bacan - Feb 14, 2006

Heath - Feb 10, 2006

Greetings,

Comments were made about the importance of the GF's role in education about the 3 diseases. In my opinion, educating people about the diseases will help to diminish and hopefully eliminate the stigma that still surrounds the diseases, especially AIDS. In this prosperous, American city in which I live, I still witness prejudice and fear of PLWAs. I have even observed healthcare professionals, of all people, demonstrate behaviors that suggest their discomfort and distaste for treating individuals with HIV.

Rosejoshi said it well when he said "make it stylish to volunteer to educate others" about the diseases. Today, talking about HIV makes most people uncomfortable. Try this: Ask someone if they're interested in participating in a community event for the fight against cancer and then compare that response to the one you see when asking a person to participate in a similar event in the fight against HIV. An amazing stark contrast. The stigma is still strong.

I believe that the stigma is fading gradually. Moreover, I think that we will know that educational efforts have conquered the stigma when we start to see more physicians extending their practices to welcome PLWAs for regular care of HIV. Even in industrialized nations like the US, there are regions where the nearest HIV specialists are several hours away while the PWLA must pass through towns along the way which have physicians qualified to treat most other ailments. The lack of physicians knowledgeable about treating HIV is an indication that it has not yet become a stylish specialty of the medical community at large. I'm not certain how much of it hinges on prejudices toward the patient and how much has to do with income.

Although I suggest that education will play an important role in the GF's future, I think it is secondary to the actual acquisition of supplies. I believe that the Global Fund has the potential to influence and pressure pharmaceutical companies to reign in the exorbitant costs of meds. I'm confident that pharmaceutical companies have long lists of reasons attempting to justify the pricing matrices for meds. I will agree that pharmaceutical companies have provided wonderful treatment options for patients in need. However, I think it is a travesty to price them at such rates that people are forced into poverty in order to be granted access to medications by way of welfare plans and public assistance. Moreover, to me it is utterly inhumane to deny other human beings essentials for living and medical treatments if they are available. At this point the GF takes the stage and acts as the advocate and guardian of the cause. Ultimately, the GF, in its position must negotiate to acquire the resources needed, especially medicine and nutrition.

One thing more. Are there any reports available that indicate successes of individuals and/or communities that have been direct recipients of Global Fund assistance? e.g. survival rate increases, infection rate decreases, etc. If I were considering being a grantor to the Global Fund, I would be more inclined to contribute if I were able to see the impact of the GFs efforts. I suppose the reports are available somewhere but being rather new here I haven't yet seen them. If anyone can direct me to such reports, please let me know. Thanks

Moderators' response:

Due to a number of scientific, practical and ethical reasons, measuring epidemiological impact (decrease in infection rates, lives saved, etc) especially in the field of HIV/AIDS before 4 or 5 years or more have elapsed since the beginning of a programme, is neither encouraged nor simple to prove beyond doubt. For this reason, programmes set targets to be achieved in the interim (referred to as process and outcome indicators e.g. increase in knowledge, changes in behaviour, number of people receiving ART and VCT , timeliness of supply distribution, amount of funds mobilized, etc.) that if achieved would, within reason, be expected to maximize the probability/chances of achieving impact). The Global Fund was officially launched as a financing mechanism late 2002. The Global Fund relies on its technical partners for implementation, and shares their technical language, including most definitions, e.g. ‘Treatment’.

While the moderators have assorted the following links to useful documents on the progress and the processes used to assess this by the Global Fund, the capacity to self-assess also lies with the communities that receive its assistance and those among them that make it possible. Both groups of stakeholders are represented in this eForum.

A few useful documents are accessible by clicking or browsing the following links:

1. Monthly progress updates:
http://www.theglobalfund.org/en/files/about/publications/progressupdate.pdf

2. Grant score cards:
http://www.theglobalfund.org/en/funds_raised/gsc/

3. AIDS programmes supported through the Global Fund:
http://www.theglobalfund.org/search/default.aspx?lang=en&component=HIV/AIDS

4. Malaria programmes supported through the Global Fund:
http://www.theglobalfund.org/search/default.aspx?lang=en&component=Malaria

Thank you all for your outstanding contributions this week. We kindly request you, each to invite 2 friends or colleagues to share in this blooming eForum experience.

toshniwalm - Feb 07, 2006

The Global Fund needs to be strengthened in terms of long term support for all the activities being carried out. Secondly the Global Fund should be kept away from politics or discrimination or any personal agenda of any of the donor members or countries. Thirdly the Global Fund needs to be expanded in terms of its activities, both quantitatively by expanding its reach to the population and as well as qualitatively by improving the health care services supported under the projects. Fourthly multisectoral coordination and collaboration through resources to support the fight against diseases is greatly needed at this time. This involvment should be focused on implementation rather than fund mobilization. The Global Fund can also intensify activities related to advocacy, and exert pressure on the targeted countries for proper implementation of adequate measures to fight these diseases.

