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Draft Report
Joint USAID - AFRO Mid-term Review of the USAID Grant Number
AFR-G-OO-04-00001 for the Prevention and Control of Selected
Communicable Diseases and for Reproductive Health in Africa.
5 - 8 June, 2007
Brazzaville, Congo
EXECUTIVE SUMMARY
I. INTRODUCTION
II. OBJECTIVES
III. EXPECTED RESULTS
IV. METHOD OF WORK
V. PROCEEDINGS
VI. WAY FROWARDIRECOMMENDATIONS
3
4
5
5
5
5
19
ANNEX
Annex 1: AGENDA 21
Annex 2: SUMMARY OF MEETINGS BETWEEN 23
USAID AND DIVISIONS
Annex 3 PRESENTATIONS
Annex 3: BUDGET BREAKDOWN FOR THE GRANT PERIOD 07-08 30
Annex 4: PARTICIPANTS 31
2
EXECUTIVE SUMMARy
The joint USAID - AFRO Mid-term Review of the USAID Grant Number AFR-G-00-04-0000 1
for the Prevention and Control of Selected Communicable Diseases and for Reproductive Health
in Africa was held in BrazZaville, Congo from 5th to Sth June 2007. The meeting brought together
USAID representatives, and different programs and Divisions from AFRO. The Divisions and
programs were: Division of Reproductive Health (DRH Division) (Child and Adolescent Health,
Sexual Reproductive Health, Maternal and Newborn Health,) Division of AIDS, Tuberculosis and
Malaria (ATM), Division of Disease Control (DDC)(Communicable Disease Surveillance and
Response, Communicable Disease Prevention and Control, Vaccine Preventable Diseases) and
Division of System Development (DSD)(Health Information Systems and Monitoring and
Evaluation ofNational Health Systems, Essential Medicines and Human Resources for Health)
The meeting was opened by Dr Lusamba, the WHO/AFRO Director of, Program
Management on behalf ofthe Regional Director
The meeting provided an opportunity for USAID and AFRO to review program
achievements from 2004 to 2007 and the draft proposals for the grant period 2007-200S. Apart
from the presentations and plenary discussions the USAID team had separate meetings with the
different divisions with detailed discussions. Specifically, the following results were achieved
during the consultation: AFRO shared Information on new strategic directions, organizational
structure, including names of new staff; the accomplishments from the inception of the new' grant
in 2004 to now were reviewed; USAID provided 'an update on new developments including
programming directions, assistance mechanisms, the Africa 2010 Project, and timing for grant
financial accruals and activity reports; the harmonization of USAID and other partners grant with
AFRO planning cycle was discussed; the draft proposals from the different programs to be
considered for the next grant amendment were reviewed; a consensus was reached on the way
forward for the review ofthe National Professional Officers (NPO).
Recommendations:
1. AFRO programs to prepare the accrual reports for the 3rd quarter by mid-June.; quarterly
accruals for future quarters are due mid September, mid December, and mid-March.
2. AFRO programs to revise the proposals taking into account the feedback received and
will interact with relevant focal persons in USAID. Proposals should be officially
submitted to Mary Harvey by the first week in July.
.3. AFRO programs to prepare the annual report by end of September 2007 and to include
reporting on the new indicators distributed by USAID along with the previously agreed
ones.
4. USAID and AFRO to continue to strengthen the partnership and collaborate with
different initiatives such as the Presidential Malaria Initiative (PMI), PEPFAR., as well as
with USAID Projects and in particular Africa 2010.
5. AFRO and USAID to communicate for the preparation ofthe visit to Washington for the
consultation with the Presidential Malaria Initiative team.
6. AFRO to hold a consultation to improve malaria partnership coordination in the Region.
7. USAID to provide information as soon as possible on the planning cycle.
S. AFRO and USAID to prepare the terms of reference for the NPO review and identify the
source offunding.
9. AFRO and USAID to continue to interact to find the best way to organize the NPOs
capacity building for resource mobilization.
10. DSD to send a concept paper for potential support by USAID using up to $100,000
coming from support provided to the three divisions to be funded under the current Grant.
3
The meeting was closed by Dr Lusamba, the WHO/AFRO Director of Program Management on
behalf ofthe Regional Director.
4
1" Introduction
"
A joint consultation between the u.s. Agency for International Development Bureau for Africa
(USAID/AFR) and the World Health Organization Regional Office for Africa (WHO/AFRO) was
held in Brazzaville from 5-8 June 2006 to conduct the mid-term review of the USAID Grant
number AFR-G-00-04-0000 1 awarded to WHO/AFRO for the prevention and control ofselected
communicable diseases and for reproductive health in Africa.
The current Grant was originally awarded in September 2004 and provided WHO/AFRO to date
with a total obligation ofTwenty Million, Three Hundred Twelve and Four Hundred One Thousand
United State~Dollars ($20,312,401) to support activities in WHO/AFRO's Division of Disease
Control (DDC), Division of Family and Reproductive Health (DRH), Division of Acquired
Immunodeficiency Syndrome (AIDS), Tuberculosis and Malaria (ATM).
The consultation involved different program areas supported with some of the USAID Grant
funds. The areas of work supported by USAID include:
ORH Division:
-Child and Adolescent Health (CAH),
-Sexual Reproductive Health (SRH),
-Materna) and Newborn Health (MNH)
ATM division: .
-Tuberculosis (TB),
-Malaria (MAL)
-HIV/AIDS (AIDS)
DDC Division:
-Communicable Disease Surveillance and Response (CSR),
-Communicable Disease Prevention and Control CCPC),
-Immunization, Vaccine Preventable Diseases (IVD)
In addition to the above work areas, the consultation also involved staff from the Division of
Health System Development (DSD) and the Partnership and Resource Mobilization Unit in the
office ofthe Regional Director.
The main purpose of the consultation was to review the progress made since the inception of the
Grant to date in various program areas .supported financially and technically by USAID and other
partners and to review the draft proposals for Grant period 2007-2008.
The meeting was opened by Dr Paul D. Lusamba, the WHO/AFRO Director of Progra,m
Management (DPM) on behalf of the Regional Director. He welcomed the USAID team and
highlighted the successful collaboration between USAID and WHO in addressing public health
priorities in Africa.
2" Objectives ofthe meeting
2.1. General Objective
5
To review program achievements from 2004 to 2007 and the draft proposals for the Grant
period 2007-2008.
2,2 Specific 9bjectives
2.1 To share infonnation on WHO/AFRO new strategic directions, organizational structure,
including new staff;
2.2. To review accomplishments from the inception ofthe Grant in 2004 to date;
2.3. To discuss USAID's new. development. aid programming directions, assistance
mechanisms, including the Africa 2010 Project, and timing for financial accruals and
activity reports;
2.4. To discuss how to fit the Grant better into AFRO's planning cycles and other partners;
2.5. To review the draft proposals to be considered for the next grant amendment
2.6. To agree on the way forward on the long proposed review of the NPO's and on building
capacity ofstaff at various levels on proposal writing and resource mobilization
3 Method of work
• Preparation by WHO/AFRO staff, prior to the review, ofwritten draft reports on program
achievements and proposals for the 2007-2008 period.
• Plenary presentations and discussions
• Meeting between the USAID team and each division to review and discuss progress
reports and the draft proposals for the Grant period 2007-2008.
4 Highlights ofthe review findings and.discussions
4.1 New WHO/AFRO strategic directions, organizational structure,
including new staff
Dr Lusamba, DPM, presented the new strategic orientations ofthe WHO "Action in the African
Region" for the period 2005-2009. The WHO Action in the African Region aims to uphold the
vision ofthe Agenda 2020 ofthe attainment by all peoples in the African region ofthe highest
possible level of health. WHO/AFRO Action is also in line with the WHO 11th Global Program
of Work, the governing bodies resolutions and the agency decentralization process.
The WHO/AFRO strategic orientations have also considered the opportunity provided by recent
international commitments on working toward reaching the Millenium Development Goals
(MDGs) and by initiatives such the Global Funds to fight AIDS, Tuberculosis and Malaria
(GFATM), Global Alliance for Vaccines and Immunization (GAVI), President Emergency Plan
for AIDS Relief(PEPFAR), the New Partnership for African Development (NEPAD) Health
Strategy, African Union resolutions and recommendations.
