New Approach to Funding – a “Striking Change”
At the World Health Assembly in Geneva last week, the Global Fund convened a meeting with partners to discuss the new funding model that was launched this year in a transition phase. We got very encouraging comments from the Ministers of Health of Zimbabwe, Myanmar and El Salvador, three of the countries participating fully in the new funding model as “early applicants.” Henry Madzorera, the Minister of Health of Zimbabwe, described the new approach as a striking change, full of constructive participation. In the one month it took Zimbabwe to draft and submit a concept note for new funding, working with a team of 25 from government and partner organizations, a series of interactions with the Global Fund made the process cooperative and constructive. “The experience was pure ecstasy, when compared with the previous application process,” Minister Madzorera said. “Instead of sitting on the opposite side of the table and acting like umpires, the Global Fund actually joined us in developing the concept note, and worked with us until it was approved.” This new approach, of early and open feedback, is at the center of the new funding model. To Minister Madzorera, the new process felt like “lions laying down peacefully with the lambs.” It benefitted from the advanced national health strategy Zimbabwe already had, and also from its ability to conduct country dialogue with many partners. Minister Madzorera said that naming an indicative target of US$245 million also made the process more predictable, and that flexibility allowed the grant amount to be adjusted upward. It is on track to be submitted for approval by the Global Fund’s Board at its next meeting in June.
Maria Isabel Rodriguez, the Minister of Health of El Salvador – who at age 90 is still young enough to learn new things – commented that constructive interaction with staff from the Global Fund during the process of preparing a concept note gave her country another perspective on their health strategy. “This assistance to our national team, in identifying our weaknesses and how to overcome them, was extraordinary,” she said. “We want to not only congratulate, but to thank the Global Fund for improving our system.”
Mark Dybul, Executive Director of the Global Fund, said the new funding model is aimed at doing transformative work. “We’re shifting toward having all partners come together, in country dialogue, to achieve a concept note that gets us to complete control of the three diseases. Partnership is fundamental to the new funding model.” Dr. Dybul also stressed the new funding model’s predictability, while encouraging full expression of demand. He added that the new funding model gives countries a better platform for coordinating grants with national health strategies. Margaret Chan, Director-General of the World Health Organization, pointed to the advantages of the new approach, intended to devise more effective grants. “You are making history,” she said. “We are making history, if we work together.”
Learning from Myanmar
Myanmar’s Minister of Health, Pe Thet Khin, echoed the game-changing nature of the Global Fund’s new funding model. Myanmar is not only participating in the full process of the new funding model, it is also the first country to move forward with grant proposals for HIV, for TB and for malaria, all at once. Minister Pe Thet Khin cited the flexibility and the inclusive dialogue in the new funding model as key elements to improving alignment between Global Fund grants and national health strategies. The new approach coincides with recent political developments in Myanmar that expand the opportunity to reach more people, including minority groups such as the Kachin ethnic group, who were not previously able to participate.
Challenges remain, such as the risk of transmission by an influx of internally displaced persons, lack of human resources, hard-to-reach areas and funding gaps. “With the ceasefires, a lot of people are coming back to the country. Peace is of paramount importance," Minister Pe Thet Khin said, adding his country needs mosquito nets and medicines to contain the risk of internally displaced persons spreading diseases. He also said he wanted to improve health care at the country’s borders. Myanmar has a high disease burden for the three diseases, including resistant forms of TB and malaria. An estimated 206,000 people are living with HIV in Myanmar, one of the most severe HIV/AIDS epidemics in Asia. More than 23,000 people die from TB every year. Minister Pe Thet Khin added a personal dimension to his commitment. Long before becoming Myanmar’s Minister of Health, he had already experienced first-hand the devastating effects of HIV and AIDS, TB and malaria in his country. “I was a victim of malaria myself and at my small clinic I treated patients with HIV and TB,” said Minister Pe Thet Khin, a pediatrician by training. “I am personally involved in the three diseases.” Minister Pe Thet Khin said that Myanmar’s commitment to increasing its funding, together with Global Fund-supported programs, will raise anti-retroviral coverage to 85 percent of those affected.
