Malawi:Challenges and Opportunities – Enhancing Strategic Collaboration for more Effective

Programs

Edith Mkawa, Principal Secretary for HIV/AIDS and Nutrition, Office of the President and Cabinet, MalawiBeth Tippett Barr, HIV Prevention, CDC-MalawiRitu Singh, HIV Cluster Lead, USAID-MalawiPlaikessi Kouadjani, Fund Portfolio Manager, Malawi-GF

PEPFAR in Malawi

• Annual funding through 2008: Approx. $22m• Annual funding: FY09-11: Approx. $65 million• Focus on:– Improving quality of care and treatment– Basic health systems strengthening

• Human Resources• Laboratory• District Planning and Program Implementation

– Behavioral and biomedical prevention– Orphans and community-based care

Global Fund in Malawi

• HIV Rounds & Funding levels– Round 1: Treatment, Care and Support: US$316m– Round 5: Orphans and Vulnerable Children: US$13m– Round 7: BCC, Community Care & Prevention service for Young people:

US$17m– HIV SSF:

• RCC Phase II consolidated with Round 7 Phase 2 to form the SSF grant with a retrospective starting date on 1st April 2012. Grant will be signed before 31st July 2012: (US$ 208 million)

• Funds all ARVs & some HIV related Commodities as well as improving CMS• Funds Malawi’s innovative PMTCT Option B+ regimen

• Malaria: – Consolidated Rounds 2&7: US$57 million– Round 9 US$ 25 million

• TB: Round 7 US$ 9 million• HSS: Round 5 US$ 52 million• MGFCCM: Malawi Global Fund Country Coordinating Mechanism

Symbiosis…. A relationship of mutual benefit or

dependence

PEPFAR & GF: A Symbiotic Relationship

• HIV: Wraparound complementary programming– GF provides test kits, ARVs, and other HIV

commodities – PEPFAR facilitates implementation of the program

across all levels:• Central: Program funding to MOH • Zonal: Support to zonal offices to strengthen planning• District: Support to DHMTs in annual planning, with

direct and indirect financial support for implementation• Facility: Supportive Supervision and Clinical Mentoring• Community: two-way referrals, mobilization and demand

creation for HIV programs

Making GF Work in Malawi: CMS

• HIV Commodities currently go through a parallel supply chain because of weak CMS system

• Global Fund: Investing in upgrading warehouses

• PEPFAR: Technical and Financial Support for the organizational overhaul of CMS, and upgrading of stock management system

Making GF work in Malawi: MOH

• PEPFAR supports coordination and communication between GF, NAC and MOH through hiring of a GF Liaison; embedded in MOH

• HIV Dept:– Technical Advisors:

• PMTCT/ART• Logistics• Monitoring and Evaluation

– Fellows• PMTCT/ART• Logistics• M&E• IT

A Symbiotic Relationship: Funding & Technical Support

PR for HIV (NAC)

PR for TB (MOH)

PEPFAR Implementing Partners / GF-

SRs

PEPFAR (OGAC)

Implementing Partners

PEPFAR-MW

USAID CDC

Global Fund

PR for Malaria (MOH)

Sub-Recipients (SR)

Communication

• CCM– USG Representation– CCM Executive Committee– CCM Adhoc Committee

• HIV/AIDS Donor Group (HADG) • Health Donor Group (HDG) • Global Fund Liaison

Our Symbiotic Relationship: Successes

• Donors cooperate with each other• Roles are fairly well defined for national program support• PEPFAR maximizes their comparative advantage

– On-the-ground– Direct support for GF proposal development– Eyes and ears to support the program which GF is funding

• Ie. Option B+: GF funded ARVs; PEPFAR trained all health workers for implementation, and supports ongoing M&E

• True opportunity for country ownership as the national system is funded to deliver HIV services

• GF/PEPFAR shared belief in ‘country ownership’ and ‘shared responsibility’ investing in strengthening national systems

Our Symbiotic relationship: Areas for ongoing collaboration

• Joint effort needed to: – Advocate:

• GF/PEPFAR common ideal of ‘country ownership’ and ‘shared responsibility’ for investing in national systems

• Additional GoM resources for HIV response

– Implement:• Regular mapping of all donor resources

– Strengthen:• Coordination and sharing of workplans & activities• Supply chain management institutions, processes and tools• Storage capacities and quality• Financial Management Systems of PRs and SRs

Our Symbiotic relationship: Looking to the…

…Immediate future: • High-level delays in SSF signing combined with imminent switchover

to VPP = high risks of stock-outs at facility level before end of 2012 • Malawi is still functioning on Round 1 RCC• GF HIV grants to finish in March 2014

…Mid- to Long-term future:• Global financial crisis; limited GF resources • Complete uncertainty after 2014• How to diversify the resource pool in a time of dwindling resources• Avoid duplication of efforts and maximize efficiency• Support high-impact interventions• Alignment of priority strategic investment in Malawi

Conclusions

• PEPFAR and Global Fund have built a very successful collaboration with NAC and MOH to implement HIV, TB, and Malaria Programs

• PEPFAR and GF have mutually benefitted from each other’s presence in the national HIV response in Malawi

• After years of financial and technical support from us both, the National HIV Program is threatened by our mutual limits in funding