The five WHO/AFRO Strategic Objectives for the period 2005-2009 include:
1. Strengthening WHO support to countries
2. Strengthening health policies and systems
6
3. Promoting the scaling-up of essential health interventions
4. Enhancing response to the key determinants of health
5. Strengthening and expanding partnerships for health
Dr Lusamba underscored tbe challenges faced by countries in scaling up effective health
interventions, mainly to the weak health systems and the poorly coordinated partner's actions. At
the WHO level, he indicated that the two main challenges are the insufficient resources and tJ1e
bureaucratic process.
As part ofthe decentralization process, WHO/AFRO is undertaking are-organization ofthe inter￾country support teams (ISTs) to bring the technical resources closer to countries. It is anticipated
that the reorganization ofthe ISTs will also facilitate the integration and coordination ofWHO
support to countries.
In his prese"iltation, Dr Lusamba also explained the new Global Management System (GSM)
being put in place by WHO to streamline procedures and improve efficiency, transparency and
accountability. Finally he concluded his remarks by presenting the new WHO/AFRO
organogram.
Key discussion points
In response to questions raised by the USAID team on 1ST' composition, coordination and
operations, Dr Lusamba indicated that until the current reform, the ICTs were programme￾oriented, e.g. VPD, CSR, CAH, RPA, EHA. There was not much integration. They were located
in several places in the region. They have now been brought to three locations, Burkina Faso for
West Africa, Gabon for Central Africa and Zimbabwe for East and Southern Africa. He
explained the role ofthe 1ST coordinator who will be directly supervised by the Regional
Director. The 1ST members are all supervised by the 1ST coordinator as frrst level supervisor and
the divisional director is the second level supervisor and they will keep a link with the relevant
technical programs. The ISTs have a programme of work which derives from the AFRO Work
Plan; its budget is decentralized and there is no need for the regional office clearance for the
activities already approved in their program ofwork.
I'
4.2 Program accomplishments from the inception of the new grant
in 2004 to now
4.2.1. Report on achievernents by Division of Family and Reproductive Health
(DRH)
Dr. T. Ketsela, Director, Division of Family and Reproductive Health presented the
achievements, challenges and future perspectives in the three areas of work supported by the
USAID grant, namely Child and Adolescent Health including pediatric IDV, Maternal and
Newborn Health and Reproductive health and Research.
4.2.1.1 Child and Adolescent Health (CAH)
7
The USAID Grant provides support for selected WHO/AFRO staffworking on CAH activities: at
the Regional level: A CAB Regional Advisor; at sub-regional level, one medical officer for
Eastern and Southern Africa and one CAH Medical Officer ( 50% support from USAID grant)
based in Ouagadougou, Burkina Faso with responsibility for scaling up of child survival
interventions and for improving Family and Community practices. At national level, USAID
Grant supports 50% ofthe salary ofthree CAH National Professional Officers (NPOs) in
Ethiopia, Democratic Republic ofCongo (DRC) and Nigeria.
The Regional Child Survival Strategy for the African Region developed by WHO, UNICEF and
the World Bank and adopted by the 56th Regional Committee ofHealth Ministers in August 2006
builds on IMCI and broadens the approach. It advocates for the implementation at scale of a key
package of cost effective child health interventions.
Pre-service training in IMCI is now' being included in 80 health training institutions in 25
countries. In 2006/2007 IMCI pre-service was introduced in three (3) countries; established in
three (3) c-ountries; and, evaluated in one country.
In the area of improving health system, assessments ofthe quality of care were conducted in
Senegal and Mali and Emergency triage Assessment and treatment (ETAT) training courses were
conducted in Ghana, Zambia, Kenya and Malawi.
In the area of improving family and community practices, Senegal, Togo and Niger were
supported to implement community management of childhood illness.
4.2.1.2. Making Pregnancy Safer (MPS)
Capacity building for MPS activities at country level was strengthened by maintaining National
Professional Officers in Angola, Mozambique, Nigeria, and Tanzania. To date in these 4
countries the Road Map is elaborated, adopted and has been implemented through a joint budget
plan involving all partners
Increasing advocacy for maternal and newborn health at country level by the development- of
REDUCE/ALIVE advocacy tools and national Advocacy plans in 3 countries
Capacity of regional office strengthened by the recruitment of a Regional PMTCT Advisor to
support ten countries) in scaling up PMTCT activities including integration of PMTCT in
maternal, newborn and child health services, access to antiretroviral therapy, training in the
adaptation of the WHO PMTCT Generic curriculum and the development of roll out plan for
training.
Support provided to more than ten countries to develop a national road map and district
operational plan
Best practices on improvement of quality of MNCH care including community participation
francophone countries (Mauritania and guinea) and 2 Anglophone countries (Zambia and
Tanzania) documented and the process of dissemination on going.
Development of a Framework for the integration ofPMTCT, FP, MIP and NUT into MNCH
services developed.
1 Angola, Cameroon, Kenya, Lesotho, Mali, Uganda, Swaziland, Tanzania, Zambia and
Zimbabwe
8
4.2.1.3 Repositioning Family Planning (RHR)
The "Repositioning Fainily Planning (RFP) lO-year Framework" was adopted by the 46 WHO
African Member States in September 2004. This strategy aims to improve maternal and newborn·
health in the African Region through strengthening fa~i1y planning (FP) services. An advocacy
toolkit on RFP has also been developed to facilitate efforts for making family planning an agenda
for all sectors.
Technical support was provided to countries on Adolescent Health through the recruitment of a
Regional Advisor from 2004-2007.
The 4th Regional Reproductive Health Task Force including a special session on newborns was
held in October 2005 in Addis Ababa, Ethiopia. The general objective was to promote
community empowerment and resource mobilisation in the context ofthe implementation ofthe
Road Map for accelerating the attainment ofthe MDGs related to maternal and newborn health in
Africa.
A total of 20 experts including partners were oriented on integration of FP into RHMNCH
services.
4.2.1.4 Nutrition ,
Technical, material, and financial support was provided to
12 countries to develop national infant and young child
feeding (IYCF) strategy. Currently more than 26 countries
have developed national strategies on IYCF with
implementation plans. These countries are translating the
Global Strategy on IYCF into action by developing national
strategies based on the Global strategy,
Fig 1: Countries with national strategies
on IYCF in 2007 (26)
Ten regional consultants from eight countries and 25 participants consisting of20
Tanzanians and five (5) WHO staff were trained in the new Infant and Young Child
Feeding Counseling: An Integrated Course. These consultants were experienced regional
consultants that AFRO is using to build regional and national capacity in their Breastfeeding,
infant feeding, and mv counseling course.
Eleven countries developed a framework on Priority Action for infant feeding and HIV/AIDS
bringing the total of countries with such a framework to 20. 'Financial, technical, and material
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assistance was provided to eight countries to conduct national training oftrainers in the Integrated
Infant and Young Child Feeding Counseling Course.
4.2.1.5 Financial Report
(II) Budget summary 2004 - 2007*
Source Bud~eted Committed Disbursed Balance
USAID 1,750,000 1,750,000 1,478,460 271,540
CDC 100,000 100,000 98,159 1,841
French 198,758 198,758 43,053 155,702
Cooperation
European union 1,074,490 1,074,490 865,082 209,408
GTZ 165,929 165,929 165,929 0
HQ'" . 971,304 971,304 216,820 754,484 '
RB 9,793,137 9,793,137 8,924,137 869,000
Grand Total 14,053,618 14,058,618 11,791,820. 2,261,798
* As at 31 May 2007
USAID GRANT - FY06 (Oct. 06-Sep Total. Total Unobligated %
07) Grant Expenditure Balance utilization
IMCI 1,339,118 908,557 430,561 68
MPS 500,000 372,023 127,977 74
RHR 208,362 105,310 103,052 51
Subtotal. 2,047,480 1,385,890 661,590 68
USAID GRANT - FY05 (Oct 05 - Sep
06)
IMCI 900,000 895,608 4,392 100
MPS 750,000 606,437 143,563 81
RHR 200,000 189,116 10,884 95
Subtotal 1,850,000 1,691,161 158,839 91
USAID GRANT - FY04 (Oct 04 - Sep
05)
IMCI 1,145,820 1,145,820 0 100
MPS 500,000 500,000 0 100
RHR 208,450 208,450 0 100
Subtotal 1,854,270 1,854,270 0 100
Grand Total 5,751,750 4,931,321 820,429 86
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4.2.1.6 Challenges
More efforts are needed by national governments and partners to improve maternal newborn and
child survival outcomes because current efforts are way below what is required. Challenges in
implementing maternal ne~born and child health interventions include: inadequate resources for
scaling,;up MNCH, impl~mentation to achieve impact, mobilizing funds within countries,
including effective utilization of newly emerging sources offunding, and weak health systems.
