Last Updated on: 26 January 2016
2. Pharmaceuticals & Health Product
expenditures vs budget $ 11,662,754 $ 18,966,115
2a. Medicines & pharmaceutical products $ 9,095,648 $ 14,494,452
2b. Health products and health equipment $ 2,567,106 $ 4,471,663
Reason for variance
Reason for adjustments
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date
0 15.Jun.10 - N/A 1 15.Jun.10 -
31.Dec.10 8,471,904 € 8,472,904 23 Jun 2010 Summary of Progress Reasons for variance between PR Request and Actual Disbursement This is the first disbursement no variance
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 1 15.Jun.10 -
30.Sep.10 B1 2 01.Oct.10 -
31.Mar.11 681,350 N/A
Summary of Progress Reasons for variance between PR Request and Actual Disbursement This PU/DR was received at the same time as the subsequent PU/DR and thus the disbursement request was treated as integral to the subsequent PU/DR (see below disbursement for period Jan-June 2011).
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 2 01.Oct.10 -
31.Dec.10 B1 2 01.Jan.11 -
30.Jun.11 1,302,884 € 842,399 07 Apr 2011 Summary of Progress Reasons for variance between PR Request and Actual Disbursement Based on the cumulative results as reported until 31
December 2010, the grant performance rating is calculated at B1 or “Adequate”. This result is mainly due to the delayed activities under two training indicators (2.1 “Number of health workers/doctors trained” and 5.1 “Number of county level staff trained”, achieving 4% and 16% of the target respectively).
With the exception of these two indicators, the overall performance of the grant is very satisfactory, with a majority of indicators reaching 90 to 100% (or higher) of their cumulative targets for the period.
The PR’s financial performance has been evaluated less positively, given a cumulative expenditure rate of 15% only.
Due to the slow financial performance, we have reduced the disbursement amount by 20%. In addition, the budget for the following items was removed:
1) Recovery costs in the amount of 68,885.60 EUR;
2) Remaining balance of the HR budget: 181,000 EUR.
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 3 01.Jan.11 -
31.Mar.11 A2 3 01.Apr.11 -
30.Sep.11 5,287,961 € 2,410,230 19 Jul 2011 Summary of Progress Reasons for variance between PR Request and Actual Disbursement
This is the first tranche of the fourth disbursement which covers the funding for first-line TB drugs. The remainder of the PR's disbursement request is under review and will be processed as a second tranche.
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 3 01.Jan.11 -
31.Mar.11 A2 3.1 01.Apr.11 -
30.Sep.11 5,287,961 € 2,815,175 26 Oct 2011 Summary of Progress Reasons for variance between PR Request and Actual Disbursement
The PR's forecasted budget for Q4 was 7,044,078 EUR, based on the revised workplan/budget (inclusive of outstanding commitments or "back log activities" from previous periods). This was corrected to 7,022,521.42 EUR based on approved reprogrammed budget. Unicef and WHO overheads had been previously disallowed but based on recent discussions in-country the Country Team agreed to disburse these in advance systematically (to be reconciled with actual expenditure at a later stage).
The forecasted budget for Q5 (buffer) is 4,907,580.36 based on the approved budget.
As a result the total forecasted amount for the period is 7,022,521.42 (Q4) + 4,907,580.36 (Q5) = 11,930,102 EUR (rounded), from which we deduct:
- PR cash balance: 5,821,298 EUR
- Cash in transit (07/04/11 disbursement #3 + 19/07/2011 disbursement
#3.1, which was made after PR submitted the PUDR): 842,399 + 2,451,230 = 3,293,629 EUR
The final disbursement amount is: 11,930,102- 5,821,298 - 3,293,629 = 2,815,175 EUROS
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 4 01.Apr.11 -
30.Jun.11 A2 4 01.Jul.11 -
31.Dec.11 4,896,880 N/A
Summary of Progress Reasons for variance between PR Request and Actual Disbursement Programmatic performance in this period has been
excellent, with all indicators achieved or overachieved but one (#1.4 "Number of fully functional microscopy centers in place") which nonetheless reached 87% of its target for the period.
Average Top Ten indicator achievement was 111%.
Financial performance in this period remains slow - however this is mainly due to the need to reprogram a number of activities in order to respond to increased procurement costs.
The PR's cash balance remains high at 5.8 million EUR while the cumulative expenditure rate has increased from 15% to 20%. In the period under review, the PR's expenditure rate was 52%
(including disbursements to SRs - it was 29% if these are not counted). A reprogrammed budget was approved with an increased procurement budget which had not yet been implemented at the close of this PU, and which accounts for 93% of the underspend in this period (and 50% of the cumulative underspend).
