PHL-H ConceptNote 0 en

STANDARD
CONCEPT NOTE
Investing for impact against In

HIV, tuberculosis or malaria
Investing for impact against HIV, tuberculosis or malaria
A concept note outlines the reasons for Global Fund investment. Each concept note should describe
a strategy, supported by technical data that shows why this approach will be effective. Guided by a
national health strategy and a national disease strategic plan, it prioritizes a countrys needs within
a broader context. Further, it describes how implementation of the resulting grants can maximize the
impact of the investment, by reaching the greatest number of people and by achieving the greatest
possible effect on their health.
Investing for impact against HIV, tuberculosis or malaria
vesting for impact against HIV, tuberculosis or malaria

malaria
A concept note is divided into the following sections:
Section 1:
A description of the countrys epidemiological situation, including health systems and

barriers to access, as well as the national response.
Section 2:
Information on the national funding landscape and sustainability.
Section 3:
A funding request to the Global Fund, including a programmatic gap analysis, rationale
and description, and modular template.
Section 4:
Implementation arrangements and risk assessment.
IMPORTANT NOTE: Applicants should refer to the Standard Concept Note Instructions to
complete this template.
Standard Concept Note Template
14 October 2014 1
SUMMARY INFORMATION
Applicant Information
Country
Philippines
Component
Choose an item.
Funding Request
Start Date
01 July 2015
Funding Request
End Date
31 December 2017
Principal
Recipient(s)
Save the Children (SC)
Funding Request Summary Table
A funding request summary table will be automatically generated in the online grant
management platform based on the information presented in the programmatic gap
table and modular templates.
14 October 2014 2
SECTION 1: COUNTRY CONTEXT

This section requests information on the country context, including the disease
epidemiology, the health systems and community systems setting, and the human rights
situation. This description is critical for justifying the choice of appropriate interventions.
1.1 Country Disease, Health and Community Systems Context

With reference to the latest available epidemiological information, in addition to the
portfolio analysis provided by the Global Fund, highlight:
a. The current and evolving epidemiology of the disease(s) and any significant
geographic variations in disease risk or prevalence.
b. Key populations that may have disproportionately low access to prevention and
treatment services (and for HIV and TB, the availability of care and support
services), and the contributing factors to this inequality.
c. Key human rights barriers and gender inequalities that may impede access to
health services.
d. The health systems and community systems context in the country, including any
constraints.
a. Current and evolving epidemiology
The HIV prevalence in the country remains low at less than one percent. But the Philippines has
been identified in the 2012 United Nations Global Report as one of nine countries to have
registered more than 25% increase in HIV incidence between 2001 and 2011 despite the declining
trend of HIV epidemic in the world.1 As of April 2014, there was one new case reported every 1.5
hours compared to one case per 24 hours in 2007.2 Figure 1 shows the trend of HIV and AIDS
cases at the national level since the first HIV case surfaced in 1984.
18,341 Cumulative HIV Cases recorded from

January 1984 to April 2014
5000
4500
812% Increase in New HIV Cases

(2008 compared to 2013)
4000
Number of Cases
3500
3000
2500
2000
1500
1000
500
0
TOTAL
Asymptomatic
AIDS
'84
'85
'86
'87
'88
'89
'90
'91
'92
2
0
10
6
29
18
38
25
32
21
39
29
66
48
85
68
72 102 118 116 154 117 189 158 123 174 184 193 199 210 309 342 528 835 15912349333848141825
51 64 61 65 104 94 144 80 83 118 140 140 162 171 273 314 508 806 15712255315244761651
'93
11
13
11
10
18
17
21
38
'94
57
'95
51
'96
50
'97
23
'98
45
'99
78
'00
40
'01
56
'02
44
'03
53
'04
37
'05
39
'06
36
'07
28
08
20
09
29
10
20
11
12
13
14
94 186 338 174
*As of April 2014

Philippine HIV/AIDS Registry - DOH
National Epidemiology Center - DOH

Figure 1. Trends in HIV and AIDS Cases at the National Level , 1984-2014
From 1984-2014, males comprised 90% (16,412) of the cumulative HIV cases while females were
only 10%. The age groups with the most number of cases were: 20-24 years (23%), 25-29 (31%),
1
2
Department of Health (2014), AIDS Epidemic Model Impact, Modeling and Analysis, Philippine Case Study, p.5. Annex 1.
Department of Health (April 2014), Philippine HIV and AIDS Registry. Annex 2.
14 October 2014 3
and 30-34 years (19%). Ninety-three percent (17,051) were infected through sexual contact and
5% (829) through needle sharing among injecting drug users (IDUs). Males having sex with males
(MSM) was the predominant mode of transmission at 84%. Of the total 1,680 AIDS cases, 83%
were male and 17% were female. There were 981 reported deaths among people with HIV and
the majority was male at 81%. There were 116 reported deaths among youth aged 15-24 years
old and 15 among children below 15 years.
The geographic distribution of the cumulative HIV cases shows that five regions comprised 85% of
the total, while the remaining 14% came from the rest of the country (ROTC). Half (8,401) of the
cases came from the National Capital Region (NCR). Figure 2 shows the percentage by region,
1984-2014.3
Figure 2. Percentage of HIV cases by region, 1984-2014
There was a significant decrease in HIV prevalence among registered female sex workers
(RFSW) from 0.13% in 2011 to 0.07% in 2013, but the prevalence among freelance female sex
workers (FFSW) had increased from 0.68% in 2011 to 1.03% in 2013 4. However, a shift in the
predominant mode of transmission from heterosexual contact to MSM was observed in 2008. The
transmission of HIV among People Who Inject Drugs (PWID) was also detected in Cebu City in
2010. Due to changes in epidemiological evidence and the drivers of the epidemic, the National
Epidemiological Center (NEC) of the Department of Health (DOH) decided to include the most-atrisk-populations (MARPs) e.g. MSM, Female Sex Workers or FSW and IDU) in the 2011
Integrated HIV Behavioral and Serological Surveillance (IHBSS). The surveillance findings
confirmed that the concentrated epidemic among MSM and IDU/PWID is evolving in certain
geographic sites.5
In 2013, the NEC-DOH conducted the IHBSS in 21 sites among MSM, and two sites among IDU
(See Table 1). The results of the 2013 IHBSS further confirmed that HIV transmissions are now
mostly concentrated among these two key populations. Findings indicated that the national HIV
prevalence among MSM increased from 1.68% in 2011 to 2.93% in 2013. In six cities, MSM
prevalence is >4% (See Table 2). There was a significant increase in HIV prevalence among IDU
in Cebu and Mandaue from 2005-2013 as shown in Figure 3.6
Table 1. HIV Prevalence among MSM, IDU and Transgender (TG)
See Annex 1.
2014 Global AIDS Response Progress Reporting | Philippines, p.8. Annex 3.
5 Philippines Health Sector Strategic Plan on HIV and STI 2015-2020 (HSSP), p.14. Annex 4.
6 2013 IHBSS Briefer MSM and Male IDU. Annex 5.
4
14 October 2014 4
Geographic
Sites/Cities
MSM
N
MSM
TG
IDU
HIV
MSM
Bacoor
300
10
3.33%
San Jose Del

Monte
300
1.00%
Butuan
300
1.00%
Puerto
Princesa
300
2.00%
Batangas
300
1.00%
Bacolod
301
0.66%
Mandaue
305
0.00%
N
IDU
HIV
IDU
260
98
37.69%
Cebu IDU male
457
239
52.30%
Cebu IDU
female
102
31
30.39%
Angeles
300
2.33%
Baguio
299
1.67%
Iloilo
300
0.67%
Cebu
300
23
7.67%
Davao
300
15
5.00%
General Santos
301
0.66%
Cagayan De
Oro
300
14
4.67%
Zamboanga
300
2.67%
Pasay
300
3.00%
Quezon City
304
20
6.58%
Makati
300
11
3.67%
N TG
300
HIV
IDU
11
3.67%
14 October 2014 5
Table 2. Cities with the Highest HIV Prevalence among MSM, 2009-2013
Cities
2009
2011
2013
Quezon
1.4%
5.6%
6.6%
Manila
3.7%
4.3%
6.7%
Caloocan
0.7%
0.3%
5.3%
Cebu
1.0%
4.7%
7.7%
Davao
3.7%
3.0%
5.0%
Cagayan De Oro
n/a
1.9%
4.7%
Figure 3. HIV prevalence among IDU, 2005-2013
The geographic sites discussed above belong to the C45 Priority Sites (See Map 1 in Annex 6)
which have been identified in the Health Sector Strategic Plan (HSSP) for HIV and Sexually
Transmitted Infections (STI) 2015-2020 as the focus of interventions. These priority sites
contribute to more than half of the epidemic due to multiple risks and high prevalence.
According to the AIDS Epidemic Model (AEM) baseline scenario, if the current level and coverage
of interventions will be maintained, infections will continue to increase. There will be around 57,236
People Living with HIV and AIDS (PLHIV) by 2017, and this will increase to 336,181 by 2030. MSM
will continue to be the most affected population. In 2017, there will be 10,273 new infections among
MSM, accounting for 90% of all new HIV infections. This proportion will continue to increase and
reach 91% (38,643) by 2030.
To avert the rapid rise in HIV infections and contribute to systems strengthening, the AEM
recommends that the Philippines adopts a policy scenario that is focused on: Scale-up Prevention
Coverage to 80% of MSM and PWID, Sustain Prevention Coverage among FSW, and Scale-up
Treatment Coverage to 90% of PLHIV with CD4 of 350 and below.
b. Key populations
Based on the epidemiological evidence, the HSSP for HIV and STI 2015-2020 included MSM,
FFSW, RFSW, PWID, TG women and Young People (high risk) as key populations and focus of
prevention, care and treatment interventions. As shown by the current and evolving epidemiology,
the main drivers are MSM and PWID. In the HIV Concept Note under the New Funding Model
(NFM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the target groups are
MSM, PWID and TG women. Although there is no population estimate on TG at the national level,
this key population is included in the Concept Note on the basis of the preliminary data collected in
Cebu, the observation that HIV prevalence in transgender communities is estimated to be as high
14 October 2014 6
as 68% worldwide7, and the recommendations gathered from the Key Affected Population (KAP)
consultations with MSM and TG.8
Both the External Mid-Term Review of the 5th AIDS Medium Term Plan (AMTP5) conducted in
October-November 2013 and Global Fund (GF) Portfolio Analysis of the Philippines HIV and AIDS
grant (June 2014) pointed out key issues that are cross-cutting among the MSM, PWID and TG,
namely: low condom use, low health seeking behaviors and low prevention coverage and uptake
of prevention services. Although prevalence is high, only a few PWID, MSM and TG know their
HIV status. Stigma and discrimination, legal barriers and the inadequate package of
comprehensive services are the key factors preventing them from accessing care and treatment.
Males who have Sex with Males (MSM). As of 2014, there are 685,416 MSM in the country and
according to the population size estimates of AEM, 40.20% (276,583) came from Category A
sites9. Survey results from the 2013 IHBSS showed that 34% of MSM belong to the 20-24 year
old age group, majority (84%) of them are living with a partner, 50% graduated from high school
and 45% are bisexual. Findings further showed that as they grow older or when they are between
the ages of 18-24, they engage in more risky sex or the anal positions. High-risk behavior exists
among MSM as evidenced by the very low condom use during their last anal sex (36%). Only 35%
of them have correct knowledge of HIV, and less than half (31%) among the 15 years old and
above had accessed the Social Hygiene Clinic (SHC) for consultation and treatment in the past 12
months before the conduct of the 2013 IHBSS. Only 23% of MSMs were reached with prevention
interventions. Linkages between peer outreach and HIV testing, STI and other services are weak.
The External Review of AMTP5 found out that only 15% of MSM have ever had an HIV test, and in
2011, only 5% of those tested know the result. 10 The 2013 IHBSS found out that there was no
significant increase because only 8% of MSM had received an HIV test and knew the results in the
last year. This was mainly attributed to the poor quality of peer education, stigma and
discrimination.
People Who Inject Drugs (PWID). As of 2014, the AEM estimates that the number of PWIDs in the
country is 9,380, 66% (6,140) of which are from Category A sites. The HIV prevalence among
male PWID in Cebu City reached 52.3% in 2013. The HIV prevalence among female PWIDs in
Cebu City is also high at 30.39%. The median age of first drug use among males was 16 years
old, while the median age of first injected drug use among males was 19 years old. Ninety-eight
percent of them injected nalbuphine, with an average of three injections per day. HIV knowledge is
low among PWID (only 35% correctly answered 5 questions about HIV) and 35% had shared
needles during their last injection.11 The shooting gallery in Cebu City was the place where 70% of
male IDU usually injected drugs while 10% do it at home. At least 31% of them got needles from a
clean source and did not share needles in their last injection. Many of them (53%) knew that there
were STI services at the SHCs and stated that they were comfortable to go to the SHC for STI
consultation. However, the level of knowledge did not translate into actual access of services as
shown by the low access of SHC services (only 10%). There was a decrease in the percentage of
male IDU who got their HIV test result in the past 12 months from 9% in 2011 to 6% in 2013. Most
of them (43) cited that they forgot to get the results. Moreover, there was an increased risky sexual
behavior among them as indicated by the decrease in condom use with their permanent female
partners from 27% in 2011 to 17% in 2013.
Like MSM, the current HIV prevention program among PWID is minimal and the coverage is low.
In antiretroviral therapy (ART) enrolment, lost-to-follow-up among PWID is a major problem.
Overall, the scale of harm reduction interventions particularly the needle and syringe program is
insufficient to generate any measurable impact on the spread of HIV in this KAP. This situation
requires an enabling environment that promotes health-seeking behaviors, that is supported by
national laws or local ordinances that will allow the implementation of a harm reduction program.
Transgender (TG). Except for the 2013 IHBSS data in Cebu City, there is no official estimate on
the total number of TGs in the country. There is no current surveillance data in the Philippines to
7
International AIDS Society: Key Affected Populations Fact Sheet, March 2014. Annex 7.
Compiled Reports on Recommendations from KAP Consultations. Annex 8.
9 Category A, B and C sites are part of the DOHs priority areas for HIV intervention which shows the cities and municipalities that have
been identified as the highest priority for intervention. Category A sites are those cities requiring the highest priority followed by
Categories B and C.
10 Philippine National AIDS Council (2014) External Mid-Term Review of the 5th AIDS Medium Term, p. 54. Annex 9.
11 See Annex 5.
8
14 October 2014 7
show the magnitude of HIV among TGs. Neither is there any official definition of transgender in the
Philippines, although almost exclusively when the term transgender is used, it refers to
transgender women. A 2011 survey of TG women in three sites showed differing definitions of
transgender among the group, but most frequently, TG people define TG as someone who was
born male, had taken female hormones and/or someone who looked and acted like a woman
(although this is subjective). Further, there is a perception that TGs are engaged in sex work in big
cities, such as Metro Manila and other highly urbanized areas 12. One of the hindering factors
determining HIV prevalence among TGs is the lack of effective and quality intervention services
that are customized to their needs.
Fifty percent of the 300 respondents in the 2013 IHBSS for TG in Cebu City belong to the young
age group of 18-24 while 31.7% came from the older age group. Majority are single (97.3%), 60%
said that they were TG while 39.7% identified themselves as female. Majority of them (97.3%)
graduated from high school. Of the 300 TG sex workers sampled, 60% were engaged in full-time
sex work (sex worker without other occupation) while 40% were sex workers with other
occupation. In the youngest age group 15-17 years old, almost 87% were sex workers without
other occupation.
In terms of their sexual behavior, most had an early initiation to sex with the youngest at 11 years
old. The median age for oral sex was 13 while first anal sex was at the age of 17. The average
number of male sex partners in the past 30 days prior to the interview was nine (9). The median
age for first condom use was 18 and some did not know how to use a condom (19.7%). Older TGs
have higher number of sexual activities which ranged from oral to anal sex.
It is evident from the responses that information and communication technology (ICT) tools were
popular among TGs as a channel for social interaction and sexual activities. Majority of the TG
(97.0%) have an account in a chat messenger, website, online social network, or mobile application.
Male partners or sex clients were met through these Internet sites. More than a third (35.7%) of the
respondents reported having oral sex partners met through online accounts and 35.5% reported
having anal sex partners met through online accounts. Of those who reported having had oral sex
with partners met through online accounts, the average is 11 oral sex partners. The same average
number is computed for those who had anal sex with partners whom they met from online accounts.
Facebook has the highest proportion of membership (86.9%) followed by Ladyboy Kisses (44.3%).
Yahoo, Twitter, Skype and Date in Asia and person.com were also identified as popular venues
for TG.
Apart from risky sexual behavior, at least 20% of them reported to have used drugs in the past 12
months, and four of them have used needle and syringe already used by another IDU. Of the
respondents, 20% reported to have used drugs in the past 12 months. A third (32.6 percent) of
those in the 25 years and older age bracket were highly engaged in drug use. Knowledge of HIV
transmission is also low with only 50% able to answer correctly all five knowledge questions. Less
than half (46%) were aware that SHC in Cebu offers HIV testing and other services
TGs are a neglected population, which makes them particularly vulnerable to HIV and STI
infection; tailored prevention interventions are not available. Even though the needs of TGs are
different from MSM, no customized prevention, care and treatment services have been developed
for them. Systematic implementation of prevention services for these populations has focused on
stand-alone behavioral change communication (BCC), which did not demonstrate effectiveness in
changing behaviors among the TG people. There is a plan to address this data gap on TG
population size estimation in the 2015 IHBSS.
c. Human rights and gender constraints

The Philippines has signed and ratified core human rights instruments, including the International
Covenant on Civil and Political Rights (ICPR), International Covenant on Economic, Social and
Cultural Rights (ICESCR), Convention on the Elimination of all Forms of Discrimination Against
Women (CEDAW), Convention on the Rights of the Child (CRC), Convention on the Rights of
People with Disabilities (CRPD), Convention on the Elimination of all Forms of Racial
12
2013 IHBSS among Transgender people in Cebu City, Philippines, Statistical Report, February 3, 2013. Annex 10.
14 October 2014 8
Discrimination (CERD) and other human rights treaties. However, prejudice towards the lesbians,
gay, bi-sexual and transgender (LGBT) people continues to exist in Philippine society and
culture13. This situation is indicated by the following:
Lack of basic sensitivity and recognition of the LGBT rights
The Constitution states that the State guarantees full respect for human rights and every
person has the right to equal protection of the laws, but sexual orientation and gender
identity are not explicitly mentioned. The Revised Penal Code of the Philippines, as well
as other criminal laws, does not have provisions punishing hate crimes.
The Philippines has no comprehensive anti-discrimination law. At the LGU level, there
are only three (3) cities that have enacted anti-discrimination ordinances. These are
Quezon City, Cebu City and Davao City. Quezon Citys local ordinance specifically
focused on anti-discrimination in the workplace based on sexual orientation and gender
identity. While there are specific anti-discrimination provisions in the Philippine National
Police (PNP) Code and the Magna Carta of Social Workers, these are not fully enforced.
Stigma and discrimination among MSM continue to be a major obstacle to improving public health
interventions among MSM and increasing service coverage. The AMTP5 External Review noted
that the weak uptake of HIV testing and counseling is the most obvious result of the fear of LGBT
populations to face the results of HIV testing.
In the case of PWID, drug use in the Philippines is strictly treated as a criminal offense rather than
a social or health issue. Hence, harm reduction for HIV prevention among PWID is very difficult to
scale up at the national level.
The climate of religious conservatism which prohibits condom use and the open education on
issues such as sexual orientation and sexual reproductive health and rights also hinders MSM and
TGs, particularly the young sub-populations from accessing information and services from SHCs
and health facilities.
Gender bias against TG people is perceived as existing in health care settings and viewed as one
of the reasons for the vacuum in TG-specific services. Gender disaggregation of services for
MSM, PWID and their female partners, including the integration of reproductive health has not yet
been sufficiently addressed. This includes the lack of orientation of women to reproductive
choices; safe pregnancy; abortion and post-abortion care; and reproductive tract cancer
screening. Counseling on hormone use and referral to other gender enhancement practices for
TGs is still lacking in the current continuum of HIV prevention, care and treatment services.
Efforts are now being made to address the issue of stigma and discrimination. In 2010, the
Commission on Human Rights (CHR) has signed memorandums with civil society organizations
(CSOs) that would start projects aimed at educating and strengthening protection programs on
human rights based sexual orientation and gender identity. On 8 October 2014, the Dangerous
Drugs Board (DDB) approved a resolution authorizing the conduct of an operations research on
needle syringe distribution. The research will hopefully provide the needed evidence that will
inform policy and programming work on harm reduction for PWID.
d. Health systems and community systems

