Three multi-country initiatives were among grants approved by the Global Fund Board

7. NEWS
28 Jan 2019
Two grants in the EECA and one in West and Central Africa were valued collectively at $24 million

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
Total 24,044,602 1,550,803

Notes:

1. For the supranational labs grant, which was­ denominated in euros, an exchange rate of 1 euro = 1.1313 dollars was used.
2. PAS = Center for Health Policies and Studies
3. PNT = Programme National de Lutte Contre la Tuberculose de la République de Benin
 
The Board was acting on the recommendations of the Technical Review Panel (TRP) and the Grant Approvals Committee (GAC). This article provides summaries of the three multi-country grants and the comments made by the GAC.
 
Advancing People-Centered Quality TB Care –– From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes / EECA / QMZ-T-PAS
 
The GAC said that the burden of drug-resistant TB (DR-TB) in the EECA remains high and that there are currently a large number of missing TB cases and poor treatment outcomes.
 
The Center for Health Policies and Studies  (PAS Center) is both the applicant and the principal recipient (PR) for this new multi-country TB grant. The PAS Center was also the PR for a regional TB grant in the EECA that ended on 31 December 2018. The main partners for the new grant will be the World Health Organization Regional Office for Europe, the TB Europe Coalition, TB People and the Global TB Caucus.
 
The new grant builds on the achievements of the previous regional grant. The goal of the new grant is to foster timely TB case detection and improved treatment outcomes in patients, with special emphasis on DR-TB in 11 countries –– Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan –– through meaningful involvement of communities and civil society and integrated people-centered TB care delivery systems able to address the needs of key populations.
 
Program interventions are structured around two main objectives:
 
  1. 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

  2. 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 fund portfolio manager (FPM) for the TB grant, Tatyana Vinichenko, explained that the current health systems are hospital-centric and that they need to be reformed to become more people-centric. “Challenges” (see second objective) refers to the need to introduce a range of structural and financial transformations, such as changing the provider payment model so that incentives are made to address patient needs rather than filling existing beds; developing sustainable patient support at community level; and increasing the role of ambulatory and primary care, and civil society organizations.

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.
 
Under the new grant, there are more civil society implementers than there were in the previous grant. The GAC said that because several civil society and community-based implementing partners will be operating as newly registered organizations, the PR will need to ensure that the new organizations have adequate capacity to deliver services.
 
Sustainability of HIV Services for Key Populations in Eastern Europe and Central Asia Region / QMZ-H-AUA
 
As the incidence of HIV infection in the EECA continues to increase, the GAC said, the HIV epidemic remains a public health issue. There is a need to scale up prevention services and expand access to treatment. At the same time, the GAC stated, given the decrease in international funding, EECA countries are also dealing with the need for a rapid transition to domestic funding.
 
Tatyana Vinichenko is also the FPM for the HIV grant. Vinichenko told Aidspan that the grant originated from a funding proposal submitted by a consortium composed of the Alliance for Public Health (Ukraine), the All-Ukrainian Network of People Living with HIV/AIDS, the Central Asian Association of People Living with HIV (Kazakhstan) and the Eurasian Key Populations Health Network (Poland). The Alliance for Public Health will serve as PR. The implementers will include non-governmental and governmental partners in the countries as well as regional networks.
 

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:

  1. Improve the financial sustainability and allocative efficiency of HIV programs;
  2. Alleviate the most important human rights and gender barriers to accessing HIV prevention and care services; and
  3. Improve the efficiency and affordability of HIV service delivery models for key populations.
 
Vinichenko said that the grant will be implemented on regional, national and municipal levels with activities at the different levels being interlinked. The municipal part will focus on the most affected populations in 12 cities that are home to 16% of people living with HIV in the EECA. The goal of the municipal activities is to improve the HIV care cascade at the municipal level as well as to attract municipal funding for key population HIV programs.

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.
 
In addition, the GAC said, the multi-country grant will aim to strengthen technical and administrative capacities, strengthen human resources and improve the quality and diagnostic capacity of the SNRL in Benin.
 
The GAC said that the laboratory network will have an important impact on TB “and beyond.” As with all multi-country grants, the GAC said, “it will be important to ensure coordination and alignment between this grant and the national TB programs for the countries involved.”
 
The GAC recommended that an outcomes-based indicator be included in the performance framework from Year 2 onwards.
 

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.


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