As noted previously, the PR's high cash balance is not reflective of actual availability of cash due to the fact that large sums are in fact requisitioned amounts (i.e. "blocked" for a specific activity line in the system, thus not available for reallocation to other purposes - see "committed amounts" in PR forecast).
In view of the above factors, while the PR's financial performance is not yet satisfactory, it is expected that the implementation of the procurement budget in the next periods will allow the PR to catch-up on its expenditure rate, so overall this is not a cause for
During the clarifications process, it was found that the PR had made substantial errors in their disbursement forecast, and in light of the amount disbursed in October (against the previous PU), no disbursement was in fact needed.
Last Updated on: 26 January 2016
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 5 01.Jul.11 -
30.Sep.11 A2 4 01.Oct.11 -
31.Mar.12 N/A
Summary of Progress Reasons for variance between PR Request and Actual Disbursement
Last Updated on: 26 January 2016
This is a combined review based on two PU/DRs for this grant - Q4 (April - June 2011) and Q5 (July - Sept 2011). No disbursement was made against the April-June 2011 PU.
Programmatic performance in this period continues to be very strong, with all indicators achieved or overachieved (or nearly achieved) but two as follows:
- indicator #1.4 "Number of fully functional microscopy centers in place" reached 74% of its target for the period, compared to 79% in the previous period. This decrease is due to the delays in procurement of new microscopes for replacement of the old ones currently in use - with the completion of the procurement process it is expected that the results for this indicator will catch up in subsequent periods.
- indicator #5.1 "Number of county level staff trained in program management" reached 80% of its target (382 trained against 475 planned). However the PR had reported this result as overachieved by including trainings which were funded by the local
government. Overall result is acceptable.
Average Top Ten indicator achievement was 104%.
A1 rating is appropriate.
Impact indicator results were reported for the year 2010, which can only be partially linked to the Global Fund grant (which was started in mid-2010 and for which drugs were not delivered until March 2011):
- TB incidence rate: 345 / 100,000 (no significant change of trend since 2008)
- TB mortality rate: 23 / 100,000 (per WHO report), showing a significant decrease from the 2008 baseline of 39
In the case of outcome indicators, the results cover the whole first year of the grant (June 2010-June 2011) and show achievement of targets overall, as follows:
- TB case detection rate: 81% (against 74% target).
- Treatment success rate: 90% (against 85% target).
This figure is relatively stable over the past few years.
- Case notification rate: reported as 436 / 100,000 by National TB Program (against 374 target). Overall trend shows gradual increase, which may be due to improved access and involvement of other sectors for TB care (per WHO).
Financial performance remains slow for this grant with a 12% burn rate against this period's budget and a 22% burn rate cumulatively. The variance is mainly attributable to procurement
(pharmaceuticals/health equipment = 65% of underspend) and HR budgets (15% of underspend) which have been slow to implement. In the case of the former, there have been delays in
procurement/delivery of drugs to the country (although most amounts are in fact "committed"
expenditure, pending delivery and payment); in the case of the latter (HR), it should be noted that delays in implementation are caused by the fact that budgets for HR were frontloaded for 2 years in Q1 - so a delay in recording expenditure is expected.
In light of the above factors, a substantial portion of the underspend can be considered as commitments - and the revised cumulative expenditure rate would be 74%, which is acceptable generally speaking.
Consistent with the above comments, the PR's cash balance appears high (7.8 million USD, of which 7.6 million are commitments).
No disbursement is requested at this stage.
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 6 01.Oct.11 -
31.Dec.11 A2 4 01.Jan.12 -
30.Jun.12 N/A
Summary of Progress Reasons for variance between PR Request and Actual Disbursement Of 13 indicators, 2 in the SDA of MDR TB are not
due for reporting. Of the remaining 11 indicators, 7 have achieved or overachieved the targets.
While indicator 1.2 Number of new smear positive TB cases registered during the reporting period continue to perform at 96% with no improvement from last Qr, 3 other indicators show low performance as follows:
1.4 Number of fully functional microscopy centers in place (71%). This achievement is lower than the last Qr.( 74%) as 2 more microscopes during this period have broken down making these centres non functional. With the distribution of 100 new microscopes at end of the reporting period, this situation will improve. However, due to lack of a proper plan to train the concerned staff on use of new microcopes as well as indecision with regard to suitable places for installation of the new
microscopes in the microscopic centres, it will take time for their full functioning;
1.5 Number of laboratories showing adequate performance among those that received External Quality Assurance (EQA) for smear microscopy during the reporting period (76%). This result is also lower than that of last Qr. (81%). The low figure is due to fall in number of laboratories that have undergone EQA. Only 219 out of 258 existing laboratories have received EQA;
5.1 Number of county level staff trained in TB program management (67%). Again, this result is lower than that reported in last Qr. (80%). This is a Top 10 indicator. tied to the current grant and no training has been conducted during this reporting period. Last training for 382 county level staff took place in Qr.4. Further work plan and budget do not show any allocation for such an activity for this Qr.