Dr. Manoj Toshniwal

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Message from D.K. Mohanty

Posted: Tue Feb 07, 2006 1:34 am Post subject:

Hallo, all friends,
I am the Health co-ordinator of Jyotirmayee Mahila Samiti, in Orissa, India, working for the RCH. The contribution of the Global Fund in the field of health is remarkable. It should reach the needy in the grassroots faster. There are several networks under NRHM scheme under Ministry of Health in the Government of India. The high child and maternal mortality rate from Malaria and TB is increasing everyday. If the Global Fund helps these existing networks in every district and sub-centres of the country, then all research findings will be immediately implemented at the grassroots.
Thank you.
E-mail: jyotirmayee2000@yahoo.co.in

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Message from Sammi Fredenbrug:

Location: Seattle, Washington USA
Posted: Tue Feb 07, 2006 5:45 am Post subject: Re: WEEK'S DISCUSSION: Appropriate Role of the Fund in Future

I believe this remarkable fund has already set a precedent on what it will be like in the future. I believe it will be highly successful and actually become a prototype for other programs. I anticipate it becoming more and more of a unifying balm between NGOs and others that so often function as independent entities, even in the neediest of regions. By bringing representation of all leadership and financial entities to the table (government, commercial private sector, etc.), a balance will hopefully be maintained. And I can see it ever evolving to address new and relevant illnesses and issues that arise as time goes on. Measureable progress will be a substantial factor in its future success, I believe. I know that were I a potential donor, I would be looking for a track record of success and accountability when considering a part in the Global Health Fund.

thank you,
Sammi Fredenburg

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Message from Ada

Joined: 19 Jan 2006
Posts: 3

Posted: Wed Feb 08, 2006 12:54 pm Post subject: Expansion.

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Having looked at the role that the Fund has played so far, they have not only supported individuals to fight the diseases of HIV/AIDS, TB and Malaria, but they have also equiped them (with their concept of self-sufficiency). I think it is limited to certain regions. I suggest massive expansion to as many countries as possible. Lots of work should be done in promoting and branding this organisation to help lots of people benefit from the aid offered.

Thank you.

Ada
Ghana

William (Bill) Parr - Feb 13, 2006

Hello Tarig,

Just a point of clarification first. I don't work for the Global Fund but rather I am employed by a PR managing a number of complex multi-country grants in the Pacific.

Nonetheless, I do get involved with the Global Fund at both the secretariat and Board level in an endeavour to bring about an alignment of policies, procedures and practices with the challenges, realities and frustrations of implementing projects 'at the coal front'.

While the GF Secretariat has invested a lot of energy and resources into developing the CCM mechanism and CCM's relationship with the GF, I have in the past felt that often the PR is the 'poor cousin' in the GF stable of relationships. And yet the PR to a not insignificant extent determines the success or failure of a project . It is the PR that carries the weight of legal responsibility through the contract with the GF. It is good to see that the GF is starting to recognise the PR as a crucial partner and is now endeavouring to strengthen relations with PR's. I do hope that this continues, and that more 'lessons from the field' are brought on board as the GF determines its role for the future.

Best wishes to all.
_________________
William (Bill) Parr
Global Fund Project Coordinator
Secretariat of the Pacific Community,
BPD5,
98848,
Noumea CEDEX
New Caledonia

Tel: +687 - 265445
Fax:+687 - 263818
E-mail: BillP@spc.int
Website:http://www.spc.int

tarigwafa -  Feb 13, 2006

Yes William:
Unfortunately the case has been demonstrated that money by itself does not resolve the problem as scaling up manufacturing capacity, streamlining of beaurocratic bottlenecks and increasing the technical capacity to provide support to these interventions at all levels must go hand in hand with the mobilizing of financial resources. Until these bottlenecks and constraints are resolved, programs funded by the GF will not be able to maximize the results for those most in need.The GF needs such statement of problems , and you are employee of GF , we are looking to see you playing a good role in participating towards the solution of these obsatcles.
with good wishes.

