GLOBAL FUND-SUPPORTED PARTNERSHIPS
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Transcript of GLOBAL FUND-SUPPORTED PARTNERSHIPS
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GLOBAL FUND-SUPPORTED
PARTNERSHIPSDO THEY WORK IN FAILED STATES?
WV SOMALIA TB PROGRAM EXPERIENCE
By
Dr Vianney Rusagara, MD - World Vision Somaliaand
Dr Milton Amayun, MD - World Vision International
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Somalia - Country profile
• Located in the horn of Africa• Country with the longest seacoast in Africa -
3,000 km (Red Sea and Indian Ocean)• Total area - 638,000 sq.km • Population - 7.96 million • Mostly semi-arid and desert • Harsh environment, favours nomadic lifestyle• One tribe, one language• One religion (100% Muslim)
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Somalia
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Somalia
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Political situation• No unified government for the last 15 years• 3 distinct geopolitical and autonomous zones
(Northwest, Northeast, South/Central)
• Northwest (Somaliland) declared as a break away republic in 1991
• Northeast (Puntland) 1998• Traditional governance used in some areas• Warlords control some areas of South/Central
Somalia
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Geopolitical subdivisions
North West (Somaliland)
North East(Puntland)
South/Central
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Somalia …..….is
mainly arid
some areas have
water – especially
the south
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Effects of long conflict• The prolonged civil war destroyed health and
social service infrastructure• Most parts have been under a complex
humanitarian emergency• Health sector probably the most affected• Infectious diseases are prevalent• TB - among top 3 public health problems• Services mainly by INGOs and UN agencies
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Effects of conflict…..
Vulnerable displaced
population
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Effects of conflict….
Many major towns
were left in ruins
Some towns needed to be restored
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Current health indicatorsInfant Mortality Rate 130/1000 live births
Under 5 mortality Rate 219 /1000 live births
Maternal mortality Ratio 1,600/100k (2004)
Life expectancy at birth M/F: 43/45 (years)
BCG coverage - 1 year old 35% (2006)
Measles coverage - 1 year old 22% (2006)
TB Incidence 372/100,000
HDI 0.299 (2005)
Purchasing Power Parity $600 (Rank: 193)
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Somalia TB Program
• Reactivated in 1995 by WHO and NGOs
• Funding entirely external
• By 2002, there was a good foundation
• Further expansion required more funds
• 2003: a 5-year proposal for TB control was approved by the Global Fund
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Global Fund TB Program
• Multi-partnership – 10 INGOs, WHO and local organizations, governments – MOH, a private firm, multilateral agencies
• Somalia Aid Coordinating Body = CCM
• Most activities based in Nairobi
• WVI - Somalia selected Principal Recipient to replace WHO.
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Program Goal and ObjectivesGoal
To decrease TB
morbidity and mortality
Main Objectives
1. Increase access to TB services
2. Improve quality of the program with treatment success rate > 85%
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TB Patients…
Some patients present at late stages with complications
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Main Activities
• Support essential Human Resource
• Improve infrastructure and provision of essential equipment
• Training/Planning
• Procurement and distribution of drugs and lab supplies
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Main Activities….
Training
Health workers at end of trainingsession
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Main Activities....
