REVIEW OF GUIDELINES OF PROPOSAL WRITING, CCM ROLES AND CHOICE OF PRINCIPAL RECIPIENTS. (EDITED)
I wish to sincerely say congratulations on your efforts to save humanity especially the developing countries of the world, which are mostly African Countries plaque by HIV/AID pandemic, TB and malaria. Through your Global Fund Programmes millions of lives are saved globally.
I know quite well that you have experts in various fields that know everything going on here in Nigeria and other African Countries than we Africans. Although this is very true, there are certain salient issues I would like to draw your attention to. Two weeks ago, I sent an enquiry requesting for submission of proposal for voluntary screening of HIV/AIDS in rural communities in Akwa Ibom State, Nigeria.
We wanted to do this in order to alleviate the sufferings of the down trodden people through testing, counseling, sensitization and referral of affected individuals to centre, where the can get treatment. We did not know that your programme also involves treatment and other services.
Your response was quite nice and okay, but I was discouraged because of bottle neck and tough bureaucracy before reaching the Nigeria’s CCM. We have a rural community base health care NGO but could not achieve much because of tough issues in accessing help.
I wish you give consideration to the following point I am making:
1. Majority of Nigerians are rural dwellers and do not know nor have heard anything about Global fund programmes since they have never had contact with any health care givers.
2. Your lofty programmes only stop in urban areas where there are Teaching hospitals, Specialist hospitals and General hospitals that is where testing, counseling and treatment usually take place.
3. There are no health care facilities in almost all the rural communities. Therefore the possibility of testing, counseling, and treatment is not there, unless some certain measures are developed.
4. Globally Nigeria is ranked second to India in terms of maternal mortality rate (MMR).
5. Greater percentage of Nigerian women about 80% and above have home deliveries.
6. Based on points 4 and 5 above one can easily envisage the level of mother to child transmission (MTCT) of HIV/AIDs.
7. Lack of proper awareness and sensitization programmes at rural level. Most rural dwellers only know that there is a disease called “eight” not “AIDS” that is killing people somewhere and to them since they have never come in contact with someone who test positive and treated for HIV/AIDS, they claim it is the disease of the mind.
8. High incidence of teenage pregnancy, promiscuity, sexually transmitted diseases (STDs) and lack of use and proper knowledge about condom increase the risk of contacting HIV/AIDS especially amongst young girls and boys.
9. Quackery in medical practice thrives seriously in rural communities with the quacks using one needle to give several people injections, one can easily imagine the rate of transmission of HIV/AIDS in this circumstance.
10. Local circumcision; Greater percentage of Nigerian women have home deliveries, TBAs (traditional birth attendants) usually use the same knife to perform circumcision on different baby boys.
11. Illegal and septic abortion usually perform by quacks on different young girls using unsterile instrument, sometimes pulling out their wombs and intestines through the virgina to the outside world.
12. Incision and drainage of abscesses done locally in rural communities utilizes one and the same knife on several people.
13. I do not need to mention cutting of umbilical cord during child birth, tribal marks and scarifications made on the body as a method of treatment and several other method not mention here which are going on in rural communities.
With all these things going on in our rural communities there is no reason to doubt the report that sub-Saharan Africa is the most acutely afflicted region with HIV/AIDS.
In the area of malaria where your organization have spent millions of dollars on insecticide treated net, no rural dweller has ever heard anything about such net.
In reality, the people seriously in need of help are completely out of touch with your lofty programmes. It is the cream of the nation who can afford this net, treatment of malaria; testing and treatment of HIV/AIDS and TB are the beneficiaries, relatives/friends of those who work in these hospitals and some urban residents who have time to visit these hospitals for treatment.
Referring to “Guidelines for Proposals-round 9, section 4.3; major constraint and gaps”. I quote “the particular vulnerability of key affected population should receive particular attention in this review, as should relative capacity of non-government and government sectors to support and expand services to these populations. An important initial question to help planning may be “where do people, especially key affected populations including women, sexual minorities, currently go for health services, and do these need strengthening to save more people and to save them more effectively and efficiently?”. The 4.3.1 goes on to elaborate on “A comprehensive description of weakness and gaps,” where five points are listed.
Also under “objectives of health system strengthening”. I also quote “As discussed in s.4.3 above, this assessment should consider the broad range of health system weaknesses that affect access to services by key affected populations (including different needs of women and men, girls and boys) sexual minorities and people who are not presently visible to service delivery providers due to stigma, discrimination and other barriers to equal access.
To make your programme broad-based extending to the down trodden of the rural communities, I wish the following points should be looked into, though space will not allow me to elaborate on them.
1. The nitty-gritty of proposal writing. Majorities of public-spirited individuals can not write proposal that would meet your starndard. It is the cream of the nation who are very far away from the downtrodden of the rural communities that have the technical know how of writing proposal that will meet your standard. I believe you do this to check-make fraudsters, however, majority of fraudsters have international repute.
2. NGOs with rural community health care interest should be chosen to initiate and conduct voluntary testing, counseling, and treatment and other programmes in all the states. Where there is no such NGO in a particular state, the nearby state NGO can perform the same function. These NGOs should employ the services of medical doctors, nurses and other paramedical staff. Designated general hospital and comprehensive health centres close to rural communities should be stocked with required drugs where patients tested positive should be referred for their treatment.
3. The duty of CCM should be to coordinate, monitor and evaluate the progress recorded by these NGOs and send the report to you for consideration. Government should only come in through their representative in the CCM.
4. Dual track financing should be highly discouraged. In Nigeria there is enough money to tackle these monsters to a stand still, but because of mismanagement. And so sending this money through them creates double jeopardy for the down-drodden.
5. To record a huge success there should be proper documentation. Registers should be kept for recording of all the communities visited. The names of villages, village heads and other community leaders, local government and state clearly recorded. The names of people tested, counseled and those placed on treatment should clearly be recorded. The register should be signed or thumb-printed by the village heads and community leaders.
6. Mosquitoes net should be distributed to the communities best on number of houses but not on head count. The village heads and communities leaders should sign or thumb-print the register
7. Investigations can easily be carried out whether such exercise have taken place in such community through CCM, local government, state government or any independent body for your confirmation.
What is happening in rural communities here would have been better seen than heard for one to be able to empathize with them.
Base on the above presentation, I hereby request to submit a proposal without necessarily passing through Nigeria’s CCM to conduct a pilot study on this in Akwa Ibom State, Nigeria for your full implementation during subsequent rounds if the project is successful.