17 4 / 2014
The Zimbabwe Capacity Development Case Study: ‘Strengthening Skills, Tools and Systems for Better, Services’,has been jointly developed by UNDP and the Ministry of Health and Child Care (MOHCC) to explore the emerging lessons during implementation of (the) Global Fund Programme in Zimbabwe.
Behaviour Change Facilitators (BCF) in Zvimba District.
This Case Study draws on information collected through review of achievements, stakeholder interviews, and observations, with the aim to present the lessons learned and forward looking perspective on the capacity development component of the Global Fund Round 8 Grants in Zimbabwe and the preparation for transition of the Principal Recipient (PR) role from UNDP to national entities.
New Funding Model
In 2013 Zimbabwe was one of the pilot countries invited to apply for funding for the HIV disease component under the Global Fund New Funding Model (NFM). This was heralded as a successful pilot for the NFM and is being used as a best practice case in other countries. Zimbabwe is also applying for funding for Tuberculosis and Malaria programming as part of the 2014 full roll-out of the NFM.
For more information on Zimbabwe’s NFM experience as an early applicant, please see ”The Experience of Zimbabwe with the Global Fund’s New Funding Model”, a case study developed by the CCM and Ministry of Health and Child Care with support from UNDP.
Findings from the Zimbabwe Capacity Development Case Study highlight lessons learned for successful implementation of Global Fund programmes, namely:
- The importance of leveraging investments in skills and infrastructure towards greater institutional strengthening;
- The value of national ownership of the CD process and its integration into broader public administration strengthening efforts;
- The significance of access to, and use of, communications and rapid feedback; and
- The importance of sustainability through the strengthening of national systems.
Handing Over Ceremony
The Case Study also provides a set of recommendations to further build the capacity of national entities in Zimbabwe and enhance the implementation Global Fund programming under the NFM. Among others these include: maximizing collaboration with national actors; focusing on information and data analysis; creating upstream-downstream and rapid feedback loops for communications; and including capacity development priorities in the Concept Note for the NFM.
The complete list of recommendations and full Case Study can be accessed here, through UNDP’s Capacity Development Toolkit (CD Toolkit) for Global Fund grant implementation, which provides practical guidance on how to strengthen institutional capacities for implementing national disease responses through modules on enabling legal and policy environments for the three diseases.
This cased study was made possible by the support and participation of the various stakeholders interviewed during documenting of the Case Study and field visits in Zimbabwe and the many partners who have contributed to this work.
11 4 / 2014
Ensuring Essential Services are Delivered to Vulnerable Groups
Whilst ensuring essential services are delivered to vulnerable groups UNDP works closely with national governments and non government organizations to use and continually strengthen their systems. This includes the supply chain of medicines and the national health information and surveillance system (HISS). In Zimbabwe this approach is enabling national entities to sustainably address the challenges posed by HIV and AIDS, tuberculosis and malaria and enable them to effectively manage national programs and Global Fund grants.
Strengthening National Systems - Monitoring and Evaluation
Mrs. Sibanda, Mpilo Provincial Health Hospital in Bulawayo explains the advantages of the District Health Information System (DHIS2) describing it as efficient, fast and reliable. photo credit: Sammy Mwiti/UNDP
By investing Global Fund resources in the Zimbabwe Ministry of Health and Child Care, District Health Information System v. 2 (DHIS2), more than 600 health workers have acquired new reporting and monitoring skills for use with new health information system. In addition over 1,200 nurses have acquired skills in the use of the mobile system, using Frontline SMS text messaging for the weekly disease surveillance system (WDSS). This has enabled more timely and accurate disease surveillance.
Since the introduction of DHIS and Frontline SMS, the completeness of the monthly (T5) and weekly surveillance reporting has increased from around 50% to over 90% as of December 2013. In addition, the reporting burden has been lessened through the integration of 11 different reporting systems into DHIS-2.
The result is more timely and reliable health information enabling improved analysis and more informed decision-making that responds to the needs of vulnerable groups.
Strengthening National Systems – Supply Chain Management
NatPharm’s storage facility in Bulawayo. Improved with Global Fund support. photo credit: Sammy Mwiti/UNDP
This includes improvement of storage facilities and the cold chain for medicines through investments in refrigeration, temperature monitoring equipment, forklifts, trucks and other warehouse facilities. Improved warehouse, transportation and storage facilities as well as new IT and telecommunications facilities have enabled more efficient warehouse management and less waste in medicines.
Support was provided to the Medicine Control Authority of Zimbabwe (MCAZ) for them to apply for pre-qualification against WHO guidelines. The successful pre-qualification meets national needs and will now allow MCAZ to provide similar services to Zambia.
