Get documents about "PROPOSAL FORM FIFTH CALL FOR PROPOSALS
Document Sample
PROPOSAL FORM
FIFTH CALL FOR PROPOSALS
The Global Fund to Fight AIDS, Tuberculosis and Malaria is issuing its Fifth
Call for Proposals for grant funding. This proposal form should be used to
submit proposals to the Global Fund. Please read the accompanying
Guidelines for Proposals carefully, before filling out the proposal form.
Timetable: Fifth Round
Deadline for submission of proposals June 10, 2005
Board consideration of recommended proposals September 28 – 30, 2005
Resources available: Fifth Round
As of the date of the Fifth Call for Proposals, US$ 300 million is available for
commitment for the Fifth Call for Proposals. It is anticipated that additional
resources will become available prior to the Board consideration of proposals.
The amount available will be updated regularly on the Global Fund’s website.
Any information submitted to the Global Fund may be made publicly available.
Geneva, 17 March 2005
The Global Fund: Proposal Form Page 1 of 89
Notes:
How to use this form:
1 Ensure that you have all the documents that accompany this form—the Guidelines for
Proposals, and Annexes A and B to this proposal form.
2 Please read ALL questions carefully. Specific instructions for answering the questions
are provided.
3 Where appropriate, indications are given as to the approximate length of the answer to
be provided. Please try to respect these indications.
4 To tick any of the boxes in the form, move the cursor to the textbox, right click and
choose ‘properties’, then ‘default value’ ‘checked’.
5 To avoid duplication of effort, we urge you to make maximum use of existing information
(e.g., program documents written for other donors/funding agencies).
6 Instructions and guidelines are printed in blue
Annexes:
Annex 1: List of Acronyms
Annex 2: Terms of Reference of China CCM
Annex 3: Terms of Reference for China CCM Special Working Group on CCM restructuring
Annex 4: Terms of Reference for independent consultant on CCM restructuring
Annex 5: Excerpt from minutes of CCM,CCM core group and CCM TB working group
concerning proposal development
Annex 6: Budget justification
Annex 7: Details on drugs, commodities and products, and human resource costs
Annex 8: Detailed year 1 and indicative year 2 workplan and budget
The Global Fund: Proposal Form Page 2 of 89
1 Eligibility
Addressing Major Threats to the Control of Tuberculosis
Proposal title
in China
Name of applicant Country Coordinating Mechanism, P.R.China
Country/countries People’s Republic of China
Type of application:
National Country Coordinating Mechanism
Sub-National Country Coordinating Mechanism
Regional Coordinating Mechanism (including Small Island Developing States)
Regional Organization
Non-Country Coordinating Mechanism
Proposal components
HIV/AIDS 1
Tuberculosis 2
Malaria
Health system strengthening
Currency in which the Proposal is submitted
US$
Euro
1
In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS components should include
collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for
different epidemic states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’
available at http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
2
In contexts where HIV/AIDS is driving the tuberculosis epidemic, tuberculosis components should include
collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for
different epidemic states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’
available at http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
The Global Fund: Proposal Form Page 3 of 89
1 Eligibility
Country/countries People’s Republic of China
Low-income
Lower-middle-income [see paragraph 1.1 below]
Upper-middle-income [see paragraph 1.1 below]
1.1 Lower-middle-income and upper-middle-income country
1.1.1 Counterpart financing and greater reliance on domestic resources
Table 1.1.1 – Counterpart Financing and Greater Reliance on Domestic Resources
In US$ (1,000,000)
Financing
sources Year 1 Year 2 Year 3 Year 4 Year 5
estimate estimate estimate
Total requested from the
Global Fund (A) [from 7.823 9.992 12.174 12.465 10.436
Table 5.1]
Counterpart financing (B)
[linked to the
interventions for which 1.683 3.913 6.918 9.006 9.848
funds are requested
under (A)]
Counterpart financing as
a percentage of: 21.5% 39.2% 56.8% 72.3% 94.4%
B/A x 100 = %
1.1.2 Poor or vulnerable populations
Describe how these populations have been identified, and how they will be
involved in planning and implementing the proposal (2–3 paragraphs).
The populations in this proposal were identified by available information on the key threats
to TB control in China. The population with MDR-TB and the seriousness of the MDR-TB
epidemic were identified by TB drug-resistance surveillance surveys carried out as part of
the WHO/IUATLD global TB drug resistance surveillance project. The population of
PLWHA was identified by the Ministry of Health together with international partners
including UNAIDS and WHO. Based on a thorough situation analysis, 134 high HIV
prevalence counties in 14 provinces were identified. The population in these counties is
involved in the GFATM round 3 and round 4 HIV/AIDS projects in China. There is clear
evidence of low TB case-detection and low TB treatment success rate in the migrant
population. Based on government statistics, 70% of the migrant population that moves
between provinces move into 6 eastern provinces. This proposal targets these 6 provinces.
Overall, the beneficiaries in this proposal have been selected on the basis of where the
greatest need is located and where the maximum impact can be expected if the project is
successfully implemented.
Those with MDR-TB, HIV-associated TB, and the migrant population are certainly poor and
are among the most vulnerable in China’s society. These patients will directly benefit from
TB (and HIV) services. Their health care providers will be trained and provided with
resources to implement interventions that will benefit these patients. During the planning
phase of the project, health care providers will be involved in its preparation. Most of the
interventions will initially be piloted in the populations that will benefit from these
interventions. During these pilot projects, quantitative and qualitative methods will be used
The Global Fund: Proposal Form Page 4 of 89
1 Eligibility
to assess applicability of the designed interventions. Patient surveys will be used to collect
relevant information to inform the design of interventions. As part of the evaluation, patient
and provider surveys (quantitative and qualitative) will be used. Thus the target groups of
this project will be involved in planning and implementing the proposal.
1.2 CCM functioning - eligibility criteria
1.2.1 Demonstrate CCM membership of people living with and /or affected by the
diseases.
There are currently two individual members of the national CCM who are people living with
HIV/AIDS.
See 3.6.3, member numbers 53 and 54
1.2.2 Provide evidence that CCM members representing the non-governmental sectors
have been selected by their own sector(s) based on a documented, transparent
process developed within each sector.
Currently the China CCM has an open, transparent, and documented process for
membership. According to the Global Fund China CCM Terms of Reference
(TOR), any institutions and/or individuals in China are eligible to apply for
membership in the CCM as long as they meet the following requirements:
1. Legally registered to operate within China and legal Chinese citizens;
2. Uphold the TOR of the CCM;
3. Concerned about and support the work of AIDS, tuberculosis and malaria
control in China, and willing to contribute to the control of these diseases;
4. Participate in the activities sponsored by the CCM in a timely manner and
actively share relevant experiences and information.
In addition, there is a documented application procedure for membership. (See
Annex 2, Terms of Reference of China CCM.)
There are 5 domestic NGO members and 3 international NGO members serving
on the China CCM. They were all selected by voluntary application and their
participation has always been emphasized since the creation of the China CCM.
China CCM has invited as many as possible NGOs to participate in its activities.
In November 2004, the CCM formally decided to review its membership and
working practices to be in line with Global Fund guidance and recommendations. A
Special Working Group was formed, and the CCM engaged a consultant (Mr.
Bernard Rivers) to visit China in February 2005 and prepare recommendations.
The CCM has now received the consultant’s review and recommendations, which
include shifting CCM membership so that all members, including NGO members,
represent their constituencies. The consultant has updated his report to reflect
recent Global Fund requirements and guidance on CCM membership. The CCM
Special Working Group is reviewing the findings and recommendations of the
independent report and making suggestions to the CCM for how to take forward
the CCM reform. This will be in line with the new Global Fund requirements on
documented, transparent processes of identifying CCM representatives.
(See Annex 3 and 4, Terms of Reference for China CCM Special Working Group
on CCM restructuring and Terms of Reference for independent consultant on
CCM restructuring.)
The Global Fund: Proposal Form Page 5 of 89
1 Eligibility
1.2.3 Describe and provide evidence of a documented and transparent process to:
a) Solicit submissions for possible integration into the proposal
At the 11th meeting of the CCM, the CCM requested the TB working group to discuss
whether to apply to Round 5 of the GFATM. The TB working group of the CCM met on 14
January 2005 to discuss this. Members of the CCM TB working group include the key
partners working on TB in China, including bilateral agency, domestic and international
NGO’s, MOH, and multilateral agencies. At the meeting, the working group agreed to apply
to Round 5 of the GFATM and proceeded to discuss which issues would be most important
to include in the application (see Annex 5). In December 2004, the Terma Foundation (an
international NGO), visited various partners in Beijing to explore the possibility of applying
for TB funding through the GFATM. Aware of Terma's interest, the chair of the TB working
group approached the Terma Foundation in January 2005 to obtain information on a
proposal that they were planning to put forward. The Terma Foundation provided a brief
draft proposal to the working group (see Annex 5).
From late April to mid- May 2005, the Terma Foundation contacted various members of the
CCM about their interest to submit a TB proposal for the GFATM. Prior to the CCM core
group meeting on 20 May 2005, the CCM secretariat contacted the Terma Foundation to
ask for any proposal that could be reviewed. The Terma Foundation was still working on
their proposal at that time but did submit a short draft proposal to the CCM secretariat (see
Annex 5)
b) Review submissions for possible integration into the proposal
At the 1 February 2005 meeting of the TB working group, the group discussed the priority
issues confronting the NTP and to discuss the issues to include in a GFATM application
(see Annex 5). The group also reviewed a draft proposal from the Terma Foundation. After
considering the key priorities for the NTP, the group recommended to the CCM to include 3
key issues in the Round 5 application—MDR-TB, TB/HIV and TB and poverty. The latter
would mainly focus on the urban poor, which is the migrant population in China. The
finding and recommendations of the TB working group was presented to the 12th meeting
of the CCM on 21 March 2005. The CCM reviewed, discussed and endorsed the
recommendations of the TB working group (see Annex 5).
On 20 May 2005, the CCM core group discussed the TB proposal to the GFATM. The core
group also reviewed Terma Foundation draft proposal. The CCM core group endorsed the
work of the writing team and of the TB working group. It decided not to include the Terma
proposal into the Round 5 TB proposal (see Annex 5).
c) Nominate (the) Principal Recipient(s) and oversee program implementation
According to China CCM TOR, the Principal Recipient is designated and approved by the
CCM.
The China CDC has been nominated and approved as the PR by the CCM based on the
performance of the China CDC as the PR for Global Fund Round 1, 3, and 4 projects. This
was confirmed at the 13th CCM Plenary Meeting.
(See Annex 5, Minutes of 10th CCM Plenary Meeting; correspondence soliciting input on
nomination of PR; and Minutes of 13th CCM Plenary Meeting.)
The Global Fund: Proposal Form Page 6 of 89
2 Executive Summary
2
2.1 Executive Summary
[Please include quantitative information, where possible (4–6 paragraphs total):]
2.1.1 Briefly describe the (national) disease context, existing control strategies and
programs as well as program and funding gaps. Explain how the proposed
interventions complement existing strategies and programs, particularly where
funding from the Global Fund has been received or approved.
China is one of the 22 high TB burden countries in the world. WHO estimates that, in
2003, 1.4 million new active TB cases developed in China, of which 600,000 were the
highly infectious, smear-positive type. This means China—with 17% of the global TB
burden—has the second highest number of TB cases in the world, behind India. To
address the serious problem of TB, the Chinese Government has gradually expanded the
implementation of the WHO-recommended DOTS strategy. Nearly all of the existing TB
control strategies, policies and projects were established with the aim of achieving the
2005 global TB control targets of 70% case-detection and 85% treatment success.
Between 2000 and 2005, DOTS coverage expanded to cover 100% of the counties in
China. The case-detection rate, which was only 30% in 2002, increased rapidly to 45% in
2003 and 64% in 2004. This, together with the high treatment success rate in its program,
means China will likely achieve the 2005 global TB control targets.
If China achieves the 2005 global TB control targets, it would be taking a major step
toward realizing the 2015 Millenium Development Goal’s (MDG’s) of halving the TB
prevalence and deaths in the country. However, China currently faces three important
threats to its TB control program. If the following threats are not addressed, there is a real
possibility that the MDG’s will not be achieved. First, China has the world’s largest
epidemic of multidrug-resistant TB (MDR-TB). Left unchecked, this epidemic could spiral
out of control. Second, the HIV/AIDS epidemic is worsening and leading to increased
morbidity and mortality of PLWHA with TB. To date, there is little collaboration between
the TB and the HIV/AIDS control programs. Third, the current TB control program is
largely ineffective in controlling TB in China’s large migrant population (estimated at
>140million people). There is an urgent need to control TB in this population as migration
continues to increase. In this application, the proposed interventions will address these
three major threats. As these are new interventions for the National TB Control Program
and National HIV/AIDS Program, they are entirely complementary to currently funded
programs, including the GFATM round 1 and round 4 TB projects, the GFATM round 3
and round 4 HIV/AIDS projects, and other projects funded by the World Bank, other
developmental partners and governmental funds. To implement these interventions, a
significant funding gap needs to be closed.
2.1.2 Describe the overall strategy by referring to the goals, objectives and service
delivery areas for each component, including expected results and associated
timeframes. Specify for each component the beneficiaries
To address the 3 key threats to control of TB in China, this proposal has 3 goals, which
are to reduce the morbidity and mortality of (1) MDR-TB, (2) TB in PLWHA, and (3) TB in
the migrant population. There are 3 major types of objectives. First, each goal has
objectives for specific interventions including implementation of DOTS-plus strategy,
TB/HIV collaboration, and activities to increase TB case-finding and treatment success in
the migrant population. Second, each goal has an objective to strengthen monitoring and
evaluation so that one can determine effectiveness of interventions and progress toward
key targets. Third, each goal has an objective to strengthen surveillance, including drug-
resistance surveillance of MDR-TB, surveillance of HIV infection in TB patients, and
surveillance of case-finding and treatment outcome in the migrant population. Many of the
The Global Fund: Proposal Form Page 7 of 89
2 Executive Summary
key service delivery areas are the same for the 3 goals including coordination and
partnership development, behavior change communication, human resource, monitoring
and evaluation, and operational research.
The target group for each of the 3 goals has been selected on the basis of where the
greatest need is located and where maximum impact on morbidity and mortality can be
expected if the project is successfully implemented. Project coverage will gradually
increase. For the DOTS-plus project, there is then gradual expansion from 2 DOTS-plus
sites (in 2 provinces with high rates of MDR-TB) to 31 DOTS-plus sites (in parts of 6
provinces with high MDR-TB rates) by year 4. For TB/HIV collaboration, the project will
gradually cover all 134 high HIV prevalence counties (in 14 provinces) involved in the
GFATM round 3 and round 4 HIV/AIDS project for China over the first 2 years. For TB
control among the migrant population, the project will gradually cover 120 districts in 6
provinces that serve as the destination for 70% of the migrants that move between
provinces. Each part of the proposal will be piloted during the initial phase to determine
the best approaches to implement the interventions.
Over the 5-year period of the proposal, the project aims to increase treatment success
from around 20% for MDR-TB and TB in the migrant population to 75% and 80%
respectively. Treatment success for HIV-associated TB cases will increase from <70% to
85%. Finally, TB case-detection in the migrant population will increase from around 30%
to 70%. Over the 5-year period, we anticipate 4,470 MDR-TB cases will be treated, 93,800
PLWHA will be evaluated for TB, 18,000 PLWHA with TB will receive HIV prevention and
care, and 120,630 TB patients in the migrant population will be identified.
2.1.3 If there are several components, describe any synergies expected from the
combination of different components—for example, TB/HIV collaborative activities
(by synergies, we mean the added value that the different components bring to
each other, or how the combination of these components may have broader
impact).
The 3 threats facing the NTP do interact with each other. The migrant population is at
increased risk for HIV/AIDS; the high TB treatment default in the migrant population also
makes this group more likely to develop MDR-TB; and HIV/AIDS and MDR-TB do occur in
the areas, e.g. Henan province has high HIV prevalence and high rate of MDR-TB. As the
NTP tackles one of these threats, this will help tackle other threats. However, it is
important to point out that, in this proposal, the provinces involved in the TB/HIV
component are different from the provinces in the migrant population component.
Therefore these two components will not be immediately synergistic to each other. Some
of the provinces implementing the MDR-TB component will also implement either the
TB/HV or the migrant population component, so there will be some synergy between the
MDR-TB and the other components. Regardless of whether there is synergy within this
project, the experiences gained from implementing this proposal will help the NTP to
tackle these key threats throughout China (and not only in GF project areas). When that
occurs, there will be additional synergy in reducing TB morbidity and mortality.
2.1.4 Indicate whether the proposal is to scale up existing efforts or initiate new activities.
Explain how lessons learned and best practices have been reflected in this
proposal and describe innovative aspects to the proposal.
This proposal aims to scale up existing efforts and initiate new activities. All of the
activities under goal 1 (tackling the threat of MDR-TB) are new except for the scaling up of
TB drug-resistance surveillance. In particular, the implementation of the DOTS-plus
strategy is an entirely new program. Many activities under goal 2 (tackling the threat of
TB/HIV) involve scaling up of existing HIV/AIDS activities but applied to a new patient
group—TB suspects and cases. At the same time, there are new TB/HIV collaborative
activities that are not in the current HIV/AIDS program. Most of the activities under goal 3
(tackling TB control in migrant population) involve scaling up existing activities because
they are part of basic DOTS activities already implemented in the NTP. However, this
The Global Fund: Proposal Form Page 8 of 89
2 Executive Summary
proposal will scale-up these activities in a population that have been largely neglected in
the past. Many of the proposed approaches to increase case-detection and treatment
success in the migrant population have not been tried before in China. As such, they are
innovative. Finally, the service delivery areas and activities in this proposal are consistent
with the Stop TB Partnership’s DOTS-plus strategy and framework and also with the
WHO/UNAIDS TB/HIV collaborative framework and guidelines.
2.2 Component and Funding Summary
Table 2.2 – Total Funding Summary
Total funds requested in US$ (1,000,000)
Year 1 Year 2 Year 3 Year 4 Year 5 Total
HIV/AIDS
Tuberculosis 7.823 9.992 12.174 12.465 10.436 52.891
Malaria
Health
systems
strengthening
Total 7.823 9.992 12.174 12.465 10.436 52.891
The Global Fund: Proposal Form Page 9 of 89
3 Type of Application
Table 3 – Type of Application
Type of application:
National Country Coordinating Mechanism go to section 3.1
Sub-National Country Coordinating go to section 3.2
Mechanism
Regional Coordinating Mechanism go to section 3.3
(including Small Island States)
Regional Organization go to section 3.4
Non-Country Coordinating Mechanism go to section 3.5
3
3.1 National Country Coordinating Mechanism
Table 3.1 – National CCM: Basic Information
Name of National CCM Date of Composition
The Country Coordination Mechanism in China March 2002
3.1.1 Describe how the National CCM operates—in particular, the extent to which the
CCM acts as a partnership between government and other actors in civil society,
including non-governmental organizations, the private sector and academic
institutions, and how it coordinates its activities with other national structures
(such as National AIDS Councils) (2 paragraphs).
Currently the China CCM has four key components: the Plenary Meeting, CCM
Secretariat, CCM Core Group, and three Technical Working Groups for AIDS, TB and
Malaria respectively. The CCM Plenary meets at least twice a year or as often as
required if the CCM Chairperson, the CCM Core Group or at least one-fifth of the CCM
members call for additional meetings as needed.
The CCM Plenary has the following primary responsibilities:
1. Organize, coordinate, review, and approve program proposals to the Global Fund;
2. Review and approve the work plans and progress reports to prior to their submission
to the Global Fund;
3. Monitor and evaluate the implementation of Global Fund programs;
4. Nominate the Principal Recipients(PR);
5. Provide suggestions and comments on the policy-making, requirements and forms of
the Global Fund program management.
Main responsibilities of the CCM Core Group:
1. Perform the functions of the CCM between plenary meetings;
2. Guide and evaluate the work of the PR;
3. Monitor, guide, and evaluate the implementation of Global Fund projects;
4. Make suggestions and comments to the CCM Plenary;
5. As directed by the CCM Chairperson and the CCM Plenary, discuss and authorize
the work plans and progress reports to be submitted to the Global Fund.
Main responsibilities of the CCM Secretariat:
1. Carry out the routine work of the CCM; be responsible for the Chairman of the CCM;
2. Make arrangements to convene the CCM Plenary and CCM Core Group meetings;
be responsible for the organization and storage of the meeting files, documents and
The Global Fund: Proposal Form Page 10 of 89
3 Type of Application
relevant materials;
3. Responsible for liaising with the Global Fund, the LFA and the PR;
4. On behalf of the CCM, submit relevant materials and reports to the Global Fund;
5. Attend to other affairs as requested by the CCM Chairperson.
Main responsibilities of the Technical Working Groups:
1. Assist in drafting the program proposals;
2. Assist the PR in making the program execution proposals;
3. Provide suggestions and comments on the work plans and progress reports prior to
their submission to the Global Fund by the PR;
4. As per CCM requirements, provide supervision and evaluation of the project’s
implementation, and report back to the CCM Core Group and CCM Plenary;
5. Finish other works required by the CCM or CCM Core Group.
The CCM acts as a partnership with governments, NGOs and other private sectors in
many aspects including program application, implementation and supervision.
Cooperation with other national institutions starts from the application, for example, MOH
coordinates proposal objectives and activities with national AIDS, tuberculosis and
malaria prevention plans and coordinates counterpart-financing proportion. At the
implementing stage, CCM coordinate program activities with center and local health
administration bureaus, ask technical support from relevant institutes such as WHO,
UNAIDS, monitoring and evaluating program management and fund usage by joint
inspection.
The Global Fund has published “Revised Guidelines on the Purpose, Structure and
Composition of Country Coordinating Mechanism”. To fulfill the new requirements from
the Global Fund and increase the efficiency of China CCM, the 11th CCM plenary
meeting established a Special Working Group (SWG) to take forward CCM reform. The
SWG invited an independent agency to conduct an assessment of the China CCM and
make recommendations. The CCM is being consulted on the report. The SWG will
develop a plan to reform CCM structure and composition, TORs for working group and
the working mechanism between the Technical Working Groups, PR and LFA. This will
be in line with the new GFATM requirements and based upon the independent review of
the CCM. It is expected that this reform will be completed by Autumn 2005.
(See Annex 2, Terms of Reference of the China CCM TOR; Annex 5, Minutes of 10th to
13th CCM Plenary Meetings; Annex 3 and 4, TOR of Special Working Group on CCM
restructuring and TOR of independent consultant on CCM restructuring.)
The Global Fund: Proposal Form Page 11 of 89
3 Type of Application
3.2 Sub-National Coordinating Mechanism
Table 3.2 – Sub-National CCM: Basic Information
Name of Sub-National CCM Date of Composition
3.2.1 Describe how the Sub-National CCM operates—in particular, the extent to which
the CCM acts as a partnership between government and other actors in civil
society, including NGOs, the private sector and academic institutions, and how it
coordinates its activities with other national structures (e.g., National AIDS
Councils)
3.2.2 Explain why a Sub-National CCM has been chosen [1 paragraph].
3.2.3 Describe how this proposal is consistent with and complements national
strategies and/or the National CCM plans [1 paragraph].
The Global Fund: Proposal Form Page 12 of 89
3 Type of Application
3.3 Regional Coordinating Mechanism (including Small Island
Developing States)
Table 3.3 – Regional Coordinating Mechanism: Basic Information
Name of Regional CM Date of Composition
3.3.1 Explain why a Regional Coordinating Mechanism has been chosen [1
paragraph].
3.3.2 Describe how this proposal is consistent with and complements national
strategies and/or the Regional Coordinating Mechanism plans. Provide details of
how it would achieve outcomes that would not be possible with only national
approaches [1 paragraph].
3.4 Regional Organizations
Table 3.4 – Regional Organization: Basic Information
Name of Regional Organization
3.4.1 Rationale
Describe how this regional proposal complements the national plans of each
country involved and how it would achieve outcomes that would not be possible
with only national approaches.
The Global Fund: Proposal Form Page 13 of 89
3 Type of Application
3.5 Non-Country Coordinating Mechanism
Table 3.5 – Non-CCM Applicant: Basic Information
Name of Non-CCM applicant
3.5.1 Indicate the type of your sector (tick appropriate box):
Academic/educational sector
Government
NGOs/community-based organizations
People living with HIV/AIDS, tuberculosis and/or malaria
Private sector
Religious/faith-based organization
Multilateral and bi-lateral development partners in country
Other (please specify):
3.5.2 Rationale for applying outside an existing CCM
Non-CCM proposals are not eligible unless they satisfactorily explain that they originate
from one of the following:
1. Countries without legitimate governments;
2. Countries in conflict, facing natural disasters, or in complex emergency situations
(which will be identified by the Global Fund through reference to international
declarations such as those of the United Nations Office for the Coordination of
Humanitarian Affairs [OCHA]); or
3. Countries that suppress or have not established partnerships with civil society and
NGOs.
