Dear Fena,

 

I agree with your comments. QA is one of the most important topics and has to be (or better: become) mandatory everywhere. Travelling often in African malaria endemic countries, I could myself see the problems, also with fake drugs. Therefore, it is even more important to make sure that manufacturers have to stick to GMP methods and only such products would be registered by local health authorities. FDA and other stringent authorities should be the point of reference.

 

Again, better and faster coordination e.g. between authorities but also between WHO, GF and others, would allow to have more effective and safe drugs spread in those markets who urgently need them faster. For me, it is strange (to use a mild word) to see that redtapism is preventing excellent new antimalarials to become available broadly, knowing that every 30 seconds an African child is dying due to malaria.

MR. ASHISH SRIVASTAVA Members of the e-forum and facilitators Mr. Srivastava, I’ve been studying your contributions with much interest. I commend you for your wealth of knowledge on processes and structures and for sharing this with the forum. I appreciate your attempts to clear up perceived misconceptions. I am very appreciative of all this and hope that as we point out the severe flaws that exists in the entire process, that no one will take this as a personal attack or offense directed to them, but take this in a spirit of camaraderie, learn from each other and become the driving force for change and transformation of the mindset, processes and structures of the GF that will result in improved and credible results in outcomes that reflects a drastic dent and shift in the disease burden of mostly preventable diseases.

Millions of infected people yet have to return to their agri-industries. Hence, we need to start seeing concrete results now and get people to the level of resuming their lives by becoming productive citizens. Our people need to go back to work to produce food to improve their livelihood and community. Above all, they need to become functionally literate so that they can master the precepts of health and wellness. This is what health literacy is all about and most of the poor people we serve don’t have a firm grip on this. Giving them medicine is not enough if we can’t rehabilitate them to return to work, if they have not mastered how to prevent opportunistic infections, contract TB and be treated for it without developing drug resistance( MDR TB) and also to be able to differentiate fake street drugs from approved drugs that will treat their Malaria.

 

When I addressed Prof Kingsley Moghalu during the GF presentation in the Human Development Summit I publicly discussed the obstacles facing the GF when it comes to the HIV/AIDS, Malaria and TB programme. I stated that treating 50 mill people by 2015 sound overly ambitious. It should also include taking them out of poverty of under $1.00 per day and must include literacy and life long learning. If you treat them and leave them in the same congested environment, they will relapse if not taken out of the environment. It is a very vicious cycle. We have to start taking care of our citizens. These are very preventable diseases. The strategy needs strengthening for it to stand on its feet. It is lacking a very critical element to attack a very preventable disease, I told him that TB is also a literacy issue.

 

One thing that has been markedly absent in all e-forum discussions is the application and integration of Millennium Development Goal # 6. The eight MDGs were set by world leaders in September 2000 and MDG # 6 deals with the specific mandate of the Global Fund.

 

