DEBBIE GUEYEPMI/SENEGAL

RESIDENT ADVISOR

F E B R UA RY 7 , 2 0 1 2

Who’s Who in International Malaria Control

Peace Corps Malaria Initiative for Africa Boot Camp

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 InitiativeThe Global FundRoll Back Malaria PartnershipWorld 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 and investing in country-led plans and health systems

• increasing impact and efficiency through strategic coordination and programmatic integration

• strengthening and leveraging key partnerships, multilateral organizations, and private contributions

• implementing a woman- and girl-centered approach

• improving monitoring and evaluation

• promoting research and 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 yearsAdvance 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 world's 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 gover nance, 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 grant's lifespan, and each disbursement is based on performance

High Level Independent Review Panel Recommendations

1. Turn the Page from Emergency to Sustainable Response1.1 No Amnesty for Fraud, but Focus Oversight on More-Recent Rounds of Grants1.2 Strengthen the Relationship between the Secretariat and the Inspector General

2. Declare a Doctrine of Risk and Manage to it2.1 Adopt a New Risk-Management Framework2.2 Redefine “Country Ownership”2.3 Apply the Risk-Management Framework to the Existing Portfolio

3. Strengthen Internal Governance3.1 Focus the Global Fund’s Board on Management, Strategy and Risk-Management3.2 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 Process4.1 Institute a Two-Stage Grant Process4.2 Apply Risk-Differentiated Grant Processes and Requirements

5. Empower Middle-Management’s Decision-Making5.1 Establish a Chief Risk Officer5.2 Align the Staffing Pattern to Bolster Grant-Management5.3 Empower the Fund Portfolio Managers5.4 Streamline and Expand the Country Teams5.5 Reinforce the Executive Management Team5.6 Leverage the Investment in the Local Fund Agents5.7 Define and Clarify the Role and Responsibilities of External Auditors

6. Get Serious About Results6.1 Measure Outcomes, Not Inputs6.2 Focus on Quality and Value, Rather than Quantity6.3 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 Malaria Advocacy Communication Harmonization: The HWG

facilitates and harmonizes partners' support in response to countries identified needs and supports the establishment of the 'three ones' principles for malaria at country level.

Resources Vector Control Procurement and Supply

Management Case Management Monitoring and Evaluation Malaria in Pregnancy

RBM Sub-Regional Networks (SRNs):

Central Africa

East Africa

Southern Africa

West Africa

Identify, coordinate, and respond to requests for technical assistance for the scale-up of malaria control and treatment interventions

World Health Organization/Global Malaria Program (GMP)

Responsible for malaria surveillance, monitoring and evaluation, policy and strategy formulation, technical assistance, and coordination of WHO's global efforts to fight malaria

As part of the World Health Organization, convenes experts to review evidence and set global policies

GMP's 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 WHO's 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 officesWHO/AFRO: regional headquarters in Brazzaville, Congo

Key Technical Documents/Reports

World Malaria ReportMalaria Treatment GuidelinesAnitmalarial efficacy and drug resistance: 2000-2010Global Plan for Artemisinin Resistance ContainmentGood Procurement Practices for Artemisinin-based

antimalarial medicinesGood Practices for Selecting and Procuring Rapid

Diagnostic Tests for MalariaRDT Product Testing ResultsIndoor 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 complicatedObjective: to have all partners supporting the

NMCP plan and strategiesChallenge: partners have their own agendas