Who’s Who in International Malaria ControlPeace Corps Malaria Initiative for Africa Boot Camp DEBBIE GUEYE PMI/SENEGAL RESIDENT ADVISOR FEBRUARY 7, 2012
Objectives Understand how the different components of PMI (USAID, HHS, CDC) work together and with other agencies; Be familiar with the major international actors in malaria control Understand how the Global Fund application process works Discuss challenges and opportunities in coordination
The Major Actors President’s Malaria Initiative The Global Fund Roll Back Malaria Partnership World Health Organization/Global Malaria Program
President’s Malaria Initiative Launched in June 2005 as a five-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions 2008 Lantos-Hyde Act: funding extended through Fiscal Year 2014 Managed by USAID in coordination with the Department of Health and Human Services (CDC), the Department of State, and the White House 17 Countries: Angola, Benin, DRC, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zambia www.pmi.gov
PMI Principles PMI aligns its activities with host country malaria control strategies and coordinates closely with international partners, non-governmental organizations, community groups, and the private sector PMI is a core component of the Global Health Initiative (GHI), along with HIV/AIDS, and tuberculosis. Adherence to GHI core principles • encouraging country ownership • increasing impact and efficiency and investing in country-led plans through strategic coordination and health systems and programmatic integration • strengthening and leveraging key • implementing a woman- and girl- partnerships, multilateral centered approach organizations, and private contributions • improving monitoring and • promoting research and evaluation innovation
PMI Goal and Interventions Goal: reduce malaria-related mortality by 70% in the original 15 countries by the end of 2015, by reaching 85% of the most vulnerable groups – primarily pregnant women and children under five years old – with proven preventive and therapeutic interventions PMI supports four key intervention strategies for malaria prevention and control: Spraying approved, long-lasting insecticides on the interior walls of homes (indoor residual spraying) Promotion and distribution of long-lasting insecticide-treated bednets (LLINs) Training for medical personnel and community health workers to improve malaria diagnosis and effective treatment Prevention among pregnant women with prophylactic drugs during prenatal care (intermittent preventive treatment)
PMI Country Operations 2 Resident Advisors in-country: USAID and CDC Provide technical support to NMCP and oversee PMI-funded programs Annual Malaria Operational Plan (MOP) Developed collaboratively with NMCP and local stakeholders Background, progress, planned activities Budget by activity and implementing mechanism Reviewed and approved by USAID-CDC Technical Working Group (TWG), followed by inter-agency steering group (ISG) that includes HHS, OMB, White House Any proposed changes must be described in reprogramming memo, approved by PMI Coordinator
PMI Country Operations Implementation mechanisms Bilateral: conceived, funded and managed from the local USAID Mission Field Support: conceived by USAID/Washington, some central funding and overall management; countries “buy in” and manage local interventions Funds allocated through competitive bidding processes Projects generally run 5 years Advance planning for funds that are slow to come
The Global Fund to Fight AIDS, Tuberculosis and Malaria Created in 2002 to dramatically increase resources to fight three of the worlds most devastating diseases, and to direct those resources to areas of greatest need Partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing Model based on the concepts of country ownership and performance-based funding, which means that people in countries implement their own programs based on their priorities and the Global Fund provides financing on the condition that verifiable results are achieved http://www.theglobalfund.org
Global Fund Guiding Principles Operate as a financial instrument, not an implementing entity Make available and leverage additional financial resources Support programs that evolve from national plans and priorities Operate in a balanced manner in terms of different regions, diseases and interventions Pursue an integrated and balanced approach to prevention and treatment Evaluate proposals through independent review process (TRP) Operate with transparency and accountability
Global Fund Core Structures - Central Global Fund Secretariat: manages the grant portfolio, including screening proposals submitted, issuing instructions to disburse money and implementing performance-based funding of grants tasked with executing Board policies; resource mobilization; providing strategic, policy, financial, legal and administrative support; and overseeing monitoring and evaluation based in Geneva, no staff located outside its headquarters
Global Fund Core Structures - Central Technical Review Panel (TRP): independent group of international experts in the three diseases and cross-cutting issues (health systems, M&E, etc.) meets regularly to review proposals based on technical criteria and provide funding recommendations to the Board
