Phase 2 of two malaria grants worth $28.9 million will scale up malaria prevention and treatment programmes in Sierra Leone, which is still rebuilding following a devastating civil war.
It is anticipated that some of the challenges that hindered the full and effective implementation of Phase 1 will be addressed by the installation since early 2013 of a fiscal agent -- directly contracted by the Global Fund -- to reduce the risk of misuse of grant funds following reporting of unsupported and ineligible expenses.
A new management unit will also administer the grant for which the principal recipient (PR) was the Ministry of Health. The PR for the other grant is Catholic Relief Services.
The decade of war that was brought to an end in 2002 had a profound impact on the health system, decimating both the social infrastructure and the inventory of health equipment. Brain drain among health workers was significant and despite efforts by public, private, civil society and international organisations to rebuild institutions and increase the capacity of the work force, the lack of trained professionals represents a major test for the health services.
Sierra Leone, like its neighbours along the West African coast, is a highly malaria endemic country, with 100% of its population at risk of infection. Malaria accounts for between 30% to 50% of hospital admissions and up to 50% of outpatient morbidity. Reported numbers of cases have fluctuated over the last decade, although the introduction of rapid diagnostic tests (RDTs) and improved laboratory diagnostic methods have spurred an increase in reported confirmed malaria cases (933,274 in 2011).
The number of malaria-related deaths was estimated at 10,399 in 2010. Although the under-five mortality rate declined by 31% between 1990 and 2011, it remains the highest in the world and malaria is the leading cause of death among children under five years old.
Building a foundation to manage risk and deliver programmes was the priority in Phase 1. For Phase 2, the Minister of Health of Sierra Leone has proposed that all donor-supported health programmes, including Global Fund grants, be managed by a new Integrated Health Projects Administration Unit. According to the GAC, this new unit has the highest level of political commitment and is supported by donors.
The GAC said that Phase 2 of the two malaria grants will build on lessons learned from Phase 1 and will emphasise: routine distribution of long-lasting insecticide-treated nets (LLINs); strengthened intermittent preventive treatment in pregnancy initiatives; malaria case management, including in the community; implementation of a new integrated community case management strategy in collaboration with UNICEF; expanded access to treatment services; and enhanced partnerships with accredited private sector health facilities.
Phase 2 should also invest in health systems strengthening with a strategic focus on M&E and procurement and supply management.
The GAC recommended that some Phase 2 money be used to enhance retention of community health workers, providing the retention strategy is in line with government policies and is harmonised with partners. This recommendation will be addressed during grant-making.
The technical partners represented on the GAC said that they were committed to (a) providing short-term technical assistance for the 2014 mass campaign, if required; (b) investing in long-term technical assistance; and (c) helping the country with grant implementation.
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.