Tarig Dafallah
HIV/AIDS STATE COORDINATOR
SUDAN
_________________
Tarig Dafallah

William (Bill) Parr - Feb 13, 2006

The Global Fund has made significant achievements in its relatively short history. Its approach in terms of creating a public / private partnership and establishing the concept of a national CCM to drive country responses to the diseases was innovative. If anything, the CCM mechanism was (in its early stages) far sighted and ahead of its time. Strengthening and institutionalising CCM mechanisms so that they are not just a 'GFATM' CCM is a fundamental cornerstone to ensuring a coordinated, multisectoral approach to the fight against the three diseases.

The GF has been the catalyst to create a substantial worldwide increase in demand for LLIN's, ART, ACT and the likes. The challenge for the GF is to convince manufacturers that this demand is sustainable as a means of encouraging new and significant investment in manufacturing capacity, particularly for LLIN's andgeneric ART.

The GF successfully mobilized huge new financial resources that would allow for a rapid scaling up of responses. Unfortunately the case has been demonstrated that money by itself does not resolve the problem as scaling up manufacturing capacity, streamlining of beaurocratic bottlenecks and increasing the technical capacity to provide support to these interventions at all levels must go hand in hand with the mobilizing of financial resources. Until these bottlenecks and constraints are resolved, programs funded by the GF will not be able to maximize the results for those most in need.
_________________
William (Bill) Parr
Global Fund Project Coordinator
Secretariat of the Pacific Community,
BPD5,
98848,
Noumea CEDEX
New Caledonia

Tel: +687 - 265445
Fax:+687 - 263818
E-mail: BillP@spc.int
Website:http://www.spc.int

rewbdog2 - Feb 12, 2006

rewbdog2 - Feb 12, 2006

education should be geared towards all and any healthcare providers,religious organizations, teachers. the first step should be geared towards disease and process starting with mode and route of transmission. start with one disease say malaria vector born , teaching should be kept simple bite by female mosquito causes infection. infection can take 3 weeks to one year to show symptoms. next symptoms shaking chills excessive fever, nausea and vomiting, body aches. then management of symptoms, tylenol for discomfort and fever, then preventative medication therapy quinine, chlorquine, mefloquine and doxycycline . 2nd step would be geared toward further infection simple bed nettings, deet , permetrin on clothing, then more complex measures would be permetrin impregnated mosquitoes. 3rd step would be to continue the experimental research on the vaccine for malaria. continue to flood united states with pictures of suffering people and children, demand more media coverage and make the world more aware of this problem maybe then can funding become more availabe to prevent firther outbreaks after this one is contained

rosejoshi - Feb 12, 2006

We plan to fail or fail to plan ? -confused

Somehow the idea Tshering brought into this forum seems more practical than when we express our idea or view. The pressure of population growth on scarce land means that the benefits of better education or irrigation are often outweighed by problems caused by scare land and decreasing availability of forest products, upon which most of the rural population depends for all or part of its livelihood. In Nepal, the landscape, environmental degradation, poverty and economic migration are all linked and they combine with other factors to increase vulnerability to HIV, factors which differ from other developing countries.
For example, the HIV/AIDS scenario in Nepal underwent a dramatic change in late-1990s. Between 1997 and 2001 the country transited from a ‘low’ to a ‘concentrated’ epidemic category . The low HIV prevalence in the general population has masked an increasing prevalence in several population groups such as female sex workers and drug injectors. Documentation of a rapidly escalating HIV prevalence among IDUs over the past several years has led some stakeholders within Nepal to question the effectiveness of needle syringe exchange in preventing the spread of HIV among IDUs... unfortunately, however, harm reduction components are illegal in Nepal and not yet been authorized by the movement of Nepal Government, so how would I express myself: do we plan to fail or fail to plan? So confused!!

Rose Joshi.


Moderators:

Many thanks for your valuable message, Mr. Joshi. We have read your informative and insightful messages, and would be happy if you could take a short time and suggest some more roles that the Global Fund could play to ensure that the most effective plans are implemented, within the special situations your country is facing.

One way you could do this is by getting together with Tshering (if he agrees) and two or three other like minded members who have contributed richly on the topic of education (if they accept), e.g Christina, Sammi, Heath, Kristi (Nurse) from Beacon New York, Ndegwa and any others, either through private messages, or a new topic within this forum: e.g. 'Advantages and disadvantages of involving the Global Fund in Information, Education and Communication activities.' Should you choose to communicate through private messages, we would be glad to receive your final suggestions. Should you choose a new topic, we would be happy to assist you in its moderation. Either way, we feel gratified by your continued involvement and rich contributions to this forum.