The Philippine health system is decentralized. With the passage of the 1991 Local Government
Code, the Local Government Units (LGUs) were granted autonomy and responsibility to provide
for their own health services while the DOH is mandated to provide national policy direction and
develop national plans, technical standards and guidelines on health. LGUs make up the political
subdivisions of the country covering 81 provinces, 138 cities, 1,496 municipalities and 42,025
barangays or villages. Under the devolved structure, the provincial governments are given the
responsibility to provide secondary hospital care, while city and municipal administrations are
charged with providing primary care. The DOH guides the LGUs through the Regional Centers for
13
Cited from The Status of LGBT Rights in the Philippines Submission to the Human Rights Council for Universal Periodic Review, 13th
Session, Rainbow Rights Project (R-Rights) and Philippine LGBT Hate Crime Watch, pp.1-2. Annex 11.
14 October 2014 9
Health Development (CHDs). The private sector which is composed of for-profit and non-profit
providers caters to 30% of the population. The DOH and the Philippine Health Insurance
Corporation (PhilHealth) perform regulatory functions over this sector.
The DOH leads the country response to HIV and AIDS through the National AIDS STI Prevention
and Control Program (NASPCP) while the NEC monitors and evaluates the HIV programs.14 The
NEC is in charge of generating three strategic pieces of information: the National HIV and AIDS
Registry, the IHBSS and special studies. The Philippine National AIDS Council (PNAC) is the
national multi-sectoral policy making body for HIV and AIDS and its counterpart at the LGUs are
the Local HIV and AIDS Councils (LACs).
Major reforms in the health sector were implemented through the Decentralization Law, the National
Health Insurance Act of 1995, the 1998 Health Sector Reform Agenda (HSRA) and the 2005
FOURmula ONE for Health (F1). These reforms resulted to two significant improvements: i) increase
in health insurance coverage from around 30% of the population in 1995 to almost 70% or 65.44
million Filipinos in 2013. The PhilHealth reported that 32% of coverage went to the Sponsored
Program (SP) for indigent households;15 and ii) slight increase in public spending on health from
3.3% of the Gross Domestic Product (GDP) to 4.4% in 2012.16 The Philippine National Health
Accounts reported that government health spending in 2012 was PhP 86,423 million compared to
PhP 84,139 million in 2011.17 Government spending on HIV and AIDS also increased by 118.48%
in 2014 or PhP 227,451,764 from PhP191,974,886 in 2013. 18
The overarching intent of the devolution of health services to LGUs was to make primary care
accessible to the people and improve health outcomes, but the process had also resulted to the
fragmentation of the health system. Hence, despite the succeeding reforms, there are still
remaining gaps in the health system. The referral system for example, is still very limited and lacks
systematic evaluation of its utilization by the clients. 19 Health information management system is
disjointed as shown by the weak integration of national and local health information and the lack of
health informatics standards.20
Currently, Kalusugan Pangkalahatan/Universal Health Care (KP/UHC) is being implemented to
accelerate and scale up health sector reforms through the F1 of the DOH. 21 Its intent is to continue
the process of resolving the gaps in the health system and strengthen its overall capacity to
provide equitable access to care. Its main goal is to provide every Filipino with quality health care
that is accessible, efficiently delivered and affordable. However, the implementation of the three
strategic thrusts of the UHC reform program has been affected by several challenges and
constraints:22
1) Financial Risk Protection (FRP) has been minimally addressed by PhilHealth spending. In
2012, PhilHealths total health expenditures (THE) was only 12%. Even though PhilHealth
insurance coverage has increased, it has not substantially reduced the private Out-of-Pocket
(OOP). In 2012, the THE reached 57.6% as compared to 48% in 2008. It has been noted that
despite PhilHealths progress in promoting coverage among the enrolled SP members, the
reach is still low. This is attributed to their limited knowledge of health insurance benefits and
the LGUs weak understanding of the procedures for enrollment. Given that LGUs are
dependent on the internal revenue allotment (IRA), those with limited financial resources
cannot afford the subsidized contribution requirements under the PhilHealth SP, hence the
gap in the enrollment coverage for poor urban and rural households. Among the PLHIV
patients, only 645 Outpatient HIV/AIDS Treatment (OHAT) filed claims in 2011 and 1,009
patients in 2012. The utilization rate of PhilHealth among PLHIV in 2011 was low at 19.48%
and 17.08% in the last quarter of 2012.23
14
DOH-NASPCP: Philippine Health Sector Strategic Plan on HIV and STI 2015-2020, p.4. Annex 4.
ECORYS Health Consortium: Annual Health Sector-wide Performance Assessment, April 2014, p. 12. Annex 12.
16 Health Sector Reform Agenda (HRSA) Monograph No. 10: Financial Risk Protection: National Health Care Financing Strategy of the
Philippines 2010-2020, 15 July 2010. Annex 13.
17 Philippine Statistics Authority Press Release posted on11 August 2014, pp.1-2. Annex 14.
18
See Annex 3.
19 Philippine Health Systems Review, 2011. Annex 15.
20 The International Bank for Reconstruction and Development / World Bank (2011): Philippine Health Sector Review. Transforming the
Philippine Health Sector: Challenges and Future Directions. Annex 16.
21 PhilHealth: Annual Report 2013, pp. 6-7. Annex 17.
22 ECORYS Health Consortium: Annual Health Sector-wide Performance Assessment, April 2014. Annex 12.
23 Philippine Institute for Development Studies, Discussion Paper Series 2013-38, July 2013. Annex 18.
15
14 October 2014 10
2) Improved access to quality health care facilities is focused on upgrading primary level and
other facilities to improve emergency obstetric care and neonatal care and ensuring
availability of drugs and medicines and health personnel in underserved areas. 24 The
infrastructure investments of DOH through the Health Facilities Enhancement Program
(HFEP) have significantly increased from 10% in 2008-2009 to 22% during the budget period
of 2010-2013. Availability and access to essential drugs has also improved from 2010 to 2012.
However, procurement issues have affected this KP/UHC strategic thrust which resulted to
delayed construction and upgrading of provincial facilities. There were also incidences of
stock-outs on drugs and vaccines due to the lack of systematic procurement planning at DOH.
The Annual Sector-Wide Performance Assessment25 noted that, figures on specific stockouts are not maintained at the facility or LGU level, but a field visit in one site revealed stockouts of several pharmaceuticals and contraceptives at the district hospital and primary care
facilities level. To address this constraint, procurement reforms were undertaken by the DOH
such as the development of Customized Procurement Manuals (CPM); creation of a
Procurement Oversight Committee, the Central Office Bids and Awards Committee (COBAC),
Procurement Monitoring Teams (PMT); and the incorporation of the Agency Procurement
Performance Indicators in the monitoring tool. Technical Assistance is also being proposed for
systematic improvement of the HIV Procurement and Supply Chain Management.
3) Attainment of health-related Millennium Development Goals (MDG) showed progress in
lowering infant and child mortality and reducing the prevalence of malaria and tuberculosis
(TB). MDG 6 which includes HIV has yet to be achieved as shown by the rapidly growing
prevalence as discussed in Section 1.1a. The strengthening of the LGUs HIV-response
capacity and implementation of community-based strategies are seen as key factors in the
attainment of health-related MDGs, particularly HIV through a comprehensive and scaled up
prevention care and treatment programs for KAP and PLHIV.26
Community systems context
CSOs can support the health sector in meeting these challenges. Health systems could be
strengthened through a process of collaboration, making use of civil societys expertise and
access to communities. They have played a big role in the countrys response to HIV and AIDS
such as: a) participation in planning and budgeting for the HSSP on HIV and STI; b) assisting
national agencies and LGUs in the implementation of sector-specific responses in focus
geographical sites; c) contributing to behavior change needed for HIV prevention; d) PLHIV
participation in the treatment model to implement ART with hospital-based treatment facilities
under the Global Fund-Round 6 and GFATM-Transition Funding Model (TFM) grants; e)
facilitating a strong referral network between treatment hubs and the PLHIV/MSM support groups
resulting to increased ART enrollment; f) participation in governance of HIV/AIDS; and g) psychosocial support to PLHIV.
However, non-government organizations (NGOs), community-based organizations (CBOs), PLHIV
and the KAP community can only be effectively utilized in strengthening the health systems when
their engagement is contracted in the context of partnership building. It should be noted that in the
1970s and 1980s, the CSOs in the Philippines were used as alternative channels for the delivery
of primary care or community based health programs due to the limited capacity of the
government to provide health care in rural or hard-to-reach areas. They have proven that they
were effective in delivering primary care services to poor communities. However, this approach
was not sustained because the CSOs have limitations in capacity, resources and referral
networks. Furthermore, the parallel structures further reinforced the fragmentation and nonintegrated delivery of health care services. Hence, there is a need to link the community systems
and health systems in an integrated and sustainable framework. In this way, the interest and
voices of all stakeholders in the health systems, especially the individuals, families and
communities that are in need of health services are mainstreamed in the policy process and in
governance structures. Although Local Health Boards, LACs and other mechanisms have been
created to ensure participation, more effort needs to be done at the community level where
financial, legal and socio-cultural barriers hinder access to quality care.
24
Annex 12, pp.18-19.

Annex 12, p.19.
26 Annex 14.
25
14 October 2014 11
Community System is not a parallel mechanism but a necessary base for reaching the KAP. In this
Concept Note, the community-based prevention interventions, which will be KAP and/or
community-led is considered as a vital strategic game changer in the countrys HIV response.
Central to this framework is the strengthening of community systems to ensure their proactive
engagement in the various processes of the interventions. This will entail leadership development,
innovative capacity building for peer education, community-based rapid testing, advocacy and
social mobilization, skills upgrading on project management, and skills enhancement for
negotiation and policy development for the MSM, PWID and TG communities.
1.2 National Disease Strategic Plans

With clear references to the current national disease strategic plan(s) and supporting
documentation (include the name of the document and specific page reference), briefly
summarize:
a. The key goals, objectives and priority program areas.
b. Implementation to date, including the main outcomes and impact achieved.
c. Limitations to implementation and any lessons learned that will inform future
implementation. In particular, highlight how the inequalities and key constraints
described in question 1.1 are being addressed.
d. The main areas of linkage to the national health strategy, including how
implementation of this strategy impacts relevant disease outcomes.
e. For standard HIV or TB funding requests27, describe existing TB/HIV collaborative
activities, including linkages between the respective national TB and HIV programs
in areas such as: diagnostics, service delivery, information systems and monitoring
and evaluation, capacity building, policy development and coordination processes.
f.
Country processes for reviewing and revising the national disease strategic plan(s)
and results of these assessments. Explain the process and timeline for the
development of a new plan (if current one is valid for 18 months or less from funding
request start date), including how key populations will be meaningfully engaged.
a. The key goals, objectives and priority program areas

The goal of the HSSP 2020 is for the country to maintain a prevalence of less than 66 HIV cases
per 100,000 population (0.66%) in 2020 by preventing the further spread of HIV infection and
reducing the impact of the disease on individuals, families, sectors and communities. The HSSP
has identified four strategies and objectives to guide the country response to the HIV epidemic.
1. Continuum of HIV and STI prevention, diagnosis, treatment and care services to KAP.
This strategy will ensure that the Cascade for the Continuum of Care is implemented, and
that any leaks in each phase will be addressed in order to reduce new HIV infections and
improve the quality of life among PLHIV.
2. Health promotion and communication on HIV and STI prevention and care services. This
strategy hinges on accelerating appropriate community-based information and education
to prevent and reduce risky practices among KAP, and the vulnerable and general
population. The assumption is that access to strengthened and quality prevention,
treatment and care packages can be accelerated through demand generation from the
community.
3. Enhanced strategic information systems. This strategy will ensure the systematic
collection of strategic information on HIV and other STIs among KAP that could guide
health policy, planning, resource allocation, program management and service delivery
and accountability.
27
Countries with high co-infection rates of HIV and TB must submit a TB and HIV concept note. Countries with high burden of TB/HIV are
considered to have a high estimated TB/HIV incidence (in numbers) as well as high HIV positivity rate among people infected with TB.
14 October 2014 12
4. Strengthened health system platform for broader health outcomes. This strategy will focus
on strengthening the key areas of health systems: a) leadership/governance; b) health
financing; c) human resource; d) medical products and technologies; e) information
systems; and f) service delivery.
Based on the strategies, the objectives are:
1. To improve the coverage and linkage of services from prevention and diagnosis among
KAP to treatment and care for PLHIV through an intensifies delivery of quality and
evidence based services;
2. To raise the awareness of key populations and the public on HIV and STI prevention and
care services;
3. To increase demand and access to available HIV and STI services;
4. To provide timely evidence-based information for planning, monitoring, evaluation and
quality assurance of HIV and STI programs; and
5. To intensify delivery of quality HIV and STI services through a strengthened support
system by addressing barriers, improving linkages and ensuring delivery of critical
enablers.
Given the 2013 IHBSS findings, a re-classification of the priority areas for a targeted and
calibrated HIV and AIDS intervention was done using these three parameters: a) KAP identified to
be highly affected by HIV; b) characteristics; and c) presence in these geographic areas. Category
A contributes to almost half of the epidemic, with multiple risks and high prevalence while
Category B contributes to 30 to 40% of the epidemic, with multiple risks. According to the HSSP,
these are the high priority sites in the next three years with maximum target of interventions
expected for KAP. These are selected from the previous Category A and B sites with 80% of full
investment for prevention intervention (see Table below).
Table 3. Category A and B Sites.
Category A (cities, except*) = 26
1. Paranaque
2. Muntinlupa
3. Taguig
4. Pasay
5. Makati
6. Mandaluyong
7. Marikina
8. Quezon
9. Caloocan
10. Navotas
11. Las Pinas
12. Manila
13. Pasig
14. San Juan
15. Malabon
16. Valenzuela
17. Pateros*
18. Angeles
19. Davao
20. Cebu
21. Mandaue
22. Baguio
23. Cebu City
24. Cagayan de Oro
25. Puerto Princesa
26. Bacoor, Cavite
Category B (cities/municipalities) = 19
1. Danao
2. Olongapo
3. Antipolo
4. Dasmarinas
5. Batangas
6. Cainta, Rizal
7. Imus, Cavite
8. Lipa, Batangas
9. Iloilo
10. Bacolod, Negros Occidental
11. Lapu-lapu, Cebu
12. Talisay, Cebu
13. General Santos city
14. Butuan
15. San Fernando, Pampanga
16. Mabalacat, Pampanga
17. San Jose del Monte
18. Meycauyan, Bulacan
19. Sta Rosa, Laguna
An operational plan and budget for the period 2015-2017 were developed in line with these four
strategies and five objectives to respond to the current needs and priority interventions. The
Operational Plan budget is shown in the table below.
14 October 2014 13
Table 4. Budget of the HSSP Operational Plan

Year
PhP
2015
2,933,529,906.16
2016
2,919,540,218.42
2017
3,448,159,631.81
Total
9,301,229,756.38
USD
66,671,134
66,353,187
78,367,264
211,391,585
% of Total
32%
31%
37%
100%
b. Implementation to date, including the main outcomes and impact achieved

The country response to the HIV epidemic started in 1984 after the disclosure of the first HIV case
in the Philippines. Development partners such as the United Nations Joint Program on HIV and
AIDS (UNAIDS), World Health Organization (WHO), Asian Development Bank (ADB), European
Union (EU), USAID and Global Fund provided funding and technical support to HIV and AIDS
programs implemented by the DOH, LGUs, NGOs and CBOs. Since 2004, the Global Fund has
invested a total of USD 32,404,783 in the Philippines to accelerate and scale up HIV prevention,
care and treatment of PLHIV and strengthen the health and community systems. Currently, the
Rolling Continuation Channel (RCC) Extension TFM-HIV with a grant of USD 21,776,057 is being
implemented and will end in June 2015.
Overall, the gains in HIV prevention, care and treatment that were achieved in the last 26 years
and the critical gaps that require actions have been consolidated in the AMTP5. The goal of the
AMTP5 is to prevent the further spread of HIV infection and reduce the impact of AIDS on
individuals. An External Mid-Term Review of the AMTP5 was conducted in October-November
2013 to assess the progress achieved and constraints encountered in the implementation. The
results of the mid-term review acknowledged that the Philippines had maintained the national
prevalence of below one percent of the adult population.
Program/project-specific evaluations were also conducted to assess the accomplishments and
gaps, namely: Evaluation of GF-Round 6 HIV Grant; External Evaluation of the Health Sectors
Response to HIV and STI in the Philippines; Evaluation of the HIV and STI Programs and
Strategies for MSM, TG and PWID; and program review of donor funded programs for KAPs.
Key achievements at the governance level
Enabling Policies/Legal Environment. Since 2010, PNAC has worked for the
institutionalization of HIV and AIDS response at the national and local levels. As of 2014,
considerable progress has been achieved in the policy environment that has direct
bearing on treatment, care and support area:
o
o
o
Implementation of an OHAT package in 2010. This benefit aims to increase the

proportion of the population having access to effective AIDS treatment package in
PhilHealth, which is a critical step in guaranteeing the sustainability of access to
ART treatment package;
Access to Cheaper Medicines Act ensures lower prices for antiretroviral
medicines (ARVs) and gives access to Trade-Related Aspects of Intellectual
Property Rights (TRIPS) flexibilities;
Lobbying for proposed amendments in the Philippine HIV and AIDS Policy and
Program Act of 2012, amending the Republic Act (RA) 8504 or the Philippine
AIDS Prevention and Control Act of 1998 which is now on its Second Reading in
the House of Representatives. The new law will restructure the legal framework
on HIV and AIDS by harmonizing it with evidence-informed strategies and
approaches (e.g. opt out HIV counseling and testing, positive prevention). The
revision of the National AIDS Law, if passed, will remove many non-supportive
HIV policies that are barriers to the current efforts in HIV prevention such as the
Comprehensive Dangerous Drugs Act (Republic Act or RA 9165) which prohibits
the distribution of clean needles and injecting equipment;
Other important national policies and laws are: a) HIV in the workplace policy of
the Civil Service Commission; b) Memorandum of the Department of Interior and
Local Government (DILG) on Strengthening Local Responses Towards More
Effective and Sustained Responses to HIV and AIDS which enjoins all cities and
14 October 2014 14
provinces to create the LACs; c) Referral System for the Care and Support
Services for PLHIV, a tool which was developed by the Department of Social
Welfare and Development (DSWD) to facilitate the collaboration of service
providers and LGUs in providing care and support for PLHIV; and d) The
Responsible Parenthood and Reproductive Health Act which facilitates the
education on sexuality, reproductive and sexual health, including HIV, for young
people;
At the LGU level, the Quezon City Government has passed the first antidiscrimination ordinance that specifically tackles the issues confronting the LGBT
community.
Investment Plan for HIV and AIDS. The investment plan is necessary for planning and
programming of resources and can be used as an advocacy tool for mobilizing resources.
The preparation of the LGU investment plan used the Investment Case Framework which
was adopted by UNAIDS in 2011. The framework is designed to maximize the benefits of
the AIDS response by supporting a more focused and strategic allocation of resources,
based on country/local epidemiology and context.28 Health departments in six high priority
cities (Quezon City, Manila, Caloocan, Pasay, Cebu City and Davao City) have worked
with the UNAIDS to develop local AIDS investment plans.
Civil Society Participation in Governance. Some CSOs were able to integrate their HIV
core work in the LGUs HIV programs, and have provided management assistance.
Examples of these LGU-CSO partnerships29 are: a) League of Angeles City Entertainers
and Managers (LACEM), which is an organization composed of mamasans (pimps) that
work closely with the City Health Office (CHO); b) Quezon City Pride Council, that
oversees programs and projects for LGBT; c) Batang Laging Umiiwas sa Tiyak na
Impeksyon (BALUTI), a youth-led organization composed of volunteer educators who are
former MARPS; d) Barangay Gender and Development (GAD) Focal Leaders; e) Klinika
Bernardo, LGU-owned and managed MSM clinic in Quezon City.
Strategic Information. The Philippines has developed a robust system for risk
assessment. Both the HIV and STI reporting systems capture data that allow
disaggregation by age, sex and the most-at-risk groups. The IHBSS is conducted every
two years and has produced data trends that proved instrumental in allowing the timely
detection of the recent rapid increases in HIV prevalence among PWID, MSM and FSW
beginning in 2007. On the other hand, the HIV and AIDS Registry captures initial CD4 and
symptomatic and asymptomatic cases to allow for disaggregation of cases diagnosed as
advanced HIV infection.
Key achievements at the program level

