross border TB control. For the GLC cohort of 2007, out of 19 MDR-TB cases among non nationals, 5 are said they moved back to their own countries and three are lost to follow-up in Jordan, this shows that MDR-TB management shall be accompanied with a strong cross border collaboration with NTPs, civil societies and organizations involved in TB care in home countries of migrants, otherwise NTP efforts will be lost. The principal experience has a track record experience in implementing GFATM proposal with transparent and efficient manner. Lessons learned from GFATM round five has shown that NTP and the Ministry of Health can not address the complex problem of TB in Jordan by themselves, there is a need for involvement of civil society and strengthening community system. The lessons learned has shown that provision of services, does not mean that the population particularly the most vulnerable ones would necessarily use the services. In order to improve accessibility, acceptability and equity, patients’ perspectives and key elements of support and care need to be taken into account in the planning and provision of services. In addition strong TB control for only Jordanian nationals shall not be a reason for complacency. For humanitarian reasons as well as public health reasons, TB control among migrants and refugees need to be improved with involving representatives of these communities.

4.4.4 Enhancing TB/HIV collaborative activities
Describe: (a) how the proposal will contribute to strengthening TB/HIV collaborative activities; and (b) the collaboration between the National TB program and the HIV services of your country. TB and HIV programmes are functioning in close collaboration. All TB patients are offered HIV testing and counseling in the last three years no HIV positive case among TB patients have been found. Active TB case finding is in place among PLWH.

4.4.5 Enhancing social and gender equality
Using specific references to objectives, SDAs, and activities included in section 4.4.1, explain how the Under the SDA number xxx, Women Education council will be further involved to mobilize

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the families and decrease stigma to TB. Under the SDA number xxx, the Jordanian Anti-TB Association is training home visitors social nurses two more will be recruited and trained. Migrants are among the most vulnerable population. The SDA number xxx will improve their understanding on their rights and responsibilities for TB diagnosis and treatment.

4.4.6

Partnerships with the private sector

Describe how contributions related to: (i) co-investment from the private sector, and (ii) donated goods or services, will add value to the planned outcomes of the proposal. Make specific reference to the associated objectives, SDAs, or activities to which they are linked. Private sector is at the forefront of early TB case detection with undiagnosed TB referring to them. The SDA xxx under this proposal ensures private sector is aware of TB symptoms and suspects are referred timely for diagnosis. The successful models of TB workplace will be piloted and expanded in Jordan. National TB registry will be adapted to document the referral of suspect from private sector and the yield. Early referral will decrease the transmission risk, improve treatment outcome, decrease burden of TB on patients and possible chance of natural selection of resistant TB with in appropriate treatment.

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Only complete section 4.4.7 if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form, DO NOT COMPLETE section 4.4.7 if the applicant selected Option 1 in section 3.1 of the Proposal Form Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

4.4.7 Links to other Global Fund resources
Describe in the table below the linkages between this Round 10 proposal and existing Global Fund resources. It is important to list the SDAs and activities as outlined in the current proposal in the left hand column, add a description as to how they relate to previous grants in the middle two columns, and then outline how the Round 10 proposal specifically addresses this in the right-hand column.
Key SDA and activity as proposed in the Round 10 proposal 1. SDA 1.1 Activity 1.2 Activity 2. SDA MDR-TB 2.1 Activity 3. SDA 3.1 Activity 3.2 Activity ACSM Expansion of ACSM Programmatic management of drug resistantTB PAL Expansion of PAL Existing grants Round 10 Proposal Round five [insert Round #]

 use “Tab” key to add extra rows

4.4.8

Links to non-Global Fund resources

Describe whether the Round 10 interventions (e.g. goals, objectives, SDAs, and activities) listed in section 4.4.1 have linkages to programs financed through non-Global Fund resources. If such linkages exist, list the non-Global Fund financed programs and their activities, and explain how the proposal complements those programs and activities. In addition, explain how the Round 10 interventions do not duplicate existing programs and activities supported by non-Global Fund resources. The activities under this proposal are not funded by other non-Global Fund resources. The activities of the current proposal are complementary to improve care.

