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                                                                                                                                                                                                                                                           c5361043-b217-4a2d-9a63-c2364d6d2672.xls



                                                                                                                   DISBURSEMENT DECISION-MAKING FORM

Legend:             Compulsory                    If applicable

   Portfolio Cluster                                           Sub-Saharan Africa: Southern Africa                                                                                            Fund Portfolio Manager


                                                                                                           1 - GENERAL GRANT AND DISBURSEMENT INFORMATION

   Country:                                                                                                                                                                                   Disbursement Request Number:
   Disease:                                                                                                                                                                                   FPM Disbursement Amount Decision:                              .00

   Principal Recipient:                                                                                                                                                                       Period Covered by       Beginning Date:
                                                                                                                                                                                              Progress Update:        End Date:
   Grant Number:                                                                                                                                                                              Period Covered by       Beginning Date:
   Grant Start Date:                                           01-Nov-2005                                                                                                                    Disbursement Request*:  End Date:
   Grant End Date:                                             31-Oct-2007                                                                                                                    * Includes buffer quarter
   Total Committed:
   Currency:                                                                                                                                                                                  Date of Previous Disbursement:                               15-Mar-2007
   Grant Phase:                                                                                                                                                                               Amount of Previous Disbursement:                              4,186,625.90


                                                                                                                                2 - PERFORMANCE EVALUATION
                                                                                                 PERFORMANCE RATING LEGEND
                                                                                                 New Scale               A - Expected or exceeding expectations   B1 - Adequate                          B2 - Inadequate but potential demonstrated                         C - Unacceptable
    PERFORMANCE RATING                   Select                 LFA Rating        Select
                                                                                                 Old Scale (LFA)         (5 or 4) - (Exceptional or Expected)     (3) - (Minor adjustments needed)       (2 or 1) - (Major adjustments needed or Little progress made)      (0) - (Major program issues)


Overall evaluation of performance




Do the LFA comments on program progress indicate any cause for concern?                                        If yes:                    I have considered causes of concern raised by the LFA regarding program progress in my overall evaluation of performance (rating and comments)
          I have provided full justification for any difference between my overall progress rating and the LFA's rating
          I have considered LFA comments on data quality and reporting, if any


                                                                                                                                3 - FINANCIAL CONSIDERATIONS

Comments on disbursements to date, expenditures and cash balance, if any




Do the LFA comments on program expenditure indicate any cause for concern?                                     If yes:                    I have considered causes of concern raised by the LFA regarding program expenditures in the comment box above
          I have provided clear explanation in the comment box above in cases where cumulative expenditures significantly deviate from budget (eg. +/- 15%)


                                                                                                4 - CONTEXTUAL INFORMATION CRITICAL TO DISBURSEMENT DECISION

   Governance(CCM, Civil Society, Donor
   and Partner Relations, GF Related - LFA,           Select
   Secretariat, etc.-, etc.)

   General Management (PR and Project
   Management, SR, Procurement, HR,                   Select
   Health Systems, M&E, etc.)

   External Factors (Political Environment,
   Currency Fluctuations, Natural Disaster,           Select
   etc.)

   Other (National Programs, SWAPS,
                                                      Select
   Corruptive Environment, etc.)




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                                                                                                                     5 - FUTURE AND OUTSTANDING REQUIREMENTS


                    REQUIRED DOCUMENTATION                             OUTSTANDING?                                                                                       COMMENTS (if Outstanding)


         Attachment to Annex A (covering disbursement period)              Select

         Audit Report                                                      Select

         Annual Review                                                     Select




                         CONDITIONS PRECEDENT APPLICABLE TO THIS DISBURSEMENT                                             FULFILLED?                                                               COMMENTS (if Outstanding)


                                                                                                                             Select

                                                                                                                             Select

                                                                                                                             Select

                                                                                                                             Select


              I confirm that the LFA and the PR have provided sufficient comments on all applicable conditions precedent to this disbursement(s)
              I have reviewed and assessed LFA comments in relation to satisfaction of all applicable CPs and have ensured that they are consistent with CPs provided in the Grant Agreement
                                                                                                                                                                                                                                                                                        ####

                                                                                                                                 6 - LFA RECOMMENDATION(S)

              I have provided decisions for each LFA Recommendation (on the “LFA On-going Progress Review and Disbursement Recommendation” Form)


                                                                                                                                 7 - DISBURSEMENT DECISION

                                                                        Amount ( )               %                   Period Covered by Disbursement Request (as above)                                                                                             Amount ( )           %
         Cash Request (from the PR)                                         0.00              #DIV/0!                Beginning Date:                                                                          Total Committed                                                       #VALUE!
         LFA Recommended                                                    0.00              #DIV/0!                End Date:                                                                                Less: Actual Disbursed to Date                     10,698,938.62      #VALUE!
                                                                                                                                                                                                              Undisbursed Grant Amount                             #VALUE!         #VALUE!

         FPM DISBURSEMENT AMOUNT DECISION                                   0.00              #DIV/0!                Amount in Words            0                                                             Undisbursed after this disbursement                  #VALUE!          #VALUE!


Rationale and Performance Basis for Disbursement Decision




Has the LFA concluded that the forecasts included in the disbursement calculation are reasonable?                                      If no:       I have concluded that the disbursement amount is still appropriate based on the rationale outlined in the comment box above.

