Presentation by Debbie Gueye, the PMI/Senegal Resident Advisor on the main players in international malaria control for Stomping Out Malaria in Africa's Boot Camp training.

1. Who’s Who in International
Malaria Control
Peace Corps Malaria Initiative for Africa
Boot Camp
DEBBIE GUEYE
PMI/SENEGAL
RESIDENT ADVISOR
FEBRUARY 7, 2012

2. Objectives
 Understand how the different components of PMI
(USAID, HHS, CDC) work together and with other
agencies;
 Be familiar with the major international actors in
malaria control
 Understand how the Global Fund application
process works
 Discuss challenges and opportunities in coordination

3. The Major Actors
 President’s Malaria Initiative
 The Global Fund
 Roll Back Malaria Partnership
 World Health Organization/Global Malaria Program

4. President’s Malaria Initiative
 Launched in June 2005 as a five-year, $1.2 billion
initiative to rapidly scale up malaria prevention and
treatment interventions
 2008 Lantos-Hyde Act: funding extended through Fiscal
Year 2014
 Managed by USAID in coordination with the Department
of Health and Human Services (CDC), the Department of
State, and the White House
 17 Countries: Angola, Benin, DRC, Ethiopia, Ghana,
Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique,
Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zambia
www.pmi.gov

5. PMI Principles
 PMI aligns its activities with host country malaria control
strategies and coordinates closely with international partners,
non-governmental organizations, community groups, and the
private sector
 PMI is a core component of the Global Health Initiative (GHI),
along with HIV/AIDS, and tuberculosis.
Adherence to GHI core principles
• encouraging country ownership • increasing impact and efficiency
and investing in country-led plans through strategic coordination
and health systems and programmatic integration
• strengthening and leveraging key • implementing a woman- and girl-
partnerships, multilateral centered approach
organizations, and private
contributions
• improving monitoring and • promoting research and
evaluation innovation

6. PMI Goal and Interventions
 Goal: reduce malaria-related mortality by 70% in the original 15
countries by the end of 2015, by reaching 85% of the most
vulnerable groups – primarily pregnant women and children
under five years old – with proven preventive and therapeutic
interventions
 PMI supports four key intervention strategies for malaria
prevention and control:
 Spraying approved, long-lasting insecticides on the interior walls
of homes (indoor residual spraying)
 Promotion and distribution of long-lasting insecticide-treated
bednets (LLINs)
 Training for medical personnel and community health workers to
improve malaria diagnosis and effective treatment
 Prevention among pregnant women with prophylactic drugs
during prenatal care (intermittent preventive treatment)

7. PMI Country Operations
 2 Resident Advisors in-country: USAID and CDC
 Provide technical support to NMCP and oversee PMI-funded
programs
 Annual Malaria Operational Plan (MOP)
 Developed collaboratively with NMCP and local stakeholders
 Background, progress, planned activities
 Budget by activity and implementing mechanism
 Reviewed and approved by USAID-CDC Technical Working
Group (TWG), followed by inter-agency steering group (ISG)
that includes HHS, OMB, White House
 Any proposed changes must be described in reprogramming
memo, approved by PMI Coordinator

8. PMI Country Operations
 Implementation mechanisms
 Bilateral: conceived, funded and managed from the local
USAID Mission
 Field Support: conceived by USAID/Washington, some central
funding and overall management; countries “buy in” and
manage local interventions
 Funds allocated through competitive bidding
processes
 Projects generally run 5 years
 Advance planning for funds that are slow to come

9. The Global Fund to Fight AIDS,
Tuberculosis and Malaria
 Created in 2002 to dramatically increase resources to fight three
of the world's most devastating diseases, and to direct those
resources to areas of greatest need
 Partnership between governments, civil society, the private sector
and affected communities represents an innovative approach to
international health financing
 Model based on the concepts of country ownership and
performance-based funding, which means that people in
countries implement their own programs based on their priorities
and the Global Fund provides financing on the condition that
verifiable results are achieved
http://www.theglobalfund.org

10. Global Fund Guiding Principles
 Operate as a financial instrument, not an implementing entity
 Make available and leverage additional financial resources
 Support programs that evolve from national plans and
priorities
 Operate in a balanced manner in terms of different regions,
diseases and interventions
 Pursue an integrated and balanced approach to prevention and
treatment
 Evaluate proposals through independent review process (TRP)
 Operate with transparency and accountability

11. Global Fund Core Structures - Central
 Global Fund Secretariat:
 manages the grant portfolio, including screening
proposals submitted, issuing instructions to disburse
money and implementing performance-based funding of
grants
 tasked with executing Board policies; resource
mobilization; providing strategic, policy, financial, legal
and administrative support; and overseeing monitoring
and evaluation
 based in Geneva, no staff located outside its headquarters

