Wednesday
15th September 2004

13th September 2004
Zimbabwe Challenges Fund's Decision

11th September 2004
The Global Fund's principal recipients . . . or neglected partners

7th September 2004
600 to get free ARVs

11th Septembert 2004
Doctors and nurses with HIV and AIDS in sub-Saharan Africa

8th September 2004
Zambian Government Declares HIV/AIDS National Emergency, Launches Collaborative Treatment Project

13th September 2004
UGANDA'S CRISIS
Generation orphaned by AIDS

24th August 2004
Glaxo to face another hearing on Aids drug prices

10th August 2004
Women Complain of Lack of Access to Aids Drugs.

13th August 2004
3 Generic AIDS Drugs Taken Off WHO Approved List

16 June 2004
U.N. Agency Drops 2 Drugs For AIDS Care Worldwide

16 June 2004
TAC Comment On The New York Times' Article [Above]

1st July 2004
Gilead Science (GILD) Surges As Earnings Trounce Expectations.
Sales Of The HIV Drug Viread Drove The Outperformance, The Company Said.

5th July 2004
ARV Rollout A Shambles, Says Report

12th July 2004
Bangkok Blog

14 July 2004
US Under Fire Over Patent Deals At World Aids Forum

27th July 2004
Copycats' Hit Drugs Firm's Profits

31st July 2004
Thoughts From Bangkok-Part I

1st August 2004
HIV Made Me Feel Ugly And Battered But No More—Rolake Odetoyinbo Nwagwu

9th August 2004
Every Day Is A Fight To Survive For Africans Who Have AIDS

20th August 2004
What The Zambian Government Won’t Say…

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Zimbabwe Challenges Fund's Decision

September 13, 2004
Bertha Shoko

ZIMBABWE has appealed against a decision by the Global Fund to deny the country Aids funds in the fourth round of proposals and now awaits the board's final say on the matter, The Standard has learnt.

Zimbabwe applied for about US$381 million for use in combating three killer diseases - Aids, tuberculosis and malaria but the proposal failed in what was considered a political move.

The Global Fund has, however, maintained that its rejection of Zimbabwe's proposal is purely on "technical grounds".

Health and Child Welfare Minister, Dr David Parirenyatwa, said the appeal was procedural and the government was now looking at other ways of sourcing funds.

Dr Parirenyatwa said the government was convinced that the rejection of Zimbabwe's proposal was political.

"The most important thing and the reason why we appealed is that it is procedural and we are concerned about the number of the people dying because of lack of treatment.

"We wrote excellent proposals to the Global Fund with the help of experts from the United Nations, World Health Organisation and numerous other health experts and we know we had a tight proposal.

"It is unfortunate that the Global Fund board does not see it this way. Aids is a humanitarian crisis and it is inhuman and cruel to deny innocent lives treatment for political reasons."

Dr Parirenyatwa said the government has resolved to mobilise resources for treatment and prevention programmes from inside the country, while the Global fund "take their sweet time deciding what to do with Zimbabwe".

"We can't let innocent lives die in the meantime. We have resolved as government to use our own funds to assist our own people. Government will allocate us some money and we are going to tap into the National Aids Trust Fund," Parirenyatwa said.

"We will rely on ourselves to mobilise funds because we have no choice and it is encouraging that the foreign currency supply situation in the country is improving by the day. It will certainly come in handy."

Zimbabwe has one of the highest HIV prevalence rates in the world and the disapproval of its application was deadly blow to its plans to provide Aids treatment to its more than 1,8 million people living with Aids.

The bulk of the US$218 applied for Aids was intended to go towards rolling out of a full scale Anti Retroviral programme in the country.

The United Nations in Zimbabwe has welcomed the appeal and urged everyone to respect the appeal process.

"The UN was disappointed that the Board of the Global Fund to Fight, AIDS, Tuberculosis and Malaria (GFATM) did not approve the country's Fourth Round proposals.

United Nations Resident and Humanitarian Coordinator in Zimbabwe, Victor Angelo said: "We welcome the appeal that has been submitted by Zimbabwe. We now must respect the appeal process and await its outcome."

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Volume 364, Number 9438 11 September 2004
The Global Fund's principal recipients . . . or neglected partners

The Global Fund to fight AIDS, Tuberculosis and Malaria recently released a progress report for its first 30 months.¹ The Fund has made pledges of US$5·4 million through 2008, and has committed $3·1 billion to almost 300 2-year programmes in nearly 130 countries, over four rounds of grants, and is on schedule to disburse nearly $1 billion to over 200 programmes by the end of 2004. However, the Fund must ensure the quick, efficient, and effective use of these resources to stem the suffering caused by the three diseases.

The Fund's second significant achievement has been "the pioneering of a number of innovative structures to ensure country ownership, speedy and light-handed oversight, and performance-based funding . . . [of] Country Coordinating Mechanisms (CCMs), a variety of recipient structures, Local Fund Agents, and monitoring and evaluations systems." Unfortunately, the linchpin organisations in this management, the principal recipients, are being neglected and undervalued by the Fund secretariat, the CCMs, UN agencies, and donors. Principal recipients must be supported if the Fund is to be highly successful.

The Fund explains the role and responsibility of the principal recipients as: "The principal recipient is legally responsible for local implementation of the grant, including oversight of sub-recipients of grant funds and communications with the Country Coordinating Mechanism on grant progress."² The Fund has therefore clearly assigned the executive role to principal recipients and hence the legal responsibility for the funds and for achieving results. Principal recipients are in the unenviable position of being responsible for funds and results, yet have little or no control over the achievement of the expected results because most often activities are undertaken by subrecipients. If a country does not perform satisfactorily, it is the principal recipient that is informed by the Fund and that is responsible for the country's performance. Principal recipients have become the centre of international criticism for slow or non-performance, and have jeopardised their instituti onal future with little support from those who should be their allies, including the Fund secretariat. The reality is that once confirmed in its role, the principal recipient may be left to its own devices, without direct support from the secretariat or development partners. Despite their crucial role, principal recipients seem to be an afterthought for the Fund secretariat, overshadowed in attention and promotion by the CCMs and the technical review committee.