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4.4.9 Strategy to mitigate unintended consequences of additional program support on health systems
Describe: (a) the potential risks and unintended consequences on health systems that may result from the implementation of the proposal; and (b) the proposed strategy for mitigating these potentially disruptive consequences. (a) Home based care if not carefully planned may weaken the status of health care services and patients’ acceptability of the existing ambulatory health structure. (b) The activities under this proposal have been planned in such a way to provide a sound balance of home-based care and use of ambulatory services by patients. Only eligible patients are provided with home based care….

4.5

Program Sustainability

4.5.1 Strengthening capacity and processes in tuberculosis service delivery to achieve improved health and social outcomes Describe how the proposal contributes to overall strengthening and/or further development of public, private and community institutions and systems to ensure improved tuberculosis service delivery and outcomes.
 If available, refer to country evaluation reviews  Support explanation with excerpts from documents that the country has adopted, identifying the source, such as a National Disease Strategy

The National TB strategic plan (annex 1) provides evidence on the Ministry of Health and NTP’s vision on sustainability of activities.R10 proposal will strengthen the capacity of the programme to address the challenges with training of staff, updating pre-service and in-service training curricula….

4.5.2 Alignment with broader developmental frameworks Describe how the proposal’s strategy aligns with broader developmental frameworks such as: • Poverty Reduction Strategies; • The Highly-Indebted Poor Country (HIPC) initiative; • The Millennium Development Goals; • An existing national health sector development plan; • Any other important initiatives.
ONE PAGE MAXIMUM 4.5.3 Improving value for money Explain how the program that the proposal contributes to represents good value for money. Specifically, given the context of the epidemic in the country and the definition of value for money provided in the Guidelines, describe how the key interventions in the proposal represent the best balance of costs and effectiveness, with consideration to the desired achievement of both short and long term impacts. Cost-effective interventions are planned to provide best value for money in this proposal. Though some of the interventions are expensive (such as treatment of MDR TB) they can be considered efficient in a longer term, since will contribute to preventing spread of drug resistant TB forms. The interventions outlined in this proposal imply comprehensive approach in TB control aiming to reduce burden of disease. It is deemed that this approach will contribute to longer-term effects of the

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program to be implemented at the national level. ONE PAGE MAXIMUM

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4.6

Monitoring and Evaluation System

4.6.1 Impact and outcome measurement systems Describe the impact and outcome measurement systems, including strengths and weaknesses, used to measure achievements of the program at impact and outcome level.
Conducting TB prevalence survey study to measure impact of interventions would be very costly and therefore the National TB Control Program will use epidemiological data and recording and reporting to measure the trend in TB notification and TB mortality as proxies for impact. Concerning the outcomes, these data are readily available with number of TB patients identified and number of patients who will be successfully treated. The major weakness of impact measurement is those service deliveries considering non Jordanians, as NTP data recording and reporting has not been developed to capture them. NTP will improve its recording and reporting to ensure outcome indicators among all groups of patients including migrants may be captured.ONE PAGE MAXIMUM

4.6.2 Impact and outcome measurement
(a) Has impact and/or outcome data been collected in the last 2 years? Yes
 answer section 4.6.2 (b)

No
 go to section 4.6.2 (c)

(b) What was the source(s) of the measurement?

 insert source (large scale surveys, demographic surveillance, vital registration systems, other)

(c) It is important to guarantee that there are systems in place to measure all impact and outcome indicators in the performance framework. In order to do this, fill in the table below, fully describing all planned surveys, surveillance activities and routine data collection in country used to measure impact and outcome indicators relevant to the proposal. Add rows as needed.
Years of Implementation Data Source Source 1 Funding
Total cost Secured funding amount and funding source Funding gap Round 10 funding request for Source 1 Total cost Secured funding amount and funding source Funding gap Round 10 funding request for Source 2 Total cost Secured funding amount and funding source Funding gap Round 10 funding request for Source 3

2011

2012

2013

2014

2015

Impact/Outcome Indicators relevant to the proposal to be measured by data source

(large scale surveys, demographic surveillance, vital registration systems, other)

(large scale surveys, demographic surveillance, vital registration systems, other)

Source 2

(large scale surveys, demographic surveillance, vital registration systems, other)