12. Global Fund Core Structures - Central
 Technical Review Panel (TRP):
 independent group of international experts in the three
diseases and cross-cutting issues (health systems, M&E,
etc.)
 meets regularly to review proposals based on technical
criteria and provide funding recommendations to the Board

13. Global Fund Core Structures - Central
 Global Fund Board
 composed of representatives from donor and recipient
gov-ernments, civil society, the private sector, private foundations,
and communities living with and affected by the diseases
 responsible for the organization’s gover­nance, including
establishing strategies and policies, making funding decisions and
setting budgets
 works to advocate and mobilize resources for the organization
 Global Fund Trustee
 manages the organization’s money, which includes making
payments to recipients at the instruction of the Secretariat
 The Trustee is cur-rently the World Bank

14. Global Fund Core Structures - Country
 Country Coordinating Mechanism (CCM)
 com-posed of all key stakeholders for the three diseases.
 Demonstrates commitment to local ownership and
participatory decision-making
 includes representatives from public and private
sectors, including governments, multilateral or bilateral
agencies, non-governmental organizations, academic
institutions, private businesses and people living with the
diseases
 does not handle Global Fund financing itself

15. Global Fund Core Structures - Country
 CCM Core Functions
 coordinate the development and submission of national
proposals
 nominate the Principal Recipient
 oversee implementation of the approved grant and submit
requests for funding
 approve any reprogramming and submit requests for
continued funding
 ensure linkages and consistency between Global Fund
grants and other national health and development
programs

16. Global Fund Core Structures - Country
 The Global Fund signs a legal grant agreement with a
Principal Recipient (PR)
 designated by the CCM
 receives Global Fund financing directly, and uses it to
implement prevention, care and treatment programs or
passes it on to other organizations (sub-recipients) who
provide those services
 makes regular requests for additional disbursements from
the Global Fund based on demonstrated progress towards
the intended results

17. Global Fund Core Structures - Country
 Local Fund Agents (LFAs)
 firms contracted by Global Fund to monitor
implementation (selected through competitive bidding)
 responsible for provid-ing recommendations to the
Secretariat on the capacity of the entities chosen to man-age
Global Fund financing and on the soundness of regular
requests for the disburse-ment of funds and result reports
submitted by PRs.

18. Operations
 Annual call for proposals (“rounds”)
 GF follows the principles of performance-based funding
in making funding decisions. Ensure that investments are
made only where grant funding is managed and spent
effectively on programs that achieve impact
 Grants initially approved for two years (Phase 1) and
renewed for up to three additional years (Phase 2) based
on performance
 Funding disbursed incrementally every three to six
months throughout the grant's lifespan, and each
disbursement is based on performance

19. High Level Independent Review Panel Recommendations
1. Turn the Page from Emergency to Sustainable Response
1.1 No Amnesty for Fraud, but Focus Oversight on More-Recent Rounds of
Grants
1.2 Strengthen the Relationship between the Secretariat and the Inspector
General
2. Declare a Doctrine of Risk and Manage to it
2.1 Adopt a New Risk-Management Framework
2.2 Redefine “Country Ownership”
2.3 Apply the Risk-Management Framework to the Existing Portfolio
3. Strengthen Internal Governance
3.1 Focus the Global Fund’s Board on Management, Strategy and Risk-
Management
3.2 Re-purpose the Committees (Investment, Audit, Finance)
3.3 Create an Executive Staff to Support the Global Fund’s Board

20. High Level Independent Review Panel Recommendations (2)
4. Streamline the Grant-Approval Process
4.1 Institute a Two-Stage Grant Process
4.2 Apply Risk-Differentiated Grant Processes and Requirements
5. Empower Middle-Management’s Decision-Making
5.1 Establish a Chief Risk Officer
5.2 Align the Staffing Pattern to Bolster Grant-Management
5.3 Empower the Fund Portfolio Managers
5.4 Streamline and Expand the Country Teams
5.5 Reinforce the Executive Management Team
5.6 Leverage the Investment in the Local Fund Agents
5.7 Define and Clarify the Role and Responsibilities of External Auditors
6. Get Serious About Results
6.1 Measure Outcomes, Not Inputs
6.2 Focus on Quality and Value, Rather than Quantity
6.3 Consolidate the Reform Agenda

