As one of the core streams of its catalytic investments (see GFO article), the Global Fund has allocated $260 million for multi-country approaches for the 2017–2019 funding cycle. According to a Guidance Note prepared by the Fund, “the objective of multi-country approaches is to target a limited number of key, strategic multi-country priorities deemed critical to meet the aims of the Strategy and not able to be addressed through country allocations.” The Global Fund Secretariat spent the first half of 2017 reviewing and holding consultations on where and how best to spend the budget for multi-country approaches. Operationalization of the program was approved in July 2017. Explanatory materials available on the Global Fund website include the Guidance Note and Frequently Asked Questions.

Note on terminology In this article, we refer to grants covering several countries in the same region, approved in the 2014–2016 funding cycle, as “regional grants”–– which is what they were called at the time –– and to similar grants being approved in the 2017–2019 funding cycle as “multi-country grants,” which is the terminology currently being used by the Global Fund. Note that we have excluded from this round-up the multi-country grants that encompass small island states like the Caribbean and the Western Pacific, or otherwise use pooled country allocation funding for operational purposes, such as the Middle East Response grant .

There are two types of multi-country grants: those that are pre-identified (pre-ID) –– i.e. with pre-identified objectives and principal recipients (PR); and those that emerge from a competitive application process. An example of a pre-identified multi-country grant is the initiative to eliminate multi-drug-resistant malaria in the Greater Mekong region of Southeast Asia. The grant has a pre-defined objective and eligible countries (Myanmar, Thailand, Laos, Cambodia and Vietnam), as well as a pre-identified PR: UNOPS. Competitive multi-country grants are those that target a priority and a specific region, but where the specific countries included, and the implementation arrangements, are not pre-defined by the Fund. Examples of these include most of the regional key population–focused programs and most of the TB multi-country grants. One important note regarding the transition from the 2014–2016 funding cycle to 2017–2019 is that regional grants will not typically be renewed. The only instances in which regional grants will be renewed are where they that have a theme which has been selected for the new cycle
and
where the applicant is pre-identified by the Fund. An example of this is the TB in mining multi-country grant in Southern Africa (see GFO article for details). Aidspan has become aware that there is some confusion regarding multi-country programs. This isn’t hard to understand, given the flux over the years in the Fund’s approach to regional programs and the sheer number and variety of initiatives. To help readers understand the full picture, Aidspan has prepared the following mapping of existing and expected multi-country grants and ongoing regional grants.
Overview of multi-country grants for 2017–2019
The Global Fund’s multi-country approaches are aligned with three strategic priorities: one each for malaria, TB, and HIV, each with designated funding (See Table 1).
Table 1: Multi-country strategic priorities for 2017–2019

Component	Priority	Funding ($ million)
Malaria	Malaria elimination in low burden countries	145 m
TB	Finding the missed people with TB	65 m
HIV	Sustainability of services for key populations	50 m
TOTAL		260 m

Source: Guidance Note: Multicountry Approach in the Global Fund’s 2017–2019 Funding Cycle
In an earlier vision for multi-country grants, $12 million was included for resilient and sustainable systems for health, but this has been reprogrammed to the strategic initiatives stream within catalytic investments. Within each disease priority, there are several sub-priority areas (a total of 14 across the three diseases). (“Sub-priority” is a term adopted by Aidspan for this article, to avoid confusion. In its materials, the Fund refers to priorities at both levels simply as “priorities.”) The sub-priorities form the basis for grants; most sub-priorities will have one grant each. The total number of planned multi-country grants (16–19) is considerably less than the number of regional grants from the previous cycle. The Fund has intentionally reduced the number, so as “to focus on those that are essential to the delivery of the Strategy,” according to a spokesperson for the Fund. Table 2 provides information on all planned multi-country grants for the 2017–2019 funding cycle. Applications for about half of the pre-ID grants have already been submitted, while requests for proposals (RFPs) for all of the competitive grants have either been issued or are expected to be issued sometime during the balance of 2018. Links to RFPs that have been issued are included in the table.
Table 2: 2017–2019 Multi-country grants information