There were four major HIV programs which are focused on FSW, MSM, PWID and TG
implemented by the DOH and CSOs with funding from donors. These programs include: GF
Round 6, NFM-TFM, the ADB-funded Big Cities Project (BCP) and the USAID-funded Reaching
Out to Most-at-Risk Populations (ROMP).
Overall, the key outcomes in prevention, care and treatment are:
28
29
Decrease in HIV prevalence among registered female sex workers, which is attributed to
increased condom use with every client from 60 to 75%;
Coverage goals for HIV prevention services for KAP was reached under TFM
implementation;
Rapid increase in ART enrolment from 56 patients in 2005 to 1,274 in 2012. As of April
2014, there are 6,437 PLHIV currently enrolled and accessing ART in the 18 treatment
hubs. ART eligibility is becoming increasingly more inclusive, moving from a threshold of
CD4 count 200 in 2005 to 350 in 2012;
Establishment and operations of 522 HIV testing facilities including 29 SHCs, which
despite their limitations have contributed to increased HIV tests in the Philippines which
totaled 1.3 million in 2012;
Developing a Local HIV Investment Plan: The Experience of Quezon City Health Departments AIDS Program.
External Review of AMTP5, November 2013 p.90.
14 October 2014 15
The needle and syringe program for PWID in Cebu City is considered as a policy
breakthrough. With the One-stop Shop comprehensive harm reduction in the Cebu SHC,
a total of 115 PWID were provided with needle/syringes in 2013 and 87 in 2014.
c. Limitations to implementation and any lessons learned

Despite these achievements, there are still gaps and weaknesses that hinder the effective
implementation of the countrys response to HIV and AIDS. This discussion examines key areas
in governance such as i) stigma and discrimination policies; ii) KAP participation in HIV and AIDS
governance; iii) strategic information; and iv) procurement. At the program level, the gaps are
analyzed in the areas of prevention and care and treatment.
Governance level
Lack of Stigma and Discrimination Policies. Policies addressing discrimination and social
stigma are yet to be enacted at the national and local levels.
Insufficient engagement and participation of KAP in leadership/governance bodies. MSM,

PWID and TG have yet to be elected in LACs and participate in strategic planning, policy
making and coordinating mechanisms for HIV and AIDS response at the national and
local levels.
Strategic Information30. The following weaknesses were observed: a) IHBSS data

analysis, dissemination and utilization are limited; b) PWID sites are few considering that
needle/syringe sharing is one of the main drivers of the epidemic, and guidance on how to
assess PWID is limited; c) Mapping of most-at-risk behaviors e.g. condom use, number of
partners, needle/syringe sharing, to guide local prevention is limited; d) HIV data from
antenatal women to detect an increase in HIV prevalence is weak; e) No systematic
screening or surveillance of behaviors or HIV in prisons; f) Monitoring data of health
services is limited in analysis and dissemination due to limited number of staff. There is
limited strategic information for quality improvement; and, g) Epidemiological surveillance
and the application of new laboratory technologies along with greater dispersion of
existing technologies (e.g. rapid tests for HIV, STI, CD4 count, Viral load).
Procurement. In Section 1.1, the issues concerning procurement that caused delays in
the construction/upgrading of primary care facilities and stock-outs of pharmaceutical
products have been identified as affecting the attainment of KP/UHC strategic thrusts.
The country response, especially program implementation has also experienced
challenges concerning procurement. A major challenge in the procurement and supply
chain management (PSM) of commodities and pharmaceutical products is the process of
procurement mandated by the government. Government procurement happens on a
yearly basis where all procurement requests are consolidated and go through the different
levels of bureaucracy. The whole procurement process takes eight (8) months to
complete. Based on past experience, orders for the current year usually arrive and are
received only in the following year. This poses a risk in terms of addressing the
increasing needs for ARVs and other commodities where the orders being received will
no longer match the current needs. This can be addressed if there is a change in the
procurement system specifically for medicines. The lead times for procuring such
commodities will pose a problem on project implementation if certain treatment cycles are
missed due to the stock-out. During the second quarter of 2014, there was an issue when
one of the treatment centers ran out of stocks because the ARV drugs were not delivered
on time. Because of this, some patients had to return to the Southern Philippines Medical
Center (SPMC) every day to check on the availability of the medicines. In some cases,
the site implementation officers had to borrow medicines from other patients. The DOH
had acknowledged that there is indeed a need to improve the forecasting of ART needs of
PLHIV.
There are also some weaknesses in the warehousing. The current warehouse for ARVs
has very limited space. The warehouse space for ARV stocks is shared with other
equipment and commodities of the other projects. Without an overall physical visibility of
30
Philippine Health Sector Strategic Plan on HIV and STI, 2015-2020, DOH-NASPCP, pp. 20-21
14 October 2014 16
the stocks on hand there could be a risk of overlooking the current stocks condition and
physical management of the stocks.
Linked to the above point is the need for an effective monitoring and reporting of the
commodities. Even with the automated online stock inventory system, i.e. National Online
Stock Inventory Reporting System (NOSIRS), efficient tracking of stocks is still a
challenge. Not all of the sites have access to this system; not all are trained and have the
capacity and equipment to use this. As shown in the example above, this situation has led
to inefficiencies, i.e. urgent calls for replenishment from the main warehouse which
required unscheduled deliveries. In addition, the limited budget and staffing of the
government on the procurement and supply management side prevents the relevant DOH
unit from visiting the sites and conducting assessments. Visibility of the entire supply
chain is very crucial in effective service delivery to the beneficiary. To address these,
Save the Children will provide support in terms of staff training on handling and managing
commodities with DOH experts.
Key challenges/issues at the program level
The HSSP for HIV and STI 2015-202031 cited the 2012 Global AIDS Response Progress
Reporting (GARPR) which stated that despite vigorous interventions, there is a) consistently low
HIV knowledge among populations surveyed (FSW, RFSW, PWID, MSM). Proportions of these
populations who correctly identified ways of prevention and rejected major myths and
misconceptions remained below 45%; and b) Use of condoms among populations surveyed is
<30%, which was very low, especially among MSM and PWID (IHBSS, 2013).
Peer Education (PE). Among the issues identified in the conduct of peer education are:
a) Need for innovative PE strategies, which is linked to the lack of local research to inform
a segmented and targeted PE strategy; b) Retention of peer volunteers which affects the
continuity of services. Linked to this is the lack of standard operating procedures,
standard criteria for recruitment and engagement of PE and measures for retention of
staff. Role uncertainty and confusion also affect retention. There are no written work
contracts and agreements with the PEs, the project or clinical facility. Lack of uniformity in
stipends paid across agencies contributes to demoralization; c) PEs lack skills in
communications, to explore whether individuals had a test or to uptake treatment and
care. Many of them are not knowledgeable about handling gender-specific issues.
Overall, there is lack of segmentation in the response to PE service delivery to key
populations.
IEC, Multimedia and Online Content. The main gaps in IEC which affect advocacy and
social mobilization campaigns are: a) Availability of media. There are limited stocks of
brochures and pamphlets and many services did not retain a master copy of the approved
leaflets and brochures for reproduction; b) Content Analysis. Media and information
materials are inadequate to address the real issues that confront clients in reducing
transmission or the risk of acquisition of HIV and STI. Because of this, basic issues
regarding condom negotiation and the common reasons why people do not like using
condoms remain unaddressed; c) Online web-chat and web interactive information
services failed to provide sufficient or adequate information to sufficiently motivate the
client to attend a service to get information face to face; and d) Many of the materials
contained graphics that did not reflect the profile and needs of the population that are
most at risk.
The Implementation of Cascade for Continuum of Care under the TFM implementation shows that
overall the coverage goals for HIV prevention for KAP were achieved. However, high-risk
behaviors have not significantly changed resulting to low condom use among MSM at last anal
sex (36.7%) and needle/syringe sharing among PWID at their last injection (35%). The results for
HIV and testing are low or only 20-30% of the KAP population in TFM sites. The External
Evaluation of AMTP5 noted that the waiting period for HIV test results hinders access to timely
treatment and care. The long turnaround time for provision of results ranging from 10 days up to 5
weeks or longer is a major factor related to poor rates of return for results, and delayed entry into
treatment among MSM and PWID.
31
Annex 4, HSSP.
14 October 2014 17
Other programs like the ADB-BCP identified human resources and procurement-related
challenges in the implementation of the interventions, such as: a) Product required by the project
does not exist or has shortage locally; b) Philippines has no registered condom and lubricant copack. The concept of co-packing condoms with water based lubricant is very new to Philippines;
c) Terumo Gauge 27 needle in 1 cc syringe has shortage as expressed by invited suppliers; and
d) Lack of human resources on the ground.
The Cebu program experience among PWID in particular highlighted the following lessons in the
implementation of the harm reduction program:
SHC-based needle and syringe program (NSP) is a model that fits well in the Philippines.
Dedicated manager/staff is essential, and more trained staff are needed to ensure quality
of services and use of data.
Strong support from DOH, PWID community, NGOs from HIV-positive groups and faithbased organizations has facilitated implementation
Working with the police is possible. Increased police understanding of public health
solution to HIV crisis contributes to public security.
It was also pointed out in the AMTP5 review that there are legal barriers to service delivery among
MSM, PWID and TG such as access to treatment and counseling for minors. The Philippine AIDS
Law restricts access to testing to individuals below the age of 18 years old except when consent
is provided by a parent or guardian.
d. The main areas of linkage to the national health strategy

The HSSP for HIV and STI 2015-2020 is guided by the goal of the KP/UHC and its three strategic
thrusts which include financial risk protection, access to quality healthcare facilities and attainment
of health-related MDGs. It is linked with the National Objectives for Health 2011-2016 where all
the health program goals, strategies, performance indicators and targets are defined to make sure
that the health sector could achieve Universal Health Care by 2016. The overall direction of the
HSSP is to contribute to the attainment of MDG 6 which is focused on HIV and AIDS, Malaria and
TB. The goal of HSSP and its four strategies as discussed in Section 1.2a of this Concept Note
clearly described how this national HIV strategy will contribute to KP/UHC and in particular, MDG
6. Strategy 1 and 2 align with the thrusts to provide quality care in healthcare facilities by
strengthening the capacity of SHCs and treatment hubs and make sure that services are
accessible through facility and community based providers. Strategy 3 and 4 are focused on
strengthening health systems which include initiatives to support the objectives of PhilHealth in
ensuring financial risk protection among the poor, in particular the PLHIV. The NASPCP is
mandated by the DOH to lead the implementation of these strategies in partnership with CSOs,
private sector and development partners.
e. TB-HIV collaboration
The Philippines still ranks ninth among the 22 high-burden countries for TB. Based on the national
TB prevalence survey in 2007, the prevalence rate of smear positive TB was 2 per 100,000 while
culture-positive was 4.7 per 100,000. Bacteriologically positive TB cases in the Philippines was
estimated to be around 430,000 in 2009. Twelve million (13% of the population) were estimated to
be TB symptomatics.32 For HIV, the current epidemiological situation was discussed in Section
1.1a of this Concept Note.
The DOH considers TB-HIV co-infection as a serious challenge to HIV and TB programs in the
Philippines. Because HIV weakens the immune system, the risk for people with HIV to develop TB
as a disease is very high. It is estimated that HIV infected persons have 5% to 10% annual risk
and 30% lifetime risk of developing TB. According to the WHO33, there is a probability that people
with both HIV and TB could die far earlier than those HIV patients without TB. Also, it was
observed that TB patients with HIV infection are more likely to die earlier than TB patients who do
not have an HIV infection.
32
33
PhilPACT Sub-Plan on TB-HIV Collaboration 2014-2016. Annex 19.

A revised framework to address TB-HIV co-infection in the Western Pacific Region, WPRO 2008.
14 October 2014 18
However, data about TB-HIV co-infection in the Philippines is limited. An institutionalized

recording and reporting system to capture co-morbidity cases has not yet been developed in the
country. Only the Metro Manila CHD was able to document TB-HIV cases. In 2011, out of the
9,331 registered TB cases of the 118 Directly-Observed Treatment, Short Course or DOTS
facilities in NCR, 3,917 were tested for HIV. Only nine (9) TB patients turned out reactive.34 Data
from the NCR HIV Treatment Hubs showed that TB is the most common opportunistic infection
(OI) among PLHIV, and about 40-50% of them are TB infected.35
As a response to the TB-HIV epidemiology, the Administrative Order (AO) 2008-0022 otherwise
known as the Policies and Guidelines in the Collaborative Approach of TB and HIV Prevention
and Control was signed and disseminated in 2008. This was revised and signed into AO no.
2014-0005 on 3 February 2014.36 The NASPCP and National TB Program (NTP) collaboration is
guided by this AO.
The Philippine Plan of Action to Control Tuberculosis (PhilPACT) Sub-Plan on TB-HIV
Collaboration for 2014-2016 supports the 12-point agenda set by the WHO. The three main points
of the agenda are focused on the following: 1) Establish and strengthen the mechanisms for
delivering integrated TB and HIV services, 2) Reduce the burden of TB among PLHIV and initiate
early ART, and 3) Reduce the burden of HIV in patients with presumptive and diagnosed TB.
The key programmatic gaps that will be addressed by this Subplan are:
1. Weak carrying out or execution of NTP policies and guidelines in the provision of TB
services among PLHIV, including Isoniazid Preventive Therapy (IPT) implementation
2. Ineffective referral mechanism for TB and HIV services
3. Limited access to centralized HIV services
4. Inadequate logistics such as HIV testing kits
5. Fast turn-over of staff especially medical technoligists providing HIV testing (not all
health centers have medical technologists)
6. Uninstitutionalized recording and reporting system
The indicators for TB-HIV collaboration are:
TB-HIV Indicators
# and % of TB patients who had an HIV
test result recorded in the TB register
# and % of HIV-positive registered TB
patients given an anti-retroviral theraphy
during TB treatment
# and % of HIV-positive patients who were
screened for TB in HIV care or treatment
settings
# and % of new HIV-positive patients
started IPT during the reporting period
80% of Cat A and B Registered TB

cases and MDR TB cases
100% of HIV and TB cases
90% of PLHIV accessing HIV Thubs

care
50% of new PLHIV with inactive TB
The scope of TB-HIV collaboration would be: a) All public and private TB DOTS facilities in
Category A and B sites; b) All Programmatic Management of Drug-Resistant TB (PMDT)
treatment centers and satellite treatment centers nationwide; and c) All SHCs and HIV treatment
hubs nationwide.
To date, Provider Initiated Counseling and and Testing was conducted in Category A and B
DOTS facilities for 16 batches and 3 batches in PMDT Treatment Centers and Satellites. HIV
Profiency Training was also conducted in 3 batches at the Research Institute of Tropical Medicine
(RITM), with 13 participants in Cagayan de Oro in partnership with the Philippine Association of
Medical Technologists (PAMET), and with the Mindanao DOTS in partnership again with the
PAMET for another 30 participants.
34
PhilPACT Sub-Plan on TB-HIV Collaboration 2014-2016. Annex 19

GF-TB Grant PR/PBSP Presentation on TB-HIV Collaboration. Annex 20
36 Administrative Order no. 2014-0005. Annex 21
35
14 October 2014 19
Such initiatives need to be sustained by complementing them with other strategies such as
human resource augmentation in facilities, upgrading of SHCs and treatment facilities, improving
data recording and reporting on TB-HIV, procurement of diagnostic equipment and development
of information and education materials on TB-HIV for use in SHCs and DOTS facilities. (Please
refer to Section 3.2: Addressing TB-HIV for the interventions.)
f.
Country processes and timelines for the development of the HSSP for HIV and
STI 2015-2020 and the operational plan for 2015-2017
The DOH, through the NASPCP, engaged national, sub-national and local stakeholders including
KAP in the formulation of the HSSP Plan for HIV and AIDS and STI. This is to ensure that the
process is inclusive, participatory and that the HSSP is collectively owned. In doing this, a series
of consultations, workshops and Focus Group Discussions (FGD) were conducted which included
representatives from government agencies, LGUs, civil society and KAP communities. Presented
below is an outline of the key processes that transpired from October 2013 until September 2014.
November 2013
March & April 2014
18 March to 15 April
2014
24 April 2014
16 May 2014
28 May 2014
June 2014
3-5 June 2014
6 June 2014
10-11 June 2014
15-17 July 2014

31 July to 1 August
2014
13 August 2014
1 September 2014
2-3 September 2014
13 September 2014
22 September 2014
Dissemination of the 5th AMTP Mid-Term review findings and

recommendations participated in by DOH, LGU/SHC representatives,
CSOs/NGOs, PLHIV community and representatives from MSM, PWID, TG
and sex workers
HIV Technical Working Group Consultation meeting to:
Discuss of the AMTP5 review findings and recommendations
Develop the log frame for the HSSP
Consultation meetings and FGD with the target population among the KAP
National Stakeholders Meeting to discuss the proposed key interventions for
the HSSP for the period 2015-2017.
Technical Working Group Sub-team Meeting on the HSSP
Costing of Health Sector Plan utilizing the AEM developed primarily by DOH
NEC and UNAIDS
Dissemination of the external evaluation of the HIV and STI Programs and
Strategies for MSM, TG and PWID
Validation writeshop on the Updated HSSP for HIV and STI
Presentation of the draft HSSP to the Country Coordinating Mechanism
(CCM) in preparation for the GFATM NFM Concept Note development
First Country Dialogue on HIV and AIDS to present and discuss the HSSP
2015-2017 and the priorities that will be included in the GF NFM Concept
Note
Conduct of a workshop for the development of the Detailed Operational Plan
for the HSSP
Conduct of a workshop on the costing of the HSSP Operational Plan
Presentation of HSSP and Scope of the GF NFM Concept Note to the CCM
Validation Workshop on the Costed Operational Plan for the HSSP
Presentation of the HSSP and the GF NFM Concept Note at the Second
Country Dialogue
Community-initiated National Consultation/Discussion on the HSSP and GF
NFM Concept Note participated in by LGBT and MSM organizations
Submission of the final documentation of the HSSP by the technical writer to
DOH for approval
14 October 2014 20
SECTION 2: FUNDING LANDSCAPE, ADDITIONALITY AND SUSTAINABILITY

To achieve lasting impact against the three diseases, financial commitments from
domestic sources must play a key role in a national strategy. Global Fund allocates
resources which are far from sufficient to address the full cost of a technically sound
program. It is therefore critical to assess how the funding requested fits within the overall
funding landscape and how the national government plans to commit increased resources
to the national disease program and health sector each year.
2.1 Overall Funding Landscape for Upcoming Implementation Period