3.5.2.1 Describe which of the above conditions apply to this proposal (3–4
paragraphs).
3.5.2.2 Describe any attempts to contact the CCM and provide documentary evidence
as an annex (2 paragraphs).
3.5.2.3 Non-CCM proposals from countries in which no CCM exists
[Describe how the proposal is consistent with, and complements, national policies and strategies
(or, if appropriate, why this proposal is not consistent with national policy) (3–4 paragraphs).
Provide evidence (e.g., letters of support) from relevant national authorities in an annex.]
3.5.3 All non-CCM proposals should include as annexes additional documentation
describing the organization, such as:
statutes of organization (official registration papers);
a summary of the organization, including background and history, scope of
work, past and current activities;
reference letter(s);
main sources of funding.
The Global Fund: Proposal Form Page 14 of 89
3 Type of Application
3.6 Proposal Endorsement and Membership Section
3.6.1 Representation
Table 3.6.1 – National/Sub-National/Regional (C)CM Leadership Information
(not applicable to Non-CCM and Regional Organization applications)
Chairperson Vice Chairperson
Name Dr. Wang, Longde Dr. Henk Bekedam
Vice Minister/ Ministry of
Title Representative/ WHO
Health, PRC
Room 401 East Diplomatic
No.1 Xizhimen Nanlu, Xicheng
Compound 23 of Dongzhimen
Mailing address District, Beijing 100044
Waidajie,Chaoyang District Beijing
P.R. China
P.R. China
Telephone +0086-10-68792031 +0086-10-65327190
Fax +0086-10-68792279 +0086-10-65322359
E-mail address zhanggx@moh.gov.cn bekedamh@chn.wpro.who.int
3.6.2 Contact information
[Please provide full contact details for two persons; this is necessary to ensure fast and responsive
communication.]
Table 3.6.2 – Non-CCM Applicants and Regional Organizations: contact information
(not applicable to National/Sub-National/Regional (C)CM applications)
Primary contact Secondary contact
Name
Title
Organization
Mailing address
Telephone
Fax
E-mail address
The Global Fund: Proposal Form Page 15 of 89
3 Type of Application
3.6.3 Membership information
[Applicable to submissions from National/Sub-National/Regional (C)CMs. Not applicable to Non-CCM
Applicants and Regional Organization applications. One of the tables below must be completed for
each national/Sub-National/Regional (C)CM member.]
[To be eligible for funding National/Sub-National/Regional (C)CMs must demonstrate evidence of
membership of people living with and /or affected by the diseases.]
Table 3.6.3 – National/Sub-National/Regional (C)CM Member Information
National/Sub-National/Regional (C)CM member details
Member 1
Agency/organization Ministry of Health, PRC Website http://www.moh.gov.cn
Type Government Sector represented Government
Name of representative Ren Minghui Member Since Mar-2002
Title in agency Deputy Director-General Fax +0086-10-68792442
E-mail address renmh@moh.gov.cn Telephone +0086-10-68792283
Coordinating various component
Main role in the CCM programs, project monitoring and No.1 Xizhimen Nanlu
and the proposal administration, proposal / work plan Mailing address Xicheng District
development review and consultation, organizing CCM Beijing 100044, PRC
activities.
Member 2
Agency/organization Ministry of Foreign Affairs, PRC Website http://www.fmprc.gov.cn
Type Government Sector represented Government
Name of representative Guo Jiakun Member Since Mar-2002
Title in agency Third Secretary Fax +0086-10-65963175
E-mail address guo_jiakun@mfa.gov.cn Telephone +0086-10-65961114
Main role in the CCM No. 2 Chaoyangmen Nandajie
Proposal / work plan review and
and the proposal Mailing address Chaoyang District
consultation
development Beijing 100701, PRC
Member 3
National Development and Reform
Agency/organization Website http://www.sdpc.gov.cn
Commission, PRC
Type Government Sector represented Government
Name of representative Zhou Heyu Member Since Mar-2002
Title in agency Director Fax +0086-10-68502670
E-mail address shs03@mx.cei.gov.cn Telephone +0086-10-68502589
Main role in the CCM No. 38 Yuetan Nandajie
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100824, PRC
Member 4
Agency/organization Ministry of Education, PRC Website http://www.moe.edu.cn
Type Government Sector represented Government
Name of representative Zhang Xin Member Since Mar-2002
Title in agency Director Fax +0086-10-66096150
E-mail address weishengzhang@moe.edu.cn Telephone +0086-10-66096849
Main role in the CCM No. 37 Damucang Hutong
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100816, PRC
Member 5
Agency/organization Ministry of Public Security, PRC Website http://www.mps.gov.cn
Type Government Sector represented Government
Name of representative Wu Mingshan Member Since Mar-2002
Title in agency Deputy Director-General Fax +0086-10-65203702
E-mail address Telephone +0086-10-65204378
Main role in the CCM No. 14 Dong Chang'an Lu
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation
development Beijing 100816, PRC
Member 6
Agency/organization Ministry of Civil Affairs, PRC Website http://www.mca.gov.cn
Type Government Sector represented Government
Name of representative Zhang Lei Member Since Mar-2002
Title in agency Program Officer Fax +0086-10-62535511
E-mail address Telephone +0086-10-85203248
Main role in the CCM No. 147 Beiheyan Lu
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100721, PRC
The Global Fund: Proposal Form Page 16 of 89
3 Type of Application
Member 7
Agency/organization Ministry of Justice, PRC Website http://www.legalinfo.gov.cn
Type Government Sector represented Government
Name of representative Wang Jian Member Since Mar-2002
Title in agency Director of Health Division Fax +0086-10-65206456
E-mail address sifabu@126.com Telephone +0086-10-65206469
Main role in the CCM No.10 Chaoyangmen Nandajie
Proposal / work plan review and
and the proposal Mailing address Chaoyang District
consultation
development Beijing 100020, PRC
Member 8
Agency/organization Ministry of Finance, PRC Website http://www.mof.gov.cn
Type Government Sector represented Government
Name of representative Wang Lei Member Since Mar-2002
Title in agency Program Officer Fax +0086-10-68511052
E-mail address Telephone +0086-10-68551277
Main role in the CCM No. 3 Sanlihe Nansanxiang
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100820, PRC
Member 9
Agency/organization Ministry of Commerce, PRC Website http://www.mofcom.gov.cn
Type Government Sector represented Government
Name of representative Chai Xiaolin Member Since Mar-2002
Title in agency Deputy Director-General Fax +0086-10-65197712; 65197903
E-mail address chaixiaolin@moftec.gov.cn Telephone +0086-10-65197711
Main role in the CCM No. 2 Dong Chang'anjie
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation
development Beijing 100731, PRC
Member 10
State Population and Family Planning
Agency/organization Website http://www.npfpc.gov.cn
Commission, PRC
Type Government Sector represented Government
Name of representative Ru Xiaomei Member Since Mar-2002
Title in agency Deputy Director Fax +0086-10-62051847
E-mail address sfpcdfa@public.bta.net.cn Telephone +0086-10-62051848
Main role in the CCM No.14 Zhiqing Lu
Proposal / work plan review and
and the proposal Mailing address Haidian District
consultation
development Beijing 100088, PRC
Member 11
State Administration for Radio Film and
Agency/organization Website http://www.sarft.gov.cn
Television, PRC
Type Government Sector represented Government
Name of representative Xiao Dangrong Member Since Mar-2002
Title in agency Vice Director Fax +0086-10-86092693
E-mail address zbsxcc@sina.com Telephone +0086-10-86092524
Main role in the CCM No.2 Fuwaidajie
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100866, PRC
Member 12
Agency/organization State Food and Drug Administration, PRC Website http://www.sda.gov.cn
Type Government Sector represented Government
Name of representative Chen Xingyu Member Since Mar-2002
Title in agency Division Director Fax +0086-10-68337662
E-mail address Telephone +0086-10-68313344 x0811
Main role in the CCM No. A38 Beilishi Lu
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100810, PRC
Member 13
State Administration of Chinese
Agency/organization Website http://www.satcm.gov.cn
Traditional Medicine, PRC
Type Government Sector represented Government
Name of representative Liu Wenwu Member Since Mar-2002
Title in agency Vice Director Fax +0086-10-65930820
E-mail address liuwenwu@natcm.gov.cn Telephone +0086-10-65955519
Main role in the CCM Building 13, Baijiazhuang Dongli
Proposal / work plan review and
and the proposal Mailing address Chaoyang District,
consultation
development Beijing 100026, PRC
The Global Fund: Proposal Form Page 17 of 89
3 Type of Application
Member 14
Agency/organization Youth League of China Website http://www.ccyl.org.cn
Type NGO Sector represented Civil Society
Name of representative Weng Li Member Since Mar-2002
Title in agency Director Fax +0086-10-85212121
E-mail address Telephone +0086-10-85212121
Main role in the CCM No.10 Dongdajie
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation
development Beijing 100051, PRC
Member 15
Agency/organization All-China Women’s Federation Website http://www.women.org.cn
Type NGO Sector represented Civil Society
Name of representative Wu Xuehua Member Since Mar-2002
Title in agency Director Fax +0086-10-65103154
E-mail address wuxuehua1951@sohu.com Telephone +0086-10-65103172
Main role in the CCM No.15 Jianguomen Neidajie
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation
development Beijing 100730, PRC
Member 16
Agency/organization All-China Federation of Trade Union Website http://www.acftu.org.cn
Type NGO Sector represented Civil Society
Name of representative Lu Jinling Member Since Mar-2002
Title in agency Vice Director Fax +0086-10-68592661
E-mail address qxf@acftu.org.cn Telephone +0086-10-68592602
Main role in the CCM No. 10 Fuxingmen Waidajie
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100865, PRC
Member 17
Agency/organization Red Cross Society of China Website http://www.redcross.org.cn
Type NGO Sector represented Civil Society
Name of representative Shi Jiefang Member Since Mar-2002
Title in agency Director Fax +0086-10-64024740
E-mail address Jiefang.shi@redcross.org.cn Telephone +0086-10-64026859
Main role in the CCM No.8 Santiao Beixinqiao
Core Group member, Proposal / work plan
and the proposal Mailing address Xicheng District
review and consultation.
development Beijing 100007, PRC
Member 18
Chinese Association of STD & AIDS
Agency/organization Website http://218.24.201.8/casapc/
Prevention and Control
Type NGO Sector represented Domestic Nongovernmental Organizations
Name of representative Dai Zhicheng Member Since Mar-2002
Title in agency Chairman Fax +0086-10-63034521
E-mail address stdaids@public.fhnet.cn.net Telephone +0086-10-63167482
Main role in the CCM No. 27 Nanwei Lu
Core Group member, Proposal / work plan
and the proposal Mailing address Xuanwu District
review and consultation.
development Beijing 100050 ,PRC
Member 19
Agency/organization Chinese Anti-tuberculosis Association Website
Type NGO Sector represented Domestic Nongovernmental Organizations
Name of representative Zhang Lixing Member Since Mar-2002
Title in agency Deputy Director and Secretary General Fax +0086-10-62252648
E-mail address tbcenter@public.bta.net.cn Telephone +0086-10-62252651
Main role in the CCM No. 5 Dongguang Hutong
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation
development Beijing 100050, PRC
Member 20
Agency/organization Home of Love Caring Website http://www.bjyah.com
Type NGO Sector represented Domestic Nongovernmental Organizations
Name of representative Huang Chun Member Since 16-MAR-2004
Title in agency Director of Home of Loving Care Fax +0086-10-63293374
E-mail address chun6638@tom.com Telephone +0086-10-63294614
Main role in the CCM No. 8 Xitoutiao You'anmenwai Dajie
Proposal / work plan review and
and the proposal Mailing address Fengtai District
consultation
development Beijing 100040, PRC
The Global Fund: Proposal Form Page 18 of 89
3 Type of Application
Member 21
The Home of Red Ribbon, Beijing Di’tan
Agency/organization Website
Hospital
Type NGO Sector represented Domestic Nongovernmental Organizations
Name of representative Xu Keyin Member Since Mar-2002
Title in agency Director Fax +0086-10-64481639
E-mail address Xukeyi8567@sina.com Telephone +0086-10-64226966
Main role in the CCM No. 13 Ditan Anwaidajie
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation
development Beijing 100011, PRC
Member 22
Agency/organization China Family Planning Association Website http://www.chinafpa.org.cn
Type NGO Sector represented Domestic Nongovernmental Organizations
Name of representative Wu Guanghua Member Since Mar-2002
Title in agency Division Director Fax +0086-10-84657979
E-mail address cfpawugh@163.com Telephone +0086-10-84657807
Level 12, Building 35, Shaoyaoju Compound
Main role in the CCM
Proposal / work plan review and No. 4 Wenxueguan Lu
and the proposal Mailing address
consultation Chaoyang District
development
Beijing 100029, PRC
Member 23
Chinese Center for Disease Control and
Agency/organization Website http://www.chinacdc.net.cn
Prevention
Type
Academic/Educational Sector represented Academic Institutions
Name of representative Shen Jie Member Since Aug-2002
Title in agency Deputy Director Fax +0086-10-63170894
E-mail address shenjie@chinaids.org.cn Telephone +0086-10-63186655 x2209
CCM Secretariat, Proposal / work plan
Main role in the CCM
preparation, technical input, program 27 Nanwei Lu
and the proposal
coordination, implementation, monitoring Mailing address Xuanwu District
development
and evaluation, review and consultation of Beijing 100050, PRC
other CCM documents.
Member 24
Agency/organization Peking University Health Science Centre Website http://www.bjmu.cn
Type Academic/Educational Sector represented Academic Institutions
Name of representative Hu Yonghua Member Since Aug-2002
Dean and Professor, School of Public
Title in agency Fax +0086-10-82801518
Health, Peking University
E-mail address yhhu@bjmu.edu.cn Telephone +0086-10-82801189
Main role in the CCM No. 38 Xueyuan Lu
Proposal / work plan review and
and the proposal Mailing address Haidian District
consultation.
development Beijing 100083, PRC
Member 25
Agency/organization Peking Union Medical College Website http://www.pumc.edu.cn
Type Academic/Educational Sector represented Academic Institutions
Name of representative Xing Ruoqi Member Since Aug-2002
Title in agency Director Fax +0086-10-65279704
E-mail address xingrq@ms.imicams.ac.cn Telephone +0086-10-65279704
Main role in the CCM No. 9 Dongdansantiao
Proposal / work plan review and
and the proposal Mailing address Dongcheng District
consultation.
development Beijing 100005, PRC
Member 26
Agency/organization Beijing Ditan Hospital Website http://www.bjdth.com
Type Academic/Educational Sector represented Academic Institutions
Name of representative Chen Yifan Member Since Aug-2002
Title in agency Director Fax +0086-10-64227308
E-mail address chenyifan51@163.com Telephone +0086-10-64288807
Main role in the CCM No. 13 Titan Lu
Proposal / work plan review and
and the proposal Mailing address Xicheng District
consultation.
development Beijing 100011 PRC
Member 27
Agency/organization Beijing You’an Hospital Website http://www.bjyah.com
Type Academic/Educational Sector represented Academic Institutions
Name of representative Huang Chun Member Since Aug-2002
Title in agency Director Fax +0086-10-63293374
The Global Fund: Proposal Form Page 19 of 89
3 Type of Application
E-mail address chun6638@tom.com Telephone +0086-10-63293374
Main role in the CCM No. 8 Xitoutiao You'anmenwai Dajie
Proposal / work plan review and
and the proposal Mailing address Fengtai District
consultation.
development Beijing 100040, PRC
Member 28
Agency/organization International Labor Organization Website http://www.ilo.org
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Djankou Ndjonkou Member Since Mar-2002
Title in agency Director, ILO Beijing Office Fax +0086-10-65321420
E-mail address beijing@ilo.org Telephone +0086-10-65325091
1-10 Tayuan Diplomatic Office
Main role in the CCM
Technical input, Proposal / work plan No. 14 Liangmahe Nanlu
and the proposal Mailing address
review and consultation. Chaoyang District
development
Beijing 100600, PRC
Member 29
Agency/organization UNAIDS Website Http://www.china.org/unaids
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Joel Rehnstrom Member Since Jan-2004
Country Coordinator, UNAIDS China
Title in agency Fax +0086-10-85322228
Office
E-mail address Joel.rehnstrom@public.un.org.cn Telephone +0086-10-85322226
Chair of AIDS Technical Working Group,
technical support for proposal / work plan 1-16-2 Tayuan Diplomatic Office
Main role in the CCM
preparation, review and monitoring, No. 14 Liangmahe Nanlu
and the proposal Mailing address
coordination with other UN-funded AIDS Chaoyang District,
development
programs, review and consultation of other Beijing 100600, PRC
CCM documents.
Member 30
Agency/organization UNDCP Website
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Member Since
Title in agency Fax
E-mail address Telephone
Main role in the CCM As a member of UNAIDS Theme Group,
and the proposal UNDCP is represented by UNAIDS in Mailing address No resident office in China
development CCM activities.
Member 31
Agency/organization UNDP Website http://www.undp.org
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Jia Lusheng Member Since Mar-2002
Title in agency Assistant Representative Fax +0086-10-65322567
E-mail address lusheng.jia@undp.org Telephone +0086-10-65323731 x388
Main role in the CCM Technical support for proposal / work plan No. 2 Liangmahe Nanlu
and the proposal preparation, review and monitoring, review Mailing address Chaoyang District
development and consultation of other CCM documents. Beijing 100600, PRC
Member 32
Agency/organization UNESCO Website http://www.unesco.org/
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Liu Yongfeng Member Since Mar-2002
Title in agency Program Officer Fax +0086-10-65324854
E-mail address yf.liu@unesco.org Telephone +0086-10-65322449
5-15-3 Diplomatic Compound
Main role in the CCM
Proposal / work plan review and No. 1 Jiangguomenwai Dajie
and the proposal Mailing address
consultation. Chaoyang District
development
Beijing 100600, PRC
Member 33
Agency/organization UNFPA China Website http://www.unfpa.org
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Siri Tellier Member Since 23-June-2003
Title in agency Representative of UNFPA China Fax +0086-10-65322510
E-mail address siri.tellier@public.un.org.cn Telephone +0086-10-65323731
Core Group member, proposal / work plan
Main role in the CCM No. 2 Liangmahe Nanlu
review and consultation, assist in project
and the proposal Mailing address Chaoyang District
implementation, monitoring and evaluation
development Beijing 100600, PRC
activities.
The Global Fund: Proposal Form Page 20 of 89
3 Type of Application
Member 34
Agency/organization UNICEF Website http://www.unicef.org
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Christian Voumard Member Since Mar-2002
Title in agency Representative Fax +0086-10-65323107
E-mail address cvoumard@unicef.org Telephone +0086-10-65323131 x1001
Core Group member, technical support for
Main role in the CCM No. 12 Sanlitun Lu
Proposal / work plan preparation, review
and the proposal Mailing address Chaoyang District
and monitoring, review and consultation of
development Beijing 100600, PRC
other CCM documents.
Member 35
Agency/organization World Health Organization Website http://www.who.int
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Henk Bekedam Member Since Mar-2002
Title in agency WHO Representative, China Fax +0086-10-65322359
E-mail address bekedamh@chn.wpro.who.int Telephone +0086-10-65327190
Vice Chair of CCM, Chair of TB Working
Group, technical support for proposal Room 401 East Diplomatic Compound
Main role in the CCM
preparation and review, monitoring and No. 23 Dongzhimenwai Dajie
and the proposal Mailing address
evaluation of the project, coordinator of Chaoyang District
development
UN-funded health programs, review and Beijing 100600, PRC
consultation of other CCM documents.
Member 36
Agency/organization World Bank Website http://www.worldbank.org.cn/Chinese
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Wang Shiyong Member Since Mar-2002
Title in agency Health Specialist Fax +0086-10-58617800
E-mail address swang1@worldbank.org Telephone +0086-10-58617600
Technical support for proposal preparation F16 China World, Tower 2
Main role in the CCM
and review, assist in project No. 1 Jianguomenwai Dajie
and the proposal Mailing address
implementation, monitoring and evaluation Chaoyang District
development
activities. Beijing,100004, PRC
Member 37
Agency/organization World Food Program Website http://www.wfp.org
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Douglas Broderick Member Since Mar-2002
Title in agency Representative Fax +0086-10-65324802
E-mail address Douglas.broderick@wfp.org Telephone +0086-10-65323731 x210
Main role in the CCM
No. 2 Liangmahe Nanlu
and the proposal Proposal / work plan review and
Mailing address Chaoyang District
development consultation.
Beijing 100600, PRC
Member 38
International Federation of Red Cross and
Agency/organization Red Crescent Societies East Asia Website http://www.ifrc.org/
Regional Delegation
Type Multilateral Development Partner Sector represented International Multilateral Organizations
Name of representative Audrey Swift Member Since Mar-2003
Title in agency Regional Health Delegate Fax +0086-10-65327166
E-mail address ifrccn12@ifrc.org Telephone +0086-10-65327162/3/4
4-1-133 Diplomatic Compound
Main role in the CCM
Proposal / work plan review and No. 1 Jianguomenwai Dajie
and the proposal Mailing address
consultation. Chaoyang District
development\
Beijing 100600, PRC
Member 39
Department for International
Agency/organization Website http://www.dfid.gov.uk/
Development(UK)
Type Bilateral Development Partner Sector represented International Bilateral Organizations
Name of representative Martin Taylor Member Since Mar-2002
Health Adviser, First Secretary, DFID
Title in agency Fax +0086-10-85296003
China
E-mail address m-taylor@dfid.gov.uk Telephone +0086-10-85296882-2022
Core Group member, technical support for
30F South Tower, Kerry Center
Main role in the CCM proposal / work plan preparation and
No.1 Guanghualu
and the proposal review, monitoring and evaluation of Mailing address
Chaoyang District
development project implementation, review and
Beijing 100020, PRC
consultation of other CCM documents.
The Global Fund: Proposal Form Page 21 of 89
3 Type of Application
Member 40
http://www.delchn.cec.eu.int,
Agency/organization Delegation of the European Commission Website
http://www.europa.eu.int
Type Bilateral Development Partner Sector represented International Bilateral Organizations
Name of representative Micha Ramakers Member Since Mar-2002
Title in agency Second Secretary Fax +0086-10-84486327
E-mail address Micha.ramakers@cec.eu.int Telephone +0086-10-84486317-124
Proposal / work plan review and
Main role in the CCM No. 15 Dongzhimenwai Dajie
consultation, assist in proposal preparation
and the proposal Mailing address Chaoyang District
and review, project implementation,
development Beijing 100600, PRC
monitoring and evaluation activities.
Member 41
Agency/organization Government of Japan Website
Type Bilateral Development Partners Sector represented International Bilateral Organizations
Name of representative Komiyama Airo Member Since Mar-2002
Title in agency First Secretary Fax +0086-10-64106975
E-mail address komiyama@eoj.cn Telephone +0086-10-64106972
Proposal / work plan review and
Main role in the CCM No. 7 Ritan Lu
consultation, assist in project
and the proposal Mailing address Chaoyang District
implementation, monitoring and evaluation
development Beijing 100600, PRC
activities.
Member 42
Embassy of the Grand-Duchy of
Agency/organization Website
Luxembourg
Type Bilateral Development Partners Sector represented International Bilateral Organizations
Name of representative Johanna Vrombaut Member Since Mar-2002
Ambassador of the Grand-Duchy of
Title in agency Fax +0086-10-65137268
Luxembourg
E-mail address ambluxcn@public.bta.net.cn Telephone +0086-10-65135937
Main role in the CCM No. 21 Neiwubu Lu
Proposal / work plan review and
and the proposal Mailing address Chaoyang District
consultation.
development Beijing 100600, PRC
Member 43
Agency/organization Government of United States of America Website
Type Bilateral Development Partner Sector represented International Bilateral Organizations
Name of representative Craig Shapir Member Since Mar-2002
Title in agency Counselor Fax +0086-10-65323297
E-mail address seligsohnd@state.gov Telephone +0086-10-65323831 x6930
Assist in proposal / work plan preparation,
No. 3 Xiushui Beijie
Main role in the CCM technical support, monitoring and
Chaoyang District
and the proposal evaluation of the project implementation, Mailing address
Beijing 100600, PRC
development review and consultation of other CCM
documents.
Member 44
Agency/organization Embassy of Italy in China Website
Sector represented
Type Bilateral Development Partner International Bilateral Organizations
Name of representative Pasqualino Procacci Member Since Mar-2002
Title in agency Cooperation Director Fax +0086-10-65326376
E-mail address procacci@ambpech.org.cn Telephone +0086-10-65327397
Main role in the CCM No. 2 East 2nd Street, Sanlitun Lu
Proposal / work plan review and
and the proposal Mailing address Chaoyang District
consultation.
development Beijing 100600, PRC
Member 45
Agency/organization Damien Foundation Belgium (DFB) Website
International Nongovernmental
Type NGO Sector represented
Organizations
Name of representative Alex Jaucot Member Since Mar-2002
Title in agency DFB Representative for South-East Asia Fax +0086-10-64637144
E-mail address alex.jaucot@damien-bel.org.cn Telephone +0086-10-84512250
Assist in Proposal / work plan preparation,
Room 1502 Guangming Hotel
Main role in the CCM technical support, monitoring and
Liangmaqiao Lu
and the proposal evaluation of the project implementation, Mailing address
Chaoyang District
development review and consultation of other CCM
Beijing 100016, PRC
documents.
