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The Global Fund

+41 (0)22 791 1700 +41 (0)22 791 1701 [email protected]

To Fight AIDS, Tuberculosis and Malaria

Chemin de Blandonnet 8

1214 Vemier

Geneva, Switzerland

4 July 2008 Peter Buijs Director CARE Ecuador Carlos Montufar E25-24 y la Cumbre Quito Ecuador

Subject:

Program Grant Agreement Number ECU-405-G02-T Implementation Letter Number 6

Dear Mr. Buijs, We refer to the Program Grant Agreement between The Global Fund to Fight AIDS, Tuberculosis and Malaria (the "Global Fund") and the CARE International Ecuador (the "Principal Recipient") for a tuberculosis program entitled "Expansion of DOTS Strategy in Ecuador", effective 29 September 2005 and amended by letters dated 19 July 2006, 11 May 2007, 18 December 2007, 24 January 2008 and 14 February 2008 and a Phase 2 Amendment effective 7 April 2008 (as amended from time to time, the "Grant Agreement"). Capitalized terms used but not defined in this letter have the meaning given to them in the Grant Agreement. By signing this letter, the Global Fund and the Principal Recipient agree to amend the Grant Agreement by: (1) attaching to Annex A of the Grant Agreement the document entitled "Performance Framework 3a: Indicators, Targets, and Periods Covered" attached to this letter; and (2) amending block 4A of the face sheet of the Grant Agreement as follows: Block 4A: Modification Number: 6 (Implementation Letter 6 dated 4 July 2008). Achievement of the indicators set out in the Performance Framework 3a to Annex A of the Grant Agreement, in addition to other relevant information, shall be used by the Global Fund as a basis for determining disbursements of Grant funds. The face sheet of the Grant Agreement, as amended, is attached. Except as modified herein, the Grant Agreement remains in full force and effect. This amendment shall come into force on the date of signature of this letter by both parties. Please confirm your agreement with the foregoing by signing both enclosed copies of this letter and returning one to us, retaining one copy for your records.

EI Fondo Mundial

The Global Fund

le Fonds mondial

To flghtAIDS, Tuberculosis illodMlliarla

!)("Mt~contl'l!tl:!:g{)A,la~l'ltl.tpalsd~

We thank you and your partners for undertaking this important effort in the global fight against tuberculosis. We look forward to the successful implementation of the Program. Yours sincerely,

Mr. William Paton Director of Country Programs

Agreed and signed:

For:

CAREEC~DO~

By: Authorized RepresfAtrtive: "

'\J

!

Mr. Peter Buijs Director

Date:

Attachment:

Performance Framework 3a to Annex A Face sheet of the Grant Agreement, as amended

Cc:

Dr. Lilly Marquez, CCM Chairperson Carlos Cruz, PricewaterhouseCoopers, LFA

2

I

I u

To Fight AIDS, Tuberculosis and Malaria

I. Country: Ecuador 2. Principal Recipient Name and address: CARE Ecuador, Carlos Monmfar E25-24 y la Cumbre, Quito, Ecuador 3. Program Title: Expansion of DOTS Strategy in Ecuador 4A. Modification Number: 06 4. Grant Number: ECU-405-G02-T Implementation Letter # 06 dated 3 July 2008 6. Phase 1 Ending Date: 7. Phase 2 Ending Date: 5. Phase 1 Starting Date: 31 October 2010 01 November 2005 31 October 2007 7A. Condition Precedent Terminal 7B. Condition Precedent Terminal 7C. Condition Precedent Terminal Date: 01 November 2005 Date: 01 February 2006 Date: 30 June 2008 7F. Condition Precedent Terminal 7D. Condition Precedent Terminal 7E. Condition Precedent Terminal Date: Date: Date: 8. Grant Funds: US$ 16,353,319 (Sixteen Million Three Hundred and Fifty-Three Thousand Three Hundred and Nineteen United States Dollars) 9. Program Coverage: D HIV/AIDS [gI Tuberculosis D Malaria D Health Systems Strengthening 10. Information for Principal Recipient Bank Account into Which Grant Funds Will Be Disbursed :

