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Dear members,

Here's a contribution by XAQSOOR from Somalia.

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Marcela.
e-Forum Facilitator

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Dear Marcela,

Thank you for your updates, I really appreciated,

According to my participation with E forum in Globalfund, I would like to crucially propose the systematic initiavive change of social magnititude of the current community poarticipation of TB,HIV/AIDS, AND ,MALARIA present epidemic spreading  comncept s to Africa as well as worldwide.

To verify my concern, I would definitely propose to get experts in Malaria and TB and HIV/Aids Trainers/Consultansts to share more dailogue in their respective communities in Africa.

Local governements have the main intervenytion in developing the  process, Global fund is the key funder of all sectors.

In somalia, fo example, Globalfund with joint implementation preoject called Globalfund HIV/Aids Program in Somalia implemenbted by Oxfam Novib and SOCSIS GF Project in 2005/6, this project produced Local NGOs traiened by Local Consultants taught the main curriculum of Organizational Development as well as HIV/Aids modern practices to strategise the main interventions of the regional bases in somalia, somaliland and putland where tthere are regional adminstrations of HIV/Aids commission: SCAC,PAC,SAC Respectively.

I will make sure that you will understand the somalia case study to my participation of E-forum Globalfund.

Thank you for giving me this opportunity.

Mr. Abdullahi Mohamoud Nur,
Somalia Consultancy Organisation of Reasearch and Empowerment (SCORE)
South-central Somalia
Horn of Africa

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Dear members,

Here's a contribution by May Mahmoud Farag Ahmed from Egypt.

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Marcela.

e-Forum facilitator

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- I may find that  the main  challenging factors that  prevent adequate scale up to meet demand is  the lack of management skills , inadequate  skilled manpower , inadequate remuneration,   inappropriate job placing  or use of  inexperienced staff . This  need  capacity building through continous training , ,improved staff skills and appropriate job placing and through  building  professional  management skills and to strengthen both internal and external monitoring  and programs evaluation systems to give a chance for early corrective actions based on the results.

I agree with Louis Meinko that there is a real demand for street children to have access to health services. Global fund should aim to build capacity  and  financially support those  NGO's that focus on providing services and care for street children.

-Global fund should promote actions that strengthen health systems , information particularly those  has an  impact on the quality and accessibility  of health services.
-There is a great need to improve the coordination between  relevant sectors within miniseries and other sectors in terms of capacity building and to promote wider stakeholders and   community participation particularly those aiming at prevention.

- Ensure that adequate procurement , supplies and distribution to health units with focus on marginal or  hard to reach communities.


    May Farag

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Dear members,

Here's a contribution by Bondu Manyeh from Sierra Leone.

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Marcela.

e-Forum facilitator

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Hello,

 

Prevention of capacity for adequate scaling up:  People are becoming aware of the disease and it's dangers - yet a lot of work needs to be done because people are still in Denial, coupled with fear of testing to know their status.  People are reluctant to do the Voluntary, Confidential, Counselling and Testing (VCCT), they hope that they are free without having the VCCT done.  They believe that what God has not made them know must remain hidden.

 

2)  Funding could be a problem; most Community Based Organizations which may easily target the interior parts of the country with the realities of the disease through sensitization, do not have proper means of transportation and communication system which are too expensive for them to cover.  Information through the local communities about the pandemic is very much necessary but lacking; if available in some communities, it is not treated seriously. 

 

3)  Treatment centres need to be improved and increased.  This is lacking for a country that is settling from the dust of a brutal war during which hundreds of women and girls were raped and tortured by their captures.  Good education and communication drive needs to be stepped up in all towns and villages.  

 

Peace.

 

Bondu

As an independent observer of the Fund funded interventions in South Asia and Africa , I have the following comments: (1) Increasing access to quality diagnostics e.g., microscopy for TB, Malaria is a critical concern. There is an acute shortage of trained technicians. (2) Country Coordination Mechanism is largely elite biased i.e., in all the fund receiving countries the CCM members are mostly either bureaucrats or dominant figures and hence not widely represented by the public. Transparency and Accountability of existing CCMs are questioned on similar grounds. In most of the cases, the moral harzard is about the CCM having a 'group thinking' i.e., collective dennial of failures, exaxerating achievements etc. (3) Incresing access to treatment, i.e. access to drugs is not a problem as long as funds are available. (4) Cultural barriers to access is not that promiment as it is project. This sometimes looks like ' blamming the victims' in order to avaoid supply side failures. The global fund must address these issues which are crucial for sustainable access. Otherwise, all the efforts may drive into just addressing sysmptoms and not the problem. In this reagrd the global fund should: (1) increse investment in health sysetms (Tangible aspects such as infrastructures, diagnostics tools and human resources) rather than focusing on a quick win over MDGs targets. Focus has to be beyond MDGs. Bihita Bidhan Khisa