Member 46
The Global Fund: Proposal Form Page 22 of 89
3 Type of Application
Agency/organization Health Unlimited, UK Website http://www.healthunlimited.org
International Nongovernmental
Type NGO Sector represented
Organizations
Name of representative Zhang Jun Member Since Mar-2002
Title in agency Program Coordinator Fax +0086-871-5737726
E-mail address zhangjunhu@hotmail.com Telephone +0086-871-5737726
Assist in proposal / work plan preparation,
Main role in the CCM 1-202 Cunlidongyuan Fu
technical support, monitoring and
and the proposal Mailing address No.18, 10 of Cuihunnalu
evaluation project implementation, review
development Kunming, Yunnan 650000, PRC
and consultation of other CCM documents.
Member 47
Agency/organization Save the Children, UK Website www.savethechildren.org.uk
International Nongovernmental
Type NGO Sector represented
Organizations
Name of representative Kate Wedgewood Member Since Aug-2002
Title in agency Program Director Fax +0086-10-65006554
E-mail address katewedgwood@savethechildren.org.cn Telephone +0086-10-65006441/65004408/85261648
Core Group member, assist in proposal /
16-A CITIC Building
Main role in the CCM work plan preparation, technical support,
No. 19 Jianguomenwai Dajie
and the proposal monitoring and evaluation of project Mailing address
Chaoyang District
development implementation, review and consultation of
Beijing 100004, PRC
other CCM documents.
Member 48
Agency/organization Merch Sharp & Dohme ( China ) , Ltd. Website http://www.msdchina.com.cn
Type Private Sector Sector represented Public and Private Enterprises
Name of representative Zhang Huiyun Member Since Oct-2002
Title in agency Associate manager Fax +0086-10-85188539
E-mail address huiyun_zhang@merck.com Telephone +0086-10-85181313-595
Unit 701 Oriental Plaza
Main role in the CCM
Proposal / work plan review and No.1 Dong Chang’An Dajie
and the proposal Mailing address
consultation. Dongcheng District
development
Beijing 100738, PRC
Member 49
Agency/organization GlaxoSmithKline Website http://www.gsk.com
Type Private Sector Sector represented Public and Private Enterprises
Name of representative Xue Qin Member Since Aug-2002
Title in agency Government Affairs Manager Fax +0086-10-85296756
E-mail address qin.q.xue@gsk.com Telephone +0086-10-85296868 x2026
8F North Tower, Kerry Center
Main role in the CCM
Proposal / work plan review and No.1 Guanghualu
and the proposal Mailing address
consultation. Chaoyang District
development
Beijing 100020, PRC
Member 50
Agency/organization Bristol-Myers Squibb China Website http://www.bms.com
Type Private Sector Sector represented Public and Private Enterprises
Name of representative Sophia Luan Member Since Aug-2002
Title in agency Corporate Affairs Director Fax +0086-21-53862127
E-mail address Sophia.luan@bms.com Telephone +0086-21-63183549
F6, Fuxing Plaza
Main role in the CCM
Proposal / work plan review and No. 109 Yandang Lu
and the proposal Mailing address
consultation. Luwan District
development
Shanghai 200020, PRC
Member 51
Agency/organization North-East Pharmaceutical Group Website http://www.nepgslc.com
Type Private Sector Sector represented Public and Private Enterprises
Name of representative An Xiaoxia Member Since Aug-2002
Title in agency Director Fax +0086-24-25806888
E-mail address anceu@sina.com Telephone +0086-24-25806655
Main role in the CCM No. 37 Zhonggong Beijie
Proposal / work plan review and
and the proposal Mailing address Tiexi District
consultation.
development Shenyang 110026, PRC
Member 52
Shanghai Desano Biopharmaceutical Co.,
Agency/organization Website http://www.desano.com
Ltd. (Beijing)
Type Private Sector Sector represented Public and Private Enterprises
Name of representative Zheng Hong Member Since Aug-2002
The Global Fund: Proposal Form Page 23 of 89
3 Type of Application
Title in agency Project Manager Fax +0086-10-65686510
E-mail address zhenghong@desano.com Telephone +0086-10-65686500 x216
14F AVIC Plaza
Main role in the CCM
Core Group member, proposal / work plan No. 2 Jianwai Dongsanhuan Nanlu
and the proposal Mailing address
review and consultation. Chaoyang District
development
Beijing 100022, PRC
Member 53
Agency/organization Mangrove Support Group Website http://www.chinamsg.org
People living with HIV/AIDS,TB and/or
Type People living with HIV/AIDS Sector represented
Malaria
Name of representative Li Xiang Member Since Aug-2002
Title in agency Project Manager Fax +0086-10-63296183
E-mail address msg@chinamsg.org Telephone +0086-10-63296183
Room 213
Main role in the CCM Proposal / work plan review and
No. 8 Xitoutiao Youanmenwai Dajie
and the proposal consultation, representing people living Mailing address
Fengtai District
development with HIV/AIDS.
Beijing 100054, PRC
Member 54
Agency/organization Mangrove Support Group Website http://www.chinamsg.org
People living with HIV/AIDS,TB and/or
Type People living with HIV/AIDS Sector represented
Malaria
Name of representative Zhang Lu Member Since Aug-2002
Title in agency Project Manager Fax +0086-10-63296183
E-mail address plwha@126.com Telephone +0086-10-63296183
Room 213
Main role in the CCM Proposal / work plan review and
No. 8 Xitoutiao Youanmenwai Dajie
and the proposal consultation, representing people living Mailing address
Fengtai District
development with HIV/AIDS.
Beijing 100054, PRC
The Global Fund: Proposal Form Page 24 of 89
3 Type of Application
3.6.4. National/Sub-National/Regional (C)CM Endorsement of Proposal
[Please note: The entire proposal, including the signature page, must be received by the Global Fund
Secretariat before the deadline for submitting proposals. The minutes of the CCM meetings at which
the proposal was developed and endorsed must be attached as an annex to this proposal.]
PROPOSAL TITLE: Addressing Major Threats to Successful Tuberculosis Control in
China
“We, the undersigned, hereby certify that we have participated in the proposal development
process and have had sufficient opportunities to influence the process and this application.
We have reviewed the final proposal and support it. If the proposal is approved we further
pledge to continue our involvement in the Coordinating Mechanism during its
implementation.”]
Table 3.6.4 – National/Sub-national /Regional (C)CM Endorsement
The Global Fund: Proposal Form Page 25 of 89
3 Type of Application
The Global Fund: Proposal Form Page 26 of 89
3 Type of Application
The Global Fund: Proposal Form Page 27 of 89
3 Type of Application
The Global Fund: Proposal Form Page 28 of 89
3 Type of Application
The Global Fund: Proposal Form Page 29 of 89
3 Type of Application
3.6.5 CCM Endorsement Details for Applications from Regional Organizations:
Table 3.6.5 – Regional Organization Endorsement
Names of CCM Country Attachment number
The Global Fund: Proposal Form Page 30 of 89
4 Components Section
4
4.1 Identify the Component Addressed in this Section
HIV/AIDS 3
Tuberculosis 4
Malaria
Health system strengthening
4.1.1 Indicate the Estimated Start Time and Duration of the Component
Table 4.1.1 – Proposal Start Time and Duration
From To
Month and year: July, 2006 June, 2011
4.2 Contact Persons for Questions Regarding this Component
Table 4.2 – Component contact persons
Primary contact Secondary contact
Name Qiang Zhengfu Yao Hongyan
Title Director
Office of International National Center For TB Control
Organization
Cooperation, China CDC and Prevention, China CDC
27 Nanwei Road, Xuanwu 27 Nanwei Road, Xuanwu
Mailing address
District, Beijing, 100050 District, Beijing, 100050
Telephone 0086 10 83160270 0086 10 83135105
Fax 0086 10 63131939 0086 10 83135105
E-mail address zfqiang@chinaglobalfund.org yaohongyan@chinatb.org
3
In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS components should
include collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are
recommended for different epidemic states; for further information see the ‘WHO Interim policy on
collaborative TB/HIV activities,’ available at
http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
4
In contexts where HIV/AIDS is driving the tuberculosis epidemic, tuberculosis components should
include collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are
recommended for different epidemic states; for further information see the ‘WHO Interim policy on
collaborative TB/HIV activities,’ available at
http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
The Global Fund: Proposal Form Page 31 of 89
4 Components Section
4.3 National Program Context and Gap Analysis for this Component
4.3.1 Epidemiological and Disease-Specific Background
Describe, and provide the latest data on, the stage and type of epidemic and its
dynamics (including breakdown by age, gender, population group and geographical
location, wherever possible), the most affected population groups, and data on drug
resistance, where relevant. (Information on drug resistance is of specific relevance if the
proposal includes anti-malarial drugs or insecticides. In the case of TB components,
indicate, in addition, the treatment regimes in use or to be used and the reasons for their
use.)
China is one of the 22 high TB burden countries in the world. WHO estimates that, in
2003, 1.4 million new active TB cases develop in China, of which 600,000 were the
highly infectious, smear-positive pulmonary disease. This means China—with 17% of the
global TB burden—ranks second in the world in the number of TB cases, behind India. In
2000, China carried out its fourth national TB prevalence survey. Results of the survey
showed that there were 4.5 million prevalent active TB cases and 1.5 million smear-
positive pulmonary TB cases in the country. With 75% of the cases occurring in persons
between the ages 15-59, the disease primarily afflicts persons in the most productive
years of their lives. Men are twice as likely to have TB than women. The prevalence of
TB in poorer rural areas was nearly twice that in urban areas; the prevalence of disease
in the central-western provinces was also nearly twice that eastern provinces.
To address the serious problem of TB, the Chinese Government has gradually expanded
the implementation of DOTS—the WHO-recommended strategy for TB control. More
than 60% of the country was covered by DOTS in 2000. Between 2000 and 2005, DOTS
coverage expanded to cover nearly 100% of the counties in China. With DOTS,
standardized treatment regimens using first line TB drugs (including isoniazid, rifampin,
ethambutol, pyrazinamide and streptomycin) have resulted in >85% treatment success
for smear-positive TB cases. But equally important is the increasing TB case-detection
rate. The TB case-detection rate was only 30% in 2002, far from the 70% target. With
strengthened governmental commitment and international partnership, case-detection
rate increased rapidly to 45% in 2003 and 64% in 2004. It is very likely that China will
achieve the global TB control target of 70% case-detection by the end of 2005.
If China can achieve the global TB case-detection and treatment success targets by the
end of 2005, it would be taking a major step toward greatly reducing the TB burden in the
country. The next critical milestone to realize is the 2015 Millenium Development Goal’s
(MDG’s) of halving the TB prevalence and deaths in China. To reach the MDG’s for TB,
China will need to address several threats to successful TB control in China. If these
threats are not addressed, it is unlikely that the MDG’s can be achieved. In fact, the
gains achieved to date may well be reversed. Below is a discussion of the three most
important threats to the control of TB in China.
The first threat is the epidemic of multidrug-resistant TB (MDR-TB), estimated by WHO
to be the largest in the world. Approximately a quarter of the world’s MDR-TB cases are
in China. According to the WHO/IUATLD global TB drug-resistance surveillance (DRS)
project, China has several of the world’s MDR-TB “hotspots”. Data from DRS surveys in
9 of China’s 31 provinces have revealed alarming rates of MDR-TB in more than half of
these provinces. In these provinces, the rate of MDR-TB in previously untreated cases
ranged from 4.5% to 10%, substantially higher than the global average. What is more
worrisome is that MDR-TB rate is >7% among previously untreated TB cases in two
provinces—Liaoning and Heilongjiang—that have implemented a successful DOTS
program for nearly 10 years. This raises concern that implementing DOTS alone cannot
control the serious MDR-TB epidemic in China.
The second threat is the emerging HIV/AIDS epidemic. The China Ministry of Health
The Global Fund: Proposal Form Page 32 of 89
4 Components Section
estimates the country has 840,000 PLWHA. Although considered a low HIV prevalence
country, China already has many local areas with high prevalence of HIV/AIDS. Most
experts believe the epidemic is moving from high-risk groups into the general population.
If more is not done to halt this epidemic, a joint China-UN assessment report estimates
the country could have 10 million PLWHA by 2010. The impact of the HIV/AIDS epidemic
on the TB epidemic in China is unknown at this time. But since 45% of China’s
population is already infected with Mycobacterium tuberculosis, introduction of HIV into
such a highly infected population should increase the incidence and mortality of TB as
well as the morbidity and morbidity of HIV/AIDS. This increase, however, will not be
uniform across China and will follow the rise in HIV/AIDS prevalence in local areas. In
some high HIV prevalent areas, anecdotal reports suggest HIV-associated TB is already
a serious problem. However, there is little collaboration between the HIV/AIDS and TB
prevention and care programs. Without such collaboration, TB rates and deaths will rise
in PLWHA. The gains achieved by implementing DOTS throughout China could be
reversed by the growing HIV/AIDS epidemic unless more is done to mitigate the impact
of the two epidemics on each other.
The third threat is the inadequate control of TB in China’s large migrant population. The
largest migration of people in China’s history is happening right now. Over 150 million
people have relocated from poor rural areas to better-off urban areas seeking better
income and living conditions. This number is increasing every day. The vast majority of
migrants are moving from poorer to richer provinces. But in every province, migrants are
also moving from rural to urban areas. According to governmental statistics, 70% of the
migrants that move between provinces have relocated to 6 provinces in eastern China. In
urban areas, the migrant population live in crowded conditions and work for long hours in
low-wage jobs such as construction and restaurant work. Less than half of the migrants
are long-term residents (i.e. more than 6 months); most are temporary residents.
There is limited information about TB in the migrant population because official statistics
in China only provide information on TB among the resident population. However, what
little information there is indicates that the number and proportion of TB cases occurring
in the migrant population is increasing in eastern China. In Beijing and Shanghai, 40%
and 50% of the TB cases respectively are reported from the migrant population. In
Shenzhen, 80% of TB cases are in the migrant population. In these cities and
municipalities, the historical decline in TB notification has reversed in recent years
because of the increase in TB cases among the migrant population. This increase is not
surprising because of the sheer number of migrants and the fact that they are from
higher TB incidence areas. The problem is that national TB control policies are just
starting to address this important group of patients. Free diagnosis and treatment for TB
is provided in only a few but not most areas. The high mobility of the population has led
to a low percentage of TB suspects completing diagnostic evaluation (70% in one study)
and an even lower percentage successfully treated (only 20% in Beijing and Shanghai).
Because migrant workers frequently face discrimination at work or by their associates if
they are known to have TB, most do not want to be diagnosed with TB. This leads to
delay in diagnosis or incomplete diagnosis. And after they start TB treatment, they
frequently cannot work, resulting in substantial loss of income. Thus they may move back
to their home province or discontinue TB treatment as soon as they feel better. These
are important challenges when trying to control TB in this population.
Without the recent success in implementing DOTS (including the rapid increase in case-
detection), it would be difficult for China to effectively address the current threats in TB
control. An effective DOTS program is the prerequisite to tackling the MDR-TB epidemic.
An effective DOTS program and an effective HIV prevention and care program are
essential components of effective TB-HIV collaboration. An effective DOTS program for
the resident population must be in place before one can have a TB control program for
the migrant population. With China moving from the 2005 global TB control targets
toward the MDG’s, it is time to tackle these key threats to control of TB.
The Global Fund: Proposal Form Page 33 of 89
4 Components Section
4.3.2 Health Systems, Disease-Control Initiatives and Broader Development
Frameworks
a) Describe the (national) health system, including both the public and private
sectors, as relevant to fighting the disease in question.
The State Council of China is ultimately responsible for the control of communicable
disease in China and has set the key national targets and plan for TB and HIV/AIDS
prevention and control. There is a State Council leading group on HIV/AIDS, which
oversee the national effort on HIV/AIDS. Under the overall guidance of the State Council,
the Ministry of Health heads up the national effort to prevent and control HIV/AIDS and
TB. The Ministry is responsible for setting all national policies and overseeing the
implementation of the National HIV/AIDS Prevention and Control Program (NAP) and the
National TB Control Program (NTP). Actual implementation of the NAP and NTP is
carried out by the country-wide system of Centers for Disease Control and Prevention
(CDC), which exists from the national level down to the county level. TB suspects or
cases can access free TB diagnosis and treatment within the CDC system, usually at the
county TB dispensary. Similarly, free HIV/AIDS services including free antiretroviral
therapy are administered by the CDC system. However, most patients with symptoms
related to TB or HIV disease initially seek care at the village clinic, township clinics or the
general hospitals. In these non-public health facilities, care is provided on a fee-for-
service basis. After a patient is diagnosed with TB in the CDC system, the village doctor
under the supervision of the county TB dispensary usually provides treatment. HIV care
and treatment can be provided at the county, township or even village level depending
on the number of PLWHA.
b) Describe comprehensively the current disease-control strategies and
programs aimed at the target disease, including all relevant goals and
objectives with regard to addressing the disease. (Include both existing
Global Fund-financed programs and other programs currently implemented
or planned by all stakeholders and existing and planned commitments to
major international initiatives and partnerships).
In 2001, the State Council developed the 10-year National TB Control Plan (2001-2010).
In this plan, the State Council adopted the WHO-recommended DOTS strategy as the
national approach to control TB. The plan sets the following targets for 2010: expanding
DOTS coverage to at least 95% of the counties in China, diagnose at least 4 million
infectious TB cases, and achieve a treatment success rate of at least 85%. In
implementing this plan, the Ministry of Health accelerated the implementation of DOTS
and 100% of the counties in China are currently implementing DOTS. In addition, it
adopted the 2005 World Health Assembly targets of 70% TB case-detection and 85%
treatment success rate for smear-positive TB cases.
To implement the State Council TB Control Plan, the Ministry of Health organized the
NTP utilizing funds from the following domestic and international sources:
1. In 2002 and 2003, the central government provided US$ 4.8 million per year to
purchase TB drugs for smear-positive cases. In 2004, the central government
increased annual TB funding to US$ 31 million. This new funding is used for
activities and incentives to increase TB case-detection, to provide case
management fee for village doctors, and to provide free treatment for smear-
negative TB cases.
2. China negotiated a US$ 104 million loan from the World Bank to support DOTS
implementation in 16 provinces for 2002-2008; the project include grant funding
by the Department of International Development (DFID) of the United Kingdom
to reduce the interest rate of the loan. The project funds basic activities included
in the WHO expanded framework on DOTS.
3. The Government of Japan through the Japan International Cooperation Agency
(JICA) has been providing TB drugs for 12 provinces since 2002; this project run
The Global Fund: Proposal Form Page 34 of 89
4 Components Section
through 2006.
4. China successfully applied to the GFATM for a 5-year TB control project to
implement DOTS in 24 provinces. The project supports DOTS implementation in
the poverty counties of the 16 World Bank/DFID project provinces and in 8 other
central-western provinces not in the World Bank project. This project was
approved in the round 1 GFATM application process and runs from 2003-2008.
Like the World Bank project, this GF project funds basic activities included in the
WHO expanded framework on DOTS.
5. China successfully applied to the GFATM for the first two year of a 5-year TB
control project (2005-2010). This project, approved during the round 4 GFATM
application process, aims to increase TB case-detection by strengthening
collaboration between hospital and TB dispensary system, increase grassroots’
health promotion activities, and address human resource constraints.
6. The Damien Foundation Belgium is supporting DOTS implementation in 3
provinces—Tibet, Qinghai and Inner Mongolia. This work complements existing
work of the larger projects mentioned above.
7. WHO (using funds from the Canadian International Development Agency) has
been supporting DOTS implementation in 3 provinces not involved in the World
Bank and the GFATM projects since late 2002. This project will end in 2005.
8. Provincial, city and county governments is providing significant amount of TB
funding (some as counterpart funding to a World Bank loan and some as regular
governmental funding for TB).
The central government has developed a National Medium and Long Term Plan for
HIV/AIDS Prevention and Control (1998-2010) and a Plan of Action (2001-2005). The
State Council has established a multi-sectoral working group on HIV/AIDS. This group is
responsible for directing and coordinating national efforts to curb the epidemic. In 2004,
China introduced the “Four Frees and One Care” policy (free treatment, free schooling
for AIDS orphans, free VCT testing, free PMTCT, and care and economic assistance to
the households of PLWHA). Free anti-retroviral therapy launched for rural and poor
urban patients and the China Comprehensive AIDS Response (China CARES) program
continues to be expanded. Nearly all provinces have developed their own
implementation plan to fit their local situation. The GFATM round 3 HIV/AIDS proposal
supports HIV prevention and care activities in 7 central Chinese provinces where the
epidemic is largely due to illegal blood plasma donation. The GFATM round 4 HIV/AIDS
proposal supports HIV prevention and care activities in another 7 central Chinese
provinces where the epidemic is largely due to injection drug use. In all major HIV/AIDS
prevention and care projects, including the round 3 and 4 GFATM projects, there is little
support for TB-HIV collaborative activities.
c) Describe the role of AIDS-, tuberculosis- and/or malaria-control efforts in
broader developmental frameworks such as Poverty Reduction Strategies,
the Highly-Indebted Poor Country (HIPC) Initiative, the Millennium
Development Goals or sector-wide approaches. Outline any links to
international initiatives such as the WHO/UNAIDS ‘3-by-5 Initiative’ or the
Global Plan to Stop TB or the Roll Back Malaria Initiative.
The current TB- and HIV/AIDS-control effort in China is part of a larger national effort to
control major diseases of poverty. The Chinese government has targeted HIV/AIDS, TB,
schistosomiasis, and hepatitis B as priority diseases to control. The commitment to tackle
these diseases was strengthened following the 2003 SARS epidemic. The recent
increase in central and provincial governmental funding to combat diseases like
HIV/AIDS and TB is a concrete demonstration of this commitment. The government is
implementing a major program to address weaknesses in its public health system,
including inadequacies in its disease control program.
China is in the process of adopting the Millennium Development Goals and putting them
into the next 5-year national development plan (2006-2010). Once adopted, the MDG’s
for HIV/AIDS and TB will be an important part of the national development objectives.
China has been supporting the Stop TB Partnership’s global effort to control TB and is
The Global Fund: Proposal Form Page 35 of 89
4 Components Section
currently a member of Stop TB Partnership Coordinating Board. After the Global DOTS
Expansion Plan was published in May 2001, China also prepared a 5-year DOTS
implementation plan to complement its 10-year National TB Control Plan. In November
2001, the Global Plan to Stop TB was published specifying activities for countries to
implement in order to reach the World Health Assembly (WHA) TB control targets by
2005. The activities in China’s National TB Control Program are in line with those in the
Global Plan to Stop TB. China has adopted WHA targets and is likely to achieve them by
2005. China has endorsed the “3-by-5 initiative” of WHO and is increasing its targets to
approach the “3-by-5” treatment goal. The “Four Frees and One Care” policy includes the
provision of free ART to poor and rural HIV/AIDS patients.
4.3.3 Financial and Programmatic Gap Analysis
4.3.3.1 Detail current and planned expenditures from all relevant sources, whether
domestic, external or from debt relief, including previous grants from the
Global Fund.
(See Table 4.3.1 and Table 4.3.3 below for details)
Domestic sources of funding :
1. Central governmental funding -- $37.0 million for 2005 and expected to remain at this
level for at least the next 3 years.
2. Sub-national governmental funding (including provincial, city/prefectural, and
county/district governments) -- $59.0 million for 2005 and expected to remain at this
level.
3. Total domestic funding is $87.8 million per year. However, this amount will likely
increase for 2005 and beyond as sub-national governments are increasing their TB
funding in 2005. But the exact amount will only be known later this year.
External sources of funding (see Table 4.3.3):
1. World Bank/DFID loan project -- $104 million loan from 2002-2008; will have $13.9
million in 2005 and remain roughly at that level through 2008.
2. GFATM Round 1 TB grant -- $48.0 million grant that started in April 2003; $6.8
million in 2005 and roughly at that level through 1st quarter of 2008.
3. GFATM Round 4 TB grant -- $56.1 million grant that will start in July 2005; about
$15.1 million during the first project year; funding decreases gradually year-by-year
till the 2nd quarter of 2010.
4. Government of Japan/JICA grant -- $3.7 million grant primarily to purchase TB drugs
in 2005; about $3.2 million grant will be provided in 2006 and then the grant will end.
5. WHO/Canadian CIDA grant -- $0.78 million grant for 2005 only.
6. Damien Foundation Belgium -- $0.57 million grant for 2005; about $0.74 million will
be available annually beyond 2005.
4.3.3.2 Provide an estimate of the costs of meeting overall (national) goals and
objectives and provide information about how this costing has been developed
(e.g., costed national strategies).