• To strengthen TB Information System
• Produce/Distribute Information Education and Communication (IEC) materials
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Main Activities….• Monitoring and
Evaluation: Close supervision and
monitoring Microscopy quality
control Quarterly and Mid-Year
Program Reviews Operational research,
external annual audit / evaluationSupervision and monitoring team
with some staff at a TB facility
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Awareness raising and Health Education
Health education is conducted before dispensing anti TB drugs to patients
Mobilization and awareness on TB (and HIV/AIDS) in a community
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Program Budget
Phase 1: 2years (Oct 2004 – Sep 2006) - US$ 8,224,136
Phase 2: 3 years (Oct 2006 – Sep 2009) - US$ 8,224,136
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Implementation arrangements
• Roles of partners clearly defined• WHO – technical advice, training, research• WV - overall program management• Supervision/M&E - WV assisted by an
INGO with national program coordinators• Coordination team chaired by WV• Program data recorded and reported using
standard WHO information system on TB
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Program partners’ architecture
Global Fund
Local Funding Agent(PricewaterhouseCoopers)
CCM (HSC)
TBCT(Technical and Management)
TB WG(Coordination Forum)
TB PROGRAMSub recipients
Principal Recipient
(World Vision)
ECHO
Community/Other partners WFP
Ministries of Health
Reports
Food
Reports Funds,Monitoring
Logistics
MonitoringPolitical support
Funds,Monitoring
Reports
Reports
Information
Coordination
Reports
Monitoring
Reports
Oversight
CCM - Country Coordinating MechanismHSC - Health Sector CommitteeTBCT - TB Coordination TeamTB WG - TB Working GroupECHO -EC Humanitarian Office
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TB Treatment facilities before Global Fund support (at end 2004)
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TB Treatment facilities opened with GF Fund support (at end 2006)
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Program Results - Case notification
Case detection increased
49% (2004) to 60% (2006)
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Somalia TB Program - Case notification Trend
TB Case notification trend 1995 - 2006
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Nu
mb
er o
f p
atie
nts
SS+ve
SS-ve
Expulm
Relapse
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Somalia TB Program - Case notification Trend
TB Case notification trend 1995 - 2006
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Nu
mb
er
of
pa
tie
nts
Relapse
Expulm
SS-ve
SS+ve
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Somalia TB Program - Case notification Trend
Somalia TB ProgramCase detection rate 2000 - 2006
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006
Year
Ca
se
de
tec
tio
n i
n %
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Program Results Treatment Outcome
Treatment success rate ca. 90%
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Somalia TB Program Treatment Outcome1995 - 2005
Somalia TB Program Treatment Outcome 1995-2005
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Nu
mb
er o
f p
atie
nts Cured
Completed
Died
Failure
Defaulted
Transfer
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Somalia TB Program Treatment Outcome1995 - 2005
Somalia TB Program-Treatment Outcome 1995-2005
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Nu
mb
er o
f p
atie
nts Cured
Completed
Died
Failure
Defaulted
Transfer
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Somalia TB Program Treatment Outcome1995 - 2005
TB Treatment Outcome: 1995 - 2005
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Tre
atm
ent
ou
tco
me
(%)
Tr. Success
Death
Failure
Defaulter
Transfer
Linear (Tr. Success)
Linear (Failure)
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Other Results…….
• Results in almost all the indicators - above targets
• Tuberculin survey – Incidence decreasing
• Phase 1 GFATM evaluation awarded an “A”
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Impact of the Global Fund Program
• Global Fund has enabled continuity of TB service in Somalia
• There are remarkable achievements in a short time
• Program staff supported
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Impact of the Global Fund Program
• Coordination for a has brought together the Ministries of the 3 (sometimes) warring authorities
• Cured patients have become advocates and stigma has drastically reduced
• Given Hope to very poor communities. • Set an example to many other programs
in Somalia.
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Coordination
Mid term review: Donor (GFATM),Private,Multilateral,Government Authorities, Civil society partnersrepresented
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Challenges
• Geopolitical divisions
• Insecurity, limited access to some areas
• Mobile populations
• Limited resources – some gaps
• Weak health delivery system
• TB / HIV
• Multi Drug Resistance
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On faith issues…• WVI is well known as a Christian INGO.
• The combination of professionalism and longevity in Somalia was its platform to work on a nationwide TB program.
• Respect for Islam, sensitivity to local practices and definitely no proselytism.
• Key: Transparency, openness and frequent consultations are the key
• Plus: Caring staff in a harsh environment.
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Lessons learned… What did not work well
Due to multi-partner nature:• Initial misunderstanding on roles
and responsibilities – detailed TORs needed!
• Local authorities: control issues. • Supervision/Monitoring teams
denied access in some areas.
“These were resolved through constant dialogue and coordination”
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Lessons learned ….What worked well
• Partners should be well chosen for complementary strengths.
• Country program decisions on TB taken jointly in a pre-agreed upon process.
• Corrective accountability: solve problems immediately – before they become crises.
• Performance-based concept works in fragile/failed states as in stable countries.
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Conclusion…..
“When resources are available, well designed and implemented programs by
professional and caring staff can succeed anywhere - even in FAILED states.”