Source 3

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4.6.3 Links with the National M&E System
(a) Describe how the monitoring and evaluation (M&E) arrangements in the proposal (at the Principal Recipient, Sub-recipient, and other levels) use existing national indicators, data collection tools and reporting systems including reporting channels and cycles. The key indicators and their definitions are selected from the internationally approved lists and sources developed by WHO and Stop TB Partnership. In particular, Monitoring and Evaluation Toolkit for HIV/AIDS, Tuberculosis and Malaria (Interagency guidelines, Second Edition, January 2006) was used as reference. Output and process indicators were developed in line with the Service Delivery Area and Activities included in the proposal’s Workplan. The selected indicators are among those which are used routinely by the National program. NTP and JATA will be responsible for monitoring and evaluation of the Round 10 project. The M&E team will work closely with National TB Control Program, National Health Information Service and other national and international counterparts. ONE PAGE MAXIMUM (b) Are all of the M&E arrangements planned for the proposal using the national M&E system? Yes
 go to section 4.6.4

No
 continue to section 4.6.3 (c)

(c) If no, explain why not and list any service delivery areas (SDAs) and/or activities that will not be monitored through the national M&E system. ONE PAGE MAXIMUM

4.6.4

Strengthening monitoring and evaluation systems
Yes
 continue to section 4.6.4 (b)

(a) Has a multi-stakeholder national M&E assessment been recently conducted (in last 2 years)?

No
 go to section 4.7

(b) If yes, has a costed M&E action plan been developed or updated to include identified M&E strengthening measures?

Yes
 continue to section 4.6.4 (c)

No
 go to section 4.7

(c) Describe whether the proposal is requesting funding for any M&E strengthening measures. These strengthening measures may have been identified through a national M&E assessment or any other relevant evaluation or review process. HALF PAGE MAXIMUM

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4.7

Implementation Capacity

4.7.1 Principal Recipient(s) Describe the technical, managerial and financial capacities of each Principal Recipient (PR) to manage and oversee implementation. Include any anticipated limitations to strong performance and refer to any existing assessments of the PR, other than Global Fund reporting mechanisms.
 Copy and paste tables below if there more than three Principal Recipients

PR 1 Name Street Address
 Description

Sector

PR 2 Name Street Address
 Description

Sector

PR 3 Name Street Address
 Description

Sector

4.7.2

Sub-recipients
be involved in Yes  go to section 4.7.2 (c) No  go to section 4.7.2 (b)

(a) Will Sub-recipients implementation?

(b)

If no, why not?

HALF PAGE MAXIMUM (c) If yes, how many Sub-recipients will be involved?
1-6 7-20 21-50 50+

(d)

Are all Sub-recipients already identified?

Yes
 go to sections 4.7.2 (e) and (f)

No
 go to section 4.7.3

(e) List the identified Sub-recipients and describe: • The work to be undertaken by each Sub-recipient; • Past implementation experience of each Sub-recipient; • Any challenges that could affect performance of each Sub-recipient as well as a mitigation strategy to address this. Jordanian Anti-TB Association (JATA) founded in 1944 with 52 active members has across to more than 70% of population Jordan. JATA as a sustainable and experienced counterpart will function as the main sub-recipient. The proposal will strengthen the capacity of JATA and empower them. to improve patientcentered approaches. Jordanian Anti-TB Association as a civil society organization will be leading Advocacy Communication and Social Mobilization (ACSM), reaching out to the communities, decreasing stigma

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associated with TB IOM TB control among migrants, TB health education among migrants Annor Sanitarium a Christian charity foundation has been supporting treatment of patients with MDR-TB for the last decade. The current proposal envisage supporting them for MDR-TB management.

(f) If the private sector and/or civil society are not involved as Sub-recipients in implementation, or only involved in a limited way, explain why. Chest Disease Society in training activities and guidelines development (Childhood TB guidelines) Faculty of Medicine in Amman and Erbid in operational research

4.7.3 Sub-recipients to be identified Describe: (a) why some or all of the Sub-recipients are not already identified; and (b) the transparent, time-bound process that the Principal Recipient(s) will use to select Sub-recipients and not delay program performance.
ONE PAGE MAXIMUM

