1. Ann Ithibu

   Tell our readers about yourself and your background

I grew up in a village in Central Kenya. I went to the University of Nairobi where I studied for my B.Sc. in Nursing, following in my mother’s foot steps. I then did a prerequisite one-year nursing internship at one of the largest government hospitals based in Kenya’s coastal region, after which I received my nursing licence and worked as a registered nurse in a private medical facility for a few months. Given my love for research, which I had cultivated by working part-time research jobs during my campus days, I then went back to university to study for a M.Sc. in Medical Statistics. During the first year of my graduate program, I worked as a research assistant in a trauma unit at the national referral hospital supported by the John Hopkins University. In this role, I followed trauma patients from the emergency department or in-patient wards if admitted, documenting their care and outcomes. I am gearing myself up for a Ph.D in the future, perhaps in health systems and policy.

2. And Aidspan? Because I know you are one of the longest-serving staff members

Yes, I am, after Brian and Joseph (members of Aidspan’s admin and finance team). I joined Aidspan in 2015 as a graduate intern for six-months, then as a consultant supporting projects within the then Research unit for a further three months. After this I worked on the Global Fund Observer for a while as a correspondent under David Garmaise’s editorship, writing articles and contributing content to other writers. That was in 2016; and then I joined the Policy Team.

3. What does your work entail, and what do you like most about it?

We (the Policy team) do a lot of research into topical issues relating to the Global Fund and its sphere of interest, and we publish these online.

We also produce articles for the GFO/OFM, some based on our research and others such as those on the Board meeting papers or, for example, the recent articles I wrote on Global Fund grant absorption rates. It is surprising how much work it is to write a relatively short article having sought out the latest data and information. I am currently working on a paper that will also be published as a series of articles documenting countries’ experiences applying for funds and implementing activities under the COVID-19 Resource Mechanism and for that I have been interviewing stakeholders from several African countries.

(Note from Arlette: to be published in July.)

The Policy team also drafts funding applications, as we are entirely donor-supported and always looking for new funding opportunities. We develop the annual workplan and write the Annual Report and the Board briefing papers. Finally, we do a fair amount of design and delivery of capacity-building programs such as the ones for our Supreme Audit Institutions (SAI) project. In this project, we are working with SAIs from across Sub-Saharan Africa, enhancing their role in performing the audit requirements for Global Fund grants which focus not only on finances but the program outcomes as well. Over the next three weeks, we will be holding three three-day five-hour workshops for SAIs in Ethiopia, Lesotho, and Namibia. As anyone who is involved in training knows, this is a huge amount of work and a challenge to keep it fresh and exciting given the online format.

What do I like most? Well, every day brings its own unique experiences and challenges. So, my favourite part of the job is that I am constantly learning new things.

4. What made you decide to continue to work for Aidspan?

Even before I joined Aidspan I was very interested in HIV. Something happened during my internship with the provincial hospital that resonated with me. In 2012, an HIV-positive young lady was admitted with an opportunistic infection and she was put on oxygen. After my shift ended at three o’clock in the afternoon, I did not return to the hospital until the following day by which time she had died ― not from her illness but because at some point the power supply went off and the ventilator and suction machines failed. When you look at the reasons why she actually died, it was an avoidable tragedy; and to this day I cannot forget it. Unfortunately, this was not an isolated incidence; I saw many more deaths among patients admitted with opportunistic infections, including tuberculosis.

This is when I realized that one cannot work on HIV in isolation without looking at the system within which HIV interventions are delivered. It was the weaknesses of the health system that failed her. These systemic challenges continue to plague our countries nearly ten years later. For example, we have clinics providing antiretroviral medicines but then the health system is not strong enough to manage to supply a consistent flow of medicines ― see our articles in GFO issues #1004 (Kenya facing a shortage of antiretroviral drugs caused by a disagreement between the government and USAID on procurement entity) and #397 (A looming shortage of antiretroviral drugs threatens the wellbeing of Kenyan citizens). So, for me, one of the motivating factors of this job is being able to highlight these issues and get to the root causes of why the system is failing us; and what we can do about it.

One issue that I always come back to is that countries have all this money from the Global Fund but still have problems in fully using it all. We need to better understand why they cannot spend it, because it impacts people’s health and wellbeing.

5. What has changed in the six years since you joined Aidspan, in terms of the key issues then compared to now?

Aidspan has truly evolved and grown in its watchdog role over the past six years that I have been here. We are more analytical in our approach and have increased our focus on issues affecting in-country stakeholders in implementing Global Fund policies. We have also expanded our focus to Francophone countries, previously 'left out' in Global Fund processes and documentation. We are also partnering with more organizations with a shared vision of enhancing accountability in the fight against the three diseases and beyond.

The situation with the three diseases, health systems and the Global Fund has certainly evolved since I joined Aidspan. Back then, there was a lot of discussion about accountability, and the use of Global Fund monies.

The conversations are now changing with more focus on those receiving the funds ― the programs themselves and the beneficiaries. Countries now have more information available to them, not just from the Global Fund but many other sources; and, as a result, stakeholders are more empowered, more knowledgeable and more aware of examples and lessons learnt from other countries. But information in itself is not enough. They have to be able to translate it into dealing with the challenges of grant implementation.

Now, as Aidspan, we see even greater challenges regarding two related issues: (i) the health system, which is cross-cutting and the foundation of the disease response, whose success depends on the strength of the health system itself; and (ii) what is happening on the country level. We had still not finished ‘unpacking’ the issues at the country level that are crucial for successful responses to the three diseases when the new challenge of COVID-19 arrived. As an example, procurement and supply management is a problem for virtually all countries. And with a pandemic that requires a quick emergency response, we see that procurement of health products such as personal protective equipment may be made in 2020, but the country only receives the good in June 2021: and it is not a question of the funds being unavailable, it is an issue of the system’s inability to deal quickly and efficiently with the procurement request. This is just one of many bottlenecks countries have to address. But probably one of the most important.

6. And what would you like to do in the future with Aidspan?

Every day brings something different and the opportunity to do something I love. For me, I particularly enjoy interacting with the countries, with the national and community stakeholders: and that’s what I plan to do more of, for as long as I can. With continued support from our donors and others, I will continue contributing to Aidspan’s analytical work and our collaboration with partners to ensure sustainable impact from the Global Fund resources.