Global Fund Consultation: Topic 1: Lives Saved


Increasing the number of lives saved, impact and value for money
Guiding Question
Thinking about what it funds and the way funding is currently provided, what should the Global Fund do more of – or less of – in order to maximize value for money and increase the number of lives saved and infections prevented?

Have your say! click here

Introduction
In the past nine years, the Global Fund has proven itself an efficient and cost-effective mechanism for expanding the world’s response to the global pandemics of HIV, tuberculosis and malaria.

By the end of 2010, over 3 million people are receiving ARV treatment from Global Fund financing. 7.7 million people have received anti-tuberculosis treatment, and 160 million long lasting insecticidal nets have been distributed for malaria prevention. Beyond the three diseases, Global Fund investments have also made major contributions to health systems and achievement of Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health). These contributions are part of a global effort to change the course of the three diseases through the provision of unprecedented, yet still insufficient, financial support.

At the same time, questions exist as to whether the Global Fund’s systems and processes for accessing funding are still as rapid and simple as originally planned. In turn, this raises for discussion the topic of whether there is sufficient predictability in Global Fund financing to ensure continued scale-up of high quality services at the country level in a sustainable and cost-effective manner. In a global environment of increasing focus on ensuring improved value for money (cost effectiveness) and increased impact for the money spent (ensuring that resources are spent on the right interventions, in the right contexts, and for the right people), it is useful to consider whether the Global Fund should do more of some things, and less of others, and also whether the current funding modalities permit sustained impact.


How to Have Your Say?
You are welcome to leave your comment here. Also we encourage you to join the time-limited eForums (English, Spanish, Russian and French - for details, go to: www.aidsportal.org/web/globalfundconsult/home ).


Join the Global Fund Consultation English eForum
- send an email to: join-globalfundconsult@eforums.healthdev.org

Join the Global Fund Consultation in Spanish, Russian or French, go to:
http://www.aidsportal.org/web/globalfundconsult/home

Further reading on this topic
In addition to the background documents currently available on the website you may also want to read part 3 of the document titled "Agenda for a More Efficient and Effective Global Fund" available here

Website here

This initiative is supported by the AIDSPortal, and Citizen News Service on behalf of the Global Fund to Fight AIDS, TB and Malaria. More information about the process online here

144 comments:

  1. Prevention is more cost effective than curative strategies. Fund should invest more on applied research and infected and hazardous waste management in developing countries.

    Dr Lalji K Verma, India
    Email: lkverma@medwasteind.org

    ReplyDelete
  2. Dear members,

    I will like to complement the Global Fund to fight AIDS, TB and Malaria (GFATM) for not only mobilizing financial resources, but also establishing systems to ensure money is spent on priority areas around TB, HIV and malaria responses in high burden countries.

    The Global Fund has surely contributed significantly in improving local responses to TB and HIV co-infection.

    In order to maximise value for money, it might be prudent to look at other co-morbidities and co-infections people living with HIV deal in our countries. For example, funding collaborative programme activities beyond TB and HIV, like those for hepatitis C (Hep C or HCV), diabetes, cancer, renal or kidney related diseases, nutrition and other areas that impact the health of PLHIV.

    Thanks

    Jitendra Dwivedi
    Abhinav Bharat Foundation (ABF)
    Gonda, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  3. Dear members,

    I would like to use this opportunity to thank all the Global Fund to fight AIDS, TB and Malaria (GFATM) actors: policy makers, financiers, implementers et al for the great work they have done and are doing to alleviate disease burden in developing countries and in particular, Africa.

    As a Medical Laboratory Scientist, I currently work in the Action Lab of Virology Research Clinic of Obafemi Awolowo Teaching Hospital, Ile Ife and I have also been privileged to work in the Tuberculosis reference lab of the University College Hospital, Ibadan.

    I have seen, firsthand, the enormity of the impact the Global Fund is having in the lives of people both in terms of proper diagnoses and treatment. However, I believe we all agree that much is yet to be done.

    To address the issue at hand of efficiency and cost effectiveness in program implementation, especially as it concerns improvement of maternal and child health, I would like to suggest that the Fund begins to look critically at policies, programs and strategies that focus on the provision of safe and sustainable blood supply.

    In my perspective, a quality blood safety program will have a direct effect on the Millennium Development Goals (MDGs) 4, 5, and 6 vis-a-vis improvement in child health, reduction of maternal mortality and reduction in the spread of HIV/AIDS. In Africa, anaemia secondary to malaria is still the leading cause of child mortality, post partum haemorrhage still claims 90% of our women at childbirth and unsafe transfusion practice accounts for about 10% of new HIV infections.

    We may not be able to immediately eradicate malaria or find a cure to AIDS but I believe while we are yet working on these things and providing prevention, treatment, care and support options, we must begin to look at how to diversify those options for maximum impact.

    A quality blood safety program represents a viable diversification option.

    Lala Oluwatobi
    Email: call4biggy@yahoo.com

    ReplyDelete
  4. I think the Global Fund to fight AIDS, TB and Malaria (GFATM) in the last years had been implementing its policy to align their financial support with the national plans. The Global Fund has been supporting activities that are a part of the national response.

    But in many countries this approach is not efficient. For example there are countries where there are no appropriate mechanisms for monitoring. The recent countries' UNGASS reports prove that key information can be manipulated at country levels to demonstrate some advances that had not been achieved.

    One thing that the Global Fund should be involved more is to emphasize the relevance of monitoring, and fiscal accountability and transparency in public and civil administration of the funds.

    Ruben E Pecchio
    Email: repo_pa@yahoo.com

    ReplyDelete
  5. I agree and thank Lala Oluwatobi for his comments and bringing up the issue of safe blood transfusion.

    The safe blood transfusion is one of the strategies of interest to the Federal Ministry of Health (FMOH) in their efforts to meet the health related millennium development goals (MDGs) and hence if Lala Oluwatobi can develop a concept note, I can share it with members of the PR Forum in Nigeria as well as the Global Fund PR Working Group who can review Lala Oluwatobi's submission during our monthly teleconference.

    Best wishes

    Professor OA Ladipo
    President/CEO
    Association for Reproductive and Family Health (ARFH)
    Abuja, Nigeria
    Emails: oaladipo@yahoo.co.uk, oaladipo@arfh-ng.org
    Website: www.arfh-ng.org

    ReplyDelete
  6. In my opinion Global Fund to fight AIDS, TB and Malaria (GFATM) should invest more on training/ refresh healthcare workers about TB, AIDS, Malaria. Not only TB but other common lung diseases
    in people living with HIV (PLHIV) not only malaria but also other common infectious diseases.

    PLHIV in sub-Saharan Africa lose their lives because they are not being diagnosed in time or because they are having wrong diagnosis.

    Paula Perdigao
    TB/ lung diseases consultant, Mozambique
    Email: paulazen@tropical.co.mz

    ReplyDelete
  7. We operate an NGO that supports residential and non-residential orphan programs in Uganda. We do everything possible to keep kids in their community but realize that there are many situations where children have no option but staying in an orphanage. Even then we make every effort to return children to their village during school holidays.

    The idea that orphanages are a bad idea and should never be supported is short-sighted and misguided. The consequence is children raising themselves or living as servants in a relatives or neighbours' home. What is a worse result for a child, being forced into child labour or growing up in an orphanage.

    Now build several small Children's Homes that try to recreate family as much as possible and a child is much better served than on the streets. Keeping Children's Homes small is difficult because little or no funding is available. All orphanages are painted with the same broad brush and the large funding sources don't want to touch them.

    Plenty of money is being spent on finding a cure and I applaud that, lots more money is spent on prevention except on protecting the children who are going to be the next generation infected because they are pushed into at risky lifestyles. They have nowhere else to go.

    There is no self sufficiency for an orphanage (not unless you can stomach child labour). They are a long term, continuing commitments. They can be run efficiently and really don't need to be fancy or elaborate, all of our homes look very much like the communities they are in. Everything we do for our own children is subsidized, either by taxes or by charity.

    No schools in the west are "for profit", boys and girls clubs, Little League, all or supported by charities; why should orphaned children be required to live in self-sufficient programs?

    We have a choice, we can find a way to care for these children, make the long term commitments and hopefully have healthy educated productive children.

    Rick Persenaire
    Director, Ugandan Orphanage Relief Fund
    Email: rickpersena@yahoo.com

    ReplyDelete
  8. I just read the message that stated that preventative strategies are more cost effective than curative strategies. I disagree with this because as we can see by statistics, new HIV cases are increasing, so, clearly prevention is working to a limited extent.

    I think both preventative and curative strategies should be applied to HIV and Global Fund needs to consider both.

    Daniel Angelis
    Email: danangelis@verizon.net

    ReplyDelete
  9. From my personal experience with the Global Fund to fight AIDS, TB and Malaria (GFATM) funding mechanism in Nigeria, I can confirm that the Global Fund resources are helping those countries accessing the funds to improve upon HIV/TB and Malaria Prevention, Care and Treatment.

    The Government, donor community and the health development partners can attest to the leveraging effects it has on the other resources available for programming. One other significant strategy of the Global Fund that maximizes value-for-money is its willingness to invest in Health Systems Strengthening (HSS). This single strategy will have system-wide effect on not only HIV/TB and Malaria as an integrated disease management program but also IMNCH, Immunization, Nutrition and many other areas.

    By this, failing quality of Services (QoS), Quality of Care (QoC) and Quality of Life (QoL) is redeemed, restored and enhanced. This in theory will definitely increase the number of live saved and deaths and diseases averted.

    In my own opinion, I will suggest that the Global Fund to put the following measure in place to optimize value-for-money:

    1.Invest more in Health System Strengthening process in African and Regions with poor and failing health systems and by standard regulation and policy for funding HSS activities encourage Host Governments to define their contributions to ensuring continuity of provision of integrated services to their population after HSS interventions. Outcome monitoring process for this strategy must be very robust.

    2.Engage the use of Strategic Information principles and techniques in learning about health outcomes indices such as using modeling techniques for predicting or quantifying actual number of HIV/TB and Malaria cases/disease or death averted in each country following HSS and disease program intervention. This looks complex though but will be worth the while.

    Thanks

    Adebayo Adedayo Olufunso
    M&E, HMIS and Programs Quality Management Specialist
    DEHPCON Consultancy Services
    Abuja, Nigeria
    Email: dayobayo@yahoo.com

    ReplyDelete
  10. I believe there is need for the Global Fund to fight AIDS, TB and Malaria (GFATM) to consider the following:
    - to scale up the support for training of the people in implementing effective HIV prevention strategies example circumcision.
    - to scale up the support for development and implementation of community sensitization strategy by including faith based organizations
    - to come up very efficient monitoring and evaluation strategies that truly can show us that lives are being saved and infections prevented for every money spent. We need to check the value for money (fund vs outcomes)

    Wabwire Paul Francis, Uganda
    Email: wabwireokmollo@yahoo.com

    ReplyDelete
  11. The Global Fund to fight AIDS, TB and Malaria (GFATM) has been doing well by giving country coordinating mechanisms (CCM) ownership of both proposal process and fund management.

    But through my experience in Tanzania's CCM I have noted that there is a critical gap on oversight audit by the CCM members. Once the fund has been disbursed it makes it difficult do to funding constraints, to conduct field oversight check on performance of principal recipient (PR), sub-recepient (SR) and sub sub-recepient (SSR). This sometimes makes the CCM to agree just the reported information by the implementers.

    I thought I should add my views.

    Richard Kasesela
    CCM (TNCM) member, Tanzania
    Email: rkasesela@gmail.com

    ReplyDelete
  12. I agree with Ruben. There is need to have a mechanism for monitoring of Global Fund to fight AIDS, TB and Malaria (GFATM) especially of principal recipients.

    And one way of doing that is to train civil society members in Budget Tracking.

    Jordan Kaisi
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  13. What was meant by my comment for the Global Fund to support prevention, was that more emphasis is required on preventive strategies than what is being done now. Prevention is not a replacement to curative initiative, nor it can be but is supplementary.

    Take for example propagating use of condoms. It is a preventive strategy and surely needs to be popularised. Injection waste (including from immunization schemes) needs to be captured 100 percent and disinfected at the earliest. Close monitoring of blood banks can be reinforced. Cough excretion etc from cases of pulmonary tuberculosis (PTB) needs to be captured and disinfected at the earliest. Awareness amongst targeted population (sex workers, IDU etc) about HIV is another preventive strategy.

    These are only some examples.

    Dr Lalji K Verma, India
    Email: vermalk@bol.net.in

    ReplyDelete
  14. The Global Fund to fight AIDS, TB and Malaria (GFATM) should invest more on youth prevention programmes and youth friendly infrastructure/ services.

    Even though youth are part of the communities receiving treatments, in many times there are no specific focus and youth friendly services available.

    Inga Ita
    Email: ingayajohn@gmail.com

    ReplyDelete
  15. As a person living with HIV I would like to express my personal gratitude to the Global Fund to fight AIDS, TB and Malaria (GFATM). I am one of the 3 million people that has benefited so much with the provision of antiretroviral (ARV) treatment.