21. Roll Back Malaria (RBM) Partnership
 Lead international forum for malaria stakeholders to
coordinate implementation activity, formulate and promote
international policy positions relating to malaria, and to
promote advocacy for malaria prevention, control, and fund-
raising.
 Launched in 1998 by WHO, UNICEF, UNDP and the World
Bank, in an effort to provide a coordinated global response to
the disease.
 Led by the Executive Director, and served by a Secretariat that
is hosted by the World Health Organization in Geneva. The
Secretariat works to facilitate policy coordination at a global
level.
http://www.rollbackmalaria.org

22. Global Coordination
 The RBM Partnership is the global framework to implement
coordinated action against malaria
 mobilizes for action and resources and forges consensus among
partners
 is comprised of more than 500 partners, including malaria endemic
countries, their bilateral and multilateral development partners, the
private sector, nongovernmental and community-based
organizations, foundations, and research and academic institutions
 RBM’s overall strategy aims to reduce malaria morbidity and
mortality by reaching universal coverage and strengthening health
systems. The Global Malaria Action Plan defines two stages of
malaria control: (1) scaling-up for impact (SUFI) of preventive and
therapeutic interventions, and (2) sustaining control over time.

23. RBM Organization
 Working Groups  RBM Sub-Regional Networks
 Malaria Advocacy (SRNs):
 Communication
 Central Africa
 Harmonization: The HWG
facilitates and harmonizes  East Africa
partners' support in response
to countries identified needs  Southern Africa
and supports the
establishment of the 'three  West Africa
ones' principles for malaria at
country level.  Identify, coordinate, and
 Resources respond to requests for
 Vector Control technical assistance for the
 Procurement and Supply scale-up of malaria control
Management
and treatment interventions
 Case Management
 Monitoring and Evaluation
 Malaria in Pregnancy

24. World Health Organization/
Global Malaria Program (GMP)
 Responsible for malaria surveillance, monitoring and
evaluation, policy and strategy formulation, technical
assistance, and coordination of WHO's global efforts to
fight malaria
 As part of the World Health Organization, convenes
experts to review evidence and set global policies
 GMP's policy advice provides the benchmark for national
malaria programmes and multilateral funding agencies
www.who.int/malaria

25. GMP Strategic Advantage
 Unique position uniting high levels of expertise – and
WHO's field presence in all regions and all malaria-
endemic countries of the world – ensures harmonized
policy advice and the critical technical assistance necessary
to effect concrete and sustainable successes at global level
 Activities focused on providing an integrated solution to the
various epidemiological and operational challenges
 Promotes sound, evidence-based and locally appropriate
strategies.
 Helps countries reach the most vulnerable populations and
ensure that needed interventions take into account social,
economic and environmental realities.

26. GMP Technical Assistance
 Supports national malaria programmes worldwide and provides
technical assistance at country level on five main topics:
 diagnosis and treatment (diagnostic tools, medicines, patient
management, quality assurance, supply chain management)
 vector control and preventive measures (mosquito control; reducing the
risk of infection for local populations and international travellers)
 elimination of malaria (expanding the malaria-free areas of the world)
 surveillance, monitoring and evaluation (generating data for decision
making, quality assurance)
 research (improving the tools to combat malaria, and the way we use
them)
 Malaria National Professional Officer (NPO) in country offices
 WHO/AFRO: regional headquarters in Brazzaville, Congo

27. Key Technical Documents/Reports
 World Malaria Report
 Malaria Treatment Guidelines
 Anitmalarial efficacy and drug resistance: 2000-2010
 Global Plan for Artemisinin Resistance Containment
 Good Procurement Practices for Artemisinin-based
antimalarial medicines
 Good Practices for Selecting and Procuring Rapid
Diagnostic Tests for Malaria
 RDT Product Testing Results
 Indoor Residual Spraying

28. WHOPES (WHO Pesticide Evaluation Scheme)
 Set up in 1960, WHOPES promotes and coordinates the testing
and evaluation of pesticides for public health
 Representatives of governments, manufacturers of pesticides and
pesticide application equipment, WHO Collaborating Centres
and research institutions, and other WHO programmes
 Four-phase evaluation and testing programme, studying the
safety, efficacy and operational acceptability of public health
pesticides and developing specifications for quality control and
international trade
 WHOPES collects, consolidates, evaluates and disseminates
information on the use of pesticides for public health.
 Recommendations facilitate the registration of pesticides by
Member States.

30. Challenges and Opportunities in Coordination
 Among these actors, PMI is only one that has both money
and people on the ground
 Global Fund: money, no people
 RBM: people (but regional focus), no money
 WHO: people, no money
 WHO is the technical leader for malaria control
programs, personnel very well respected
 Global Fund: It’s complicated
 Objective: to have all partners supporting the NMCP plan
and strategies
 Challenge: partners have their own agendas