[afro-nets] GFATM Terminates Nigeria HIV Grants

GFATM Terminates Nigeria HIV Grants for Inadequate Performance
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Source: Global Fund Observer (GFO), http://www.aidspan.org/gfo/
an independent newsletter about the Global Fund provided by
Aidspan

In a dramatic development, the Global Fund has terminated two
HIV grants to Nigeria on the grounds that their performance has
been inadequate. This action was recommended a few months ago by
the Fund's Secretariat, but at first, when discussing the matter
by email, some board members dissented. However, by the time the
issue reached the Board meeting last week, no board members
spoke up in defence of Nigeria's handling of the grants, and the
decision to terminate the grants passed easily.

Because all grants are supposed to be "performance-based", the
Fund theoretically has the right to terminate grants at any
stage; but the most likely point for such action is when, to-
wards the end of Phase 1 (Years 1-2), the Fund assesses grants
for "Phase 2 Renewal" (covering Years 3-5). Prior to the deci-
sion about the two Nigerian grants, the Fund had issued what it
calls a "No Go" decision for only three out of 130 grants. These
were a Senegal malaria grant, a South Africa HIV/TB prevention
grant, and just last month, a Pakistan malaria grant.

The two terminated Nigerian grants were a Round 1 grant provid-
ing ARV treatment, and a Round 1 grant providing PMTCT (Preven-
tion of Mother to Child Transmission) services. The amount of
funding that Nigeria will not receive as a result of these
grants being denied Phase 2 funding is $81 million.

According to documentation provided by the Secretariat to Board
members:

* Nigeria's ARV grant was supposed to have 14,000 people on
treatment by the end of the fourth quarter, but the actual num-
ber was zero. And it was supposed to have 24,000 on treatment by
the end of the seventh quarter, but the actual number was 6,865.

* Multiple other targets have not been met.

* Funds have been spent at a much lower rate than they should
have been.

* Questionable data has been provided to the Fund by the Princi-
pal Recipient, NACA (National Action Committee on AIDS) � in
particular, at one point, numbers of people that the PR reported
as being on treatment turned out instead to be numbers of people
who could have been treated if all the drugs sent to health fa-
cilities had been used.

* Funds have been spent on inappropriate activities � for in-
stance, $50,000 was spent to send fourteen people on information
missions to Botswana at a time when the grant was not perform-
ing.

* The CCM rated these grants as "B1: Adequate" when this clearly
was not the case. The CCM failed to acknowledge or report many
of the problems.

* Promised CCM reforms have not taken place.

The people who are currently receiving ARV treatment under these
grants will, despite the termination, continue to have their
treatment financed by the Fund for up to two years while alter-
native options are pursued. Furthermore, Nigeria was approved
for a major ARV grant in Round 5 that will be administered by a
different PR once the grant agreement is signed.

GFATM Terminates Nigeria HIV Grants (2)
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Much as the Global Fund has right to determine who gets and who
does not get its support, it is important that it exercise this
right within the framework of established principles of the
process.

There are now a host of countries that have radically reformed
their health systems and policies either because of funds made
available by the Global Fund or promised by the fund.

The quantum of support made available or promised by the Global
Fund in some cases far excess the support that these programs
get from their own governments. In short, a dependency has been
created in most countries. And naturally, such dependency goes
all the way to the patient level.

A few examples: Change to Artemisinin-based combinations in over
five countries that come to mind, MTCT programs, ARV roll-out,
Change to FDC in TB management.

Most countries would not have considered these options, expen-
sive as some are, without the promised or delivered support of
the Global Fund.

In sum, the Fund is presently a major player in the health de-
livery system in many countries and it raises questions when it
takes the option of pulling out, rather too easily, it appears.

The Global Fund must be absolutely sure of the system of ac-
countability of its funds before entering the arena. If the sys-
tem proposed by the country would not put the Fund and its
agents in a position to intervene early in preventing abuse, it
would be better that the Fund did not go in!!

When the GF withdraws support and patients are asked to take
tablets once a day instead of twice daily, and resistant strains
begin to develop, who suffers? And this is happening!!

Fortunately, one can consider the GF as evolving and hopefully
soon, better approaches will evolve.

Frank Baiden
mailto:fbaiden@hotmail.com