RESOLUTION
The Country Coordination Mechanism Extraordinary Meeting to launch the Country Dialogue within the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria,
May 14-15, 2014, Bucharest, Romania
The Resolution of the CCM’s meeting sessions:
- TB National Strategy
The Country Coordination Mechanism (CCM) decided that, in line with the recommendations of the recent WHO/ECDC Review of the National Tuberculosis Programme (NTP) and the requirements of the Global Fund, the current draft of the „National strategic plan for TB control 2013-2017” (NSP) should be revised under the ownership and leadership of the Ministry of Health and updated by addressing the current NTP gaps in line with the NTP review and the needs of reforming the health system. In order to reach this aim, a working group will be created in line with the Terms of Reference of the National working group for revising the TB National Strategic Plan and developing a TB Concept Note for the Global Fund (see ANNEX 5). The working group will update the current draft of the TB National Strategic Plan and submit it to the Ministry of Health for its official endorsement by 15 September 2014 and will develop and finalize the TB Concept Note for its submission by the CCM to the Global Fund by the 6 October 2014
The NSP will incorporate the „National Plan to Prevent and Control M/XDR-TB 2012-2015” launched in 2012, and it will consider all increased domestic funds over the next year as committed by the Ministry of Health, and external resources (see ANNEX 3). The NSP will also consider priority interventions such as: a) the establishment of an effective centralized procurement and the uninterrupted supply of all internationally recommended anti-TB drugs required to constitute a regimen compliant with WHO treatment regimens; b) the expansion of ambulatory treatment of TB patients, home based care and day care treatment; c) the rationalization of hospitalization practices in order to prevent further spread of drug resistance and to use the available resources from the governmental budget more efficiently. The official approval of the revised National strategic plan for TB control with multi-annual budget based on the identified needs, endorsed by a Memorandum signed by the Government of Romania represents the real commitment of the Ministry of Health towards international donors and condition for future Global Fund grants. The Global Fund Grant will be available only after the endorsement of the National Strategic Plan by the Romanian Government.
- Conclusions of the Panel Discussions regarding main priorities to be articulated in the Concept note
Within the CCM meeting organised on 14-15 May, two panels were held in order to identify interventions aimed to reduce the impact of TB. The main conclusions focus on: (1) targeted interventions for vulnerable populations (e. g. homeless people, poor people, injecting drug users); (2) services targeted to the general population, TB/MDR-TB patients (addressing treatment compliance, resistance and failure); (3) interventions targeting decision makers, local authorities; (4) interventions targeted to improving NGOs activities and reach; (5) areas that need to be covered by targeted interventions (see ANNEX 4).
- Working Group
A national working group is officially established to draft the National strategic plan for TB control for approval by the Ministry of Health and the development of the Concept Note for applying to the Global Fund New Funding Mechanism by the 6 October 2014.
Working group componence
| Institution / Entity | Main representative | Secondary representative | |
| 1. | MoH | Cristinela Velicu | Alexandru RafilaAmalia Serban |
| 2. | NTP | Gilda Popescu | Domnica Chiotan |
| 3. | National HIV/AIDS Program | Adrian Abagiu | Gabriel Coltan |
| 4. | People affected by the disease | Stefan Radut (ASPTMR)Marina Carzol(corresponding member) | Catalina Constantin (ASPTMR) |
| 5. | RHRN | Monica Dan (RHRN – ARAS) | Marian Ursan (RHRN – Carusel Association) |
| 6. | RAA | Silvia Asandi | Mihaela Stefan |
| 7. | UNICEF | Eugenia Apolzan | Eduard Petrescu |
| 8. | WHO | Victor Olsavszky(Chair) | Cassandra Butu(WG secretariat) |
| 9. | WHO consultant | David Berger |
- Country dialogue for the Global Fund application
The CCM decided that the Country dialogue will be organized in such a manner so that it would be finalized by the end of July 2014, in parallel with the elaboration of the Concept Note.
The CCM decided that the process of nomination of PR for the GF-NFM grant will be based on the provisions of CCM by-laws. The PR nomination will be organized by the CCM by the end of June 2014.