Disease	Sub-priority	Application approach (# of grants)	Expected submission timing	Sub-priority funding ceiling ($ million)
Malaria	1. Elimination of malaria in Mesoamerica and Hispaniola	Pre-ID (1)	Complete	6.0 m
	2. Elimination of malaria in South Africa	Pre-ID (1-2)	Apr 2018 or later	20.0 m
	3. Elimination of malaria multi-drug resistance in Greater Mekong (RAI)	Pre-ID (1)	Complete; being impl.	119.0 m
TB	4. TB in mining, Southern Africa	Pre-ID (1)	Complete; being impl.	22.5 m
	5. Supranational labs in Eastern and Southern Africa	Pre-ID (1)	Apr or Aug 2018	4.5 m
	6. Improving quality of care and prevention for MDR-TB in Eastern Europe (See RFP)	RFP (1)	Apr 2018	5.0 m
	7. Support LAC countries transitioning from Global Fund TB funding	RFP (1)	Aug 2018	4.5 m
	8. Interventions among refugees in East Africa (See RFP)	RFP (1)	Apr  2018	7.5 M
	9. Supranational lab in Western and Central Africa (See RFP)	RFP (1)	Apr 2018	6.0 M
	10. TB/MDR-TB interventions mobile pop. in Asia; Afghan (See RFP) and Greater Mekong (See RFP)	2 RFPs (2)	Apr 2018	5.0 m Afghan; 10.0 m Mekong
HIV	11. Sustainability of service for KPs in LAC region	2 RFPs (2-3)	Aug 2018	10.5 m LAC; 6.5 m Carib.
	12. Sustainability of service for KPs in EECA region (See RFP)	RFP (1-2)	Apr 2018	13.0 m
	13. Sustainability of service for KPs in Southeast Asia region	Pre-ID (1)	Aug 2018	12.5 m
	14. Sustainability of service for KPs in MENA region (See RFP)	RFP (1)	Apr 2018	7.5 m

For details on each sub-priority, please see the Global Fund’s Guidance Note.
Ongoing regional grants
There are 24 active regional grants funded through the previous 2014–2016 cycle. Their implementation stages range from first to final years. In addition to the regional grants, there are a number of multi-country grants which were not classified by the Fund as “regional,” which are excluded from the tally below. See the 
Note on terminology
above for details. One major difference between the 2017–2019 funding cycle and 2014–2016 is that there are no multi-country HIV grants available for sub-Saharan Africa in the current cycle, whereas about half of all regional HIV grants were in sub-Saharan Africa previously; see GFO article for more details on that decision. Tables 3–6 list all of the regional grants that are ongoing at this time.
Table 3. Sub-Saharan Africa regional grants

Disease	Grant title	Principal recipient	End date	Countries included
Malaria	MOSASWA Cross-border initiative	Lubombo Spatial Dev. Initiative 2	Dec 2019	Mozambique, South Africa, Swaziland
Malaria	Malaria Elimination in Southern Africa (Elimination 8)	Non-Profit Association "Southern Africa Malaria Elimination Eight Initiative Sect."	Sep 2018	Botswana, Swaziland, Namibia, South Africa, Angola, Mozambique, Zambia, Zimbabwe
TB/HIV	Contribute to reduction of new HIV infections, TB incidence & HIV/TB related morbidity & mortality among cross border and mobile population in IGAD member countries	Intergovernmental Authority on Development	Mar 2019	Djibouti, Ethiopia, Kenya, Somalia, Sudan, South Sudan and Uganda
TB/HIV	Improving HIV/TB/Hepatitis harm reduction services and promotion of human rights of People who Inject Drugs in 5 West African countries	RO Alliance Nationale Contre le Sida (ANCS)	Dec 2019	Sénégal, Burkina Faso, Cape Verde, Côte d’Ivoire and Guinea Bissau
TB	Supporting Uganda SRL and other Countries to Improve TB diagnosis in the ECSA Region	East, Central and Southern Africa Health Community	Oct 2019	Botswana, Burundi, Eritrea, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, Somalia, S. Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe
HIV	Creating community treatment observatories in 11 West African countries	International Treatment Preparedness Coalition	Dec 2019	Benin, C.I., Gambia, Ghana, Guinea, Guinea-B., Liberia, Mali, Sénégal, Sierra Leone, Togo
HIV	VIH et Handicap en Afrique de l’Ouest	Handicap International Federation	Dec 2019	B. Faso, Cape Verde, Guinea-Bissau, Niger, Mali, Sénégal
HIV	ANECCA Regional Project for Catalysing Improvement of Care, Tr. and Support for Children and Adolescents Living with HIV in Africa	African Network for the Care of Children Affected by HIV/AIDS	Oct 2018	Burundi, Ethiopia, Malawi, Nigeria, South Sudan, Tanzania, Uganda
HIV	KP Reach	Humanist Institute for Co-op. with Developing Countries (HIVOS)	Dec 2018	Botswana, C.I., Kenya, Malawi, Nigeria, Sénégal, Seychelles, Tanzania, Uganda, Zambia
HIV	Africa Regional Grant - Removing Legal Barriers	UNDP	Dec 2018	Botswana, C.I., Kenya, Malawi, Nigeria, Sénégal, Seychelles, Tanzania, Uganda, Zambia
HIV	HIV and Harm Reduction in Eastern Africa	Kenya AIDS NGOs Consortium	Sep 2018	Burundi, Ethiopia, Kenya, Mauritius, Seychelles, Tanzania (including Zanzibar), Uganda
HIV	ALCO HIV/AIDS prevention project targeting keys & vulnerable pop. along the Abidjan-Lagos Corridor	Abidjan-Lagos Corridor Organization	Dec 2018	Côte d’Ivoire, Ghana, Togo, Benin, Nigeria