The overall cost of meeting the national goals and objectives can be divided into 3 parts
(see Table 4.3.1):
1. Cost of basic DOTS program: the activities and costing for this is fully described in
the Project Implementation Plan of the World Bank/DFID TB project and in the
GFATM Round 1 TB proposal. The salary of TB staffs should also be included as
part of the cost for the basic program; this cost—about US$ 42 million per year—is
not included in the World Bank or the GFATM project proposal. The total cost of
basic DOTS is $121 million in 2005; this increases to $131 million per year in 2006
as the case-detection rate in China increases to 70% by the end of 2005.
2. Cost of additional activities to increase TB case-detection to 70%: the activities and
costing for this are partly described in the GFATM Round 4 TB proposal, which
contains detail costing for several activities to increase TB case-detection. Additional
The Global Fund: Proposal Form Page 36 of 89
4 Components Section
budget for this comes from the central government TB budget of $37 million per
year. The central government’s budget to increase TB case-detection includes about
$10.7 million to increase sputum examination sites at township level, $2.9 million for
additional health promotion, and $4.2 million as incentives to village staffs for case-
reporting and identification of smear-positive cases, and $4.0 million for drugs to
treat smear-negative TB cases. Overall additional activities to increase case-
detection will cost $30 million per year
3. Cost of scaling up new activities in MDR-TB, TB/HIV, and TB in the migrant
population: the activities and costing for this is fully described in this proposal.
As mentioned above, more detail description of the costing method can be found in the
World Bank/DFID Project Implementation Plan. Here we will briefly describe the method.
The method for costing is based on unit costs for specific activities and the number of
units per year. Units can be number of health units, number of health care workers, or
number of patients. The projected number of units per year is based on the expansion of
DOTS (which is 100% of counties in 2005), number of health workers, and the case-
detection rate (estimated to be 70% in 2005). Each of the activities in the program, e.g.
training, supervision, health promotion, diagnosis, treatment, case management, etc,
were cost and then the costs were applied to the number of units per year.
4.3.3.3 Provide a calculation of the gaps between the estimated costs and current and
planned expenditures.
Table 4.3.1 describes the calculation of funding gap in the national TB control program.
As can be seen from the table, the funding need, availability and gap can be calculated
separately for the 3 types of funding stated in 4.3.3.2. The funding gap increases year-
by-year. This is due to several factors. First, although the funding need for basic DOTS
activities remains constant from 2006 onward (at $130.6 million) because TB case-
detection is expected to reach 70% by the end of 2005, the funding gap continues to
increase because external funding for basic DOTS (from both the World Bank and the
GFATM round 1 TB projects) gradually decreases and phases out by end of 2008.
Second, external funding for activities to increase TB case-detection decreases over time
mainly due to decreasing funding in the GFATM round 4 project. Third, funding need for
new activities in MDR-TB, TB/HIV, and migrant TB (in this proposal) is there but no funds
are available yet. For these 3 reasons, there is an increasing funding gap in the national
TB control program.
Part of the funding gap for basic DOTS activities in 2005 will be met by additional funding
from local governments (provincial level and below). It is difficult to determine the amount
of additional local governmental funding at this time as most funds will be provided later
in 2005. Therefore the estimated gap in funding basic DOTS activities in future year will
be partly filled by local government.
Table 4.3.1 – Funding need, availability and gap
Funding (in million US$)
2004 2005 2006 2007 2008 2009 2010
Basic DOTS 111 121.1 130.6 130.6 130.6 130.6 130.6
Increase case-
detection 31.7 30.1 30.1 25.9 29.9 29.9
Funding Others (MDR,
need HIV/TB, migrants) 9.5 13.9 19.1 21.5 20.3
Available Basic Domestic
funding DOTS fund 64.9 74.1 74.1 74.1 74.1 74.1 74.1
The Global Fund: Proposal Form Page 37 of 89
4 Components Section
External
fund 38.3 25.7 21.7 18.6 12.5 0.7 0.7
Domestic
fund 13.7 13.7 13.7 13.7 13.7 13.7
Increase
case- External
detection fund 7.55 13.9 12.2 9.4 8.4 4.7
Domestic
Others fund
(MDR,
HIV/TB, External
migrants) fund
Basic DOTS 7.8 21.3 34.8 37.9 44 55.7 55.7
Increase case-
detection 10.45 2.5 4.2 2.8 7.8 11.5
Funding Others (MDR,
gap HIV/TB, migrants) 9.5 13.9 19.1 21.5 20.3
Total funding gap 7.8 31.8 46.8 56 65.9 85.0 87.5
Table 4.3.3 - Financial Contributions to National Response
Financial contributions in Euro / US$
2004 2005 2006 2007 2008 2009 2010
Domestic (A) 64.9 87.8 87.8 87.8 87.8 87.8 87.8
External (B) 38.3 33.3 35.6 30.8 21.9 9.1 5.4
External source
1(WB/DFID) 21.2 13.9 10.3 10.4 10.7
External source 2
(JICA) 3.6 3.7 3.2
External source 3
(WHO-CIDA) 0.8 0.8
External source 4
DFB 0.8 0.6 0.7 0.7 0.7 0.7 0.7
External source 5
GF(1) 11.9 6.8 7.4 7.4 1.1
External source 6
GF(4) 7.6 13.9 12.2 9.4 8.4 4.7
Total resources
available (A+B) 103.2 121.1 123.4 118.6 109.7 96.9 93.2
Total need (C) 111.0 152.8 170.2 174.6 175.6 182.0 180.8
Unmet need
(C)-(A+B) 7.8 31.8 46.8 56 65.9 85.0 87.5
The Global Fund: Proposal Form Page 38 of 89
4 Components Section
4.3.4 Confirm that Global Fund resources received will be additional to existing and
planned resources, and will not substitute for such sources, and explain plans
to ensure that this is the case.
The activities proposed in this proposal have not been implemented as part of the
national TB control program (although a few local areas have implemented some of
these activities). As can be seen from the table 4.3.1, existing and planned resources in
the NTP have focused on basic DOTS activities and on activities to increase the 70% TB
case-detection. Therefore the requested funds in this proposal are additional to existing
and planned resources. In addition, there are resources for HIV/AIDS activities from
central government, local governments, and from external partners like the GFATM
round 3 and round 4 HIV/AIDS projects. However, existing and planned HIV/AIDS funds
do not include funding for TB/HIV collaborative activities. Therefore the TB/HIV funding
requested in this proposal is complementary and additional to existing HIV/AIDS funding.
The Global Fund: Proposal Form Page 39 of 89
4 Components Section
4.4 Component Strategy
4.4.1 Description and justification of the program strategy
[This section must be supported by a summary of the Program Strategy section in
tabular form.
Tables 4.4a and b (following section 4.4.1) are designed to help applicants
clearly summarize the strategy and rationale behind this proposal. For
definitions of the terms used in the tables, see Annex A. (See Guidelines for
Proposals, section V.B.2, for more information.)
In addition, please also provide a detailed quarterly work plan for the first 12
months and an indicative work plan for the second year. These should be
attached as an annex to the proposal form.]
Narrative information in section 4.4.1 should refer to Tables 4.4a and 4.4b, but should
not consist merely of a description of the tables.]
The Global Fund: Proposal Form Page 40 of 89
4 Components Section
Table 4.4a. Goals and Impact Indicators over Life of Program
Goal
Goals over five years
No.
#1 Reduce the morbidity and mortality of multidrug-resistant TB (MDR-TB) in China
#2 Reduce the morbidity and mortality of TB in persons living with HIV/AIDS (PLWHA) in China
#3 Reduce the morbidity and mortality of TB in the migrant population in China
Goal Baseline Year 1 Year 2 Year 3 Year 4 Year 5
Impact indicator Source and comments
No. Value Year Source target target target target target
Baseline value to be
#1 Treatment success rate of MDR-TB -- -- 65% 70% 75% collected in year 1 of
project
Baseline value to be
Treatment success rate of TB in
#2 -- 70% 75% 80% 85% collected in year 1 of
persons with HIV infection
project
Baseline value to be
Case-detection rate of TB in the
#3 50% 60% 70% 70% 70% collected in year 1 of
migrant population
project
Baseline value to be
Treatment success rate of TB in
#3 -- 65% 70% 75% 80% collected in year 1 of
the migrant population
project
Note: Current treatment success rate for MDR-TB, HIV-associated TB and TB in the migrant population and case-detection of TB in migrant population are not
known. For MDR-TB and TB in the migrant population, data from small cohorts indicate treatment success is around 20% as many patients default or transfer
before end of treatment. For HIV-associated TB, data on treatment is not available but it is likely <70% because of the high death rate associated with this
disease. The targets in this project aims to reduce morbidity and mortality by substantially increasing treatment success and case-detection to international
target levels.
The Global Fund: Proposal Form Page 41 of 89
4 Components Section
Table 4.4b. Objectives, Service Delivery Areas and Coverage Indicators over Life of Program
Program objectives over five years
Objective description Link to
Objective
goal by
No.
number
#1 Prevent the development of MDR-TB in China #1
#2 Assessment of MDR-TB epidemic in China #1
#3 Implement the DOTS-Plus strategy in selected sites of China #1
#4 Monitor and evaluate the effectiveness of DOTS-plus projects in China #1
#5 Build a supportive environment for TB/HIV collaboration #2
#6 Conduct surveillance of HIV prevalence in TB patients #2
#7 Improve case-finding of HIV in TB patients and of TB in PLWHA #2
#8 Improve prevention, treatment and care of TB among PLWHA #2
#9 Improve prevention, treatment and care of HIV/AIDS among TB patients #2
# 10 Establish the monitoring and evaluation system for TB/HIV collaborative activities #2
# 11 Build a supportive environment for implementing a TB control program among the migrant population #3
# 12 Increase TB case-detection and treatment success among the migrant population #3
# 13 Establish the monitoring and evaluation system for TB control in the migrant population #3
Frequenc
Year 1 Year 2 Year 3 Year 4 Year 5
Baseline y of data
Objective Directly target target target target target
Service delivery area Indicator description collection
No. tied
Valu
Year
e
Level 2
1.1 Prevention of No. of provinces that
#1 Yes 0 2005 0 31 31 31 31 Annual
MDR-TB disseminated the national
standard for TB diagnosis
The Global Fund: Proposal Form Page 42 of 89
4 Components Section
and treatment to all its
cities/counties/districts
Level 2
2.1 Assessment of
No. of provinces that
#2 the MDR-TB Yes 0 2005 7 7 7 7 3 Annual
started drug-resistance
epidemic in China
surveillance surveys
3.1 Coordination and
Level 2
partnership
No. of leading groups and
development to
#3 Yes coordinating groups for 0 2005 10 16 44 78 78 Annual
implement the
DOTS-plus project
DOTS-plus
established
strategy
3.2 Human resource
Level 1
development to
No. of people trained in
#3 implement the Yes 0 2005 244 300 1028 1156 1236 Annual
DOTS-plus project
DOTS-plus
implementation
strategy
Level 3
3.3 Timely detection
No. and percentage of
of MDR-TB in 372 986 3271 6769 6769
#3 Yes suspected cases of MDR- 0 2005 monthly
DOTS-plus (85%) (90%) (95%) (95%) (95%)
TB tested with drug
project areas
susceptibility testing
3.4 Treatment of Level 3
MDR-TB in No. and % of MDR-TB 87 227 757 1577 1577
#3 Yes 0 2005 monthly
DOTS-plus patients enrolled on (85%) (90%) (95%) (95%) (95%)
project areas treatment
3.5 Supporting
patients through
Level 3
direct observation
Percent of MDR-TB
#3 to enhance Yes 0 2005 95% 100% 100% 100% 100% quarterly
patients provided with
adherence to
directly observed therapy
treatment of
MDR-TB
3.6 Behavioral Level 3
#3 Yes 0 2005 600 1400 4000 9000 9000 quarterly
change No. of patients, family
The Global Fund: Proposal Form Page 43 of 89
4 Components Section
communication members and close
through contacts given BCC
community materials
outreach to
increase
awareness and
understanding of
MDR-TB and its
treatment
3.7 Procurement and
supply
management Level 2
system to provide Percentage of DOTS-plus
#3 Yes 0 2005 100% 100% 100% 100% 100% monthly
an uninterrupted sites reporting no stock
supply of TB out of drugs
drugs for MDR-
TB treatment
3.8 Operational
Level 2
research to
No. of sites implementing
#3 improve DOTS- Yes 0 2005 16 12 12 0 0 annual
operational research
plus projects in
according to national plan
China
Level 2
4.1 Monitoring and
Percentage of DOTS-plus
evaluation (M&E)
#4 Yes sites submitting accurate, 0 2005 90% 95% 100% 100% 100% quarterly
of DOTS-plus
complete and timely
projects in China
reports
5.1 Coordination and Level 2
partnership % of sites (at provincial,
#5 development for Yes city, and county levels) 0 2005 114 214 214 214 214 annual
TB/HIV with coordinating group
collaboration established
5.2 Advocacy Level 3
#5 initiative to Yes No. of advocacy materials 0 2005 4560 8560 8560 8560 8560 annual
increase distributed to decision-
The Global Fund: Proposal Form Page 44 of 89
4 Components Section
awareness of makers
decision-makers
about TB/HIV
5.3 Behavioral
change
communication Level 2
through mass No. of radio and TV
#5 Yes 0 2005 456 856 856 856 856 annual
media to increase programs that feature
community TB/HIV broadcasted
awareness of
TB/HIV
5.4 Behavioral
change
communication
Level 2
through
No. of project areas with
#5 community Yes 0 2005 67 134 134 134 134 annual
BCC services that feature
outreach to
TB/HIV
increase
awareness of
TB/HIV
5.5 Strengthening of Level 2
civil society to No. of counties with
participate in NGOs/CBOs providing
#5 Yes NA 2005 67 134 134 134 134 annual
TB/HIV HIV/TB support services
collaborative according to national
activities guidelines
Level 1
No. of TB and HIV
5.6 Human resource
service deliverers who
development for
#5 Yes received in-service 0 2005 30716 58856 58856 58856 58856 annual
TB/HIV
training on collaborative
collaboration
TB/HIV activities during
the year
5.7 Operational Level 2
#5 Yes 0 2005 16 12 12
research to No. of sites implementing
The Global Fund: Proposal Form Page 45 of 89
4 Components Section
improve TB/HIV operational research
collaboration according to national plan
Level 2
6.1 Monitoring of HIV No. of medium/low HIV
#6 prevalence in TB Yes prevalence provinces 0 2005 15 15 15 15 15 annual
patient carrying out surveillance
of HIV in TB patients
7.1 Prevention of HIV
Level 3
in TB patients by
% of TB patients who
#7 increasing HIV Yes NA 2005 80% 85% 90% 90% 90% annual
receive HIV counseling
testing in TB
and testing
patients
Level 3
% of PLWHA (receiving
HIV testing and
7.2 Intensified TB
counseling or in HIV
#7 case-finding in Yes NA 2005 80% 85% 90% 90% 90% annual
treatment and care
PLWHA
services) who were
screened for TB
symptoms
Level 2
% of counties where
8.1 Prevention of TB health care and/or
#8 infection in Yes congregate settings with NA 2005 80% 90% 100% 100% 100% annual
PLWHA a high HIV prevalence is
implementing the TB
infection control policy
Level 3
% of PLWHA with TB
9.1 Prevention of HIV
#9 Yes referred to HIV care and NA 2005 80% 85% 90% 90% 90% annual
in TB patients
support services during
TB treatment
9.2 Prevention of Level 3
#9 opportunistic Yes % of HIV-positive TB NA 2005 60% 70% 80% 90% 90% annual
infection in patients eligible to receive
The Global Fund: Proposal Form Page 46 of 89
4 Components Section
PLWHA with TB co-trimoxazole preventive
therapy (CPT) started on
CPT
Level 3
% of HIV-positive TB
9.3 Provision of ART patients eligible to receive
#9 during TB Yes antiretroviral therapy who NA 2005 70% 80% 90% 90% 90% annual
treatment begin or continue ART
during or at the end of TB
treatment
Level 3
9.4 Support patients
% of TB patients who
through direct
report direct observation
#9 observation of TB Yes NA 2005 80% 85% 90% 90% 90% annual
of ART and TB
and HIV
medications according to
treatment
national guidelines
10.1 Monitoring and Level 2
evaluation (M&E) % of TB/HIV service
# 10 of TB/HIV Yes delivery points submitting 0 2005 90% 100% 100% 100% 100% annual
collaborative accurate, complete and
activities timely reports
Level 2
11.1 Coordination and
No. of sites (at provincial,
partnership
city and county levels)
development for
# 11 Yes with the relevant policies 0 2005 21 76 146 146 146 annual
TB control among
for referral of follow-up of
the migrant
TB suspects and patients
population
in the migrant population
11.2 Human resource Level 1
development to No. of service deliverers
implement TB who received in-service
# 11 Yes 0 2005 168 608 1168 1168 1168 annual
control activities training on TB activities
for the migrant for the migrant population
population during the year
# 11 11.3 Behavioral Level 2 0 2005 28 28 28 28 28 annual
The Global Fund: Proposal Form Page 47 of 89
4 Components Section
change No. of radio and TV
communication programs that feature TB
through mass in migrant population
media to increase
awareness of and
reduce stigma
toward TB
11.4 Behavioral
change
communication
through Level 2
community No. of counties with BCC
# 11 Yes 0 2005 12 60 120 120 120 quarterly
outreach to services that feature TB
increase in the migrant population
awareness of and
reduce stigma
toward TB
11.5 Strengthening of Level 2
civil society to No. of counties with
participate in TB NGOs/CBOs providing
# 11 0 2005 12 60 120 120 120 annual
control activities TB support services to
for the migrant migrants according to
population national guidelines
11.6 Operation
research to
Level 2
improve the TB
No. of sites implementing
# 11 control program 0 2005 12 8 annual
operational research
among the
according to national plan
migrant
population
The Global Fund: Proposal Form Page 48 of 89
4 Components Section
12.1 Timely detection Level 3
and quality No. of new smear-
treatment of TB positive cases TB cases
# 12 Yes NA 2005 1170 6050 12920 14680 16450 quarterly
cases in the among the migrant
migrant population registered and
population treated
12.2 Supporting Level 3
patients through % of TB patients who
direct observation report direct observation
# 12 Yes NA 2005 60% 65% 70% 75% 80% quarterly
to enhance of TB medications
treatment according to national
adherence guidelines
12.3 Control of TB Level 3
drug resistance in % of new smear-positive
the migrant TB cases that interrupt
# 12 Yes NA 2005 25% 22% 18% 15% quarterly
population by treatment for more than 2
performing consecutive months
defaulter tracing (default rate)
Level 2
13.1 Monitoring and % of service delivery
evaluation of TB points implementing TB
# 13 control in the Yes service for the migrant 0 2005 85% 90% 95% 100% 100% quarterly
migrant population submitting
population accurate, complete and
timely reports
The Global Fund: Proposal Form Page 49 of 89
4 Components Section
4.4.1.1 Provide a clear description of the program’s goal(s), objectives and service
delivery areas (provide quantitative information, where possible).
China is poised to achieve the global TB control targets of 70% case-detection and 85%
treatment success rate in 2005. However, actual reduction in TB prevalence and
deaths—key targets in the Millennium Development Goals—may not occur because
there exist major threats to the control of TB in China. The program aims to tackle the
three most important threats by setting forth 3 goals:
1. Reduce the morbidity and mortality of multidrug-resistant TB (MDR-TB) in
China
2. Reduce the morbidity and mortality of TB in persons living with HIV/AIDS in
China
3. Reduce the morbidity and mortality of TB in the migrant population in China
Under goal 1 (MDR-TB), there are 4 objectives and 11 service delivery areas.
Given the seriousness of the MDR-TB epidemic in China and the size of the country, it is
not possible to quickly reduce the morbidity and mortality of MDR-TB in China.
Preventing the development of MDR-TB is the highest priority. But many parts of China
already have high rates of MDR-TB. In these areas, preventing the development of
MDR-TB by itself is unlikely to control the MDR-TB epidemic. Therefore it is important for
China to begin implementing the DOTS-plus strategy and reduce the existing burden of
MDR-TB cases. This proposal provides the resources for China to gradually develop the
experience and capacity to implement DOTS-plus projects. A sound monitoring and
evaluation system will be needed to determine the progress and problems in the DOTS-
plus projects. Finally, a comprehensive picture of the seriousness of MDR-TB in all
provinces is needed to determine where DOTS-plus should be targeted if China is to
reduce the morbidity and mortality of MDR-TB. Taken together, these objectives and
their associated service delivery areas form a comprehensive approach to tackling MDR-
TB—one that is based on the WHO DOTS-plus framework. This proposal will reduce TB
morbidity and mortality of MDR-TB in the 31 DOTS-plus sites in 6 provinces and will
refine the policies and implementation guidelines for the DOTS-plus strategy in China.
Objective 1: Prevent the development of MDR-TB in China
Service delivery area:
1.1 Prevention of MDR-TB
Because of the seriousness of the MDR-TB epidemic in China, preventing the further
development of MDR-TB is a priority. This objective will contribute to existing effort to
prevent MDR-TB by developing a national standard for TB diagnosis and treatment for all
health providers and facilities and by increasing the use of 4-drug fixed-dose combination
TB drugs. By linking this objective with the GFATM round 4 TB project, all local health
bureaus will receive these national guidelines and all general hospitals will be trained
and monitored on the implementation of the national standard of TB care.
Objective 2: Assessment of MDR-TB epidemic in China
Service delivery area:
2.1 Assessment of the MDR-TB epidemic in China
An understanding of the MDR-TB epidemic in different provinces in China is important to
determine whether the current efforts to control MDR-TB are effective and to target
interventions such as DOTS-plus strategy to areas with the most serious MDR-TB
problem. This objective will complement existing effort of WHO and the World Bank/DFID
TB project to assessment the MDR-TB epidemic in different provinces in China. Over the
5-year period, all 31 provinces will carry out a drug-resistance surveillance survey. This
will provide new or updated information on the MDR-TB epidemic in all provinces.
The Global Fund: Proposal Form Page 50 of 89
4 Components Section
Objective 3: Implement the DOTS-Plus strategy in selected sites of China
Service delivery areas:
3.1 Coordination and partnership development to implement the DOTS-plus strategy
3.2 Human resource development to implement the DOTS-plus strategy
3.3 Timely detection of MDR-TB in DOTS-plus project areas
3.4 Treatment of MDR-TB in DOTS-plus project areas
3.5 Supporting patients through direct observation to enhance adherence to
treatment of MDR-TB
3.6 Behavioral change communication through community outreach to increase
awareness and understanding of MDR-TB and its treatment
3.7 Procurement and supply management system to provide an uninterrupted supply
of TB drugs for MDR-TB treatment
3.8 Operational research to improve DOTS-plus projects in China
Objective 3 will gradually expand the DOTS-plus strategy in selected areas in China,
focusing on areas with highest levels of MDR-TB. To implement the DOTS-plus strategy,
it is essential to build the political commitment to support this work. This will be
accomplished by establishing governmental leading groups at national level and in the 6
provinces in the project (3.1). Staff involved with DOTS-plus activities will be trained
using national DOTS-plus guidelines and standardized training materials. Over the 5-
year period, 4,000 staff will be trained on how to carry out DOTS-plus project activities
(3.2). Using standard guidelines, at least 18,000 TB patients will be evaluated for MDR-
TB and at least 4,200 MDR-TB patients will be identified (3.3). These patients will be
treated for MDR-TB using standardized and individualized treatment regimens using
second-line TB drugs for 24 months (3.4). 100% of MDR-TB patients will be managed by
directly observed therapy (DOT) (3.5). Over the 5 year period, 24,000 pieces of BCC
materials will be given to patients and their family members or close contacts so as to
reduce stigma and improve treatment adherence (3.6). By implementing a drug
management system for first and second-line TB drugs, 100% of DOTS-plus sites will
have an uninterrupted supply of TB drugs will be available for treatment of MDR-TB
(3.7). Finally, 10 operational research projects in 40 sites will be carried out to improve
the approaches to implement DOTS-plus projects in China (3.8). One project will obtain
baseline information on MDR-TB patients and their treatment in project areas.
Objective 4: Monitor and evaluate the effectiveness of DOTS-plus projects in China
Service delivery area:
4.1 Monitoring and evaluation (M&E) of DOTS-plus projects in China
A M&E system for DOTS-plus project will be established and implemented in all DOTS-
plus sites, including a recording and reporting system, standardized indicators and
analysis approach. By year 5, 100% of DOTS-plus site will have regular and accurate
reporting. National and provincial CDC’s will carry out regular supervision of all DOTS-
plus sites. Baseline data on treatment success and level of drug resistance in the project
area will be collected at start of project and these data will be collected during year 5 of
project to determine impact of project on treatment outcome and level of drug resistance.
Under goal 2 (TB/HIV), there are 6 objectives and 16 service delivery areas.