Large population movements, especially in the recent past, in countries emerging from strife like South Sudan, make situation very serious with regard to exposure to HIV epidemic; such countries need to be considered for quick- response mechanisms to install prevention, awareness and management strategies. Refugees are returning in great numbers from high HIV-AIDS prevalent countries of asylum. It is necessary that local structures are established and NGOs be given the capacity to respond. At the same time, local infrastructure like road network is being developed at a very rapid rate, influencing population distribution as a result of the growth of satellite towns and market centers along the roads. These are 'hot spots' for the rapid spread of HIV-AIDS. I think organisation coming up with good ideas for intervention before things get out of control, deserve to be given priority. Global Funds funding mechanisms- which are often very weak-in such a case, need to be reconsidered to avoid delays in local capacity building.This will lower the prevalence rate, but if steps are not taken quickly, the situation will become worse and involve far more funding.

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ashish

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Dear members,

Please find below the contribution from Kizza Paul from Uganda.

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1. CHALLENGES WITH HEALTH SYSTEM
As far as the Government has practiced Decentralization by involvement of local Government and it is continuening to inform the Health system as well as the Local Government , few challenges still exists , other wise the system looks functioning well. 

1. Global Fund and or other partners through a special programme let them initiate the formulation of special Fund to be directed to NGO District/Councils for Rehabililation/Construction of health facility infrastructures.
2. Global fund /or other partners , let work hand in hand with the Government by Funding health Institutions as well as re-opening the previously closed Government health institutions so as to see suit /Gain as many health workers as possible to fill the scarcity.
3. Global Fund and/or other partners through a special programme initiate the formulation of special fund to update/upgrade knowledge and skills to deserved health workers as individuals or groups from advanced institutions if possible up – Country.
4. Global Fund and/or other partners in hand to hand with the Government let se a clearly motivation policy which is hand to – reach areas oriented.
5. Global Fund and /or other partners let advice the Government to Co-operate other partners National or International in Medical equipment and supplies procurement and distribution in the Country.

