Sustaining the Fund’s Funds for Malaria: Hidden Costs

Recently we examined a proposal that financial support from the Global Fund to Fight AIDS, TB and Malaria (GFATM) be used to sustain health systems.  Two decisions by the GFATM Board in April make this proposition seem less like wishful thinking.  The first of these challenging decisions was to attempt to mobilize resources to reach $US 8 billion annually by 2010. This represents a quadrupling of current resource levels and approximately one-quarter of what the partners project as total resource needs to fight the three diseases by that time, i.e. US$ 28-31 billion per year.

The second key decision was the establishment of the “Rolling Continuation Channel” (RCC). The RCC would provide CCMs with the opportunity of applying for continuing funds for existing grants before they expire as distinct from submitting new grant proposals. The caveat is that eligibility would be reserved for high performing grants.

How would malaria grants fare under the RCC regime? The GFATM’s Progress Report 2007 notes that two malaria indicators/targets, ITNs distributed and anti-malarial treatments provided, fall below achievements for TB and HIV targets. To date, malaria grants have the lowest proportion scoring a performance rating of ‘A’, 16% compared to 25% for HIV and 32% for TB grants. If both ‘A’ and ‘B1’ ratings are defined as ‘high performance’, malaria does a little better comparatively (71%), through still in last place after HIV (74%) and TB (84%).

How can malaria grants become stronger performers and thus qualify for RCC? Recently Roll Back Malaria partners have provided concerted assistance to a number of countries to ensure that they submit the strongest GFATM Round 7 grants possible.  At a discussion forum sponsored by the Global Health Council, Dr. Michel Kazatchkine, the new Executive Director of GFATM, talked about the need not only for assistance in grant development, but also in quality implementation when he said that, “I’ve been saying when talking about partnerships that we need those not only to design the grant and be the best request possible but also to help it being implemented.”

Dr. Kazatchkine suggested that a better coordinated “reservoir of technical assistance” be made available.  The job of technical assistance is actually not within the mission of the GFATM, and so the onus to ensure that malaria grants succeed, and thus be eligible for RCC, falls back on partner groups like RBM. One could call such inputs the ‘hidden costs’ of GFATM grants. Hopefully all countries and donors will recognize that contributing to the GFATM is only one side of the coin, and that grants once awarded may not be sustained without extra resources needed for technical implementation support.

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