Tropical Health Matters

According to the Ghana Chronicle of 24 January 2007, the National Malaria Control Program (NMCP) reports that the number of child deaths due to malaria has been cut in half.  The achievement is credited to the country’s grant from the Global Fund to Fight AIDS, TB and Malaria (GFATM).  Ghana is the recipient of two GFATM grants for its malaria program. The NMCP Director was quoted as saying, “Malaria reported cases dropped from 3.5 million in 2003 to about 3.1 million in 2006”, as a result of these grants. She went further to enumerate that 1.5 million ITNs had been distributed and 4 million tablets administered for malaria treatment. This sounds good in the press, but is this progress real? A visit to the Global Fund website confirms achievements.

A GFATM representative who was present stressed that the Global Fund is a performance based organization.  In short, release of funds is based on achievement of targeted indicators. During the first two years of a GFATM grant, known as Phase 1, key indicators are more along the lines of processes (staff trained, resources in place) and outputs (commodities distributed).  On entering Phase 2 a country is expected to start reporting actual epidemiological progress on disease control. Effective and integrated national monitoring and evaluation systems are crucial for measuring performance that guarantees continued release of grant money.

Ghana’s Round Two Malaria Grant has passed this hurdle and has entered Phase 2.  The ‘score card’ issued for Round 2 Phase 1 performance is quite positive in noting that, “Within the first 16 months of the Program and in spite of procurement delays, 150,000 ITNs have been distributed (reaching the Month 18 target three months ahead of schedule). Additionally, by the fifth quarter of the program, 57,623 women had received IPT (360% of target). The program’s community-based agents (4039 trained, 183% of target) raised awareness and sustained the demand for both of these interventions. In Ghana 70% of malaria attacks are managed at home. A key feature of the program has been to educate home caregivers to respond more quickly and efficiently to malaria cases as they occur within the family. 1454 health workers (309% of target) and 3828 community agents (239% of target) have been trained in home-based malaria care.”

Ghana’s second malaria grant, awarded during Round 4, is also performing well according to the progress report on the GFATM website: “PR (Principle Recipient) has achieved or overachieved most targets. Surveys are ongoing to document results related to three outcome/impact indicators. Expenditure rate is satisfactory and implementation rate is on track with planned activities.” For example, implementers report that 214% of the target for women received Intermittent Preventive Treatment, and 155% of the targeted children under five years of age had slept under an ITN prior to the survey.

Ghana sets a hopeful example for not only getting malaria resources and commodities out to people in need, but also in being able to track and report progress. Fortunately the GFATM offers guidance in Monitoring and Evaluation. The challenge in phase two will be verifying that this infusion of external funds does result in lower morbidity and mortality and that the country can sustain these efforts after the grant expires.

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