	Factors	Redressing ways
1.	Peer educators themselves do not like to use condoms with their regular partner.	1.       Promote fun with condoms and to help them believe that condom use indicates concern for the partner’s health and therefore is a responsible behavior. 2.       IEC materials like condom menu cards, condom playing cards, hand book on ‘A friend who cares’ rotating cube etc need to be distributed among the PEs, so that they could use them to motivate the peer groups.
2.	Peers do not like to practice non penetrative sex	Ø      Train PEs on sex and sexuality Ø      Special emphasis on types of non-penetrative sex
3.	Peers are not convinced that PEs sharing of the common myths and misconceptions is a fact.	Ø     During Training and monitoring visits, staff needs to build the PEs ability to give logical and scientific explanations with rational examples and reasoning for common myths & misconceptions. Ø     The FAQ book can be provided to all PEs to enable them to address the myths & misconceptions in a convincing way.
4.	Peer educators who keep IEC materials with them to train peers find it difficult.  This is because of lack of private space and to keep their families away from their life style.	Ø       Should increase awareness of the importance of PE through their campaign, especially through street plays and other similar folk media.  It is important that they do not disclose PEs are those who belong to high-risk behavior groups.
5.	Peers do not inform their PEs about their symptoms.	Ø       Need to inform peers, the benefits of sharing information about their health problems with their PEs especially for availing timely and appropriate health care.
6.	Peers do not like to take treatment from health care providers trained in syndromic case management.	Ø       Inform the groups that PEs will be an effective link to health care providers and so to avoid quality treatment.
7.	PEs are unable to follow-up peers referred	Ø       Discuss with PEs the problems in referral follow up and alternative ways to ensure follow up. Ø       Do not reprimand PEs for not doing follow up, but instead focus on their problems.
8.	Some health care providers do not cooperate with the PEs when they refer their peers.	Ø       Meet referral doctors at least once a month to know their problems in managing referrals and seek their cooperation and request them to reinforce key messages in a non-stigmatized and non-judgmental manner. Ø       In case a health care provider is not co-operative, they need to identify other referral doctors.
9.	Some Peers, who are not satisfied with the treatment given by the referred doctors, discourage other peers from seeking treatment from them.	Ø       Explore reasons for such dissatisfaction.  If desired, they need to discuss the issues with the referral doctors and ensure that the peer groups are satisfied with the treatment.
10.	Peers are not confident that the doctors will maintain confidentiality about their symptoms.	Ø       Emphasize the importance and need for confidentiality during their advocacy meeting with the doctors.
11.	PEs find difficulties to motivate their peers to go for their periodic check-up, especially if they are asymptomatic.	Ø       Increase awareness about symptomatic and the importance of periodical checkup. organize periodic screening camps at a place and time most suited to majority of the beneficiaries.
12.	PEs not able to motivate their peers for partner treatment.	Ø       Enhance their awareness programs about the importance of partner treatment. Ø       Efforts need to be made to help couples, take joint responsibility for each other’s sexual health.  Indicate that the responsibility and concern for his/her well being is most required. Ø       Provide medication to the partner through the infected person.
13.	Prostituting messages for youth and the unmarried.	Ø       Training need to be imparted on ‘A&B’. Ø       Developing skills on how to say ‘No’ to peer pressure. Ø       Information on risk associated with premarital sex thereby emphasizing ‘say not to sex’ before marriage. Ø       Emphasize on ‘A’ as a 100% risk free practice.
14.	PEs hesitate to keep penis model and condoms at home because of fear of being reprimanded or being identified as having multi partner sex.	Ø       NGOs in consultation with PE, need to find alternative sites to store condoms. Ø       NGOs can highlight the role and importance of PEs in their mass education programs, especially through street plays and other non-formal modes so that the community is aware of the role of PEs. Ø       It is not necessary for them to mention that PEs are selected from those who practice high-risk behavior.
15.	Lack of privacy in the field for condom demonstration especially for street based sex workers.	Ø       Identify shops near the PEs work area to sit with one peer at a time and train them in condom use. Ø       Shops with a fridge or a cabinet in the center with space behind are most convenient ones. Ø       Identify other sources trees, quite spots at bus stop, public toilets etc. Ø       Enable PEs to meet either at NGO office or at the drop in center.
16.	Family members of PEs do not allow them to interact with their peers.  This is especially true for adolescents in the urban slums.	Ø       Talk to family members about their social responsibilities and its contribution in collective societal battle against prevention and control of HIV/AIDS. Ø       Introduce family members to other PEs who have the support of their families so that they learn about their actual roles and responsibilities.
17.	PEs are not able to maintain confidentiality.  Some times they quote other peers as an example to motivate resistant peers.	Ø       Emphasize ethical and legal implications of breaking confidentiality and serve as role models and maintain confidentiality under all circumstances.

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Dear members,

Please find below the contribution from lkmtheog from India.

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Firstly, we thank you for the opportunity to contribute to the debate on factors preventing adequate scale-up to accelerate the eradication of malaria.

Our company Nets for Africa is based in both Harare and Francistown. Our mission is to "Protect People", and, although we may be a commercial company we have taken the responsibility of producing high-quality long-lasting nets at affordable prices very seriously.

We have invested a great deal of time, money and technological resources in developing our product, which is comparable to other leading world-wide brands. Based on price, available quantity/capacity, delivery time and ability to distribute within the region, our product PreventaNET is very well placed.

The long lasting impregnation process used by the Nets for Africa in the manufacture of our PreventaNET employs the Zimbabwe Ministry of Health and Child Welfare and interim-WHO approved K-O TAB 1-2-3 process. The insecticide is the FAO/WHO approved Bayer deltamethrin active ingredient (WHO Specification 333/TC April 2005 and FAO Specification 333/TC May 2005 and FAO/WHO Evaluation
Report 333/2004). K-O TAB 1-2-3 (Deltamethrin WT + binder, BAYER), like Interceptor (Alpha-cypermethrin LN, BASF); PermaNet 2.0 & 3.0 (Delatmethrin LN, Vestergaard Frandsen) & Lambda-cyhalothrin LN (Syngenta), is undergoing WHOPES Phase III testing at WHOPES Collaborating Centers but has been given interim approval for use by both WHO and the Ministry of Health and Child Welfare in
Zimbabwe.

In terms of servicing the large demand for long-lasting nets in the region we are unfortunately experiencing some barriers to entry.

The main barrier is that the established international brands seem to have 'tied up' the market. This means that aid agencies etc. are biased towards buying their products as opposed to buying our products even though we are cheaper (our price is almost half of that of our competitors meaning aid money can go twice as far and buy twice the quantity of nets therefore saving more lives), have the
capacity (at any one time we hold 1,5 million nets in stock and produce 2,5 million nets a year) and can deliver immediately (competitors nets have a delivery lead time of several weeks or more), and finally the fact that we actually producing a product which is on par quality-wise and efficacy-wise.