To reduce the morbidity and mortality of TB in PLWHA, it is essential to build
collaboration between the TB and HIV/AIDS care and treatment programs. This proposal
aims to build this collaboration in the highest HIV prevalence counties in China. These
counties are currently implementing a comprehensive HIV/AIDS care and treatment
program (covered by China CARES and the GFATM round 3 and 4 HIV/AIDS proposals)
and a comprehensive DOTS program. However, there is insufficient collaboration
between the two disease programs to handle the serious problem of TB and HIV
together. The proposal aims to build a supportive environment for TB/HIV collaboration,
to monitor the prevalence of HIV in TB patients, to enhance case-finding of TB in
PLWHA and of HIV in TB patients, to prevent TB in PLWHA, to implement HIV
prevention and treatment for TB patients and to conduct monitoring and evaluation of
The Global Fund: Proposal Form Page 51 of 89
4 Components Section
TB/HIV collaborative activities. Taken together, these objectives and their associated
service delivery areas form a comprehensive approach to TB/HIV collaboration—one
that is based on the WHO/UNAIDS framework for TB/HIV collaboration. This proposal
will reduce TB morbidity and mortality of TB in PLWHA in the 134 project counties, and
will help refine the national policies and implementation guidelines for TB/HIV
collaboration nationwide.
Objective 5: Build a supportive environment for TB/HIV collaboration
Service delivery area:
5.1 Coordination and partnership development for TB/HIV collaboration
5.2 Advocacy initiative to increase awareness of decision-makers about TB/HIV
5.3 Behavioral change communication through mass media to increase community
awareness of TB/HIV
5.4 Behavioral change communication through community outreach to increase
awareness of TB/HIV
5.5 Strengthening of civil society to participate in TB/HIV collaborative activities
5.6 Human resource development for TB/HIV collaboration
5.7 Operational research to improve TB/HIV collaboration
Objective 5 will build a supportive environment for TB/HIV collaboration beginning with
the building of coordination and partnership in all 14 provinces, 66 cities and 134
counties in this project (5.1). An advocacy initiative will increase the awareness of
governmental leaders to TB/HIV by distributing 33,400 pieces of advocacy materials to
them (5.2). 3880 radio and TV programs on TB/HIV will be broadcasted over the 5-year
period (5.3). All project areas will use NGO/CBO/peer support group to distribute BCC
materials on TB/HIV to high-risk groups (5.4). The project will support at least one
NGO/CBO/peer support group in each project county to be involved with TB/HIV
activities (5.5). The human resource capacity to tackle TB/HIV will be strengthened by
training 266,000 health care workers in TB/HIV collaborative activities (5.6). Finally, 10
targeted operational research projects, carried out in 40 sites, will determine how to
improve the implementation of TB/HIV collaborative activities collect and collect baseline
information on TB/HIV.
Objective 6: Conduct surveillance of HIV prevalence in TB patients
Service delivery area:
6.1 Monitoring of HIV prevalence in TB patient
Objective 6 will build a national system for HIV surveillance among TB patients, including
surveillance in the project counties (i.e. high HIV prevalence settings) where TB patients
will be routinely tested and surveillance in medium/low HIV prevalence settings using
provincial cross-sectional/sentinel surveys that will be performed every year on a limited
sample of TB patients. Information from this surveillance system will help China monitor
the TB/HIV co-epidemic and determine areas where intensive TB/HIV collaborative
activities should be implemented.
Objective 7: Improve case-finding of HIV in TB patients and of TB in PLWHA
Service delivery areas:
7.1 Prevention of HIV in TB patients by increasing HIV counseling and testing in TB
patients
7.2 Intensified TB case-finding in PLWHA
Objective 7 will increase case-finding of HIV in TB patients by offering counseling and
testing to all TB patients in project counties. At least 90% of TB patients, or
approximately 200000 patients, will be offered testing over the 5-year period. The
objective will also increase case-finding of TB in PLWHA. At least 90%, or approximately
100000 PLWHA, will be evaluated for TB over the 5-year period. This objective will build
a strong patient referral system between the TB and HIV/AIDS programs to facilitate the
TB/HIV collaboration.
The Global Fund: Proposal Form Page 52 of 89
4 Components Section
Objective 8: Improve prevention, treatment and care of TB among PLWHA
Service delivery area:
8.1 Prevention of TB infection in PLWHA
In objective 8, the provincial CDC will work with all 134 project county CDC’s to
implement TB infection control policies in high HIV prevalence settings (e.g. HIV care
clinic, drug rehabilitation center). This will reduce the transmission of TB thus prevent TB
infection in PLWHA.
Objective 9: Improve prevention, treatment and care of HIV/AIDS among TB
patients
Service delivery areas:
9.1 Prevention of HIV in TB patients
9.2 Prevention of opportunistic infection in PLWHA with TB
9.3 Provision of antiretroviral therapy (ART) during TB treatment
9.4 Support patients through direct observation of TB and HIV treatment
For TB patients who are identified to be a PLWHA, they can enter the continuum of care
for HIV/AIDS. By year 5, the local CDC’s will work to ensure that at least 90% of TB
patients who are PLWHA (or approximately 200,000 over 5 years) will be referred to the
HIV/AIDS program for HIV prevention services (9.1). By year 5, the local CDC’s will
ensure that 90% of TB patients who are eligible for co-trimoxazole preventive treatment
(CPT) will be offered CPT and 90% of eligible patients will be offered antiretroviral
therapy based on national eligibility criteria (9.2 & 9.3). By year 5, the local CDC’s will
provide support to 90% of patients so that there is direct observation of TB and HIV
treatment (9.4).
Objective 10: Establish the monitoring and evaluation system for TB/HIV
collaborative activities
Service delivery area:
10.1 Monitoring and evaluation (M&E) of TB/HIV collaborative activities
The provincial CDC’s will establish and implement a M&E system for DOTS-plus project
in all DOTS-plus sites, including a recording and reporting system, standardized
indicators and analysis approach. By year 5, 100% of project counties will have regular
and accurate reporting.
Under goal 3 (TB in the migrant population), there are 3 objectives and 9 service
delivery areas.
To reduce morbidity and mortality of TB in the migrant population, it is important to
increase TB case-detection among the migrant population. But even more important is
increasing the treatment success rate in this highly mobile and difficult-to-reach
population. Innovative approaches will be used to enhance adherence to treatment and
reduce treatment default. The proposal will build a supportive environment, which will
include increased governmental commitment and multisectoral involvement. Finally,
monitoring and evaluation will be established to track progress in reducing morbidity and
mortality of TB in this population.
Objective 11: Build a supportive environment for implementing a TB control
program among the migrant population
Service delivery areas:
11.1 Coordination and partnership development for TB control among the migrant
population
11.2 Human resource development to implement TB control activities for the migrant
population
11.3 Behavioral change communication through mass media to increase awareness
of and reduce stigma toward TB
The Global Fund: Proposal Form Page 53 of 89
4 Components Section
11.4 Behavioral change communication through community outreach to increase
awareness of and reduce stigma toward TB
11.5 Strengthening of civil society to participate in TB control activities for the migrant
population
11.6 Operation research to improve the TB control program among the migrant
population
A supportive environment is needed to ensure the success of a TB control program
among the migrant population. The national policy and plan for control of TB in the
migrant population will be established and various stakeholders will review and
contribute to this plan; the plan will then be disseminated to all project areas (11.1). To
build the human resource capacity to implement this program, 4,280 staffs will be trained
over the 5-year period (11.2). 140 radio and TV programs will be broadcasted over the 5-
year period to increase community awareness of and reduce stigma of migrant
population toward TB (11.3). By year 3, all 120 project counties will involve
NGO/CBO/peer support group in performing community outreach to the migrant
population and their employers using BCC materials (11.4). At least one NGO/CBO/peer
support group will be involved per county/district in the project (11.5). As many of the
activities in this proposal are new and innovative, 5 operational research projects will be
implemented in 20 sites to determine the best approach to project implementation. One
project will collect baseline information on case-detection and treatment success rate in
the migrant population (11.6).
Objective 12: Increase TB case-detection and treatment success among the
migrant population
Service delivery areas:
12.1 Timely detection and quality treatment of TB cases in the migrant population
12.2 Supporting patients through direct observation to enhance treatment adherence
12.3 Control of TB drug resistance in the migrant population by performing defaulter
tracing
Over the 5-year period, 51,000 new smear-positive TB patients among the migrant
population will be diagnosed and treated (12.1). Various approaches, including
involvement of NGO/CBO/peer support group, will be used to enhance treatment
adherence and to provide DOT to at least 80% of TB patients by year 5 (12.2). Outreach
workers will perform defaulter tracing on 100% of patients who default for treatment and
reduce treatment default to 15% or less by year 5 (12.3).
Objective 13: Establish the monitoring and evaluation system for TB control in the
migrant population
Service delivery area:
13.1 Monitoring and evaluation of TB control in the migrant population
A M&E system for TB control in the migrant population will be established and
implemented in all project areas, including a recording and reporting system that will
track the referral of patients who move between districts, standardized indicators and
analysis approach. By year 5, 100% of project counties will have regular and accurate
reporting.
4.4.1.2 Describe how these goals and objectives are linked to the key problems and
gaps arising from the description of the national context. Demonstrate clearly
how the proposed goals fit within the overall (national) strategy and how the
proposed objectives and service delivery areas relate to the goals and to each
other.
a) Goal 1: Reduce the morbidity and mortality of multidrug-resistant TB (MDR-TB) in
China
China has the world’s largest MDR-TB epidemic. The existing NTP and its various
The Global Fund: Proposal Form Page 54 of 89
4 Components Section
projects are working to reduce the development of MDR-TB by expanding the coverage
of DOTS to all parts of China, by improving the quality of the DOTS program, and by
bringing more and more TB suspects and cases under the care of DOTS program
through a public-public mix-DOTS (PPM-DOTS) project. These efforts are being
supported by existing TB projects including the GFATM round 1 and 4 TB projects. To
build on these efforts, objective 1 will implement additional activities including the
development of a nationwide standard for diagnosis and treatment of TB for all health
care providers and a plan to expand the use of fixed-dose combination TB drugs.
Aside from prevention of MDR-TB, it is important to understand the extent and trend of
the MDR-TB epidemic. There is substantial variation in the magnitude of MDR-TB
between provinces. Information about MDR-TB in every province will help target efforts
to control MDR-TB to those areas with the highest rate of MDR-TB. Objective 2 will
contribute to existing efforts to implement drug resistance surveillance surveys in all 31
Chinese provinces.
There is growing evidence that implementation of the basic DOTS program may not be
sufficient to reduce the level of MDR-TB in areas where high MDR-TB rates already
exists. In these areas, the recommendation is to implement treatment for MDR-TB.
Objective 3 aims to implement the DOTS-plus strategy in selected sites in China where
high MDR-TB rates already exist. Through this objective, China will gain the experience
to implement key elements of the global DOTS-plus strategy and its NTP will be able to
diagnose and treat MDR-TB. It is very important to monitor and evaluate this DOTS-plus
project. Only then can we properly assess the effectiveness of these projects and use
the lessons learned for future expansion of DOTS-plus in China. Objective 4 will
establish the monitoring and evaluation system for DOTS-plus projects.
b) Goal 2: Reduce the morbidity and mortality of TB in PLWHA persons in China
As China scales up its HIV/AIDS care and treatment program, the program is
encountering many patients with TB, especially in areas with high HIV prevalence. But
due to limited collaboration between the HIV and TB prevention and care programs,
morbidity and mortality of TB in PLWHA is likely high at this time even though little
information has been collected within China on this problem. Only by building
collaboration between the two programs can the morbidity and mortality of TB in PLWHA
be reduced. The objectives under this goal follow closely those in the WHO/UNAIDS
TB/HIV collaborative framework.
There are several aspects of TB/HIV collaboration. First, it is important to build a
supportive environment for TB/HIV collaboration (objective 5). This includes
strengthening the coordination and partnership between the two disease control
programs, building political support for TB/HIV collaboration, increasing community
awareness of TB/HIV, building the human resource capacity to implement TB/HIV
collaborative activities, and carrying out operational research studies to identify the best
approaches to implement TB/HIV collaborative activities in China.
Second, it is important to improve the diagnosis of HIV infection in TB patients and
improve the diagnosis of TB in PLWHA (objective 7). Third, it is important to prevent TB
in PLWHA. Objective 8 will implement TB infection control policies in high HIV
prevalence setting. The use of isoniazid preventive therapy will be implemented as part
of the operational research agenda to determine its operational feasibility in China.
Fourth, it is important to improve prevention, treatment and care of HIV/AIDS in TB
patients. Objective 9 seeks to achieve this by helping TB patients access HIV prevention
information, promoting condom usage in TB patients, refer patients to harm reduction
programs, facilitating the use of CPT and ART, and enhancing their treatment
adherence. Fifth, monitoring and evaluation provides the means to assess quality,
effectiveness, coverage and delivery of collaborative TB/HIV activities (objective 10).
Finally, as China scales up TB/HIV collaborative activities, a national system for HIV
surveillance among TB patients is needed. Surveillance is essential to inform national
The Global Fund: Proposal Form Page 55 of 89
4 Components Section
program planning and implementation, provide the information necessary to assess the
need for collaboration, advocate for collaboration, allocate resources to appropriate
areas, and measure the impact of HIV on TB patients (objective 6).
c) Goal 3: Reduce the morbidity and mortality of TB in the migrant population in China
To reduce the morbidity and mortality of TB in the migrant population, objective 11 aims
to build a supportive environment for implementing a TB control program in this
population. First, new areas of coordination and partnership must be developed. This
includes multisectoral involvement and collaborations between TB control programs in
different counties, cities and provinces are needed to ensure completion of diagnosis and
treatment. Second, human resource capacity to implement such a control program must
be developed. Third, a behavioral change communication program tailored to the needs
of the migrant population and their employers is needed to reduce stigma, discrimination,
and to improve adherence to treatment. Fourth, operational research will be essential to
develop and pilot many of the approaches before they are implemented more broadly.
Ultimately, TB case-detection and treatment success among the migrant population must
increase in order to reduce TB morbidity and mortality. Objective 12 aims to accomplish
this by several means. First, free diagnosis and treatment must be available to all TB
patients in the migrant population. In addition, there must be special efforts to increase
the identification of infectious TB cases in the migrant population. Second, failure to
complete treatment is the most serious threat to successful control of TB in the migrant
population. Therefore innovative approaches are needed to provide directly observed
therapy, to make TB services more convenient to this population, and to provide
incentives and enablers to patients. Third, the risk of developing drug-resistant TB is high
in this highly mobile and difficult-to-reach population. To minimize drug-resistance,
outreach workers will conduct defaulter tracing among the migrant population.
Because there is so little information about TB in the migrant population, it is essential to
establish a monitoring and evaluation system specifically to track TB among the migrant
population. Objective 13 will develop and implement such a system, which will include a
TB recording and reporting system designed to capture information about TB in the
migrant population and can be used to track and report on cases that move between
different parts of the country.
[For health systems strengthening components only:]
4.4.1.3 Describe in detail how the proposed objectives and service delivery areas are
linked to the fight against the three diseases. In order to demonstrate this link,
applicants should relate proposed health systems interventions to disease
specific goals and their impact indicators. To demonstrate the contribution of
the proposed health systems strengthening intervention(s) in fighting the
disease(s) include at least three disease relevant indicators with a baseline
and annual targets over the life of the program. [This may be done in form of an
annex based on the format of table 4.4.b.]
Clearly explain why the proposed health systems strengthening activities are
necessary to improve coverage in the fight against the three diseases. [When
completing this section, applicants should refer to the Guidelines for Proposals, section
III.B.&F.]
4.4.1.4 Provide a description of the target groups, and their inclusion during planning,
implementation and evaluation of the proposal. Describe the impact that the
project will have on these group(s).
The target groups in this proposal have been selected on the basis of where the greatest
need is located and where the maximum impact can be expected if the project is
The Global Fund: Proposal Form Page 56 of 89
4 Components Section
successfully implemented. The target groups include patients who will directly benefit
from TB (and HIV) services and the health care providers/community-based workers who
will be trained and provided with resources to implement interventions that will benefit
these patients. Because of the size of the country, it is not possible to immediately
implement the proposed interventions throughout the country. The proposed target
groups have been carefully selected so that, by implementing interventions in these
groups, it will build the capacity and experience to scale-up these interventions to the
rest of the country.
For the implementation of the DOTS-plus strategy, the project will initially be
implemented in 2 cities in Heilongjiang and Zhejiang province. These provinces were
selected because they have high rates of MDR-TB and have achieved global TB control
targets—70% case-detection and 85% treatment success for smear-positive cases. After
the first 2 years, DOTS-plus will expand to 4 other provinces with high rates of MDR-TB.
Selection of these provinces will be partly based on the drug-resistance surveillance
studies to be performed. However, there are already several candidate provinces with
high rates of MDR-TB such as Henan, Liaoning and Inner Mongolia.
For the implementation of TB-HIV collaborative activities, the project will focus on HIV
prevalence counties that is implementing comprehensive HIV care and treatment. In the
first 2 years, the project will be implemented in the 134 counties (in 14 provinces) that
are included in the GFATM round 3 and round 4 HIV/AIDS projects for China. The 14
provinces are Anhui, Hebei, Henan, Hubei, Shanxi, Shaanxi, Shandong, Yunnan,
Xinjiang, Guangxi, Sichuan, Hunan, Jiangxi, and Guizhou. Not only will the project focus
on areas with the greatest need, it will also complement HIV care and treatment efforts in
the existing GFATM projects.
For the implementation of a TB control program for the migrant population, the project
will focus on 6 provinces where 70% of the migrants relocate to when they moved
between provinces. The 6 provinces are Beijing, Shanghai, Guangdong, Zhejiang,
Jiangsu, and Fujian. Within these provinces, the project will focus on counties/districts
with at least 80,000 migrants. Overall, the project will serve a population of approximately
45 million migrants.
The impact of the project will be to substantially reduce the TB morbidity and mortality in
those with MDR-TB, HIV-associated TB, and TB in migrants. Many more patients will
access to high-quality diagnosis and treatment and the treatment success rate for these
patients will substantially increase. The diagnosis and treatment for these patients will be
provided free of charge. For these patients, the stigma and discrimination associated
with TB, including MDR-TB or HIV-associated TB, will be reduced. The health care
providers in this project will be trained and provided with policies and resources to
implement a high-quality care and treatment program for these patients.
During the planning phase of the project, health care providers who will implement the
project will be involved in preparing the implementation plans and approaches. Most of
the interventions will first be piloted in the populations that will benefit from the
interventions. During these pilot projects, quantitative and qualitative research methods
will be used to assess applicability of the designed interventions. Patient surveys will be
used to collect relevant information to inform the design of interventions. As part of the
evaluation, patient and provider surveys (quantitative and qualitative) will be used. Thus
the target groups of this project will be involved in all phases of the project, from project
design to evaluation.
The Global Fund: Proposal Form Page 57 of 89
4 Components Section
4.4.1.5 Provide estimates of how many of those reached are women, how many are
youth, how many are living in rural areas. The estimates must be based on a
serious assessment of each objective.
Table 4.4.1.5 Objectives
Estimated percentage of people reached who are:
women Youth Living in rural areas
Objective 1 NA NA NA
Objective 2 NA NA NA
Objective 3 35% 10% 70%
Objective 4 NA NA NA
Objective 5 50% 30% 80%
Objective 6 35% 10% 80%
Objective 7 35% 10% 80%
Objective 8 NA NA NA
Objective 9 35% 10% 80%
Objective 10 NA NA NA
Objective 11 40% 10% 80%
Objective 12 40% 10% 80%
Objective 13 NA NA NA
Several objectives were not appropriate for estimating the number of women, youth and rural
inhabitants that would be reached. They include the following: policy development on
prevention of MDR-TB (objective 1), drug-resistance surveillance survey (objective 2),
development of monitoring and evaluation system (objectives 4, 10, 13), and implementation
of infection control policies in health facilities (objective 8).
For objectives 3, 6, 7, 9, 11, and 12, the percentage of women among those reached is 35-
40% of the total. This is because these objectives seek to reach TB patients (including
PLWHA who have TB). In China, the rate of TB is much higher in men than women.
Therefore only one-third of all TB patients are women. Likewise, the percentage of youth
among those reached is only 10% of the total because only 10% of TB patients are youths.
The only exception to the above is objective 5 where the percentage of women and youth
among those reached are 50% and 30% of the total, respectively. This is because the
objective seeks to provide behavioral change communication and we expect the general
population to be reached by this objective.
The Global Fund: Proposal Form Page 58 of 89
4 Components Section
4.4.1.6 Provide a clear and detailed description of the activities that will be implemented
within each service delivery area for each objective. This should provide
reviewers with a clear understanding of what activities are proposed, how these
will be implemented, and by whom.
Goal 1: Reduce the morbidity and mortality of multidrug-resistant TB (MDR-TB) in
China
Objective 1: Prevent the development of MDR-TB in China
Service delivery area 1.1: Prevention of MDR-TB
Activity 1.1.1 Develop a nationwide standard for diagnosis and treatment of TB in all
health facilities, including use of first and second-line TB drugs.
Activity 1.1.2 Dissemination of guidelines for use by all health providers and facilities in
the country.
Activity 1.1.3 Develop a monitoring system to ensure that all health facilities are using
first and second-line TB drugs in accordance with the national standard.
Activity 1.1.4 Implement the monitoring system throughout the country.
Activity 1.1.5 Develop an implementation plan to expand the use of fixed-dose
combination (FDC) TB drugs in China.
The MOH (including both the Department of Disease Control and Dept of Medical
Administration) will organize a group of national and international experts to develop a
nationwide standard for diagnosis and treatment of TB. This standard will be adapted from
the international standard of TB diagnosis and treatment being developed by the
international community. The MOH will issue these guidelines to each provincial health
bureau. In turn, the provincial health bureau will issue the guidelines to the city and county
health bureaus. The MOH will organize national experts to develop a monitoring system for
use of TB drugs in health facilities. The CDC’s at all levels will train health providers to use
these guidelines and to monitor their implementation. The training and monitoring are
being funded by the GFATM round 4 TB grant on public-public mix DOTS (PPM-DOTS).
The MOH will organize experts to develop a plan to expand the use of FDC TB drugs in the
country; this work will involve the State Food and Drug Administration (SFDA). The MOH
will use this plan to guide future TB drug procurement.
Objective 2: Assessment of MDR-TB epidemic in China
Service delivery area 2.1: Assessment of the MDR-TB epidemic in China
Activity 2.1.1 Assess the level of MDR-TB in all provinces by organizing a drug-
resistance surveillance (DRS) program that is based on the WHO/IUATLD guidelines for
drug resistance surveillance.
Activity 2.1.2 Implement DRS surveys according to national plan.
Under the guidance of the MOH, the China CDC and its National TB Reference Laboratory
(NRL) will organize and manage the nationwide DRS program. The provincial CDC’s will
implement the DRS surveys with support from NRL and WHO’s supranational reference
laboratory network. Implementation activities include the training of provincial and county
level staffs to recruit patients, collect sputum specimens, perform culture and drug-
susceptibility testing, analyze data, monitor study progress, and perform quality assurance
of laboratory testing. This funds requested for this service delivery area will supplement the
funds provided for these activities in the World Bank/DFID TB project and by WHO.
Objective 3: Implement the DOTS-Plus strategy in selected sites of China
Service delivery area 3.1: Coordination and partnership development to implement
the DOTS-plus strategy
Activity 3.1.1 Establish leading group for DOTS-plus project in the Ministry of Health to
The Global Fund: Proposal Form Page 59 of 89
4 Components Section
oversee DOTS-plus projects in China
Activity 3.1.2 Establish leading group for DOTS-plus project in the provincial health
bureau of each province implementing DOTS-plus projects
The MOH and the provincial health bureaus in each of the provinces implementing DOTS-
plus will establish a governmental leading group for DOTS-plus projects. This will ensure
coordination and governmental support at all levels. These groups will meet every 6
months.
Service delivery area 3.2: Human resource development to implement the DOTS-plus
strategy
Activity 3.2.1 Establish DOTS-plus technical expert group at central level and in each
province implementing DOTS-plus project.
Activity 3.2.2 Develop and publish DOTS-plus project implementation guidelines/manual
including diagnostic criteria treatment algorithm, treatment regimens, and management of
adverse drug reactions, criteria for hospitalization, recording and reporting system,
Activity 3.2.3 Develop a training curriculum and the training materials appropriate for
different cadres of staff involved in DOTS-plus project activities.
Activity 3.2.4 Based on the training curriculum (under 3.2.3), provide in-service training
for different cadres of staffs involved with DOTS-plus project activities.
Activity 3.2.5 Set up an expert group (i.e. concilium) to oversee diagnosis and treatment
of MDR-TB patients at each DOTS-plus site.
The MOH will establish a DOTS-plus expert group at central level; the provincial health
bureau in each province implementing the project will establish a provincial DOTS-plus
expert group. The national DOTS-plus expert group will write the DOTS-plus project
implementation guidelines/manual with support from international experts. The national
CDC will publish these guidelines. Based on these guidelines, the national CDC will
develop the national DOTS-plus training curriculum and materials (including training of
trainers materials) with the assistance of international experts in DOTS-plus strategy.