    My worry is that of late the effort seem to change direction very little money is reaching Zambia yet a lot of people are in need of the support. It is out of this support our country can reduce child mortality rate and improve the maternal health in an effort to meet
    the millennium development goals (MDGs) 4 and 5.

    Harrison Mwima
    Treatment Advocacy and Literacy Campaign (TALC)
    Lusaka, Zambia
    Email: harrisonmwima@gmail.com

    ReplyDelete
  16. In the case with Liberia I feel that the Global Fund to fight AIDS, TB and Malaria (GFATM) should support programmes and groups working with the sex workers and sexual minorities. The Country Coordinating Mechanisms (CCM) also doesn't have a representative from sex workers or sexual minorities, so that also needs to be addressed.

    Stephen McGill, Liberia
    Email: smcgill_sail@yahoo.com

    ReplyDelete
  17. I join my colleague who commented that the Global Fund to fight AIDS, TB and Malaria (GFATM) should improve monitoring by training civil society members in budget tracking.

    We civil society members in Sierra Leone are faced with huge challenge while getting support for tuberculosis (TB) as TB issues are neglected in Sierra Leone and AIDS projects get funded.

    Although TB cases are rising in Sierra Leone, yet there are no proper mechanisms to monitor TB programmes and civil society too is not optimally involved in such programmes as equal partners.

    Therefore I will like to say that the Global Fund should consider building capacity of civil society around budget tracking, advocacy, monitoring and evaluation, and other areas.

    Abdulai Abubakarr Sesay
    National Director
    Civil Society Movement Against Tuberculosis Sierra Leone (CISMAT-SL)
    Freetown, Sierra Leone
    West Africa
    Email: movementagainsttb@hotmail.com

    ReplyDelete
  18. In Zambia, there have been efforts to involve traditional healers but that is not enough and a lot more needs to be done. In order to fight HIV, TB and malaria effectively, the Global Fund to fight AIDS, TB and Malaria (GFATM) should consider integrating or mainstreaming traditional healers in the response.

    In Zambia, the traditional healers are involved through training as treatment supporters. They have been involved in DOTS (directly observed treatment short course) programmes as HIV/TB adherence supporters. Also they have been encouraged to refer the cases that they cannot manage and not vice versa (modern clinic referring those cases for which modern medicine has nothing to offer!).

    This approach has, to some extent created some mistrust among traditional healers as they feel that they are equal partners and yet health institutions cannot refer any patient whose problems scientific medicines are not able to solve. Referrals has been one sided, and in favour of modern health institutions. They feel they are being cheated and losing their clients.

    My opinion is that if the Global Fund is to be effective in this area, it is ideal to work with traditional healers and have their herbs examined for efficacy. Those drugs that prove to be effective in certain health problems, should be promoted and those that are not discouraged with reasons. We know for sure that some herbs are good; why then demonise all of them. Before modern; scientific medicines existed people were treated on these herbs.

    Jordan Kaisi, Zambia
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  19. I am commenting on the discussion around prevention and curative responses. I think one of the key areas the Global Fund to fight AIDS, TB and Malaria (GFATM) should consider supporting is community intervention - as this is the most effective way to reach out to more people who are currently not being accessed by existing programmes and services.

    I am working as District TB/HIV Coordinator in Kisarawe, Tanzania and we are supported by PATH TB/HIV Project since the year 2009. I piloted some ACSM interventions including Photovoice, CBO involvement, training of primary school health teachers, traditional healers and drug pharmacists.

    It is clearly evidenced that these interventions can bring up more TB patients from peripheral areas but also it ensures proper Directly Observed Treatment Shortcourse (DOTS) usage. However to reach more people and to increase the programme impact, we need to involve different traditional groups, community and religious leaders, in TB, HIV prevention methods. It is high time that the Global Fund should invest more resources in these interventions.

    Mugyabuso
    Email: mugyabuso2000@yahoo.com

    ReplyDelete
  20. My take on this critical debate is focussed mainly on the issue of striking a balance between high impact programming and value for money. Even as the Global Fund to fight AIDS, TB and Malaria (GFATM) gathers more input on how to re-design and move forward, the recent emphasis on the twin issues of programme impact and value for money must ensure proper balance that is more informed by local conditions in each recipient country, and highly contextualized funding requirements that appreciate existing and sometimes militating dynamics on things like donor reporting, procurement rules, etc.

    More time is spent by Global Fund recipients on measuring and reporting on the grants than on actual programme delivery. Besides extremely stringent financial procedures end up compromising the quality of programmes delivered due to a lot of time and attention being paid on ensuring value for money.

    More balanced and realistic approach needs to be taken to resolve this impasse.

    Bernard Orimbo
    Email: onyangobee@yahoo.com

    ReplyDelete
  21. I agree as what was mentioned by Dr Lalji K Verma from India that prevention is more cost-effective than curative. Here, what we have to do is that give more and complete information about the issue we are handling.

    When we do preventive strategies, it will give a long and big impact for preventing all kind of diseases which may threaten children and all human beings.

    Tabrani Yunis
    Center for Community Development and Education (CCDE)
    Banda Aceh, Indonesia
    Email: ccde.aceh@gmail.com, potret.ccde@gmail.com
    Website: www.ccde.or.id

    ReplyDelete
  22. Yes, it is true that prevention is more cost-effective and Global Fund to fight AIDS, TB and Malaria (GFATM) needs to more support prevention programmes. It is so right especially for third world countries like mine.

    Isaac Kireti Moshi
    Kilimanjaro, Tanzania
    Email: kili-heritage@email.com

    ReplyDelete
  23. I totally agree with Bernard Orimbo who commented that the Global Fund to fight AIDS, TB and Malaria (GFATM) needs to achieve high impact programming and measure value for money without compromising the programme outcomes (lives saved and infections prevented).

    In fact I have raised this issue with someone from the Global fund at the Harm Reduction Conference in Beirut recently.

    Ismail Baba, Malaysia
    Email: bismail@usm.my

    ReplyDelete
  24. From the Global fund perspective, one wonders if ever much attention would be paid to preventive approaches considering the problems associated with programme reporting monitoring and evaluation associated with implementing preventive interventions.

    Measuring impact also is a major problem since this will in most cases be seen in the long term. The Global Fund system needs a radical review if preventive interventions are to be given the priority that it need.

    Dr Odume Bethrand
    National Tuberculosis and Leprosy Control Programme (NTBLCP)
    Department of Public Health
    Federal Ministry of Health
    Abuja, Nigeria
    Email: babsodume@yahoo.com

    ReplyDelete
  25. One problem we may have with getting the traditional healers involved is the fact that this may lead to vulnerable patients to have a false security about their chances.

    I have seen patients with terminal illnesses spending thousands of their hard-earned saving on traditional healing. This money is probably more useful for the poor families who may use it for their survival.

    Rusli Ismail, Malaysia
    Email: isrusli@kb.usm.my

    ReplyDelete
  26. In my view, more than anything else, the Global Fund to fight AIDS, TB and Malaria (GFATM) has managed to stand out as a reliable source of funding for fight against these three deadly diseases.

    However, basing on some of the experiences in my country, Uganda, where at some point, corrupt government officials swindled Global Fund money and since then, we don't seem to see any formidable satisfactory progress in bringing those who perpetuated this crime to book, except a few public shows of some kind of legal action with completely no will to actually effect such
    legal processes on the part of government (since these people are just walking around freely, having acquired massive assets in foreign countries with stolen funds from global fund, I would recommend the following:

    - Rigorous monitoring and evaluation requirements, on the part of the recipient countries, this could ensure performance based funding;
    - Transparency in decision-making, including grant funding, this could support accountability.
    - Countries with tainted records of mismanagement of the funds should be pressed to prosecute those officials and they should be made to refund the money, since many times these stolen cash are invested in huge private undertakings, these assets can be frozen and the funds recovered. The legal arm of the Global Fund should therefore play a rigorous role here.

    Otherwise, on the part of the Global Fund being made available to recipient countries, I think this has been well done, only that more follow up and demand for accountability needs to be stepped up.

    Kennedy Kassaza, Uganda
    Email: kennedy.kass@gmail.com

    ReplyDelete
  27. While I want to commend the Global Fund for the huge gap it is bridging in meeting the needs of People living with or affected by the target infections or diseases, I strongly believe the Fund could and should do more in improving the quality of lives of its beneficiaries.

    One emerging threat to these epidemics is non-adherence or poor adherence (for HIV and TB) and drug resistance for all the diseases including HIV infection. An underlying cause of which is poor nutrition caused by poverty as many people affected or living with these diseases often complain.

    This truth is not farfetched as majority of the communities worst hit (most affected) by the combination of these three (3) epidemics are in low-income countries where a greater percentage of the population lives below 1.25 USD PPP per day.

    Especially for HIV treatment, which is more like a lifelong process, not being certain of where and how the next meal would come from has often posed the temptation of stopping or skipping Antiretrovirals (ARV) treatment for people living with HIV.

    This in the long run might lead to more drug resistance and (may be) death if not addressed.

    The Global Fund should therefore seek to improve quality of lives of those affected by facilitating income generating mechanisms that would provide economic empowerment and so doing address poverty and improve treatment adherence.

    The Global Fund should also seek to work more directly with communities affected (people living with/affected by the diseases/infection) and put structures in place to monitoring spending of allocated funds in order to address mismanagement.

    Adejoke Sonoiki
    Journalists Against AIDS (JAAIDS), Nigeria
    Website: www.nigeria-aids.org
    Email: adejokesonoiki@gmail.com

    ReplyDelete
  28. In India most of the people living with HIV are facing discrimination. There is no law to protect their human rights. But funding is going to agencies which are working on the medical or clinical aspect of the HIV pandemic.

    So in India we are not doing enough for moving forward in rights-based direction.

    Asim Sarode
    Human Rights Activist Lawyer
    Pune, India
    Email: asim.human@gmail.com

    ReplyDelete
  29. It might be good enough to focus on prevention but we must also know that it is equally important to keep those already living with the virus in good health. What might be necessary here is an enabling environment for equal participation in prevention interventions by all (both the infected and uninfected). We need to step up the strong statement of 'Prevention with Positive' or what we refer to as "Positive Health, Dignity and Prevention'.

    People living with HIV (PLHIV) have a responsibility to participate meaningfully and be recognized as equal positive agents to fight HIV in any country.

    Steve Amolo, Kenya
    Email: stamolo@yahoo.com

    ReplyDelete
  30. I would like to support Dr Lalji K Verma's comment (focus on prevention programmes too) and add:

    The Global Fund to fight AIDS, TB and Malaria (GFATM) should have a component in its strategy on prevention programmes alongwith a clear plan of action for the treatment, care and support for those already living with HIV or dealing with TB or malaria, and scientific research to measure prevention outcomes.

    Mohammed Saadi Sukkaria
    Email: islamz@gmail.com

    ReplyDelete
  31. I should say that if the Global Fund to fight AIDS, TB and Malaria (GFATM) was not instituted and implemented, the world landscape of HIV/AIDS, TB and Malaria epidemics would have been a real disaster.

    So GFATM is doing so well. However I wish to agree with some colleagues that the programme needs to focus more on the promotion of legislation on HIV/AIDS, transparent governance, excellent auditing system, adequate nutrition in HIV/AIDS and the quality of life of people living with and or affected by HIV.

    I agree with Kassaza that fraudulent officers or actors who have embezzled GFATM funds at national level should be brought to book and the money recovered. This will however demand rigorous audting measures and the creation, implementation and evaluation of memorandums of understanding on
    good governance of GFATM funds and recovery of stolen money. In Cameroon, one minister of public health is behind the bars with a host of those who collaborated with him to sideline GFTAM money. Such efforts should be intensified and above all vigilance should be assured to make sure such
    things do not happen again.

    Adejoke mentions that the GFATM should focus more on income generating projects(IDPs) to better the quality of those living with or affected by HIV. Mechanisms should be put in place within such IDPs to make sure that at the operational level the IDP money is executed for the intended results. There have been implementations of IDPs the world over by many organizations including the World Bank and it would be a good thing to visit their lessons learned to make the GFATM IDPs a success producing the outcomes inclusive of improved nutrition that would reinforce ART as
    envisaged by colleague Adejoke. I would also like to add my voice to the cry of assuring adequate legislation particularly for HIV/AIDS as Asim also mentioned in his post.

    In Cameroon an HIV/AIDS law which was drafted since early 2000 has not been passed by parliament as a result stigma be itself or societal is on the rise further driving breaking the silence around HIV/AIDS issues underground. Advocacy on HIV/AIDS legislation both at national and
    international levles should be put at high gear.

    The GFATM should be seriously looking at the sustainability of free ART since this strategy has greatly scaled up VCT and is one very important AIDS action prevention tool.

    Amungwa Athanasius Nche, Cameroon
    Email: athanestherhaw@gmail.com

    ReplyDelete
  32. The idea of Health Systems Strengthening is Key and I agree that this will improve greatly the performance of the GFATM, but remember, the focus should be the communities with the diseases.

    The most important thing is to ensure that the money flows down to the communities, first by removing the impediments imposed to the funds by government bureaucracies.