The result is a more efficient and reliable supply chain of medicines for HIV, TB and Malaria in Zimbabwe, which are essential to providing services to vulnerable groups, including people living with HIV.
A case study has been prepared to capture the emerging lessons of strengthening national systems for disease responses in Zimbabwe and to help ensure that the systems will be sustainable in the future. Please click this Capacity Development Zimbabwe Case_Study link for more information. This was made possible as a result of close collaboration between the Zimbabwe Ministry of Health and Child Care, NatPharm, other partners, the Global Fund and UNDP Zimbabwe.
09 4 / 2014
Global Fund Governance
The purpose of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) is to attract, manage and disburse additional resources in order to make a sustainable and significant contribution to the reduction of the impact caused by the three diseases.
It recognises that this is achieved only through country-driven, coordinated and multi-sector approaches involving all relevant partners. A variety of actors, each with unique skills and experience, must be involved. The Global Fund relies on ‘Country Coordinating Mechanisms’, or CCMs, in each country, “Principal Recipients” (PRs), and other local partners to ensure resources are efficiently used to help those most in need.
The CCM is a partnership composed of all key stakeholders in a country’s response to the three diseases. The CCM is responsible for submitting applications for funding to the Global Fund based on priority needs at the national level, and nominating the entities accountable for administering the funding (known as Principal Recipients or PRs). After grant approval, the CCM oversees progress during implementation.
The core functions of CCMs are to:
- Coordinate the development and submission of national applications for funding.
- Nominate the Principal Recipient(s).
- Oversee implementation of the approved grant and submit requests for continued funding.
- Approve any reprogramming and submit requests for continued funding.
- Ensure linkages and consistency between Global Fund grants and other national health and development programs.
Global Fund CCM Eligibility Requirements, Minimum Standards and Recommendations
Eligibility Requirements represent the minimum criteria that all CCMs must meet in order to be eligible for funding by the Global Fund and are assessed by the Fund, and where CCMs are not compliant this can impact on the CCM’s ability to submit a Concept Note.
The six eligibility requirements are;
- Transparent and inclusive concept note development process.
- Open and transparent PR selection process.
- Oversight planning and implementation.
- CCM membership of affected communities, including and representing people living with diseases and of people from and representing Key Affected Populations.
- Transparent and documented processes for electing non-government CCM members.
- Management of conflict of interest on CCMs.
07 4 / 2014
05 4 / 2014
Why are Human-Rights Based and Gender-Sensitive Programming Important for National Disease Responses?
Enabling Legal and Policy Environment for HIV, TB and Malaria
An enabling legal and policy environment refers to laws, regulations, policies and law enforcement practices, as well as human rights-based and gender-sensitive programming, that support responses to the three diseases and promote participation in those responses by affected individuals and communities. The UNAIDS Investment Framework, which identifies the key interventions needed to have maximum impact against HIV, refers to these activities as “critical enablers” and development synergies that are crucial to ensuring the effectiveness of and enabling access to HIV prevention, treatment, care and support.
The Right to Health
Responding to HIV, TB and malaria are key contributions to realizing the right to health. The human right to health is recognized in numerous international instruments affirming that every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity. The realization of the right to health may be pursued through numerous, complementary approaches, such as;
- The formulation of health policies
- The implementation of health programmes
- The adoption of specific legal instruments.
The right to health is closely related to and dependent upon social determinants of health and the realization of related human rights, including the rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information and the freedoms of association, assembly and movement.
Programming to strengthen enabling legal and policy environments
An enabling legal and policy environment refers to laws, regulations, policies and law enforcement practices, as well as human rights- and gender-based programming, that support responses to the three diseases and promote participation in those responses by affected individuals and communities. In the context of the UNAIDS Investment Framework, these activities are referred to as “critical enablers” that are crucial to ensuring the effectiveness of key prevention, treatment, care and support interventions.
Programming to strengthen enabling legal and policy environments is significantly under-resourced in most HIV, TB and malaria programmes. For example, UNAIDS reported in 2013 that the majority (54%) of 133 countries reporting HIV spending did not invest in human rights programming at all, and of those that did invest, only eight spent more than 1% of total budget on these programs. As recommended by the Global Commission on HIV and the Law, particular attention is needed to removing punitive laws regarding key affected populations. Sound legal frameworks need to be complemented by sustained investment in anti-stigma programming to promote healthier social norms of inclusion, tolerance and non-discrimination. More attention is needed to enforcement mechanisms for anti-discrimination laws, where they exist, including support for legal services for people living with HIV and members of key populations, as well as programs that educate people living with HIV or those affected by the diseases about their rights.