Mark Edington, Head of Grant Management at the Global Fund, praised Myanmar for its “strong capacity, good strategy and national leadership” and said Myanmar’s progress on its new grants was very positive. In addition to its new grants for the three diseases, Myanmar will also be eligible for the Mekong Artemisinin-Resistance Initiative, a region-wide initiative funded by the Global Fund to tackle the emergence of artemisinin-resistance in Laos, Cambodia, Viet Nam, Thailand and Myanmar. The five countries are moving forward rapidly to apply for regional funding, which is expected to be made available in early 2014. Edington said that by investing in a regional initiative, the Global Fund hopes to become a catalyst for other potential donors to join in the fight against the spread of resistant forms of malaria.
From the Frontlines: South Sudan
When she walks out of her hut, Alwal Mawang has a majestic gait that tells a story from her past. She carries a box in her hands. She sets the box down and opens it to reveal a package of drugs that she uses to treat children infected with malaria in her village in Rumbek, South Sudan. Alwal is one of thousands of community-based distributors providing malaria treatment to village children in South Sudan.
She is saving lives. She says that her mission today is no different from the one that inspired her for the 21 years she stayed in the bush fighting for freedom for her people. Then, she was Sergeant Alwal, a military standing that her gait gives away. Today they call her “Doctor Alwal.” She likes her new title better. Whether a doctor, or a solider, her mission of saving lives is unchanged. While she was a guerilla, her region in the South lost many people. Then, she thought all would be well after military forces left her homeland. But after helping bring freedom to her people, new challenges emerged. “There was a new enemy,” she declared. “His name is malaria. He is the worst killer in my community.”
The two battles are close and personal to her. She lost many friends and family during the war. Her husband, Colonel Mawang, was injured in action but survived to see the end of the war. Then one morning, he collapsed and died. Last year, Alwal’s nephew died of malaria. The boy was in a small village not served by a health center or even by a community-based distributor. For her family and community, Alwal will fight on. She is not paid as a community-based distributor, but she calls this her “most important work, a new purpose in life.” With the support of the Global Fund, in partnership with PSI and BRAC, an organization working with community-based distributors to control malaria in the villages of South Sudan, Alwal and many others have replaced traditional healers who administered herbs and sometimes soup to cure malaria. Besides her military gait, Alwal learned discipline, commitment and respect for people. That makes her a conscientious soldier in her new cause. She, and the army of community health workers like her, are bringing malaria drugs to the people in South Sudan.
Civil Society in Latin America
In Mexico City, the First Regional Meeting of Principal Recipient Civil Society Organizations of the Latin America and Spanish-speaking Caribbean regions took place last week. Discussions centered on the way civil society plays a vital role as Principal Recipient, sub-recipient and sub-sub-recipient. Civil society can also be a powerful voice calling for access to treatment, prevention and care, mobilizing resources and ensuring the response to the three diseases reaches those who need it. Civil society has a proven role in accessing marginalized communities, and in spreading prevention and treatment literacy.
Organized by HIVOS, an international NGO based in the Netherlands, the meeting gathered representatives that actively discussed the important role that human rights play in the response to HIV, and shared best practices on strengthening health and community systems. HIVOS is also a Global Fund Principal Recipient in several countries in the region. The meeting further reinforced to everyone present that civil society organizations are increasingly supporting interventions that guarantee the sustainability of the response, empower key populations and promote social and structural changes in the fight against AIDS, also reducing stigma and discrimination. As a result of the sometimes brave and bold advocacy of national activists and partners, vulnerable groups such as women and girls, men who have sex with men, transgendered people, sex workers, people who inject drugs, migrants and people in prison are being given a voice in setting the priorities of the country’s response, and access to funding in order to implement programs for AIDS, TB and malaria.