Your eForum Moderators

Tshering - Feb 12, 2006

There is a popular saying that everyone has been chanting for centuries “prevention is better than cure.” However, the case has been and still is that when allocating budgets, most goes towards treatment since health education and prevention are time consuming and need long-term commitment; and the results of health education are not achieved as fast as giving drugs: “Give a pain killer; it will give you quick relief”.

The other thing we have been saying is that Education is the main answer to many questions and a solution to many health problems. There is a great need for funding education, especially girls education which needs to be emphasized where the gender disparity is high – like in many south Asian countries. There is an abundance of evidence supporting the view that where womens' education is high, overall health performance is excellent. The time has come to look beyond the medical explanation of disease and to understanding and explore the in-depth, the root causes of these three major dieseases (HIV/AIDS, MALARIA AND TB) - focused on the social model for health – poverty, gender disparities, inequalities in health and list goes on....

GF should be focused on sustainability projects such as education, health promotion and protection, rather than only in a “quick fix”.

Thanks
_________________
Looking forward to participating in fruitful global discussions any health realted topics.

rosejoshi - Feb 11, 2006

I am Rose Joshi, 31 male from Kathmandu Nepal. I invite you to read this article from my little work with the The International Planned Parenthood Federation (IPPF) at: http://www.ippf.org/ContentController.aspx?ID=12630 . It would a good idea for GF to fund innovative programmes involving to guardians and their children affected and infected with diseases, all around from the world. I have never seen such additional types of programmes for fathers or mothers either in research or in practice, that give confidence and offer hope to parents living with HIV. What does GF think about my new appeal ?
_________________
With Love and Hug
Rose Joshi

tarigwafa - Feb 11, 2006

Hello all;
In my country, SUDAN , those who work in AIDS, MALARIA, and TUBERCULOSIS, senior health professionals and international NGOs are the only persons who are aware about the Global Fund . GF is missed in all other departments of health ,NGOs, CBOs and no one has heard about it . In my mind, the main cause of this ignorance is the siting of the GF high in hierarchy of international organizations, and the long time it takes to reach the people in need. I expect the GF to play a good role if it's directed towards the grass-roots.
_________________
Tarig Dafallah

Dr Benjamin Udodigbo - Feb 10, 2006

I think that the major plank upon which the success of the GF's intervention will rest in the future is the issue of sustainability.
In the particular case of HIV/AIDS control,it is not going to be enough to allow the response to be caged in by time.If you commence therapy for somebody,are you going to terminate after sometime because project funds are exhausted?
Even in the cases of TB and malaria,what happens to follow-up and monitoring?

To my mind the GF should transmute from an adhoc arrangement to a permanent one--something in the mould of a UN organ.I was reveiwing the PEPFAR project with a friend the other day and we were wondering what will happen to those already on PEPFAR-funded treatment in the event that a president that does not think like the current one takes the White House in the next elections.

After satisfying ourselves about sustainability,the GF must commit its resources to the monitoring of its disbursements to ensure accountability.This accountability must be bilateral-- on the part of the donor as well as on the part of the recipient.Experiences with other funders suggest that issues of accountability are usually viewed through the prism of the recipient ,in this case commonly the third world nay Africa while we conveniently close our eyes to the various forms of insider abuse going on.Substantial sums go into accommodation (office and lodging) while limited sums actually go into response escalation.We know that some of the best jeeps on these parts belong to some big international funding organs.

I suggest that the GF should be wary of joining the bandwagon.The civil society should be constructively engaged in order to carry activities down to the grassroots.

Thanks for this great opportunity to be a global citizen.

I got this mantra in one of the sessions I attended at ICASA 2005:
Treat the people,Fund the fund,Drop the debt!
_________________
The situation of hiv/aids in africa is indeed alarming.Somebody out there should continue the good work.

Shahid Mallick - Feb 10, 2006

There is no doubt GF is contributing hugely towards HIV/AIDS and Malaria prevention. However, the fund should emerge from a bureaucratic system and build the capacities of at least some committed and ethical people to play its future roles, since money alone cannot really solve any problem, let alone HIV/AIDS. These people should not be chosen by the government or large national or international organizations.

Shahid Mallick, Bangladesh.

ggray - Feb 10, 2006

An appropriate role in the future for GFATM would be to really take a long hard look at what is driving the HIV epidemic and address what exasperates it i.e. issues of stigma and discrimination, access to equitable treatment, care and support , massive scale-up of quality VCT and empowerment of PLWHA.

Only through long term sustainable efforts, funding and capacity building of PLWHA and other community based organisations can the epidemic be seriously addressed.

Programs that target and educate (in a non threating way) those most at risk ie youth, IDU, MSM and sex workers are the solution to bringing about a collective awareness creation and behaviour change.