              I have provided full justification for any difference between my disbursement decision and the LFA's Recommendation and/or PR Request
              I have provided full justification for disbursement in case of under-performance of the program (e.g., B2 or C Rating)


                                                                                                              8 - DOCUMENTATION SUPPORTING THE DISBURSEMENT

                            Supporting Documentation                                      Date Signed
         PR Disbursement Request
         LFA On-going Progress Review and Disbursement Recommendation
         Other:
         Other:


                         PR has provided an authorized signature and date on the report
 PR Request




                         Report period dates are correct and follow exactly sequentially from PR's previous report
                         The expenditure and program progress is reported to a date not more than six months ago         Date:
                         Calculation of Disbursement Request is correct (from Cash Reconciliation and supporting statements)
                                                                                                                                                                                                                                                                            7/10/2010
 PR Request
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                                Periods for which cash is requested are reasonable and follow directly after report period
                                LFA report has been properly signed and dated
 LFA Report


                                LFA has properly verified the PR's bank / bank account details (LFA has referenced the grant agreement face page containing the correct PR bank details for this disbursement)
                                LFA report period dates are correct and follow directly after the report period in the previous report
                                LFA has properly conducted all required verifications (Section 4.C. or 1.B)
                                I have updated the Grant Performance Report (GPR)
 Other




                                An LFA implementation work order is currently in place for this grant agreement and will expire not later than one month from today          Expiry date:
                                The required procurement information for the previous disbursement has been entered into the Global Fund's Price Reporting Mechanism: yes/no

                                                                         Beneficiary Details                                                                                                                     Principal Recipient Details

         Owner of Bank Account:                                                                                                                                           PR Name:
         Bank Account Name:                                                                                                                                               PR Type:
         Bank Account Number:                                                                                                                                             Address:
         Beneficiary Bank Name:                                                                                                                                           PR Additional Representative:
         Bank Address:                                                                                                                                                    PR Tel. Number:
         Bank SWIFT Code:                                                                                                                                                 PR Fax. Number:
         Bank Code (Other):                                 0                                                                                                             PR e-mail:



         Routing Instructions:




                                                                                                                                     9 - RECOMMENDATION OF DISBURSEMENT

Particular attention is drawn to the following matters:
>> Grant agreement has expired or will expire within one month                                                                                                            Grant Disbursement Number
                                                                                                                                                                          Grant Amount
                                                                                                                                                                          Disbursement Amount                              0.00
                                                                                                                                                                          Undisbursed After Disbursement                   #VALUE!
                                                                                                                                                                          Global Fund Rating                               Select
                                                                                                                                                                          Grant End Date                                   31-Oct-2007
                                                                                                                                                                          Grant Phase

Statement by Fund Portfolio Manager
I have carefully reviewed the PR disbursement request and the associated LFA report and have taken account of all contextual information in my knowledge as portfolio manager for this grant as the basis for my answers and comments on this form and the accompanying file note. All
matters that should be brought to the attention of the Cluster Leader are set out above or in the accompanying file note. Based on this review and knowledge of the grant I recommend payment of this disbursement.


                                                                                                            jkj
              ---------------------------------------------------   -----------/------------------/ 200    ---------------------------------------------------------
              Signature                                             Date                                   Printed Name and Title of Signatory


Statement by Cluster Leader
I have reviewed this disbursement worksheet and the supporting documentation as listed above and have taken account of any matters brought to my attention therein. Based on my review, I recommend payment of this disbursement.



              ---------------------------------------------------   -----------/------------------/ 200    ---------------------------------------------------------
              Signature                                             Date                                   Printed Name and Title of Signatory


Statement by Additional Reviewer (for disbursements in excess of 2,000,000 USD)
I have reviewed this disbursement worksheet and the supporting documentation as listed above and have taken account of any matters brought to my attention therein. Based on my review, I recommend payment of this disbursement.



              ---------------------------------------------------   -----------/------------------/ 200    ---------------------------------------------------------
              Signature                                             Date                                   Printed Name and Title of Signatory



                                                                                                                                                         10 - FINANCE REVIEW

              Statement by Finance Officer                                                                                                                             Statement by Chief Financial Officer

                        This disbursement is within committed funds
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                       Undisbursed grant amount: #VALUE!                                                  % funds disbursed:                 96.46%
               The supporting documents are in order

                                                                                                                                                                           I recommend payment instructions to the Trustee for the above disburseement.
     The above has been verified by:

                                                                                                                                                                                                                                                                                        Barry Greene, Chief Financial Officer / Ian Carter,
                                                                                                               Eric Godfrey, Finance Officer                                                                                                                                            Financial Controller
     -------------------------------------------------------------- -----------/------------------/ 200        ---------------------------------------------------------   --------------------------------------------------------------------------------/------------------/ 200     ---------------------------------------------------------
     Signature                                                      Date                                       Printed Name and Title of Signatory                         Signature                                                            Date                                    Printed Name and Title of Signatory



To be completed by Signatory of Bank Order


     Payment instruction signed by:
                                                                                                                                                                           WBT Reference Number
     Date:                                           Initials




                                                                                                                                                                                                                                                                                                                               7/10/2010

				
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