Newsletter
Issue 200: 29 October 2012
GFO is an independent newsletter about the Global Fund.
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CONTENTS OF THIS ISSUE:
1. NEWS: The AMFm Endangers Public Health, Oxfam says
A report from Oxfam is very critical of the Affordable Medicine Facility–malaria, which is hosted by the Global Fund.
2. NEWS: Global Fund Has Been a Strong Supporter of Harm Reduction in EECA, but What About the Future?
The community of people who inject drugs and their advocates in Eastern Europe and Central Asia credit the Global Fund as being the major supporter of harm reduction programmes in the region, but they are worried about whether these programmes will continue to be financed by the Fund.
3. NEWS: Experts Provide Their Views on the Future of the Global Fund
The Global Fund has “missed the point” by jumping directly into the politically very sensitive issue of an allocation model, according to one expert on a new online forum.
4. NEWS: Campaign Launched to Lobby for More Financing for the Global Fund
The Here I Am campaign advocates for increased funding for the Global Fund using tools such as videos, blogs and young ambassadors.
5. NEWS: Diagnostic Review Finds that Eritrea Has Used Grant Funds Constructively to Strengthen Health Systems
The diagnostic review of Global Fund grants to Eritrea found that the country has used Global Fund resources to strengthen its national health systems but manifests some weaknesses, such as a failure to define national standards.
6. NEWS: OIG Cites Good Practices in CARICOM HIV Grant
The Office of the Inspector General says that the HIV grant to the Caribbean Community Secretariat is a good model of how a regional grant can benefit small island states.
7. NEWS: “Friends” Organisations Promote the Work of the Global Fund
Friends from donor countries mostly carry out mobilisation of political and financial support for the Fund, while those from grant receiving countries focus on raising awareness about the three diseases.
See section near the end of this newsletter listing additional articles available on GFO Live.
ARTICLES:
1. NEWS: The AMFm Endangers Public Health, Oxfam says
Global Fund calls Oxfam’s claims “untrue”
The Affordable Medicine Facility–malaria (AMFm) endangers public health, according to Oxfam. There are alternative approaches that can deliver better health outcomes for poor people, the agency said in a report released on 24 October 2012.
The AMFm is a subsidy programme for artemisinin-based combination therapies (ACTs) currently underway in seven pilot countries. A recently concluded independent evaluation termed the AMFm a “game-changer,” having successfully increased the availability and reduced the prices for quality ACTs among the private sector providers (see GFO article).
The Global Fund has hosted the AMFm as a pilot project since 2009. The Board of the Global Fund is scheduled to decide on the future of the AMFm at its meeting on 14–15 November.
According to the Oxfam report, increased availability is not proof that the medicines got to those in need or that treatments were given appropriately. The report blamed AMFm for causing “a crisis in the global market” by triggering excessive demand for ACTs, even among countries with low malaria prevalence.
The report warned of the danger of resistance as a result of excessive sale of ACTs, particularly now when malaria cases are known to be on the decline.
Oxfam also faulted the AMFm model’s reliance on the private retail sector. The report argued that such providers lack the incentive to carry out proper diagnosis and treatment. Instead, Oxfam recommended that community health workers be trained on diagnosis and treatment, and that private pharmacies only support public sector provision in towns.
Oxfam also recommended that the Global Fund stop hosting the AMFm and that UNITAID and the UK Department for International Development, two of the main donors, cease funding the project.
According to BBC News, the Global Fund issued a statement in response to the Oxfam report in which it said Oxfam's claims were “simply untrue.”
The Fund said, “Some Western aid groups oppose a pragmatic approach that includes any involvement of the private sector. But the reality of this programme is that it is getting life-saving medicine to people who need it most from the private sector outlets where they already seek treatment.”
[This article was first posted on GFO Live on 25 October 2012.]
Editor’s Note: There is a spirited discussion on the AMFm taking place on the Aidspan website here. Scroll to the bottom of the article on that page to see the comments.
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2. NEWS: Global Fund Has Been a Strong Supporter of Harm Reduction
in EECA, but What About the Future?
The Global Fund's importance to people who inject drugs in Eastern Europe and Central Asia (EECA) cannot be overstated, according to Serge Votyagov of the Eurasian Harm Reduction Network, writing in “Lucy’s Blog” on the website of the Huffington Post. The blog is written by Lucy Cheshire, the Executive Director and Secretary to the Board of the TB Action Group.
From 2002 to 2009, the Global Fund provided more than all other international sources combined ($263 million) for harm reduction in EECA, Mr Votyagov said. “In addition to providing funds for commodities such as clean needles and syringes, some Global Fund HIV/AIDS grants have provided funding for stigma reduction, community mobilization, strengthening civil society and policy advocacy and has helped to facilitate real dialogue on harm reduction within countries, e.g. within country coordinating mechanisms (CCMs).”
