Not long ago, Kenya was sharing its malaria achievements with the Director of WHOâ€™s Global Malaria Program. According to a government brochure to mark the occasion, â€œ12 million treatment doses of the new first line treatment, artemether-lumefantrine, have been procured and distributed.â€ In addition after the new drug treatment policy was rolled out in 2006, â€œnumbers of children accessing free treatment in government health facilities (increased) from 50% to 63%.â€ In this column we also made note of the importance of Kenyaâ€™s national policy of universal coverage rather than targeting only vulnerable groups. It would seem that these achievements are at risk.
The East African Standard quoted the advocacy group Kenya NGO Alliance Against Malaria (KeNAAM) on 28th September 2007 that, â€œFailure on the part of the Government to budget for this vital drug and to adequately account for Global Funds resources now puts the lives of thousands of Kenyans at riskâ€.
Although we found stocks of artemether- lumefantrine in clinics in the Kisumu area in late August 2008, apparently there are stock-outs now that threaten the life saving achievements to date. KeNAAM therefore, calls on other donors to step in and fill the void.
A closer look into the funding situation sheds some light on the current problem. Kenya has two grants from the Global Fund to fight AIDS, TB and Malaria (Rounds 2 and 4) as can be found on the GFATM website. Round 2 includes drugs for integrated management of child illness (IMCI) along with ITNs and IPT. The Round 4 Grant addresses prompt reatment, epidemic control and ITNs. According to the Grant Score Card for Phase 1 of the Round 2 Grant, only half of the funds planned were disbursed due to slow implementation and late reporting.
The Round 2 Grant was given a â€˜conditional goâ€™ requiring additional clarification from Kenyaâ€™s Central Coordinating Mechanism before additional funds could be released. Additional report cards on the GFATM website show that disbursements have been held up due to procurement problems as well as lack of forecasting based on workplans.
Although disbursements for Round 4 are more closely in line with expectations, the grant report card still expresses concerns about procurement, transparency and also linkages with Round 2 activities.
Like KeNAAM we stress the need for all donors to help in the short term. In the long term though there is need for
better management of GFATM resources. The competition for these resources is high, and malaria proposals have not fared as well as those for TB and HIV, in part due to management problems and bottlenecks in national malaria programs. Kenya would do well by its people by paying more heed to the accountability and performance standards required from the Global Fund.