Guatemala is trying to move from malaria control to malaria elimination. The Global Fund recently approved $10.8 million in incremental funding for the next implementation period of malaria grant GUA-M-MSPAS, for which the principal recipient (PR) is the Ministry of Health.
Guatemala has the second highest number of malaria cases in Central America after Honduras, although there have been dramatic declines in morbidity and mortality in the last decade. Since 2008, there have been no reported malaria deaths, and the number of cases in the last five years has remained relatively stable despite improved surveillance.
These gains are considered fragile due to environmental conditions, migratory patterns and malaria burdens in neighbouring countries. Approximately 45% of Guatemala’s population is at risk of malaria, with 26% considered high risk. At-risk groups include pregnant women, children under five years of age, agricultural migrants and all people living in malaria-endemic areas.
After reviewing the request for continued funding from the country coordinating mechanism (CCM), the Secretariat’s country team for Guatemala recommended against funding activities that were not considered good value for money or technically appropriate. These included “hang up” interventions to ensure consistent use of long-lasting insecticide-treated nets (LLINs); molecular diagnostic tools; and follow-up at seven, 14 and 28 days post-treatment.
The country team proposed some reprogramming, which was consistent with technical advice provided by malaria technical partners and endorsed by the Grants Approval Committee. Savings will be re-invested in expanding LLIN coverage from 80% to universal coverage, conducting a therapeutic efficacy study and covering the costs of a fiscal agent. Aiming for 100% LLIN coverage was seen by the GAC as the best way to guarantee at least 80% LLIN usage.
Key risks identified include: (a) weak internal financial controls; (b) inadequate PR implementation arrangements; (c) poor quality of health services, and (d) ineffective procurement processes. To address these risks, the GAC recommended that a fiscal agent be recruited effective January 2014; that the implementation arrangements be changed to ensure that the grant is integrated into the national malaria programme; that an acceleration plan be developed; that relevant national guidelines be updated and disseminated; and that use of a procurement agent be continued. These recommendations will be addressed during grant-making.
Decisions on annual disbursements for the grant will be based on performance. The GAC left open the possibility that funds already committed in the disbursement decisions could be de-committed if there is insufficient progress.
The GAC acknowledged the government’s commitment to fully cover malaria treatment costs, but stressed the importance of following up to ensure that this commitment is met.
Information for this article was taken from Board Decision GF-B30-EDP3 and from GF-B30-ER2, the Report of Secretariat Funding Recommendations. These documents are not available on the Global Fund website.