    The idea of Civil Society OR International NGOs as the PRs is quite a welcome idea especially in Kenya where the government ministries have been a big impediment to the roll out of GFATM.

    The next step is to strengthen the capacities of the Civil Society organizations, the beneficiaries of the fund to implement quality interventions. This has been very successful by some programs in the Country that the GF can emulate.

    Steve Amolo, Kenya
    Email: stamolo@yahoo.com

    ReplyDelete
  33. I perfectly agree with Ismail Baba, Dr.Odume and Rushli Ismail that there should be a greater focus on impact measurement and the involvement of traditional leaders and healers.

    I would like to add that proper programming should include a sound monitoring and evaluation plan that spells out the methods and roadmap for the monitoring, supervision and evaluation of all GFATM programmes before, during and after activities to be sure the implementation is regulated within the framework of the result chain from Input to Output to Outcome to Impact (IOOI) which means that every single activity should slide along this IOOI framework with each actor or stakeholder knowledgeable and skilled enough to operate within this continuum.

    I also see the idea that the GFATM system should assure its GFATM grants along three planes, namely PLANNING PROCESS, PROJECT CYCLE AND AID COORDINATION. Across these three planes seven skills should be guaranteed all the stakeholders namely partnership building(one hand cannot tie a bundle or several heads are better than one), presentation skills leading to proposal writing so that all GFTAM funds are given out as per well written projects with a sound M & E plan, Negotiation skills with community leaders to engage the community members, Communication skills to lead to change and problem-solving skills that value win-win conflict or problem solving scenarios.

    It would therefore go without saying that an effective knowledge management process should effectively be imbedded in all GFATM projects at all levels.

    Dr. Odume has already highlighted the challenge of impact measurement so perhaps it could be the moment for the GFATM team to so conceptualize the frameworks within which this could be possible. Concerning the involvement of traditional leaders and healers, I fully endorse this approach because their clients and subjects fully acknowledge the very psychosocial, and culturally sensitive atmosphere within which they function. If HIV/AIDS, Malaria, Tuberculosis are integrated into their healing and governance activities, messages about these epidemics would circulate more effectively and efficiently in the communities and help to scale up HIV prevention. In 2008 I presented a paper on the neglected power of traditional rulers in the HIV/AIDS prevention, treatment, care and support continuum activities during an international AIDS conference on research in Cote d'Ivoire and it was well acclaimed and published to show that we often miss the point by not fully engaging traditional healers and leaders in AIDS action.

    Amungwa Athanasius Nche, Cameroon
    Email: athanestherhaw@gmail.com

    ReplyDelete
  34. Kennedy Kassaza, Uganda, has a varied point that there is need to have those who misappropriate Global Fund to be punished. Despite the fact that the governments on whose the Global Fund have been misused are made to refund the money as is in the case of Zambia, we have not seen any action taken on individual bases against those who committed the crimes; especially when the funds involved are substantial. It therefore follows that the punishment by the Global Fund are meted on all the citizen of that country through the tax payers fund.

    It is my opinion that Global Fund puts in place mechanism of monitoring which will compel the recipient country to get to the wings or individuals that commit these crimes. This will deter others from misappropriating the funds.

    Jordan Kaisi
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  35. I will like to add that the Global Fund to fight AIDS, TB and Malaria should seriously consider supporting projects that provide prevention, treatment, care and support for other diseases that impact the lives of people living with HIV - especially as they grow older.

    Care for diabetes, cardiovascular diseases, for instance is very expensive in private sector and limited to tertiary care hospitals in public sector. The solution needs to be practical so that most PLHIV benefit from the services,

    Jitendra Dwivedi, India
    Email: jitendraabf@gmail.com

    ReplyDelete
  36. I think there is no doubt that the Global Fund should be supporting prevention, treatment, care and support programmes for all three conditions - TB, Malaria and HIV. But prevention programmes are usually getting undervalued as the impact is difficult to measure perhaps and takes a long time to see the outcomes. Just to add my vote that don't undermine prevention - and support prevention as we scale up treatment, care and support services.

    Abdul Naib

    ReplyDelete
  37. Don't forget youth Global Fund to fight AIDS, TB and Malaria (GFATM). There are hardly any effective interventions on prevention aspects for young people - we need that more. Also youth friendly services are missing - present services are not youth friendly.

    Vincent Pinto

    ReplyDelete
  38. We greatly appreciate the work of the Global Fund and the model for more sustainable development putting more ownership of programs, strategies and implementation into the hands of the country.

    Related to the question - What should the Global Fund do more of:

    It is widely understood in the for profit sector that effective leadership and efficient management are essential to achieve results and get the maximum return on investment.

    This is as true in the health sector as it is in any sector. Leadership and management at all levels of implementation of Global Fund Programs need to be required and clearly proposed in applications for funding and development of practical leadership and management skills are needed in all areas of implementation.

    Joseph Dwyer
    Global Lead, Health Systems Strengthening
    Management Sciences for Health
    Cambridge, USA
    Email: jdwyer@msh.org

    ReplyDelete
  39. We must focus on several aspects:
    - We need to restructure the relationship between CCM and the Principal Recipient of the grant so that there is strict control, mutual accountability, better monitoring and evaluation and transparency in functioning
    - I think that the process of supervision did not achieve control and must follow processes like internal audit, external audit
    - I think it is necessary to have complete data from the receiver on the main achievement and in a transparent manner made available at any time
    - I think we need to train CCM members on how to do follow-up, supervision and audit
    - Are there clear criteria for the operations of supervisory visits to places of work and whether these standards have been circulated to all
    - How easy is the access to existing services for the people and assessing what are the obstacles

    Mohammed Saadi Sukkaria
    Email: islamz@gmail.com

    ReplyDelete
  40. I will like to add that prevention, treatment, care and support services for transgender (TG) living with or at risk of HIV are very poor, unfriendly and therefore underutilized. Needs of TG community are specific and we will hope that the Global Fund to fight AIDS, TB and Malaria (GFATM) not only support more projects for TG, led by TG community based organizations and also help build their capacity in financial, programme management.

    Rahul Kumar Dwivedi, India
    Email: contactrahullko@gmail.com

    ReplyDelete
  41. In Brazil, I believe a lot more needs to be done on prevention. Even simple information like sign and symptoms of infections is lacking in communities.

    Young people do not consider themselves vulnerable to tuberculosis or HIV. So effective programmes aimed at young people are the need of the hour.

    Rapid access to diagnosis and treatment of tuberculosis, STD or HIV is unsatisfactory.

    I think it would be necessary to invest in advocacy, communication and social mobilization much more than it is currently being done to make the difference.

    One underused but often effective strategy is to invest in art events (short documentaries, drama pocket, visual art installations) to be displayed on the street, causing discussion among children, youth and adults.

    Another effective strategy would be to support projects of mobile unit for diagnosis and treatment, which roam places where the population lacks public health units.

    Claudia Costa, Brazil
    Email: claufcost@gmail.com

    ReplyDelete
  42. I can see the Ministry of Health (MOH) in Cameroon which is urging civil society organizations (CSOs) to join hands in reaching various homes as a strategy to diminish malaria.

    This should be scaled up in other countries as well.

    Dr Asomba Tobias
    Email: asombacohecf@yahoo.com

    ReplyDelete
  43. I had the opportunity to work in a project supported by the Global Fund to fight AIDS, TB and Malaria.

    I work at the grassroots so my suggestion based upon my experience on what works, is that every team member must consistently practice self-evaluation - this is one way of ensuring we do our job honestly and we do our best to fight HIV, TB and Malaria.

    Kariobangi
    T-plus organization
    Email: tiplus.org@gmail.com

    ReplyDelete
  44. I strongly agree with Joseph Dwyer that in Global fund application, Leadership and management at all levels of implementation of Global Fund Programs need to be required and clearly proposed. But it is of note that in developing countries that need this funding, defining leadership could be difficult because meeting the paper requirement in most applications had never been the case but seeing this translate to needed outcome in programme implementation has always been our bane.

    In my years of work in TB programme, I have come to observe that the litmus test to determining an effective leadership is simple. Can we find a way of administering a questionnaire in this regard to immediate staff of any programme coordinator applying for Global Fund grant? With this, more than any other way we may be looking at, incompetent leaders can never get a GF grant. A good leader at the head of a programme naturally will beget good leaders at other levels of programme implementation. Get a grant approved and running in the hands of good leaders, efficient management will be the order in programme implementation!

    Dr Odume Bethrand
    National Tuberculosis and Leprosy Control Programme (NTBLCP)
    Abuja, Nigeria
    Email: babsodume@yahoo.com

    ReplyDelete
  45. While I appreciate the fact that the Global Fund has been a blessing in the world and Nigeria in particular, I really want to emphasise on the need to put in adequate systems and policies to not only monitor the implementers at all level, but also the governance mechanisms of CCMs should be reviewed and ensure that conflict of interest is well checked amongst all key actors.

    The grant implementing process should be made more transparent to guard against embezzlement. The use of CSOs is key but the engagement of the media at all aspect of grant implementation should
    be looked into and provision made to ensure all the in-country GF entities should give account of all their actions and inactions etc.

    Emmanuel Abi Couson
    Country Coordinating Mechanism (CCM), Nigeria
    Email: emmaabi@yahoo.com
    Website: www.ccmnigeria.org

    ReplyDelete
  46. I emphasize the importance of monitoring and evaluation. As the impact is often slow to be felt, the monitoring and evaluation can reschedule time errors, or complete the missing, or to cancel what is not updated. For each program funded by the Global Fund, all proposals are developed based on the realities of the requesting country.

    I think the key to a successful financing is in the National Implementation Strategy that fosters coordination and collaboration of all stakeholders to achieve the country and where I like the Global Fund in strict management of funds, but I suggest to be less rigid in the context of the implementation of activities. Example: validation by the Global Fund of an activity planned in the proposal lost time and increases the understanding of PR and SR - the Global Fund needs to strengthen countries improve their monitoring and evaluation frameworks especially strengthen consultations with stakeholders and beneficiaries of each program and at all levels.

    Email: razafinjanahary2000@yahoo.fr

    ReplyDelete
  47. Thank you GFATM. Coming from a poor country that relies heavily on transport to deliver health services please invest more in that area.

    The Gambia has less than 50 public health facilities (hospitals, health centres and clinics) most of which are located in urban and peri-urban communities.

    The vast majority have to travel or walk great distances to access health services. That's why the Ministry of Health has mobile outreach clinics to reach out to poor and underserved populations.

    Recent reviews have shown that nearly 60% of women and children access reproductive and child health services including IPT and PMTCT from these mobile clinics. These clinics are visited by a team of health staff once or twice a month to conduct reproductive and child health (RCH) services. Good and reliable transport is needed to improve upon the gains already registered.

    Transport is also a cross cutting issue. It should be an integrated matter between the disease programmes being supported by GFATM in the countries they operate. How else would the bednets, ARVs, TB drugs, prevention programmes, etc reach people who need them in the villages?

    If The Gambia's case is to serve as an example over half of those respective target groups would not be reached if there were no reliable transport. Transport has been described as the missing link in the MDGs. Therefore investing and supporting transport will have a ripple effect in the overall delivery of health services resulting in a positive impact not only on the 3 diseases but also on other maternal and child health indicators. What is needed are ambulances, outreach vehicles and motorcycles. And their running cost. This can be included under health systems strengthening (HSS).

    Cherno Jallow, The Gambia
    Email: chejallow@hotmail.com

    ReplyDelete
  48. As a person dealing with multidrug-resistant tuberculosis (MDR-TB) I am lucky to be in urban area and live close to one of the few government TB centres in India where treatment of MDR-TB is covered. But there are many other complications like hearing loss which I have suffered - and - the cumulative cost of going to hospital so frequently for a long period of time, and being out of job for more than a year, transport cost is also huge, queues in hospitals long.

    Please consider this for support in GF funding.

    Nadeem Ahmad, India
    Email: contactnadeemlko@gmail.com

    ReplyDelete
  49. I recently moved to and now live in eastern Uttar Pradesh and every member of my family has got malaria at some point or the other in the past 2 years. Every time we had to pay for diagnostics, drugs and other related costs because government centre is at least 7-10 kilometres from where we live. I will like to see malaria care free and within easy reach in our communities.

    Also programmes like mosquito control are hardly existent except in posh or elite areas. The living conditions, the open drains, etc makes it clear that malaria programme needs to be integrated with community development programmes for longer term better outcomes.

    Anand Pathak, India
    Email: indopakpeacemarch@yahoo.co.uk

    ReplyDelete
  50. From my own experience, I want to ask the Global Fund to fight AIDS, TB and Malaria to support and partner with nutrition programmes so that people who are seeking anti-TB treatment are benefited with nutritional support. TB drugs are so toxic and our small breakfast of a 'pao' (bread) is possibly not enough to help us deal with strong medicines.

    Kiran Jaiswar, India

    ReplyDelete
  51. Most community service organizations work at the grassroots to help change lives. We know for a fact that the most impact is created by those
    organizations that work at the grassroots level and which in most cases work on stringent budgets.