4.7.4 Coordination between or among implementers Describe: (a) how coordination will occur between multiple Principal Recipients if there is more than one nominated Principal Recipient for the proposal; and (b) how coordination will occur between each nominated Principal Recipient and its respective Subrecipient to ensure timely and transparent program performance.
(a) MOH and JATA as two principle recipient will meet on a monthly basis and more often if needed to ensure coordination of activities. Both MOH and JATA are members of CCM. The CCM will monitor the project progress to ensure that the activities are carried out according to the workplan and indicators of programmatic and financial performance are accomplished. It will make the key financial and programmatic decisions and will have the responsibility to address the main problems and challenges related to the project. (b) Each of PRs have direct contact with their subrecepients. Since the tasks of each PR is different coordination among stakeholders are quite straightforward. In addition a quarterly meeting of all SRs and PRs will be held to discuss implementation progress (just a day before CCM meeting).The CCM meetings will be convened quarterly or more often as necessary. Technical working groups for each component will work with the stakeholders between the CCM meetings and prepare the documentation to be endorsed by the CCM. The CCM and the Ministry of Health will carry out the role of coordination with other programmes and development initiatives. The CCM will ensure practical coordination and collaboration with all local partners involved. TWO PAGE MAXIMUM

4.7.5 Strengthening implementation capacity (a) The applicant is encouraged to include a funding request for management and/or technical assistance to achieve strengthened capacity and high quality services, supported by a summary of a technical assistance (TA) plan based on the indicative percentage range in the Guidelines. In the table below provide a summary of the TA plan.
 Refer to the Strengthening Implementation Capacity information note for further background and detail

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Management and/or technical assistance need Management and/or technical assistance activity Intended beneficiary of management and/or technical assistance Estimated timeline Estimated cost
 same as proposal currency

 add extra rows as needed

(b) Describe the process used to identify the assistance needs listed in the above table. HALF PAGE MAXIMUM (c) If no request for management and/or technical assistance is included in the proposal, provide a justification below. Or, if the funding request is outside the indicative percentage range, provide a justification below. HALF PAGE MAXIMUM

4.8

Pharmaceutical and Other Health Products
4.8.1 Scope of Round 10 proposal

Does the proposal seek funding for any pharmaceutical and/or health products?

Yes  go to section 4.8.2 No  skip the remainder of section 4.8

4.8.2

Table of roles and responsibilities
Does the proposal request funding for addition al staff or technica l assistanc e?
 indicate Yes or No

Function

Name of the organization(s) responsible for this function

Role of the organization(s) responsible for this function

Procurement policies, systems, and planning

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4.8.2 Table of roles and responsibilities
Intellectual property regulations Quality assurance and quality control Management and coordination
 more details required in section 4.8.3

Product selection Management Information Systems (MIS) Forecasting Storage and inventory management
 more details required in section 4.8.4

Distribution to other stores and end-users
 more details required in section 4.8.4

Ensuring rational use and patient safety Pharmacovigilance Drug resistance Surveillance

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4.8.3 Past management experience Describe the past experience of each organization that will be involved in managing pharmaceutical and other health products.
Total value procured during last financial year
 same currency as proposal

Organization name

Short description of management experience

 use the ‘Tab’ key to add extra rows

4.8.4 Alignment with existing systems
1.1.1 Describe how the proposal uses existing country systems for the management of the additional pharmaceutical and health product activities that are planned, including pharmacovigilance and drug resistance surveillance systems. If existing systems are not used, explain why. ONE PAGE MAXIMUM

4.8.5 Storage and distribution systems
National medical stores or equivalent (a) Which organization(s) have primary responsibility to provide storage and distribution services under the proposal?
 tick the corresponding boxes to the right and enter the name of the organization(s)
 specify

Sub-contracted national organization(s)
 specify

Sub-contracted international organization(s)
 specify

Other:
 specify

(b) For storage partners, what is each organization's current storage capacity for pharmaceutical and health products? If the proposal represents a significant change in the volume of products to be stored, estimate the relative change in percent, and explain what plans are in place to ensure increased capacity. The Ministry of Health is responsible for customs clearance, storage and inventory management of drugs and other health commodities and products within the National TB Program, including those to be supplied with the Global Fund support. The procedure of airport storage, customs clearance and pickup by the NTP CO has been functioning properly. ONE PAGE MAXIMUM (c) For distribution partners, what is each organization's current distribution capacity for pharmaceutical and health products? If the proposal represents a significant change in the volume of products to be distributed or the area(s) where distribution will occur, estimate the relative change in percent, and explain what plans are in place to ensure increased capacity. The NTP has established reliable practices of distribution of drugs and other health products to all TB service facilities. Drugs and supplies are dispensed to the service delivery sites including the penitentiary system on a quarterly based on the peripheral stock monitoring data. All treatment delivery sites use standard drug management and stock monitoring documentation according to DOTS.