The process of country dialogue, concept note development and other NFM / CCM – related activities agreed by the CCM are described in the following table:
| No. | Elements of the Country Dialogue | Implementation actions; schedule / deadlines | Responsible Parties |
| 1. | Documented evidence of impact: Conducting program evaluations and other research to determine outcomes and impact of programs including capacity assessments of health and community systems to deliver services | Report on NTP Programme review: August 2014 (final report)DRS FLD: December 2014 (preliminary results) | WHO/ECDCRAA & NTP |
| 2. | Disease and health sector landscape: Forging a common understanding of a country’s disease and health sector landscape including latest epidemiological studies and identifying data gaps; areas for coordination and partnership; and any weaknesses in health or community systems that could affect disease programs | CCM meeting14-15 May 2014Further actions:
CCM meetings June / July National working group |
CCM |
| 3. | Human Rights and Inclusion: Ensuring meaningful participation of people living with HIV, TB and key affected populations in design, implementation, and monitoring of Global Fund-supported programs, including an assessment of any legal or policy barriers to service access, and designing programs to address those barriers | Assessment included in the WHO/ECDC Report on NTP Programme ReviewFocus groups/Interviews/meetings conducted among TB patients, key affected populations and MARPs15th of June 2014 | CCM |
| 4. | National, Donor & Global Fund investments: Mapping the funding landscape and ensuring alignment and complementarity between donor and national funding in the overall budget for the disease response | – National Health Strategy approved by the Ministry of Finance/GovernmentDeadline: December 2014- Negotiations with Ministry of Finance to increase domestic contribution for TB & TB-HIV – COUNTERPART FINANCING– National TB Strategy elaborated and approved
Deadline: August 2014 |
MoH |
| Assessment of CCM governance re. compliance with all GFATM eligibility requirements and minimum standards and implementation of actions | Technical assistance under discussion with GFATMAugust 2014 for requirements 1 and 2December 2014 for requirements 3,4,5 and 6 | CCM Secretariat, GFATM TA | |
| Nomination of Principal Recipient, election of CCM Chair and Vice-chair | June 2014 | CCM | |
| Submission of Norway Second Proposal | June 2014 | MoH | |
| 7. | Elaboration of the Concept Note | June – 1st of September | CCM |
| 8. | Implementation Arrangement Mapping | September 2014 | CCM, PR |
| 9. | Risk and Implementer Capacity Assessment | September 2014 | CCM, PR |
| 10. | Endorsement of Concept Note | September 2014 | CCM |
| No-cost extension of the grant ROM-607_G04T-TFM– treatment, monitoring and evaluation for MDR-TB patients- social and psychological support for MDR-TB patients for maintaining treatment adherence;- social and psychological support for homeless TB patients;
– grant management activities |
1st of October 2014– 3oth of March 2015 | PR | |
| Submission of the Concept Note to GFATM | 06 October | CCM | |
| 12. | Review of the funding application by the TRP (Technical Review Panel)
|
November2014 by TRPDecember 2014 by GAC 1 | GFATM |
| 13 | Endorsement of the strategy by the Government | December 2014 | Government |
| Grant making | January /Feb. 2015 | GFATM | |
| 15. | GAC 2 (Global Fund’s Grant Approval Committee) Review | March 2015 | GFATM |
- Structure of the country dialogue
| Action Plan for organizing and implementing Country Dialogue to develop a “Concept Note” for Global Fund grant within the New Funding Model for Romania | |||
| No. | Action |
Responsible parties | Completion date |
| 1. | Collecting CCM members’ proposals
regarding key interventions to be included in the draft Concept Note |
CCM Secretariat | by end of May 2014 |
| 2. | Meeting of Working group, CCM
with participation of WHO consultant on TB National Strategy |
CCM Secretariat,
CCM and working group |
By the end of 20th-30th of June 2014 |
| 3. | CCM meeting
Election of CCM Chair and Vice-chair PR Endorsement of the no-cost extension decision for the grant ROM-607_G04T-TFM |
CCM Secretariat,
CCM |