In order to understand the overall funding landscape of the national program and how this
funding request fits within this, briefly describe:
a. The availability of funds for each program area and the source of such funding
(government and/or donor). Highlight any program areas that are adequately
resourced (and are therefore not included in the request to the Global Fund).
b. How the proposed Global Fund investment has leveraged other donor resources.
c. For program areas that have significant funding gaps, planned actions to address
these gaps.
a.
Funding for program areas
The annual national health budget is part of the Social Services Expenditure Program of the
governments general appropriations. A sub-category of the health budget is the Other Infectious
Diseases and Emerging and Re-Emerging Disease which includes HIV and AIDS together with
dengue, food and water-borne diseases.
Based on the National AIDS Spending Assessment (NASA), total government AIDS spending for
2012 (USD 4.656 million) increased by 84.09% in 2013 (USD 8.579 million). The government
percentage share in the overall AIDS spending from 2012-2013 ranged from 48.41% (2012) to a
high of 59.18% (2013). Private sector domestic contributions were below 1% at 0.24% (2012) and
0.12% (2013). The biggest contributors were the external sources at 51.35% (2012) and 40.10%
(2013). Among the external sources, the largest contribution came from the Global Fund at
44.91% in 2012 (USD 4.343 million) and 22.07% in 2013 (USD 3.181 million).
The HSSP on HIV and STI 2015-2020 sets the national direction for HIV response. Part of it is the
Operational Plan 2015-2017 which contains the cost estimates for the initial 3-year
implementation. A total of USD 211,391,585 is the estimated cost of operations for HIV/STI for
2015-2017. There are four major strategies, each one of which has specific activities with the
corresponding budget for each year starting from 2015 until 2017. The strategies and activities are
further categorized as to the program areas, cost categories and fund source as reflected in the
following tables:
Table 5. Operational Costs as to Program Areas for 2015 to 2017
Program Area
Prevention
Care and Treatment
Advocacy, Communication and Social
Mobilization
Health Systems
M&E
GRAND TOTAL INDICATIVE BUDGET
Amount (US $)
Percent to Total
120,020,979
56.8%
66,216,383
31.3%
2,738,620
1.3%
20,991,933
9.9%
1,423,670
0.7%
211,391,585
100.0%
14 October 2014 21
The GARPR identified the abovementioned Program Areas to be considered in the preparation of
the Operational Plan. Among the five (5) areas, Prevention will be prioritized at 56.8% and Care
and Treatment at 31.3%. Health Systems will be 9.9% while Advocacy, Communications and
Social Mobilization and Monitoring and Evaluation will be at 1.3% and 0.70%, respectively.
The Operational Plan 2015-2017 also contains the costs of each strategy and activities. Table 6
below lists down the different cost items in the Operational Plan 2015-2017 and the percentage to
total of each cost category.
Human Resources get the highest allocation at 44.5% followed by Health Products at 20.3%.
Pharmaceutical Products is at 18.3%, Training is at 5.8% while the other nine budget line items
have percentages of less than 5% each.
Table 6. Operational Plan as to Cost Category for 2015-2017
Amount (US $)
Percent
to Total
Human Resources
94,135,444.45
44.5%
Health Products- Prophylactic
10,364,123.37
4.9%
Health Products- Reagents
21,001,814.51
9.9%
Health Products- Testing
11,644,909.16
5.5%
Pharmaceutical Products (ARV Drugs/Medicines)
24,539,144.10
11.6%
Pharmaceutical Products (Drugs/Medicines)
14,233,891.74
6.7%
Training
12,242,617.12
5.8%
Systems Strengthening and Program Coordination
5,177,720.55
2.4%
Planning and Administration
4,639,661.74
2.2%
Advocacy, Communication and Social Mobilization
3,351,517.54
1.6%
Research and Surveillance
3,075,694.36
1.5%
Infrastructure
3,029,545.45
1.4%
Monitoring and Evaluation
1,454,286.36
0.7%
Health Equipment
Living Support to Clients/Target Population / Human
Resources
Technical Assistance
949,545.45
0.4%
887,082.27
0.4%
664,587.18
0.3%
211,391,585
100.00%
Cost Category
Table 7. Operational Plan as to Fund Source for 2015-2017
Fund Source
DOH- CENTRAL OFFICE (GOP)
DOH- HFEP (GOP)
DOH- REGIONAL OFFICE (GOP)
LOCAL GOVERNMENT UNIT (LGU)
PHIC (GOP)
DEVELOPMENTAL PARTNERS (ODA)
GF TB HIV PROJECT (GF-TB HIV)
UNFUNDED
Amount (US $)
65,068,176
1,784,091
3,429,150
85,207,837
19,612,713
1,344,374
168,397
34,776,848
211,391,585
Percent to Total
30.8%
0.8%
1.6%
40.3%
9.3%
0.6%
0.1%
16.5%
100.0%
Overall, the Operational Plan37 indicates that the total government share is about 82.8%. As
shown in the table above, the biggest share among the government sector will come from the
37
HSSP Operational Plan 2015-2017. See Annex 35.
14 October 2014 22
LGUs at 40.3%. The Department of Health (Central & Regional Office & Health Facilities
Enhancement Program) at 33.2% will be the second source while PhilHealth contributions will be
9.3%.
The non-government fund source (development partners and Global Fund TB HIV Project) will
only be 0.7%. The unfunded portion of the Operational Plan 2015-2017 is estimated at 16.5%.
Financial Gap Analysis
Considering the data mentioned above in the Operational Plan for 2015-2017, Table 8 below links
the resource need contained in the Operational Plan 2015-2017 as well as that of the current year
2014 with the anticipated resources from 2014 to 2017. This table shows the matching of the
resource requirement with the potential sources that will be available for each year. Any
unmatched amount will be considered as the financial gap or the unfunded areas that will still
require resourcing.
The resource requirement from 2014-2017 is about $291.632 million ($80.240M for 2014;
$66.671M for 2015; $66.353M for 2016; $78.367M for 2017) while the total resources that will be
possibly available for the same 4-year period is $193.419 million ($15.837M for 2014; $57.327M
for 2015; $59.075M for 2016; $61.180M for 2017). There will be a financial gap totaling $98.213
million from 2014 to 2017.
Table 8. Financial Gap Analysis
HIV SPENDING
(in US Dollar)
Fund Source
Domestic:
National
& SubNational
Social
Security
Insurance
Total Govt
Private
Total
Domestic
External:
UN
agencies,
Bilaterals &
other multilaterals
Global
Fund
Total
External
Total
Resources
Resource
Need 20142017
2012
4,655,901
2014
2015
8,579,180
9,514,102
37,418
1,197,273
4,680,548
8,616,597
22,919
2016
2017
49,721,459
51,777,854
53,989,941
6,131,466
6,798,106
6,683,141
10,711,375
55,852,925
58,575,960
60,673,082
17,185
4,703,467
8,633,782
10,711,375
55,852,925
58,575,960
60,673,082
623,120
2,598,419
2,552,927
506,774
4,342,676
3,181,203
2,572,330
967,662
4,965,796
5,779,622
5,125,257
1,474,436
9,669,263
14,413,404
15,836,632
24,647
Resource
GAP
b.
2013
Proposed Investment
(in US Dollar)
499,427
506,570
0
499,427
506,570
57,327,361
59,075,387
61,179,651
80,240,452
66,671,134
66,353,187
78,367,264
(64,403,820)
(9,343,773)
(7,277,800)
(17,187,613)
How the proposed Global Fund investment has leveraged other donor
resources
14 October 2014 23
This discussion was not yet undertaken at the time of the Concept Note development, but the
Philippine Country Coordinating Mechanism (CCM) plans to facilitate a buy-in exercise among
donors for potential resource contribution to the GF-NFM funding request.
c.
Planned actions to address funding gaps
As shown in Table 8 Financial Gap Analysis, a total amount of US$98.213 million ($64.403M in
2014; $9.344M in 2015; $7.278M in 2016 and $17.188M in 2017) will be the financial gap in
resources.
While the Operational Plan 2015-2017 has initially identified possible fund sources, of which the
government through the DOH, PhilHealth and LGUs will have the biggest share, the government
will still have to exert its best effort to mobilize the resources of the identified government units. In
addition to this, the following initiatives will be undertaken to address the financial gap:
Efforts will be made to attain higher levels of efficiency, economy and effectiveness in
productivity and managing operational costs within government;
With the infusion of fresh funds, the government is expecting the favorable action by
lawmakers on the amendment of the National AIDS Law which advocates for the
appropriation of sin taxes to the HIV budget;
Conduct of Partnership Forums on HIV can be made where buy-in on contributions to the
different interventions included in the HSSP will be initiated with the participation of the
private sector and other donor agencies;
Fundraising campaign for HIV will be done through the use of media and volunteers;
The GF under the NFM and the possible above allocation funding as well as savings from
other disease programs, e.g. Malaria, are considered as possible sources in reducing the
financial gap.
2.2 Counterpart Financing Requirements

Complete the Financial Gap Analysis and Counterpart Financing Table (Table 1). The
counterpart financing requirements are set forth in the Global Fund Eligibility and
Counterpart Financing Policy.
a. Indicate below whether the counterpart financing requirements have been met. If
not, provide a justification that includes actions planned during implementation to
reach compliance.
Counterpart Financing
Requirements
i. Availability of reliable
data to assess
compliance
ii. Minimum threshold
government contribution
to disease program (low
income-5%, lower lowermiddle income-20%,
upper lower-middle
income-40%, upper
middle income-60%)
Compliant?
Yes
Yes
No
No
If not, provide a brief

justification and planned
actions
The National AIDS Spending
Assessment (NASA) report;
DOH reports
Minimum threshold on
government contribution
complied. Per financial gap
analysis table template, 64% is
the computed threshold.
14 October 2014 24
iii. Increasing government

contribution to disease
program
Yes
No
Total government contribution

to the HIV program:
2014: $10.711M
2015: $55.853M - (421%
increase from 2014)
2016: $58.576M - (4.8%
increase from 2015)
2017: $60.673M - (3.6%
increase from 2016)
b. Compared to previous years, what additional government investments are

committed to the national programs in the next implementation period that counts
towards accessing the willingness-to-pay allocation from the Global Fund. Clearly
specify the interventions or activities that are expected to be financed by the
additional government resources and indicate how realization of these
commitments will be tracked and reported.
c. Provide an assessment of the completeness and reliability of financial data
reported, including any assumptions and caveats associated with the figures.
Counterpart financing
Government investments in HIV and AIDS will be increasing compared to previous years (See
Table 8). The projected investments for 2015-2017 of the national government include the
PhilHealth which targets 100% enrollment, coverage and utilization. Resources from the LGUs
will still have to be mobilized to ensure budget allocation for HIV and AIDS programs.
The Financial Gap Analysis and Counterpart Financing Table template reflect the computed
counterpart of 64% which is way above the minimum 20% threshold requirement for government.
The Operational Plan for 2015-2017 includes focused interventions of the government on the HIV
and AIDS program. The 2015 national budget already provides for the appropriation for the
Health Facilities Enhancement Program (HFEP) which will be allocated for health equipment and
physical improvement of the SHCs and treatment hubs. The commitment of assuming the costs of
health products and pharmaceuticals as well as the procurement thereof indicates that the
government will exert all possible efforts in preventing HIV infection and strengthening access to
treatment.
The financial data for the funding landscape came from the NASA, Summary Budget of Global
Fund Existing Round 6 Grant, Operational Plan 2015-2017 and data provided by the DOH and
UNAIDS as well as the national budget prepared by the Department of Budget and Management
(DBM).
14 October 2014 25
SECTION 3: FUNDING REQUEST TO THE GLOBAL FUND

This section details the request for funding and how the investment is strategically targeted
to achieve greater impact on the disease and health systems. It requests an analysis of the
key programmatic gaps, which forms the basis upon which the request is prioritized. The
modular template (Table 3) organizes the request to clearly link the selected modules of
interventions to the goals and objectives of the program, and associates these with
indicators, targets, and costs.
3.1 Programmatic Gap Analysis

A programmatic gap analysis needs to be conducted for the three to six priority
modules within the applicants funding request.
Complete a programmatic gap table (Table 2) detailing the quantifiable priority modules
within the applicants funding request. Ensure that the coverage levels for the priority
modules selected are consistent with the coverage targets in section D of the modular
template (Table 3).
For any selected priority modules that are difficult to quantify (i.e. not service delivery
modules), explain the gaps, the types of activities in place, the populations or groups
involved, and the current funding sources and gaps.
The programmatic gap table includes seven (7) sections: treatment and care; HIV prevention for
MSM, HIV prevention for TG, HIV prevention for PWID, HIV testing and counseling for MSM, HIV
testing and counseling for TG and HIV testing and counseling for PWID.
To calculate the MSM+TG population (denominator) used in both the programmatic gap table and
the modular template, the estimated MSM+TG population in the Category A sites 38 plus the
estimated MSM+TG population in Bacoor, Puerto Princesa, Zamboanga and Cagayan De Oro
cities (cities with estimated HIV prevalence in MSM above 2%). To estimate the population in need
of HIV prevention and testing services, this is multiplied by the percent of MSM who had anal sex in
the last 12 months (67% based on the IHBSS 2013), a proxy for risk.
The TG population size in the Philippines is not known and in general, data is not disaggregated
from MSM data. However, available data suggests that about 12-15% of individuals reached by
MSM services are actually transgender. This matches closely with regional estimates that 0.3% of
the population above 15 years old is transgender39. For the purposes of developing separate
denominators, baseline values and targets for TG we have assumed that 15% of the MSM+TG
population is TG. Population size estimates for all KAP will be conducted in 2015; after this, targets
for TG reached and tested in the NFM may need to be adjusted. Further, we have used the most
recent working definition of TG40:
Would self-identify as a TG woman, but may also identify/label themselves using various
terms/labels more common in their locality
o Whose birth assigned sex is male (AND)
o Whose gender identity is more female/woman (AND)
o Whose gender expression (appearance, behaviour, attitude) is more feminine
(accepted: sometimes masculine)
May or may not have injected/taken female hormones
May or may have not undergone any body modifications (for breasts and/or hips, surgical
or non-surgical)
May have varying sexual orientations (hetero, homo, bi, poly, etc.)
The denominator used for PWID in the programmatic gap table and the modular template is the
estimated PWID population in all Category A sites. The Category A sites include the majority of
Cebu province, where injecting drug use is concentrated.
38
Category A sites contribute to almost half of the epidemic with multiple risks and high prevalence.
UNDP and Asia Pacific Transgender Network (2012), Lost in Transition: Transgender people, rights and HIV vulnerability in the Asia
Pacific Region. Annex 22.
40 Power Point Presentation of Raine Cortes, Understanding the Localized Transgender Definition, 18 December 2012. Annex 23.
39
14 October 2014 26
HIV prevention for MSM

Selected indicator: % MSM reached with HIV prevention package - defined package of services
The IHBSS 2013 (see Annex 5) found that only 12% of MSM surveyed had accessed a SHC in the
last 12 months and while slightly more (17%) had received HIV information from a Peer Educator
(PE), this is a serious gap in the national program whose prevention efforts focus on the SHCs.
This contributes to ongoing high risk behaviors in MSM, with only 37% of MSM and TG people
reporting condom use at last anal sex (IHBSS, 2013).
The 2013 IHBSS found that MSM in older age groups had riskier sexual practices: in the 15 to 17
year age group 10% practiced anal versatile sex and 22% reported anal receptive sex compared to
26% reporting anal versatile and 31% anal receptive sex in the 25 and older age group. Older MSM
are known to meet online and also at venues such as bars, saunas and other on-site sex
establishments. Outreach proposed in the Concept Note will focus on reaching MSM at these sites
and providing HIV testing and counselling on-site. A comprehensive internet based communication
strategy is also proposed with links between sites where MSM meet and information about HIV
testing.
The current TFM program of the Global Fund provides HIV prevention interventions for MSM and
TG in 12 cities (see Table 1). In the first half of 2015, two donor-funded programs (Big Cities and
ROMP) will reach MSM in the same cities as the TFM plus an additional 4 cities in Greater Metro
Manila (GMM) and Cebu (see Table 1), although funding for both of these will end in June 2015
and end of year targets are not possible. The TFM, too, will end in June 2015. The RITM program
through the DOH operates in GMM and employs MSM peer educators as change agents who
reach peers and serve as role models; this program will run for the foreseeable future.
In cities other than those covered by the TFM, RITM, ROMP or the Big Cities projects, MSM
specific programs do not exist, although the DOH is committed to providing MSM prevention
services in existing SHCs. They set a target for 80% of MSM to be reached in Category A sites by
2017.
Selected indicator: % MSM who had an HIV test in the last 12 months and know the results
The 2013 IHBSS also found extremely low rates of HIV testing among MSM at 8% and this
negatively impacts on the epidemic. The majority of HIV positive MSM are unaware of their status,
with ongoing risk behaviors and no access to treatment and care. Those that are tested and found
positive are often lost to follow up, unaware of their CD4 count and not linked to treatment and
care.
In general, while HIV testing in the Philippines is available, the focus of testing may be on the
wrong groups. For example, many overseas Filipino workers (OFWs) receive HIV testing as a preemployment requirement, but few of these are MSM. Another example, data from Manila SHC
showed that in one (1) year 1,765 people were tested for HIV for the purposes of health certificates
for work, but none of these were reactive. In contrast, only 328 were referred by friends, mainly
MSM and 21% of these were reactive41.
Few services are MSM friendly, specifically target MSM or employ MSM peers and the geographic
coverage of services is low. Further, testing services are available mostly at the SHCs which may
have restricted opening hours and be located far from MSM communities 42. It should also be noted
that the IHBSS 2013 found that 59% of MSM surveyed did not know where to get an HIV test
indicating the need for effective demand generation campaign.
41
WHO, NEC, DOH (2012), Health Sector Models to increase access to HIV counselling and testing for males who have sex with males in
the Philippines. Annex 24.
42 WHO, NEC, DOH (2012), Health Sector Models to increase access to HIV counselling and testing for males who have sex with males in
the Philippines. Annex 24.
14 October 2014 27
A barrier to HIV testing is the testing protocol. The current guidelines state that results can only be
given to someone after confirmatory testing by Western Blot at the reference laboratory. This
means that confirmed results are only available about one (1) month after the test is performed.
Further, only registered medical technologists are allowed to perform the test (see Annex 25).
Apart from pilots running in a few sites in GMM, rapid testing is not available, and even in those
sites where rapid diagnostic tests are used, MSM, TG and PWID are often asked to return in two to
three days to the SHC for results43. Many people are lost to follow-up after initial testing.
The RITM 3S Program: Smart, Safe and Sexy aims to decrease the waiting time for HIV testing
results by piloting a same day testing algorithm in certain cities in Metro Manila targeting MSM.
After two (2) positive rapid tests, patients are linked to the treatment hubs where they receive
baseline CD4 and have blood drawn for confirmatory testing at the reference laboratory using
Western blot44. This promising pilot has yet to be evaluated.
While the efforts of the TFM, Big Cities project and ROMP have improved the availability of HIV
testing services for MSM in certain Category A and B cities, including piloting the use of rapid
testing (see Table 9), all of these are unfunded from mid-2015.
HIV prevention for TG
Selected indicator: % TG reached with HIV prevention package - defined package of services
As above, the national program sets a target of 80% of TG reached with HIV prevention
interventions by 2017 with a package that includes: outreach, information, education,
condoms+lubricant and referral to other health services. In the NFM sites (13 sites with allocated
funding and 3 with above allocated funding) a target of 80% coverage is also set. In other cities,
although most are served by SHC, TG specific programs do not exist. The DOH is committed to
providing HIV prevention services to TG through the SHCs in cities outside of the NFM sites.
Selected indicator: % of TG who receive an HIV test in the last 12 months and know the results
An IHBSS of TG people in Cebu found that only 4.3% had been tested for HIV in the last 12
months and knew the result. Further, few were aware that they could receive testing for HIV at the
SHC (see Annex 26). There are no specific services for TG people which offer HIV testing in
almost all parts of the country.
HIV prevention for PWID
Selected indicator: % PWID who receive sterile needle syringe in the last year
The 2013 IHBSS found that 29% of PWID received needle/syringes from an SHC or PE in the last
12 months, which is far from both the national target and the percentage coverage which would
impact on the epidemic in this population. As a result 61% reported ever sharing injecting
equipment and 35% shared during their last injection.
The HSSP operational plan sets a target for PWID to be reached with an HIV prevention intervention
which includes: HIV information and education, condoms and lubricant, needles/syringes and
information about other health services. The targets are 55% in 2015, 68% in 2016 and 80% in 2017
in Category A sites.
The USAID-funded ROMP project and the ADB-funded Big Cities project both target PWID in Cebu
province (Cebu, Mandaue, Danao and Lapu Lapu cities), likewise the Global Fund TFM grant (in
Cebu, Mandaue, and Danao; see Table 9). However, all of these will be unfunded from June 2015
and do not have yearend targets. Apart from these, there are no other specific services for PWID,
although the DOH is committed to providing HIV prevention services for PWID through SHCs in the
cities outside of the NFM sites.
43
UNDP and Asia Pacific Transgender Network (2012), Lost in Transition: Transgender people, rights and HIV vulnerability in the Asia
Pacific Region. Annex 22.
44 3S program: Smart, Safe and Sexy (2013,) Research Institute for Tropical Medicine. Annex 27.
14 October 2014 28
Selected indicator: % of PWID who received an HIV test in the last 12 months and know the result
Only 6% of PWID have received an HIV test in the last 12 months and know their results (IHBSS,
2013), an extremely low rate particularly in a setting where the estimated HIV prevalence in this
population is 48%. It is imperative that more PWID are aware of their status, given the knowledge
and tools to prevent the further spread of HIV. Program managers also note that male PWID who
are diagnosed positive with HIV are often reluctant to disclose their status to their female partners
who may or may not also be PWID.
As above, the TFM, Big Cities and ROMP projects offer HIV testing and counseling for PWID in
Cebu Province (see Table 9) but as mentioned above, all of these are unfunded from the middle of
2015.
Table 9. Category A and B sites and Current HIV and AIDS Programs (See Annex 6 Map of New
C45 Sites)
Category TFM
Other programs
Angeles City
Cat A
TFM
Cagayan de Oro City
Cat A
TFM
Cebu City
Cat A
TFM
ROMP + Big Cities
Mandaue City
Cat A
TFM
ROMP + Big Cities
Manila City (GMM)
Cat A
TFM
RITM
Marikina City (GMM)
Cat A
TFM
Pasay City (GMM)
Cat A
TFM
Quezon City (GMM)
Cat A
TFM
ROMP
Davao City
Cat A
TFM
Caloocan (GMM)
Cat A
TFM
Pasig City (GMM)
Cat A
TFM
Bacoor
Cat A
Puerto Princesa City
Cat A
Zamboanga City
Cat A
Makati City (GMM)
Cat A
Baguio City
Cat A
Las Pinas City (GMM)
Cat A
Mandaluyong City (GMM)
Cat A
Big Cities
Muntinlupa City (GMM)
Cat A
RITM
Paranaque City (GMM)
Cat A
Big Cities
Pateros City (GMM)
Cat A
San Juan City (GMM)
Cat A
Taguig City (GMM)
Cat A
Big Cities
Valenzuela City (GMM)
Cat A
Danao
Cat B
TFM
Lapu Lapu City
Cat B
ROMP
Talisay
Cat B
Antipolo
Cat B
Bacolod City
Cat B
Batangas City
Cat B
Butuan City
Cat B
Cainta, Rizal
Cat B
Dasmarinas
Cat B
General Santos City
Cat B
Iloilo City
Cat B
Imus, Cavite
Cat B
14 October 2014 29
Lipa City
Mabalacat
Meycauayan
Olongapo
San Fernando City
San Jose City
Sta. Rosa
Cat B
Cat B
Cat B
Cat B
Cat B
Cat B
Cat B
HIV treatment and care