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The existing system will be used for supply of first and second line drugs to be supplied under this project. Given current involvement of NTP in drug distribution, no additional workload will be faced by NTP central office.ONE PAGE MAXIMUM

4.8.6 Pharmaceutical and health products for initial two years
Complete the Pharmaceutical and Health Products List and list all of the products that are requested to be funded through the proposal. If the pharmaceutical products included in the Pharmaceutical and Health Products List are not included in the current national, institutional or World Health Organization Standard Treatment Guidelines (STGs), or Essential Medicines Lists (EMLs), describe below the STGs that are planned to be utilized, and the rationale for their use. Applicants are invited to justify the prices based on either the range provided in the Unit Costs for Selected Key Health Products information note or with another published international reference source. If the provided price is out of range, provide justification. Also, if local legislation is preventing access to low cost prices through local manufacturers or similar mandates, clarification should be provided as well as a plan for addressing such barriers over the life of the proposal. ONE PAGE MAXIMUM

4.8.7 Multi-drug resistant tuberculosis
Yes Is the provision of treatment of multi-drug resistant tuberculosis included in this tuberculosis proposal?
 include USD 50,000 per year over the full proposal term to contribute to the costs of Green Light Committee Secretariat support services

No
 do not include the Green Light Committee costs

4B. CROSS-CUTTING HSS – PROGRAM DESCRIPTION
Read the Round 10 Guidelines to consider including optional cross-cutting HSS interventions
SECTION 4B can only be included in the Round 10 tuberculosis proposal if:    the applicant has identified gaps and constraints in the health system that have an impact on tuberculosis, tuberculosis and malaria outcomes; the interventions required to respond to these gaps and constraints are 'cross-cutting' and benefit more than one of the three diseases (and potentially benefit other health outcomes); and section 4B is not included in the Round 10 HIV or malaria proposal.

Section 4B can be downloaded from the Global Fund's website if the applicant intends to apply for crosscutting HSS.

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ROUND 10 – Tuberculosis
5. FUNDING REQUEST
The Round 10 Guidelines contain different guidance for sections 5.1 and 5.2 depending on whether the applicant selected Option 1, 2 or 3 in section 3.1 of the Proposal Form Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

5.1

Financial Gap Analysis
Section D and H of the Gap Analysis table below must be completed differently depending on whether applicant selected Option 1, 2 or 3 (see above)

 Summary Information provided should be described further in sections 5.1.1 – 5.1.3  Currency must be the same as identified on the proposal cover page  Adjust the years as necessary in the table from calendar years to financial years to align with national planning and fiscal periods

Financial gap analysis
Actual 2008 2009 2010 Planned 2011 2012 2013 Estimated 2014 2015

SECTION A: Funding needs for the full national tuberculosis program
LINE A  Provide annual amounts

LINE A.1  Indicate the amount of the funding need for the full national tuberculosis program
over the full term of the Round 10 proposal

SECTIONS B, C AND D: Current and planned resources to meet the funding needs of the full national tuberculosis program Section B: Domestic
Domestic source B1: Loans and debt relief

 provide name of source here

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ROUND 10 – Tuberculosis
Financial gap analysis
Actual 2008 Domestic source B2 National funding resources Domestic source B3 Private sector contributions (national) LINE B: Total current & planned DOMESTIC resources 2009 2010 Planned 2011 2012 2013 Estimated 2014 2015

 Total of Section B entries

Section C: External (non-Global Fund)
External source C1  provide source name here External source C2

 provide source name here
External source C3 Private sector contributions (International) LINE C: Total current & planned EXTERNAL (non-Global Fund) resources