Global Fund Core Structures - Central Global Fund Board composed of representatives from donor and recipient gov-ernments, civil society, the private sector, private foundations, and communities living with and affected by the diseases responsible for the organization’s governance, including establishing strategies and policies, making funding decisions and setting budgets works to advocate and mobilize resources for the organization Global Fund Trustee manages the organization’s money, which includes making payments to recipients at the instruction of the Secretariat The Trustee is cur-rently the World Bank
Global Fund Core Structures - Country Country Coordinating Mechanism (CCM) com-posed of all key stakeholders for the three diseases. Demonstrates commitment to local ownership and participatory decision-making includes representatives from public and private sectors, including governments, multilateral or bilateral agencies, non-governmental organizations, academic institutions, private businesses and people living with the diseases does not handle Global Fund financing itself
Global Fund Core Structures - Country CCM Core Functions coordinate the development and submission of national proposals nominate the Principal Recipient oversee implementation of the approved grant and submit requests for funding approve any reprogramming and submit requests for continued funding ensure linkages and consistency between Global Fund grants and other national health and development programs
Global Fund Core Structures - Country The Global Fund signs a legal grant agreement with a Principal Recipient (PR) designated by the CCM receives Global Fund financing directly, and uses it to implement prevention, care and treatment programs or passes it on to other organizations (sub-recipients) who provide those services makes regular requests for additional disbursements from the Global Fund based on demonstrated progress towards the intended results
Global Fund Core Structures - Country Local Fund Agents (LFAs) firms contracted by Global Fund to monitor implementation (selected through competitive bidding) responsible for provid-ing recommendations to the Secretariat on the capacity of the entities chosen to man-age Global Fund financing and on the soundness of regular requests for the disburse-ment of funds and result reports submitted by PRs.
Operations Annual call for proposals (“rounds”) GF follows the principles of performance-based funding in making funding decisions. Ensure that investments are made only where grant funding is managed and spent effectively on programs that achieve impact Grants initially approved for two years (Phase 1) and renewed for up to three additional years (Phase 2) based on performance Funding disbursed incrementally every three to six months throughout the grants lifespan, and each disbursement is based on performance
High Level Independent Review Panel Recommendations1. Turn the Page from Emergency to Sustainable Response 1.1 No Amnesty for Fraud, but Focus Oversight on More-Recent Rounds of Grants 1.2 Strengthen the Relationship between the Secretariat and the Inspector General2. Declare a Doctrine of Risk and Manage to it 2.1 Adopt a New Risk-Management Framework 2.2 Redefine “Country Ownership” 2.3 Apply the Risk-Management Framework to the Existing Portfolio3. Strengthen Internal Governance 3.1 Focus the Global Fund’s Board on Management, Strategy and Risk- Management 3.2 Re-purpose the Committees (Investment, Audit, Finance) 3.3 Create an Executive Staff to Support the Global Fund’s Board
High Level Independent Review Panel Recommendations (2)4. Streamline the Grant-Approval Process 4.1 Institute a Two-Stage Grant Process 4.2 Apply Risk-Differentiated Grant Processes and Requirements5. Empower Middle-Management’s Decision-Making 5.1 Establish a Chief Risk Officer 5.2 Align the Staffing Pattern to Bolster Grant-Management 5.3 Empower the Fund Portfolio Managers 5.4 Streamline and Expand the Country Teams 5.5 Reinforce the Executive Management Team 5.6 Leverage the Investment in the Local Fund Agents 5.7 Define and Clarify the Role and Responsibilities of External Auditors6. Get Serious About Results 6.1 Measure Outcomes, Not Inputs 6.2 Focus on Quality and Value, Rather than Quantity 6.3 Consolidate the Reform Agenda
Roll Back Malaria (RBM) Partnership Lead international forum for malaria stakeholders to coordinate implementation activity, formulate and promote international policy positions relating to malaria, and to promote advocacy for malaria prevention, control, and fund- raising. Launched in 1998 by WHO, UNICEF, UNDP and the World Bank, in an effort to provide a coordinated global response to the disease. Led by the Executive Director, and served by a Secretariat that is hosted by the World Health Organization in Geneva. The Secretariat works to facilitate policy coordination at a global level. http://www.rollbackmalaria.org
Global Coordination The RBM Partnership is the global framework to implement coordinated action against malaria mobilizes for action and resources and forges consensus among partners is comprised of more than 500 partners, including malaria endemic countries, their bilateral and multilateral development partners, the private sector, nongovernmental and community-based organizations, foundations, and research and academic institutions RBM’s overall strategy aims to reduce malaria morbidity and mortality by reaching universal coverage and strengthening health systems. The Global Malaria Action Plan defines two stages of malaria control: (1) scaling-up for impact (SUFI) of preventive and therapeutic interventions, and (2) sustaining control over time.