Mr Votyagov said that within the community of harm reductionists and people who inject drugs, people were optimistic up until Round 11 that the heightened emphasis on the human rights of marginalised groups in the Global Fund Strategy would lead to an increase in support. “As the Global Fund seeks to replenish in 2013, the community and its advocates are naturally following developments quite closely.”
The blogs quotes Irina from Kyrgyzstan as saying, “There is methadone till 2015, but we don't know what will happen next.” HIV and drug dependence treatment in Kyrgyzstan is secured only until 2015, when the existing Global Fund programme ends.
See Mr Votyagov’ full comments in Lucy’s Blog.
[This article was first posted on GFO Live on 18 October 2012.]
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3. NEWS: Experts Provide Their Views on the Future of the Global Fund
New online forum launched by CGD
The Global Fund has “missed the point” by jumping directly into the politically very sensitive issue of an allocation model (i.e. how to divide the money). This is the view of Anders Nordström, Ambassador for Global Health at the Swedish Ministry for Foreign Affairs, as expressed on a new online forum.
The Global Fund Forum was recently launched by the Centre for Global Development to present the views of prominent thinkers and practitioners on what reforms the Global Fund should prioritize and how it should best fulfil its mandate. The initial posts are from Mr Nordström; Erin Hohlfeder, Policy Director, Global Health at ONE; and Prashant Yadav, Director Healthcare Research at the William Davidson Institute, University of Michigan.
Mr Nordström says that the Global Fund should simplify its ways of working and at the same time allow for more robust and differentiated interactions with countries. “It is not reasonable to have the same operating model (with country coordinating mechanisms, local fund agents, principal recipients, etc.) in countries where the Global Fund provides a $10 million grant as in countries where the total resources amounts to hundreds of millions and constitute perhaps as much as 30–40% of the national budget," Mr Nordström said.
Mr Nordström argues that the discussion on the allocations model should have come “only after some more serious work based on the new strategy defining the Global Funds strategic role in different country contexts.”
In her post, Erin Hohlfeder says that while a new allocation model should give significant weight to a country’s disease burden and income level, it should also incorporate criteria related to past performance, “so as to incentivize innovation and exemplary performance and to mitigate instances in which countries write excellent proposals but cannot deliver sufficient outcomes.” If this is done, Ms Hohlfeder says, the Global Fund should then consider creating a smaller “catch up fund” for countries with extreme burden and lower capacity to execute, so they don’t fall further behind.
In his post, Prashant Yadav says that the Global Fund needs to have better control over the supply chain that helps it deliver products and services to the final recipients. “Exercising control over the supply chain is not the same as owning the assets in the supply chain or controlling all decisions,” Mr Yadav said. “It requires a model where there is greater accountability and performance tracking at each level and greater involvement of efficient private sector actors in portions of the supply chain that they are best suited to manage.”
The Global Fund Forum will add new perspectives in the coming weeks. In addition, readers are invited to join the discussion on the page that introduces the forum.
[This article was first posted on GFO Live on 19 October 2012.]
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4. NEWS: Campaign Launched to Lobby for More Financing for the Global Fund
Self-made videos highlight the impact of the grants
The aim is to influence the 4th Replenishment Process in 2013
The Global Fund Advocates Network (GFAN), a platform of around 250 individuals and civil society and “Friends of the Fund” organisations, has launched a campaign to advocate for increase in funding of the Global Fund.
The “Here I Am” campaign highlights the real life experiences of people affected by the three diseases and gives them a forum to share these experiences.
The campaign will make use of several tools to achieve its goals, including the use of ambassadors, websites and blogs, and video stories.
Ambassadors
The Here I Am ambassadors are people who are directly affected or infected by the three diseases and who can speak about the impact of Global Fund investments in their communities.
The campaign will identify 2-6 individuals from each region of the world to serve as ambassadors. The ambassadors will work in close collaboration with the Communities Delegation on the Global Fund Board. The World AIDS Campaign International will provide support to facilitate their communication, training and travel.
The campaign has already identified two ambassadors; Thokozile Beatrex Phiri and Maurine Murenga.
Thokozile is a TB-HIV advocate from Malawi who has been active in both national and international arenas. She works for the Malawi Interfaith AIDS Association, which currently serves as the secretariat of the SAVE Lives from HIV and AIDS campaign. In 2012, Thokozile joined the Communities Delegation on the Global Fund Board.
Maurine Murenga is an HIV/AIDS activist from Kenya who focuses her efforts on issues related to access to treatment, human rights, public awareness, and care and support for young women and girls. Maurine serves as the coordinator of Lean on Me, an organisation that provides care and support to young women and adolescents living with HIV.
