GLOBAL FUNDSUPPORTED PARTNERSHIPS

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GLOBAL FUND-SUPPORTED PARTNERSHIPS

• DO THEY WORK IN FAILED STATES?
• WV SOMALIA TB PROGRAM EXPERIENCE
• By
• Dr Vianney Rusagara, MD - World Vision Somalia
• and
• Dr Milton Amayun, MD - World Vision International

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Somalia - Country profile

• Located in the horn of Africa
• Country with the longest seacoast in Africa -
  3,000 km (Red Sea and Indian Ocean)
• Total area - 638,000 sq.km
• Population - 7.96 million
• Mostly semi-arid and desert
• Harsh environment, favours nomadic lifestyle
• One tribe, one language
• One religion (100 Muslim)

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Somalia
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Somalia
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Political situation

• No unified government for the last 15 years
• 3 distinct geopolitical and autonomous zones
• (Northwest, Northeast, South/Central)
• Northwest (Somaliland) declared as a break away
  republic in 1991
• Northeast (Puntland) 1998
• Traditional governance used in some areas
• Warlords control some areas of South/Central
  Somalia

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Geopolitical subdivisions
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Somalia ..

• .is
• mainly arid
• some areas have
• water especially
• the south

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Effects of long conflict

• The prolonged civil war destroyed health and
  social service infrastructure
• Most parts have been under a complex humanitarian
  emergency
• Health sector probably the most affected
• Infectious diseases are prevalent
• TB - among top 3 public health problems
• Services mainly by INGOs and UN agencies

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Effects of conflict..

• Vulnerable displaced
• population

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Effects of conflict.

• Many major towns
• were left in ruins
• Some towns needed to be restored

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Current health indicators
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Somalia TB Program

• Reactivated in 1995 by WHO and NGOs
• Funding entirely external
• By 2002, there was a good foundation
• Further expansion required more funds
• 2003 a 5-year proposal for TB control was
  approved by the Global Fund

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Global Fund TB Program

• Multi-partnership 10 INGOs, WHO and local
  organizations, governments MOH, a private firm,
  multilateral agencies
• Somalia Aid Coordinating Body CCM
• Most activities based in Nairobi
• WVI - Somalia selected Principal Recipient to
  replace WHO.

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Program Goal and Objectives

• Goal
• To decrease TB
• morbidity and mortality
• Main Objectives
• 1. Increase access to TB services
• 2. Improve quality of the program with treatment
  success rate gt 85

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TB Patients

• Some patients present at late stages with
  complications

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Main Activities

• Support essential Human Resource
• Improve infrastructure and provision of essential
  equipment
• Training/Planning
• Procurement and distribution of drugs and lab
  supplies

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Main Activities.

• Training

Health workers at end of training session
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Main Activities....

• To strengthen TB Information System
• Produce/Distribute Information Education and
  Communication (IEC) materials

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Main Activities.

• Monitoring and Evaluation
• Close supervision and monitoring
• Microscopy quality control
• Quarterly and Mid-Year Program Reviews
• Operational research, external annual audit /
  evaluation

Supervision and monitoring team with some staff
at a TB facility
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Awareness raising and Health Education
Mobilization and awareness on TB (and HIV/AIDS)
in a community
Health education is conducted before dispensing
anti TB drugs to patients
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Program Budget

• Phase 1 2years (Oct 2004 Sep 2006) - US
  8,224,136
• Phase 2 3 years (Oct 2006 Sep 2009) - US
  8,224,136

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Implementation arrangements

• Roles of partners clearly defined
• WHO technical advice, training, research
• WV - overall program management
• Supervision/ME - WV assisted by an INGO with
  national program coordinators
• Coordination team chaired by WV
• Program data recorded and reported using standard
  WHO information system on TB

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Program partners architecture
CCM - Country Coordinating Mechanism HSC - Health
Sector Committee TBCT - TB Coordination Team TB
WG - TB Working Group ECHO -EC Humanitarian Office
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TB Treatment facilities before Global Fund
support (at end 2004)
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TB Treatment facilities opened with GF Fund
support (at end 2006)
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Program Results - Case notification

• Case detection increased
• 49 (2004) to 60 (2006)

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Somalia TB Program - Case notification Trend
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Somalia TB Program - Case notification Trend
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Somalia TB Program - Case notification Trend
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Program Results Treatment Outcome

• Treatment success rate ca. 90

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Somalia TB Program Treatment Outcome1995 - 2005
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Somalia TB Program Treatment Outcome1995 - 2005
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Somalia TB Program Treatment Outcome1995 - 2005
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Other Results.

• Results in almost all the indicators - above
  targets
• Tuberculin survey Incidence decreasing
• Phase 1 GFATM evaluation awarded an A

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Impact of the Global Fund Program

• Global Fund has enabled continuity of TB service
  in Somalia
• There are remarkable achievements in a short time
• Program staff supported

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Impact of the Global Fund Program

• Coordination for a has brought together the
  Ministries of the 3 (sometimes) warring
  authorities
• Cured patients have become advocates and stigma
  has drastically reduced
• Given Hope to very poor communities.
• Set an example to many other programs in Somalia.

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Coordination

• Mid term review
• Donor (GFATM),
• Private,
• Multilateral,
• Government Authorities,
• Civil society partners
• represented

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Challenges

• Geopolitical divisions
• Insecurity, limited access to some areas
• Mobile populations
• Limited resources some gaps
• Weak health delivery system
• TB / HIV
• Multi Drug Resistance

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On faith issues

• WVI is well known as a Christian INGO.
• The combination of professionalism and longevity
  in Somalia was its platform to work on a
  nationwide TB program.
• Respect for Islam, sensitivity to local practices
  and definitely no proselytism.
• Key Transparency, openness and frequent
  consultations are the key
• Plus Caring staff in a harsh environment.

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Lessons learned What did not work well

• Due to multi-partner nature
• Initial misunderstanding on roles and
  responsibilities detailed TORs needed!
• Local authorities control issues.
• Supervision/Monitoring teams denied access in
  some areas.
• These were resolved through constant dialogue
  and coordination

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Lessons learned .What worked well

• Partners should be well chosen for complementary
  strengths.
• Country program decisions on TB taken jointly in
  a pre-agreed upon process.
• Corrective accountability solve problems
  immediately before they become crises.
• Performance-based concept works in fragile/failed
  states as in stable countries.

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Conclusion..

• When resources are available, well designed and
  implemented programs by professional and caring
  staff can succeed anywhere - even in FAILED
  states.