 Total of Section C entries

Complete this version of Section D if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form: Section D: External (Global Fund)
 Insert additional lines below if there are more than two existing tuberculosis Global Fund grants
Grant D1  provide grant number here Grant D2  provide grant number here LINE D: Total current & planned EXTERNAL (Global Fund) resources

 Total of Section D entries

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ROUND 10 – Tuberculosis
Financial gap analysis
Actual 2008 2009 2010 Planned 2011 2012 2013 Estimated 2014 2015

Complete this version of Section D if the applicant selected Option 1 in section 3.1 of the Proposal Form: Section D: External (Global Fund)
 Insert additional lines below if there are more than two existing tuberculosis Global Fund grants
Section D1: Grants not included in consolidated disease proposal Grant D1-A

 provide grant number here
Grant D1-B

 provide grant number here
Section D2: Grants included in consolidated disease proposal and listed in section 3.1(b) Grant D2-A

 provide grant number here
Grant D2-B

 provide grant number here
LINE D: Total current & planned EXTERNAL (Global Fund) resources

 Total of Section D entries
LINE E : Total current and planned resources

 Line E = Line B + Line C + Line D

Calculation of gap in financial resources and summary of total funding requested in Round 10  must be supported by detailed budget
LINE F: Total funding gap Line F = Line A – Line E

LINE G: Round 10 tuberculosis funding request
 must be same amount as requested in tables 1.1, 5.3, 5.4 and detailed budget for this disease

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ROUND 10 – Tuberculosis
Part H – Cost Sharing calculation for Lower-middle income and Upper-middle income applicants
In Round 10, the total maximum funding request for tuberculosis in Line G is:

(a)

For Lower-Middle income countries, an amount that results in the Global Fund's overall contribution (all grants) to the national program being not more than 65% of the national disease program funding needs over the proposal term; and For Upper-Middle income countries, an amount that results in the Global Fund overall contribution (all grants) to the national program being not more than 35% of the national disease program funding needs over the proposal term.

(b)

Line H = Cost Sharing calculation as a percentage (%) of overall funding from Global Fund

Complete this cost sharing calculation if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form:
Cost sharing = (Total of Line D amounts for proposal period + Total of Line G amounts) X 100 Line A.1

%

Complete this cost sharing calculation if the applicant selected Option 1 in section 3.1 of the Proposal Form:
Cost sharing = (Total of Line D1 amounts for proposal period + Total of Line G amounts) X 100 Line A.1

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ROUND 10 – Tuberculosis
5.1.1 Explanation of financial needs and additionality of Global Fund financing
Describe how the annual amounts were: (a) (b) developed; budgeted in a way that ensures that government, non-government and community needs were included to reflect implementation of the country's tuberculosis program strategies; and (c) developed in a way that demonstrates the funding requested in the proposal will contribute to the achievement of outputs and outcomes that would not be supported by currently available or planned domestic resources. ONE PAGE MAXIMUM

5.1.2 Domestic funding
 corresponds to LINE B in Table 5.1

Describe the processes used in country to: (a) prioritize domestic financial contributions to the national TB program including HIPC [Heavily Indebted Poor Country] and other debt relief, and grant or loan funds that are contributed through the national budget; and (b) ensure that domestic resources are used efficiently, transparently and equitably, to help implement treatment, prevention, care and support strategies at the national, sub-national and community levels. Due to financial crisis the Ministry of Health has decreased funding from 10% to 20% to TB programme as a part of overall government saving. Other programme and other Ministries have also faced a similar decrease in budget. Having said that the Government remains committed to TB control and assures salaries, procurement of first line anti-TB drugs and other supplies and maintenance of facilities. NTP and MoH have robust financial procedures and control mechanism in place and make sure the funds are used in effective way. The Ministry of Health has appointed a financial audit company to ensure accuracy of use of resources. In designing the National TB control strategy, NTP has prioritized implementing cost-effective interventions

5.1.3 External funding
 corresponds to LINE C in Table 5.1

Describe: (a) any changes in contributions anticipated over the proposal term and the reason for any identified reductions in external resources over time; and (b) any current delays in accessing the external funding identified in Table 5.1 that should be explained, including the reason for the delay, and plans to resolve the issue(s). ONE PAGE MAXIMUM

5.2

Detailed Budget

Instructions for completion of the detailed budget:
 For guidance on the level of detail required (or for a template) refer to the budget information available in Section 5.2 of the Guidelines

1.

