Global Fund News Flash: Issue 31
Regional Applications in the New Funding Model
Diseases know no borders, so the effective response to HIV, TB and malaria sometimes requires a regional approach with cross-border interventions. Under the new funding model, the Global Fund will continue to support strategically-focused regional applications that achieve high impact, represent value for money and reach key affected populations. The new approach to funding aims to make the process of accessing funds more predictable, more responsive and more flexible. With this in mind, all regional applications will follow a two-step process under the new funding model. Applicants will first be asked to submit a short expression of interest that makes the case for their regional proposal, expected impact and funding needed. Eligible expressions of interest will then receive an invitation to submit a concept note, and applicants will also be given an indicative funding amount. During country dialogue and concept note development, the Global Fund will engage with the applicant to ensure active participation of key affected population networks and partners.
In order to ensure that there is an equal opportunity to access funding set aside for regional applications, there will be two windows for applicants to express interest: one in April 2014 and the other in April 2015. It is expected that approximately half the available funds will be set aside for each year. By January 2014, the Global Fund will make available all tools and guidance needed to submit an expression of interest. The total amount of funding set aside for regional applications during the 2014-2016 period will be determined following the outcome of the replenishment launch in December 2013 and is expected to be approved by the Board at its meeting in March 2014.
The numbers are in, from a new Kenya AIDS Indicator Survey, and it looks like strong reforms in implementing health programs in Kenya are showing how to break the back of HIV and AIDS. The report shows that Kenya’s HIV prevalence now stands at 5.6 percent, a reduction by almost exactly half, from a peak of 10.5 percent in 1996. The results are even more dramatic considering that the number of people living with HIV continues to rise as people live longer with the help of antiretroviral drugs. While incidence data is not out yet, Dr. Peter Cherutich of Kenya’s National HIV and STI Control Program (NASCOP) says the reduced prevalence seems to point to a remarkable reduction in new cases of HIV.
The survey also shows that Kenya’s HIV epidemic is not as generalized as previously thought. Certain areas in the country have pockets of hyper-epidemics, and Kenya is starting to take steps to tailor interventions to address these hotspots. John Ochero, Fund Portfolio Manager for Kenya said: “We are encouraging Kenya to be even more ambitious in developing proposals that target the country’s key populations in HIV infections.”
Good implementation of programs begets impact. The overall HIV prevalence results have a strong correlation with improved performance of the Global Fund grants in Kenya, a great turn around for a portfolio that didn’t start very strongly. “Kenya has had problems with its implementation in the past,” said Ochero. But the country’s reforms have dramatically changed the face of HIV, TB and malaria in the country. Kenya’s Country Coordinating Mechanism has streamlined itself and improved communication and trust between the country and the Global Fund. It also established a firm conflict-of-interest policy. “We now have a strong mutual collaboration and understanding between us and Geneva,” said Cherutich. With the changes, Kenya’s grants with the Global Fund are performing remarkably well. Ochero says the improved rating of the grants points to the great work that Kenya is doing in the fight against the three diseases.
Colombia Wins Malaria Award Proyecto Malaria Colombia, a Colombian health initiative supported by the Global Fund, has won a top malaria prize in the Americas for its success in fighting the disease among vulnerable populations and for strengthening community health care. Colombia has the highest disease burden in Latin America after Brazil, with 24 per cent of the population being at risk of infection. Indigenous groups, populations of African descent and communities displaced by violence are among the most affected by malaria. Proyecto Malaria was launched in 2010, when Colombia reported more than 115,000 cases of malaria. It is concentrated in specific areas. Five departments - Córdoba, Antioquia, Chocó, Valle del Cauca and Cauca – accounted for 80 percent of all malaria cases in Colombia. By focusing the response, effective action was taken. By 2012, the number of reported cases had dropped by almost 50 per cent.
Administered by Colombia’s state agency for development, FONADE, and by the Fundación Universidad de Antioquia, Proyecto Malaria Colombia provides diagnostic and prevention services in rural areas through a network of community health workers, including the delivery of mosquito nets. The program organizes games and other community events in local languages aimed at educating people about the disease and the correct way to install nets to fend off “zancudos”, as mosquitoes are known in most Latin American countries. The success of Proyecto Malaria Colombia has gone beyond fighting malaria. The program has expanded primary health services in hard-to-reach areas with little state presence, providing villages with someone from their own community to deliver pre-natal, maternal and child care. It has also developed women’s leadership skills in the communities. And the program’s experience and methods are being used to address other public health problems, such as leishmaniasis and tuberculosis.
“We are providing a roadmap to health,” said Olga Murillo, the program’s manager. Colombia’s indigenous tribal groups such as the Embera, the Kuna, the Zenú or the Waunano have historically suffered from exploitation and discrimination. In more recent times, they are often caught in the crossfire of violence between illegal armed groups and drug traffickers. Diseases, clear-cutting of forests, illegal mining in ancestral lands and internal displacement have added to their plight, in some cases putting them at risk of extinction. The Champion Against Malaria in The Americas 2013 award was awarded by the Pan American Health Organization, the regional office of the World Health Organization, the Pan American Health and Education Foundation, the Center for Global Health at the George Washington University and other partners.
Some 219 million people around the world suffer from malaria, and each year nearly 600,000 die from the disease. In the Americas, nearly 106 million people live in areas at high risk of malaria, although between 2000 and 2012 the number of cases in the region declined by 60 per cent and the number of deaths dropped by 70 per cent.
From the Frontlines: Mongolia
The Global Fund’s increased focus on high-impact countries is part of an overall strategy to reach more people affected by AIDS, TB and malaria. But together with that shift is a consistent commitment to remaining global, and going where work is needed. Mongolia, a nation of 2.8 million people and the world’s most sparsely populated country, needs investment in tuberculosis, which recorded 3,944 new TB cases and 210 drug resistant TB in 2012.
“We have to address the increasing number of MDR-TB cases in Mongolia ,” said Manab Basnet, Global Fund’s Fund Portfolio Manager in charge of Mongolia. “This can be done by increasing early case finding using innovative approaches and by optimizing treatment delivery to reduce transmission.” A big challenge lies in the fact that the country has vast swaths of land in between small community settlements. Moving test specimens from villages across such distances in the sparsely populated country to the cities where testing facilities are located takes a long time. In cases of drug-resistant tuberculosis, some diagnosis and treatment can take much longer. To help take care of the problem, the Global Fund has supported the purchase of the first GeneXpert machine in the country; two others will soon be procured. The machines may not be enough to meet all demand, but they will make a significant difference in Mongolia. There are other signs of optimism, in the contribution of other partners. One is the Mongolian Anti-Tuberculosis Association (MATA), which works with the Ministry of Health in the country and hundreds of dedicated health volunteers who monitor TB treatment implementation in the grassroots. The National Tuberculosis Program has also created good and sustainable community partnerships with NGOs such as MATA, The Mongolian TB Coalition (MTC), World Vision Mongolia and the Mongolian Association of Family Medicine Specialists (MAFMS). These non-governmental organizations are key to providing accessible patient support, care and control services with community-based projects. “If we continue working well with partners,” says Di Wu of the Mongolia Country team at the Global Fund, “our work can create rapid impact that can save a larger number of lives and big future costs.”