Stop TB Partnership

Founding Principles of GDF

The founding principles of the GDF are sustainability, independence, transparency, accountability, responsiveness, additionality and flexibility. These are applied in the four operational areas of Governance/Financing, Application/Review, Procurement and Monitoring.

In addition, GDF activities are required to:

  • Contribute to DOTS Expansion;
  • build on existing TB control activities and funding and do not replace any existing inputs;
  • raise government commitment and facilitation;
  • promote standardization;
  • offer assured high-quality TB drugs and cheaper prices.

Global TB Drug facility prospectus - founding principles

GDF prospectus [.pdf]

1. The GDF will be independent, transparent, accountable, flexible, rapid, and responsive.

2. The GDF will aim to achieve substantial economies of scale through pooled demand forecasting, standardization of regimens, manufacturer prequalification, bulk purchasing, and reduced transaction costs.

3. Drug supply via the GDF will not support maintenance of non-DOTS efforts. Only governments and non-governmental organizations (NGOs) that adhere to proven effective diagnostic, treatment, and disease monitoring practices encompassed in the DOTS strategy will be eligible to receive grants of TB drugs from the GDF.

4. The GDF will expect national DOTS expansion plans to achieve clear, measurable TB control results (people cured, lives saved). The country-specific results of GDF contributions and the associated TB control programme achievements will be published in an annual report and made available to the general public.

5. Operations will seek to minimize the burden placed on governments or other applicants in preparing GDF applications and complying with conditions of GDF grants. This is consistent with the expectation that the facilities would decrease current drug procurement inefficiencies, not add to them.

6. Additionality: all GDF assistance must represent new resources for TB control in countries receiving a GDF grant. The GDF will ensure that its assistance does not replace existing health care financing from national or international sources. Rather, the GDF will expect that any national or international resources or assistance made available through its grants be re-applied from drug procurement to other under-funded components of TB control activities. Furthermore, the GDF will not duplicate or replace the mandates of existing organizations.

7. Some governments procure high-quality TB drugs through their own drug supply programmes or with financing provided by other donors. The GDF will offer assistance to these programmes in tendering and bulk purchasing, if this assistance is requested and appropriate.

8. The GDF will provide grants of drugs-in-kind with resources mobilized by and for the GDF. Responsiveness to the reasonable requests of high TB burden countries, or donors acting in their relationship with these countries, will be emphasized. This may mean that those governing the GDF will need to further consider the benefits and risks of opening windows to procure drugs for specific countries with resources other than those directly mobilized by the GDF. This may be difficult in the first years of GDF operations.

9. The GDF will extend access to high quality first-line (those used in the initial treatment of those with tuberculosis. They are relatively inexpensive with low toxicity.) TB drugs for countries implementing or expanding effective DOTS treatment programmes. By increasing availability, quality assurance, efficient procurement and standardization, the GDF will address two significant obstacles to TB control-insufficient treatment of active TB patient and the spread of drug resistance.

10. The GDF will catalyze national commitment and public support for rapid DOTS expansion. By providing significant assistance with drug supply, the GDF will provide incentive and assistance to policy-makers, and it will free up limited human and financial capacity in TB burdened countries for the difficult, patient work of DOTS expansion. If countries are to meet their TB control targets, governments will need to increase outlays for clinical services, training, supervision, monitoring, and other activities, because the number of patients to be treated will nearly triple. In the context of these burdens on developing country budgets for health, GDF assistance is obviously critical.

11. The GDF will catalyze increased national commitment for public funding of TB drugs procurement. Drug costs account for less than half of total treatment cost of treating TB patients. GDF assistance will be supplied with the intent of increasing capacity and public support in recipient countries for TB drug funding. Successful DOTS expansion will result in increased efficiency and cure rates, and decreased TB transmission. The GDF goal anticipates that healthier populations, lowered TB transmission and burden, and the consequent social and economic benefits will increase national resolve to assume responsibility for sustaining effective TB control. See the section on "Benefits" as well as Annex C.

12. The GDF will be time-limited, with an expected life of 10-15 years. As such, the GDF does not intend to create dependency or to reduce existing local drug procurement capacities. Rather, it will work with partners in the health and development community to ensure that there is ongoing support for the strengthening of overall drug procurement systems and quality assurance mechanisms in low-income nations. Creating a consolidated and identifiable market for TB drugs with transparent and competitive procurement may provide incentives for further development of industry over the medium term.

Strategies will be identified to gradually transfer procurement responsibility back to participating nations prior to the GDF's closure.

13. Sustainability generally signifies the ability to maintain resources (human, capital, financial, physical, environmental, etc.), activities and results for a given objective over the long term. In the international development arena, it is often understood to mean that countries receiving external assistance should not become or remain dependent on external resource flows. Moreover, recipients should begin to assume the financial burden long before external assistance ends.

14. Sustainability depends on the premise that a local sense of ownership and commitment must exist to ensure the maintenance of an activity. Various mechanisms have been utilized to encourage donor-recipient partnerships and shared ownership in projects. These include cost-sharing mechanisms, capacity building, phase-out plans, and revenue generating mechanisms as well as participation and dialogue of all stakeholders in project planning and evaluation.

15. Strengthening of national procurement and supply capacity should continue to be aided by other donors and governments themselves, in the context of Essential Drug Programmes (EDPs), with the long-term view of integrating responsibility for TB drugs once incidence and prevalence have been reduced to a fraction of present levels. The GDF could help facilitate that support and offer lessons learned in drug supply management.

16. The GDF will ensure independent appraisal and monitoring of treatment standards, drug supply management, and verifiable outcome indicators of patients treated and cured. The results of this monitoring will inform decisions on maintenance or renewal of GDF support.

Iso

GDF is ISO 9001:2000 compliant for provision of quality-assured anti-TB drugs and related services to eligible national TB control programmes.