    To save lives, the Global Fund should identify ways of simplifying the application process for these organizations or better still it should develop a special call for application that is specifically targeted at
    organizations working at the grassroots to source for funding from.

    This will ensure that they do not have to apply through the Country
    Coordinating Mechanisms which in some cases are ridden with corruption and malpractices. The fund will only have to have a small amount that will be easy to manage and monitor. A transfer of skills and building of partnerships should also be a priority for these CSOs for more sustainable impact.

    Most of these organizations when empowered will definitely increase the number of lives saved and create more impact and value for money at the grassroots and thus sustained impact.

    Simon Odiwuor K'Ondiek, Kenya
    Email: kondiek@gmail.com

    ReplyDelete
  52. Regarding Lives Saved I would have to say that if it were not for the GFATM,in my country most of the people with HIV would have died already, as Bolivia does not have a budget to support this disease, and the only certain ARVs that are bought for Bolivia are with the Grant of the Global Fund. We do receive a donation from Brasil but it only covers a few ARVs and for a 6 month period.This means that all the people living with HIV are now alive, thanks to this grant.But not only that, it also covers all the basic requirements such as opportunistic infection drugs, reagents, supplies, consumables and all that is required to provide care for all these patients. So as much as for lives saved I think the GFATM did a tremendous work. Nonetheless we must work harder to ensure prevention, and from my point of view there are only 2 efficient ways to work in PREVENTION thinking about the future:

    1. Educational policies must include a prevention curricula regarding HIV in
    all schools. This needs to be done by including this information in the
    National Ministry of Education as a compulsory topic to be taken at all
    school levels, starting with the very basic levels.

    2. Work with all Medical Universities to include in their curricula a specific topic regarding HIV, so that newly formed Doctors can take care of
    HIV Patients at the Every Health Care Center. Be it a very basic service or a very advanced service.

    I think those would be great opportunities to increase prevention.

    Of course all of this must be done with the most possible control to avoid the misuse of the Funds.

    Gilvan Ramos, Bolivia
    Email: g.ramos@ibis-hivos.org

    ReplyDelete
  53. When I think about what the Global Fund funds for my country and the way funding is currently distributed, I keep on lamenting, looking at the number of people dying daily in the regions of Cameroon.

    First suggestion is that the representation on Global Fund CCMs and other committees should be from all across the country - not just one city or big cities only. In Cameroon, 8 members on this list are from Yaounde alone.

    Second suggestion is that regional community representatives should be
    rotated from different countries within the region.

    Third suggestion is that medicines for opportunistic infections are not available in local clinics in my country. For example, cotrimoxazole is not available usually.

    Due to poor nutrition, it becomes difficult for people to adhere to strong medications.

    We also strongly support what Dejoike has mentioned about income generation activities to be considered for affected communities in poor settings by the Global Fund.

    Strict monitoring and evaluation of these funds in-country by community activists wil go a long way to get the most value of money spent.

    Wendi Bernadette, Cameroon
    Email: actwid_k@yahoo.com

    ReplyDelete
  54. The facts speak for themselves. It is practically in developing countries the problem of corruption exists as well brought out by Kennedy Kassaza, Uganda.

    My suggestion is that the Global Fund should select NGO recipients by an open and transparent consultation with the government and affected communities. When people will be informed about the project regularly then it will increase accountability. This is more a matter of trust than
    inspection. Only if the groups handling the finances are trustworthy then the problem can be solved.

    Paul Ponniah
    Email: paulponniah@yahoo.in

    ReplyDelete
  55. The Global Fund is doing an admirable job; however, the field needs to continue to push for efficient, effective, transparent, and accountable funding of global health programs.

    One thing that is puzzling is why the misappropriation of funds when there are a number of control bodies involved in GF - such as LFA, CCM, MoH, PR etc.

    With such tight control and/or oversight, frauds would be at the very minimal.

    Perhaps GF should consider adopting different business approach strategies to effectively and efficiently carry out their objectives.

    Rosemary Khissa
    Email: khissarose@yahoo.com

    ReplyDelete
  56. In Zimbabwe we had a problem of writing the proposals and other required documents. This is one reason probably why Zimbabwe has less resources granted by the Global Fund to fight AIDS, TB and malaria.

    Tamuka Foundation
    Email: tamukafoundation@yahoo.com

    ReplyDelete
  57. I think it would be necessary to invest more in grassroots advocacy (like vernacular publications provide more news coverage in regional languages),communication and social mobilization at local level.

    Effective strategy is to invest in mobile advocacy events (short
    documentaries, drama pocket, quiz on TB in school campus or at districts level) to be displayed on the districts and school campus, causing discussion among school children, journalists, politician, government
    official among others.

    Pawan Kumar, India
    Email: pawan@imcfj.org.in

    ReplyDelete
  58. The Global Fund has done a commendable job in saving lives over the past decade. I will just like to support earlier comments to give more attention to programmes addressing needs of the transgender community.

    Piyush Kumar, India
    Email: piykumagg@rediffmail.com

    ReplyDelete
  59. Had adequate infection control and prevention services existed when I needed them, I would not be affected by these epidemics. So I will surely put in my vote for scaling up quality prevention services, engaging affected
    communities meaningfully and with dignity in prevention services, and also continue to scale up treatment, care and support services. Thank you Global
    Fund.

    Preeti Pandey, India

    ReplyDelete
  60. I understand that the core issues of the GFATM are AIDS, malaria and tuberculosis. This is a good enough focus but when colleagues begin to talk of diabetes, malnutrition, and some may eventually
    talk of hypertension and others, I am inspired to suggest that the plan of action should identify all the satellite issues which stakeholders should also include in their project proposals.

    Perhaps as Pinto points outs, the youth who are hardest hit by these epidemics should equally have a more aggressive focus against the said epidemics.

    I believe that if a thorough stakeholder identification and analysis is done a lot of refocusing may need to be done to ensure that no opportunity or stakeholder expertise is missed to scale up the fight and eventually totally bring down the prevalence of HIV, malaria and TB.

    Amungwa Athanasius Nche, Cameroon
    Email: athanestherhaw@gmail.com

    ReplyDelete
  61. While the Global Fund can be quite effective in scaling up existing programs in some areas it has generally failed to address the needs of ethno-linguistic minorities in the Mekong Region that are disproportionately impacted by HIV. The log frame mentality is the death of thought and sometimes the death of people.

    David A Feingold
    Director, Ophidian Research Institute
    And International Coordinator for HIV/AIDS and Trafficking
    Office of the Regional Advisor for Culture
    United Nations Educational Scientific and Cultural Organization (UNESCO), Thailand
    Email: ophidianfilms@hotmail.com

    ReplyDelete
  62. We do really appreciate the efforts Global fund has put in to save the lives of people in developing countries with high burden diseases of public health importance. But for countries to effectively manage the funds properly for the intended purpose of saving lives there is a need to train the managers of the programs on proper planning, prioritizing activities and budgeting accordingly, they should also understand there is need for paradigm shift in delivery of health care services.

    Much more emphasis and funding is required to strengthen and build capacities of the laboratory services as this is cornerstone of diagnosis and monitoring of patients on treatment in order to avoid drug resistance as it is of now.

    Dr Grace Kahenya
    Management Sciences for Health, Zambia
    Email: gkahenya@msh.org

    ReplyDelete
  63. I think that the Global Fund improves from round to round the balance between prevention actions, care and capacities building for all stakeholders.

    However I think that there is a need for much more integration as well for the health facilities level as the civil society organization in charge of behaviour change, communication activities for the 3 diseases (Tuberculosis, HIV and Malaria).

    This synergy will allow us to have more impact. Right now in some countries there is a competition between PR from the Ministry of Health and Civil Society, this situation impact negatively in project implementation, the CCM should play fully its responsibility during PR's selection. The Global Fund should evaluate CCM's performance.

    Bernabe Yameogo, Canada
    Email: yambernabe@yahoo.com

    ReplyDelete
  64. MORE COLLABORATION BETWEEN VARIOUS UNITS: PROCUREMENT, MONITORING AND EVALUATION, FINANCE, LEGAL etc

    No doubt, the Global Fund has been a major source of support to developing countries including Ghana. However, I agree with Simon that the application process should be simplified to encourage grassroots' participation.

    Nevertheless, whilst simplifying the process, there is the need to also ensure strict adherence to correct, timely and accurate reporting. The coordinating role of CCM in proposal development and submission in-country, should be adhered to. The Global fund should also shorten the Grant negotiation process: the various units: Procurement, Monitoring and evaluation, Finance, Legal etc, should collaborate to ensure that there is no cross-fertilization of suggestions.

    Dr Constance Bart-Plange
    Manager, National Malaria Control Programme, Ghana
    Email: conmarfouk@yahoo.co.uk

    ReplyDelete
  65. I must commend the very insightful issues that have been raised by my colleagues and fellow contributors. I can see that the GFATM has a great future if attention is paid to issues that have been raised:

    1) LEADERSHIP AND MANAGEMENT as raised by Dr Dywer and Dr Odume. I would like to say selection of leaders for the various GFATM programs should be based not only on paper qualification but also on personal experience; PEOPLE WHO HAVE A REASON TO WANT TO MAKE A CHANGE.

    2) The APPLICATION PROCESS SHOULD BE SIMPLIFIED especially for grassroots CSOs who may not be able to meet up with the stringent requirements but whose activities directly affect the lives of common people in a positive manner

    3) Institute PUNITIVE MEASURES AGAINST EMBEZZLEMENT

    4) Expand focus to include issues that ripple into the core areas such as support initiative as suggested by Adejoke Sonoiki and BLOOD SAFETY programs.

    Lala Oluwatobi, Nigeria
    Email: call4biggy@yahoo.com

    ReplyDelete
  66. I will like to recommend that the Global Fund to fight AIDS, TB and Malaria (GFATM) should consider analyses like one published the Times of India, 26 April 2011 edition (page 13) which gives a graphic account of the NGO status and mode of operation by accountability, good management practice, graded technical staff, and research team.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  67. It is important to ensure that funds are being used for the purpose for which they are intended.

    Also, in India, RNTCP has different mechanisms to ensure treatment continuity in private and public sector (70% patients go to private sector!). In many cases the patient does not continue the treatment for the specified period of time, and there is no adequate of tracking in private and public sector. This is where funding support can make a difference to ensure treatment literacy and adherence at the ground level.

    The so called 'free treatment', if available at all, involves such a tedious process in terms of time and quality of services, that it becomes the last resort for a patient.

    Shobha Shukla, India
    Email: shobha1shukla@yahoo.co.in

    ReplyDelete
  68. Global Fund has not done much, if any (but it should do) in some African countries especially in Zambia (and as was witnessed in the case in Uganda where Mr Kyato, the human rights activist was killed), in addressing the challenges posed and putting in place intervention strategies to address HIV/AIDS and its resultant conditions in homosexuality.

    This is because the community regards homosexuality as immoral, un-Zambian and sin, and rightly so, because Zambia is a Christian nation. As such, to avoid and overcome the challenges of stigma and discrimination that they may face, gays have as well female sexual partners too; you can imagine in this situation how HIV/AIDS and its resultant conditions perpetuated through this channel are being sustained. The fight against HIV/AIDS then, becomes a mammoth mountain to climb and it is like fighting a losing battle.

    Commercial Sex Work (CSW) or sex between the unmarried are as immoral, un-Zambian and sin just like homosexuality. Society has recognised and knows the danger and challenges posed by sex work and other sexual activities between the unmarried as big problems, as such, strategies for interventions have been initiated, but not in the case of homosexuality.

    Whether we like it or not we have homosexuals in Zambia and the question of HIV/AIDS in these groups cannot be ignored if we are to have a meaningful solution to the challenges of HIV/AIDS. Global Fund should therefore, put in place mechanisms of monitoring and ensuring that global fund addresses and is used for prevention, treatment and support and care for all: the infected and affected by HIV/AIDS regardless.

    Recognising that we have the challenges of HIV/AIDS in homosexuals is not the same as approving the behaviour in homosexuality, as Zambia views it. If the flow of the viruses through one channel are left unchecked and continue supplying communities with this deadly disease the fight against the pandemic will never be won. There is a question of human rights as well to be addressed; the right to health for all.

    Jordan Kaisi, Zambia
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  69. In order to increase the value/results for their money, the Global Fund needs to think about including strict guidance and heavy emphasis on nutrition and livelihoods as cross-cutting sectors.

    Otherwise, the GFTAM will be obliged to continue to subsidize treatment without addressing the root causes of the problems, and the reasons why many people find themselves affected by HIV, TB or malaria, and when/if the funding one day stops, the vicious cycle will start right up again. It may mean a larger initial investment, but for more long-term results.

    Kelly Ann Yotebieng
    Email: kyotebieng@caro.crs.org

    ReplyDelete
  70. 1. I do not see any contradiction between prevention and therapy; as far as HIV is concerned, if there is a way to kill the virus and save lives, it is one of the best prevention measures.