MDG # 6... combating HIV/AIDS, malaria and other diseases

The half way mark towards 2015 deadline is here. What strategy does the GF have built in its structures to ensure that this particular goal is met? If I have to measure the performance of the GF on all levels this is exactly how the performance and the process will be measured. Has the GF in all its structures and processes from the top to the bottom linked MDG # 6 to its outcomes? I apologize for my ignorance if I failed to take note of the lack of linkage and documentation in any of the submissions. This is not to be taken lightly, but is viewed as a crisis that requires immediate interventions. This is a massive failure of the entire process. What I read comrade’s Asima's submission "General Assembly President Srgjan Kerim stressed the need for leadership and political accountability, saying Member States need to sustain and scale up the progress they have made so far. “We must not lose the momentum of our global response,” he said. “For every two people that begin HIV treatment, there are five new HIV/AIDS infections.” Can anyone explain to me how things have gotten to this point where we have almost lost track of this? Respectfully, what President Srgjan Kerim, didn't disclose to the world is the number of people that do not stay on treatment because of the severe side effects and toxicity they suffer (pathophysiology) and become drug resistant as a result. Why aren’t we given real numbers about the actual HIV/AIDS mortality ratio compared to successful treatment? As some one who has completed 1 year in the Masters Degree Programme in Infectious Diseases/Epidemiology this is the most critical determinant that confirms whether our programme is effective and is having a significant impact. On the other hand, this is telling me as a qualified community health educator that the programme capacity is very weak and that we the perception is that the war against HIV/AIDS is won, but we actually have lost the battle. If Srgjan Kerim stated that “For every two people that begin HIV treatment, there are five new HIV/AIDS infections”, this implies that there is a measure of failure in country priorities. My question to you is: Where is the CCM leadership with regards to country priorities? What will be the rationale/justification for member states to scale up programs? Is statistical data of program participants that have abandoned treatment because of the severe side effects and toxicity they suffer (pathophysiology) and become drug resistant as a result considered in the treatment modality? Is the actual HIV/AIDS mortality ratio compared to successful treatment also considered? Let us get back to the discussion of the MDGs. The MDG's are at the half way mark and it doesn’t appear that the GF on all levels is anywhere close to addressing and resolving the issues above. Should the CCM be put under the microscope for this? I think so because they are the ones that set the country priorities. How is the MDG# 6 mandate linked to the GF mandates? Is it just my perception that there appears to be disconnect between the MDGs and the GF mandates and outcomes? If so, then the ramifications of this are irreversible and irreparable. I took note of your differentiation between "unnoticed factors" which are important for improvement and "process evaluation", which as you stated is responsible for improvement of co-ordination & understanding of oversight problems, are essential. I took note of your attempts to educate this forum on the GF process, coordination and understanding of oversight problems. I thought what we do must be linked to MDG # 6. Forum members nor facilitators in any forum/discussions have linked their discussion and solutions offered to MDG# 6. This in itself is unpardonable and inexcusable. Every discussion is void of that clear linkage. You stated that "GF secretariat should develop appropriate intervention techniques with inclusion of planned & strategic intervention for grass root solutions e.g solution to the risk factors of affected population, grassroot high risk behaviour. Oversight problems are often occurs in grass root level in many developing countries e.g. labour migration,literacy level,gender disparities & factors attributed to the MDR(TB),AIDS & MALARIA." What do you think is one major factor --underlying causation to the above mentioned variables in oversight problems? Do you ascribe to the notion that “literacy” is an unnoticed factor when India as a Country as well as Africa as a Continent, that has all the makings of an illiteracy spectrum of disastrous proportions? Do you know that this is underlying to program failure? As the global expert in the field of functional literacy through worldview transformation I have great difficult coming to terms with your description of "unnoticed factors". I can't for the life of me call issues in literacy "unnoticed factors". It demonstrates one’s vision and comprehension of the magnitude of the problem that has plagued the world for over five decades that is affecting every outcome of process evaluations. This has affected and disrupted the lives of a millions and millions of people because our conceptualization, understand and definition of the problem. This is the reason why Bandaids and quick fixes have been used and the results speak for themselves. Because of the program structures and the "unnoticed factor" and the status literacy has been accorded in terms of priority, the price common people will pay will be with their life and future generations. Is there a solution to all this? Yes…but we can’t bring back those that have died as a result of our priorities. Is everyone aware that we give people medicine, but that doesnt transform their worldview. Their traditional a-scientific worldview cannot conceptualize or assimilated our Western conceptualizations of drug adherence, drug toxicity, drug resistance and opportunistic infections. They don't understand these dynamics and are remotely seperated from this. For that reason they need functional literacy and worldview transformation so that they can give new meaning to these complexities. It doesn’t matter how they contracted HIV/AIDS, we can’t bring them back from the grave to correct our “unnoticed factors”. We are making decisions over millions and millions of lives ...can't we do it right? My perceptions of the entire process is that it is mechanical. As a academician and practitioner I see lots of problems. It seems that I am the only one advocating this position and I wonder why? WE NEED AN IMMEDIATE AND DRASTIC SHIFT IN PARADIGM IF WE WANT TO SAVE MILLIONS OF LIVES AND MEET MDG# 6 Fenna E. Bacchus CEO/President Functional Illiteracy Research and Education Inc. 544 Walnut Street Altamonte Springs, FL 32714-2329 - USA Tel/Fax:+1 (407) 774-6542 Cell:+1 (407) 484-0292 (Emergency Contact) www.fireinc.org

Regarding oversight & co-ordination of GF supported programs, understanding of clear distinctions between un-noticed factors which are important for improvement & process evaluation which is responsible for improvement of co-ordination & understanding of oversight problems, are essential. e.g CSS (COMMUNITY SYSTEM STRENGTHENING).

 

Though GF process includes various components e.g CCM,TRP,LFA,national bodies, GF secretariat, governance & grant-recipient process, these components are complete in structure but oversight problems may exists in implementation of process.

 

In CSS oversight problems could be occur in understanding of rationale for decentralization i.e.accessment of ART treatment& medical attentive services in affected population in countries where GF products& services are not technically, mechanically & clinically accessible.

 

GF supported program could be improved by decentralization & needs delegation of national & local governance procedures. GF secretariat is responsible for procurement of goods, services & consultancies, GF secretariat should develop appropriate intervention techniques with inclusion of planned & strategic intervention for grass root solutions e.g solution to the risk factors of affected population, grassroot high risk behaviour.

 

Oversight problems are often occurs in grass root level in many developing countries e.g. labour migration, literacy level, gender disparities & factors attributed to the MDR(TB),AIDS& MALARIA. Community, private & public sectors organization could play an important role in grants consideration & health system strengthening, co-ordination can be improved by horizontal approaches & decentralization of national bodies authorithy, policy implementation & procedure awareness.

