Among the grants approved by the Global Fund Board on 21 December 2018 (see GFO article) were three multi-country grants. Two of the grants were for Eastern Europe and Central Asia (EECA); the third was for West and Central Africa. (See table.)
Table: Multi-country grants approved recently from the 2017–2019 allocations ($)
|Applicant||Grant name||Principal recipient||Amount approved||UQD|
|Multicountry EECA TB||QMZ-T-PAS||PAS 2||4,998,976||1,004,800|
|Multicountry EECA HIV||QMZ-H-AUA||Alliance for Public Health||13,000,000||546,003|
|M.C. Sup. Labs TB (WCA) 1||QMZ-T-PNT||PNT 3||6,045,626||0|
2. PAS = Center for Health Policies and Studies
3. PNT = Programme National de Lutte Contre la Tuberculose de la République de Benin
Ensure full engagement of communities and civil society in TB prevention and care with the aim of improving TB and DR-TB case detection and patient care outcomes; and
- Strengthen health systems to enable integrated patient-centered TB and DR-TB care delivery systems for meeting challenges and addressing the needs of key populations.
The program targets health systems by providing support to improve the quality of health care; to strengthen people-centered approaches in TB care delivery; and to build supportive environments for universal health coverage and other key dimensions of health systems reform. The program also addresses sustainable community systems strengthening by providing support for local civil society organizations in the areas of institutional capacity building, planning, leadership, community monitoring and advocacy.
The GAC referred to the TB grant as “a critical grant for the region.” It said that the grant focuses on improving outcomes; supports countries to advocate for changing the model of MDR-TB care; and facilitates the transition to new MDR-TB regimens.
Vinichenko told Aidspan that focusing on outcomes was a guiding principle of the work done during grant-making. She explained that the PAS Center, partners and the country team built a logical framework that:
- Refined the aims of the program;
- Identified gaps that prevent achieving these aims;
- Explained how the proposed activities will address these gaps;
- Identified concrete results of these activities that could be measured (with a focus on tangible national level results); and
- Demonstrated linkages between these activities and outcomes and impact.
The goals of the grant are (a) to reduce the HIV epidemic in the EECA region through accelerating progress on Fast-Track by 2020; and (b) to ensure the sustainability of HIV services for key populations in 14 countries –– Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan.
The grant has three objectives, as follows:
- Improve the financial sustainability and allocative efficiency of HIV programs;
- Alleviate the most important human rights and gender barriers to accessing HIV prevention and care services; and
- Improve the efficiency and affordability of HIV service delivery models for key populations.
The GAC said that this grant is “highly relevant” to the HIV epidemic in the EECA and that it also presents an opportunity to provide support to community-based organizations.
The GAC noted that the grant covers multiple countries and involves several regional networks. “While this brings a benefit of strong partnerships and wide regional sharing of knowledge and experience,” the GAC said, “there is a need for the PR to pro-actively monitor any potential risks and challenges of implementing a grant across many countries and applying appropriate mitigation measures, as relevant.”
The EECA multi-country HIV program and the EECA multi-country TB program (see previous section) intend to collaborate closely and have already signed a memorandum of understanding.
Supranational Reference Laboratory Network in West and Central Africa / TB / QMZ-T-PNT
The GAC said that until late 2017, the countries of West and Central Africa lacked a recognized supranational reference laboratory (SNRL), so they worked with SNRLs in Europe or in Eastern and Southern Africa –– which, it said, is not an optimal situation.
(“Supranational” means transcending national boundaries or governments.)
The FPM for Benin, Gilles Cesari, told Aidspan that thanks to support from a Benin TB grant, massive investments in Benin’s national reference laboratory (NRL) were made in 2016–2017. Subsequently, the World Health Organization (WHO) evaluated the Benin NRL and nominated it to be the first ever SNRL in West and Central Africa.
Cesari said that the multi-country grant will allow the Benin SNRL to build the capacity of existing NRLs in the region (all countries have an NRL) and to create a network (i.e. a community of sharing) among these NRLs that will promote south-south capacity building.
The capacities of the existing NRLs vary widely, Cesari said. One of the first activities of the multi-country grant is a baseline assessment of the NRLs which will lead to action plans for each NRL to build capacities.
The GAC said that the objectives of the multi-country grant include the following:
- Improve laboratory service provision for quality assured first- and second-line drug susceptibility testing and make these services available to people in need;
- Enhance the impact of diagnostic testing; and
- Build the capacity of NRLs to undertake epidemiological and national-level monitoring surveys.
Some of the information for this article was taken from Board Document GF-B40-ER2 (“Electronic Report to the Board: Report of the Secretariat’s Grant Approvals Committee”), undated. This document is not available on the Global Fund website. For the two EECA grants, additional information was provided by the FPM, Tatyana Vinichenko. For the reference laboratory grant, some information was obtained from Gilles Cesari, the FPM for Benin.