while it has a budget but for Qr.8 only. PR has included the 264 trained under the National Program with government funding in reporting the results based on GFATM's agreement to change the targets from "tied to current grant" to "tied to national program" (Enkhjin e-mail of 13 Dec. 2011 refers). If considering that GFATM has agreed to change the target to be "tied to the national program", it is acceptable that PR has included the number of participants (264) trained under the routine national program. In such a case, the target achievement would be 113% (646/570).
Of the 6 Top 10 indicators, 5 show achievement of target while 1 training indicator 5.1 as above mentioned is showing low achievement (67%) but indicator 5.1 has a target achievement of 113% if considering GFATM's agreement to change the nature of the target. Top 10 Indicators rating is A1 (101.5%) if considering the Indicator 5.1
achievement rate at 67% and the rating is still A1 (109%) if considering the Indicator 5.1 achievement rate at 113%. All Indicators rating is A2 (96%). The final quantative rating is A1, however the grant rating is downgraded to A2 owing to procurement delays and delays in the MDR-TB program start-up.
In light of the large cash balance available at PR level, a disbursement is not required against the forecast for this period.
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 7 01.Jan.12 -
31.Mar.12 B1 5 01.Apr.12 -
30.Sep.12 1,242,098 € 1,051,045 24 Aug 2012 Summary of Progress Reasons for variance between PR Request and Actual Disbursement Grant performance was very good in Period 6 with a
quantitative indicator rating of A1 and an average indicator performance of 103%. Detailed results and rating appear in the attached Grant Rating Tool for the same period.
At the end of Period 7 however, the quantitative indicator rating had gone down to B1 - mainly as a result of a "zero" achievement rate for Top-Ten indicator #4.2 "Number of MDR-TB cases initiated on MDR-TB treatment". While MDR-TB case detection had progressed in this period to reach the
anticipated target (25 cases or 100% achievement), delays in procurement of second-line drugs have caused delays in enrolment of same patients on treatment. However it is acknowledged that the transition period and unclarity in GLC-related requirements in the second half of 2011 were partially a cause for this delay.
On the other indicators, the results are satisfactory overall, with an average performance of indicators of 95% (all indicators). In particular, treatment success rate is 90% (106% achievement of target), and cases registered were 21,747/22,180 (98%). Progress on the refurbishment and equipment of microscopy centers was also made, although the results are still below target (85%).
The disbursement decision is based on the following calculations:
A: Forecasted carry-over activities and outstanding commitments from Q1-Q7 (ending March 2012): 5,811,982 EUR
B: Approved budget for April-Sept 2012 = Q8 (219,443) +Q9 (2,775,082 EUR) = total 2,994,525 EUR
C: PR cash balance: 7,755,462 EUR
Equals A + B - C = 5,811,982 + 2,994,525 - 7,755,462 = 1,051,045 EUR
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 8 01.Apr.12 -
30.Jun.12 A1 6 01.Jul.12 -
31.Dec.12 5,396,247 $ 5,519,029 06 Dec 2012 Summary of Progress Reasons for variance between PR Request and Actual Disbursement The overall performance during the reporting period
was excellent. The results for Y2 for the two impact indicators are not yet available - the WHO Global TB Report 2012 has not been published yet. All the targets for the three outcome indicators are met or exceeded. Out of 13 output indicators, 10 have nearly met, met or exceeded their intended targets, 3 have achieved 74%, 84% and 89% (Number of lab-confirmed MDR-TB patients detected,
Number of MDR-TB patients initiated on MDR-TB treatment, and Number of fully functional microscopy centers in place). The performance of the MDR-TB treatment indicator could have been better if not for the problems with quality of an MDR-TB medicine (Cycloserine), which was found to have irregularities when QA/QC was conducted by the PR at a qualified lab. A certain batch of these drugs had to be replaced, and the replacement shipment arrived at the very end of this reporting period (on 25 June 2012).
The PR included an amount of 432,967 as a recovery fee from the catch-up activities (funds that are allready at the PR's bank account and are charged the recovery fee of 7%), The GLC fee of 25,000 is not paid for the Year 2 of the grant. This is being added to the forecast. The GLC fee payment (for the Year 2 and Year 3) is made separately.