By the end of 20th-30th of June 2014 |
| 4. | Revision of current TB Strategy – 1st draft | CCM SecretariatMoH & WHO | By 15 July 2014 |
| 5. | Main joint TB/HIV issues to be tacked in the concept note through joint official letter | Marius Nasta InstituteINBI – to be confirmed | 1st of July 2014 |
| 6. | Consultation with key affected population and vulnerable groups
regarding key interventions to be included in the Concept Note(check if PWID, homeless etc. were included in the WHO consultation/focus groups + define “MARPs”) |
Organisations and institutions working
with affected populations and vulnerable groups |
by 1sf of July 2014 |
| 7. | Meetings with national stakeholders:
NGOs and state-run institutions working in TB domain (*Roma NGOs, family doctors etc.) |
working group(*monthly meeting of the WG, ) | by 1st of July 2014 |
| 8. | Meetings with national stakeholders:
NGOs and state-run institutions working in HIV domain |
CN working group | by 15th of July 2014 |
| 9. | Meeting on review of Draft CN | CCM Secretariat, CCM and working group | by 18th of July 2014 |
| 10. | National TB Strategy – final draft – submitted for endorsement | MoH | 1st of September |
| 11. | Review of CN | CCM Secretariat, CCM and working group | Before 7th of October |
| 12. | Endorsement of CN by CCM | CCM Secretariat and CCM | By 7th of October |
*transparency – communication and updates on the CD on the CCM website
- CCM eligibility, composition and requirements
Current status: 32 members
Membership: GOV, MLBL, EDU, PLWH, NGO, PS
| Requirement | Status | Action |
| Requirement #1 | Met | Regular review |
| Requirement #2 | Met | Regular review |
| Requirement #3 | Not met | Need for technical assistance |
| Requirement #4 | Not met | Need for technical assistance |
| Requirement #5 | Not met | Need for technical assistance |
| Requirement #6 | Not met | Need for technical assistance |
- CCM requirements to be fulfilled with technical assistance
The request for technical assistance was sent by the ROM CCM Vice-chair on May 22nd for GFATM Secretariat approval.
- Sustainability
In order to insure the sustainability of these interventions, constant financing from domestic or international sources has to be guaranteed. A clear commitment should be made by the government to contract the World Bank loan and to adapt the European Structural Funds to the needs identified in the TB and HIV health systems.
Annexes
Annex 1: Background information
Annex 2: Status of TB and HIV epidemics
Annex 3: Resources provided by international donors
Annex 4: Conclusions of the Panel Discussions regarding main priorities to be articulated in the Concept note
Annex 5: National working group for revising the TB National Strategic Plan and developing a TB Concept Note for the Global Fund – Terms of reference
The resolution is signed by the Country Coordination Mechanisms members:
National Institute for Infectious Diseases “Prof. Dr. Matei Bals”
Ministry of Health
Ministry of Labour, Family and Social Protection – General Directorate for Persons with Disabilities
Ministry Of Labour, Family, Social Protection and Elderly People
National Antidrug Agency (ANA)
Ministry of National Education – The General Department of Lifelong Education and Learning
Ministry of Defence, Preventive Medicine Centre
Ministry of Justice- National Administration of Penitentiaries
Ministry of Labour, Family and Social Protection-General Directorate for the Child Protection
Association of Patients with MDR-TB
Romanian Association of TB Patients
National Federation of Organizations of PLWHA (UNOPA)
Pneumology Institute “Prof. Dr. Marius Nasta”
The National School for Public Health and Sanitary Management
UNICEF Romania
WHO Romania
Romanian Angel Appeal Foundation
Close to You Foundation (ADV)
Accept Association
Foundation for People Development
Save the Children Romania
ARAS (Romanian Association against AIDS)
Youth for Youth Foundation
Centre for Health Policies and Services (CPSS)
Romanian Red Cross
ALIAT Association
Society for Contraceptive and Sexual Education
Population Services International Romania (PSI)
Health Aid Romania
Integration Association
Romanian Harm Reduction Network (RHRN)
The Romanian Association of International Medicine Manufacturers (ARPIM)
Acknowledged by Ministry of Health,