    2. In order to increase the number of lives saved it is vital to make the access to life-saving treatments easier as much as possible in any country of the world. This is still a challenge everywhere for the so called hard to reach, like the injecting drug users (IDUs). They are hard to reach not for their personal deliberated choice but for the stigma and discrimination which marginalise them in our society. We need a global mobilisation in order to reach drug users, welcoming and treating them according to a humanitarian strategy. Even in their case therapy plays a preventive role while violent approaches, stigma and discrimination favour the virus spread.

    Massimo Barra, Italy
    Email: massimo.barra@cri.it

    ReplyDelete
  71. While UNAIDS claims that non-sexual HIV transmission is very low and that transmission through unsafe healthcare is almost negligible, WHO research shows that unsafe injection practices in health facilities could be contributing 15% or more to HIV prevalence in developing countries. This is a very substantial figure and yet the issue receives little or no funding and is relatively unrecognized by people, professionals and patients in developing countries, where transmission rates are highest and healthcare standards are lowest.

    Modes of transmission surveys need to be based on empirical figures. There is little point in targeting sexual behavior alone where this is not the main or the only problem. The 'behavioral paradigm', which claims that almost all HIV is transmitted through heterosexual sex, needs to be tested as it informs almost all current HIV prevention programming.
    Regards
    Simon Collery

    ReplyDelete
  72. As the above-line indicates one of my thoughts. The other one is to consider FUNDING PEOPLE WITH DISABILITIES. Especially Disable Persons' Organisations, who have very limited funding opportunities.

    Rakesh Chand, Fiji
    Email: chand@connect.com.fj

    ReplyDelete
  73. I appreciate the work of the Global Fund; and also recommend that it should give more emphasis on involving genuine NGOs in its programmes and supporting them accordingly.

    Dr PS Sarma, India
    Email: drpappuss@yahoo.co.in

    ReplyDelete
  74. Taking this opportunity, I would like to appreciate the Global Fund to fight AIDS, TB and Malaria (GFATM), for its strong support for people in need in the developing countries including my country Ethiopia with focusing on Civil society organizations.

    I recommend the GFATM to include activities on Reproductive health.

    Providing GF context trainings on ,onitoring and evaluation, grants and financial management, resource mobilization and community mobilization areas - Organizational capacity building including, organizational development, human resource development and governance.

    Simachew Yigzaw, Ethiopia
    Email: simachew_yigzaw@yahoo.com

    ReplyDelete
  75. To be sincere with the activities carried out by The Global Fund, it has transformed the worried and had saved a lot of souls in the world, but in the recent time (based on OIG evaluation carried out last year in Nigeria within March till April 2010 in my country in which am part of the team), it shows that there's no constant audit activities to know if those NGOs are spending according to the approved budget submitted to The Global Fund in any round. I will say here that The Global Fund should always carry-out Audit evaluation either periodically or quarterly in all the country that are funding their NGOs.

    Eric Joshua Oluwakayode, Nigeria
    Email: ericjossy2003@yahoo.com

    ReplyDelete
  76. Yes GFATM has great achievements in prevention and control of HIV/AIDS, TB and Malaria. However I think much can be done if the program choose and implement the best strategies that suit the country context and culture.

    My message is to enable the managers and the implementers of these programs to do option appraisal to see what is suitable for their countries rather than importing and imposing specific strategies. It is better to let the countries choose rather than to be pushed towards specific approach or to achieve particular indicators.

    Dr Heitham Awadalla, Sudan
    Email: bauga1@hotmail.com

    ReplyDelete
  77. Thanks for initiating the e-discussions. It seems to be a productive approach which will provide opportunities for people from different strata to express their views as well as to share their experience with regard to Global fund and its programmes.

    The statistics given in the note are attractive. But we need to really look into the actual impact which has been made by Global fund programmes.

    To my view those statistics are something like an interim achievements or some outcomes which may lead to an impact. More need to be focused at different layers.

    The existing programme management systems or programme management functions are not fully competent to facilitate the process of desired changes. I feel there are gaps both in management structures as well as the management procedures. It is better to re-look into all those things and revitalize the systems.

    There are certain key issues which affects the country level governance and management systems also:

    - The conflict of interest - the members or their must not receive the funds
    - Tokenistic participation of community in programme planning
    - Incompetency in the monitoring systems
    - Unrealistic capacity building systems

    These issues have to be addressed properly to strengthen the programmes.

    Satheesh, India
    Email: somasatheesh@yahoo.com

    ReplyDelete
  78. We (at Phase 366) completely agree with the suggestion Vincent Pinto posted on Youth issues especially in SADC. As the figures suggest that the youth within this region are the ones most at risk.

    Phase 366 is the First Urban Social Awareness and Youth Development Organisation within Zimbabwe. Fusing both Web and Mobile inter-phased platforms as a way of disseminating information among the urban and Rural youth of Zimbabwe and Africa.

    Enock Mawema, Zimbabwe
    Email: enock.mawema@gmail.com

    ReplyDelete
  79. The Global Fund monitoring and Evaluation mechanism on impact assessment is critical in Financial management.

    The recipients must get value for the donor funds by perpetual audit before any further disbursement of funds is done. Checks and balances must be put in place to mitigate high level corruption, theft and/ or mis-allocation of funds at a minimum time rather than wait for negative reports which could have been detected and acted on to minimize risks of loss and wasteful procedures, at times the culprits are well known but no action is taken until too late.

    The Zambian case where stolen funds are alleged to have been refunded is a pathetic scenario of abuse of office and power.

    Developing countries must come with budgetary allocations in cases where the GF has taken measures and stopped funding without consideration possible death, suffering and non-adherence by affected populations.

    A lot needs to be done for sustainability, vertical and horizontal approaches are critical to avoid human waste.

    Joseph N Ngunju, Kenya
    Email: ngunjujoseph@yahoo.com

    ReplyDelete
  80. I agree with Leadership strengthening and Management. When we talk of leadership, we should include all community gatekeepers: traditional leaders, Village headman and community involvement at large. We need to find a way on how to strengthen the community dialogue. UNDP and UNAIDS have an excellent programme that can effectively address the challenge of HIV pandemic called Community Capacity Enhancement - Community Conversations (CCE-CC).

    The funds spent so far in attempt to address the HIV pandemic are enormous, yet there's an increase in HIV new infections, because programmes are planned and designed without the recognition and involvement of communities. If we seriously aim to address the HIV pandemic, then we need paradigm shift and be more innovative.

    Communities have solutions to their challenges, but need someone to facilitate the process to long lasting change.

    We can draw learning from past programmes and able to combine GF resources with community resources.

    Penina Ita, Namibia
    Email: ingayajohn@gmail.com

    ReplyDelete
  81. Global Fund money is International money. Accountability is important to ensure that those who should benefit do benefit.

    Thus there should be an agreed strategy, pathway and accountability to all concern at all levels with international input.

    Secondly, it might pay to train before we do anything to ensure that everyone understands what is expected.

    Thus we need to PLAN followed by TRAINING and IMPLEMENT/then EVALUATE. The argument has been different countries with different needs and different cultures. This has caused confusion to the extent that nobody knew what needed to be done when and where.

    Mohammed Kibirige
    Email: mskibirige@btinternet.com

    ReplyDelete
  82. I think the prevention is more cost-effective than curative. However, to save people's lives the Global Fund must continue its support for the curative services until the countries fully perform its duties.

    Expanding the coverage of both preventive and curative services is a big challenge in developing countries. Integration of HIV/AIDS, TB and Malaria services within the national health services package is the best way to scale-up the service coverage and this require more investment in health system strengthening (HSS).

    The sustainability of services is an issue particularly the affordability of medicine when the external grants end. To ensure affordability of drug to the patients I think the GF should think to ask the countries to contribute and share financially in the procurement of medicine and increase this share gradually year by year as GAVI policy with countries regarding the procurement of vaccines. I think this policy at least in some countries is needed to avoid any interruption of medicines with respect the GF continued funding for treatment for 2 years after the grants ended.

    Dr Adel Al-Jasari
    National Malaria Control Program Manager
    Republic of Yemen
    Email: aljasari@hotmail.com

    ReplyDelete
  83. I would like to underscore the firm statement on zero tolerance for corruption from Shobha Shukla, India. Effective built-in control systems should be applied clearly understood by the public, medical profession and administrators as well.

    Corruptors should be made public and brought to justice for deterring further corruption. Let's safeguard the noble intentions of The Global Fund to fight AIDS, TB and Malaria (GFATM).

    Muherman Harun, Indonesia
    Email: muhermanharun@gmail.com

    ReplyDelete
  84. In Guyana the most-at-risk populations (MARPs) is not getting the priority they need to save lives, prevent infections and protect human rights.

    Sex workers, transgender community members, men who have sex with men (MSM) and those living with HIV are facing discrimination. There is no law to protect their human rights. But funding is going to agencies which are working on the medical or clinical aspect of the HIV pandemic.

    More work need to be done with these groups directly. The Global Fund need to look into this if we want to get to Zero New Infection by 2015.

    So in Guyana we are not doing enough for moving forward in rights-based direction with these target group.

    Miriam Edwards, Guyana
    Email: miriam.passion@yahoo.com

    ReplyDelete
  85. I for Jeevan Sagar Trust, greatly appreciate the way the Global Fund to fight AIDS, TB and Malaria (GFATM) is saving lives and preventing new infections.

    I will like to support:
    - Impact measurement and involvement of traditional healers as leaders.
    - Effective punitive measures against those who misuse funds
    - To integrate care for diabetes, cardiovascular diseases in HIV programmes for those people living with HIV who need it

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  86. The Global Fund has contributed immensely to save lives. I will like to see that the Global Fund money reaches organizations of affected communities themselves - which is happening already but needs to happen all the more. Affected communities need to trained to do stringent monitoring and evaluation and other areas of programme management.

    Fred Mwansa, Zambia
    Email: fredmwansa@yahoo.ca

    ReplyDelete
  87. I would like to share that my organization has three ambulances, but what I need is a multi-tasking vehicle for general purposes, but the government has no scheme for such vehicles. So the Global Fund to fight AIDS, TB and Malaria should assess local realities and needs before sanctioning funds.

    This is so badly required in educational and prevention projects and other tasks that in the absence of such vehicle, we have to incur heavy expenditure on hiring transport for collecting food, clothes, ferrying staff, etc and then taking the same to our projects.

    On the other hand I notice that hundreds of donated ambulances are not being used to capacity in various hospitals.

    Dr NK Gautam, India
    Email: navnidhisandhya@yahoo.com

    ReplyDelete
  88. I agreed with Adebayo Adedayo from Nigeria that Global Fund must continue to strengthen the fight against HIV, TB and Malaria and invest more in the Health System Strengthening (HSS) process.

    Concerning other health aspects such as blood safety, lung diseases, Hepatitis C, orphans and malnutrition, they have already been underlined by the Global Fund at its Twenty-Second Board Meeting (held in Sofia, Bulgaria, 13-15 December 2010) to be taken in consideration for future proposals.

    The Global Fund should provide more technical assistance and build capacities of in-country people on: finance, research, and monitoring and evaluation.

    Dr Tatiana Sanda
    Focal Point - HIV/TB and Malaria
    Ministry of Health (MoH), Niger
    Email: akstania@yahoo.fr

    ReplyDelete
  89. It will be better to limit the coverage and ensure quality, standard and sustenance for services related to most common diseases affecting people living with HIV (PLHIV). This will ensure impact visibility on AIDS epidemic instead of providing general healthcare services in AIDS clinics.

    Richard Shilamba, Tanzania
    Email: chesociety@yahoo.com

    ReplyDelete
  90. I feel that the Global Fund to fight AIDS,TB and Malaria (GFATM) will benefit if improved and genuine monitoring and evaluation systems get in place to truly assess programme performance and impact.

    Dr Tapan Sen Gupta, India
    Email: nursingschoolsdss@gmail.com

    ReplyDelete
  91. While in agreement with most submission, I think Global Fund engagement of the Country Coordinating Mechanisms (CCMs) is structurally deficient.

    The architecture which tries to focus on mid-level system strengthening is like the ancient hanging garden of Babylon. If we really want to be cost effective, it is important that a strong oversight structure in country is strategically positioned. The best structure will therefore be the CCM Secretariat. Attempt to put the responsibility on the door-step of PRs, CCM Oversight Members who are largely part-time members, the LFAs, the GF Country team is like playing the proverbial ostrich game. There is no hiding from reality. In fact, it is an affirmation of the cliche "PENNY WISE, POUND FOOLISH".

    CCM secretariats if empowered to take critical steps toward successful programme implementation will go a long way in checking the excesses of the PRs, and also reduce logistic expenditures by the GF on LFAs, GF Country teams, the OIG etc. GF needs to build trust in in-country systems if the Paris declaration on strengthening country system is not another lip-service. If so desired, we can assist in-putting a doable CCM Secretariat organogram together for the GF to adapt. The present grant oversight arrangement as constituted is not only a pipe drain on the dwindling GF resources, but also very distracting and less focus on achieving results at the expense of best performances and local peculiarities.

