Interview with Eric Fleutelot*

Eric Fleutelot is the technical director of the Major Pandemics Cluster at the Expertise France Health Department.

• You recently presented the new strategy at the

  webinar

   

  dedicated to L'Initiative. What does it consist of?

We conducted a brainstorming exercise, involving L'Initiative steering committee and team, as well as partners, that led to the development of a new strategy which focuses on four pillars:

• Mobilizing expertise

This refers to our procedures for mobilizing technical expertise. These are in line with the initial objectives on which L'Initiative was founded in 2011: to facilitate access to Global Fund financing and contribute to grant efficiency. This pillar is expected to contribute to developing increasingly relevant and high-quality funding requests, and to support countries in implementing activities financed by the Global Fund. Countries are free to request support for a wide variety of areas such as financial management, monitoring and evaluation, assistance in the quantification of pediatric antiretroviral medicines (ARVs) and so on. These missions are carried out with a view to ensuring the capacity building of Principal and Sub Recipients and Ministries of Health, even though we are sometimes requested to compensate for a specific lack of expertise.

Our pool of experts is more Francophone than French, as the majority of the experts we collaborate with come from the regions where we operate, especially from French-speaking Africa. And, through these experts, we seek to introduce a capacity-building component because, beyond acting, we wish to ‘accompany’ those who are in charge of taking action.

• Supporting catalytic projects

As a donor, we support these projects with the intention of complementing Global Fund funding to make health practices or policies evolve faster. Such projects are selected because they push forward a way of working on the three diseases or with health systems. In Myanmar, for instance, we are supporting a project that is experimenting with the use of a tuberculosis (TB) diagnostic test validated by the World Health Organization (WHO) but not yet adopted by the National Tuberculosis Control Program (NTP). The NTP was interested in implementing a pilot phase that will help it use this method in a decentralized way, and to include it in its national recommendations. These projects contribute to changing practices. In Cambodia, we are funding the Pasteur Institute to implement a project to strengthen latent TB among people living with HIV (PLHIV). The project is based on the new WHO recommendations which we are planning to adapt and we are studying the possibility of decentralizing the intervention.

We also support activities that benefit the healthcare system as a whole: the laboratory support project led by SOLTHIS in Niger or Fondation Mérieux in Myanmar are examples of our wish to carry out activities that, beyond an immediate objective related to the three pandemics, will be profitable for the entire healthcare system in the fight against other diseases. It is also in this spirit that we finance projects that accelerate access to viral load testing (an investment made in the context of HIV treatment but whose uses are being expanded) or the safety of blood transfusion (necessary to avoid HIV infection but which also benefits Hepatitis C and improves maternal health).

In terms of strengthening the supply chain, the project led by the Nouvelle Pharmacie de Côte d’Ivoire (NPSP), called MEDTIC, helps to identify substandard or fake drugs to prevent them from entering the supply chain. Up to now, the project has tested digital tools for antimalarial drugs that are highly trafficked in West Africa, but in future the system will be able to analyze all drugs.

• Generating and sharing knowledge

L'Initiative has set up a Unit for Monitoring, Evaluation and Capitalization of Practices to strengthen our capacity to collect and analyze information about and results of our interventions. The objective is to develop knowledge that can be shared, but not necessarily scientific knowledge. As an example, we planned to analyze our support to funding requests which represented a large part of our technical assistance activities in 2020: we supported 32 countries through more than 65 missions (for a total of €10 million earmarked for supporting funding requests) and we know that there are lessons to be learned from this experience.

This is why a study was commissioned, in the course of which we interviewed 120 experts, and we conducted about 20 in-depth interviews with key informants. The findings of this study will be brought to the attention of the Ministry of Europe and Foreign Affairs, in particular the Ambassador in charge of global health issues, and to the Global Fund, for possible improvements. In particular, it seems to us that there is still too little civil society involvement in the process. We have also been alerted to the imbalance of power relations between the country, particularly the Country Coordinating Mechanism (CCM), and some country teams at the Global Fund, that can limit the ability of countries who do know their needs and priorities to express them but whose strategic documents (such as national strategic plans) are not always up-to-date.

• Supporting the influence of French or Francophone actors

As a French stakeholder, we still have the feeling that French-speaking countries (ministries and civil society organizations) are less listened to by the Global Fund's bodies. It is an international organization where English is the dominant language and the place given to the specificities of the French-speaking African world is reduced. We would like this influence to be better taken into account, in particular in the way specific issues related to human rights are addressed, the participation of civil society in Global Fund processes and a better sharing of the results of interventions that are based on scientific evidence.

Additional Resources L'Initiative strategy is accessible via this link: https://www.initiative5pour100.fr/actualites/article/nouvelle-strategie-pour-linitiative-304 The replay of L'Initiative webinar is available here: https://youtu.be/hvm7f31QJ-c The Monitoring, Evaluation, Accountability and Learning strategy is available here: https://www.initiative5pour100.fr/notre-impact-0 The assessment of the Initiative 2020 commitments is available here: https://www.initiative5pour100.fr/actualites/article/bilan-engagements-2020