Tropical Health Matters

A total of 85 grants were approved in Round 6 of the Global Fund to Fight AIDS, TB and Malaria (GFATM) at it recent Guatemala meeting, but malaria advocates are disappointed that only 19 (22%) of the approved grants were for malaria programs, and only eight will go to high-burden countries in Sub-Saharan Africa. In previous rounds, malaria got up to a third of the total funds. In addition, only 31% of 35 submitted malaria proposals made the cut, compared to 38% for HIV and 62% for TB. This experience raises two important issues. First, does burden of disease play any role in prioritizing grant awards? Secondly, are there specific problems with malaria proposals?

Each of the three diseases is a serious health and development challenge. TB has been neglected by international health programs, HIV is devastating large portions of the productive age population in many countries, and malaria is a major cause of child mortality. In Africa HIV accounts for twice as many deaths overall as malaria, but in children under five years of age, malaria deaths are three times higher than HIV. Arguments in support of the lion’s share consistently allocated to HIV may relate to the cost of interventions, but with Long Lasting Insecticide-treated Nets (LLINs) and Artemisinin-based Combination Therapy (ACT) being recommended for malaria, that argument carries much less weight. Under these circumstances, one would expect relatively equal treatment for the diseases.

Possibly the problem rests in the quality of malaria proposals. This would be ironic since during proposal writing time, donors join together to help countries develop them , even when there is uncertain capacity on the ground to carry out a grant if it is awarded. Another factor in judging a new proposal is performance of existing grants. GFATM prides itself in being a performance based organization, and no one would ever wish for less accountability when it comes to international grants. What could be happening is that Round 6 malaria proposals were denied due to poor performance of their predecessors.

Poor performance can be due to basic lack of capacity and competence, but also due to unrealistic goal setting in the early grants. Many projects underestimated the time it would take to get set up and running – the need to address customs and drug registrations, the ability of M&E systems to report, etc. Thus, projects promised unrealistic progress on indicators and may have been penalized in Rounds 5 and 6 for this. Instead of penalties, technical assistance (TA) to overcome the problems would be more helpful and result in saving more lives from malaria deaths. The reality though is that the GFATM is strictly a financial agency and does not provide TA. Donors flock around during the grant writing process, but where are they when the grants begin to falter?

So far in-course TA for the malaria grants has been provided through regional workshops by the RBM Partnership, and recently the US Government made TA services available if CCMs or PRs would apply. Unfortunately few of the eligible countries/projects availed themselves of this TA, and even among those who did, few were malaria grantees.

Announcements for Round 7 and 8 also came out of the 14th GFATM Board Meeting. It is crucial for partners to plan now not just to help write new malaria grants, but to get on board in making the existing malaria grants perform up to expectations.

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