    Dr Fatai Wole Bello
    Executive Secretary, Country Coordinating Mechanism (CCM), Nigeria
    Email: fwbello@yahoo.com

    ReplyDelete
  92. We have to view the preventive as well as 'curative' activities in their proper perspectives. While providing ART (Anti Retroviral Therapy) is not a cure it contributes immensely to bring down the transmissibility of virus from a person to person. That has been proven. That is prevention. On the other hand, preventive programmes leading to safer behaviours have contributed in bringing down the level of epidemic in the world. That also has been proven.

    Therefore prevention, care and treatment should be essential components of any HIV programme.

    Dr G Weerasinghe, Sri Lanka
    Email: gweeras@yahoo.co.uk

    ReplyDelete
  93. The Global Fund should scale up programmes addressing HIV and TB in prisons.

    Awareness raising on HIV prevention among other prevention activities should be enhanced coupled with sustainable treatment, care and support to people living with HIV (PLHIV).

    Richard Shilamba, Tanzania
    Email: chesociety@yahoo.com

    ReplyDelete
  94. The laws should be supportive of programmes that provide services for the larger good of humankind. It will be great if the Global Fund to fight AIDS, TB and Malaria should find a way to resolve this issue so that laws are supportive of programmes the Global Fund supports to fight AIDS, TB and Malaria.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  95. I will like to suggest that the Global Fund to fight AIDS, TB and Malaria (GFATM) should ensure that the government is not hand-picking NGOs rather competent and genuine community-based organisations that qualify should get the support they duly deserve.

    Unfortunately as per reports Bangladesh government has only worked with select NGOs on a range of issues. At times the NGO is not even based in the field. If any project is implemented by the local NGOs and through local people, the result will sustain and cost will be minimized and they will have social responsibility to the local people.

    SM Nazer Hossain, Bangladesh
    Emails: adab.chittagong@yahoo.com, adab.nazer@gmail.com, isde.bangladesh@gmail.com

    ReplyDelete
  96. The Global Fund should commit its funding to programs intending to support activities that encourage improved life skills and capacity among caregivers to manage and cares for OVCs. And to promote quality care and management of services to OVCs.

    Muddu Yisito Kayinga, Uganda
    Email: ymkayinga.cotfone@gmail.com

    ReplyDelete
  97. I was here in the first phase of intervention.. it did not include people with HIV as part of the solution... "AIDS victims" were the problem or in need of end stage care?

    For a person not infected with HIV prevention could be just about knowing who have HIV in my circle and avoiding sex/ unprotected sex with this person.

    For the person working in HIV it could be programs and projects with interventions that may include people with HIV under the principle of GIPA

    For the person with HIV especially those who have moved from "victims" to person with HIV (several million thanks to the Global Fund to fight AIDS, TB and Malaria) Prevention includes having medicines that keeps their viral load at undetectable levels so that they are less infectious, they are able to return to work and planning for stable productive living.

    We should demand even more efficient and effective spending and accounting for donor funds from those who hold the purse and those who benefit from the spending so what kind of programming will make the person with HIV recognize that he/she must be part of the solution...

    What kind of programming will enable projects at community level that move away sometimes downright frustration and negative emotions ...which can engender squabbles and mediocrity because community feels that it gets crumbs from the table...

    The Global Fund must accept that with the success it has there will be even greater expectations from us humans.

    Even those who preach focus and priority will expect diversion and addition if their agenda wants it.

    Coming together is a beginning; keeping together is progress; working together is success (Henry Ford Sr).

    Olive Edwards, Jamaica (Caribbean)
    Email: olive_edwards@yahoo.com

    ReplyDelete
  98. For us here is Belize the CCM does not have an MSM representative, nor a representative from the sex workers population. For years it was about simply getting a PLHIV to fill a spot, until 2011. What is clear about CCM function is that Civil Society have not taken a proactive lead in understanding its role. This passivity has allowed for marginalized groups to be isolated from the process.

    This to me defeats the purpose of direct marginalized population representation in the process. The lesson learnt from all this is that there is a bias to support large organizations to the detriment of small organizations. This to me is a structural problem that needs to be understood. Not only in Belize, but across the regions of the world.

    Caleb Orozco, Belize
    Email: unibambusiness@gmail.com

    ReplyDelete
  99. Well ensuring high impact and value for money is very important, but how has the Global Fund management team ensured accountability for the funds?

    If the accountability has been effective, is the Global fund management team contented with the outcomes?

    All in all in my opinion in order to score a balance between high impact and value for many, the following two issues should be put into consideration:

    1. Active involvement of people infected and affected with the problem (TB and HIV) and general communities where the infected persons come from. This can be done through social audit programs at different levels through this achievements, best practices, and gaps of the program can be identified, and usually community people have the best answers to their problems.

    2. As we think of strategies of saving more lives from contracting TB, and the value for money, people are getting TB though not active, but its activated as a result of lowered immunity. There are a number of factors that contribute to the low immunity where POOR FEEDING is one of them! As a way of prevention if Global Fund money could also address millennium development goal (MDG) number 1 of extreme poverty and hunger?

    There are people living with HIV/AIDS who at time go without a meal a day or have one meal! Do you expect such a person's immunity to be high? or what chances does such a person have to keep the TB inactive?

    So preventive information sharing at different levels is crucial, civic education on the role of beneficiaries and local community in evaluating the Global Fund programs is also important in ensuring value for money, addressing factors that can fuel the activation of TB and other infections addressed by the Global Fund could be of great help.

    Margaret Namaganda, Zimbabwe
    Email: margaretnamaganda@yahoo.com

    ReplyDelete
  100. This message is not to congratulate the GF. This is a warning message. The Global Fund vision is marvellous but in Ecuador the Global Fund associate (the Ecuadorean Government) is not working as it should.

    The distribution process lacks of organization in Ecuador. Just read the last month local news. You have to improve if you want to have a positive impact.

    Let's fight against the new pandemics the same way an organization did against the polio.

    Francis Dykmans, Ecuador
    Email: francis.dykmans@gmail.com

    ReplyDelete
  101. Have more than 30 years working with TB/HIV and The Global Fund was
    a great challenge but the Resistance of Mycobacterium to INH and RFP and
    disparities about AIDS had only one
    explanation related to the field
    work ,while suppliers are in a nice office , people are suffering,and
    getting worse in a clinical point
    of view.Epidemiological indicators
    are the best testimony of the program

    ReplyDelete
  102. I think we can enhance our goal (increase the life saved) through concentration on the prevention scientific research.

    Mohammed Saadi Sukkaria, CCM Member, Syria
    Email: islamz@gmail.com

    ReplyDelete
  103. I am the director of a Dutch NGO working in Romania and both partner with a Serbian NGO (both Stop TB Partner NGOs) who like ourselves find it extremely difficult to gain funds for projects to run tuberculosis prevention projects. As with many small NGOs we are often overlooked in funding terms despite the fact many small NGOs do a great deal of work in prevention.

    Here in Romania which has the highest rate of TB in Europe all too often the first time a person sick with TB ever sees a TB prevention poster is when it's too late: when they are entering the TB Hospital already infected.

    We need funds for projects that take the prevention message out to the population including the large rural and ethnic minority population so that we can educate on the TB subject. I would like to see the Global Fund available to smaller NGOs working in prevention who are registered and can provide accreditation for the work they do.

    Brian Douglas, Romania
    Emails: stichting_rchf@yahoo.com, brian.e.douglas@gmail.com

    ReplyDelete
  104. In monitoring and evaluation, the emphasis seems to be just on numbers, disregarding quality of service. I believe quality of service can best be determined by consumers of services where there are no power barriers and those reporting are assured their contributions will not jeopardise their access to services.

    In the health care facility, there is still too much of the power barriers that hamper the communication between health consumers and providers, and this in itself poses a big barrier to quality of service. This is one component of meaningful community involvement that should be seriously looked at.

    Martha Tholanah, Zimbabwe
    Email: m_tholanah@yahoo.com

    ReplyDelete
  105. The Global Fund to fight AIDS, TB and Malaria (GFATM) needs to consider innovation by introducing SMALL GRANTS Fund Scheme that can be utilized by grassroots organizations that are at the forefront of improving the lives and welfare of vulnerable and affected communities and this mechanism to my opinion should be handled by Global Fund itself other than mandating the CCM because there we're guaranteed of a transparent selection of Grant winners. Here I will like to remind about the tragedy in Uganda where we lost lots of fund due to fund mismanagement.

    Muddu Yisito Kayinga, Uganda
    Email: ymkayinga.cotfone@gmail.com

    ReplyDelete
  106. I appreciate the contribution of Global Fund to fight AIDS, TB and Malaria (GFATM) all over the world. The only thing I want to highlight is that, there should be stronger financial monitoring to utilize the fund properly.

    There are examples, that LFA rated better performance over the first and part of second phase of a particular round in a country and certainly, OIG found misappropriation of fund and changed the PR.

    My point is that the LFA should also be made accountable if such incidence happens in any country.

    Parvez Sazzad Mallick, Bangladesh
    Emails: psm_1969@yahoo.com, parvez.mallick@gmail.com

    ReplyDelete
  107. I would like to send my contribution to this discussion under two themes:

    1. The Global Fund has done a great job and has contributed immensely to save millions of lives. I cannot sufficiently over emphasise on how many people are alive and happily so, thanks to GF money.

    However even in some countries where GF money is saving lives, people are still dying from preventable diseases because they don't have access to life saving commodities or medicines. This has happened in some countries that have been funded to scale up malaria prevention and because of the systematic 10% cut on the budget, a gap is put in place both of the LLINs and the funds to distribute those attributed. After these cuts the GF should help countries to mobilise resources to close the gaps in order not to miss the opportunity offered to achieve serious impact.

    2. Community expertise is often missing in proposal review process. This should be uplifted and supported. Sometimes not so pertinent community components are included where as at the same time more pertinent aspects are removed. I recommend some TRP members should have expertise in community approaches so as to properly guide CSS proposals.

    Esther Tallah, Cameroon
    Email: esther.tallah@gmail.com

    ReplyDelete
  108. It's not useful to oppose prevention and treatment. They are both equally important in the response to HIV. The key issue is how we combined and integrated them in a comprehensive and holistic approach.

    Health systems strengthening (HSS) and community systems strengthening (CSS) with a special attention to most-at-risk-populations (MARPs) need to be central to Global Fund financing.

    Regarding the funding issue and linking it to national ownership and long term and sustain funding, I would like to suggest a matching funding system.

    In this matching funding system, each government before benefiting from the GF need to contribute financially. And The government contribution will be multiply by some agreed factor by the GF.

    Baba Goumbala
    HIV/AIDS Alliance Africa Representative
    Senegal
    Email: bgoumbala@aidsalliance.org

    ReplyDelete
  109. I will like the Global Fund to fight AIDS, TB and Malaria (GFATM) to consider medical sciences beyond the modern medicine with due validation.

    Paul Ponniah, India
    Email: paulponniah@yahoo.in

    ReplyDelete
  110. Value for money is a strange word. The twin issues - program impact and value for money are rarely cared. Besides, the principle / rule of proprietary in incurring expenditure is not given due regard.

    Fazlul Haque, Bangladesh
    Email: FazlulH@unops.org

    ReplyDelete
  111. Our experience in developing countries particularly large countries like India, Pakistan, Bangladesh indicate that over last 4-5 decades the project approach has demoralized the health system and very little happens in the routine. The values like commitment, opportunities and accountability are least respected. The project staff ( hired by several funding partners) are not only paid better remuneration but also better facilitated in terms of facilities like computers/lap-tops, telephones /mobiles , vehicle for movements. The regular officer in the health system keeps struggling for these facilities.

    More over when there is some success the partners associated claims the credit and whatever does not work is blamed to the local health system partner. The Global Fund must opt the approach of TOGETHER WE SAIL or TOGETHER WE DROWN meaning both credit and discredit must be shared.

    The critical inputs and lot of hand holding is to create regular skilled human resource mix and a comprehensive approach over period of 25-30 years.

    Looking at Public Health and Health Management people to monitor and address implementation bottlenecks will be the key to success. Involvement of community by specific fund demarcation need to be done for community system strengthening (CSS). Only verbal sympathy for such system as is routine now will not take us long.

    THE COUNTRY TEAM APPROACH: The concept of country team approach is good but needs to be further expanded in big countries as State Team Approach and encourage "State Specific Strategic Planning for Investment in Health".

    The basic NATIONAL STRATEGY APPLICATIONS need to be adapted for area specific causes of lives dying, impact on quality of survivors and overall impact on health. INTERVENTIONS need to be appropriate for the states (not more than 20 million population be considered as an unit)

    Keeping the above criteria in Mind priority for HIV/AIDS will be at a lower level than TB, Malaria, Enteric Fevers, Pneumonia. As corporate social responsibility (CSR) one need to support maternal and child health at large.

    TECHNICAL ASSISTANCE: A review of worldwide country specific strategies do indicate adequate insight in planning. The main challenge Strategic plans address what with how much money but very rarely give details of how to implement various strategies/ activities listed.

    Looking at implementation hurdles and providing solutions and providing funding for them (marginal budgeting for bottlenecks - MBB approach) for the implementation hurdles in consultation with local peer groups will again be critical in getting results in terms of effective coverage (inclusive of quality) and thereby impact.