 

GF guidance may be effective in countries with less financial structure,mobilization of available resources & fiduciary arrangement of grant recipient.

 

Thank you

 

ASHISH SRIVASTAVA

EX-INTERNATIONAL MARKETING

CCM (SEAR-INDIA) 81237

D.Meppiel,

 

It sounds like a good idea that I would love to support 100%...but then we need to ask ourselves

 

1. What bureaucratic measures do all these processes have to go through and for how long?

 

2. In the end what results are we hoping for?

 

3. On one hand, fake drugs are a massive problem in Africa and Asia; the market is flooded with fake drugs everywhere you turn..on the other hand, the vast majority of the people we serve fall within the illiteracy spectrum.

 

4. What will be the short and/or medium to longterm impact of the QA process if Third World governments lack capacity to enforce their own laws?

Rada:

I would be interested in knowing more about the selection process and make-up of the Board, the Technical Review Panel and the Independent Appeal Panel. This would enable me to determine what powerful influences and factors/criteria are at work in making decisions concerning funding, etc. Any specific information would be greatly appreciated.

Dear Rada,

Thank you for your contribution to the forum. The Global Fund makes available information on Board members, the Technical Review Panel and the Independent Appeal Panel on its website: www.theglobalfund.org.

Please find below some links to web pages and documents that I hope you will find useful in answering your questions.

Board Homepage
Board Members 

The Global Fund's by-laws, Article 7 (pp.3-7) that specifies the appointment of Board Members (also available in French)

Technical Review Panel Homepage
Round 8 TRP Members
TRP Terms of Reference (available in the six UN languages)

Appeals (section 5 has information on the composition of the Independent Appeal Panel) 
Rules governing Internal Appeal Mechanism (also available in Spanish, French and Russian)

Best regards,

Alastair Green
e-Forum Facilitator

Dr Mohammed Fareed,

 

I'm in concurrence with you and enjoyed your enlightening me on the details of the problem. Thank you for also enriching my knowledge. I will try to present a very practical approach/solution that is highly effective.

 

With regards to # 4 "Develop a mechanism of Responsibility/Accountability between CCM and Global Fund", as a Certified Health Care Risk Manager, QA/Utilization trained Professional Registered Nurse I strongly recommend an oversight body that does random spotchecks of the activities of the entire "chain". This process stipulates the organization to have well qualified staff with a medical/nursing/public health background.

 

The applicable laws of the host country are also observed. I'm also a trained mediator. What do I mean by this? Being a Veteran graduate (14 yrs) of the American Institute of Medical Law, we are highly trained as fraud detectives/investigators in any health care system/setting or related activity...investigating Risk Management issues, including the process how funding is channeled, how contracts are awarded--nepotism, favoritism and tribalism.

 

Then we look at the Quality Assurance Process and TQM, the UM -- Utilization Review...are the services under utilized, appropriately utilized or are there a loophole that allows abuse of services etc.? For the latter we make immediate P & P recommendations to stop the bleeding of funds. We are extremely proactive and prevent an occurence before it happens, or once it has occurred we do loss control by minimizing and managing the loss. This is not an easy process since it requires to put mechanism in place which take a while due to the bureaucracy.

 

I'm simply educating this forum and not accusing or abusing the forum for explaining an answer to a suggestion that wasn't explored in detail. Hence, this answer is in response to your suggestion. Companies with such expertise apply them in local situations not just in Western countries. That is why I am a trained Political Scientist specialized in International Relations and as part of my core curriculum I have studied Economic Development, the Political Economy and Foreign Policy of Africa, Asia and Latin America and update myself annually as much as I can. When you learn the political history, especially the effects of colonization and look at new-neo colonialism and corruption, corruption perceptions indices of TI you have a good picture how wide spread this has infiltrated in the structures. In some countries it is embedded very deep and appears in reputable news papers, discussed by name that those prosecuted are recipients of the GF and that millions of $$$ are unaccounted for. This is public information and not an accusation or slander of any organization if mentioned. Close blood/ethnic relations nepotism and tribalism in the "entire chain" which are usually concealed from investigators can be fished up.

 

Thank you for allowing me for as a woman to make a contribution. I would love to come to Afghanistan some day soon.

 

Respectfully and Humbly,

 

Fenna E. Bacchus, MA, C.H.Ed, L.H.R.M, C.H.R.M, AIM, RN CEO/President Functional Illiteracy Research and Education Inc. 544 Walnut Street Altamonte Springs, FL 32714-2329 - USA Tel/Fax: + 1 (407) 774-6542 Cell: + 1 (407) 484-0292 (Emergency Contact) www.fireinc.org FACEBOOK: Fenna Bacchus skype: Soulmateprincess1