4.2.1.7 DRH Future Perspectives
These include:
I. Rapid scale up of integrated child survival and maternal health interventions in priority
countries to achieve impact in reducing maternal and under five mortality,
2. Strenithening WHO regional, sub-regional and country capacity,
3. Increased emphasis on integration of activities with other units / programmes (Maternal
health, IMCI+MAL+EPI+NUT+HIV), linking RH and HIV programmes and services,
4. Increased attention to health system strengthening, increased emphasis on advocacy and
local resource mobilization (including tapping new resources),
5. Monitoring and evaluation to demonstrate impact.
4.2.1,.8 Key discussion points
• A set of indicators agreed on in 2004 should be used in monitoring progress.
• The reports should be enriched by adding mortality trends both for maternal and child
health.
'. Identify appropriate ways for accessing funding such as GAVI-HSS, GF, PEPFAR to
strengthen maternal and child health and nutrition. Two workshops were conducted to
build capacity of WHO/DRH staff and key consultants in developing integrated,proposals
to GF for Anglophone and francophone countries in April and May 2007.
• USAID requested that the financial report should show the portion of the grant that is
used for staffsupport and activities.
• If possible include in the report information showing how catalytic funds from USAID
has enabled AFRO to establish or strengthen new alliances and mobilize more resources
4.2.2 Report on Achievements by the Division for Disease Prevention and
Control (DOC).
4.2.2.1 Communicable Disease Surveillance and Response (CSR)
USAID support has contributed to the significant achievements of WHO/AFROs
Communicable Disease Surveillance and Response (CSR) in 2005-2006. Forty-three
(43) out of the forty-six (46) Member States of the WHO African region are
implementing the Integrat,ed Disease Surveillance and Response (lDSR) strategy. Thirty￾two (32) countries have achieved the target of training health workers in at least sixty
percent (60%) oftheir districts. 12 countries (Benin, Burkina Faso, Ethiopia, Gambia, Ghana,
Kenya, Mali, Malawi, Namibia, Niger, and Uganda) have introduced IDSR training in their
11
undergraduate and public health postgraduate training programs. All countries are
reporting trends on priority communicable diseases have been produced than ever before
and the use of surveillance and response information is being promoted through
generation of reports, feedback, and production of bulletins. The number of countries
producing weekly epidemiological feedback bulletin has increased from 24 in 2004 to.33 in 2007.
To enhance the regional office support to countries, a regional Rapid Epidemic Response
Network was established and its members (composed of epidemiologists, clinicians, social
mobilization experts, and logisticians) were oriented on the principles and standards of WHO
procedures for epidemic control. The network members participated in the investigation and
control of Ebola and Marburg outbreaks reported in Congo and Angola. Emergency stocks of
drugs, vaccine, equipment, and reagents were also made available to countries and fourteen
countries have elaborated their Epidemic Preparedness and Response (EPR) plans.
In 2006, the following technical support was provided to Member States to respond to major
outbreaks.
• Av'ian: Influenza: Nigeria, Cameroon, Niger, Burkina Faso, & Cote d'Ivoire
• Cholera: Ethiopia, Angola, Senegal, Uganda, Sao Tome and Principe, Tanzania and
Equatorial Guinea
• Meningitis: Burkina Faso, Niger and Uganda
• Yellow fever: Togo, Burkina Faso, Coted'Ivoire and Guinea
• Plague: DR Congo
• Rift Valley Fever: Kenya
• Chikungunya: Mauritius, Seychelles
A Regional ad-hoc expert panel and Working Group on pandemic influenza are in place to
support countries in the development of Avian and Pandemic preparedness and response plans.
All countries have prepared national preparedness and response plans for pandemic influenza and
put in place a multi-sectoral and multi-disciplinary task force to coordinate avian influenza
preparedness and response. Forty-two (42) countries participated in the inter-country avian
influenza training oftrainers training sessions. Four participants consisting of an epidemiologist,
clinician, laboratory expert ,and the DPC attended the course.
All major outbreaks that occurred in 2006 and first half of 2007 were laboratory confirmed
through the laboratory networks. The External Quality Assessment (EQA) in bacteriology has
been extended to cover the whole national public health bacteriology reference laboratories.
Sixty-nine (69) laboratories from all 46 Member States are currently participating in this program.
A regional network of laboratories has been established to support Member States in diagnosis of
H5 influenza. Technical support to countries experiencing "avian influenza outbreak was also
provided.
4.2.2.2 Immunization and Vaccine-Preventable Diseases (IVD)
WHO/AFRO's goal is to support Member States for implementing sustainable interventions to
control vaccine preventable diseases and achieve maximum impact on child survival. This is
being done within the framework of the "Regional Strategic Plan for· Expanded Program of
Immunization (EPI) 2006-2009" and the WHOIUNICEF "Global Immunization Vision and
Strategy" (GIVS) for 2006-2015 and will contribute to the attainment ofthe health targets of the
MDGs.
In 2006 the following priority program objectives were set for enhancing the routine delivery of
immunization services:
12
•
•
•
•
•
Focus support on the Big 4 (Angola, DRC, Ethiopia and Nigeria) and the countries
Central African Block ofWHO/AFRO
High advocacy on introduction or continuation of Hib vaccination
Support countries to improve data quality (DQS) and to develop Comprehensive Multi￾year Plans (cMYP's)
Ensure sustainable supply, quality and management ofvaccines
Support to integration through routine immunization
To reach these objectives, WHO/AFRO provided financial and technical support to 40% of
countries for comprehensive multi-year planning, use of data quality self-assessment tool as well
as vaccine management tools; seven (7) inter-country and 12 in-country training sessions were
held on MLM, vaccine management and regulation; and the first "African Vaccine Regulatory
Forum" was held to foster exchanges between African regulators and with others (U.S. FDA,
etc.). These efforts resulted in the following main achievements:
13
Routine DTP3 coverage rose from
73% in 2005 to 82% by end 2006.
Number of countries with DTP3 <
50% was reduced from 5 in 2005 to 3
in 2006.
Routine health services integrated
with childhood immunization
vitamin A (32 countries), anti￾helminthes (12 countries), ITNs (11
countries), promotion of breast
feeding, use ofORT for diarrheas,
etc.
2005
c:::::::J EMRO
.• _ S50%
=~O~~~% @ ~90%
Source: 200512006 JRF
2006
In the area of integrating immunization with other health interventions, several tools and a
"Strategic Framework for Integration of Child Survival Interventions" were developed and
disseminated. Several interventions were also delivered within EPI activities: Vitamin A, de￾worming, Health Education and ITN distribution (during campaign and routine). The roles and
responsibilities of VPD Surveillance Officers were expanded beyond AFP, measles and MNT to
include IDS & outbreak investigation & response, avian Influenza preparedness, IMCI
assessment and anti-retroviral therapy monitoring and evaluation.
The following priorities are set for 2007:
Increase & sustain routine immunization coverage through reaching every district (RED)
& integration with other child health interventions
Increase capacity ofimmunization services through:
Integrated training on EPI and child health
Updating ofEPI curricula in pre-service training
Networking among medical and nursing schools
Improve supply, availability & quality of vaccines through support to vaccine
management, regulation and procurement activities
Increase sustainability of national immunization programs through cMYP planning and
strengthening resource mobilization activities.
Regarding polio eradication, as of 23fd May 2007, 105 wild polio virus were reported in three (3)
countries (Nigeria, DRC and Niger) versus 377 for the same period in 2006.