Using the curriculum, the national and provincial CDC’s will train different cadres of staffs
involved with DOTS-plus activities. At each DOTS-plus diagnosis and treatment site, an
expert group (or a concilium) will be established by the local CDC under the guidance of
the provincial expert group.
Service delivery area 3.3: Timely detection of MDR-TB in DOTS-plus project areas
Activity 3.3.1 Identify MDR-TB cases by performing DST on the following patients: (1)
patients at start of category II treatment; (2) patients who fail category I or II treatment; and
(3) patients on category I or II that have smear-positive sputa at end of month 3 of
treatment.
Activity 3.3.2 Provide essential laboratory equipments for culture at each DOTS-plus
site.
Activity 3.3.3 Implement a quality assurance program (including proficiency testing) for
laboratory testing at different levels
Each DOTS-plus site will identify MDR-TB cases according to project guidelines by
collecting sputum specimens and sending it to the designated laboratory for culture. Each
DOTS-plus site laboratory will send positive culture to the provincial TB reference
laboratory for DST. The project will provide essential laboratory equipment (culture
equipment and biosafety cabinet) to each DOTS-plus site. The National TB Reference
Laboratory will implement a quality assurance system for laboratory testing at DOTS-plus
sites in collaboration with the provincial TB reference laboratories.
Service delivery area 3.4: Treatment of MDR-TB in DOTS-plus project areas
Activity 3.4.1 Provide standardized treatment regimen for MDR-TB patients, including
use of second-line TB drug.
Activity 3.4.2 Provide individualized treatment regimen for MDR-TB patients with drug-
resistance to second-line drugs or when drug toxicity require drug substitution.
Activity 3.4.3 Provide ancillary drugs for treatment of side-effect to MDR-TB treatment
Activity 3.4.4 Provide regular monitoring of patients during treatment for MDR-TB.
Activity 3.4.5 Provide travel and meal cost for patients when they return for follow-up at
DOTS-plus treatment center.
Activity 3.4.6 Hospitalize seriously ill DOTS-plus patients during initial phase of
The Global Fund: Proposal Form Page 60 of 89
4 Components Section
treatment and when complications arise.
Each DOTS-plus site will provide treatment to MDR-TB patients, including second-line TB
drugs and ancillary drugs to treat side-effects, and provide regular follow-up during
treatment. To reduce lost-to-follow-up, each DOTS-plus site will provide travel and meal
cost to patients during their monthly visit. Patients requiring hospitalization will be arranged
by the DOTS-plus site. Hospitalization will be funded by the multiple sources including
government, medical insurance, and the patient. The expert group (or concilium) at each
DOTS-plus site will be responsible for managing each MDR-TB patients, including
treatment regimen, complications, and decision to hospitalize.
Service delivery area 3.5: Supporting patients through direct observation to enhance
adherence to treatment of MDR-TB
Activity 3.5.1 Provide DOT throughout the course of MDR-TB treatment using peripheral
health workers and provide financial incentive for providing DOT.
Activity 3.5.2 Provide transportation subsidy to very poor MDR-TB patients so they can
travel to medical clinic for DOT.
Each DOTS-plus site will arrange for DOT for each MDR-TB patient and provide a case-
management fee to DOT worker. The site will also provide transportation fee to
approximately 20% of MDR-TB patients who are very poor so they can travel to the
medical clinic for DOT.
Service delivery area 3.6: Behavioral change communication through community
outreach to increase awareness and understanding of MDR-TB and its treatment
Activity 3.6.1 Develop and produce IEC and BCC materials about MDR-TB for patients
at-risk for or already diagnosed with MDR-TB to increase their understanding of the
disease, its treatment and importance of treatment adherence.
Activity 3.6.2 Develop IEC and BCC materials for family members and close contacts of
MDR-TB patients to reduce stigma to this disease and to elicit their support for patients
during the long treatment phase.
Activity 3.6.3 County, township and village health workers to deliver BCC materials to
TB patients and their family members and close contacts.
The national CDC will contract with health promotion institutions to develop IEC and BCC
materials for patients and their family members and close contacts. The provincial CDC’s
will train the local CDC’s in each DOTS-plus site on use of the IEC/BCC materials (as part
of 3.2.4). At each DOTS-plus site, the county CDC’s will train township and village health
workers to deliver the BCC materials (part of activity 3.2.4).
Service delivery area 3.7: Procurement and supply management system to provide
an uninterrupted supply of TB drugs for MDR-TB treatment
Activity 3.7.1 Develop a drug management system for DOTS-plus project areas.
Activity 3.7.2 DOTS-plus project staffs implement the drug management system.
The national DOTS-plus expert group will develop a drug management system and its
associated drug recording and reporting forms (part of 3.2.2). The national and provincial
CDC’s will provide training on drug management to DOTS-plus sites (as part of activity
3.2.4) and the national CDC, each provincial CDC and each DOTS-plus site will implement
the drug management system.
Service delivery area 3.8: Operational research to improve DOTS-plus projects in
China
Activity 3.8.1 Determine the operational research priorities for implementation of DOTS-
plus strategy in China.
Activity 3.8.2 Implement operational research projects based on defined priorities.
Activity 3.8.3 Apply useful results from operational research projects to further
development of national policies
The national DOTS-plus expert group will establish a research management sub-group to
oversee the operational research in DOTS-plus projects. This group, which will include
national and international experts in DOTS-plus, will develop the operational research
priorities for DOTS-plus activities for China. The group will contract with research centers
in academic institutions, local CDC’s, and other research centers to carry out the
operational research. The operational research management group will meet quarterly to
The Global Fund: Proposal Form Page 61 of 89
4 Components Section
monitor research projects. Once a year, the national DOTS-plus expert group will hold a
research dissemination meeting to present research results and discuss their application to
national DOTS-plus policies.
Objective 4: Monitor and evaluate the effectiveness of DOTS-plus projects in China
Service delivery area 4.1: Monitoring and evaluation of DOTS-plus projects in China
Activity 4.1.1 Develop and implement a recording and reporting system for DOTS-plus
projects in China.
Activity 4.1.2 Develop indicators, method for data collection and analysis, and report
summary so as to enable the evaluation of key activities in the DOTS-plus projects.
Activity 4.1.3 Conduct regular supervision of the DOTS-plus projects
Activity 4.1.4 Evaluate the effectiveness and impact of project by collecting baseline and
follow-up information on treatment of MDR-TB as well as the level of TB drug resistance in
DOTS-plus project areas.
The national DOTS-plus expert group will develop the DOTS-plus recording and reporting
system and develop the indicators and data analysis to evaluate DOTS-plus activity (part
of activity 3.2.2). The CDC’s and the DOTS-plus expert group at national and provincial
level will organize regular supervision of TB control activities in the DOTS-plus project
sites. International experts in the Green Light Committee will also participate in the
supervision visits twice a year. The national DOTS-plus expert group will work with the
provincial DOTS-plus expert group to collect information on treatment outcome and on the
level of TB drug resistance in the project areas.
Goal 2: Reduce the morbidity and mortality of TB in HIV-infected persons in China
Objective 5: Build a supportive environment for TB/HIV collaboration
Service delivery area 5.1: Coordination and partnership development for TB/HIV
collaboration
Activity 5.1.1 Establish and maintain the national TB/HIV leading group. This group,
composed of representatives from MOH, China CDC and other national partners will meet
regularly and provide overall coordination of TB/HIV collaboration nationwide.
Activity 5.1.2 Establish and maintain the national TB/HIV working group. This group,
composed of TB and HIV/AIDS experts from China CDC, other national and international
partners, and representatives from patient groups, will develop and oversee the national
implementation plan for TB/HIV collaboration.
Activity 5.1.3 Establish and maintain TB/HIV coordinating groups at provincial,
city/prefecture and county levels. Sub-national TB/HIV coordinating groups will meet
regularly to monitor and evaluate the implementation of collaborative TB/HIV activities
locally.
Activity 5.1.4 The TB/HIV working or coordinating group at each level will develop the
local implementation plan for TB/HIV collaboration.
The MOH will establish the national TB/HIV leading group as well as the national TB/HIV
working group. The MOH will organize quarterly meetings of the national TB/HIV leading
group during the first 2 years and then semi-annually thereafter. The MOH will also
organize quarterly meetings of the national TB/HIV working group. The health bureau at
each governmental level from provincial level down to county level will establish TB/HIV
coordinating groups and will organize their meetings. The national TB/HIV working group
and the sub-national TB/HIV coordinating groups will develop the implementation plans for
TB/HIV collaboration during year 1 and 3 of project.
Service delivery area 5.2: Advocacy initiative to increase awareness of decision-
makers about TB/HIV
Activity 5.2.1 Develop advocacy materials (brochures and videos) to raise awareness
The Global Fund: Proposal Form Page 62 of 89
4 Components Section
among policy makers and partners at all levels of the important link between TB and HIV
and what they can do to reduce the burden of TB and HIV.
Activity 5.2.2 Disseminate advocacy materials at HIV/AIDS meeting attended by
governmental leaders and other partners.
The national CDC will contract with a media company to develop the brochures and videos
on TB/HIV. These will be disseminated to the provincial health bureau and they will
disseminate it to lower level health bureau. The health bureau and CDC’s will use the
brochures and videos to inform key decision makers and stakeholders (including
community leaders) at each governmental level. Materials will be provided during meetings
for HIV/AIDS attended by governmental leaders. Materials will be developed during year 1
of the project and repeated at year 3; materials will be disseminated every year.
Service delivery area 5.3: Behavioral change communication through mass media to
increase community awareness of TB/HIV
Activity 5.3.1 Develop BCC materials on TB/HIV for the general population (radio and
TV programs) to be distributed through the mass media.
Activity 5.3.2 Broadcast and disseminate BCC materials (radio and TV programs,
newspapers and magazine articles) through the mass media.
The national CDC will invite a media company to produce radio and TV programs in year 1
and 3. The programs will be developed from an understanding of local beliefs about the
diseases and services and aim to dispel myths and to reduce the stigma surrounding both
diseases and to increase usage of prevention, care and support services. Each year, the
CDC at each level will implement the BCC by contracting with local TV and radio stations;
the CDC’s will publish articles on TB/HIV. This BCC strategy will build on and supplement
the BCC strategies of the China CARES projects supported by Global Fund Round 3 and
Round 4 projects.
Service delivery area 5.4: Behavioral change communication through community
outreach to increase awareness of TB/HIV
Activity 5.4.1 Develop and produce TB/HIV IEC and BCC materials about TB and its
linkage with HIV for specific high-risk groups such as plasma donors, injecting drug users
and sex workers.
Activity 5.4.2 Develop TB/HIV materials for TB patients and PLWHA to enhance their
understanding of and adherence to TB treatment, co-trimoxazole and/or ART.
Activity 5.4.3 Train community outreach workers to deliver BCC materials to specific
high-risk groups and to TB patients and PLWHA
The national CDC will contract with health promotion institutions to develop and produce
BCC materials for high-risk groups and for TB patients and PLWHA. The local CDC’s in the
project areas will train community workers (with NGO/CBO) or peer support group leaders
identified under activity 5.5.1 to deliver community outreach using BCC materials. BCC
materials will be developed during year 1 and revised in year 3. Training of community
workers or peer group leaders will take place twice a year. These activities will build on and
supplement the BCC activities of the China CARES projects supported by Global Fund
Round 3 and Round 4 projects.
Service delivery area 5.5: Strengthening of civil society to participate in TB/HIV
collaborative activities
Activity 5.5.1 Develop and publish guidelines for involvement of NGO/CBO/peer support
groups in TB/HIV collaborative activities.
Activity 5.5.2 Conduct workshops among representatives of NGO/CBO/peer support
groups to inform them of the linkage between TB and HIV and to encourage community
participation in collaborative TB/HIV activities.
Activity 5.5.3 Provide support to NGO/CBO/peer support groups in implementing
TB/HIV collaborative activities, including the delivery of BCC materials.
The national CDC, under the guidance of the MOH, will develop guidelines for involvement
of NGO/CBO/peer support groups in TB/HIV collaborative activities during year 1. Based
on the guidelines, the national and provincial CDC’s will conduct workshops for
representatives of NGO/CBO/peer support groups once a year. In addition to training, local
CDC’s will contract with NGO/CBO/peer support groups to carry out TB/HIV collaborative
activities, including the delivery of BCC materials (this is linked to activity 5.4.3). These
The Global Fund: Proposal Form Page 63 of 89
4 Components Section
activities will build on and supplement the activities to strengthen civil society in the China
CARES projects supported by Global Fund Round 3 and Round 4 projects.
Service delivery area 5.6: Human resource development for TB/HIV collaboration
Activity 5.6.1 Develop and publish guidelines and working manual for implementing
TB/HIV collaborative activities.
Activity 5.6.2 Develop national TB/HIV training curriculum and materials appropriate for
different cadres of staff involved in TB/HIV collaborative activities, including doctors,
nurses, laboratory staffs, HIV counselors, community/PHA support group staffs. Also
develop training materials for pre-service training of health staff.
Activity 5.6.3 Based on the training curriculum (under 5.6.2), provide in-service training
for different cadres of staff involved with TB/HIV collaborative activities.
Activity 5.6.4 Train the educators of health staff on TB/HIV so they can incorporate this
into their pre-service training of health staff.
Activity 5.6.5 Develop and maintain database on training history for staff working on
TB/HIV activities.
The national CDC, supported by the national TB/HIV working group, will develop and print
the guidelines and working manual for implementing TB/HIV collaborative activities. Based
on these guidelines, the national TB/HIV training curriculum and materials (including
training of trainers materials) will be developed by the national CDC with the assistance of
international experts in TB/HIV, national TB and HIV experts and human resource capacity
development experts. Using the curriculum, CDC’s at different levels will train different
cadres of staffs involved with TB/HIV collaborative activities. The national and provincial
CDC’s will collaborate with medical and public health schools to train educators on pre-
service training using TB/HIV training materials. The guidelines, working manual, training
curriculum will be developed in year 1 and revised in year 3; revisions will take into account
useful operational research results (see activity 5.7.3). Training of staffs will take place in
year 1 (except for new staffs who will be trained whenever they start); refresher training
takes place every 2 years. Pre-service training will take place every other year.
Service delivery area 5.7: Operational research to improve TB/HIV collaboration
Activity 5.7.1 Determine the operational research priorities for TB/HIV collaborative
activities for China.
Activity 5.7.2 Implement and oversee operational research projects based on defined
priorities, including conducting supervision visits to projects.
Activity 5.7.3 Apply useful results from operational research projects to further
development of national policies
The China CDC, with input from the national TB/HIV working group, will set up a TB/HIV
operational research management group. This group, which includes national and
international experts in TB and HIV, will develop the operational research priorities for
TB/HIV collaborative activities for China. The group will contract with research centers in
academic institutions, local CDC’s, and other research centers to carry out the operational
research. The TB/HIV operational research management group will meet quarterly to
monitor research projects. Once a year, the China CDC will hold a research dissemination
meeting to present research results and discuss their application to national TB/HIV
policies.
Objective 6: Conduct surveillance of HIV prevalence in TB patients
Service delivery area 6.1: Monitoring of HIV prevalence in TB patient
Activity 6.1.1 Develop a national plan and the guidelines for carrying out HIV
surveillance among TB patients.
Activity 6.1.2 Based on national plan and guidelines, conduct surveillance of HIV
prevalence in TB patients in project counties (high HIV prevalence areas) using data from
routine diagnostic HIV testing.
Activity 6.1.3 Based on national plan and guidelines, conduct surveillance of HIV
prevalence in TB patients in all provinces, including medium/low HIV prevalence settings,
using sentinel surveillance/cross-sectional surveys.
The China CDC will organize an expert group with national and international participation
to develop a national plan for carrying out HIV surveillance among TB patients. The group
The Global Fund: Proposal Form Page 64 of 89
4 Components Section
will discuss the appropriateness of existing methods for surveillance of HIV among TB
patients. In project counties where there is high HIV prevalence, local CDC’s will
implement surveillance using data from routine diagnostic HIV testing (see activity 7.1.2).
In all provinces, surveillance of HIV prevalence in general TB population will be carried out
by the provincial CDC using cross-sectional/sentinel surveys.
Objective 7: Improve case-finding of HIV in TB patients and of TB in PLWHA
Service delivery area 7.1: Prevention of HIV in TB patients by increasing HIV
counseling and testing in TB patients
Activity 7.1.1 Establish HIV counseling and testing service within TB services and/or
referral mechanism to HIV programme for such testing
Activity 7.1.2 Provide HIV counseling and testing to all TB patients.
Local CDC’s in project areas will establish HIV counseling and testing service for all TB
patients. Depending on local situation, this can be done by performing HIV counseling and
testing within TB services, performing HIV counseling and then send the patient’s serum to
HIV testing center, or referring the patient to HIV counseling and testing center. If the
patient is referred, proper referral mechanism will be established between the TB and
HIV/AIDS service to reduce lost-to-follow-up (see activity 7.2.2). Training of staff to carry
out the HIV counseling and testing in TB services will be carried out as part of activity
5.6.3. The CDC will provide the HIV counseling and testing free-of-charge. This is linked to
HIV counseling and testing in the GFATM round 3 and 4 HIV/AIDS projects.
Service delivery area 7.2: Intensified TB case-finding in PLWHA
Activity 7.2.1 TB screening among PLWHA at diagnosis and at every contact with the
health service at all levels.
Activity 7.2.2 Establish a referral system for patients from TB to HIV/AIDS service
providers and vice-versa. This includes developing the protocols, referral forms and
tracking systems to facilitate and follow-up on referrals between TB and HIV service
providers.
Activity 7.2.3 Use of travel supplements to facilitate referral of patients between TB and
HIV service providers.
The local CDC’s in the project areas will work with HIV care providers to increase TB
screening among PLWHA. Training to improve the clinical diagnosis of smear-negative TB
and the training of HIV care providers will be carried out as part of activity 5.6.3. The
national CDC will develop the protocols, referral forms and tracking system for referral of
patients between the TB and HIV service providers. Training on this referral system will be
performed as part of activity 5.6.3 in all project counties. To increase successful referral,
the county CDC’s will provide travel supplements to those who need to travel longer
distances (about 25% of the patients). The use of travel supplements in activity 7.2.4 also
includes usage under activity 9.2.1 and 9.3.1.
Objective 8: Improve prevention, treatment and care of TB among PLWHA
Service delivery area 8.1: Prevention of TB infection in PLWHA
Activity 8.1.1 Develop national TB infection control policies and guidelines for high HIV
prevalence settings, e.g. HIV care clinics, drug rehabilitation centers.
Activity 8.1.2 Conduct workshops and trainings to directors of health facilities on the
national TB infection control policies and on how to implement these guidelines.
Activity 8.1.3 Selective administrative and environmental control approaches to reduce
risk of TB transmission will be implemented in settings where HIV/AIDS patients
congregate.
The national CDC will establish an expert group (including national and international
experts) to develop the TB infection control policies and guidelines, including a risk
assessment tool. The local CDC’s in the project areas will conduct workshops and trainings
to director of health facilities or other institutions where HIV/AIDS patients congregate.
Based on national guidelines and risk assessment, local facilities with high number of
HIV/AIDS patients will implement selective administrative and environmental control
approaches to reduce risk of TB transmission.
The Global Fund: Proposal Form Page 65 of 89
4 Components Section
Objective 9: Improve prevention, treatment and care of HIV/AIDS among TB patients
Service delivery area 9.1: Prevention of HIV in TB patients
Activity 9.1.1 Promote HIV prevention to all TB patients through use of local HIV
prevention BCC materials.
Activity 9.1.2 Distribute condoms at all TB facilities.
Activity 9.1.3 Facilitate access to harm reduction strategies for injecting drug users with
TB.
The HIV/AIDS program funded partly by the GFATM round 3 and 4 HIV/AIDS projects will
provide information about HIV prevention and how to access appropriate HIV prevention
methods (condoms, harm reduction for IDU). The local CDC’s will purchased and make
available condoms at all TB facilities free-of-charge. The TB program in the local CDC’s
will refer patients to the HIV/AIDS, methadone replacement and harm reduction programs
and transport fee if necessary (see activities 7.2.3 and 7.2.4).
Service delivery area 9.2: Prevention of opportunistic infection in PLWHA with TB
Activity 9.2.1 Refer all HIV-positive TB patients to HIV services for assessment of
eligibility for co-trimoxazole preventive therapy (CPT).
Activity 9.2.2 CPT to be given to all HIV positive TB patients (unless on ART and CD4>
200).
The local CDC’s in project areas will refer all HIV-positive TB patients to the local HIV
service providers in order for these patients to be assessed for eligibility for CPT and to
start CPT if eligible. The referral is part of activity 7.2.2; travel supplement will be provided
as part of activity 7.2.3 to enhance success of referral.
Service delivery area 9.3: Provision of antiretroviral therapy (ART) during TB
treatment
Activity 9.3.1 Refer all HIV-positive TB patients to HIV services for assessment of
eligibility for ART.
Activity 9.3.2 Based on weekly joint conferences between HIV and TB care providers,
PLWHA who have TB will be start ART according to national guidelines.
Activity 9.3.3 Provision of fixed dose combination (FDC) antituberculous drugs in high
HIV prevalence populations.
The local CDC’s in project areas will refer all HIV-positive TB patients to the local HIV
service providers for these patients to be assessed for eligibility to start ART and to start
ART if eligible. The referral is part of activity 7.2.2; travel supplement will be provided as
part of activity 7.2.3 to enhance success of referral. ART will be initiated on the basis of
joint assessment by HIV and TB care providers during weekly co-management
conferences. In project areas, the MOH will procure 4-drug fixed-dose combination (4FDC)
TB drugs in order to reduce pill burden and increase adherence in PLWHA who are on
both TB treatment and ART. The ART program is part of the GFATM round 3 and 4
HIV/AIDS project.
Service delivery area 9.4: Support patients through direct observation of TB and HIV
treatment
Activity 9.4.1 Develop joint adherence support strategy for patients on TB treatment and
CPT, ART, and other drugs used in the management of HIV/AIDS.
Activity 9.4.2 Conduct joint training on TB and HIV treatment to adherence supporters.
Activity 9.4.3 Service providers use adherence support materials to promote patient
adherence.
The national CDC will convene an expert group to develop joint adherence strategy for
patients on TB and HIV care and treatment. Training materials will be developed by the
national CDC as part of activity 5.6.2. Training will be conducted by the local CDC’s as part
of activity 5.6.3. The adherence support materials developed through activity 5.4.2 will be
used by service providers dealing with TB or HIV treatment.
Objective 10: Establish the monitoring and evaluation system for TB/HIV
The Global Fund: Proposal Form Page 66 of 89
4 Components Section
collaborative activities
Service delivery area 10.1: Monitoring and evaluation (M&E) of TB/HIV collaborative
activities
Activity 10.1.1 Develop and implement a joint national TB/HIV M&E strategy and plan.
Activity 10.1.2 Develop and implement a recording and reporting system for TB/HIV
collaborative activities.
Activity 10.1.3 Incorporate information system for TB/HIV collaborative activities into
internet-based TB reporting system.
Activity 10.1.4 Conduct regular supervision of TB/HIV collaborative activities at all levels.
Activity 10.1.5 Annual evaluation of national implementation of collaborative TB/HIV
activities including external experts.
The China CDC, under the guidance of the national TB/HIV working group, will convene an
expert group to develop the national TB/HIV M&E strategy and plan. The same expert
group will modify the existing TB and HIV recording and reporting tools to capture the
information needed to monitor and evaluate collaborative TB/HIV activities. This M&E plan,
including the recording and reporting system for TB/HIV collaboration, will be implemented
by local CDC’s in project areas. The national CDC will contract with a software
development company to incorporate the information system for TB/HIV collaborative
activities into the existing internet-based TB reporting system. The MOH, the national
TB/HIV leading group and the TB/HIV working and coordination groups at all levels will
organize regular supervision and evaluation of collaborative TB/HIV activities; this will be
supported by national and international experts in TB and HIV. Annually, MOH will carry
out a more intensive evaluation of national implementation of TB/HIV collaboration.
Goal 3: Reduce the morbidity and mortality of TB in the migrant population in China
Objective 11: Build a supportive environment for implementing a TB control
program among the migrant population
Service delivery area 11.1: Coordination and partnership development for TB control
among the migrant population
Activity 11.1.1 Develop and publish the national strategy, policies and plan to control TB
among the migrant population.
The MOH will convene a group of experts to develop the national strategy, policies and
plan to control TB among the migrant population. This work will be supported by
international experts. The group will meet 2 times to develop an initial draft for circulation to
wider group of stakeholders, then meet a third time to finalize the plan. The national CDC
will publish the final plan.
Activity 11.1.2 Invite other ministries and stakeholders such as Civil Affairs, Public
Security, and Finance to review and comment on the national strategy, policies and plan to
control TB among the migrant population during its development.
The MOH will invite other ministries and stakeholders to review and comment on the
national strategy and plan to control TB among the migrant population.
Activity 11.1.3 Hold the Inter-agency Coordination Committee to Stop TB in China to
finalize the responsibilities of different sectors in control of TB among the migrant
population.