Selected indicator: % eligible adults and children receiving ART
In early 2015 new national guidelines for ART will be implemented, shifting treatment eligibility from
a CD4 count of 350 or less to a CD4 count of 500 or less. This will increase the number of people
who are treatment eligible; in 2015, it is estimated that 24,729 adults and children will be eligible for
treatment, an increase from 18,679 under the old guidelines. The NASPCP budget request to the
DOH will grow over the years to cover this additional need; however they anticipate that their
request will not be able to increase in line with forecasted needs. As such, the DOH will procure
70% of required drugs in 2015, 80% in 2016 and 90% in 2017. This leaves a gap of 30% in 2015,
20% in 2016 and 10% in 2017.
Overall issues with HIV prevention services
A 2013 review of peer educators and HIV prevention services in the Philippines noted weaknesses
in the current system which may contribute to ongoing risk behaviors in KAP and inadequate reach
of programs. The review made recommendations to address this including increasing coverage of
PEs, ensure that PEs are able to be gender responsive, hire female and TG peer educators, the
development of standard operating procedures and training curriculum for PEs, consistency in the
provision of stipends to PEs, reducing the case load for each PE and investment in infrastructure
improvements that allow services to grow at local level (See Annex 28).
The review also noted the importance of empowering communities to be involved in planning and
provision of services. While some TFM sites work through NGOs, in others the involvement of
CBOs and NGOs in the delivery of services is limited or non-existent.
There are also legal, regulatory and police barriers to access by KAP to HIV prevention services.
These include lack of a regulatory framework which allows the operation of needle/syringes
programs, mistreatment by police of KAP, lack of mandated representation by KAP in local
government structures and poor understanding of KAP and HIV in local government units and law
enforcement agencies.
Recently a resolution from the DDB on 8 October 2014 paved the way for the implementation of
needle/syringe programs as part of the National HIV program, but only as an operational research
project. There is still a need to translate this into local level ordinances which will allow for the
inclusion of needle/syringe programs in local government planning and budgeting.
Analysis of gaps in the HIV cascade
The design of this concept note was guided by an analysis of what had worked and not worked
during the TFM grant and other projects. Formal evaluations of the TFM, ROMP, Big Cities and
RITM projects were not available at the time of writing. However, service data from the TFM,
discussions with program managers, a 2013 evaluation of HIV prevention services in the
Philippines and a review of HIV testing options for MSM were used to identify gaps, leakage points
and issues in the HIV cascade.
It was particularly important to understand how to improve and build on the successes of the TFM
for the design of the NFM.
The analysis identified several gaps:
14 October 2014 30
1. Reach While the TFM overall met its coverage goals for HIV prevention services for KAP, the
IHBSS shows that high risk behaviors still occur, with only 36.7% of MSM and TG using a condom
at last anal sex and 35% of PWID sharing needle/syringes at their last injection. This is likely
related to the quality of Behavioral Change Communication (BCC) messaging, peer education and
outreach. Program managers noted that the PEs stated that they could not reach anymore KAP
(they had reached saturation) and that there were sub-populations of MSM, TG and PWID that
they were not finding. The TFM set a target for each PE to reach 17 new individuals a month, but
there were concerns that PEs were not able to effectively engage with these many people. Further,
there are legal barriers to KAP accessing services, including changing legislation around
needle/syringe programming. Transgender people and MSM also report police injustice and
mistreatment.
The TFM PEs currently aim to reach 17 new individuals each month and provide information, skills,
condoms and lubricant and advice on how to access SHCs; additionally for PWID they provide
needle/syringe and advice on safe injection. It was felt that the PEs were rushing to provide services
in order to meet their targets and not engaging effectively at each service contact. Also, the PEs who
were working on the program had reached saturation, that is, they had reached all KAP in their
network and were failing to identify new subsets of KAP.
2. HIV testing and results While the TFM met its targets for prevention coverage, it did not meet
targets for MSM, TG or PWID who were tested for HIV and knew the results. Only 20-30% of the
KAP population in the TFM sites received an HIV test and knew the results. The reasons for this
include long waiting times for confirmed test results (as described above); poor coverage of testing
services which are usually only performed at SHCs, which may be inaccessible due to
geographical distance to the community or unavailable due to limited opening hours or uninviting
for MSM, TG and PWID. The pilot of rapid testing protocols is only in limited sites, and confirmatory
testing at the reference laboratory is still required for confirmation of HIV.
3. Linked to care The TFM set a target for 50% of those testing positive to receive a baseline
CD4 test and they achieved this target. However, program managers felt this target was too low
and cited a lack of availability of CD4 machines as a limiting factor in high numbers of newly
diagnosed PLHIV knowing their status. It was also noted that many PLHIV were not aware of the
importance of CD4 testing nor that their CD4 count determined their eligibility for treatment.
4. Enrolled on treatment The TFM did not collect data on how many of those tested and with
baseline CD4 were then enrolled on treatment. However, the National ART registry shows that in the
Philippines the average CD4 count at treatment initiation is 165 cell/mm 3. It is likely that most KAP
in the TFM sites are also late initiators to treatment due to loss to follow-up, being unaware of their
CD4 count early in the disease or altogether unaware of their status until they are at a more advanced
disease stage.
Figure 4. Gaps in the current TFM program HIV cascade
14 October 2014 31
3.2 Applicant Funding Request

Provide a strategic overview of the applicants funding request to the Global Fund, including
both the proposed investment of the allocation amount and the request above this amount.
Describe how it addresses the gaps and constraints described in questions 1, 2 and 3.1. If the
Global Fund is supporting existing programs, explain how they will be adapted to maximize
impact.
In the Philippines, MSM, TG and PWID all have extremely low rates of access to a continuum of HIV
services and as such, the HIV epidemic in this population continues to grow unabated. Barriers to
accessing these services prevent key populations from having the knowledge, tools, care, support and
treatment which would allow them to improve their health and adopt new behaviors which would
decrease transmission of HIV in their communities.
As described above, an analysis of what worked and what did not work during the implementation of
the TFM and other programs guided the design of this concept note. The main strategy is to increase
the number of KAP who enter into each stage of the HIV cascade: reached by HIV prevention
interventions; received HIV testing, counseling and results; linked to care; enrolled in treatment
program and retained in treatment.
Reached by HIV prevention services
In terms of reach, the concept note includes strategies and interventions which will increase the
number of PWID, TG and MSM who will be reached by HIV prevention interventions, the first stage of
the cascade:
1. Increase coverage
The NFM coverage targets for HIV prevention are 80% each year of MSM and TG in 13 cities and an
additional three (3) cities with above allocated funding (see Table 10), an increase from TFM targets. By
the end of the NFM grant, the coverage in Category A cities (plus Bacoor, Puerto Princesa, Cagayan De
Oro and Zamboanga) will be 42% with allocated funding and 47% with above allocated funding. Including
domestic sources, 80% of MSM will be reached by 2017 in all Category A sites (see Table 11).
For PWID, the NFM sets targets of 60% in 2015, 70% in 2016 and 80% in 2017 in three (3) cities (with
allocated funding) and an additional three (3) cities with above allocated funding (see Table 11). By the
end of the of the grant, the coverage of PWID HIV prevention interventions in the Category A sites will
be 55% with allocated funding and 64% with above allocated funding. With domestic funding, the % of
PWID reached in Category A sites will be 80% by 2017.
The NFM will continue in the TFM sites, building on the successes of this program. With the above
allocated funding request, the NFM can: a) expand to other cities which have recently been identified
as having an HIV epidemic in MSM (i.e. HIV prevalence above 2%; Zamboanga, Bacoor, Puerto
Princesa cities); and b) Expand the PWID program to cover more of Cebu province (Lapu Lapu, Toledo
and Talisay cities).
HIV prevention services will also play an important role linking KAP to other services. Referral from HIV
prevention services on outreach will focus on referring to SHCs for STI testing and treatment, hepatitis
B vaccination. From SHC and from outreach, KAP will be referred for Prevention of Mother-to-Child
Transmission (PMTCT) and drug dependence treatment and rehabilitation. Travel costs are included in
the funding request.
14 October 2014 32
Figure 5. Referral Network
2. Provide HIV prevention services on outreach in targeted sites

The IHBSS showed that about 90% of PWID injected drugs in shooting galleries and MSM are known
to congregate in bars, spas and clubs with many also meeting partners online. In the TFM, it was noted
that PEs were not reaching certain subsets of KAP, particularly groups of MSM and TG who may be
unknown to the PEs. Currently, PEs and outreach workers do not conduct regular mapping activities
and so the NFM will support the development of Standard Operating Procedures (SOPs) for outreach
which will include guidelines on how to conduct micro-mapping and improve data collection in order to
identify new networks of KAP and target outreach to those sites where KAP live and meet.
The HIV prevention program will focus on providing services on outreach, using micro-mapping results
to identify outreach sites. Condoms, lubricant, needles and syringes will all be available at the outreach
sites. The funding request includes budget for condoms, lubricant, needles and syringes.
Table 10. Target Cities under the NFM (See Annexes 29 and 30 for Maps 2 and 3 of Cities under the
NFM Allocated and Above Allocation Funding)
City
Allocated
Cebu City(Cebu)
Above
allocated
MSM/TG
PWID
HIV
prevalence
MSM
HIV
prevalence
PWID
HIV
prevalence
TG
7.67
52.3
(Male)
3.7
30.4
(Female)
Quezon City
(GMM)
6.58
Manila City
(GMM)
6.38
Caloocan City
(GMM)
5.5
14 October 2014 33
Davao City
(Region XI)
5.0
Cagayan De Oro
City (Region X)
4.7
Makati City
(GMM)
3.7
Pasay City
(GMM)
3.0
Mandaue City
(Region VII)
Angeles City
2.3
Marikina City
(GMM)
1.9
Danao City
(Cebu)
Pasig City
(GMM)
0.33
37.7
Bacoor City,
Cavite (Region
IV-A)
3.3
Zamboanga City
(Region IX)
2.7
Puerto Princesa
City (Region IVA)
2.0
Toledo City
(Cebu)
Lapu Lapu City

(Cebu)
Talisay City
(Cebu)
3. Increase quality of outreach and peer education

The NFM will set the target number of KAP per PE to 100 per year with the aim of increasing quality
and also engaging more PEs which will expand the networks reached through the engagement of more
PEs. In deciding to decrease the case load per PE the following were considered:
14 October 2014 34
Peer educators at Quezon Citys Klinika Bernardo reported that they were frequently reporting
service contacts rather than individuals reached and that it would not be possible to reach the targeted
number of individuals;
PE will have additional responsibilities in the NFM particularly providing counseling and other
support for KP during testing, and there is an increase in targets for testing;
While coverage targets were met under the TFM, the quality of the intervention has not been
proven. Indeed, high risk behaviors continue and HIV testing rates are low in TFM sites;
It was reported that current PE had reached all the KAP in their network. Employing more PEs will
reach new networks of KAP;
Examples from other countries (India, Cambodia) suggest that for successful peer led behavior
change and linkage to testing and counseling services, each PE should have regular contact (i.e. at
least once a month) with 50-100 of their peers
PEs are volunteers who are paid a monthly allowance and are not costly;
PE evaluation described the brevity and simplicity of most PE to KAP interactions and it was felt that
a smaller case load will allow each PE to spend more time with KAP
All PEs are volunteers but receive a small allowance to cover travel and food costs. PE allowances will
be standardized across all NFM sites. The funding request includes allowances for one PE for every
100 KAP to be reached on a regular basis. Importantly, in the TFM no targets were set for number of
service contacts made per PE, the only target being to reach 17 new individuals per month. It is
important that PEs have regular contact with each KAP; in the NFM this will be defined as at least once
a month.
In addition the funding request includes budget for an international expert to provide support to CBOS,
NGOs and SHCs to develop PE training modules, improve communication and advocacy strategies,
BCC tools and effective and easy to use data collection tools for outreach.
Table 11. Baseline and Coverage Targets for HIV Prevention Interventions
Baseline
(TFM
data,
first half
2014)
MSM target prevention
allocated
MSM target prevention
above allocated
TG target prevention
allocated
TG target prevention
above allocated
MSM target tested
allocated
MSM target tested
above allocated
45
46
57,568
12,193
2015
2016
2017
Coverage
in NFM
sites45 by
2017
Coverage in
Category A
sites + other
cities46 by
2017
72,185
73,560
74,964
80%
80%
70,539
81,161
82,821
80%
80%
12,739
12,981
13,229
80%
80%
14,036
14,322
14,616
80%
80%
43,311
51,491
59,971
64%
34%
47,723
56,812
66,257
64%
37%
Thirteen (13) sites with allocated funding and an additional six (6) sites with above allocated funding.
Puerto Princesa City, Cagayan De Oro, Bacoor and Zamboanga for MSM and TG
14 October 2014 35
TG target tested
allocated
TG target tested above
allocated
7,643
9,087
10,583
64%
34%
8,442
10,026
11,692
64%
37%
PWID target prevention

allocated
PWID target prevention
above allocated
2,575
3,054
3,547
80%
80%
3,289
3,779
4,282
80%
80%
1,545
2,137
2,838
64%
44%
1,973
2,645
3,427
64%
53%
PWID target testing

allocated
PWID target testing
above allocated
1,195
388
4. Community systems strengthening

A key strategy in this concept note is the empowerment of communities to be effectively involved in
and/or lead efforts to reduce the burden of HIV in their community. This means they are involved in all
aspects of the response but particularly the following:
Planning how and where to reach members of their community through regular mapping and
planning exercises;
Reaching other members of their community to promote safer behaviors and improve health
seeking;
Either providing HIV testing and counseling, or referring members of their community to HIV
testing and counseling services;
Branding and publicizing HIV prevention commodities and related information, education and
communication tools;
Organizing and participating in regular training activities; and
Working with other stakeholders, including local government, to advocate for policy and
legislative change to support communities, reduce stigma and increase HIV prevention efforts
The CBO role in all sites will be to identify and support PE, assist in outreach and micro-mapping
activities, work in the development of SOPs, guidelines and BCC tools, conduct advocacy activities and
participate in LAC, LGU and CCM meetings. In some sites, they will be directly implementing services,
in others, they will support the SHC. During consultations with KAP, TG representatives stated that
they would prefer a safe space to meet, other than the SHC. While this type of service does not
currently exist, in select sites, the NFM will support CBOs to create such a space.
All NFM partner NGOs and CBOs will be provided with technical assistance to develop advocacy
plans, strengthen communication and networking skills, financial management, monitoring and
evaluation, accountability and governance systems. Key populations will be provided with training in
networking and communication and advocate for their inclusion in LACs, in the CCM and in the TWG.
In NFM sites with no identified NGO or CBO, nascent CBOs will be identified and provided with
technical and financial support to participate in the service network and in planning and advocacy
activities.
5. Enabling environment
Two officers will be employed to manage strategies to address stigma, legal and regulatory barriers to
KAP accessing HIV prevention and testing services:
a. An advocacy and communication officer will be hired to oversee efforts spearheaded by CBOs
including:
Developing and implementing advocacy and communication plans

Work with LACs to develop and implement stigma reduction strategies
14 October 2014 36
Work to improve communication between LACs and other stakeholders

Provide onsite training to LACs to better understand HIV, gender and sexuality, M&E, PLHIV
inclusive planning, PLHIV rights and sensitive communication
Advocate for legislation which will reduce the legal age for anonymous HIV testing (currently,
those under 18 years of age need parental approval )
Identify issues around workplace discrimination of MSM, TG and PWID and develop a joint
strategy to address this
b. A police and community liaison officer will work to provide training to police and CBOs to understand
the importance of police support for HIV prevention programs
The police and community liaison officer will be employed to achieve the following:
Facilitate meetings between law enforcement agencies and CBOs/NGOs

Facilitate development of agreements between police and services providing needle/syringes,
with an aspirational goal of documented memorandums of understanding between police and
CBOs/NGOs
Work at the regional and national level to increase police and other stakeholders acceptance
of harm reduction
Conduct training and sensitisation workshops with police to better understand the MSM and
TG populations
Develop training modules
Work with CBOs to increase legal literacy among KAP and assist in documentation related to
legal issues
6. Gender
a. Providing appropriate services for women - Women who inject drugs are often excluded from harm
reduction and other HIV services. This is because of several additional barriers that they face:
increased stigma associated with female injecting drug use; violence and other abuse; family
commitments, and lack of ease with services which are traditionally male focused. Concrete efforts to
address these are proposed in this concept note including:
Employment of female outreach workers and female peer educators at HIV prevention and
testing services;
Improved data collection about female injecting drug use in the Philippines;
A womens only room in select sites, or specific hours for female injecting drug users to visit
the drop in center
Counseling to diagnosed male partners to disclose their status to their female partners;
Referral to SHC for sexual health services, family planning;
Referral to health centers for PMTCT;
Information and education about HIV tailored for women, and,
Linking women to the womens and childrens desks in the community, as part of an enhanced
service delivery network.
b. Providing appropriate services for transgender people - Transgender people are often included in
data collection, planning and services for MSM but the lives and needs of transgender people remain
distinctly separate from those of MSM. The concept note proposes several specific measures to
address this:
Separation of services for TG and MSM, with some services designated for TG only in select
sites;
Employment of TG peer educators;
Improved data collection about TG and formative research to better understand their needs
and risks;
Provision of counseling and advice about the use of drugs for gender affirmation, including
possible drug interactions, safe injecting advice and sterile needle/syringes if necessary;
Training and sensitization of health providers about genital examination and specimen
collection for TG, and,
14 October 2014 37
While it is not known how many TG in the Philippines are men, SHC, NGO and CBO staff will
be sensitized to their needs, including the need for pap testing after hysterectomy47.
7. Young people
The TFM aimed to replicate strategies initiated by UNICEF through implementation of most at risk
children and youth (MARCY) intervention focusing on young MSM (aged 12 to 17). These are young
males who like males but may or may not have had sex with a male. The goal was the development of
preventive behaviors that reduce risk of HIV infection, including delay of sexual debut in these young
men. This activity was planned for implementation under the TFM but was delayed due to problems
with parental consent. Recently, consent for these activities was granted and so the MARCY
intervention will commence in the last quarter of 2014. In order to capitalize on what was achieved
under the TFM, the NFM will continue to support this activity. These include the following activities that
will be taken on by the PR and SRs:
Collaboration with other NGO networks engaged in policy advocacy to continue to push for policy
changes around the following:
o Amending existing laws to remove the legal barriers on HIV testing and counselling for
those below 18 years old
o Developing local plans with increased budget allocations for most at-risk young people
and the prevention of mother-to-child transmission
Mapping HIV and AIDS service delivery networks and making these known and available to
the most at-risk young people
Improving the capacity of service providers peer educators and outreach workers so they will
understand the needs of the most at-risk young people and mainstream HIV and AIDS
awareness in their daily work
Ensuring the participation of the most at-risk young people in developing key messages and
strategies to raise awareness and stigma
HIV testing and counseling