Key Discussion points
The issue of country selection and rational for recruiting NPOs or international'staff was
discussed. Beyond giving priority to the big 4 (Angola, DRC, Ethiopia, Nigeria), other specific
criteria such as the magnitude of problem and reporting are used to select countries for posting
NPOs.
WHO/AFRO indicated that USAID seed funds are still needed even if other partners are now
funding the immunization campaigns. There is still a need to strengthen the routine
immunization service delivery system.. In the era of capacity building, IVP will continue to seek
and enhance the collaboration with DRH, DSD and other programs.
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4.2.3 Report on Achievements bythe Division of HIV/AIIJS, Tuberculosis and
Malaria (ATM )
Dr Rufaro Chatora, the Director ofthe Div~sion for AIDS, TB and Malaria presented the
objective ofthe division which is to fight AIDS, TB and Malaria. He indicated that the scope of
the USAID Grant covers Tuberculosis, Malaria and Pediatric HIV under the Division of
Reproductive Health.
4.2.3.1 Malaria Prevention and Control (MAL)
As part ofthe program activities supported by the USAID Grant and other partners, WHO/AFRO
has been able to develop and disseminate a set of guidelines and technical documents to inform
malaria pqJicy and program development in African countries. The technical guidelines
developed include:
- the strategic framework for malaria prevention and control during pregnancy which
provides strategic guidance for malaria control during pregnancy; and has been widely
disseminated;
- a statement was qeveloped and disseminated on the use sulfadoxine-pyreniithamine (SP) for
intermittent preventive therapy for pregnant women in African countries in light of increase
spread ofresistance to SP.
- the guideline for Malaria Strategic planning, ,has been reviewed and updated to facilitate
evaluation and development of national strategic plans;
- other guidelines were developed by AFRO in the area of Community based interventions,
Home Management of Malaria, Case management, monitoring and evaluation of malaria
programs.
Noted achievements have been reported in scaling up essential malaria control interventions,
including the expansion of IRS coverage in 2005-2006: over five (5) million structures were
sprayed, protecting more than 20 million people in 20. countries. The average operational
coverage was 84% ranging from 65% in Botswana to 98% in Madagascar. In Central Africa
epidemiologic bloc, coverage rates for the three countries deploying IRS were: 93.8% for Sao
Tome and Principe, 80% for Equatorial Guinea, and 60.8% for Angola. The distribution of
insecticide-treated nets has expanded: over nine (9) million insecticide-treated nets were
distributed in 11 countries in 2006, through antenatal clinics or in integration with immunization
campaigns. This was achieved in collaboration with the Immunization Program and partners. The
IPTp strategy is adopted in all the 35 endemic countries where it is recommended. Of the 35
countries 20 are already implementing the strategy country-wide and 15 are doing it in limited
areas
Regarding malaria treatment, in 2006 and 2007, six (6) additional countries were supported to
adopt Artemisinin-based Combination Therapy (ACT) policies and 14 countries received
assistance to implement and monitor the policies. To date, 39 countries have adopted ACTs
compared to seven (7) in 2003, and 20 at the end of 2004. There are currently 25 countries
implementing the ACT Policy compared to 4 countries in 2004.
Technical support has beeen provided to scale up the implementation of Community Based
Interventions (CBIs) in 15 countries. CBIs implementation profiles were compiled for 20
countries
15
WHO/AFRO has made significant progress in strengthening of partnerships to fight malaria. The
collaboration with the U.S. Presidents Malaria Initiative (PMI) has been very successful.
WHO/AFRO and PMI organized joint missions in 13 countries for field assessment, planning,
monitoring and evaluation (M&E) ofnational malaria program activities.
Global Funds for Malaria approval ~d funds disbursement have been improving sin~e 2004 as a
result ofsupport provided by WHO and partners for proposal development; grant negotiation and
implementation.·'
WHO/AFRO has also provided direct technical support to the 17 countries selected for the World
Bank Malaria Booster Program
With USAIDIMAC resources, technical and financial support was provided to Central Africa and
West Africa Networks for Monitoring' Antimalarial Treatment.
WHO/AFRO supported 12 countries (Kenya, Tanzania, Zambia, Rwanda, Ghana, Niger,
Burundi, Democratic Republic of Congo, Madagascar, Angola, Ethiopia, Botswana) to build
and/or strengthen national M&E systems including capacity building for data management.
AFRO also supported surveys such as Malaria Indicators surveys, Post ITN campaign distribution
surveys, and health facility survey to monitor the quality of the implementation of ACT policy.
AFRO produced the Africa 'Malaria Report 2006 and Country Profiles 2006. M&E staff salaries
were.paid thm the USAID grant.
For the financial report for the Malaria program, from 2004 to 2007 USD 20,130, 821 were
committed and USD 16,664,334 disbursed plus USD 2,166,363 for Program Support Cost.
Malaria financial report in US $ for the period 2004-2007
2004-07 Budeeted Committed Disbursed Balance
USAID 2,884,945 2,799,945 2,720,753 ·85,000
DFID 5,089,381 4,608,381 4,589,723 481,000
DFID-SAMC 3,970,099 3,889,861 2,608,330 80,238
CIDA 2,953,686 2,811,683 1,771,418 142,003
USAID-MAC 1,632,965 1,615,063 925,000 17,902
(MAL Only)
WHO-HQ 1,240,000 1,090,203 853,206 149,797
World Bank 1,442,478 417,685 0 1,024,793
Regular 2,898,000 2,898,000 2,898,000 0
Budeet
Subtotal 22,111,554 20,130,821 16,664,330 1,980,733
PSC (130/0) 2,166,363
Totals
4.2.3.1 Tuberculosis Prevention and Control (TUB)
In the WHO/AFRO program area of Scaling up ofCorrimunity TB Care, the number of countries
with plans and implementing CTBC has increased from 17 in 2004 to 30 in 2007. Malawi and
Uganda have reached country wide coverage ofCTBCservices. A positive outcome is the
16
reduction in default rates from 15% to <10% in 7 countries. The USAID Grant provided funds to
maintain staff positions at the regional office (RO) and WHO country offices (WCO) to support
CTBC activities.
WHO/AFR has provided technical and financial assistance to Kenya, Malawi and Uganda to pilot
test approaches for improving quality of interventions in CTBC. The results ofthe pilot test
would soon be made available.
Regarding TB/HIV activities, by December 2006, 34 countries have been supported to implement
TB\HIV interventions. These involve screening for lIlV in TB patients and for TB in HIV\AIDS
patients. As a result, Tb patients accessing HIV testing, preventive treatment and ARVs are
increasing.
In general, the TB case detection rate has leveled offsince 2003 and perhaps declined slightly in
2005. The treatment success rate has not changed much since 1999 though there is a slight
increase in 2005; however Africa remains far from the set targets for 2006. The possible
explanations include the effect of HIV; overestimation ofthe number of cases and of course high
default rates. There is a need to undertake research to establish reasons behind these trends.
The TB financial report showed USD 3,716,799 Committed and USD 3,258,782 disbursed
TUB financial report in US $ for the period 2004-2007
Source Budgeted Committed Disbursed Balance
USAID 3,716,799 3,716,799 3,258,782 458,017
HQ 1,151,800 1,151,800 1,151,800 59546
RB 0 0 0 0
Grand
total 4,868,599 4,868,599 4,410,582 517563
Dr. Chatora concluded the presentation by underlying the good progress in malaria control which
needs to be consolidated and to focus on improving quality ofservices in prevention and
treatment. He also highlighted the need to ensure improvement in key tuberculosis indicators and
quality ofservices.
Key Discussion points
• The USAID team expressed the need to know more about the AFRO AIDS programme
beyond the PMTCT and pediatric HIV care already funded under the current grant. The
focus for AFRO is mainly on PMTCT; Pediatric care; strengthening health system
including diagnosis and laboratory capacity; surveillance, monitoring and evaluation
including drug resistance; male circumcision, and ART expansion.
• The issue of a TB focal person and technical documents for advocacy, communication
and social mobilization was raised by USAID. The process to recruit that person is
ongoing and will be finalized shortly. AFRO is also working to finalize the regional
strategy for advocacy and social mobilization
• The importance of MDR/XDR TB was also discussed. AFRO has now a dedicated
person based in Harare to work on the issues si~ce the problem is more in Southern
Africa.