The MOH will utilize the annual ICC meeting (with all sectors participating) to finalize the
responsibilities of different sectors.
Activity 11.1.4 Develop and publish implementation guidelines for the national plan to
control TB among the migrant population, specifying responsibilities for different groups.
The MOH will convene an expert group, including international experts, to write the
implementation guidelines. The group will draft a set of working guidelines for the first year
of the project. On the basis of the experience in implementing these guidelines in pilot
areas during the first year, they will be revised in the 2nd year. The national CDC will be
responsible for publishing these guidelines.
Activity 11.1.5 To build collaboration between cities or counties/districts (within or
between provinces), disseminate relevant policies and implementation guidelines to project
areas and specify responsibilities for referral or follow-up of TB patients during the course
The Global Fund: Proposal Form Page 67 of 89
4 Components Section
of TB diagnosis and treatment when patients move from one area to another.
The MOH will disseminate the policies and guidelines to the provinces. The provincial
health bureau will disseminate these policies and guidelines to their cities and counties.
Service delivery area 11.2: Human resource development to implement TB control
activities for the migrant population
Activity 11.2.1 Develop and publish working manual with implementation guidelines for
TB control activities among the migrant population.
The MOH will convene an expert group, including international experts, to write the working
manual with the implementation guidelines. The group will draft a set of working guidelines
for the first year of the project. On the basis of the experience in implementing these
guidelines in pilot areas during the first year, they will be revised in the 2nd year. The
national CDC will develop and publish the working manual.
Activity 11.2.2 Develop training program, including curriculum, methodology and
materials for different interventions used to control TB in migrant population.
Based on the implementation guidelines and working manual, the national CDC with
support from international experts will develop the training curriculum and materials for
implementing TB control activities among the migrant population. The materials will be
tailored to specific groups of staff implementing these activities. There will be 6 types of
training materials in the training program.
Activity 11.2.3 Implement a training program on the overall management of the program
to control TB in the migrant population.
Based on the training program, the CDC’s at different level will train staffs to carry out the
program activities. The national CDC will train the provincial CDC’s staff, and provincial
CDC’s will train the prefecture and the county/district staffs.
Service delivery area 11.3: Behavioral change communication through mass media
to increase awareness of and reduce stigma toward TB
Activity 11.3.1 Develop BCC materials on TB in migrant population for the general
population (radio and TV programs) to be distributed through the mass media.
Activity 11.3.2 Broadcast and disseminate BCC materials (radio and TV programs,
newspapers and magazine articles) through the mass media.
The national CDC will invite a media company to produce radio and TV programs in year 1
and 3. The programs will be developed from an understanding of local beliefs about the
diseases and services and aim to dispel myths and to reduce the stigma surrounding TB
and to increase usage of TB services. Each year, the CDC at each level will implement the
BCC by contracting with local TV and radio stations; the CDC’s will publish articles on
TB/HIV.
Service delivery area 11.4: Behavioral change communication through community
outreach to increase awareness of and reduce stigma toward TB
Activity 11.4.1 Develop and produce BCC materials about TB for the migrant population
and for employers of the migrant population.
Activity 11.4.2 Develop BCC materials for TB patients to enhance their understanding of
and adherence to TB treatment.
Activity 11.4.3 Train community outreach workers to deliver BCC materials to the migrant
population and to employers of the migrant population.
The national CDC will contract with health promotion institutions to develop BCC materials
for the migrant population and for the employers of the migrant population. The local
CDC’s in the project areas will train community workers (with NGO/CBO) or peer support
group leaders identified under activity 11.4.3 to deliver community outreach. BCC materials
will be developed during year 1 and revised in year 3. Training of community workers or
peer group leaders will take place every year.
Service delivery area 11.5: Strengthening of civil society to participate in TB control
activities for the migrant population
Activity 11.5.1 Develop and publish guidelines for involvement of NGO/CBO/peer support
groups in TB control activities for the migrant population.
Activity 11.5.2 Conduct workshops among representatives of NGO/CBO/peer support
The Global Fund: Proposal Form Page 68 of 89
4 Components Section
groups to inform them of the importance of TB in the migrant population and to encourage
community participation in activities to control TB in this population.
Activity 11.5.3 Provide support to NGO/CBO/peer support groups in implementing TB
control activities among the migrant population, including the delivery of BCC materials.
The national CDC, under the guidance of the MOH, will develop guidelines for involvement
of NGO/CBO/peer support groups in TB control activities among the migrant population
during year 1. Based on the guidelines, the national and provincial CDC’s will conduct
workshops for representatives of NGO/CBO/peer support groups once a year. In addition
to training, local CDC’s will contract with NGO/CBO/peer support groups to carry out TB
control activities, including the delivery of BCC materials (this is linked to activity 11.3.3).
Service delivery area 11.6: Operational research to improve the TB control program
among the migrant population
Activity 11.6.1 Determine the operational research priorities for TB control in the migrant
population.
Activity 11.6.2 Implement operational research projects based on defined priorities.
Activity 11.6.3 Apply useful results from operational research projects to further
development of national policies
The China CDC will set up an operational research management group for TB in the
migrant population. This group, which will include national and international experts in TB
and the migrant population, will develop the operational research priorities for TB in the
migrant population. The group will contract with research centers in academic institutions,
local CDC’s, and other research centers to carry out the operational research and social
assessment. The operational research management group will meet quarterly to monitor
research projects. Once a year, the China CDC will hold a research dissemination meeting
to present research results and discuss their application to national TB/HIV policies. This is
especially important during the first 2 years of the project when results of operational
research will play an important role to define the national policies and guidelines for control
of TB in the migrant population.
Objective 12: Increase TB case-detection and treatment success among the migrant
population
Service delivery area 12.1: Timely detection and quality treatment of TB cases in the
migrant population
Activity 12.1.1 Provide free diagnosis and treatment for TB suspects and cases among
the migrant population, including free x-ray examination, sputum examination, TB drugs
and follow-up examination.
Activity 12.1.2 Develop a program (including the operational guidelines) involving health
facilities that perform routine health examination for the migrant population so that they will
refer TB suspects in the migrant population to the TB dispensary for complete work-up for
TB.
Activity 12.1.3 Develop training materials (based on operational guidelines) for staffs
involved in the referral program from health examination sites for migrant population.
Activity 12.1.4 Train staff in the local CDC’s and in health institutions carrying out health
examination of migrant population; training includes the implementation of the referral
program and the follow-up of referred suspects.
Activity 12.1.5 Follow-up on TB suspects and cases in the migrant population that are
reported from the general hospital system to ensure that they come to the TB dispensary
for follow-up.
Activity 12.1.6 For TB suspects and cases that will leave the county/district before
diagnosis was made or treatment initiated, implement a referral system so that follow-up
can be made in the destination county/district
The local CDC’s in this project will provide free TB services for the migrant population. The
national CDC will work together with provincial CDC’s in this project to develop a program
and the operational guidelines to channel TB suspects identified through routine health
examination for the migrant population to the TB dispensary. The national CDC will work
together with provincial CDC’s to develop training materials. The provincial CDC’s will train
staffs in the local CDC’s and in the health facilities carrying out health examination of
The Global Fund: Proposal Form Page 69 of 89
4 Components Section
migrant population. These trainings are complementary to those provided to CDC staffs
under 11.2.3. The local CDC’s are already following up on TB suspect and cases in the
resident population reported from the hospital system; the CDC’s will now extend this work
to involve the migrant population. The local CDC’s will provide travel subsidies to TB cases
and suspects from the migrant population that are referred to them. The local CDC’s will
implement the referral and follow-up system for TB suspects and cases leaving a particular
county/district; this referral is based on the policies and guidelines under activity 11.1.5.
Service delivery area 12.2: Supporting patients through direct observation to
enhance treatment adherence
Activity 12.2.1 Provide DOT to all TB cases in migrant population.
Activity 12.2.2 Establish TB service delivery site and hours of operation that will facilitate
the accessibility of TB cases in the migrant population to treatment and case management.
Activity 12.2.3 Provide incentives and enablers to TB patients so as to improve
adherence to TB treatment, including DOT.
The local CDC’s will be responsible for establishing treatment adherence supporters for TB
patients in the migrant population; they will elicit the participation of NGOs/CBOs/peer
support groups in providing DOT to TB patients. The local CDC’s will establish TB service
delivery sites and hours of operation that will increase accessibility to the migrant
population, and will provide incentives and enablers to TB patient.
Service delivery area 12.3: Control of TB drug resistance among TB patients in the
migrant population
Activity 12.3.1 Hire outreach workers to visit patients to provide DOT and to trace
defaulters.
Activity 12.3.2 Provide transportation fee to outreach workers to provide DOT and to
trace defaulters.
The local CDC’s will hire or contract with outreach workers. The CDC’s will elicit the
participation of NGOs/CBOs/peer support groups in providing DOT and to trace treatment
defaulters. The local CDC’s will provide transportation fee to outreach workers, and include
NGOs/CBOs/peer support groups in this work whenever possible.
Objective 13: Establish the monitoring and evaluation system for TB control in the
migrant population
Service delivery area 13.1: Monitoring and evaluation of TB control in the migrant
population
Activity 13.1.1 Develop and implement a TB recording and reporting system for TB
suspects and cases among the migrant population, including TB registers and regular
reports.
Activity 13.1.2 Develop and implement an information system for recording referral of TB
suspects and cases between counties, districts, cities, provinces. This includes referral
registers, feedback logs, and reporting of final treatment outcome
Activity 13.1.3 Develop indicators, method for data collection and analysis, and report
summary so as to enable the evaluation of key TB control activities in the migrant
population
Activity 13.1.4 Incorporate the information system for TB among migrant population into
the existing national internet-based TB surveillance system. This includes the suspect,
case, treatment outcome and referral information for the migrant population
Activity 13.1.5 Conduct regular supervision of areas implementing activities to control TB
in the migrant population
The China CDC will convene an expert group, including international experts, to develop
the TB recording and reporting system for TB in the migrant population, including the
information system for referral of TB suspects and cases between counties. The CDC will
develop the indicators, data analysis and summary of information on TB in the migrant
population. The national CDC will contract with a software development company to modify
the existing internet-based TB reporting system. The CDC’s at all levels will organize
regular supervision of TB control activities in the migrant population. This will be supported
by national and international experts.
The Global Fund: Proposal Form Page 70 of 89
4 Components Section
4.4.1.7 Outline whether these are new interventions or existing interventions that are to
be scaled up, and how they link to existing programs.
All of the interventions outlined under goal 1 (tackling the threat of MDR-TB) are new
except for those under objective 2 (drug-resistance surveillance). The interventions to
prevent MDR-TB (under objective 1) and to implement and then monitor and evaluate the
DOTS-plus strategy in selected areas of China (objective 3 and 4) are entirely new. The
Ministry of Health has been collaborating with WHO to carry out DRS studies in China
since 1996. However, only about 2 provinces per year (on average) have carried out DRS
studies. This proposal aims to substantially scale-up DRS surveys in China—about 7
provinces will be surveyed each year—and obtain drug-resistance information for every
province within a few years.
The interventions outlined under goal 2 (tackling the threat of TB/HIV) will be implemented
in the 134 counties in the GFATM round 3 and round 4 HIV/AIDS projects for China.
Therefore this proposal will scale-up existing HIV/AIDS activities in these counties but
expand their coverage to TB suspects and cases. Expanded activities include the
following: behavioral change communications and strengthening civil society including
involvement of NGOs and peer support group (part of objective 5); establishing HIV
counseling and testing for TB patients (part of objective 7); and interventions to improve
prevention, treatment and care of HIV/AIDS among TB patients (objective 8). For these
interventions, there is a scale-up of what is already being done in the existing HIV/AIDS
program. However, there will be new efforts to link TB patients to these HIV/AIDS
interventions.
Interventions that are entirely new include the following: establishment of TB/HIV leading
groups and coordinating groups, advocacy initiatives, human resource for TB/HIV
collaborative activities, and operational research on TB/HIV collaboration (all part of
objective 5); surveillance of HIV prevalence in TB patients (objective 6); intensified TB
case-finding in PLWHA (part of objective 7); prevention of TB in PLWHA (objective 8); and
monitoring and evaluation of TB/HIV collaborative activities (objective 10). These
interventions are not in the existing HIV/AIDS program and not in the 2 GFATM HIV/AIDS
projects. Therefore these are new and additional interventions.
Most of the interventions outlined under goal 3 (tackling TB control in migrant population)
can be considered a scale-up of existing interventions. This is because many of the
proposed interventions, e.g. training, behavioral change communication, diagnosis and
treatment of infectious TB cases, recording and reporting system, are part of basic DOTS
activities. The scale-up involves implementing these interventions in a population that have
been largely neglected in the past.
Among the proposed interventions under goal 3, there are innovative activities that can be
considered entirely new interventions. Involvement of civil society in reaching migrants is
an innovation for the TB control program (objective 11). In addition, many of the
approaches to increase case-finding and treatment success are new and innovative. They
include referral from mandatory health examination for migrant population, implementation
of a new referral system for cases that transfer between districts, more accessible service
delivery and hours of operation, use of outreach workers to trace treatment defaulters, and
operational research (part of objective 12)..
4.4.2 Describe how the activities initiated and/or expanded by this proposal will be
sustained at the end of the Global Fund grant period.
There are several ways in which the activities in this proposal will be sustained at the end
of the GF grant period. First, the Chinese Government has increased and will continue to
increase its commitment to control of priority communicable diseases like TB and
HIV/AIDS. It has substantially increased funding control of communicable diseases and is
building up the public health infrastructure to battle these diseases. For instance, central
The Global Fund: Proposal Form Page 71 of 89
4 Components Section
funding for TB and HIV/AIDS increased 7-fold and 1.1-fold between 2004 and 2005,
respectively. Local level funding for TB and HIV/AIDS has also increased.
Second, the key to ensuring sustainability of activities in this proposal is to help
governmental leaders become aware of the threat of MDR-TB, TB/HIV and TB in the
migrant population and the benefits from controlling these diseases. Through the
surveillance and monitoring and evaluation activities in this proposal, the Government will
better understand the magnitude of MDR-TB, the seriousness of TB in PLWHA and the
immense challenge of controlling TB in the migrant population. The activities in the
proposal will also pilot and implement on a broad scale successful approach to tackle
these major threats to successful TB control. As a result of this, we believe the
Government should be willing to invest in sustaining these interventions.
Third, this proposal will help the Ministry of Health develop new policies in TB control.
These policies, implemented as part of this proposal, will remain after the project is over
and become requirements for the National TB Control Program. This is another way to
ensure sustainability of the program.
Fourth, the amount of governmental funding as a proportion of the total funding in this
project will increase year-by-year. The increase is from 18% in year 1 to 48% in year 5.
This increase is even greater for TB/HIV and TB in migrants as percentage of counterpart
funding will reach 66% and 52% by year 5. If one excludes the cost of drugs for treatment
of MDR-TB, governmental funding also exceeds 50% by year 5 for the MDR-TB
component. International experts believe the price of drugs for treatment of MDR-TB will
continue to fall as the demand for these drugs increases. All of this will help sustain the
program because the government will gradually increase their financial input and the price
of drugs will drop.
4.4.3 Describe gender inequities regarding program management and access to the
services to be delivered and how this proposal will contribute to minimizing these
gender inequities (2 paragraphs).
There is very little information about gender inequities with regards to MDR-TB treatment,
TB-HIV collaborative activities, and TB services for the migrant population. This is because
these are all new areas for the National TB Control Program. There is insufficient
experience in China to determine the problems. To minimize any gender inequities, all of
the activities will be piloted before broader implementation. During the pilot stage, we will
use quantitative and qualitative methods to collect information on access to project
services and the effectiveness of these services for different gender. This information will
be used within this project to develop and implement specific activities, including behavior
change communication that will minimize gender inequities.
4.4.4 Describe how this proposal will contribute to reducing stigma and discrimination
against people living with HIV/AIDS, tuberculosis and/or malaria, and other types
of stigma and discrimination that facilitate the spread of these diseases (1–2
paragraphs).
This proposal will use behavioral change communication extensively to reduce stigma and
discrimination for TB patients. For MDR-TB patients, stigma and discrimination tend to
come from family members and other contacts to patients, as they tend to be the ones who
are aware of the diagnosis of MDR-TB. Thus BCC will focus on these contacts to the
patients. For HIV-infected patients with TB, there is already stigma and discrimination from
having HIV/AIDS. The BCC in this proposal will be linked to and will strengthen existing
BCC for HIV/AIDS and aim to reduce the stigma and discrimination from having two
infectious diseases. In high HIV prevalent areas, we will target the BCC to all members of
society. For migrant population, they face very serious discrimination from co-workers and
employers when they are diagnosed with TB. We will especially design BCC targeted to
employers and co-workers.
The Global Fund: Proposal Form Page 72 of 89
4 Components Section
4.4.5 Describe how principles of equity will be ensured in the selection of patients to
access services, particularly if the proposal includes services that will only reach
a proportion of the population in need (e.g., some antiretroviral therapy
programs) (1–2 paragraphs).
The services in this proposal are not inherently biased against any particular group of
people. Because the services are provided free of charge, patients have equal access
regardless of amount of financial resources they have. The entry point for most of the
services in this proposal is at the county or district TB dispensary. The TB dispensary is
well established, well known and usually easily accessible. Nevertheless behavioral
change communication will provide information about the location where patients can
receive the project services. As the BCC is targeted to the entire community, it will help
ensure that all members of society are aware of the project services, thus helping to
ensure equity in access.
4.5 Program and financial management
4.5.1 Indicate whether implementation will be managed through Single
a single Principal Recipient or multiple Principal
Recipients. Multiple
Chinese Center for Disease Control and Prevention (China CDC)
Table 4.5.1 – Implementation Responsibility
Responsibility for implementation
Nominated Address, telephone and
Area of
Principal Contact person fax numbers,
responsibility
Recipient(s) e-mail address
No.27, Nanwei Road, Beijing
100050, China
Chinese Center for Executive/
Prof. Qiang Zheng-Fu Tel: +86 10 8316 0720
Disease Control Technical/
Executive Director, Fax: +86 10 6313 1939
and Prevention Managerial/
China PR E-mail:
(China CDC) Administrative
zfqiang@chinagolbalfund.org
4.5.2 Describe the process by which the CCM, Sub-CCM or Regional CM
nominated the Principal Recipient(s).
According to China CCM TOR, the Principal Recipient is designated and approved by
the CCM.
The China CDC has been nominated and approved as the PR by the CCM based on the
performance of the China CDC as the PR for Global Fund Round 1, 3, and 4 projects.
This was confirmed at the 13th CCM Plenary Meeting.
(See Annex 5, Minutes of 10th CCM Plenary Meeting; correspondence soliciting input on
nomination of PR; and Minutes of 13th CCM Plenary Meeting.)
The Global Fund: Proposal Form Page 73 of 89
4 Components Section
4.5.3 Describe the relevant technical, managerial and financial capabilities for each
nominated Principal Recipient.
The China CDC is a national institution working in the fields of disease control and
prevention under the leadership of the Ministry of Health of the People’s Republic of
China. It is responsible for the implementation and supervision of national disease
control strategies and providing technical guidance and training nationwide through its
network of provincial and county level CDCs. The China CDC has also demonstrated its
managerial and financial capacities through numerous successful international projects
supported by different donor agencies. It is currently the only institution with the full range
of abilities to support the implementation of the Global Fund projects in China.
As the PR of Global Fund-supported projects on AIDS (GF 3&4), malaria (GF 1) and TB
(GF 1&4), the China CDC will ensure coordination among Global Fund supported
projects.
At present, the capacity of the China CDC is being strengthened through the following
processes:
Increasing human resource capacity and enhancing staff training at different levels,
especially at national and provincial levels;
Strengthening the monitoring and supervision of financial management systems at
provincial and lower levels;
Improving the implementing abilities of local project offices
4.5.4 Has the nominated Principal Recipient previously Yes
administered a Global Fund grant?
No
4.5.5 If yes, provide the total cost of the project and describe the performance of the
nominated Principal Recipient in administering previous Global Fund grants(1–
2 paragraphs).
The PR is currently implementing several Global Fund projects totaling over $272.2
million. These projects are:
Round 1 TB, $48.1 million
Round 1 Malaria, $6.4 million
Round 3 HIV/AIDS, $97.9 million
Round 4 HIV/AIDS, $63.7 million
Round 4 TB, $56.1 million
With the leadership of the China CCM, the China CDC has been working closely with the
Global Fund, LFA and CCM members to meet the goals of all its Global Fund projects.
Areas of performance include negotiating grant agreements, implementing project
activities, and furnishing accounting and program progress reports to the Global Fund
and CCM.
Achievements by the PR include:
The establishment of the Terms of Reference for the PR and regulations for financial
management and procurement and supply management for Global Fund projects.
The coordination of the writing, reviewing and revising of the support documents
related to the two-year grant agreements and the signing of these agreements with the
Global Fund for the approved Round 1 TB and Malaria projects in January 2003 and
the Round 3 HIV/AIDS project in 2004.
The development and organization of working protocols with Global Fund provincial
project offices. There are 24 provincial offices for the TB project, 10 for the Malaria
The Global Fund: Proposal Form Page 74 of 89
4 Components Section
project, 7 for Round 3 HIV/AIDS project, and 7 for Round 4 HIV/AIDS project.
Preparing for and successfully meeting the requirements of the Global Fund’s
assessment of FM&S capacity and institutional system capacity.
Succeeding in having the Global Fund listed among the tax-free international
organizations in China by the General Administration of Customs on May 26, 2003.
Working with TB, Malaria and HIV/AIDS project offices to develop 6-month and two-
year work plans, M & E plans, procurement and supply plans and partnership
development plans.
organizations in China by the General Administration of Customs on May 26, 2003.
Working together with TB, Malaria and AIDS project office, developing the 6-month
and two-year work plan, M&E plan, procurement and supply plan and partnership
development plan.
4.5.6 Describe other relevant previous experience(s) that the nominated Principal
Recipient has had:
The China CDC has acted as an implementing agency for a number of donor-sponsored
international projects in collaboration with bilateral and multilateral partners in broad
areas of disease control and public health. As the coordinator of international projects,
the China CDC has not only shown its ability to provide technical guidance to project
implementation, ongoing monitoring, and regular reporting, but has also demonstrated
the capacity to link with different sectors (e.g., education, public security, and civil
affairs), which will be required in this proposal. Furthermore, through a network of
provincial and county level CDCs, the PR has a direct link to the main providers of HIV
prevention services throughout China. As the principal recipient of Global Fund-
supported projects on malaria and TB, the China CDC is also able to ensure that
coordination between these projects is maintained (e.g. on procurement).
In 2003, the China CDC took the lead in successfully controlling SARS. It is also the lead
agency in China on the control of TB, HIV/AIDS and other communicable diseases.
4.5.7 Describe the proposed management approach and explain the rationale
behind the proposed arrangements.
The PR conducts project activities under the leadership of CCM. Key documents, such
as work plans, procurement plans, budgets, annual reports, financial settlements, etc.
that the PR submits to the Global Fund must be approved by CCM prior to the
submission. The National Project Offices established for each approved Global Fund
project are responsible for developing and implementing the program implementation
plan, and providing supervision, evaluation and guidance to provincial program offices;
the Provincial Project Offices are required to be set up and conduct project activities
under the leadership of Central PR and the guidance, supervision, evaluation and
management technically of Malaria and TB national offices.
The PR will assign duties to provincial project offices to clearly define the responsibility of
each office. Provincial program offices will submit semi-annual program progress reports
and expenditure and settlement reports to the national project offices. After confirming
the submitted information, national project offices submit a complete report to the PR.
Yes go to
4.5.8 Are sub-recipients expected to play a role in the 4.5.9
program?
No go to 4.6
The Global Fund: Proposal Form Page 75 of 89
4 Components Section
4.5.9 How many sub-recipients will be, or are expected to 1-5
be, involved in the implementation?
6-20
21 – 50
more then 50
4.5.10 Have the sub-recipients already been identified? Yes go to
4.5.11 - 4.5.13
No go to
4.5.14 & 4.5.15
4.5.11 Describe the process by which sub-recipients were selected and the criteria
that were applied in the selection process (e.g., open bid, restricted tender,
etc.); (2–3 paragraphs).
According to the implementation of the Global Fund project, the Ministry of Health
authorized the Provincial Health Bureau in each of the GF project provinces to select
their sub-recipient according to the situation within each province. Because the National
TB Control Programme is implemented by the public health department and involves the
CDC system, the sub-recipients have generally involved the health bureau or the
provincial CDC’s. The nominated sub-recipient in each province is proposed to the PR
for its approval and the PR considers the management and technical capability of the
sub-recipient in its decision.
4.5.12 Where sub-recipients applied to the CCM, but were not selected, provide the
name and type of all organizations not selected, the proposed budget amount
and reasons for non-selection in an annex to the proposal (1–2 paragraphs).
