THE GLOBAL FUND PROGRAMME IN MALAWI

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THE GLOBAL FUND PROGRAMME IN MALAWI

• PRESENTED AT THE GLOBAL FUND REGIONAL MEETING
• HELD AT SUN BIRD CAPITAL HOTEL
• LILONGWE, MALAWI December, 2009

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PRESENTATION CONTENT

• Demographic and Health Profile
• The Global Fund Architecture in Malawi
• The Global Fund Investment in Malawi
• Key Achievements
• Key Challenges
• Addressing the Challenges

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DEMOGRAPHIC AND HEALTH PROFILE

• Malawis is 13 million (2008 census results)
• About 50 are young people below 18 yrs
• Life expectancy is about 40 years
• National adult prevalence(15-49) 12.0
• Urban adult prevalence (15-49) 15.6
• Rural adult prevalence (15-49) 11.2
• Total HIV population 898,888
• Number of infected women (15) 473,348

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DEMOGRAPHIC AND HEALTH PROFILE

• 6 million episodes of Malaria per year
• 40 of all U/5 children inpatients are due to
  Malaria and Anaemia
• 30 of all hospital deaths in U/5 children are
  due to Malaria and Anaemia
• TB incidence rate 242 per 100,000
• TB prevalence rate 292 per 100,000
• TB mortality rate 16 per 100,000

• Infant mortality rate is at 72 per 1,000 live
  births
• Under Five mortality rate is 122/1000 live births
• Maternal mortality rate is estimated at 807 per
  100,000 live births

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THE GLOBAL FUND ARCHITECTURE IN MALAWI

• Introduction
• Grant Oversight through the Malawi Global Fund
  Coordinating Committee MGFCCMalawi CCM
• Multi-sectoral membership, chaired by the
  Secretary to the Treasury
• Current secretariat is NAC but in the process of
  setting up an independent one under the Ministry
  of Finance
• Clear terms of reference (operations manual)
• Core functions are to mobilize resources from the
  Global Fund and oversee the planning,
  implementation and resource utilization

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THE GLOBAL FUND ARCHITECTURE IN MALAWI

• Introduction
• Linkages to governance, national and sectoral
  coordinating structures (Govt. of Malawi, NAC
  Board, Malawi Partnership Forum, SWAp, TWGs, HIV
  AIDS Development Group and various
  constituencies)
• Since 2003, benefited from a total of 8 grants
  under HIVAIDS TB and, Malaria
• R1 HIVAIDS, RCC, R5 OVC, R7 HIV Prevention, R2
  R7 Malaria, R5 HSS, R7 TB
• About US700 million committed through these
  grants

Vice CCM Chairperson endorsing a proposal
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THE GLOBAL FUND ARCHITECTURE IN MALAWI

• Funding Implementation Modalities
• Global Fund is a member of the pool funding
  mechanisms
• HIV and AIDS Pool
• R1 HIVAIDS, RCC, R5 OVC, R7 HIV Prevention
• Health Sector Swap
• R2 R7 Malaria, R5 HSS, R7 TB
• Implemented through the Public, Private and Civil
  Society Sectors (Incl. Org. for PLHIV, NGOs,
  FBOs, CBOs)

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THE GLOBAL FUND INVESTMENT IN MALAWI

• HIV AIDS grants

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THE GLOBAL FUND INVESTMENT IN MALAWI

• HSS, TB and Malaria grants

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KEY ACHIEVEMENTS

• System and Processes
• Increased resource availability to implementing
  agencies at all levels, including the community
• Alignment of most donor support to country
  systems and mechanisms
• Institutionalisation of systems and procedures
  for programme and financial management
• Strengthened participation and coordination of
  stakeholders in the national response

Stakeholder participation during R7 proposal
development
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KEY ACHIEVEMENTS

• System and Processes
• Increased participation of PLHIV in programme
  activities
• Capacity strengthened in terms of equipment
• Increased availability of various health products
  (ARVs, OI drugs, LLNs, medical equipment)
• Increased staff recruitment (Incl. UNV doctors
  and retired health workers) and retention in
  public health facilities

ARVs procured through Global Fund Support
Equipment provided to strengthen systems
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KEY ACHIEVEMENTS

• Systems and Processes
• Improved infrastructure for pre-service training
  schools, colleges and health facility
  infrastructure
• Increased health training school outputs
  (doctors, nurses, pharmacists, lab techs)
• Increased access to services for the vulnerable
  groups including children, women, elderly and OVC
  (EID, treatment for young people)

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KEY ACHIEVEMENTS

• Programme Coverage
• Increased coverage and access to various services
  by vulnerable groups (children, women, girls,
  PLHIV, elderly, etc)
• Increase in number of sites providing HTC from 14
  in 2001 to 700 by June 2009
• Increased number of sexually active people tested
  per year from 283,462 in 2004 to 1,320,894 people
  by June 2009 (34 male 66 female)
• Increase in number of sites providing PMTCT from
  34 in 2004 to 544 by June 2009
• Increased number of HIV pregnant women who
  received a complete course of ARV prophylaxis
  from 2,179 in 2004 to 32, 251 in 2008

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KEY ACHIEVEMENTS

• Programme Coverage
• Increased coverage and access to various services
  by vulnerable groups (children, women, girls,
  PLHIV, elderly, etc)
• Increase in number of sites providing ART from 9
  in 2003 to 224 by June 2009
• Increase in number of people ever started on ART
  from 13,183 in 2004 to 234,395 by June 2009
• Over 5 million mosquito nets have been
  distributed since 2002
• Increased net ownership at least one net per
  household is 60 from 6 in 2000

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KEY CHALLENGES

• Capacity constraints
• Frequent staff turn over has negatively affected
  implementation of the programme
• Procurement and Supply Chain Management has
  resulted in delays in procurement especially for
  health products
• Financial and programme management by some
  implementing partners have resulted in slow
  uptake of funds by implementing partners
• Inadequate staffing (quantity and quality),
  especially in the Health Sector have negatively
  affected scaling up of programmes and low
  resource absorption
• Managing expectations of implementers on Global
  Fund financial support, which puts pressure on
  PRs and SRs

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KEY CHALLENGES

• Prolonged grant negotiations have affected
  approvals and disbursement of funds resulting in
  delays in programme implantation
• Difficult grant conditions precedent and special
  terms and conditions have slowed disbursements
  and implementation
• Financial management and procurement requirements
  which are perceived to be difficult and
  complicated

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ADDRESSING THE CHALLENGES

• Continue dialogue and consultation with relevant
  Govt. ministries and departments (DHRMD, MOLGRD)
  on local staff deployment to safeguard critical
  positions for grant management and implementation
• Strengthen communication between Global Fund
  (Incl. LFA) and PRs (country visits, tele/video
  conferences)
• Continuous information sharing amongst GF, PRs
  and SRs

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ADDRESSING THE CHALLENGES

• Thorough review of CPs and STCs before grant
  signing
• Continuous capacity building of PRs and SRs in
  proposal development financial management,
  procurement, ME and other key grant management
  functions
• Continuous capacity building (pre and in-service
  training) of implementing partners including
  health workers
• Aligning CPs and STCs to country agreements on
  disbursement triggers (HIVAIDS Pool and SWAp)

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END OF PRESENTATION

• Thank You for Listening!
• Zikomo Kwambiri!