17
• The USAID team enquired about WHO collaboration with the GFTAM. AFRO is
supporting the countries for capacity building in proposal development, grant negotiation
and implementation.
• The issue of malaria Monitoring & Evaluation in a context of multiple partners was
raised. The malaria program is·working with WHO Global Malaria Prograt11 (GMP),
Roll Back Malaria M&E Reference Group (RBl'A/MERG) and PMI to harmonize the
approaches' and indicators for M&E. The grant period 2007-2008 will continue to focus
_on M&E. AFRO is also planning with PMI, World Bank and other partners to support 10
to 15 countries in 2007 to develop and cost M&E plans
• The issue of household ITN possession and use after mass distribution campaign was
raised. AFRO is working with partners such as CDC and the measles malaria partnership
to undertake post campaign survey to monitor the usage of ITNs and to advice countries
to take corrective action when necessary
• The USAID team appreciated the good collaboration between WHO and PMI
4.2.4 Presentation by the Division for Health System Development (DSD)
It has been noted that the efficiency and effectiveness of all interventions against the priority
health problems (HIV, Malaria, TB, and MCH) depend highly on functional health systems. The
WHO/AFRO Division of Health Systems and Services Development (DSD), is tasked to provide
technical guidance for strengthening Health Systems ~o countries in the African Region.
DSD is providing support to countries to strengthen or build integrated primary health care by
reinforcing. the national and district health.systems functions of stewardship, health financing,
resource creation, and better services delivery through (i) the development and implementation of
community oriented health policies and realistic plans within the context of national socio -
economic development; and the improvement of health services performance in terms of quality,
effectiveness, efficiency, coverage and equitable accessibility. The assistance to countries is
provided through the three (3) Inter-Country Support Teams in Harare, Libraville, and
Ouagadougou, the Country Offices and a number of collaborating centres and institutions.
During the current biennium, DSD's emphasis is on: (i) the strengthening of.leadership in health
(Conducting Health situation analysis; Developing national policies and strategic plans;
Developing partnership mechanisms (SWAPs, PPP, intersectoral collaboration); Linking health to
other national development frameworks (e.g. PRSPs, MTEFs); Managing health reforms;
Enhancing intelligence and evidence generation and use); (ii) supporting policy implementation
(Essential medicines supply and management; Blood safety; Health systems research; Health
information systems; Quality of care; Health Financing and National Health Accounts) and (iii)
supporting improving in service delivery (operationalization of district health systems through
primary health care (PHC) strategy; strengthening health referral system; establishing and
supporting the health system-community interface
The Division is currently leading the task force on scaling up essential health intervention that
comprised all the priority programmes. The aim is to discuss and agreed on integration issues at
the district level.
The potential areas of collaboration are:
• Health systems capacity building and improving performance
• Production and retention ofskilled health worker
18
•
•
•
•
•
Improving quality of health care and access to safe blood and essential medicines
Strengthening regulatory capacity for pharmaceutical sector
Community empowerment and non-state sector participation in health development.
Strengthening ofNational Health Inf')rmation Systems
Monitoring and Evaluation ofNatioflal Health Systems
Key Discussion points
During the discussion, a number of issues were raised including the partnership with ·NGOs and
donors for the strengthening of national health systems, and the Health Manpower strategy for
Africa. USAID will explore ways to provide seed money for some DSD activities on health
systems strengthen·ing. It was agreed to exchange information with the division on health
systems related issues. USAID expressed its interest to work with AFRO in the task force for
scaling up essential health interventions. Africa 2010 has expressed interest to work with AFRO
in the natiorialhealth Account.
4.3. USAII)'s new development aid programming directions and assistance
mechanisms,
Ms. Mary Harvey assured the audience that the African Region is still a priority for USAID
despite the proposed changes in the USG programming directions. She highlighted the need for
standardized in~icators for reporting and also for i~proved coordination and collaboration with
the various partners in the field in order to impact the burden of diseases and health conditions in
the African Region. Ms. Harvey reminded the meeting about the need to review NPO's work and
see how it influences the countries performance. She expressed USAID commitment for more
collaboration with AFRO and expressed her satisfaction about the partnership with AFRO.
As far as Grant management and reporting are concerned, Ms. Harvey indicated that USAID
fiscal year runs from October 1st to September 30th• The format for annual reporting on activities
was agreed upon since 1999.. USAID expects to receive the annual report of Grant
implementation by m~d September.. Quarterly financial accrual reports are regularly sent and
help a lot to build confidence between USAID and WHO. Some USAID bilateral missions have
provided funding for the grant. It is suggested that for those countries, quarterly accruals should
be provided to the local USAID mission by the WHO country office (WCO). This interaction at
country level would be an opportunity to build partnership, between WCO and USAID missions.
The next quarterly accrual,report should be submitted by mid June 2007.
Ms Mary Harvey has promised to give more information on new developments on the USAID
side that might affect our joint activities. She requested that USAID and WHO/AFRO explore
how to fit better the Grant into WHO/AFRO planning cycle.
4.4. Review the draft proposals to be considered for the next grant
amendment
The USAID team met the different divisions and programs to review the reports and different
proposal component. Reports from the divisional meetings are attached in annex.
19
4.5. Proposed review of the NPOs and building capacity of staff at
various levels on proposal writing and resource mobilization
During the joint USAID, DFID and WHO/AFRO review meeting in 2005, it was r~commended
to undertake a review oftl1e NPOs work From AFRO perspective and experiences the ~NPOs are
playing a critical role in the success of different programs at country level. The new AFRO
decentralization process has provided an opportunity for·the weos to perform are-profiling
exercise which will enable them to identify the required position based on country specificities
and priorities.
WHO recognizes the need to have strong staff with critical mix ofNPOs and international in its
country offices. It is also recognized that the quality ofNPOs vary from country to country.
There are several reasons to undertake NPOs evaluation:
An important portion of funds from grants provided by partners to WHO/AFRO is used
to recruit NPOs
Some bilateral partners are not well informed about the work ofNPOs;
Documenting NPOs achievements and success stories can provide materials for use to
advocate for them and secure their positions by mobilizing more resources from partners.
A review of NPOs will also provide an opportunity to get feedback on the RO and 1ST
support to NPO and interaction between NPOs working in different programs;
A review can also look at the function NPOs are performing compared to their original
terms ofreferences and to identify the need ~or capacity strengthening in specific areas.
After fruitful exchanges a consensus was reached to organize the NPOs review. The first step
will be to agree on the terms of reference and methodology for the review and to identify the
source offunding for the exercise.
The issue of capacity building for proposal development was raised as a way.for
WHO/AFRO to think about how mobilize new partners and resources to support various
programs. A training was organized in 2005 for DRR staff, unfortunately, the follow up after
training was not so good. Both WHO/AFRO and.USAID welcome the idea of capacity
building for proposal writing and resource mobilization strategy to diversify secured sources
offunding for regional, sub-regional and country programs. The WHO/AFRO Partnership
and Resource Mobilization Unit will prepare a concept paper to inform dialogue with USAID
and other partners on how to help WHO/AFRO in this area ofresource mobilization.
5. Way forward/ Action Points
1. WHO/AFRO programs to prepare the accrual reports for the 3rd quarter by mid June
2007;
2. WHO/AFRO staff to revise the 2007-2008 proposals to·incorporate suggestions from the
meeting and to interact with relevant focal persons at USAID. The Draft proposals
should be submitted to Mary Harvey by the first week in July.
3. WHOAFRO staffto revise the draft annual reports based on the deliberations during this
meeting and to prepare the final annual report by mid September 2007
20
4. USAID and WHO/AFRO will continue to strengthen the partnership and collaborate with
different initiatives such as Presidential Malaria Initiative (PMI) and PEPFAR. And with
USAID Projects and in particular Africa 2010 Project,
5. WHO/AFRO is invited to send a high level team to Washington to consult with
Presidential Malaria Initiative team
6. WHO/AFRO to hold a consultation to improve malaria partnership coordination
7. USAID to provide information as soon as possible on the planning cycle
8. WHO/AFRO and USAID to prepare the terms of reference for the NPOs review and
identify the source offunding.