    That takes us to a focus on quality; Opting any intervention with evidence is fine. But if quality is not monitored and as long as the attention is only on numbers and percentage only we neither will see any impact on the lives saved nor the disability limited.

    Dr K Suresh, India
    Email: ksuresh@airtelmail.in

    ReplyDelete
  112. Traditional healers and registered medical practitioners need clear
    demarcating guidelines for planning any sustainable solutions. TB case notifications at the earliest may be decided as an objective which will need verifications. In India there are traditional healers and non qualified registered medical practitioners (RMPs) who have developed networking skills and referral mechanisms that speaks volumes regarding the healthcare industry. The urban and the rural divide is diminishing fast and these practitioners are prescribing several allopathy medicines in forms which they find fit for the gullible TB patients.

    In a system where the doctor sensitises these practitioners at a pay (both the doctor and these providers from the program) at regular intervals has been noted to do the following:

    1) The local doctor builds up her own private pool of patients (all
    patients) through the network of these providers

    2) The traditional healers and the RMPs get trained and sensitised repeatedly (every Thursday), send patients after they have done ALL the investigations that they feel like getting done from private laboratories (Mantoux, X-Ray , blood, Ig status, drug sensitivities @4000-5000 rupees and taking a small share out of that money, starting treatment for the patients on their own for the first few months - taking money for each visit that the patient makes (at times even giving injections), repeating blood counts and chest X-rays, making the patients buy the medicines from their own local shops also and THEN after a period of 2-4 months on an average, turning the patients over to the national programme.

    The OPD medical doctors due to paucity of time and lack of focus while taking adequate history and somewhat lack of motivation and understanding that the patient may have been taking ATD already - diagnoses and registers in the name of a NEW CASE and starts the patient on CAT I regime after doing a sputum microscopy (some are already smear negative at the time).

    The trick is that even when these patients are diagnosed, these VERY
    private providers become their DOT providers under the national programme and again get paid by the national programme for the entire course of DOT.

    So in fact they are making money:
    a) at the beginning during trainings
    b) they make more money during their own diagnostic and treatment schedule
    c) get some money for referring and recognition when they eventually send the patient to the DMC (designated microscopy center under the national programme) and
    d) then again as DOT providers for that same patient

    to be continue...

    Dr Shanta Ghatak, India
    Email: drshantaghatak@gmail.com

    ReplyDelete
  113. The patients - essentially do not understand the game. And there has been no provision so far to get into routing out this malady. The situation needed close monitoring and some judicious usage of supervisory skills and well documented resource utilisations which could never be really taken up because of the continuous, pressing need of presenting how well these private providers have been roped in.

    The sad situation at the community level , the constraints that these working patients face, the young children and their parents who bear the brunt of the reality is harsh and inexcusable.

    Writing heavy worded proposals, building strengths in millions has been a very lucrative business so far in my experience and has really done some real good in terms of saving lives but documenting some basic truths with the correct parameters has been holding back the good of the TB control programme. Research for the sake of research is good and it has helped the TB community. THINKING BIG and THINKING GLOBALLY is the current BUZZWORD in most of the important professional circles but very sadly that level of commitment is lacking, knowledge of the ground reality is absent and technically sound supportive supervisory skill building is just not there in the current scenario.

    Thinking for the small TB community - for their small support systems, gaining acceptance in their own small areas of work, getting small checks in place may be the most valued need of the hour.

    MDR-TB is spinning out of control and next decade may take a toll on all the current support and provisions because the magnitude of PMDT scale up is unsustainable in the long run.

    Dr Shanta Ghatak, India
    Email: drshantaghatak@gmail.com

    ReplyDelete
  114. Community intervention through community leaders and civil societies organizations helps a lot in creating awareness in reduction of TB and serve as a linkage to DOT centres in all LGAs in Nigeria. The gaps identified are; To create more awareness and train all these local beer and cigarette sellers on participation on quick intervention of TB. Secondly to educate the society that TB is curable.

    Christy Omidiji, Nigeria
    Email: omidijiocb@yahoo.com

    ReplyDelete
  115. I propose that Global Fund supports strategies that focus on management of OVCs at the household level as well as advocating for integration of OVC programmes and services into the district / sub county development plans.

    These strategies are intended to build the capacity of caregivers to ably manage and care for OVCs in homes and also to equip the OVCs with life skills that will enable them make informed decisions and acquire vocational skills that will enhance their employable skills for gainful and self employment. The strategies will go along way in bridging the gaps between caregivers, OVCs and the policy/ decision makers.

    Muddu Yisito Kayinga, Uganda
    Emails: ymkayinga@cotfone.org, ymkayinga.cotfone@gmail.com

    ReplyDelete
  116. I believe that the CCM to have a greater ability to control and oversee the grant and the quality of the performance of PR, because, frankly, we find that the recipient is the main way to deal with immediate CCM and find that it does not show great importance to CCM

    Mohammed Saadi Sukkaria, CCM member, Syria
    Email: islamz@gmail.com

    ReplyDelete
  117. I think it is clear from the evidence that increased involvement, in all aspects of proposal development, PR and SR selection, programme implementation, of Civil Society and people living with or affected by the diseases, as well as specific involvement of the so called MARPS groups, is essential to achieving greater impact and value for money.

    The Fund needs to show and defend a better understanding of health care delivery and the systems that support this. The Fund should be the champion for a health and community system approach.

    It should only enter partnerships for the right reasons rather than because it is politically expedient to do so. While it could be argued that to ignore political imperatives would jeopardise future funding, it won't. If donors want to cut funding they will always find an excuse but it would be far better to stick to our founding principles than be so willing to set them aside.

    Spending less time, energy and money on internal system navel gazing, which is what appears to be happening at present (although it is dressed up in fancy language to suggest otherwise), would enable an increased focus on effective grant performance, leading to increased lives saved.

    Mick Matthews
    Email: Mick.Matthews@theglobalfund.org

    ReplyDelete
  118. I will request the Global Fund for evaluating programs not only for accountability and affordability or accessibility but for effectiveness as well, this will ensure that programmatic areas receiving funding, are those which really need it most.

    It's also very important that Global Fund as it tries to shift more responsibility to country coordinating mechanisms (CCMs) on local fund management, there is need for monitoring that transfer for a period of time to ensure adherence to Global Fund guidelines. This will ensure funds do not get diverted to areas not assigned for within governments budgetary allocations.

    Anna Irungu, Kenya
    Email: tiplus.org@gmail.com

    ReplyDelete
  119. It would be better to focus on Communities, using the platform to generate data and creating confidence and direct availability of drugs and counseling.

    Akinbo AA Cornerstone, Nigeria
    Email: akinbo@helpaidsorphans.com, akinboadebunmiadeola@yahoo.com

    ReplyDelete
  120. - To save more lives by best use of the resources from the Global Fund to fight AIDS, TB and Malaria.
    - Keep more people informed to increase health seeking behaviour about TB and engage cured TB patients.

    Dr M Lutfor Rahman, Bangladesh
    Email: pcgfatm@yahoo.com

    ReplyDelete
  121. Because delay in seeking treatment often time comes from ignorance of patients dealing with TB, HIV or Malaria. I think that Global Fund should invest more in teaching essential notions about these diseases in schools - even at the Elementary level and through media: newspapers and radio.
    .
    Email: mlafay55@hotmail.fr

    ReplyDelete
  122. From the records and available statistics we are aware that GFATM has done a commendable job of saving lives. That 6.5 million of live have been saved so far is not a mean achievement, given the financial and political environment, that we have seen in the last few years.

    That 3 million people are on Anti Retro viral treatment,7.7 million people are on Anti TB treatment and a further 160 million Insecticide Treated Nets have been distributed for Malaria prevention is not simple.

    However, I wonder if all these are matching the value of Money , that the GFATM has pumped into Countries, such as Kenya (developing
    country) where the fight against these diseases will be won at the
    community level, in my opinion.

    There has been little attention paid to community level participation, a lot more needs to be done at the community level as opposed to the well articulated National Level Policies and Strategies by Technocrats supported by Donors with vested interests, totally ignoring the Community Systems Strengthening (CSS).

    Global Fund must therefore have a paradigm shift, to succeed in addressing these issues, besides there is the emerging challenges on the Most At Risk Populations (MARPS), Injecting Drug Users, sex workers and Men Having Sex With Men (MSM).

    These and more, complicates the impact and Value for money, because how else are we going to create impact without the Community involvement?

    Dr Tobias Kichari, Kenya
    Email: medicaredev@uonbi.ac.ke

    ReplyDelete
  123. First I would like to thank the GFTAM secretariat for this valuable discussion. In my opinion to combat and control these epidemic diseases it is better to use a comprehensive approach targetting all aspects: preventive and curative care. On which aspect to spend more? this depend on local context and epidemiology in each country.

    This leads me to say that the Global Fund should play a major role in building capacities of these countries to conduct researches and to be able to decide areas of priorities scientifically.

    The second point is that usually importing of ideas and strategies to prevent or control a disease (eg HIV) from other countries may not work properly in specific country. Local cultural social and economic context may differ totally. Adaptation of these strategies to suite different situation is essential. So I agree with those who call for training and capacity building for local staff to take this challenge effectively.

    Dr Heitham M Ibrahim
    University of Leeds, UK
    Email: bauga1@hotmail.com

    ReplyDelete
  124. Global Fund has a social responsibility, and equity and justice should be contemplated in the distribution of funds. Countries that spend millions in war instead of investing in health, should be penalized in the distribution of funds.

    WHO estimates 33.4 million people in the world living with HIV-AIDS, 2.7 million newly infections/year, and 2 million AIDS-related deaths. In 2030, the estimate number of people with HIV in poor countries who are in need of treatment will be 50 million.

    HIV-AIDS is a treatable and preventable condition 96 like most other infectious diseases. But only one-third of those who would benefit from treatment are actually getting it and prevention programs are not nearly as extensive as they should be.

    Agreed commitments are not being met - Millennium Development Goals (MDG) are away from achievement. HIV can92t be seen isolated. Prevention and treatment of HIV includes combat HIV/AIDS but also Malaria and other diseases, eradicate poverty and hunger, improve maternal health, promote gender equality and empower women, reduce child mortality, achieve universal primary education, ensure environmental quality (sanitation, housing, but also climate changes sensitivity).

    Agreed commitments are not being met 96 funding and help is not on the way.

    Wealthy nations that donated billions to create the Global AIDS Fund in 2001, pledging universal access to treatment by 2010, still owe billions. So two out of every three HIV patients a total of 10 million who need drugs in most of Africa and much of Asia, Russia, Eastern Europe, and even South America still can't afford them (Pharmexec, 2010).

    Nevertheless total global military expenditure in 2009 is estimated to have been USD 1531 billion. This represents an increase of 6 per cent in real terms compared to 2008, and of 49 per cent since 2000. All regions and sub-regions saw an increase in 2009, except the Middle East. The subregion
    with the most rapid growth in military expenditure over the 10-year period 2000-2009 was Eastern Europe, at 108 per cent. The bulk of this growth (88 per cent) is accounted for by the Russian Federation. The other subregions with the largest increases since 2000 are North Africa (107 per cent), North America (75 per cent), East Asia (71 per cent), and South Asia (57 per cent). The subregion with the lowest growth in military spending over the past 10 years was Western and Central Europe (7 per cent). The USA's military spending accounted for 43 per cent of the world total in 2009, followed by China with 6.6 per cent, France with 4.2 per cent and the UK
    with 3.8 per cent. (www.sipri.org/research/armaments/)

    Besides the global financial crisis and economic recession two-thirds of countries for whom data was available increased military spending, including 14 of the top 15 spenders. (http://www.sipri.org/research/armaments/milex/resultoutput/trends)

    However the Global Fund has provided $964 million to China, 40 percent of which targets HIV/AIDS. Russia has set the precedent for transitioning from a recipient country to a Global Fund supporter. Flush with energy profits in 2006, officials there said they would reimburse the Global Fund for USD270 million in projects. (The Body, 2010)

    RESOURCES EXIST for armament but are not available for reducing HIV and other diseases, poverty and to reach more equality in the world.

    It's time to CHANGE!

    Isabel Nunes, Portugal
    Email: seres.vih.sida@gmail.com

    ReplyDelete
  125. I think that the Global Fund to fight AIDS, TB and Malaria (GFATM) should invest more in education; knowledge is power. There is a saying that go: "My people perish for lack of knowledge." and that: "You shall know the truth and the truth shall set you free."

    It is only a knowledgeable community that can overcome their obstacles, because, by so doing, they will have the know-how to the problems. Not only providing education to people in health sector alone but also and more especially to people at community level who are directly involved and stay with people who experience these health problems: HIV, TB, Malaria and other related health calamities.

    Also, Global Fund should look at the effective ways to implement TASK SHIFTING. People at grassroots would play a primary and major roles in the interventions against HIV, TB and Malaria as they are well known by patients who stay with them in the communities. They can be called upon at any time when they are needed by their clients.