Submit a detailed budget in Microsoft Excel format.

ROUND 10 – Tuberculosis
2. 3. 4. 5. Ensure that this detailed budget is consistent in numbering with the Round 10 interventions in section 4.4.1 of the Proposal Form, the Performance Framework, and the detailed work plan. From the detailed budget, prepare table 5.3, the summary by objective and service delivery area. From the detailed budget, prepare table 5.4, the summary by cost category. Do not include a request for CCM or Sub-CCM funding in this Round 10 proposal. Requests for funding are available through a separate application. The application is available at: http://www.theglobalfund.org/en/ccm/

ROUND 10 – Tuberculosis
5.3 Summary of Detailed Budget by Objective and Service Delivery Area
 Use the same objective and SDA numbering as the description in section 4.4.1, the Performance Framework, and the detailed budget and work plan.  Annual totals at the end of this table must equal annual totals in the detailed budget and tables 1.1 and 5.4

Objective number

Service delivery area

Year 1

Year 2

Year 3

Year 4

Year 5

Total

 use “tab” key to add extra rows as needed

Round 10 tuberculosis funding request:

ROUND 10 – Tuberculosis
5.4 Summary of Detailed Budget by Cost Category
 Summary information provided in the table below should be described further in sections 5.4.1 to 5.4.3  Annual totals at the end of this table must equal annual totals in the detailed budget and tables 1.1 and 5.3
Cost Category Human resources Technical and management assistance Training Health products and health equipment Pharmaceutical products (medicines) Procurement and supply management costs Infrastructure and other equipment Communication materials Monitoring & Evaluation Living support to clients/target populations Planning and administration Overheads Other (specify): Year 1 Year 2 Year 3 Year 4 Year 5 Total

Round 10 tuberculosis funding request:

ROUND 10 – Tuberculosis
5.4.1 Overall budget context Describe any significant variations in cost categories by year, or significant five year totals for those categories.
HALF PAGE MAXIMUM

5.4.2 Human resources (a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or top-ups will be consistent with agreed in-country salary frameworks, such as national salary or inter-agency frameworks.
 Attach supporting information as evidence, including draft documents where applicable

HALF PAGE MAXIMUM (b) In cases where human resources represents an important share of the budget, summarize: (i) the basis for the budget calculation over the initial two years; (ii) the method of calculating the anticipated costs over years three to five; and (iii) to what extent human resources spending will strengthen service delivery.
 Attach supporting information as evidence, including draft documents where applicable

HALF PAGE MAXIMUM

5.4.3 Other large expenditure items
If ‘other’ cost categories represent important amounts in the summary in table 5.4, (i) explain the basis for the budget calculation of those amounts; and (ii) explain how this contribution is important to implementation of the national tuberculosis program.
 Attach supporting information as evidence, including draft documents where applicable

HALF PAGE MAXIMUM

5.4.4 Measuring service unit cost and cost effectiveness
Provide the following: where available, estimates of recent average service delivery unit costs at the programlevel for key services with an explanation of how the estimates were developed; (b) estimates of the expected average service delivery unit costs for key services that are included in the proposal; and (c) a description of how key service delivery unit costs will be measured at the programlevel, over time throughout the lifecycle of the grant. (a) HALF PAGE MAXIMUM

ROUND 10 – Tuberculosis
5.5 Funding Requests in the Context of a Common Funding Mechanism
 In this section, common funding mechanism refers to situations where all funding is contributed into a common fund for distribution to implementing partners

5.5.1 Common funding mechanism
If the country’s response to tuberculosis is through a programbased approach, does the proposal plan for some or all of the requested funding to be paid into a common-funding mechanism to support that approach?