This stage of the HIV cascade is the main point of leakage in the Philippines response to HIV in KAP.
To address these gaps and build on the successes of the TFM, the following strategies to increase the
number of KAP who are tested and aware of their HIV status are included in the concept note:
1. Increase targets
In the NFM, targets for HIV testing in MSM, TG and PWID will increase to 80% of all those reached
with HIV prevention intervention tested and know the results. In year one, 60% of those reached with
HIV prevention interventions will receive HIV testing, counselling and results; in year two, 70%; and in
year three, 80%). The NFM sets an ambitious target that 100% of those tested will receive results.
The NFM will contribute to national targets in Category A sites (and other cities with high HIV
prevalence)48 for HIV testing and counseling. With the allocated funding request, by 2017 34% of MSM
and TG and 44% of PWID in these cities will have received an HIV test and know the results. With
above allocated funding request, 37% of MSM and TG and 53% of PWID will have received HIV
testing, counselling and results (see Table 11).
2. Same day testing protocol
It is believed that using rapid testing in the community is the only way that the current national targets
for testing and counseling can be reached as decentralized counseling and testing models have
repeatedly been shown to decrease loss to follow up and increase retention in care. In order to address
the long waiting time between sample collection and receipt of test results and subsequent loss to
follow-up a same day testing protocol will be implemented in the NFM sites.
In early 2015, PNAC is committed to developing new policies and guidelines for HIV testing and
counseling, including allowing people other than a medical technologist to perform the test, such as
47
48
WHO (2014) Consolidated guidelines on HIV prevention, testing and treatment for key populations
Puerto Princesa, Zamboanga, Bacoor
14 October 2014 38
outreach workers at HIV prevention services. NASPCP will validate a same day testing protocol for
inclusion in the national guidelines. Funding for these activities is provided through the TFM.
The protocol will include the use of three (3) different rapid tests, the first as a screening test and then if
the screening test is reactive a further two (2) tests will be performed in parallel. If either both of these
tests are reactive this is a confirmation of HIV. If only one of these is reactive, the client will need to
receive confirmatory testing using Western blot; however it is expected that this will occur rarely. After
a confirmed HIV test, the client will be accompanied by the outreach worker to the Treatment Hub for
baseline CD4 testing and if eligible enrollment in the ART program (see Figure 6).
The testing protocol does not match the WHOs guidelines for rapid testing, employing an approach
that the second two tests will be given in parallel, rather than one after the other. While there is
potential that the protocol could be more costly, as two additional test kits will be used for those
reactive on first test, the estimated number of additional test kits to be procured is only 6600 per year
and the total cost of additional test kits over the 2.5 year grant period is only USD18,810. As this is the
main leakage point in the HIV cascade for KAP, the NFM set an ambitious target that all those tested
would know their results and it was felt that the best way to do this was to provide a confirmed HIV test
result in a community setting in the shortest time possible. It was felt that parallel testing was the best
way to achieve this.
The funding request includes the cost of rapid test kits, training on the rapid testing protocol for
outreach staff, medical technologists and SHC staff and the hiring of medical technologists for the first
18 months of the grant. It is envisaged that full implementation of the new guideline for people other
than medical technologists to perform HIV testing will take at least one year. In the final year of the
grant, it is assumed that outreach workers will perform all testing and counseling in the NFM sites.
Figure 6. Same day testing protocol
4. Testing on outreach
The NFM sites will perform the majority of the HIV testing and counseling on outreach; however, the
ability of the SHCs to perform rapid testing will also be assured through training and support to SHC
staff and KAP will still be able to receive rapid tests at the SHCs. At each site, an outreach team which
includes peer educators, outreach workers and medical technologists will conduct testing on outreach
at least three (3) times a week.
14 October 2014 39
At certain sites, a mobile voluntary counseling and testing (VCT) van will provide same day HIV testing
and counseling at outreach sites. The funding request also includes a budget for special testing events.
5. Demand creation
The results of the IHBSS showed 70% of all MSM have an online account and 24% of the MSM who
have an online account met a sexual partner online. Growing evidence supports the success of social
media and other online campaigns in changing behaviors and reducing HIV risk in MSM 49,50. mHealth
technology where mobile phone applications and SMS services can be used to remind people to get
tested and to adhere to drug regimens have also been shown to be successful in key populations 51.
These types of campaigns are also affordable, have the potential to reach a greater number of MSM
than traditional outreach methods and may be more acceptable to MSM who do not wish to publicly
identify themselves as MSM. As such, it is central to the proposed communication strategy to use
online technologies to contact MSM, provide information and create demand for HIV testing and
counseling services.
Some good examples of the use of the Internet and social media to increase MSM demand for HIV
counseling and testing (HCT) in the Philippines include one NGO whose PE enter chatrooms and
engage online users in a dialogue about HIV and HCT. Other NGOs use Facebook and blogs to
spread information about HCT and HCT sites. One website allows visitors to register for a test, an
assigned volunteer then tracks the MSM through the entire process to make sure that they have an
appointment, reach the appointment, get their results and, if necessary, are guided to treatment, care
and support. However, these are not well maintained, with a recent review of HIV prevention strategies
in the Philippines testing one website to find that most web contacts were unresponsive and those that
did respond failed to give correct information (see Annex 26)
The PR will request proposals from local contractors who can design and monitor an Internet strategy
and/or mobile phone strategy to reach MSM, drawing on the successes of the above strategies, but
expanding them to reach more MSM and improving on the current system to address issues identified
in evaluations. The request for proposals will call for a program design that addresses the following:
Engage and work with MSM network, community based organizations and other community
representatives as well as NASPCP, LGUs and SHCs to develop a social media campaign to
increase demand for HIV testing and counseling services
Conduct initial formative and social research on MSM, their Internet usage and mobile phone
usage and current barriers to HIV testing
Explore the use of a range of platforms including Facebook, Twitter, Blogs, YouTube
Webisodes and social networking sites, particularly those where men meet men.
Develop and implement intensive social media campaign; manage key accounts (e.g.
Facebook, Twitter, YouTube etc.)
Monitor and regularly improve and amplify campaign content, in response to ongoing research
and surveillance and in consultation with community and government stakeholders
Organize social media driven events, including campaign launch and manage paid advertising
banners via local gay websites
Develop and manage a website which will serve as an information hub for MSM and host an
HIV risk self-assessment, multimedia content which introduces HIV testing process and
information on available testing services
The development of the campaign should be based on good practice examples including, but
not limited to the following: www.adamslove.org, www.endingHIV.org.au, www.testbkk.org,
Queer as F**K (series of YouTube webisodes developed in Australia),
Additionally, the usage of mobile phone services and applications (mHealth) including SMS, MMS,
video clips and images which can help with treatment adherence and maintaining regular testing
49
Noestlinger C. Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male-tofemale transgender women: RHL commentary (1 May 2012). The WHO Reproductive Health Library; Geneva: World Health Organization.
Annex 31.
50 Pedrana A, Hellard M, Gold J, Ata N, Chang S, Howard S, Asselin J, Ilic O, Batrouney C, Stoove M Queer as F**k: Reaching and Engaging
Gay Men in Sexual Health Promotion through Social Networking Sites J Med Internet Res 2013;15(2):e25. Annex 32.
51 Thirumurthy H and Lester RT mHealth for health behaviour change in resource-limited settings: applications to care and beyond (2012)
Bulletin of the WHO. Annex 33.
14 October 2014 40
through reminder SMS and other support and linked to Social Hygiene Clinics and community based
organizations will be explored.
An indicative budget is included for this activity, although the total budget is not known currently. A
request for proposals by the PR will happen in the first half of 2015 with a service contract in place by
the start of the NFM.
Linkage to care
1. Implement a case management approach
After confirmed HIV diagnosis on outreach or at the SHC, 90% of newly diagnosed people will be
supported to receive CD4 baselines testing. This will be achieved through case management
approach. Each newly diagnosed person will be assigned an outreach worker who will accompany
them to the treatment hub to receive testing. If the diagnosis occurs outside the opening hours of the
treatment hub, the case manager will take contact details for the client and arrange to collect them and
bring them to the treatment hub as soon as possible. For those who are not yet eligible for treatment,
the outreach worker will follow-up every six (6) months, for those eligible, for first three (3) months, the
outreach worker will provide intensive support meeting with the client at least every two (2) weeks.
Importantly, this will ensure that all newly diagnosed are enrolled in the treatment program, with greatly
reduced loss to follow-up and also, that the collection of data for the AIDS registry is not interrupted.
The outreach worker will be a salaried staff member, who will have additional duties such as
supervising peer educators, supervising data collection and collating data for reporting purposes.
Eventually, they will provide HIV testing and counseling on outreach. The funding request includes a
budget for one outreach worker to supervise every ten (10) PE.
2. Provide support for baseline CD4 testing
Three (3) additional CD4 count machines will be procured through the Global Fund TB grant. These
will increase the availability of CD4 testing in the country, addressing another bottleneck in the HIV
cascade. CD4 reagents will be procured for the first year of the grant, after which the DOH is
committed to supplying CD4 reagents for the country.
Further, for those patients who are unable to afford travel and laboratory costs for CD4 monitoring an
enablers fund will be provided which will cover for some of these costs.
Enroll and retain in treatment
1. Ensure adequate supply of ARTs
This concept note includes a request to Global Fund to procure ARTs to cover a forecasted gap in
supplies. In the allocated funding request, funding is requested to cover 15% of the need in 2015, 10%
in 2016 and 5% in 2017. This funding request is seen as crucial, as increasing numbers of treatment
eligible adults and children are expected to access the treatment hubs and an adequate supply of ART
must be assured. The government commitment and the allocated funding request will provide ART for
85% of treatment eligible adults and children in 2015, 90% in 2016, and 95% in 2017. It is also
recognized that there will be a period of transition from the old to the new guidelines and it is unlikely
that the numbers of people accessing the treatment hubs will increase to 90% (the national target) of
the estimated treatment eligible population by 2015. Therefore, in order to procure adequate drugs to
meet the national target of 90% of treatment eligible adults and children on treatment, the above
allocated funding request includes ART for 15% of those eligible in 2015, 10% in 2016, and 5% in
2017. The total coverage achieved from the allocated, above allocated request and government budget
is 90% each year.
2. Support to PLHIV
At the treatment hubs, site implementation officers will be employed to provide psychosocial and other
support to PLHIV. Seven nurses (project aides) will be employed to support newly diagnosed PLHIV at
the treatment hubs.
14 October 2014 41
3. Improve the national procurement system

Technical assistance will be provided to DOH to improve procurement and supply management,
addressing bottlenecks and systematic issues as described above.
The technical assistance will focus on:
Development of a special procurement process for health related commodities, crucial
interventions that need to be delivered quickly

Conducting an assessment of the NOSIRS and identify gaps, make recommendations for further
improvements
Reviewing the existing tools (templates) of DOH stock management for tracking commodities
from receipt to distribution as well as monitoring and reporting

Checking the tracking systems (DOH Document Tracking) and provide guidance or share Save
the Childrens template in tracking procurement

Reviewing systems of filing procurement, orders and stock records and recommend
improvements, if applicable.
Re-assessing the storage and inventory management training that was conducted and assessing
the impact/improvement of the training to the different levels

Providing PSM training and Drug Management Guidelines.
Reviewing the current offline reporting and tracking systems being used by DOH and introduce
improvements
Regular monitoring and site visits
Training additional staff to monitor distribution systems in sites using simple tools and forms
The funding request also includes budget for a storage warehouse and staff.
Addressing TB/HIV
Given the limited resources of the HIV and AIDS grant under the NFM, funds under the Global Fund
TB grant will be utilized to address the gaps in TB-HIV. As presented in Section 1.2e above, TB is the
most common opportunistic infection among PLHIV. Based on the data of treatment hubs in the NCR,
about 40-50% of PLHIV are infected with TB.
Through the GF TB grant, several interventions will be adopted to address the gaps in TB-HIV
collaboration. These are aimed towards contributing to decreasing the burden of HIV among TB
patients as well as decreasing the burden of TB among PLHIV. These are part of the TB-HIV
collaboration plan which has been adopted by the HSSP and the accompanying Operational Plan for
2015-2017. Identified strategies include the following:
a. Human Resource Augmentation This entails hiring of additional medical technologists who
can peform HIV testing in Category A and B TB facilities. One technical staff will also be hired
at the NASPCP to ensure that the TB-HIV links within the program are enhanced and
strengthened.
b. Expansion of Satellite Treatment Hubs This refers to the renovation and refurbishment of
existing SHCs that may be transformed into satellite treatment hubs.
c. TB-HIV IEC Materials Development IEC materials such as flip charts, posters and brochures
will be developed to aid TB DOTS staff in doing Provider-Initiated Counseling and Testing
(PICT) as well as help improve access to information on TB for PLHIV. Key messages found
in these materials will be incorporated in the training of site implementation officers and project
aides funded under the GF HIV and AIDS grant. These staff stationed at the treatment hubs
are expected to provide advice to patients on TB testing and refer them to the TB facilities.
d. TB-HIV Data Recording and Reporting Given the gaps in data and information on TB-HIV,
e.g. number of TB patients who know their HIV status, number of HIV positive TB patients
enrolled to ART, number of PLHIV screened for TB, number of PLHIV on TB treatment, etc.,
relevant data recording and reporting forms that show the TB-HIV link will be developed.
These include a TB-HIV masterlist and a TB-HIV reporting form. It is expected that these
forms will be rolled out to both TB DOTS and treatment hub facilities.
e. Diagnostic Equipment To address the issue of diagnosis, three CD4 machines will be
procured together with digital xray machines. These will be assigned to treatment hub and TB
DOTS facilities in high-burden sites.
14 October 2014 42
Health systems and community systems strengthening

The role of civil society in the national response to HIV and AIDS has been recognized in the
Philippines. CSOs assist national agencies and LGUs to implement sector-specific responses in
various geographic sites in the country which contribute to the behavior change needed for HIV
prevention as well as support PLHIV.52
In ensuring a community led-HIV prevention response, the GF NFM HIV and AIDS Grant will align with
and will be supportive of PNACs initiatives to engage CSOs and CBOs in the governance of HIV/AIDS.
Through national and/or local NGOs that will be tapped as sub-recipients (SRs), the NFM will provide
technical assistance on:
Financial Risk Protection
Development of an advocacy and communication agenda targeting both the KAP and the
LGUs to increase the utilization of PhilHealth among PLHIV
Improving Access to Quality of Care
Assessment of existing HIV and AIDS NGOs in terms of their capacities , competence and
ability to support other CBOs
Coalition building among MSM, TG and PWID community organizations with other KAP to
sustain their plans in preventing HIV and linking PLHIV to care
Capacitating CBOS as they take part in monitoring of procurement supply management of the
government, particularly on ART and other commodities
Contributing to the Attainment of MDG
Conduct of and participation in the Program Implementation Review of the HIV and AIDS
program to determine regions/ cities contribution in attaining the MDG 6
Facilitating sustainability planning among KAP organizations that have been known to
implement HIV and AIDS programs for more than a year or two.
At the national level, human resource augmentation will be provided to the two technical units of the
DOH to sustain and further enhance technical oversight of the ongoing HIV and AIDS programs in the
country and the health information system on HIV and AIDs not just for the GF NFM but for the entire
country program.
The NEC provides strategic information to partners & stakeholders for planning of programs and
projects, and for monitoring and evaluating current interventions and strategies.
To sustain the ongoing implementation of the surveillance and M&E system of the country amidst the
emerging epidemic, the NEC needs to strengthen and further improve its passive and
active surveillance. While the government was able to provide human resources to supplement NEC
staffing, additional support from Global Fund is needed. Additional staff will enable NEC to fulfill their
mandate at the national level, and at the same time provide technical oversight and support to the GF
HIV and AIDS NFM Project Team.
This requires five full-time staff that will work on the different elements of the surveillance system and
ensure that quality data are collected, consolidated, analyzed and generated on a regular basis for use
of the national program, NFM Project Team as well as different HIV and AIDS stakeholders. The basic
job descriptions of the additional staff that NEC is requesting are summarized below:
M&E officer (1), Assistant M&E Officer (2)
The staff requested to strengthen the active surveillance system will assist in the implementation and
data management of the IHBSS, Rapid Assessment of HIV Vulnerability (RAV), Estimation and
Projection Package (EPP) Spectrum analysis and the AEM.
The IHBSS round consists of several major activities that are necessary to come up with strategic
information from the surveillance. These activities include preparation, mapping, data collection,
questionnaire validation, data encoding and cleaning, data analysis, and report writing. To address the
evolving HIV epidemic and the recommendations of several evaluations, improvements and
innovations are incorporated in the plans for the upcoming 2015 IHBSS. These include (a) increasing
52
AMTP5 Mid-term Review. See Annex 5.
14 October 2014 43
the number of IHBSS sites for MSM, TG, and PWID (b) enhancing the Mapping Protocol based on the
University of Manitoba programmatic mapping protocol; (c) training of mappers to improve quality of
data; and (4) integrating size estimation activities such as unique object distribution and service
multipliers.
The three M&E staff will provide technical assistance to local IHBSS teams during the conduct of the
surveillance; assist in the data cleaning and analysis of the results of the IHBSS for the factsheets and
the report; assist in the data collection, data collation, and analysis of the RAV and other size estimates
in all 70 Priority Areas of HIV Intervention (PAHI); assist in the use of the size estimates to guide
targeting and planning of the Program and other projects; facilitate the dissemination of the IHBSS and
Philippine Size Estimates report; assist in the EPP Spectrum analysis and AEM; facilitate submission
of needed reports and documents in relation to IHBSS, Estimates and Modelling; and analyze the
impact and outcome indicators of the NFM related to the IHBSS results, Estimates and Modelling.
M&E Officer (1), Assistant M&E Officer (1)
The passive surveillance system is composed of SHC reporting, laboratory reporting, and the
Philippine HIV/AIDS Registry which contains data on diagnosed HIV cases, PLHIV on ART, and death.
The unit is also set to strengthen the reporting system for STI, linkage to care, and retention in care for
both ART and pre-ART patients. One of the major plans for enhancing the passive surveillance is the
implementation of Unique Identifier Code (UIC) and electronic reporting systems in treatment hubs and
SHCs. The use of UIC will not be limited to the monitoring of SHC accomplishment. The UIC will also
be used to link clients from outreach/SHC reach to testing to diagnosis and linkage to care and
treatment.
The two M&E staff will monitor the different reporting systems of the Philippine HIV/AIDS Registry;
assist in the management of the HIV Registry (reported HIV cases, ART, and death) Database and
SHC and UIC Databases; plan and facilitate the rolling out of revised reporting forms (Form A to E) of
the Registry to laboratories, treatment hubs, and Antenatal Care (ANC) facilities; plan and facilitate the
rolling out of electronic reporting system to treatment hubs and the revised SHC reporting form
(including UIC) to local SHCs; analyze data for the different components of the HIV cascade (e.g.
reported HIV cases, ART, linkage to care, death, etc.); analyze the outcome and output indicators for
NFM indicators related to the Registry, SHC reporting, and laboratory reporting.
At present, the TFM Grant supports the salary of the NEC Administration Officer and Assistant. These
two positions will be funded by the DOH after the project ends. A surveillance officer position which
has been funded by ADB will also be funded by the DOH beginning in December 2014/January
2015. Presented below is the NEC staffing structure which includes the positions that are requested
from GF NFM. Only three positions are permanent and funded by the government. The rest are
contractual positions which are funded by either the government through job orders or by donors.
Those hired through job orders usually have a contract of only three to six months. This set-up makes
it difficult to attract and retain staff. With the recent completion of the DOHs Rationalization Plan,
wherein the additional request for regular staffing for NEC was denied, it is important that these
positions are supported to enable NEC to deliver on its outputs on a regular basis. Without additional
support from donors such as GF, the NEC will have to scale down on its deliverables.
14 October 2014 44
Figure 7. National HIV/AIDS and STI Surveillance and Strategic Information Unit Staffing
The funding request also includes support for the following staff at NASPCP:
Project Associates at the NASPCP. NASPCP is responsible for the central coordination of all
health-related programs and projects for HIV and AIDS. It is responsible in ensuring quality of
trainings on prevention, treatment and care, and has the mandate for ensuring uninterrupted
treatment to PLHIV through on-time coordinative work with the PSM of the DOH. At present,
almost all of the NASPCP staff are project-based, i.e., with contracts ending in 2014 and mid2015. For the NASPCP to fully function, it is therefore necessary to hire three staff who will
focus on: a) Prevention and Community Systems Strengthening, b) Treatment, Care and
Support, and c) PSM. Their roles and responsibilities are as follows: Provide technical
assistance on the development of HIV Prevention/Treatment policies, guidelines and technical
support in the operationalization of strategies, and activities towards effective and timely
delivery of the NFM project interventions; Provide technical oversight of the treatment hubs /
facilities, ensuring facilitation of linkages between prevention and treatment, care and support
in support of the NFM implementation; Closely work with the incoming PR in the following
areas: a) monitoring of the NFM implementation, b) providing technical guidance and advice in
ensuring the achievement of expected project results, c) coordination on PSM to ensure
seamless implementation of the PSM system of ARV and other HIV products of the national
program, and d) strengthening TB-HIV collaboration initiatives; Facilitate the stakeholders
discussions on the assessment of project implementation.
Funding is also requested for an ethnographic study among MSM which will supplement quantitative
analysis from the IHBSS. The main objective of the study is to further explore and understand
facilitators and barriers behind identified MSM behaviors. These behaviors focus on condom use, HIV
testing, and access to HIV services.
Summary of funding request
The total allocated funding request is USD 12,799,311. More than half of the budget request is for the
implementation of HIV prevention programs for MSM and TG (34%) and PWID (15%); treatment care
and support is at 23%; program management cost is at 12%; health management and information
systems is at 6%; community systems strengthening is at 3%; removing legal barriers to access is at
4%; and procurement and supply chain management is at 3%.
14 October 2014 45
Figure 8. Summary of Allocated Funding Request
The total above allocation funding request is USD 3,797,986, with the bulk going to the procurement of
ARTs (59%). See Figure below.
14 October 2014 46
Figure 9. Summary of Above Allocation Funding Request
3.3 Modular Template