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 8 01.Apr.12 -
30.Jun.12 A1 6.1 01.Jul.12 -
31.Dec.12 25,000 $ 50,000 06 Dec 2012
Summary of Progress Reasons for variance between PR Request and Actual Disbursement The overall performance during the reporting period
was excellent. The results for Y2 for the two impact indicators are not yet available - the WHO Global TB Report 2012 has not been published yet. All the targets for the three outcome indicators are met or exceeded. Out of 13 output indicators, 10 have nearly met, met or exceeded their intended targets, 3 have achieved 74%, 84% and 89% (Number of lab-confirmed MDR-TB patients detected,
Number of MDR-TB patients initiated on MDR-TB treatment, and Number of fully functional microscopy centers in place). The performance of the MDR-TB treatment indicator could have been better if not for the problems with quality of an MDR-TB medicine (Cycloserine), which was found to have irregularities when QA/QC was conducted by the PR at a qualified lab. A certain batch of these drugs had to be replaced, and the replacement shipment arrived at the very end of this reporting period (on 25 June 2012).
The GLC fee of 25,000 is not paid for the Year 2 of the grant. This is being added to the forecast. The GLC fee payment (for the Year 2 and Year 3) is made separately.
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 9 01.Jul.12 -
31.Dec.12 A2 7 01.Jan.13 -
30.Sep.13 21,045,635 $ 6,527,030 14 May 2013 Summary of Progress Reasons for variance between PR Request and Actual Disbursement The overall performance during the reporting period
was very good. Impact and Outcome indicators were not due for reporting with this PU/DR. Of the nine programmatic indicators, 7 were due for reporting in this period, of which 4 indicators met or exceeded their targets and 3 indicators achieved 93% or more of their targets. The lowest achievement was noted for the indicator 1.2 “Number of new smear positive TB cases notified” where it was at 93%.
Average performance on TOP 10 indicators is 97%
(A2). Average performance of all indicators is 99%
(A2). As a result, compared to the previous reporting period, the indicator performance slightly dropped and is now A2 (previously A1).
The difference between the PR's request of US$21,045,635 and the Country Team’s disbursement recommendation of US$ 6,527,030 is related to the PR having re-stated the previously reported expenditure amounts and therefore also cash balance figures including the commitments in the reported cash outflow. PR is requested to provide more explanation on these differences and confirm if this is linked to the migration of the financial statements to their new financial management software (VISION).
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 10 01.Jan.13 -
30.Jun.13 A2 8 01.Jul.13 -
30.Sep.14 14,153,393 $ 2,300,000 17 Feb 2014 Summary of Progress Reasons for variance between PR Request and Actual Disbursement
The disbursement decision is based on the following calculations:
Amount approved (USD) Quarter 13-16 budget: 10,201,288
Plus, buffer period budget: 8,333,890 Add, Commitments: 4,859,132 Add, Carry Forwards: 3,169,364 Total Forecast: 26,563,674 Less, expenditure rate adjustment -9,297,286 Less, Cash balance Principal Recipient-12,233,568 Less, Cash balance Sub-Recipient - 645,804 Amount to be Disbursed: 4,387,016
This Anual Disbursement Decision will be released in two tranches:
Inmediately: 2,300,000
30 April 2014: 2,087,016 (Conditional to an update of PR's expenditure rate and cash balance as of 31 March 2014)
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 10 01.Jan.13 -
30.Jun.13 A2 8.1 01.Jul.13 -
30.Sep.14 14,153,393 $ 2,087,016 14 Apr 2014 Summary of Progress Reasons for variance between PR Request and Actual Disbursement
This corresponds to the release of the second cash transfer.
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 10 01.Jan.13 -
30.Jun.13 A2 8.2 01.Jul.13 -
30.Sep.14 14,153,393 $ 1,268,985 14 Jul 2014 Summary of Progress Reasons for variance between PR Request and Actual Disbursement
This is an addtitional disbursement due to the long lead times and urgent procurement orders to be placed before the end of July 2014, mainly related to digital x-ray machines and prevalence survey items.
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 11 01.Jul.13 -
31.Dec.13 N/A
Summary of Progress Reasons for variance between PR Request and Actual Disbursement
Last Updated on: 26 January 2016
Progress Updates Disbursement Information
PU PU Period TGF
Rating DR DR Period
Covered PR Request Disbursement Amount
Disbursement Date 12 01.Jan.14 -
30.Jun.14 A2 9.1 01.Jul.14 -
30.Jun.15 5,905,865 $ 5,450,144 20 Oct 2014 Summary of Progress Reasons for variance between PR Request and Actual Disbursement Following the analysis of the overall performance of
the program during 1 January to 30 June 2014, the Global Fund has decided to give an overall A2 rating, corresponding to meeting expectations.
the program during 1 January to 30 June 2014, the Global Fund has decided to give an overall A2 rating, corresponding to meeting expectations.