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Edith Mkawa , Principal Secretary for HIV/AIDS and

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, Malawi Beth Tippett Barr, HIV Prevention, CDC-Malawi

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Edith Mkawa , Principal Secretary for HIV/AIDS and

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  1. 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, Malawi Beth Tippett Barr, HIV Prevention, CDC-Malawi Ritu Singh, HIV Cluster Lead, USAID-Malawi Plaikessi Kouadjani, Fund Portfolio Manager, Malawi-GF

  2. 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

  3. 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

  4. Symbiosis…. A relationship of mutual benefit or dependence

  5. 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

  6. 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

  7. 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

  8. A Symbiotic Relationship: Funding & Technical Support PEPFAR (OGAC) PR for HIV (NAC) Global Fund PR for TB (MOH) PEPFAR-MW Sub-Recipients (SR) PR for Malaria (MOH) USAID CDC PEPFAR Implementing Partners / GF-SRs Implementing Partners

  9. Communication • CCM • USG Representation • CCM Executive Committee • CCM Adhoc Committee • HIV/AIDS Donor Group (HADG) • Health Donor Group (HDG) • Global Fund Liaison

  10. 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

  11. 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

  12. 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

  13. 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

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