New Funding Model – All Systems Go
All grants for the first three countries participating fully in the new funding model were signed in late June and early July and are now ready for disbursement - a milestone in the Global Fund’s new approach to funding the fight against the three diseases. The grants cover HIV, tuberculosis and malaria programs in Myanmar, an HIV program in Zimbabwe and an HIV program in El Salvador, worth a total of US$622 million. Despite a consultation-intensive process, participants have heaped praise on the new approach, describing it as full of constructive participation and feedback and with additional outreach to key affected populations. The aim of the new funding model, launched in February, is to reach more people affected by HIV and AIDS, TB and malaria. A small number of countries and regions were invited to take part as “early applicants,” who go through the full process with frequent interaction between all partners and stakeholders - from country dialogue and submission of a concept note to creation of a new grant. This allows applicants to have a better platform for coordinating grants with national health strategies, and engaging with the people most affected. In a fundamental shift from previous ways of doing things, Myanmar, Zimbabwe and El Salvador each identified program gaps and outlined priority programs from their national strategy, as well as additional programs that deserve consideration as extra funding becomes available. Despite the successes of the new funding model, there is room to learn. The regions and three other countries eligible to apply as early applicants under the new funding model are also moving forward, and may benefit from the experience of these first three applicants. The Global Fund staff and partners are incorporating lessons from the transition phase before the new funding model is fully implemented in 2014.
Do It Right (Then Share the Technique)
As one of the first countries selected as an early applicant under the new funding model, Zimbabwe is already sharing lessons it learned in the process of generating their concept note. Accepting an invitation from colleagues in Uganda, members of Zimbabwe’s core writing team went to Kampala, Uganda, to meet for two days last week 12-13 July to share their experience. The Zimbabwe team described the actions they took, what they saw as good achievements, and some of the challenges they experienced during the writing process. Overall, they were very positive. In less than a month, they were able to mobilize a very consultative country dialogue, submit a high quality concept note, engage effectively with the Technical Review Panel in incorporating its feedback and then finalize the grant application, which was approved by the Board of the Global Fund in June. That seemed like record time, and was characterized by really constructive back-and-forth with staff at the Global Fund. Participants cited the improved predictability of financing and the opportunity for alignment with national processes and strategic planning as major advantages of the new funding model. "From what I see, the defining factor in the success of Zimbabwe's application was the very high degree of unity of purpose exhibited by everybody involved,” said Vinand Nantulya, Chair of Uganda’s Country Coordinating Mechanism.
Participants at the meeting also talked through areas that need to be improved. They cited a need for better guidance on country dialogue, and what its nature, scope, elements and outputs should be. Some members also described a need to better understand the distinction between “incentive funding” and “full expression of demand.” Discussions also included the role of the Country Coordinating Mechanism in the new funding model process, and how that may or may not change. Overall, participants recognized the great benefit of collaboration between the Ministry of Health, the National AIDS Council and the Country Coordinating Mechanism, and the support provided by the Global Fund and key technical partners, as well as the commitment and hard work of the many people who were involved.
Fighting Malaria on the Airwaves in Hispaniola
From the microphones of his small radio station in the border between the Dominican Republic and Haiti, Father Guillermo Jose Perdomo wages an uneven battle against a deadly enemy – malaria. Radio Marien, a Jesuit broadcasting station, plays a vital role in raising the awareness of the importance of the correct use of insecticide-treated nets to combat the insect-borne disease in this far-flung corner of the world. “Malaria affects the poorest of the poor, especially our brothers and sisters from Haiti who cross the border seeking jobs,” said Perdomo, director general of Radio Marien in the border town of Dajabon, on the Dominican Republic side. “I want to contribute from the airwaves to fight this evil.” Thanks to Global Fund grants, Father Perdomo has been involved in the distribution of insecticide-treated nets in partnership with the Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Diaz and the Asociación Dominicana de Planificación Familiar, two community-based health centers. But the grey-haired pastor says handing out nets is only half the job. “We have distributed 15,000 nets through a women’s organisation, but this has to be complemented with information,” he said. “The lack of information is our greatest challenge. We need to teach our listeners how to maintain the nets in good condition and not to wash them too much.” On its airwaves, Radio Marien mixes the broadcasts of health programs with Christian teachings, soap operas and, of course, the ubiquitous merengue music. Despite living side by side, the Dominican Republic and Haiti share a past laced with prejudice and violence – the boundary that separates the two countries in the north is a river ominously-named Massacre River. But Perdomo says the battle against malaria requires a united front. Hispaniola, an island shared by Haiti and the Dominican Republic, is the only Caribbean island where malaria still persists, representing a financial burden to their economies, especially in the agriculture and tourism industries. Biological and epidemiological data indicate that malaria can be eliminated from Hispaniola, where the more lethal plasmodium falciparum, one of four distinct species of the malaria parasite that affect humans, is more prevalent. Ten countries in Central America and the Caribbean, including the Dominican Republic and Haiti, have joined a regional initiative that aims to eliminate malaria by 2020, with support from the Global Fund. The Global Fund, which is currently supporting malaria grants in Nicaragua, Honduras, Guatemala, Dominican Republic and Haiti, has set aside an additional US$10 million for that regional initiative.
In Old Dhaka, a Tale of Grief and Hope
Sumi speaks in a slow, whispery voice as she recounts her short life. Born to poor parents, she was raped while she worked as a maid, disgraced and expelled from her family home, only to end up marrying a man who forced her into sex work in the cramped brothels of Dhaka. But her coal-black eyes appear to glow as she remembers the day some help finally knocked on her door. Sumi, 19, makes a living as a sex worker in Bangladesh’s capital, but now she has a place she calls home - and where she receives counselling on HIV and AIDS.
“I met an outreach worker from Lalbag who gave me information about the Drop-In-Centre and the services it provides for female sex workers,” she said. “I really like coming to the Drop-In-Centre. We share our grief, joys and experiences. It is like a second home for me.”
With support from the Global Fund, some 30,000 female sex workers receive HIV and AIDS counselling at these community-based centres in Bangladesh. Peer counsellors work on behavioral change communication and provide female sex workers with information and counselling on HIV prevention and the use of condoms, with the aim of preventing the spread of the disease among those most vulnerable. “Before, I knew nothing about HIV and AIDS. I had not tested myself and did not know what the disease is and how it spreads,” said Sumi. She is dressed in a pretty bright-red sari with printed blue and green flowers. “Now I know about the methods of preventing it and preventing other sexually transmitted diseases and I inform my friends who do sex work in the same area about HIV and the methods of preventing infection.”
Like Sumi, many of these young female sex workers have broken lives and exist on the margins of society. At the centers, they have found a shelter where they can wash their clothes, take a bath, rest, play games and receive counselling on alternative livelihoods. There are also referral services for treatment of sexually-transmitted diseases.
Sumi, who was lucky not to have contracted HIV, says she understands the importance of educating her clients. Of the dozen or so female sex workers huddled in the Drop-In-Centre on a recent humid morning, she was the only one who agreed to tell her story. At first she was shy and did not make eye contact. But as she gained confidence she raised her chin. “I have gained the power to resist the demands of my clients who want unsafe sex, and have developed negotiation skills to ensure that my clients do not force me into unsafe sex with them,” she said. “I have even influenced my clients positively in the sense that they have started checking their HIV status and use condoms.”