RBM Organization Working Groups RBM Sub-Regional Networks Malaria Advocacy (SRNs): Communication Central Africa Harmonization: The HWG facilitates and harmonizes East Africa partners support in response to countries identified needs Southern Africa and supports the establishment of the three West Africa ones principles for malaria at country level. Identify, coordinate, and Resources respond to requests for Vector Control technical assistance for the Procurement and Supply scale-up of malaria control Management and treatment interventions Case Management Monitoring and Evaluation Malaria in Pregnancy
World Health Organization/ Global Malaria Program (GMP) Responsible for malaria surveillance, monitoring and evaluation, policy and strategy formulation, technical assistance, and coordination of WHOs global efforts to fight malaria As part of the World Health Organization, convenes experts to review evidence and set global policies GMPs policy advice provides the benchmark for national malaria programmes and multilateral funding agencies www.who.int/malaria
GMP Strategic Advantage Unique position uniting high levels of expertise – and WHOs field presence in all regions and all malaria- endemic countries of the world – ensures harmonized policy advice and the critical technical assistance necessary to effect concrete and sustainable successes at global level Activities focused on providing an integrated solution to the various epidemiological and operational challenges Promotes sound, evidence-based and locally appropriate strategies. Helps countries reach the most vulnerable populations and ensure that needed interventions take into account social, economic and environmental realities.
GMP Technical Assistance Supports national malaria programmes worldwide and provides technical assistance at country level on five main topics: diagnosis and treatment (diagnostic tools, medicines, patient management, quality assurance, supply chain management) vector control and preventive measures (mosquito control; reducing the risk of infection for local populations and international travellers) elimination of malaria (expanding the malaria-free areas of the world) surveillance, monitoring and evaluation (generating data for decision making, quality assurance) research (improving the tools to combat malaria, and the way we use them) Malaria National Professional Officer (NPO) in country offices WHO/AFRO: regional headquarters in Brazzaville, Congo
Key Technical Documents/Reports World Malaria Report Malaria Treatment Guidelines Anitmalarial efficacy and drug resistance: 2000-2010 Global Plan for Artemisinin Resistance Containment Good Procurement Practices for Artemisinin-based antimalarial medicines Good Practices for Selecting and Procuring Rapid Diagnostic Tests for Malaria RDT Product Testing Results Indoor Residual Spraying
WHOPES (WHO Pesticide Evaluation Scheme) Set up in 1960, WHOPES promotes and coordinates the testing and evaluation of pesticides for public health Representatives of governments, manufacturers of pesticides and pesticide application equipment, WHO Collaborating Centres and research institutions, and other WHO programmes Four-phase evaluation and testing programme, studying the safety, efficacy and operational acceptability of public health pesticides and developing specifications for quality control and international trade WHOPES collects, consolidates, evaluates and disseminates information on the use of pesticides for public health. Recommendations facilitate the registration of pesticides by Member States.
Challenges and Opportunities in Coordination Among these actors, PMI is only one that has both money and people on the ground Global Fund: money, no people RBM: people (but regional focus), no money WHO: people, no money WHO is the technical leader for malaria control programs, personnel very well respected Global Fund: It’s complicated Objective: to have all partners supporting the NMCP plan and strategies Challenge: partners have their own agendas