The Terma Foundation, a U.S.-based NGO, submitted a draft proposal to the CCM core
group. The proposed budget was US$ 10 million for a project that would support TB
control activities for around 2 million people in Tibet. The CCM core group decided not to
include the Terma proposal into the Round 5 TB proposal to the GFATM (see Annex 5
for minutes of CCM core group meeting). Because Terma’s proposal was not accepted,
the CCM did not consider whether the Terma Foundation could be a sub-recipient in this
GFATM proposal.
4.5.13 Describe the relevant technical, managerial and financial capabilities of the
sub-recipients.
[Describe anticipated shortcomings or challenges faced by sub-recipients and how they
will be addressed (e.g., capacity-building, staffing and training requirements, etc.).]
The provincial health bureau or provincial CDC serves as the sub-recipient in the Global
Fund project provinces. These institutions have extensive experience in managing TB
control projects including the past World Bank Health V project and current projects from
the Global Fund (1st round TB project), the World Bank, and Government of Japan and
Canada. Although some managerial, technical and financial deficiencies have been
identified during the implementation of the first round GF TB project, they are not
unexpected in view of the size and scale of the project (i.e. 24 provinces). These issue
The Global Fund: Proposal Form Page 76 of 89
4 Components Section
are being addressed the capacity of the sub-recipients are being improved through
training and feedback from monitoring missions. This proposal will provide additional
capacity building opportunities. The placement of central level staff into provinces and
the establishment of a GF TB project office will facilitate further strengthening of the
capacity of sub-recipients to manage this project.
4.5.14 Describe why sub-recipients were not selected prior to submission of the
proposal.
4.5.15 Describe the process that will be used to select sub-recipients if the proposal is
approved, including the criteria that will be applied in the selection process (1–
2 paragraphs).
4.6 Monitoring and Evaluation (M&E)
4.6.1 Describe how this proposal and its Monitoring and Evaluation plan
complements or contributes towards existing efforts (including existing Global
Fund programs) to strengthen the national Monitoring & Evaluation plan
and/or relevant health information systems.
The national TB reporting system routinely collects information on TB cases and their
treatment. From this database, report summaries and analyses are generated. These
form the basis of the current M&E plan of the national TB control program. The M&E plan
in this proposal complements or contributes to this effort by monitoring and evaluating
TB/HIV, MDR-TB and TB in the migrant population. M&E in these areas cannot be done
in the current national M&E system. The M&E plan specifically complements current
efforts in the following ways:
1. The current TB reporting system has no information on TB in PLWHA. As part of the
TB/HIV collaborative activities, TB patients will receive HIV counseling and testing. It
will be possible to determine the HIV status of TB patients, determine which TB
patients are PLWHA and determine their treatment outcome. These information will
be recorded in a confidential manner and linked to other TB data being collected. It
will then be possible to separately determine the number and type of TB cases in
PLWHA and their treatment outcome. These information complement and contribute
to the existing national M&E plan.
2. The national TB reporting system does not routinely collect information on whether a
patient is a migrant or not. Therefore the current national M&E plan have no
information on TB control in this important population. The current proposal will
modify the TB reporting system to capture information on TB cases and treatment
outcome in the migrant population. As more than 10% of China’s population are
migrants, it is important for the national M&E system to have information about TB
case-detection and treatment outcome in this population.
3. As part of the DOTS-plus strategy, a M&E plan for the diagnosis and treatment of
MDR-TB will be developed and implemented. This M&E plan will permit an
assessment of how DOTS-plus is being implemented in China. Since the reporting
system for the national TB control program do not contain information on MDR-TB,
this M&E plan will complement the existing national M&E plan.
Aside from patient information, a number of programmatic indicators for service delivery
areas will be incorporated into the M&E plan (see table 4.4b for indicator list and
The Global Fund: Proposal Form Page 77 of 89
4 Components Section
frequency of data collection). TB control program staff involved in this project will collect
data for these programmatic indicators. As part of project implementation, data will be
collected using a modified recording and reporting system for TB/HIV collaboration and
TB in the migrant population; for DOTS-plus, a new recording and reporting system will
be used.
4.7 Procurement and Supply Management
4.7.1 Briefly describe the organizational structure of the unit currently responsible for
procurement and supply management of drugs and health products. Further
indicate how it coordinates its activities with other entities such as National
Drug Regulatory Authority (or quality assurance department), Ministry of
Finance, Ministry of Health, distributors, etc.
The procurement department of PR is responsible procurement and supply management
of drugs and health products. The Organizational chart of PSM unit is as below:
Organizational chart of PSM unit
LFA
Develop
End Users
procurement plan
PR CPOs
Procure Department
China CDC NPO
Receive & distribute
Submit requirment
Select Bidding Agent
PPOs
Financial Department
Develop bidding document
Deliver
Payment
Open bidding
Prepayment /credit
Evaluation Committee Supplier Sign Contract
The State Food and Drug Administration(SFDA) is in charge of comprehensive
supervision on the safety management of food, health food and cosmetics and is the
competent authority of drug regulation. All pharmaceutical products in China should
pass through the safety and effectiveness examination and be registered and
supervised by SFDA, so the quality of these products procured using GF fund are
secured by the SFDA.
The supplier’s representative will be responsible for physically checking shipment that
The Global Fund: Proposal Form Page 78 of 89
4 Components Section
arrives with drugs as PR wishes. GFCCO will delegate sub-PR to perform local
random product testing. PR will establish post-delivery monitoring mechanisms;
however, the entities identified as destination sites will be responsible for reporting
any problems or potential problems, for which all necessary steps will e taken to find
clarifications or solutions.
4.7.2 Procurement Capacity
a) Will procurement and supply management of drugs and health products be carried
out (or managed under a sub-contract) exclusively by the Principal Recipient or will
sub-recipients also conduct procurement and supply management of these
products?
Principal Recipient only
Sub-recipients only
Both
b) For each organization involved in procurement, please provide the latest available
annual data (in Euro/US$) of procurement of drugs and related medical supplies by
that agency
The Procurement Department of China Global Fund Project is responsible for
procurement funded by the Global Fund. The estimated total value of procurement
conducted by this department during last 12 months is $1.548 million.
4.7.3 Coordination
a) For the organizations involved in section 4.7.2.b, indicate in percentage terms,
relative to total value, the various sources of funding for procurement, such as
national programs, multilateral and bilateral donors, etc.
The Procurement Department of China Global Fund Project is responsible and only
responsible for procurement funded by the Global Fund. It doesn’t handle any
procurement from other funding.
b) Specify participation in any donation programs through which drugs or health
products are currently being supplied (or have been applied for), including the Global
Drug Facility for TB drugs and drug-donation programs of pharmaceutical
companies, multilateral agencies and NGOs, relevant to this proposal (1 paragraph).
The Global Fund: Proposal Form Page 79 of 89
4 Components Section
4.7.4 Supply Management (Storage and Distribution)
Yes continue
a) Has an organization already been nominated to provide the
supply management function for this grant?
No go to 4.7.5
b) Indicate, which types of organizations will be involved in the supply management of
drugs and health products. [If more than one of these is ticked, describe the relationships
between these entities (1 paragraph)]
National medical stores or equivalent
Sub-contracted national organization(s) (specify which one[s])
Sub-contracted international organization(s) (specify which one[s])
Other (specify)
c) Describe the organizations’ current storage capacity for drugs and health products
and indicate how the increased requirements will be managed.
All project provinces and counties have already developed their own storage spaces.
This project will not require additional spaces, but partition special area for additional
procurement under this grant.
PR will develop a plan and information system to minimize the risk that products will be
out of stock. It can ensure the supply chain continuous and delivery of products to the
consumers it intends to serve. Specific institutions at national, provincial and county
levels are responsible for the procurement, transportation, distribution and management
of products for the project to avoid diversion of resources of any kind from their originally
intended use.
Sub-PR must establish local inventory management and control. This inventory control
must be based on acceptable and reliable practices, such as first in, first out system,
stock rotation control system for warehoused products, internal auditing mechanisms
and good governance structures. PR, provinces and counties will monitor regularly the
usage, distribution and administrative at different levels and will make inspections of the
inventories of each receiving entity.
Project requires a monthly stock report from project sites in general, more frequently
report required if any potential out of stock presented. National project office will make
decision of redeployment according to these reports. Procurement for medicine and
health supply will perform every year. Any trend of underestimated requirement can be
adjusted by reinforcing procurement, bringing second year procurement forward and
modifying future procurement plan.
The Global Fund: Proposal Form Page 80 of 89
4 Components Section
d) Describe the organizations’ current distribution capacity for drugs and health
products and indicate how the increased coverage will be managed. In addition,
provide an indicative estimate of the percentage of the country and/or population
covered in this proposal.
Drugs distribution will be controlled by central level to the project provinces. The
suppliers and import agents will be responsible to deliver the products to project
provinces as will stated in the contract. Under special circumstance, the procurement
department will arrange distribution when suppliers and import agents are not
applicable.
Different prefecture and counties within the province can re-adjust according to the
demand. The National Statute of ARV Distribution is drafting and was going through
the normal review procedure in the Ministry of Health. According to this Statute, a
practical guideline has been put into operation throughout the whole nation. The
project area will also follow this guideline when it is promulgated officially and a copy
of the Statue will be send to LFA, too. Currently the distribution of medicines from
provincial to lower levels should follow the existing system.
Due to several reasons such as clime, amount of patients, distribution of patients,
and patients’ interest (avoid discrimination), etc, various distribution modes exist in
different and even same project area simultaneously as listed below. GF project
require project area to assign specialists to manage project medicines’ distribution.
Every delivery will be record in detail with signature. The distribution record and
whether patients can take medicine on time are within M&E contents. The existing
distribution methods from provincial to county level to patients are:
Provincial to county level:
Provincial deliver to county level;
County send authorized staff to draw from provincial level.
County to patients:
Patients or their family member draw from county hospital;
County health workers deliver to patients;
Township/village health workers draw from upper level, and deliver to
local patients.
[For tuberculosis and HIV/AIDS components only:]
4.7.5 Does the proposal request funding for the treatment of Yes
multi-drug-resistant TB?
No
An application to the Green Light Committee (GLC) has not been made. In
communication with the GLC, we have been informed that an application does not need
to be submitted with this proposal.
4.8 Technical Assistance and Capacity-Building
4.8.1 Describe capacity constraints that will be faced in implementing this proposal
and the strategies that are planned to address these constraints. This
description should outline the current gaps as well as the strategies that will be
used to overcome these to further develop national capacity, capacity of
principal recipients and sub-recipients, as well as any target group. Please
ensure that these activities are included in the detailed budget.
There are three main capacity constraints that will be faced in implementing this
proposal. First, there is limited experience in China on how to tackle these 3 key threats
The Global Fund: Proposal Form Page 81 of 89
4 Components Section
in TB control. It will take time to gain the necessary experience to tackle these new
issues. Second, there is substantial national and provincial expertise to implement
DOTS but these have not been used to tackle the new challenges in this proposal. Third,
implementation of the 2 current GFATM TB projects and the World Bank/DFID TB
project has enhanced the national capacity to implement large-scale projects. But this
proposal will present additional implementation challenges. Therefore additional
managerial and technical capacity at the central level will be added to implement this
project. The following approaches are being taken to build capacity to implement this
proposal.
1. To develop the necessary experience to tackle these new issues in China, project
implementation in each of the 3 areas will gradually expand. Each of the 3 projects
will start with pilot areas and then gradually scale-up. HIV/TB pilots will are starting
in 2004 using other funds. Operational research projects will be implemented early in
the project so that results from these targeted studies can help inform national and
provincial experts on how to improve project implementation.
2. To further strengthen national capacity and to support provinces during their
implementation, the MOH will set up national expert groups in each of the 3 areas of
this proposal. These experts will directly provide support to the provinces in
implementing this proposal. By being involved in the project implementation, these
national experts will gain experience in how to tackle these key issues. The proposal
has built in substantial domestic technical assistance in nearly every aspect of
technical work.
3. To strengthen the technical capacity at the central and provincial level, the proposal
will utilize international technical assistance. In other parts of the world, DOTS-plus
and TB/HIV pilot projects have been successfully implemented and the
implementation of these projects are now expanding. There are also experiences in
tackling urban TB. International experts will assist in many aspects of the proposal,
e.g. the development of national guidelines and implementation plans, training
curriculum and material, planning and implementation of MDR-TB and HIV
surveillance program, and regular supervision and monitoring visits. For the regular
monitoring of DOTS-plus projects, international experts from the Green Light
Committee of the Stop TB Partnership will be invited.
4. To strengthen the central capacity to manage this project, a 10-person unit will be
set up at the central level. This unit will include both technical and managerial
experts, with the focus being on the former. Such a unit will substantially strengthen
the central capacity to manage this project.
The Global Fund: Proposal Form Page 82 of 89
5 Budget Section
5
All budget breakdowns requested in the following sections are to be provided as an
attachment to the hard and soft (electronic) copies of the proposal form.
5.1 Component Budget
Table 5.1 – Funds Requested from the Global Fund
Funds requested from the Global Fund
in US$ (1,000,000)
Year 1 Year 2 Year 3 Year 4 Year 5 Total
Human resources 1.375 2.293 3.348 3.598 3.678 14.292
Infrastructure and
0.099 0.000 0.000 0.000 0.000 0.099
equipment
Training 1.135 1.711 2.265 2.680 2.271 10.062
Commodities and
0.144 0.575 1.216 2.279 2.202 6.417
products
Drugs 2.828 3.069 2.687 1.841 0.716 11.141
Planning and
1.341 1.594 2.008 1.717 1.419 8.080
administration
Other (operational
0.900 0.750 0.650 0.350 0.150 2.800
Research)
Total funds requested
7.823 9.992 12.174 12.465 10.436 52.891
from the Global Fund
The component budget must be accompanied by a detailed year 1 and indicative year 2
workplan and budget. This should reflect the main headings used in section 4.4.
(component strategy) and should meet the following criteria, (please see this information
from annex 6 and 8):
a) It should be structured along the same lines as the component strategy—i.e.,
reflect the same goals, objectives, service delivery areas and activities.
b) It should be detailed for year 1 and indicative for year 2, stating all key assumptions,
including those relating to units and unit costs, and should be consistent with the
assumptions and explanations included in section 5.2.
c) It should provide more summarized information and assumptions for the balance of
the proposal period (year 3 through to conclusion of proposal term).
d) It should be integrated with a detailed workplan for year 1 and an indicative
workplan for year 2.
e) It should be fully consistent with the summary budgets provided elsewhere in the
proposal, including those in this section 5.
A detailed workplan for year 1 and an indicative workplan for year 2 see Annex 8; the year3
information can see Annex 6.
5.1.1 Breakdown by Functional Areas
Monitoring and evaluation:
Table 5.1.1a – Costs for Monitoring and Evaluation
Funds requested from the Global Fund for monitoring
and evaluation (in US$, 1,000,000)
Year 1 Year 2 Year 3 Year 4 Year 5 Total
The Global Fund: Proposal Form Page 83 of 89
5 Budget Section
Monitoring and
0.638 0.539 0.553 0.476 0.418 2.624
evaluation
Procurement and supply management:
Table 5.1.1b – Costs for Procurement and Supply Management
Funds requested from the Global Fund for procurement
and supply management (in US$, 1,000,000)
Year 1 Year 2 Year 3 Year 4 Year 5 Total
Procurement and supply
0.000 0.000 0.000 0.000 0.000 0.000
management
Technical assistance:
Table 5.1.1.c – Costs for Technical Assistance
Funds requested from the Global Fund for technical
assistance (in US$, 1,000,000)
Year 1 Year 2 Year 3 Year 4 Year 5 Total
Technical assistance 1.334 2.208 3.269 3.523 3.618 13.952
5.1.2 Breakdown by Service Delivery Area
Table 5.1.2: Estimated Budget Allocation by Service Delivery Area and Objective.
Year 1 Year 2 Year 3 Year 4 Year 5 Total
Value per year (in US$, 1,000,000) 7.823 9.992 12.174 12.465 10.436 52.891
Service delivery
Objectives Estimated percentage of budget (%)
area
Objective 1 1 0.90 0.07 0.00 0.00 0.00
Objective 2 1 5.11 3.65 3.00 2.93 1.58
Objective 3 1 0.04 0.03 0.03 0.01 0.00
2 1.73 0.96 1.20 0.80 0.00
3 0.34 0.38 0.82 1.15 0.00
4 2.83 5.44 13.98 28.25 33.47
5 0.13 0.21 0.47 0.80 0.76
6 0.09 0.00 0.03 0.00 0.00
8 2.71 1.62 1.33 0.10 0.00
Objective 4 1 0.37 0.23 0.27 0.19 0.00
Objective 5 1 7.45 7.06 4.70 3.09 2.17
2 0.22 0.03 0.10 0.02 0.01
3 3.77 3.70 2.55 1.63 1.14
The Global Fund: Proposal Form Page 84 of 89
5 Budget Section
4 6.01 7.43 4.80 3.27 2.30
5 1.50 1.78 1.32 1.29 1.54
6 16.22 9.67 6.58 4.25 0.07
7 2.74 1.62 1.33 0.10 0.00
Objective 6 1 5.04 3.75 3.24 3.01 3.59
Objective 7 1 1.17 1.50 0.95 0.66 0.46
2 4.22 4.29 3.72 3.40 3.27
Objective 8 1 5.14 3.04 0.71 0.42 0.00
Objective 9 1 2.06 3.23 2.64 2.58 3.08
2 2.68 3.42 2.17 1.50 1.06
3 4.77 6.47 4.48 3.57 3.30
4 0.14 0.00 0.00 0.00 0.00
Objective 10 1 1.89 1.06 0.77 0.45 0.32
Objective 11 1 0.34 0.00 0.04 0.00 0.00
2 2.07 1.68 1.99 1.07 0.56
3 0.53 0.19 0.20 0.07 0.04
4 0.57 1.49 1.80 1.13 0.59
5 0.36 0.81 1.25 1.16 1.38
6 2.10 1.12 0.10 0.00 0.00
Objective 12 1 1.24 3.62 4.60 3.27 1.93
2 2.97 11.54 19.41 20.58 26.28
3 0.62 2.43 4.06 4.13 5.12
Objective 13 1 0.86 0.34 0.27 0.17 0.09
Project
management 9.07 6.13 5.07 4.96 5.88
1
ffi
Total: 100% 100% 100% 100% 100%
5.1.3 Breakdown by Partner Allocations
Table 5.1.3 – Partner Allocations
Fund allocation to implementing partners (in
percentages)
Year 1 Year 2 Year 3 Year 4 Year 5
Academic/educational
1.41 0.80 0.49 0.00 0.00
sector
Government 87.21 89.62 91.33 93.55 93.54
Nongovernmental/
1.21 2.33 2.50 2.45 2.92
community-based org.
Organizations
representing people
living with HIV/AIDS,
tuberculosis and/or
malaria
The Global Fund: Proposal Form Page 85 of 89
5 Budget Section
Private sector 7.61 5.24 4.03 2.40 1.62
Religious/faith-based
organizations
Multi-/bilateral
2.56 2.00 1.64 1.60 1.92
development partners
Others
Total 100% 100% 100% 100% 100%
The Global Fund: Proposal Form Page 86 of 89
5 Budget Section
5.2 Key Budget Assumptions for requests from The Global Fund
5.2.1 Drugs, commodities and products
a) Provide a list of anti-retroviral (ARVs), anti-tuberculosis and anti-malarial drugs
to be used in the proposed program, together with average cost per person per
year or average cost per treatment course.
Below is a table with the TB drugs to be used in the treatment of MDR-TB along
with the average cost for the 24 months of treatment. See Annex 7 for more details.
Drug for MDR-TB Average cost (US$) Source of drug price
treatment
Ethambutol 40.05 Global drug facility
Pyrazinamide 29.20 Global drug facility
Ofloxacin 128.45 Green Light Committee
Cycloserine 1134.00 Green Light Committee
Ethionamide 287.42 Green Light Committee
Kanamycin* 83.52 Green Light Committee
Capreomycin* 662.40 Green Light Committee
Injection syringe (5 ml) 14.04 Global drug facility
Injection water (5 ml) 4.61 Global drug facility
Transportation cost 108.92
Total 1198.05
* Average cost for the injectable agents, kanamycin and capreomycin, have
been calculated assuming they will be used for 6 months.
For standard TB treatment, the central government will provide the funding as part of the
government counterpart funds for this project. Standard TB treatment for new and
retreatment cases utilizes isoniazid, rifampin, ethambutol, pyrazinamide and
streptomycin given every other day using standard WHO dosages. Cost for each course
of treatment: new smear+ve cases ($18); retreatment smear+ve cases ($33); serious
new smear-negative cases ($17); other new smear-negative case ($12). The prices
listed are the current prices for drug purchase in current TB projects in China using
national and international competitive bidding.
b) Provide the total cost of drugs by therapeutic category for all other drugs to be
used in the program. It is not necessary to itemize each product in the
category.
Below is a table with a list of drugs by therapeutic category. These drugs are used
as treatment for side-effects during the 24-month of MDR-TB treatment.
Category of drugs Average cost/patient
Anti-emetics $18
Anti-gastritis medications (e.g. antacids, H2- $36
blockers, proton-pump inhibitors)
Non-steroidal anti-inflammatory drugs $24
Anti-gout medications $6
Thyroxine $6
Anti-psychotic, anti-depression, anti- $18
convulsants
Pyridoxine $12
c) Provide a list of commodities and products by main categories e.g., bed nets,
The Global Fund: Proposal Form Page 87 of 89
5 Budget Section
condoms, diagnostics, hospital and medical supplies, medical equipment.
Include total costs, where appropriate unit costs.
Please see annex 6 for detail budget calculation of total cost.
Item Unit cost Total cost
Class II biosafety cabinet $6,000 $186,000
Vortex $200 $6,200
Culture incubator $1,000 $31,000
Condoms $0.1 $1,447,200
Condom distribution container $10 $1,340
Office equipment (for project See Annex
office & PR office) – computers, 6 for unit
$102,766
printers, copier, phones, fax cost
machine, furniture, etc
Medical supplies for following
diagnostic tests:
Sputum smear $1
$1,255,793
Sputum culture $8
Chest x-ray $4 $1,355,726
Liver function test $6
Renal function test $6
Complete blood count $4
$2,860,800
Electrolyte, including K, Mg,
$16
uric acid
TSH $4
DST for first-line drugs $12 $38,850
DST for second-line drugs $21 $3,153
Rapid HIV test kit $5 $781,020
HIV confirmatory testing $10 $81,204
5.2.2 Human resources costs
In cases where human resources represent an important share of the budget, explain
how these amounts have been budgeted in respect of the first two years, to what extent
human resources spending will strengthen health systems’ capacity at the patient/target
population level, and how these salaries will be sustained after the proposal period is
over (1–2 paragraphs). (Please attach annex).
The human resource cost for this project accounts for 26.1% of the total budget. The
amount of funds for human resource has been budgeted into 4 main categories: direct
patient service, training and support for other meetings, technical assistance, and
supervision activities. During year 1 and 2, 50.3% and 74.8%, respectively, of the human
resource cost is for direct patient services, including case-management fee for DOT,
community workers to carry out BCC and other activities, 31.9% and 16.6% respectively
are for training activities, and 15.2% and 7.1% respectively are for domestic technical
assistance (see annex 7 for details).
These human resource input will strengthen the capacity of health care workers to carry
out TB control activities by providing them with needed training. Thus the health system
capacity to provide patient service will also be strengthened. For example, the funding of
extended hours of service will help migrants access TB services. Sustainability of these
human resource input can be achieved in different ways. First, the need for domestic
technical assistance and trainings will be much less in the future once the program has
been implemented and the needed experience has been gained. So the amount of
funding for future human resource will decrease over time. Second, the amount of
government counterpart funding in the project increases year-by-year. This will make it
easier for funding to be maintained at the end of the project. Finally, if the project
achieves its intended results, governmental leaders will understand the importance of
these key threats to TB control and of the value of the interventions in this proposal.
The Global Fund: Proposal Form Page 88 of 89
5 Budget Section
Governmental investments will likely increase to fund the human resource needed to
carry the interventions.
5.2.3 Other key expenditure items
Explain how other expenditure categories (e.g., infrastructure, equipment), which form
an important share of the budget, have been budgeted for the first two years
Training is an important expenditure category in this proposal, especially in the first 2
years. The method and justification for calculating training costs is described in detail in
Annex 4. As can be seen from the budget justification, most of the cost in this category is
for travel cost of participants, meeting room, training materials, and per diem for
participants. The large budget reflects the importance of training in implementation of
these new interventions in the National TB Control Program. Planning and administration
cost accounts for around 15% of the total budget. This reflects the cost of managing the
program by the GF unit to be established, by the PR, and supervision cost. In addition,
the program puts a major emphasis on BCC for patients and the broader community.
Finally, 2.8% of the budget is for operational research, drug resistance surveillance, and
monitoring of HIV in TB patients. More than 80% of this is spent in the first 3 years when
it is important to carry out program-related research to determine how to improve
program implementation. Detail budget for all these areas can be found in Annex 4.
The Global Fund: Proposal Form Page 89 of 89
Related docs
