Thank you for submitting your questions regarding the RFA. We have decided to extend the Q&A deadline and will update responses here. In the meantime, please see responses to the questions that were previously submitted below:

1) The RFAs encourage coordinated or combined applications. If an organization intends to respond to both RFAs, is there a preference for submitting two distinct applications versus a combined application?

We leave this to your determination. Breakthrough T1D does not have a preference.

2) We plan to submit for both A and B through an integrated proposal. How will this impact page limits? Will more space be available and if so, how much more?

For partners wanting to submit as a consortium partners the following approach is required:

• A combined/integrated proposal is allowed,
• The existing page limits per RFA are maintained (so effectively 25 pages per RFA / 50 total),
• The applicant is required to clearly delineate responses to each RFA’s objectives and evaluation criteria,
• Separate budgets/workplans tied to each funding stream is required, even if implementation is integrated.

3) Under G.3 submission instructions, the RFA refers to a standard Breakthrough T1D approved budget template; however, under G.2, it is stated that financial applications should be submitted using the organization’s budget template. Which format should be used for applications?

Applicants should use their organization’s standard budget template when submitting the overall organizational budget and financial information. The reference to the standard template is an error.

4) Section B.1 of the RFA states that the co-financing mechanism must be government-led, with all financing flowing through national procurement systems. What happens in a country where those systems are too weak to manage the process reliably? Would Breakthrough T1D consider allowing procurement to run through an alternative channel, or is use of the national system a hard requirement regardless of capacity?

The RFA requires the use of national systems and prioritizes strengthening and working through existing country systems rather than creating parallel or duplicate mechanisms. As such, use of the national system is a core requirement of this funding opportunity.

Applicants are encouraged to address any identified system capacity challenges within their proposed implementation approach, including risk mitigation and capacity-strengthening measures where appropriate.

5) Does the $1.9M budget cover both the operational costs of the implementer and the actual co-financing subsidy capital, or is the implementer expected to fundraise as part of its approach, or is the co-financing capital separate and provided directly by ALIGN-T1D?

The implementer is not expected to independently fundraise in order to deliver the proposed scope of work. The current anticipated budget of up to $1.9 million is intended to cover both implementation/operational costs and catalytic co-financing support associated with the proposed activities.

At the same time, robust catalytic co-financing remains an important component of ALIGN-T1D’s overall strategy. The current funding commitment reflects our present stage in the funding cycle, and we are actively continuing resource mobilization efforts with the goal of further strengthening the co-financing package ahead of implementation.

Accordingly, applicants are encouraged to propose a realistic implementation approach based on the currently anticipated funding envelope, while also identifying the level or threshold of catalytic co-financing support that would be necessary to achieve successful implementation and intended outcomes. This information will help inform ongoing planning and resource mobilization efforts.

6) The RFA focuses on public sector procurement. Where a significant share of insulin access currently occurs through the private sector or donation programs, should the proposal describe how the co-financing mechanism interacts with or transitions those channels, or is private sector and donation engagement entirely out of scope?

We leave this to your discretion. While the RFA is focused on strengthening public sector procurement and financing systems, applicants may discuss the role of private sector and donation channels where they are relevant to the country context and current insulin access landscape.

Proposals may describe how the proposed co-financing mechanism would interact with, complement, transition from, or reduce reliance on these channels over time, particularly where they currently play a significant role in ensuring access. However, the primary focus of the proposal should remain on sustainable public sector systems, government-led financing approaches, and alignment with national procurement and health system strengthening objectives outlined in the RFA.

7) Which countries are currently participating in ALIGN-T1D country focused activities, and which countries are eligible for the current call for expressions of interest?

For your information, ALIGN T1D is investing directly in country-based activities under MOH leadership. Initial grants are in process for Uganda, Ethiopia, and Chhattisgarh State in India. Additionally, a call for expressions of interest has been published for eligible countries for the next round of ALIGN-T1D Grants. The eligible countries in this round are Bangladesh, Benin, Cambodia, Ghana, Kenya, Morocco, Nigeria, Peru, Tanzania, the Philippines, and Zambia. Depending on the responses to the call, 3-5 additional countries will be selected to receive the next round of grants.

8) The RFP specifically asks for organizations that are five years old. If our organization will be turning 5 this year, will this make us ineligible to submit? Does this requirement apply to sub-recipient partners as well?

The five-year requirement is intended to help ensure that organizations receiving funding have the experience, operational capacity, and track record necessary to responsibly manage funds and implement successful programs. However, we recognize that organizational capacity and experience can sometimes be demonstrated through other means beyond the exact age of the organization.

Organizations that are approaching the five-year mark at the time of submission are still encouraged to apply. In such cases, we will consider the organization’s demonstrated capacity, leadership experience, prior programmatic success, and overall readiness in light of the organization’s age at the time of submission.

9) We are currently preparing a consortium application for RFA-B. Can funds can be transferred directly to individual consortium institutions in their respective countries by the donor, or is the lead organization required to receive and subsequently disburse funds to consortium partners through sub-granting arrangements?

Understanding that there are different legal requirements depending on the country in which each organization is based, please propose the disbursement mechanism that best suits the legal requirements of your country as well as the partnership approach being proposed.

Applicants should also ensure that the proposed arrangement is consistent with the requirements and guidance outlined in the RFA. Depending on the proposed consortium structure, this may include either direct contracting arrangements or sub-granting mechanisms managed by the lead organization. Clear roles, responsibilities, and fund flow arrangements should be described in the application.