Table 4: Latin America and the Caribbean regional grants

Disease	Grant title	Principal recipient	End date	Countries included
TB	Strengthening of the TB laboratory Network in the Americas	Organismo Andino de Salud - Convenio Hipólito Unanue	Dec 2019	Argentina, Belize, Bolivia, Chile, Colombia, C.R., Cuba, Ecuador, El Salvador, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Dom. Rep., Uruguay, Venezuela
HIV	Removing Barriers to accessing HIV and sexual and reproductive health services for key populations in the Caribbean	Caribbean Community Secretariat (CARICOM)	Sep 2019	Antigua & Barbuda, Bahamas, Barbados, Belize, Dominica, Dom. Rep., Grenada, Guyana, Haiti, Jamaica, Montserrat, St. Kitts & Nevis, Saint Lucia, St. Vincent & G., Suriname, Trinidad & Tobago
HIV	Challenging stigma and discr. to improve access to and quality of HIV services in the Caribbean	UNDP	Sep 2019	Belize, Cuba, Dominican Republic, Guyana, Haiti, Jamaica, Suriname, Trinidad and Tobago
HIV	Secretaria de la Integracion Social Centroamericana	Secretaria de la Integracion Social Centroamericana	Jun 2019	Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
HIV	Trans women without borders against transphobia and HIV/AIDS	International Organization for Migration	Mar 2019	Argentina, Belize, Bolivia, Chile, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Uruguay
HIV	Acelerando la accion reg. a favor de los Der. Humanos, Sexuales y Reproductivos y la No Violencia hacia las Mujeres con VIH	Humanist Institute for Co-operation with Developing Countries (HIVOS)	Dec 2018	Bolivia, Honduras, Nicaragua, El Salvador, Guatemala, Colombia, Costa Rica, Ecuador, Panama, Peru, Dominican Republic

Table 5: Eastern Europe and Central Asia regional grants

Disease	Grant title	Principal recipient	End date	Countries included
TB	Decreasing the burden of tuberculosis disease and halting the spread of drug resistance in eleven EECA countries through increasing political commitment and translating evidence into implementation of patient-centered TB models of care	Center for Health Policies and Studies	Dec 2018	Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine
HIV	Right to Health: Community Actions to Increase Access of MSM and Transgender People to HIV Services in C. and E. Europe and C. Asia	Eurasian Coalition on Male Health	Dec 2019	Armenia, Belarus, Georgia, Kyrgyzstan, Macedonia
HIV	Enhancing effectiveness, accessibility, sustainability and scale up of HIV treatment programs in the EECA region with special emphasis on key populations	ICO East Europe and Central Asia Union of People Living with HIV	Oct 2018	Moldova, Georgia, Uzbekistan, Kazakhstan, Russian Fed., Ukraine, Kyrgyzstan, Tajikistan, Belarus, Armenia, Azerbaijan, Latvia, Lithuania, Estonia, Poland

Table 6: Asia and the Pacific regional grants

Disease	Grant title	Principal recipient	End date	Countries included
HIV	Evidence based advocacy on community based testing and monitoring of quality services for key populations in seven countries	Save the Children Federation, Inc.	Dec 2020	Bangladesh, Cambodia, Indonesia, Nepal, Thailand, Myanmar, Vietnam
HIV	To increase access to essential HIV and harm reduction services for people who inject drugs in Asia through removing legal barriers, community systems strengthening and increasing the evidence base	India HIV/AIDS Alliance	Dec 2019	Cambodia, Indonesia, India, Nepal, Philippines, Thailand, Viet Nam
HIV	Sustainable HIV Financing in Transition (SHIFT)	Australian Federation of AIDS Organisations	Dec 2018	Indonesia, Malaysia, Philippines, Thailand