Video Stories
More than 100 video stories have been collected from all over the world, featuring people speaking about the impact of the Global Fund investments in their lives. These are self-filmed 2-3-minute videos. Many of the stories were collected at the International Aids Conference in Washington in July 2012.
Websites
The Here I Am website is the platform where all GFAN members can find information and through which all the tools are made available. The website features the video stories mentioned above and information on the Global Fund replenishment process.
The Huffington Post, an online newspaper, will feature one new story every week as part of the Here I Am blog that is hosted by Lucy Cheshire, the Executive Director of TB ACTION Group/Kenya. Each story can be shared from the website through Facebook and Twitter.
The Here I Am campaign aims to influence the Global Fund’s 4th Replenishment Process, which takes place in 2013. This is where most donors are expected to announce their pledges for the period 2014–2016.
[This article was first posted on GFO Live on 10 October 2012.]
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5. NEWS: Diagnostic Review Finds that Eritrea Has Used Grant Funds
Constructively to Strengthen Health Systems
The review also identified weaknesses in programmes and systems
PR has agreed to take actions to address the weaknesses
Eritrea has used Global Fund resources from a number of grants constructively to strengthen its national health systems, a diagnostic review of the country’s grants released by the Office of Inspector General (OIG) has found. The review identified other good practices. But it also revealed weaknesses in programme management and in financial and procurement systems.
The review was conducted from 16 April to 4 May 2012. It covered the five grants to Eritrea that were active at the time of the review, which had a total budget of $79 million of which $54 million had been disbursed. The principal recipient (PR) for all the grants was the Ministry of Health (MOH). The grants are administered by the Project Management Unit (PMU) of the MOH.
A diagnostic review is different from a country audit in that no overall opinions are provided and no assurance is given regarding how grant funds were spent. This review sought to identify and share good practices as well as identify key weaknesses in the implementation of Global Fund grants.
The OIG review identified several good practices. Concerning Eritrea’s national health systems, the OIG singled out the practice of providing pre-service training for associated nurses. The OIG described this as a “remarkable initiative not commonly seen in Global Fund-supported programmes.”
The OIG found that Global Fund resources have been used to strengthen national systems instead of creating parallel grant-specific systems and processes. In addition, the OIG noted that there was comprehensive verification of sub-recipient expenditures in Eritrea.
According to the OIG, the government has produced clear and comprehensive guidelines and tools for the supervision of the lower-level health facilities.
The OIG also identified several weaknesses in Global Fund grants in Eritrea. The OIG said that Eritrea faces a general shortage of human resources in health, which is made worse by high attrition rates and considerable mobility of staff. According to the OIG, this has had negative consequences in several areas, such as quality control of laboratory services, infant diagnosis of HIV infection, supervision of HIV and tuberculosis services, and data management.
The OIG noted that programme mobility in Eritrea is limited by difficulties in obtaining vehicles. Almost all government vehicles in Eritrea are administered by public service car pools at central and zoba (i.e. regional) levels, including vehicles bought with Global Fund support. A programme officer who requires a vehicle for supervision or data quality control has to apply to the pool and will be allocated a vehicle based on availability. This is a process that can take several weeks and is subject to cancellation at short notice.
The OIG said that in order to circumvent this process, the programmes are making use of private hire vehicles, which are costly. Next to human resources constraints, the difficulties in obtaining vehicles were cited by programme coordinators and supervisors as the main reason for not conducting planned supervision and quality control visits.
The OIG said that another major weakness in Global Fund grants in Eritrea is a gap in knowledge about risk groups and risk behaviours. The OIG noted that prevention programming for men who have sex with men (MSM) is compromised by the fact that same sex relationships are not legal in Eritrea.
The OIG observed a number of weaknesses in tuberculosis control in Eritrea. They include declining treatment success rates since 2008; declining case notification rates since 2005, and inconsistent programme guidance and service provision for paediatric tuberculosis.
The OIG said that Eritrea has not defined national standards for drug management. The lack of standardisation creates serious challenges for the quantification and management of national stocks.
With regard to the weaknesses in the review identified in procurement and supply management (PSM), the OIG said that the MOH has agreed to do the following:
- define national standards for drug management and prepare technical specifications for the new logistics management information system;
- strengthen procurement procedures, including ensuring appropriate training for staff in PSM policies and good procurement practices, updating and streamlining bid documents, strengthening penalty clauses in contracts and implementing a formal supplier performance monitoring system;
- improve quality assurance mechanisms by providing training to staff in drug registration and prequalification procedures, and ensuring compliance with the Global Fund policy for quality control testing of drug samples; and
- take measures to minimise the risk of loss of inventory by reducing the fire hazard in warehouses and insuring warehouses.