Complete the modular template (Table 3). To accompany the modular template, for both the
allocation amount and the request above this amount, briefly:
a. Explain the rationale for the selection and prioritization of modules and interventions.
b. Describe the expected impact and outcomes, referring to evidence of effectiveness of
the interventions being proposed. Highlight the additional gains expected from the
funding requested above the allocation amount.
d.
Rationale for selection of modules and interventions
The choice of modules was based on the need to address leakages at each stage of the HIV cascade,
with a focus on under-served KAP (MSM, TG and PWID) as fits the current epidemic in the Philippines.
As such the modules chosen relate to each stage of the cascade (see Figure 10).
To increase the number of people reached by HIV prevention services and to then ensure that
they are tested and know the results, Module Prevention programs for MSM and TG and
Module Prevention programs for PWID and their partners were selected.
To ensure that all of those testing positive are linked to care, the Module on Treatment, Care
and Support was selected
To ensure that those all those who are eligible for treatment receive treatment, the Module
Procurement and Supply Management was included
Cross cutting modules include: Health Management and Information Systems, Community Systems
Strengthening, Removing legal barriers to access, and Program Management.
14 October 2014 47
Figure 10. Selected Modules
e.
Expected impact and outcomes
The AEM Report of the Philippines shows clearly that without increasing coverage of HIV prevention
services for key populations in the Philippines, the number of infections will continue to increase. The
AEM investigates the impact of various scenarios on the HIV epidemic, including different levels of
coverage of HIV prevention for key populations and ART for PLHIV. The report recommends Scale up
prevention coverage to 80% of MSM and IDU, sustain prevention coverage among FSW and Scale-up
treatment coverage to 90% of PLHIV with CD4 of 350 and below. This scenario is predicted to have the
following impact:
2022
2030
By running the AEM using the target coverage in the NFM sites, we can see that the proposed
allocated funding request would avert a total of 7,118 infections from 2015 to 2017. The model also
14 October 2014 48
Prevention 80% (all

KAP) ART 90% @
CD4 350
Annual
infections
averted
Total # on ART
Annual
infections
averted
Total # on ART
21,788
25,848
39,716
37,945
showed that if
coverage levels
remain the same the
total infections
averted between
2015 and 2022
would be 46,149
compared to
business as usual (see Figure 12).
.Figur
e 11. HIV infections averted in NFM sites
14 October 2014 49
3.4 Focus on Key Populations and/or Highest-impact Interventions

This question is not applicable for low-income countries.
Describe whether the focus of the funding request meets the Global Funds Eligibility and
Counterpart Financing Policy requirements as listed below:
a. If the applicant is a lower-middle-income country, describe how the funding request
focuses at least 50 percent of the budget on underserved and key populations
and/or highest-impact interventions.
b. If the applicant is an upper-middle-income country, describe how the funding
request focuses 100 percent of the budget on underserved and key populations
and/or highest-impact interventions.
The Philippines is designated a Lower Lower-Middle-Income-Country (LLMIC). The HIV epidemic

in the Philippines has been growing and disproportionately affects some populations, particularly
MSM, TG and PWID who have low access to health services, including HIV counseling and
testing, treatment and prevention services.
The concept note focuses on KAP: MSM, TG and PWID. During the first country dialogue it was
decided that sex workers would not be included in the concept note. The reasons for this are that
sex workers are already well served by the SHCs, while PWID, MSM and TG underutilize these
services. It was clear that a different approach from the current facility based HIV prevention and
testing services for MSM, TG and PWID was needed as all have extremely low rates of accessing
HIV prevention and testing services (2013 IHBSS).
This funding request focuses 50% percent of the budget on HIV prevention services for these
underserved and key populations PWID, MSM and TG with high impact HIV prevention
interventions.
These high impact interventions include those recommended by the WHO in their recent
Consolidated Guidelines for HIV Prevention, Diagnosis, Treatment and Care for Key Populations
(see above Section 3.3).
SECTION 4: IMPLEMENTATION ARRANGEMENTS AND RISK ASSESSMENT

4.1 Overview of Implementation Arrangements
Provide an overview of the proposed implementation arrangements for the funding
request. In the response, describe:
a. If applicable, the reason why the proposed implementation arrangement does not
reflect a dual-track financing arrangement (i.e. both government and nongovernment sector Principal Recipient(s).
b. If more than one Principal Recipient is nominated, how coordination will occur
between Principal Recipients.
c. The type of sub-recipient management arrangements likely to be put into place
and whether sub-recipients have been identified.
d. How coordination will occur between each nominated Principal Recipient and its
respective sub-recipients.
e. How representatives of womens organizations, people living with the three
diseases, and other key populations will actively participate in the implementation
14 October 2014 50
of this funding request.

The proposed NFM grant will not have a dual-track financing arrangement; a single nongovernment Principal Recipient (PR) has been nominated.
Prior to the full implementation of the HIV and AIDS grant under the NFM in 1 July 2015, there
will be a three (3) month transition between DOH, the TFM PR, and Save the Children, the new
PR under the GFATM NFM. This will ensure that there will be no major disruption in
programming, especially in the treatment and care of PLHIVs, which includes continuous ARV
supply and counseling. The accountabilities of both agencies during this period will be clarified.
Minimal pre-financing funds to enable the new PR to facilitate the transition will be requested.
These will be used to cover salaries of key staff, support their orientation on the grant and
GFATM requirements and organize meetings with DOH and other stakeholders.
For the grant implementation proper, Save the Children as the sole nominated PR will continue to
use the present DOH structure and its LGU partners at all levels --- from the national and regional
offices of the DOH to the LGUs and communities. The City Health Offices (CHO), health
facilities, treatment hubs and community service delivery points will be utilized for services.
The HIV and AIDS grant will be implemented and managed by the PR and SRs. Save the
Children will establish a Project Management Team at the national office, composed of the
Project Director, a HIV and AIDS Specialist with a strong background either in prevention or
community systems strengthening, Finance and Grants Manager, Logistics Manager and
Monitoring and Evaluation Manager. They will be supported by two Finance Officers, an
Administrative Officer, a Management Information Systems Officer and a Driver. In the target
sites in Mindanao, two Area Coordinators will be hired to facilitate the implementation of the
project activities that will be done in cooperation with the SHCs, NGOs and CBOs. They will be
supported by two Administration Assistants. Save the Childrens Country Senior Management
Team will provide oversight and guidance to the Project Team.
Overall, the PR through the Project Management Team will be accountable for the general
program and financial management of the HIV and AIDS Grant, including quality procurement
processes aligned with international standards, submission of regular progress reports to the HIV
and AIDS TWG and CCM. It will also liaise with the Global Funds Local Fund Agent (LFA) and
Country Team as necessary.
Save the Children will also mobilize inputs and resources from its Headquarters and other
country offices in the region to support the Project Management Team in providing technical
assistance to the DOH and SRs and in ensuring the effective management of the HIV and AIDS
grant. This will include inputs on program management, PSM, SR support, quality assurance and
monitoring and evaluation. This will be done through South-to-South learning and semi-annual
technical visits.
Presented below are the roles and responsibilities of the PR in terms of the
technical/programmatic, financial and logistical support to the SRs in implementing the project as
well as in partnership and coordination with the DOH.
Program
Management
including
Monitoring and
Evaluation
Assess SRs needs in program implementation and management including M&E,

looking at how targets and indicators can be effectively and periodically tracked,
reporting modalities and provide technical assistance to SRs
Assess and analyze data provided by SRs and constantly check for quality;
identify gaps or inconsistencies that may reflect data reporting difficulties or issues
in program implementation. Verify and approve SRs reports and data
Conduct regular program monitoring visits to SRs and field sites looking at
progress in the implementation of agreed project deliverables (i.e. activities, outputs
and outcomes)
Provide feedback to SRs for effective implementation and quality outputs
Ensure that programs are aligned with national and international guidelines
Assist SRs in analyzing their performance, identifying bottlenecks, potential issues
and options to overcome challenges
Facilitate and support capacity development/training for partners/SRs including
sharing of strategies, interventions and lessons learned from other countries in the
region
Support SRs in the preparation of Progress/Update reports
14 October 2014 51
Consolidate reports of SRs and submits periodic Project Updates/Disbursement

Reports (PU/DR) to the TWG
Build capacity of SR staff on financial management and control system
Financial
Develop budget/expenditure monitoring tools for SRs that can be used for tracking
Management
program implementation and spending
Conduct regular finance monitoring visits
Evaluate quantification accuracy, forecasting methodology, and procurement
Procurement
process involving different units/persons in DOH and SRs involved in PSM
and
Supply
Help develop PSM plan and ensure that capacity for proper warehousing,
Chain
transportation, local storage, and supervision of PSM are included and adequately
Management
quantified
Evaluate other gaps in PSM roles and responsibilities
Assess procedures and controls, ensuring alignment with GFATM requirements
Train DOH and SR staff in better forecasting as well as in quantification,
specification and accountability
Work in collaboration with other relevant sector/staff of Save the Children to
Partnership
ensure optimum team cohesiveness and coordination of project activities
and
Work in collaboration with the DOH-NASPCP to make sure that all program and
Coordination
M&E tools and procedures are aligned and consistent
Produce necessary reports, presentations, publications and other materials
Actively contribute to the national and regional level advocacy meetings with policy
makers and others on HIV care, treatment and support issues.
Apart from the representative of the PR (via the SR) at the provincial/city level, there will be no
duplication of structure or function between the DOH and the PR. To ensure alignment with the
DOH-led programs, the NFM will augment staff to support the NASPCP and the NEC as
described in Section 3.2. This will allow both offices to effectively carry out their respective
functions in implementing the HSSP and provide technical direction and inputs to the NFM HIV
and AIDS project.
For the DOH staff augmentation, Save the Children will be responsible for recruiting and hiring
the staff in consultation with DOH. A secondment arrangement will be made between the two
organizations, with both parties agreeing on the Terms of Reference or Job Description of the
staff, targets and deliverables for the period as well as the performance management system. As
Save the Children-hired personnel, the seconded staff are still expected to abide by the principles
and code of conduct of Save the Children (e.g. Child Safeguarding Policy, etc.). Day-to-day
management and supervision of the staff rest with the relevant DOH supervisor while human
resources and administrative oversight will be taken on by Save the Children. The latter includes
submission of monthly time sheets and accomplishment reports to Save the Children and
participation in periodic meetings. Save the Children will be responsible for managing the funds
allocated for the DOH staff augmentation while DOH will be responsible for ensuring that
seconded staff have the necessary operating environment and resources to enable them to fulfil
their roles and responsibilities. This will include provision of office space and equipment and
supporting their operational / activity expenses.
The PR will engage two SRs in implementing the grant in the target sites. There will be one SR
for Luzon which will cover eight cities in the GMM including Angeles City, and there will be
another SR for the Visayas, which will cover three cities in Cebu. The PR will directly oversee
and manage the implementation in Mindanao, specifically in the cities of Davao and Cagayan de
Oro.
The SRs will be selected in accordance to the process and criteria set and agreed upon by Save
the Children and NASPCP. The initial key criteria will include: (i) having a good track record in
developing pioneering programs in partnership with KAP; (ii) ability to design, implement and
effectively manage appropriate HIV and AIDS strategies and interventions, that focus on
prevention, community systems strengthening and advocacy; (iii) sound financial management;
(iv) clear monitoring, evaluation and accountability framework and mechanisms; and (v)
governance.
The SRs are expected to be responsible for: (i) the delivery of the program results, strategies and
activities; (ii) strategically engaging with the KAP communities, service providers, LGUs and other
stakeholders; (iii) close monitoring of the outputs and outcomes of the project on a regular basis;
(iv) preparation of progress and financial reports; (v) meeting agreed standards and requirements
in relation to program and financial management as stipulated by the donor; (vi) ensuring their
accountability to the KAP and other HIV and AIDS stakeholders.
14 October 2014 52
In Mindanao, the PR will work directly with the City LGUs, DOH-Regional Offices and CBOs in
implementing the HIV and AIDS project. The PR will recruit one Area Coordinator each for
Davao and Cagayan de Oro who will closely work with the local service providers (social hygiene
clinic/City Health Office staff). They will in turn be responsible for overseeing the site
implementation officers / outreach workers and the peer educators who will be closely working
with the MSM and TG communities and other stakeholders. The Area Coordinators will be
supported by Administration Assistants based in the sites in terms of their finance and logistical
needs.
The PR and SRs will establish inter-agency and multi-sectoral partnerships to explore issues and
appropriate interventions for MSM, TG and PWID.
Figure 12. Governance and Coordination Implementation Map
The PR will ensure that all key stakeholders will receive relevant project-level data and reports for
their monitoring, analysis, planning, decision making and policy advocacy.
The peer educators will be trained on how to track and monitor their target groups. They will
submit their monitoring report to the outreach workers or site implementation officers for
consolidation on a monthly basis. SRs project staff and Save the Childrens area coordinators
will review and validate these reports with the peer educators during the learning group/feedback
session prior to submission to the Monitoring and Evaluation (M&E) Officers of the SRs.
The SRs M&E Officers will check the completeness and accuracy of collected data prior to
submission to the PR. The PR through its M&E Manager will consolidate all data collected from
the 13 sites and further validate and check its accuracy.
The PR will perform quality checks on collected data and submit cleaned project level data to the
TWG for analysis, addressing gaps and coming up with recommendations to improve program
implementation in the field. The PR will likewise submit cleaned data (related to National
Indicators) to the NEC for further consolidation and analysis and for sharing with the NASPCP.
The PR will share the data with the Local Fund Agent (LFA) for reporting to GFATM.
For transparency and coordination, the PR will also share the data collected with the concerned
DOH regional offices and provincial/city health offices for their internal consolidation, reporting,
and program planning.
14 October 2014 53
Figure 13. Data and Reporting Flow Map
In relation to the Financial or Fund Flow, Save the Children, as a global organization, provides
funding for its different country offices including the Philippines Country Office via transfers from
Headquarters. Save the Children is fully responsible and accountable for all partnership
commitments, technical, administrative and financial requirements of its overseas programs,
ensuring their program quality, adherence to donor regulations and delivery of timely, accurate
reporting.
In the case of the GFATM funds, the funds are disbursed directly to Save the Childrens GFATMdedicated bank account in the United States. The Philippines Country Office submits a monthly
cash flow forecast with the wire transfer request form based on the HIV and AIDS projects work
and financial plan. Save the Children Headquarters disburses the requested funds directly to the
Philippines Country Offices dedicated GF bank account. From this bank account, in-country
payments will be made to the SRs on a quarterly or bi-annual basis subject to the submission and
approval of progress reports and disbursement reports (please refer to the Figure below).
Figure 14. Financial or Funding Flow Map
The PR and SRs will work with national, sub-national and local stakeholders. The PR will recognize
their mandated roles and functions in the NFM grant implementation.
14 October 2014 54
National and sub-national stakeholders

The Department of Health supervises the implementation of HIV and AIDS program in the
country. The department provides technical oversight of the program through the NASPCP while
monitoring and evaluation support, in both government and externally funded programs, is done
through the NEC. Further support is provided by the HIV and AIDS TWG led by NASPCP in
reviewing the HIV and AIDS programs, including the NFM Grant. This will be done through the
review and analysis of project reports and provision of technical recommendations in the different
aspects of operational implementation.
The Infectious Disease Cluster Head and Regional Epidemiology Surveillance Unit of the DOH
Regional Offices (RO) consolidate and utilize data for their program planning, implementation
and local policy work in all provinces and cities within its jurisdiction. The Provincial Health Teams
are out-posted representatives of the DOH-RO at the provincial level; they directly provide
implementation support to all health programs, including HIV and AIDS under the technical
supervision of the Regional Coordinator.
Other HIV and AIDS Partners and Technical Assistance Providers such as the World Health
Organization (WHO), USAID and UNAIDS may provide various technical assistance functions
such as monitoring and evaluation, including periodic external assessments of the project and its
impact relative to the National HIV and AIDS Program goals and objectives; and collation and
analysis of all HIV and AIDS reports from all provinces. These partners may be engaged by either
the NASPCP or TWG through a memorandum of agreement (MOA) in complementing the
initiatives of the NFM Grant.
The Philippines Country Coordinating Mechanism has the oversight functions for the Global
Fund Grant, PR performance and capacity for resource management in support of effective and
efficient achievement of program objectives. In carrying out this role, the CCM ensures that
Global Funds principles of partnerships, community engagement, inclusiveness, transparency
and accountability are adhered to.
PricewaterhouseCoopers (PwC) as the LFA for the proposed grant, will audit the PRs financial
and program management.
Local stakeholders
The Provincial Health Office leads the planning and the overall implementation of the HIV and
AIDS Program within the jurisdiction of the City/Provincial Government. The office coordinates
closely with the City Health Office (CHO), Rural Health Units, DOH-RO and DOH central office.
The CHO manages service delivery, health promotion, community organizing and social
mobilization, and logistics management at the grassroots level. The CHO works with the multisectoral LACs.
The LAC is a critical structure at the city/municipality level that can be tapped for initiating
changes in policies and programs on HIV and AIDS. Their tasks include coordination, facilitation,
support and oversight of the community response to HIV and AIDS. In principle, it should
encourage inclusive participation in developing policies and programs that address HIV and
AIDS. The council is vital in advocacy and policy change formulation because it serves as a
platform for consulting different sectors and stakeholders. It should empower the community to
own the local HIV and AIDS response; it should support projects and activities such as
awareness raising, prevention education and, behavioral surveillance and sero-surveillance; and
should ensure standardized serological testing and counseling. Given these, the SRs with the
PRs support will facilitate the CBOs and KAP communities participation and engagement in the
LACs.
The PR and SRs will ensure that the KAP particularly the MSM, TG and PWID will be engaged
throughout the various phases of the project. Their inputs will be sought most especially in the
areas of prevention and community systems strengthening including advocacy. As part of the
PRs accountability mechanism, their observations and feedback on the project components will
be regularly elicited to better inform the strategies and approaches being adopted by the project.
14 October 2014 55
4.2 Ensuring Implementation Efficiencies

Complete this question only if the Country Coordinating Mechanism (CCM) is
overseeing other Global Fund grants.
Describe how the funding requested links to existing Global Fund grants or other funding
requests being submitted by the CCM.
In particular, from a program management perspective, explain how this request
complements (and does not duplicate) any human resources, training, monitoring and
evaluation, and supervision activities.
The current HIV and AIDS grant, managed by the Department of Health, entitled, Sustaining the
Gains for Essential Program Services of Round 6 HIV Grant in the Philippines will be completed
by 30 June 2015. This is funded through the GFATM Consolidated Grant: Transitional Funding
Mechanism/New Funding ModelInterim Applicant Mechanism (TFM/NFM-IAM).
On 1 July 2015, the proposed HIV and AIDS project under the NFM will officially commence under
the PR-ship of Save the Children, assuming that the concept note is approved and the grant
making process is completed on time.
The proposed project will not share human resources or any other inputs with the Malaria Grant.
However, there will be some complementation of activities under the TB Grant as part of the TBHIV collaboration. This includes staff augmentation in Category A and B TB facilities, development
of social hygiene clinics into satellite treatment hubs, procurement of CD4 machines and
development of IEC materials for PLHIV on OIs with special emphasis on TB screening and DOTS
access. There will be no duplication in terms of allocation of resources for human resources,
trainings, PSM, etc. within the proposed HIV and AIDS Grant.
4.3 Minimum Standards for Principal Recipients and Program Delivery

Complete this table for each nominated Principal Recipient. For more information on
minimum standards, please refer to the concept note instructions.
PR 1 Name
Sector
Does this Principal Recipient currently manage a Global