In the first rounds of funding the secretariat often chose the UN Development Programme as the principal recipient. Increasingly, and especially in Latin America, the Fund has sought national organisations to become principal recipients. The Fund promotes local organisations over international ones, with the laudable goals of developing local capacity and promoting local ownership.

Once named as principal recipient, national organisations may face several difficulties. National organisations are easy whipping posts for those looking to criticise the Fund's performance. Principal recipients are often portrayed as lumbering feet-dragging bureaucrats and middlemen who do nothing useful, but slow down the disbursement of funds and procurement of medications, and charge for the pleasure. The stress on national principal recipients can be tremendous, creating an enormous emotional drain on small or young organisations. This pressure can become great enough to cause nominated national recipients to withdraw their candidacy, as was the case with the Corporación Kirimina in Ecuador (Quevedo M, Quito, Ecuador, personal communication). The Fund secretariat is in a difficult situation, trapped between a need to quickly disperse desperately needed funds and the goal of providing for country-led management and local capacity-building. But it can and should do more to actively strengthen and support local principal recipients.

When the Fund secretariat confirmed NicaSalud (a local federation of non-governmental organisations) as principal recipient for the three projects in Nicaragua, NicaSalud realised that it needed support for the international procurement of medicines. NicaSalud was without funds to hire the needed expert. It sent requests to 12 representatives of bilateral and multilateral donors and UN agencies in Nicaragua, requesting $21 000 to hire a consultant to prepare the institutional analysis, procurement plan, and training to handle the procurement contemplated under the Global Fund activities. Of the 12 requests, NicaSalud received one potentially positive telephone call, two negative telephoned replies, and five written negative responses. The reason most often given for the negative responses was that the activity was unplanned, and that although they did have funds to support the Global Fund, that support was targeted at the CCMs and specific groups, not at the principal recipient. In t he end, NicaSalud borrow ed the funds from another project, hired the consultant, and submitted a procurement plan that was reviewed and approved by the local fund agent. 2 months later NicaSalud signed three agreements with the Fund.

The pressure can be intense. For example, the Agua Buena Human Rights Association criticised NicaSalud for its "bureaucracy" and questioned its effectiveness.³ Another, more generalised comment comes from AIDSPAN: "a real and widespread problem, which is that once the Global Fund sends grant money to a Principal Recipient (PR), it sometimes takes months for the PR to move that money to the organisations that are actually doing the work."⁴ At these moments of intense public pressure the principal recipients are usually alone, and defended by no one in the arena of public opinion.

The Fund is an ongoing experiment; the activities and results blossoming around the world. The Fund secretariat, donors and multilateral agencies, advocacy groups, and the CCMs need to make a fresh analysis of the role of principal recipients that should lead to valuing and supporting them as well as an appreciation of their difficult role.

Allan J Hruska

Arrayán 2702, Dpto 304, Providencia, Santiago, Chile

ajhruska@umich.edu

Until May 15, 2004, I was Executive Director of NicaSalud, a federation of 26 NGOs that is principal recipient for three Global Fund projects in Nicaragua. I was financed by the Global Fund to visit the principal recipient in Peru and attend the regional Global Fund meeting in Panama in November, 2003. I thank Joan Jennings for valuable comments on an earlier version of the manuscript.

1 The Global Fund to Fight Aids, Tuberculosis and Malaria. A force for change: the Global Fund at 30 months. 2003: http://www.the globalfund. org/en/about/publications/forceforchange (accessed Aug 25, 2004).

2 The Global Fund to Fight Aids, Tuberculosis and Malaria. Country coordinating mechanisms. http://www.theglobalfund.org/en/apply/ mechanisms (accessed Aug 25, 2004).

3 Agua Buena Asociación de Derechos Humanos. Artículos. April, 2004: http://www.aguabuena.org/articulos/artabri2004.html (accessed Aug 23, 2004).

4 Rivers R. Pointed lessons from a regrettable row. Global Fund Observer (GFO) Newsletter, June 7, 2004. http://www.aidspan.org/gfo/archives/newsletter/GFO-Issue-25.htm#Row (accessed Aug 23, 2004).

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600 to get free ARVs

By Ronald Kalyango

THE executive director of The AIDS Support Organisation (TASO), Dr. Alex Coutinho, has said 600 people living with HIV/AIDS will get anti-retroviral (ARVs) drugs this year.

“The country has a provision of drugs to benefit only 2,000 people but we will begin with 600 in the first two years and in the third year, the 800 people will be the last category to get the drugs,” he said.

Coutinho was speaking at TASO’s general meeting at the TASO Mulago complex.

He said TASO’s biggest challenge was the increasing number of patients yet they had limited space of operation.

“Due to the increasing number of patients at the headquarters, we are planning to set up a health centre at Kanyanya such that people from Bwaise, Kawempe, Makerere and others within the proximity can get services from there, other than coming to the headquarters,” Coutinho said.

Kampala Mayor John Ssebaana Kizito asked TASO officials not to sideline traditional medicines, saying they should be used alongside the ARVs.

“We should not overlook the role of traditional medicine. It is my prayer that since only 600 people are to benefit from the ARVs this year, the rest should as well continue using the local medicine,” he said.

Published on: Tuesday, 7th September, 2004