II. The fiscal year of the Principal Recipient is from 01 July to 30 June 12. Local Fund Agent ("LFA") : PricewaterhouseCoopers del Ecuador Cia. Ltda., Diego del Almagro N32-48 y Whimper Edificio IBM-PB Quito, Ecuador Tel: +593 2 256 2288 Fax: Attention: Roberto Tugendhat E-mail: [email protected] 14. Name/Address for Notices to Global Fund: 13. Name/Address for Notices to Principal Lelio Marmora Recipient: Tearn Leader ad interim Ivan Palacios Latin America and the Caribbean Director Programa Desarrollo Social Integral Carlos Montufar E15-14 y la Cumbre The Global Fund Chemin de Blandonnet 6-8 Quito, Ecuador 1214 Vernier-Geneva, Switzerland Fax: + 593 22433069 Tel. : +593 22253 615 Fax: +41 22 791 1701 E-mail: [email protected] Tel. : +44 22 791 1700 This Agreement consists of the two pages of this face sheet and the following: Annex A - Program Implementation Description and Standard Terms and Conditions the attachments thereto (including the Performance Framework and Summary Budget) I

Performance Framework 3a: Indicators, Targets, and Periods Covered

Ecuador

1~Nov-07

1-Feb-08

31~Jan~08

30-Apr-08

31-Jul-08

31-00t-08

16-Mar-08

14-Jun-08

14-Sep-08

i5-Dee-OB

1-May-08

1-Aug-08

N

1.2

41,2%

2005

PCT

Tasa de exito del tratamiento

80%

2004

PCT

Tasa de abandono de tratamiento

96%

2004

PCT

Outcome

Case detection rate (new smear-positive cases)

Deteccion de casas (casas nuevas BK+)

Outcome

Treatment Success Rate

Outcome

Treatment abandoment rate

27% (79412853)

2004

PCT

60% (192013200)

53% (170713200)

1920/2583 (74%)

1920/2583 (74%)

1920/2583 (74%)

2100/2853 (81%)

2350/2853 (91%)

3'977

2005

PCT

8787

10'654

11'500

12'000

13'000

13'876

15'301

2583/2583 (100%)

16'016

Y- over program term

1.3

! 1:); !

ImelY oetectlon and Number of all estimated

nel:~;e~ar ~:t:a~:~~~: ~:~::t;~::~:gun

iUu,,,

3'048

2005

PCT

2004

PCT

DOTS

4189 (51.2%)

3573-47.2%

r 1.4

1.5

TB: Detecci6n oportuna Y Number and percentage of new tratamiento de caUdad de smearHpositive T8 cases successfully treated casos

Number of staff from PNT and partners trained in leadership and program management

HSS: Service delivery

1455/548 'MO" I (6 pro~~~:;'

83%(6

N°, Y % de casos nuevos TBP 8K + 80% eXltosamente tratados

oN 1

82 %

"oov",ce'

provinces)

N° de empleados del PNT y socios capacitados en Iiderazgo y gesti6n 0 deprogramas

2004

PCT

40

900

2000 (25.4%) 3300 (43.6%)

92511115 (83%) (6

I (75%:,?0",,"0 (11 pro"nees) (11

317

317

pro,,;~eesi

317

1492/1798 (83%) (6

p;",,;n~~s); (11

pro,,;~eesi

63.7%

1932/2328 (83%) (5

Y - cumulative

55%

annually

84%(6

Y- cumulative

pro,,;nees); (11 pro,,;nees:

317

annually provinces)

Y - over program

361

term

lndlcatordefrnitlon Persons trained in the one of the following areas: leadership, institutional development, formation of strategic alliances and genera! management tools

This Is

a new indicator for Year 3 'oao,

1.6

T8: Identification of

INumber

l of respiratory

92.5%

68430173931

infectious cases

2007

PCT

Not measured

Not measured

15349 /16504 32092/34508 50929 154752

6976~~~5016 7077~~~6104 ~~~85/77188

oa,

y ~ cumulative annually

IE.,ve"ryhli" Ph'hem"o',ponn,