9. USAID and WHO/AFRO to agree on the best way to organize the capacity building of
staff at regional, ICT and WCO for resource mobilization
10. DSD to send a concept paper for potential support by USAID using up to $100,000
coming from support provided to the three divisions to be funded under the current Grant.
21
Annexes:
Annex 1: Agenda ofthe Consultation "
DRAFT PROGRAMME OF WORK
JUNE 05
09.00 - 09.30:
09.30 - 10.00:
(DPM).
10.00 - 13.15:
10.00 -10.45:
10.45 -11.00:
11.00 -11.45:
11.45 -12.30:
12.30 -13.15:
13.15 - 14.30:
14.30 - 15.15:
15.15 - 16.00:
JUNE 06
09.00 - 12.30:
12.30 -13.30:
13-30 - 17.00:
JUNE 07
9.00 - 12.30:
Courtesy visit to DPM.
Overview ofWHOIAFRO strategic orientations and new structure
Highlights by ATM, DDC, DRH and discussions on:
• Grant accomplishments (achievements and financial reports)
• Perspectives based on draft biennial plans for 2008/2009
• Perspectives by DSD
DRH
Coffee break
DDC
ATM
DSD
Lunch with ATM, DDC, DRH and DSD
Overview of USAID new development AID programming directions
and processes
Discussions (ctd).
(19.00 - 21.00: Diner with DPM, ATM, DDC, DRH, DSD)
Working session with ATM Team
Lunch
Working session with DDC Team
Working session with DRH Team
22
12.30 -13.30:
13-30 -17.00:
JUNE 08
09.00 -12.30:
12.30 -13.30:
13.30 -16.30:
16.30 - 17.00:
JUNE 09
Lunch
Working session with DSD Team
Working sessions with Divisions (ctd)
Lunch
Identification and prioritization of cross-cutting activities:
Way forward on the review ofthe NPOs, strengthening capacity for
Grant proposal development, Grant amendment process,
management and reporting.
Wrap up and closure of consultation.
USAID team members continue informal meetings with selected Directors and
Advisors. '
23
Annex 2: Notes from the USAID Team meeting with
WHO/AFRO Divisions
Minutes ofthe USAID and ATM meeting 06 June 2007
Introductory remarks
Dr Chatora"w~lcomedthe USAID team and asked for suggestions on how to proceed. Ms.
Harvey suggested to first review the progress reports before examining the proposals. She
informed ATM about the change ofmalaria focal persons within USAID. She highlighted the
PMI expansion to 15 countries in the African region and the important partnership with WHO.
Ms. Harvey also appreciated the use by Tuberculosis and Malaria Units ofthe format previously
agreed upon to prepare their reports.
Review of Malaria report and proposal
The USAID team asked for inclusion ofthe table on the budget report by expected results and for
clarifications on the table in annex 1 reporting on some indicators. The Malaria team explained
that the annex 1 table is for reporting on indicators for the current AFRO biennium and indicated
that the table on budget report be included into the 'final report.
The USAID team indicated that the Annual Report on the accomplishment for the grant period
2006 - 2007 should be prepared by September 2007. In that report, the malaria program will
need to emphasize the impact of interventions. USAID is also expecting to see countries reports
from Rwanda, DRC to be reflected in the regional office one. It is suggested that WHO provides
quarterly accruals and the annual report to the local USAID missions such as in Rwanda and
DRC who have put some funding in the grant. This interaction at country level would be an
opportunity to build partnership, between WCO and USAID missions. The next quarterly
accrual report should be submitted by mid June 2007. .
The issue of M&E in a context of multiple partners was raised: The malaria program is working
with GMP, RBMlMERG and PMI to harmonize the approaches and indicators for M&E. The
Malaria Indicators Survey (MIS) built consensus for household surveys and is being used by the
different partners. More work is still to be done to harmonize the health facility survey. WHO is
promoting the IMCI tools for health facility surveys which have been used for several years to
monitor the quality ofmalaria treatment. Dr Duale suggested to disseminate M&E guidelines and
other tools to health training institutions such as public health schools and nursing schools.
WHO guidance about ACT at community level was also discussed: WHO recommendation is
clear: the first line drug for malaria treatment should be accessible and used at community level.
With the new ACT policy, pilot studies are carried out in some countries to document the
feasibility of community management of malaria with ACT using community health workers.
24
The Africa 2010 project expressed its willingness to work with WHO/AFRO to document and
disseminate the experiences and lessons learnt about the use ofACT at community level as well
as countries experiences on ACT pharmacovigilance.
The USAID team requested clarification about the shift of activities as compared to last grant
period and wanted more attention be given to M&E and the support to PMI activities.
Improvement will be made on these areas. More justifications will be needed in the proposal for
the changes in staff proposed to be paid under the grant. The role ofIDSR for malaria, TB and
HIV surveillance was also discussed including the laboratory surveillance which is a key
common area identified within the AFRO ATM Division.
Final recommendations: To improve the proposal and facilitate better understanding by
indicating specific normative and technical assistance provided and by emphasizing WHO
comparative advantage and strategic orientations The final proposal is expected to be ready by
end ofJune, early July
Review of TB report and proposal
More information was requested about the sources offunding for WHO/AFRO TB program. The
Italian funds are earmarked for countries and the NORAD funding terminated last year. There is
a need to report on the impact ofthe implementation,of quality care, the development of
advocacy guideline and the guideline for community care that were mentioned as critical
activities to be implemented in the previous grant period.
The USAID team mentioned the need to link the NPO's work to the performance at country level
since an important part ofthe grant is used to pay the NPO's salaries. The annual report on the
activities carried out with the USAID TB Grant for DRC is expected from the country.
The USAID team requested clarification about the shift offocus on the activities for the next
grant period. It seems that the focus is more on MDR, XDR/TB and less on community DOTS
and other prevention interventions. WHO/AFRO will continue to strengthen community DOTS
in order to make sure that the TB indicators are improving. The Director of ATM Division
indicated that DOTS remains the main strategy for TB in AFRO and it was taken into account
during the re-profiling exercise at the regional office and 1ST levels as well as the plan of action
(POA) for 2008 - 2009.
In revising the TB proposal will focus on the original priority areas ofthe grant and provide more
justification about the need to address MDR, XDR TB.
WHO/AFRO proposes to conduct epidemiological sub-national studies in selected countries in to
provide data for model for better estimates ofTB cases. The general impression is that the
number of expected cases has been overestimated as evidenced by a study carried out in Eritrea.
Dr Sukwa will share the report with the USAID team. WHO/AFRO would like to explore the
possibility for Africa 2010 to collaborate in this specific area.
The issue ofrecruitment for the advocacy, communication and social mobilization focal person
was discussed. The process to recruit that person is ongoing and will be finalized shortly. It is
important for AFRO to have that person because in many ofthe GFATM approved proposals for
the TB component, advocacy and communication represent an important part and countries will
25
need technical support. Africa 2010 is ready to collaborate with WHO/AFRO and ECSA Health
Community in capacity building for TBadvocacy, communication and social mobilization.
Clarifications were provided about the issue of data base for TB drug resistance monitoring.
Briefing on AFRO AIDS Program
USAID is providing financial support for OVC, PMTCT and pediatric HIV through the Division
ofReproductive Health (DRH) but wanted to know more about the overall AFRO plan and
potential needs and AFRO's partners and relationship with PEPFAR..
AFRO's first priority is to maintain staff at regional, country level and to recruit stafffor the 1ST
level in order to continue to ensure the WHO technical role. Sixty-four NPOs and 24
international staff are already in place at country level and the recruitment at 1ST level is going
on. Additional countries like South Africa, Guinee Bissau, and Liberia have requested
international staff.
Expansion of HIV in post conflict context has been acknowledged and WHO/AFRO plans to
document lesson learnt and best practices to share and disseminate. USAID is willing to assist
with resource mobilization for Liberia by linking the USAID mission and WCO.