Fund grant(s) for this disease component or a cross-cutting
health system strengthening grant(s)?
Yes
Minimum Standards
CCM assessment
No
Save the Children currently

manages a portfolio of $198
million in Global Fund grants,
including six PR grants (five in
High Impact Asia).
1. The Principal Recipient demonstrates

management structures and planning
effective
Save the Childrens expertise

in health systems
development, quality
standards and child- and
adolescent-friendly service
delivery, and our known ability
to collaborate with
government agencies and
support the strengthening of
health systems, have enabled
us to implement successfully
across all three of the Global
14 October 2014 56
Funds thematic focus areas,

with a new grant on Health
Systems Strengthening.
In addition to technical
strength, Save the Children
has brought its management
and partnering approach to
bear in its role as a PR,
leading on overall program
oversight, quality control,
management and capacity
building of SRs, M&E, and
innovation. Save the
Childrens approach has
resulted in consistently high
performance ratings from the
Global Fund in these
countries. This experience will
be brought to bear in the
design and implementation of
the Philippines program.
Save the Childrens strong
management of Global Fund
grants features a dedicated
Program Team with
appropriate management,
technical, grants and finance
expertise under the leadership
of a Project Director. This
team ensures effective
monitoring of in-country
activities and sub grantee
implementation, while at the
same time serving as primary
liaison with the Global Fund
Country Team.
In addition, a dedicated team
in the Save the Children
headquarters and the regional
level provide specific award
management and technical
support to each Save the
Children GF program,
including:
Start-up support
Ongoing guidance and
oversight of management
and planning
Tailoring of its
organizational
policies/practices to be
responsive to changes in GF
policies and procedures
Ensuring South-to-South
sharing of best practices
among Save the Children's
Global Fund programs.
14 October 2014 57
For this application, Save the

Children intrinsically
understands the need to
provide strong and efficient
management and oversight as
the PR, and brings to this role
both the organizational
capacity and management
structures and processes that
will ensure project success.
2. The Principal Recipient has the capacity and systems for

effective management and oversight of sub-recipients
(and relevant sub-sub-recipients)
3. The internal control system of the Principal Recipient is

effective to prevent and detect misuse or fraud
As a PR, Save the Children

currently manages over 95
SRs, utilizing established
systems and processes to
deliver evidence-based
programs in partnership with
stakeholders and civil society.
As its portfolio has grown, it
has established and solidified
a high quality disbursement
system, ensuring transparent,
clear and accurate processes
and documentation pertaining
to grant making and oversight.
Save the Children has
developed GF-specific tools
and best practices that are
shared and applied
consistently to SR
management across GF
grants including an SR
assessment protocol, sub
grant template, and SR tender
and selection process, all of
which will be adapted and
utilized for this project. In
particular, Save the Children
has worked to ensure that SR
selection is objective and
transparent in the interests of
the highest quality
programming.
Save the Childrens Country
Directors are accountable for
the overall financial
performance and integrity of
the Country Office funding
portfolio, while responsibility
for individual program financial
performance and compliance
rests with each Project
Director. Save the Children
utilizes a robust delegation of
authority framework to
appropriately assign financial
accountability and
responsibility throughout each
program.
Strict adherence is maintained
to the Country Office Finance
14 October 2014 58
Procedures Manual, which

details the internal procedures
designed to ensure
consistency and accuracy in
accounting and reporting, and
compliance with GAAP and
Save the Children-prescribed
Finance Policies and
Procedures, and which
specifies the roles and
functions of all financial and
accounting staff to ensure a
vigorous segregation of
duties.
4. The financial management system of the Principal

Recipient is effective and accurate
In addition, Save the Children

relies on both internal and
external audit to verify
financial accuracy and
compliance with donor
regulations. The independent
accounting firm of KPMG LLP
performs an annual audit of
Save the Childrens financial
statements, which includes
audits of selected worldwide
locations and reviews of the
internal control systems. They
also perform an A-133 audit of
Save the Childrens federal
awards. Its Internal Audit
Department performs
operational audits and
periodic reviews of domestic
and international locations
each year.
All Save the Children offices
utilize Agresso financial
software to capture
accounting information by
themes, sub-offices and
sources of funding in country.
Agresso provides customized
reporting and analysis that
enables Country Offices to
produce accurate and timely
financial reports for program
managers and donors, and
standard monthly, quarterly
and annual management
reports for Save the Children
internal monitoring and
management.
These reports are reviewed on
a monthly basis to ensure that
program activities are carried
out according to plan and
budget, and are compliant
with donor regulations on
procurement. In addition,
Save the Children
Headquarters finance staff
14 October 2014 59
reviews the reports prior to

their submission to the donor,
as in the case of GF grants.
The Headquarters team also
has developed processes to
help Country Office teams
meet specific GF and LFA
requests, such as funds
receipt verification, and cash
and bank reconciliations.
These practices are replicated
for each new grant to ensure
standardized financial
management across Save the
Childrens Global Fund
portfolio.
As a result of its extensive
experience in humanitarian
relief efforts, Save the
Children has an established
warehouse in Metro Manila for
storing medicines and medical
supplies. It has warehouses
located in Tacloban and
Ormoc in Eastern Visayas,
and in Estancia in Northern
Iloilo. It has recently set up a
warehouse for non-food items
and medicines in Davao City,
Mindanao, as part of its
emergency preparedness
program. Complementing this
infrastructure is the ongoing
capacity building of its staff to
ensure proper handling and
storage of medicines.
5. Central warehousing and regional warehouse have

capacity, and are aligned with good storage practices to
ensure adequate condition, integrity and security of
health products
All Save the Children

warehouses are staffed by
Warehouse Officers, who are
responsible for receiving,
dispatching and managing the
stocks placed in the
warehouses in accordance
with the Save the Childrens
Warehousing and Stock
Management Manual for Nonfood Items and Drug
Management Guidelines.
The Warehouse Officers are
also responsible for
monitoring the condition of the
goods, record keeping and
timely and regular reporting.
They also make sure that all
the needed documentation on
stock management is in place.
Furthermore, Save the
Children has a logistics
function at both the regional
office and country office levels
14 October 2014 60
that supports procurements

and establishes and
implements best practices and
procedures. This system
ensures that rigorous
monitoring is in place to
assure product quality
throughout the full chain of
procurement.
The in-country Logistics Team
is headed by the Logistics
Manager supported by a team
of staff that has segregated
functions of Procurement,
Warehousing, Fleet and
Transport, Asset Management
and Medical Logistics.
The Procurement Team is
responsible for the sourcing
and procurement of all Save
the Children program
supplies, services and
commodities making sure that
procurement is carried out in
accordance to its policies and
procedures; and that all
accompanying processes are
fair proportionate, transparent
and in compliance with donor
rules and applicable laws. All
procurements are tracked
through a procurement tracker
where all pertinent information
regarding the status of the
procurement is recorded and
updated on a regular basis
throughout the different stages
of procurement until payment.
6. The
distribution
systems
and
transportation
arrangements are efficient to ensure continued and
secured supply of health products to end users to avoid
treatment/program disruptions
Save the Children has a

strong network of transport
providers and has just recently
carried out a Supply Chain
Efficiencies Project where a
comprehensive market
assessment was done in its
current program sites and
major cities in the country. By
the end of 2014, Save the
Children will have a complete
supply chain mapping for the
whole country with transport,
warehousing, and sourcing
information, to ensure that
disruptions in supply are
avoided, especially in times of
humanitarian crisis.
7. Data-collection capacity and tools are in place to monitor

program performance
Save the Childrens global

M&E approach known as
MEAL (Monitoring, Evaluation,
14 October 2014 61
Accountability and Learning)

is directed at building more
accountable M&E systems,
with a focus on quality and
beneficiary engagement, as
well as fostering a culture of
learning across programs. To
this end, Save the Children is
building a stronger
Management Information
System database in order to
better capture our MEAL
activities and take advantage
of technological advances in
data collection. Within this
context, Save the Children
has extensive experience
globally in developing,
monitoring and reporting on
Global Fund-specific
indicators, and ensuring that
these are not only tracked
efficiently but also deliver data
that is useful for decisionmaking and measurement of
success.
Save the Children partners
with national level
stakeholders, including the
DOH to ensure that the M&E
indicators developed for GF
grants are also relevant to
(and harmonized with) the
national M&E plan under the
national HIV strategic
framework. It also ensures
that both qualitative and
quantitative M&E data feeds
into the reporting system, and
that data collected from
beneficiaries is done in an
ethical manner. Save the
Children seeks to capture the
voices of children and young
people to better inform its
program activities.
8. A functional routine reporting system with reasonable

coverage is in place to report program performance
timely and accurately
Save the Children has a

dedicated Awards/Grants
management team at the
country level that coordinates
all financial and programmatic
issues for all donor-funded
projects. This includes an
online Awards Management
System that allows teams to
track their existing grant
reporting requirements,
budgets and program
activities, as well as ensure
that reporting deadlines are
met.
14 October 2014 62
For GF grants, Save the

Children has developed a
collaborative process for
report preparation, review and
submission that ensures all
reports are not only submitted
on time but have also passed
both Country Office and Home
Office review and sign-off for
accuracy. SRs are provided
with deadlines for their own
reporting that ensures time for
collation of all SR data prior to
development of the PRs
PU/DR. The Project Team and
Headquarters team
collaborate further postsubmission to provide timely
responses to any queries from
the LFA.
Save the Children has
extensive experience in the
Philippines in ensuring
adequate and timely
distribution of commodities.
Should a procurement role be
necessary for the PR, Save
the Children is able to call
upon both in-country expertise
as well as regional expertise
through its experience in
Myanmar and Nepal in the
procurement of
pharmaceutical commodities
for GF grants.
9. Implementers have capacity to comply with quality

requirements and to monitor product quality throughout
the in-country supply chain
Save the Childrens

Pharmaceutical Supply Chain
Guidelines are attached for
reference.53
Whenever procurement is
undertaken for GF grants,
Save the Children works to
ensure that GF and national
rules and regulations
pertaining to such activity are
taken into account, and that
sufficient staffing and
expertise is on board to
ensure not only safe and
efficient distribution but also
ongoing quality and
effectiveness. (See number 5
above)
4.4 Current or Anticipated Risks to Program Delivery and Principal Recipient(s)

Performance
53
Please refer to Annex 34.
14 October 2014 63
a. With reference to the portfolio analysis, describe any major risks in the country and
implementation environment that might negatively affect the performance of the
proposed interventions including external risks, Principal Recipient and key
implementers capacity, and past and current performance issues.
b. Describe the proposed risk-mitigation measures (including technical assistance)
included in the funding request.
A. Risks related to the Philippines Policy and Planning Context
1. The main risk to achieving effective outcomes on the HIV and AIDS policy and program in
the Philippines is the lack of adequate resources to sustain the initiatives on HIV and
AIDS both at the national and local levels. The existence of local ordinances earmarking
funds for HIV and AIDS activities is not usually a guarantee that this will be consistently
enforced and sustained. A major factor affecting this is the change in local public officials
every three years.
Other related risks include:
To date, the HSSP Operational Plan and Budget are not yet formally approved by the
DOH. Lack of sign-off will mean that no commitments have been made and therefore
resources may not be allocated for its full implementation.
Potential change in the health priorities and program under a new administration with
the coming national elections in May 2016
Lack of awareness and sensitivity of Local Chief Executives on the issue of HIV and
AIDS and the role they play in addressing the problem, leading to its de-prioritization
in the agenda and programs of LGUs
2. Law enforcement practices which focus on the arrest of individuals who openly distribute
clean needles and syringes to PWIDs. The Philippine policy stance towards the drug
problem has traditionally been tilted towards the prohibitionist approach. Unless Section
12 of R.A. 9165 is amended and the possession of needles and syringes is
decriminalized, implementation of the NEP will continue to be hampered. Consequently,
providing PWIDs with access to clean needles and syringes to prevent HIV infection will
remain a challenge.
3. Risk of slippage of implementation targets and reduction in the quality of technical
oversight with the removal and/or transfer of key technical people from the field offices as
a result of the Human Resources for Health (HRH) Rationalization Plan and the
Department of Budget Managements continued rejection of requests for staffing positions
within the DOH. For the HIV and AIDS program to flourish, especially the NEC and
NASPCP, having an adequate number of trained personnel are vital to program
management at the central and local levels.
B. Programmatic and Performance Risks

Foreseen programmatic and performance risks include:
1. Systems of reporting and data validation of data of National HIV and AIDS program. With
DOH as PR for the TFM, the NEC and NASPCP were given appropriate staff support to
ensure that the HIV and AIDS program data base will be complete, accurate, and reliable
and will release timely reports. In transferring the PR role to an NGO and with NFMs new
focus on prevention, staff support to NEC and NASPCP will be limited. With less staff,
foreseen risks include delayed gathering and validation of relevant data needed by the PR
which will be vital in planning and direction setting. Staff complementation from other
grants and hiring of personnel on a short term basis are suggested ways to mitigate the
abovementioned risks.
Similar to the TB and Malaria Grants, the proposed NFM Grant for HIV and AIDS will
provide transitional support to the Program while DOH assumes responsibility for these
positions. It is hoped that DOH will develop specific guidelines on the use of suballotments for hiring contractual personnel.
14 October 2014 64
2. Participation and Community Engagement. In a number of cities such as Cebu, Davao

and Quezon City, peer to peer approach has been working in reaching the KAP for VCT.
However, in other target cities, peer educators have not yet been identified. In case
immediate recruitment will be done, the challenge will be on maintaining and retaining
their services. The peer educators role will be vital in the NFM project because they will
serve as the navigators, links and referral points to mobile VCT, SHCs and treatment
hubs. In mitigating this, mapping and tapping active HIV and AIDS CBOs and local
NGOs to take on the role as points of information, referral, and coordination with the LACs
and LGUs will be done.
3. Performance of Frontline Service Providers of SRs. There is a risk that the SRs might not
be able to closely monitor how the frontline service providers such as peer educators,
outreach workers, etc. are applying the training inputs in their respective work. Training
inputs that are critical for them to effectively apply are the rapid testing methodology and
the immediate support that needs to be provided to the KAP. If this is not correctly done,
the quality of care and accuracy of results may be affected. To address this, SRs will be
supported in helping the outreach workers and the peer educators develop simple action
plans in implementing their activities. Mechanisms for close supervision and monitoring
will be established at the level of the SRs/Area Coordinators, site implementation
officers/social hygiene clinics and participating CBOs.
4. Managing the increase in demand of services from newly diagnosed HIV positive MSM,
TG and PWID. One of the foreseen risks is the readiness of peer educators, outreach
workers, site implementation officers and SHC staff to meet the demands for quality
services which include case management and close follow-up. In mitigating the risk,
regular supervision sessions of the site implementation officers, outreach workers and
peer educators will be conducted by the SRs to ensure that clear strategies and
approaches are developed for managing the cases and maintaining regular contact with
the PLHIV.
C. Fiduciary and Financial Risks

Primary financial risks identified include:
SRs that were qualified and selected show low absorptive capacity
PRs and SRs weak financial reporting
Inability to deliver targets on time during the implementation process
Negative impact of exchange rate fluctuations
Fraud or diversion of funds or non-financial assets
The PR will draw on its global experience in managing GF funds so it can maintain a high level of
financial management and fiduciary oversight. It will ensure that plans are implemented in a
timely manner to ensure good fund absorption rate, high financial efficiency and good financial
reporting. Regular program and financial guidance and monitoring will be provided to SRs to
ensure that they have the relevant capacity to effectively manage the program and the funds.
Fluctuations in exchange rates may be cushioned with good monitoring of currency performance
against economic indicators.
D. Risks related to Health Products and Services
In the HSSP, the DOH pledged to procure some of the ARVs, which is an important element in
ensuring program support and sustainability. While this is an important step towards ensuring
sustained treatment among PLHIVs and prevention, there is still the potential risk of disruption of
treatment services due to the following:
1. Potential underestimation in the number of PLHIV requiring ART and increase in HIV
cases beyond predicted projections
2. Weaknesses in the PSM which could lead to stock-outs
3. Lack of synchronicity between the annual budgeting process and the procurement
process and the delays in procurement and slow compliance to custom requirements
14 October 2014 65
The program will continue to procure through DOH and UNICEF pre-qualified manufacturers and
accredited suppliers. The requested additional ARVs and other commodities will be procured
through Save the Children and will be consigned to DOH. All commodities will pass through
quality assessment monitoring where quality check processes will be conducted by Save the
Children and DOH.
In mitigating the risks, the PR, NASPCP (PSM staff) and NEC will work together to ensure that an
appropriate tracking and stock inventory system is utilized (e.g. NOSIRS), and projection targets
are accurate. Technical assistance and training on addressing the gaps in PSM will be provided
by Save the Children.
E. External Risks
Under this category, major risks in the country that could affect the continuity of health services
delivery for PLHIV include catastrophic events brought about by external hazards such as storms,
floods, and earthquakes.
Since the health care delivery system plays a critical role in PLHIV communities, Save the
Children will be working with LGUs and civil society groups to prepare for the eventuality of a
major disaster or catastrophe. Through Save the Childrens support, Service Delivery Networks
will be mapped together with Regional and Provincial Delivery Points, Distribution Points
(warehouses) and other healthcare delivery system outside the pre-identified high risk
municipalities and cities. Resources from the additional Service Delivery Networks and
Distribution Points could be mobilized to provide support in disaster-affected areas.
CORE TABLES, CCM ELIGIBILITY AND ENDORSEMENT OF THE CONCEPT NOTE
Before submitting the concept note, ensure that all the core tables, CCM eligibility and
endorsement of the concept note shown below have been filled in using the online grant
management platform or, in exceptional cases, attached to the application using the offline
templates provided. These documents can only be submitted by email if the applicant
receives Secretariat permission to do so.
Table 1: Financial Gap Analysis and Counterpart Financing Table
Table 2: Programmatic Gap Table(s)
Table 3: Modular Template
Table 4: List of Abbreviations and Annexes
CCM Eligibility Requirements
CCM Endorsement of Concept Note
14 October 2014 66

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STANDARD

Investing for impact against In

Investing for impact against HIV, tuberculosis or malaria

vesting for impact against HIV, tuberculosis or malaria

A description of the countrys epidemiological situation, including health systems and

Information on the national funding landscape and sustainability.

Implementation arrangements and risk assessment.

Standard Concept Note Template

Save the Children (SC)

Funding Request Summary Table

Standard Concept Note Template

SECTION 1: COUNTRY CONTEXT

1.1 Country Disease, Health and Community Systems Context

18,341 Cumulative HIV Cases recorded from

812% Increase in New HIV Cases

94 186 338 174

*As of April 2014

National Epidemiology Center - DOH

Standard Concept Note Template

Figure 2. Percentage of HIV cases by region, 1984-2014

Standard Concept Note Template

San Jose Del

Cebu IDU male

Standard Concept Note Template

Figure 3. HIV prevalence among IDU, 2005-2013

Standard Concept Note Template

Standard Concept Note Template

c. Human rights and gender constraints

Standard Concept Note Template

Lack of basic sensitivity and recognition of the LGBT rights

d. Health systems and community systems

Standard Concept Note Template

Standard Concept Note Template

Annex 12, pp.18-19.

Standard Concept Note Template

1.2 National Disease Strategic Plans

a. The key goals, objectives and priority program areas

Standard Concept Note Template

Table 4. Budget of the HSSP Operational Plan

b. Implementation to date, including the main outcomes and impact achieved

Implementation of an OHAT package in 2010. This benefit aims to increase the

Standard Concept Note Template

Key achievements at the program level

Standard Concept Note Template

c. Limitations to implementation and any lessons learned

Insufficient engagement and participation of KAP in leadership/governance bodies. MSM,

Strategic Information30. The following weaknesses were observed: a) IHBSS data

Standard Concept Note Template

Standard Concept Note Template

d. The main areas of linkage to the national health strategy

PhilPACT Sub-Plan on TB-HIV Collaboration 2014-2016. Annex 19.

Standard Concept Note Template

However, data about TB-HIV co-infection in the Philippines is limited. An institutionalized

80% of Cat A and B Registered TB

90% of PLHIV accessing HIV Thubs

PhilPACT Sub-Plan on TB-HIV Collaboration 2014-2016. Annex 19

Standard Concept Note Template

March & April 2014

15-17 July 2014

Dissemination of the 5th AMTP Mid-Term review findings and

Standard Concept Note Template

SECTION 2: FUNDING LANDSCAPE, ADDITIONALITY AND SUSTAINABILITY

2.1 Overall Funding Landscape for Upcoming Implementation Period