    Jordan Kaisi, Zambia
    Email: jkaisi09@yahoo.co.uk

    ReplyDelete
  126. Having worked for almost 8 years in implementing and managing Global Fund supported grant programs - at the Sub-recipient level and at the Principal Recipient level - I'd like to take this opportunity to commend the Global Fund for making available much needed resources to more than 150 countries worldwide to "fight AIDS, Tuberculosis and Malaria."

    The Global Fund mechanism/model has ensured that grant funds are utilized to address a variety of public health and social issues surrounding the three diseases. The number of people that were reached - e.g. counseled and tested for HIV, diagnosed and treated for TB, and diagnosed and treated for Malaria - is evidence that grant programs can be accountable to every dollar that is being invested. The model, I believe, is still in evolution and is not perfect. It's constantly changing to suit the needs of different country programs, and at the same time ensuring that "global standards" are maintained - e.g. in procurement, in M&E, etc.

    The model has proven that investment made to the three disease programs would result into increased prevention activities, more people having access to much needed treatment, more healthcare workers trained to deliver quality program services, resulting to more lives served and saved. It is high time that the Global Fund explore the possibility of expanding its programs to cover "co-morbidities" that to some extent are impacting on the gains made over the last 5 to 8 years -

    * TB and diabetes
    * HIV and STIs
    * HIV and STI linked to gender and reproductive health
    * HIV and STI linked to adolescent health

    Expanding the coverage outside the three disease programs will equate to better "value for money" to a number of countries, especially in the Pacific.

    Albert Angelo L Concepcion, Philippines/ New Caledonia (Pacific)
    Emails: AlbertC@spc.int, aalconcepcion@gmail.com

    ReplyDelete
  127. I agree with Jitendra on HIV, TB, malaria and nutrition integration. High funding is a necessity for developing countries as treatment alone without the necessary food falls short of what is intended to achieve.

    Mavis Kahwemba, Zimbabwe
    Email: kahwemba@uz-ucsf.co.zw

    ReplyDelete
  128. The Global Fund has done a great job in saving lives, but its ability to empower sexual diversity groups is still a mix bag of successes here and there. Its ability to get affected population to lead and advocate on its behalf remains weak in my mind especially in the Caribbean.

    Caleb Orozco, Belize
    Email: unibambusiness@gmail.com

    ReplyDelete
  129. There's a need to make attention to human rights based performance through emphasizing funding for civil society organizations within Community Systems Strengthening (CSS) and development if practical guidelines for HRBA within CSS including partnership between Government and civil society in service provision and monitoring if service quality.

    Robert Bennoun
    Email: robert.bennoun@gmail.com

    ReplyDelete
  130. Using the term Health System strengthening (HSS) is very vague. For different people HSS would mean different. My suggestion is to clearly define health system. For example rural medical practitioners in India are part of the health system as they are a main venue for treatment services in major part of the rural India. So do we mean to strengthening their role or eliminate
    them over time. And secondly when we use task shifting why can't we train and integrate them in the existing system.

    So these are the debates. I would say to have clear priorities of a specific country and the flexibilities to invest in development of the systems not only to address the current problems but also gearing up for future health needs by investing in the development of Health human resource policy, Health informatics development, medical supplying procurement system development, developing human resource training institutions and so forth.
    (the views expressed are of mine and does not necessarily reflect that of my organisation's)

    Farhad Ali, India
    Email: farhadali1@gmail.com

    ReplyDelete
  131. 1. Plan - Appropriate plans and implementation (scaling up) are not well managed
    2. Train - Monitoring and evaluation is not what it should be because the personnel may not be appropriately trained
    3. Funds - unless teams agree on a specific strategy and structure funds will not reach where they should.
    4. Prevention - general awareness both for the public and people living with HIV (PLHIV) is crucial to the success of the projects. PMTCT is a good example where we can achieve a lot in a short time with minimal input of resources
    5. Rotary - we can work together with rotary to move things forward. Rotary is good at this kind of work.

    Mohammed S Kibiri
    Email: mskibirige@btinternet.com

    ReplyDelete
  132. As a church we are interest in Global Fund to fight AIDS, TB and Malaria. The project have to be with prevention, treatment, care educating people on HIV/AIDS, TB and malaria.

    As a church we appreciate implementation and will like Global Fund to improve maternal and child health and reduce the spread of HIV.

    Pastor Phainos Muhindi
    Christ Abundant Life Church
    Email: phinosmuhidi@yahoo.com

    ReplyDelete
  133. Not all persons with AIDS, TB and Malaria are vulnerable. To assure that those affected persons can become the most advantageous communities among least advantageous or poorest of the poor. Not only look into the name of 3D, the fund should be utilized balance approach to where Global Fund is targeted, in order to assure sustaining improvement and recovery from those diseases.

    Soe Thant Aung
    Email: soethant@yahoo.com

    ReplyDelete
  134. In most part of Africa and Tanzania in Particular almost everyone is vulnerable to malaria although pregnant women ,children, and people living with HIV are more vulnerable. Today an effective first line drug (ACT) is available and people are accessing long lasting insecticides treated nets (LLITNS) "Thanks to the Global Fund", however the malaria disease with its complications that include anaemia/ mulnutrition to pregnant women, children and people living with HIV, still births, underweight to newly born babies and convulsions, just to mention a few has remained the main killer disease and about 50% of OPDs is due to malaria.

    In addition the costs that goes with it at household level are to a great extent the underlining causes of poverty. Mosquito density is too high and investments for behaviour development/ change at the community level (households) in taking more responsibilities for sustainable change given the current tools (ITNS+ACTs) is minimum.

    In order to realise the MDG goals Mosquito source reduction and IRS are urgently needed by the communities to backup the ongoing initiatives. Dealing with the malaria vector more seriously by engaging the beneficiaries (Community at household level and their local Authorities ) greater synergy shall be built among the communities for sustainable actions and more lives will be saved and infections prevented.

    Beatrice Minja
    Executive Director
    Tanzania National Malaria Movement
    Email: beatriceminja@yahoo.co.uk

    ReplyDelete
  135. I think it would be necessary to invest in advocacy and communication with schools and businesses to the permanent information about transmission and prevention.

    While it would be important to invest in art events (short documentaries, drama pocket, visual art installations) to be displayed on the street, causing discussion among children, youth and adults.

    Another effective strategy would be to support projects of mobile health unit for diagnosis and treatment.

    And I agree with Jordan, improve monitoring by training civil society members in budget tracking.

    Claudia Costal, Brazil
    Email: claufcost@gmail.com

    ReplyDelete
  136. I agree with Ruben and Jordan principal recipients of all categories including ministries, departments and government agencies that recieve the funds as PR or SR. Training CSOs on budget tracking will also require a well thought plan.

    Also quality of programme delivered should be thoroughly assessed not just paper assessment of their reports.

    Chibuike Amaechi, Nigeria
    Email: good2neighbour@yahoo.com

    ReplyDelete
  137. I think the Global Fund management team in countries needs to cut down salaries budget.

    The Global Fund should also cut down much spending on conferences, workshops and meetings and instead be more practical when it comes to address people needs, be it medical, and psychosocial needs. Give opportunity to grassroots organizing and community base responses.

    IT will be great to have a watchdog system by employing CSOs, NGOs and different communities member to volunteer. Whistle blowing should be encouraged too.

    Recommendation: Support more program and projects that are sustainable and cost effective, support GIPA, support minorities and human rights efforts.

    Improve on the accounting system.

    Stephen McGill
    Email: smcgill_sail@yahoo.com

    ReplyDelete
  138. In my country funds were not released in time which badly impacts our programmes in Samoa.

    Our only recommendation on the Global Fund, it needs the involvement of NGOs for its control in the Country Level through its Umbrella for NGOs. It is sad to see that the Government holds the power over usage of the funds.

    Fitu Fuimaono
    Executive Director
    Samoa AIDS Foundation, Samoa
    Email: saf@samoa.ws

    ReplyDelete
  139. I am grateful to the Global Fund for supporting countries such as Zimbabwe in three diseases components of malaria, TB and HIV. It is applauded especially when the country is going through economical challenges.

    However, the delayed approval on grants requested has affected many TB patients and these must be done quicker now that UNDP took over to oversee grant spending following the abuse by some authorities.

    There is need to facilitate the enrolment of patients on treatment for MDR-TB. More work still needs to be done in-order to ensure that the National Health system is able to detect all cases of MDR-TB, and this calls for the establishment of a surveillance system for drug resistant TB. The lack of country specific data to quantify the burden of MDR-TB in the country, available data is outdated with the last survey having been done in 1995 that remains as a challenge for the country.

    Having spoken to some Laboratory scientists, as a result of this challenge the grant missed a total of 305 people that were to be trained on ETR in by year end. Laboratory Scientists have also been expressing dissatisfaction over the quality of specimen that they receive for either DSM or culture.

    TB in prisons must be given top priority as it is affecting prison officers who spend more time with inmates and grant application in future must look into it as a matter of urgency that need support from Global Fund in the country.

    Grant is experiencing challenges with the implementation of the Electronic TB Register as the National TB programme for the country to implement this system.

    Nhau Mangirazi
    Email: nhaumangirazi@yahoo.com

    ReplyDelete
  140. Andrew Hunter06 May, 2011

    What the Global Fund should do less of.....

    GFATM funds are being used in numerous countries in Asia (and probably other regions as well) for programmes that violate basic human rights and accepted universal ethical standards in health care.

    The funding of compulsory detention centres for drug users and sex workers is one example.

    The other things we see over and over in sex work programming is compulsory or highly coercive testing- for STIs and HIV.

    Compulsory testing of sex works is not only driven by government policies which ignore human rights- but is also being driven by GF indicators which give programmes ridiculous targets of the number of sex workers (or MSM or IDUs) who must be tested in order to meet M and E targets.

    This not only violates the rights of sex workers and others, but in many cases it wastes huge amounts of money doing repeat tests for people who really don't need testing.

    These results are then not kept confidential- they are, in many cases, shared with sex business owners and needlessly shared among staff of implementing organisations.

    In many cases sex workers were better off before the Global Fund came in and scaled up the abuses of their rights and gave governments and NGOs money to further control their lives.

    Andrew Hunter
    Asia PAcific Network of Sex Workers (APNSW), Thailand
    Website: sexwork.asia
    Email: apnswbkk@gmail.com

    ReplyDelete
  141. "Ruby Holler by Sharon Creech
    Here’s yet another entry in my unofficial Ana’s Quest to Read All the Carnegie Medal Winners Series: Ruby Holler is the story of Dallas and Florida, a pair of thirteen-year-old orphan twins who have spent most of their lives at an orphanage by the name of Boxton Creek Home. When they’re not at the orphanage, they’re with adoptive families who are abusive at worst and neglectful at best, and who inevitably return the “trouble twins”, claiming that on second thought they’ve changed their minds about adopting them. Unsurprisingly, Florida and Dallas are reluctant to trust adults, and they’ve become convinced that they’re actually as terrible and unlovable as everyone around them seems to think.

    Enter Tiller and Sairy, an old couple who live at a beautiful old farm house in a valley named Ruby Holler. Initially they don’t mean to adopt the twins, but they need companions for the separate dream trips they’re thinking of taking, and so they hire them for the summer. But Florida and Dallas aren’t keen to be separated, and they swear that before this can happen they’ll take the night train and disappear forever. But as they get attached to Ruby Holler and begin to feel at ease with Tiller and Sairy, they keep postponing their escape for just one more day…
    "

    ReplyDelete
  142. "During the first 100 days of our nation's downward spiral into oblivion (commonly known as the Obama administration) the Democrat controlled congress rammed a massive party loyalty rewards program (commonly known as the stimulus bill or American Recovery and Reinvestment Act) down the throats of the hard-working American taxpayers. The $787 billion dollar fiasco didn't stimulate the economy in any measurable sense however a clever new accounting trick (jobs saved or created) was developed to prove the success of Mr. Obama's first major assault on America.

    With a less compliant Republican congress to contend with, Mr. Obama and his comrades have sidestepped the democratic process in favor of governance through executive order and regulation. Representative government in Washington D.C. as designed by the Founders and Framers has ceased to exist. Everything and everyone from goat herders to guitars, find themselves under strict governmental regulation (and in timidation) and ""We the People"" no longer have any say in the government that we are forced to fund."

    ReplyDelete
  143. "In the process of setting electoral districts, gerrymandering is a practice that attempts to establish a political advantage for a particular party or group by manipulating geographic boundaries to create partisan, incumbent-protected districts. The resulting district is known as a gerrymander; however, that word can also refer to the process.

    Gerrymandering may be used to achieve desired electoral results for a particular party, or may be used to help or hinder a particular demographic, such as a political, racial, linguistic, religious or class group.

    When used to allege that a given party is gaining disproportionate power, the term gerrymandering has negative connotations. However, a gerrymander may also be used for purposes that some perceive as positive, such as in US federal voting district boundaries that produce a majority of constituents representative of African-American or other racial minorities (these are thus called ""minority-majority districts"")."

    ReplyDelete
  144. So good topic really i like any post talking about STD Symptoms but i want to say thing to u STD Disease not that only ... you can see in STD Illness STD symptoms in men and more , you shall search in Google and Wikipedia about that .... thanks a gain ,,,

    ReplyDelete