Given the epidemiological context, the focus on PMtCT and pediatric HIV is a very important
approach in the African region. VCT is still low and needs to be reinforced. The main areas of
focus for AFRO are: testing and counseling; surveillance to monitor the trend ofthe disease;
Drug resistance monitoring; lab capacity building; procurement and supply management system;
capacity building; treatment and care including at community level. ,
The role ofWHO/AFRO is mainly to support countries for strategic planning and
implementation, monitoring and evaluation ofHIV/AIDS programs. WHO/AFRO's role in the
partnership coordination and alignment is also very important. WHO/AFRO plans to very
quickly develop simplified guidelines for use at community and health center levels to address 3
ATM diseases. The USAID team emphasized the need to collaborate in the area ofwater
sanitation and .hygiene on interventions to prevent diarrheal disease for AIDS patients and also to
prevent water borne diseases such as cholera.
Additional Discussion Topics
The issue ofRBM partnership coordination with WHO was discussed. It is noted that while the
RBM structure is clearly set up at global level, there is still some confusion at regional and sub￾regional levels. This situation has for some time created confusion between WHO staffwork and
RBM activities at inter-country and country levels. It is important to find the best way to work
together by clarifying the roles and responsibilities of different RBM partners. The Director of
ATM Division will attend the next RBM board meetings to represent AFRO. WHO/GMP and
WHO/AFRO are also contributing to the technical working groups within the RBM partnership.
The collaboration with PMI and World Bank booster program and measles malaria partnership
has shown good result at country level. It is important for WHO/AFRO to organize a
consultation meeting of partners to discuss better collaboration of partners' interventions in the
region.
26
ATM, MAL and the USAID team had a teleconference with Ms. Hope Sukin and Dr. George
Greer ofUSAID Bureau for Africa in Washington to discuss the Grant review and RBM issues
and agreed on that WHO AFRO should CCI!vene a consultation to improve partnership. USAID
invited AFRO to send a high level team to \Vashington to consult with the PMI team.
Way forward
1. Malaria and TB programs to prepare report on accruals by mid June
2. Malaria and TB programs to revise the proposals after the meeting and to interact with
relevant focal person at USAID and submit the proposals by the first week ofJuly.
3. Malaria and TB programs to prepare the annual report by end of September
4. Malaria program to continue the collaboration with PMI for scaling of essential
interventions and monitoring and evaluation
5. AFRO to prepare a high level team visit to PMI in Washington later this year;
5. TB'program to advocate for a study to provide better estimate ofTb cases
6. TB to keep USAID and Africa 2010 updated on progress in hiring the TB ACSM
Advisor and planned activities;
6. RPA to continue the discussion with USAID for future collaboration beyond the pediatric
HIV and PMTCT and especially for the support to Liberia
7. AFRO to convene a malaria partnership meeting by end of 2007
8. ATM programs to consult further with Africa 2010 Project for future collaboration
Minutes ofthe USA/DIODe meeting 06 June 2007
Discussion with IVD team
Ms Mary Harvey drew the attention ofIVD on the necessity to use the same format sheet as the
other units and on one indicator under "Maternal and Child Health", namely the number of
countries receiving support. She appreciated the report on progress and challenges from the
countries where USAID supports the positions of NPOs to support routine EPI. The USAID
Missions appreciate the NPOa The Senegal WCO regularly informs USAID mission on progress
in immunization. Se was pleased to acknowledge the VPD Annual Report was one ofthe best
reports but the revised report should include the support provided by other partners and follow the
format established for Grant reporting in 1999.. She also wanted to discuss with VPD the
detailed comments from USAID Missions as well as the criteria for selecting countries.
Regarding polio, she had concerns about the Regional Communication Officer being posted in
Nigeria, far from the rest of the team. VPD promised to give her the reasons behind the decision
to post the Communication officer in Nigeria.
Regarding the VPD Routine Immunization proposal, the following remarks were made:
- The objectives need to be aligned with those ofthe Regional Strategic Plan
- Talking about integration, there is a need to make the distinction between the impact of
CHDs and real routine activities
- The wording "sustain coverage" posed problem as the goal is to increase coverage instead
The support to service delivery in Nigeria must go beyond IPDs and· address routine
immunization services in the South as well
27
- A budget must be secured for using NPOs from some countries to support less performing
countries
A list of all staffsupported with USAID funds should be provided
- USAID/Liberia obligated 100,000 to WHO/Liberia.- A clarification is needed as.to the status
ofthis Grant was requested. .
- USAID would like to receive more information on the work done in training (details on
training meetings to enable USAID participation) and the work on integration (copies of the
produced documents to USAID)
USAID will send AFRO the draft report of a meeting held in Washington between GAVI,
UNICEF and WHO
Immunization Basics is satisfied with the collaboration with WHO/AFRO and would likeg to
continue to provide support in the areas oftraining and RED implementation
- USAID could provide experts to support communication activities
- The Africa 2010 has technical expertise, which could be made available to AFRO in the areas
of monitoring and evaluation, advocacy, communication and dissemination, health financing
and system strengthening.
Discussion with CSR team
Dr. Yada, acting DDC, asked Dr. Allanrangar, responsible Advisor for Epidemic Preparedness
and Response (EPR) to give an overview ofCSR activities and achievements
After the presentation and discussions, it was suggested that specific activities conducted with
USAID funds for AI (e.g., January AI meeting held in Brazzaville, regional lab network for
diagnosis of H5N 1) should be added to the narrative.
USAID has developed a new set ofindicators which should be reported in addition to the current
ones in September 07.
Ms. Harvey informed the CSR Team that USAID could contribute an additional $500,000 for AI
activities to complement the CDC funds. It is suggested that these funds might be used to fund
1ST positions in West Africa (Epidemiologist in particular). It was pointed out that the Central
Africa block has similar personnel needs. There is also a critical need for contingency supplies at
regional and 1ST levels .USAID suggested that CSR may need to revise the budget proposal to
include contingency supplies.
The CSR team stated that with the conversion of ST position·s to FT posts, allocation for staff
support need to be increased. The CSR revised funding proposal will be submitted by next week
including job descriptions for requested positions.
Ms.Harvey and Dr. Duale shared with the team the report on the recent meeting with CDC and
USAID OFDA on Cholera. Dcouments from The WHO/AFRO meeting and an internal meeting
held at CDC were shared. The idea was to move beyond just preparing cables, but develop a
more proactive and comprehensive approach to cholera. This might include a joint activity to
comprehensively address the problem in one ofthe Cholera affected countries. It was suggested
by USAID that AFRO might convene a multi-partner meeting. The USAID/AFRO/CDC joint
cable for cholera was also submitted as it was thought that some ofthe actions in the cable might
be useful in the development ofthe proposal·on cholera to be presented at the next regional
committee
28
The meningitis situation was also discussed and Ms. Harvey provided a draft cable for
WHO/AFRO review and input. The cable will be sent in advance ofthe next season.
Minutes ofthe USAID/DRH meeting 07 June 2007
The Director of DRH Division, Dr. T. Ketsela welcomed the meeting. She requested that
each unit presents its report and proposal followed by discussion.
Mrs Harvey in her remarks recognized the fact that DRH has always been timely in
submitting accruals and thanked the division for preparing good reports. It was
highlighted that Dr.. Bartley before retiring in November 2006 had trained one national
officer to prepare accruals and as such the regularity should be maintained.
Dr. Duale, in his remarks observed that from a recent mission he conducted in Sierra
Leone, it seems like guidelines developed by WHO are not reaching training institutions.
Efforts should be made to disseminate widely WHO guidelines.
Reports
It was advised that the format used since the inception' ofthe current grant in 2004 should
be followed for annual report. An example of a malaria report was provided.
Reports should show the contributions of other partners- this is good to show that there is
collaboration and partnership.
Reports should show the achievements beyond reporting activities implemented. It is
important to include in the report information from countries where an activity
implemented lead to change in policies, improved coverage in key child survival
interventions, improved community practice in care seeking etc..
It would be useful to have more information on countries where NPOs supported by the
grant are posted (e.g CAH: Ethiopia, DRC and Nigeria, MPS: Angola, Mozambique,
Nigeria and Tanzania) in a way to show the contribution of NPOs to health programmes
in those countries and demonstrate the added value of NPO's presence in the country.
NPOs should be encouraged to link with.USAID missions at country level to strengthen
WHOIuSAID partnership.
As much as possible the report should include information coming from countries on
what happen after a strategy such as child survival strategy or Road Map on Maternal and
Newborn had been adopted and how implementation is progressing.