Yes
 complete all of section 5.5

No
 do not complete section 5.5

5.5.2 Operational status of common funding mechanism
Describe the main features of the common funding mechanism, including the fund's name, objectives, governance structure and key partners. HALF PAGE MAXIMUM

5.5.3 Measuring performance
Describe how program performance helps determine financial contributions to the common fund. HALF PAGE MAXIMUM

5.5.4 Additionality of Global Fund request
Describe how the funding requested in the proposal will contribute to the achievement of outputs and outcomes that would not be supported by current or planned resources available to the common funding mechanism. HALF PAGE MAXIMUM

5B. CROSS CUTTING HSS – FUNDING REQUEST

Read the Round 10 Guidelines to consider including optional cross-cutting HSS interventions
SECTION 5B can only be included in the Round 10 tuberculosis proposal if: the applicant submitted section 4B with tuberculosis. Section 5B can be downloaded from the Global Fund's website if the applicant intends to apply for cross-cutting HSS interventions.

PROPOSAL CHECKLIST: SECTIONS 3-5 Tuberculosis

CHECKLIST
Document attached?
 mark an ‘X’ if attached

Section 3 and 4: Proposal Summary and Program Description

List document name and number

4.1 4.1 4.1

National Health Sector Development / Strategic Plan National Tuberculosis Control Strategy and/ or Costed Implementation Plan Sub-sector policies that are relevant to the proposal (e.g. national or sub-national human resources policy, norms and standards, gender policies/strategies and plans, policies on community or CSO partnerships with government health or other systems) Most recent self-evaluation reports/technical advisory reviews, including any epidemiology report directly relevant to the proposal National Monitoring and Evaluation Plan (e.g. health sector, disease-specific, or other) National policies to achieve gender equality in regard to the provision of tuberculosis prevention, treatment, and care and support services to all people in need Most recent bio-behavioral surveillance of key population(s) National report on gender specific operational research and any gender analysis/assessments that might have been undertaken of the tuberculosis response National pharmacovigilance policy Map if proposal targets specific region/population group Any recent report on health system weaknesses and gaps that impact outcomes for the three diseases (and beyond if it exists) Document(s) that explain basis for coverage targets A completed Performance Framework (mandatory) A detailed work plan (mandatory) A copy of the Technical Review Panel (TRP) Review Form from Round 8 or 9, if relevant. A recent evaluation of the Impact Measurement Systems as relevant to the proposal (if one exists) Performance Framework work plan

4.1

4.1 4.1

4.1 4.1

4.1 4.2 (b) 4.3.2

4.4 4.4.1 4.4.1 4.4.2 4.6.1

PROPOSAL CHECKLIST: SECTIONS 3-5 Tuberculosis

4.7.1 4.7.1

A recent assessment of the Principal Recipient capacities (other than Global Fund Grant Performance Report) Documents describing the organization, such as official registration papers, summary of recent history of organization, management team information
 only for Non-CCM applicants

4.7.2

List of Sub-recipients already identified (including name, sector they represent, and SDA(s) most relevant to their activities during the proposal term) A completed tuberculosis Pharmaceutical and Health Products List  only mandatory if applicant is procuring these
products

4.8.6

Section 4B: Cross-cutting HSS (only one per country’s application)

Document attached?
 mark an ‘X’ if attached

List document name and number Performance Framework work plan

4B.2 4B.2

A completed separate cross-cutting HSS Performance Framework (mandatory, if applicable) A detailed separate cross-cutting HSS work plan (mandatory, if applicable) Document attached?
 mark an ‘X’ if attached

Section 5: Funding Request

List document name and number detailed budget

5.2 5.4.2 5.4.3 5.5.1

A detailed budget (mandatory) Information on basis for budget calculation and diagram and/or list of planned human resources funded by proposal Information on basis of costing for ‘other’ cost category items Documentation describing the functioning of the common funding mechanism
 only include if there is a common funding mechanism

5.5.2

Most recent assessment of the performance of the common funding mechanism
 only include if there is a common funding mechanism

PROPOSAL CHECKLIST: SECTIONS 3-5 Tuberculosis

Section 5B: Cross-cutting HSS Funding Request

Document attached?
 mark an ‘X’ if attached

List document name and number detailed budget

5B.1 5B.4.2

A separate cross-cutting HSS detailed budget (mandatory, if applicable) Information on basis for budget calculation and diagram and/or list of planned human resources funded by proposal (only if relevant) Information on basis of costing for ‘other’ cost category items Other documents relevant to sections 3, 4 and 5 attached by applicant Document attached?
 mark an ‘X’ if attached

5B.4.3

List document name and number