The principal reason cited is that the product which we use to treat our PreventNET's, K O Tab 1-2-3, is not on a par with chemicals used to treat competing nets. As cited above K O tab 1-2-3 is actually at the same stage of WHOPES approval as that of other brands.

So, in terms of improving and scaling-up capacity to meet the overwhelming demand for nets within the region, it is important that donors and agencies etc. are aware of the fact that there are products on the market (such as K O Tab 1-2- 3) which are equivalent with those used by Vestergaard etc.

Please advise if it is a Global Fund prerequisite to bundle a factory-treated net with a retreatment kit with a shelf-life of 2 years, bearing in mind that our factory-treated nets last up to 5 years or 20 washes.

Finally, would it not be of great benefit to support local business? Especially, since the products are on a par?

WHAT FACTORS INTERMS OF CAPACITY ARE PREVENTING ADEQUATE SCALE-UP TO MEET DEMAND AND WHAT COULD THE GLOBAL FUND AND /OR TIS PARTNERS DO TO OVERCOME IT? Hence as a poor father of four and as a youth, am a sympathizer of orphans. In fact I have been looking for ways in which I can get assisted so as to assist others especially of HIV/AIDS of which am trained. All what I come across are some of the obstacles faced by the global fund and other actors in providing adequate scale to meet the demand. Diversity as a major factor co-ordinates with other factors to make it even stronger hence where there is diversity ,comes communication and where there is communication comes the means of communication, and too meet all these there must be finance. Poor managements of organizations also affect the implementations targeted. This is due to hungry personnel who are never transparent to their head offices, such officers with fill theoretical documents which were practiced nowhere to evident their day to day participation in their work. Due to lack of proper monitoring of the events going in the organizations, this has deep-rooted itself and to the people who are to be assisted take it as a theoretical propaganda. Limitations is also another bother because most of the organizations do not listen to individual views instead they listen to and give support organizations, groups e.t.c. thus limiting their operations. In fact there are individuals who are trained to advocate against HIV/AIDS yet they don’t know how they can get individual sponsors- i.e in some African communities they understand when they are informed by their individuals. Discriminations is seen when these organizations come under the recognized churches hence some people take it as discriminated if they don’t belong to the supported churches. In some Africa communities, traditional believes also hinder the operations – some communities do not believe In going to church or to hospital. This implies that there is need for adequate personnel to keep them informed on either weekly basis or so. Remoteness is also affecting the prosperity of the scale-up. This is because some areas are very remote such that there are roads that the only means of transport is motorcycles and bicycles. It then follows that a remoter area, the inhabitants are poor hence cannot attend any sensitization forums or gatherings. Independency –most of the organizations are placed under very busy government ministries and as a result they end up supporting the ministries directly instead of taking their work. Also the use of natives in the big offices of the organizations blocks its operations because a needy person who is familiar to the officer may apply for help after which these officials just dump the applications and no further communications. These personnel officers are seen as tourists when they visit some of these remote places urging people to form groups and get registered so as to be assisted and as a result this letter of registrations get expired with nothing archived hence failure of operations. In order to overcome the obstacles the most important thing is to change the mode of administrations because some global organizations were formed some centuries ago and what had been happening in these centuries are quite deferent from what is happening this days. Here are my suggestions, Include individuals in your operations Work independently Take the organization offices nearer to the needy people Employ the needy in your offices for efficiency sake

Now in the designing and implementation of the program, there is not much planning. The planning doesnot means the word meaning planning. it just tells about the program design and implementation and even follow-up. But now every program are becoming worst because of the poor excecution. The problem with the public sector is lack of ability to take the challenges. So the same thing is followed with the old program implementors. The new bloods with the new ideas has to come to take care of the new projects. they can finout the new way to implement the success. When it comes to a new hand, they will be planning in every sense of planning. So while giving the fund, it should not take as a way to dispose the fund. But findout the better way and best way out of it to utilize the resourses. As the father of economics says, the resourses are scares and the wants are unlimited. So we have to carefully use the resourses. While we were in college life, we were conducted so many campaigns foe HIV. There we find one thing, now the ways of awareness availabe is not reaching the desired one. So the programs are just meant for the publicity. So it has to be changed. People like me are seeking opportunity, but we are not getting good ones. Those who are not interested again getting the projects and thus they don't have interest they can't use it properly. So it has to be changed. Participation of the young bloods has to come to the front. Then only system will change, with out a change in the system, nothing will workout. Thank you, Phenomon Joy feno@sify.com