Generally it was felt that we under-report our work. There has been more. work that has
been done than what is reported. Hence the importance of having country reports in a
timely manner.
29
When changes have occurred during the course of the implementation of the grant, e.g
staff moving from voluntary funding to regular budget funding, it should be highlighted
in the report.
There is a need to be more detailed especially in stating the number of countries
supported rather than stating" a number of countries"
There was a need to explain the criteria for selecting countries supported. It was
explained that the criteria used include the following: high levels of mortality rates form
mothers and children, high burden of disease, government readiness to address the health
problem, among others.
, There is a need to harmonize the expected results with the indicators, baseline and targets
as defined'in the initial main grant proposal in 2004.
It is always useful to report on activities which have been implemented in an integrated
manner demonstrating strong collaboration of programmes at regional and country level
Partnership between VPD and CAH in training and implementing child survival packages
was highlighted.
It was highlighted that efforts should be made to capture what use has been made of
M&Edata. '
Proposals
USAID mission request that the same formulation of the grant title and expected results
be kept and ifthere are difference, provide some explanations.,
It is useful to indicate if other partners are contributing to the achievement of a particular
expected result. Also useful to indicate that the proposed activities are included in the
DRH POA and is consistent with Regional Expected Results. .
Child and Adolescent Health Programme and Maternal Health Programme agreed that
CAH will implement activities listed under neonatal care and treatment as the newborn
care focal person is in CAH. However these activities will be implemented in close
collaboration with maternal health unit ofDRH.
It was agreed that DRH programmes managers should continue the dialogue with various
focal persons at USAID and finalize the proposals.
USAID mission asked reasons why the TaskForce was no longer among activities to be
supported in the next proposal. It was explained that after the last task force meeting in
October 2006, the Regional Director had provided orientation to set up .an Advisory.
30
Committee on Maternal and child health in line with WHO rules. A proposal was made
and is with the Regional Director for approval.
Tables including the outputs, activities and proposed budgets were reviewed and " corrections proposed.
Next steps
1. Programmes to prepare the accrual report for the second quarter by end of
June 2007
2. Programmes to finalise the reports by end of September 2007
3. Programmes to review proposals based on comments made, interact with
.USAID focal points and finalize them. The proposals should be signed by 30
September 2007.
Minutes ofthe USAIDIDSD meeting 07 June 2007
The USAID team met with DSD advisors to discuss cross-cutting areas of collaboration with
other Divisions for the strengthening of national health systems; The discussion focused on issues
related to health information systems and monitoring and evaluation, essential medicines and
human resources development for health.
Health Information Systems and monitoring and evaluation of
national health systems
The Health Information System (HIS), has four sub-functions, namely data generation, data
management (storing, processing, dissemination, communicating and sharing), data analysis and
reporting, and data use. In fulfilling its functions, the HIS draws upon a number ofsub-systems:
Population-based sources (vital registration system, household surveys and census) and Service￾based sources (health status record, service provision record and administrative record systems).
Issues related to community based health information systems, improvement of immunization
coverage rate and vital registration of births and deaths have been discussed. There is a need to
assist countries to build a monitoring system for district health systems that cuts across all
diseases and to strengthen the national health information systems to provide timely and accurate
information for decision making.
The USAID Team brought up the ongoing work ofthe Health Metrics Network and advised to
continue to work closely with them. For the improvement of immunization coverage rate and
health system issues, it was agreed to exchange the experience of polio programme and link with
Experts working in this field in Nigeria and Ethiopia.
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Essential Medicines
Regular availability of affordable essential medicines play crucial role in the delivery of health
services. However, in most countries in the African Region, procurement and distribution systems
are weak and lack adequate resources to support their efficient operation to meet the increasing
demand. In order to address these challenges and .improve accessing medicines, adequate
resources and collaboration with partner organizations to·strengthen national medicine supply and
distribution systems is essential.
Some ofthe activities that can be done together with other priority programs include:
• developing tools for quantifying and forecasting ofmedicines;
• assisting in the preparation of national procurement and distribution plans;
• ,training personnel on effective supply chain management
• strengthening supply chain management information system and
• monitoring and evaluation ofsupply systems
Human Resources for Health
There is an unprecedented crisis of human resources for health (HRH) which is limiting access to
effective health services, particularly the poor and the most vulnerable, and hindering the
progress towards health development goals and targets such as the Millennium Development
Goals (MDGs).
Some ofthe challenges/issues discussed:
• Technical capacity in human resources strategic planning and management is weak in
most countries. There is lack of coordination between human resources planning and
production. One contributing factor is that the HRH units are weak in terms of
capacity/skills and cloud to enable them to strategically tackle and monitoring the
complex HRH situation in countries.
• Shortage of health personnel in terms of numbers due to low production of health
workers (training institutions unable to produce and replenish the diminishing stock of
health workers) as well as due to migration of health workers. It is estimated that Africa
needs approximately 1,780,057 million2 health workers (i.e. doctors, nurses, midwives
and other health workers) compared to existing that are 1,183,325 professionals.
Furthermore due to long term of underinvestment in the overall health sector and HRH
development in particular, has led to current under production of health workers in
sufficient numbers to replace those who. have left and pay for the retention efforts made
by countries
• De motivated staff due to poor remuneration; working conditions and distribution ofstaff
seriously affect the capacity of countries ofthe region, and hamper policy, planning,
development and implementation of key health interventions.
• Each priority programs focusing on integration of its program into pre-service nursing
and medical curriculum instead ofstrengthening the HRH division to strategically work
with institutions and review curricula comprehensively.
2 World Health Organization Regional Office for Africa 2006. Human resources for health statistics.
Working document, Brazzaville, Congo.
32
The response to the HRH crisis is gaining momentum at all levels. More stakeholders, partners,
alliances, networks and platforms for supporting the HRH agenda and committing resources have
been established to address human resources for health issues. For example, the creation ofthe
Global Health Workforce klliance at internationalleveI.
The operations and functions ofthe HRH team at regional level were explained. It was
explained that the Regional Office does not have a Human (manpower) resources Plan for Africa,
however the programme operates under the guidance ofthe Regional Strategy for the
development of human resources. The programmes function and provides technical support to
countries under four main components:
• Support for development and reviewing and implementation of human resources
for health plans and policies;
• Support for strengthening the education and training systems in countries
.' .Support to strengthening human resources management capacity (including
motivation and retention strategies, etc)
• Generation ofInformation and research (HRH observatory)
Possible support/partnership with USAID
To champion the reversal ofthe HRH crisis within the context ofMDGs when making
decisions /resolution on priority health programs/disease by including in grants to priority
programs not only aspects of capacity building/training, but to have inbuilt motivating
factors/benefits that will contribute to the retention of health workers.
Support for Regional Office short term'staff and NPO in some crisis countries to support
governments efforts;
Support for generation of evidence and research in HRH
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Annex 3: List ofParticipants
Organisation/ Name TellEmaii
WHO Division
USAID Dr. M. Harvey 202-712-5483
Dr. S. Duale maharveY@usaid.gov
202-884-8809
sdualertUaed.ore:
DPM Dr. P. Lusamba-Dikassa
ATM Dr. R. Chatora
Dr. R. Vaz
Dr. G. Ki-zerbo
Dr. T. Sukwa
Dr. S.Fall
Mrs. V. Mfungue
DDC Dr Adamou Yada
Dr. D. Nshimirimana
Dr. M. Dicko
Dr. E. Mutabaruka
Dr. F. Kasolo
Mrs. M. Nzeng
Dr. Sam Okiro
Dr Y Allarangar,
Dr Guigui-Zoundi MT
Mr A Mouhani,
Dr Ali Ahmed; Woodfill,
Dr. Celia
DRH Dr. T. Ketsela
Dr. D. Cabral
Dr S. Mothebesoane-Anoh
Dr. C. Delhot
Dr. P. Habimana
Dr. C. Sagoe-Moses
Dr. A. Mbewe
Dr. I. Toure-Diop
Mr. H. Dibi
Dr. G. Bartley
Mr. F. Gamba
Mr. P. Mbemba
DSD Dr. A. Diarra-Nama
Dr. E. Soumbey-Alley
Dr. M. Awases
ERG Mr. B. Cardoso
Mr. A. Embounou
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