National Strategic Plans and Country Dialogues
Depending on local context, the need for such programming should feature in national strategic planning processes and country dialogues and adequate resources should be sought in proposals to the Global Fund and other sources
On Line Guidance for Strengthening Enabling Environments
The UNDP Global Fund Capacity Development Toolkithas a module that provides guidance and resources on strengthening the Legal and Policy Enabling Environment for HIV TB and Malaria. It has been designed to improve the design and implementation of national programs and projects for the three diseases.
24 3 / 2014
23 3 / 2014
World TB Day 24 March
Of the nine million people a year who get sick with TB, three million of them are ‘missed’ by health systems. This requires a global effort to find, treat and cure all those ill with TB and accelerate progress towards zero TB deaths, infections, suffering and stigma.
The World Health Organization, the Stop TB Partnership and the Global Fund to Fight AIDS, TB and Malaria, have produced this joint brochure which highlights the problem of the millions missing out on quality care and calls for everyone suffering from TB to have access to quality TB care including diagnosis, treatment, prevention and cure.
Dr Mario Raviglione, WHO Director of the Global TB Programme said, “We hope our focus this year on the people ill with TB who are missed helps drive practical action in the field. We cannot miss the opportunity now with new TB strategy, new diagnostics, and more partners engaged in universal health coverage and TB efforts, to reach all people and communities – they have a right to access quality diagnosis and care.”
“It is easy to reach people like me with TB services, but to reach those most vulnerable, most at risk, those that are poor, weak, scared, stigmatized, and alone – for this, you need additional efforts, you need innovative thinking and, beyond anything else, you need to care. I am happy we are having this conversation on reaching, treating and curing everyone with TB at a global level. This is what it is all about,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership.
“Our partners are driving a more targeted approach, and we fully support that,” said Mark Dybul, the Executive Director of the Global Fund. “People in countries with these missing cases can take advantage of the flexibility and agility of the new funding model to reach more people affected by TB.”
UNDP as a partner of the Global Fund and national stakeholders so far we have helped countries to detect 600,000 cases of TB: http://on.undp.org/rf9Gx.
In Haiti, more than 70% of TB patients identified were cured of the disease: http://www.undp.org/content/undp/en/home/ourwork/hiv-aids/successstories/haiti_s-fight-against-aids-and-tuberculosis/#.UyxbCSm8Fwh.twitter.
UNDP-administered grants fight TB in Sudan, where over 48,000 cases have been treated: http://www.sd.undp.org/content/sudan/en/home/ourwork/humandevelopment/successstories/ntp-and-gfatm-formulate-new-messages-for-tb-education—/
In Tajikistan micro loans boost income of TB patients with UNDP and Global Fund support: http://www.undp.org/content/tajikistan/en/home/ourwork/hiv_aids/successstories/tuberculosis-treatment-is-enhanced-micro-loaning-practices-boost/
20 3 / 2014
Photo: CC Image courtesy of Doug88888 on Flickr
The Global Fund launched full implementation of its new funding model this month, and at its core is a shift from a blanketing “one size fits all” approach to a more targeted approach, so that greater impact can be achieved globally and more people can actually be reached. Many countries that were informed on 12 March about their allocation amount for 2014-2016 are understandably now quite interested to know how those allocation amounts were determined. Many are asking: What was the allocation formula?
The Global Fund has prepared and published an explanation. It’s called “Overview of the Allocation Methodology” and it is pretty comprehensive and detailed. It can be found on the Global Fund website.
Read more in the Global Fund News Flash: Issue 40.
See the allocations website here.
17 3 / 2014
Results checklist: Strengthening the implementation capacities for National Programmes and Global Fund Grants
Global Fund Principal Recipients (PR) and their Sub-Recipients (SR) require a number of implementation capacities to successfully implement Global Fund grants. This checklist outlines examples of results that can be achieved when implementation capacities are strengthened.
Pointers on using the checklist
- Contextualize: The sample results in the checklist should be adapted to the local country context and the prevailing challenges and capacity development efforts;
- Inform planning: Use the results checklist to inform planning of capacity development efforts and the formulation of outputs;
- Monitor frequently: When implementing the programme, establish rapid feedback loops and monitor frequently to ensure progress towards the expected results;
- Celebrate success: Make a big deal out of achieving the desired results - this will help build momentum in the capacity development process.
Download the checklist here.
14 3 / 2014
The E.F Watson medical clinic is currently being renovated thanks to UNDP-administered Global Fund grants. This renovation includes provision of a standard pharmaceutical storage room and ablution facilities, and is part of a US $3.7million capacity development package targeting 52 health facilities in Zimbabwe — a country where about 15 percent of adults aged 15 to 49 are HIV positive, according to UNAIDs.
From UNDP. Read the full story here: http://www.undp.org/content/undp/en/home.html