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A proposed shift in Partnership focus: From change-management to country implementation support

A proposed shift in Partnership focus: From change-management to country implementation support. RBM Harmonization Working Group 12 th RBM Board Meeting May 10, 2007 Geneva. INCREMENTAL SCALE-UP VERSUS SCALING-UP FOR IMPACT: COUNTRIES AND PARTNERS AT A CROSSROADS.

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A proposed shift in Partnership focus: From change-management to country implementation support

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  1. A proposedshift in Partnership focus: From change-management to country implementation support RBM Harmonization Working Group12th RBM Board MeetingMay 10, 2007Geneva

  2. INCREMENTAL SCALE-UP VERSUS SCALING-UP FOR IMPACT: COUNTRIES AND PARTNERS AT A CROSSROADS • The Board has endorsed a new rallying cry : • “Scale Up” • Existing full package of proven interventions • Nation-wide to high coverage • Rapidly • “For Impact” • Track action and document changes in coverage and benefits in human and economic terms • Together, these influence implementation action and reiterate Abuja and RBM Global Strategic Plan Targets • Difficult trade-offs

  3. “UN-HARMONIZED” APPROACHES: • Single interventions • Sub-national “projects” • Gradual scale-up • Focus is not scaling up on effective interventions as quickly as possible • Each partner doing their own thing with their own plan and systems • Un-monitored and un-evaluated work

  4. 15 COUNTRIES PARTICIPATING IN US PRESIDENT’S MALARIA INITIATIVE Mauritania Mauritania Niger Niger Mali Mali Eritrea Chad Chad Senegal Senegal Sudan Sudan The Gambia The Gambia Burkina Faso Djibouti Djibouti Guinea Guinea Benin Nigeria Nigeria Sierra Leone Sierra Leone Ethiopia Ethiopia Togo Cote d'Ivoire Ghana Liberia Liberia Central African Rep Cameroun Somolia Eq Guinea Uganda Uganda Kenya Kenya Gabon Congo Congo Rwanda Rwanda Congo, DRC Congo, DRC Burundi Burundi Tanzania Tanzania Angola Angola Malawi Malawi Zambia Zambia Mozambique Mozambique Zimbabwe Zimbabwe Madagascar Madagascar Botswana Botswana Namibia Namibia Swaziland Swaziland South Africa Lesotho

  5. COUNTRIES PARTICIPATING IN WORLD BANK MALARIA BOOSTER PROGRAM Mauritania Mauritania Niger Niger Mali Mali Eritrea Chad Chad Senegal Senegal Sudan Sudan The Gambia The Gambia Burkina Faso Djibouti Djibouti Guinea Guinea Benin Nigeria Nigeria Sierra Leone Sierra Leone Ethiopia Ethiopia Togo Cote d'Ivoire Ghana Liberia Liberia Central African Rep Cameroun Somolia Eq Guinea Uganda Uganda Kenya Kenya Gabon Congo Congo Rwanda Rwanda Congo, DRC Congo, DRC Burundi Burundi Tanzania Tanzania Angola Angola Malawi Malawi Zambia Zambia Mozambique Mozambique Zimbabwe Zimbabwe Madagascar Madagascar Botswana Botswana Namibia Namibia Swaziland Swaziland South Africa Lesotho

  6. COUNTRIES PARTICIPATING IN BOTH US-PMI AND WB BOOSTER Mauritania Mauritania Niger Niger Mali Mali Eritrea Chad Chad Senegal Senegal Sudan Sudan The Gambia The Gambia Burkina Faso Djibouti Djibouti Guinea Guinea Benin Nigeria Nigeria Sierra Leone Sierra Leone Ethiopia Ethiopia Togo Cote d'Ivoire Ghana Liberia Liberia Central African Rep Cameroun Somolia Eq Guinea Uganda Uganda Kenya Kenya Gabon Congo Congo Rwanda Rwanda Congo, DRC Congo, DRC Burundi Burundi Tanzania Tanzania Angola Angola Malawi Malawi Zambia Zambia Mozambique Mozambique Zimbabwe Zimbabwe Madagascar Madagascar Botswana Botswana Namibia Namibia Swaziland Swaziland South Africa Lesotho

  7. GFATM PER-CAPITA FUNDING LEVELS IN MALARIA-ENDEMIC AFRICAN COUNTRIES Gabon Global Fund summary country lifetime budgets per-capita population US$ 0.00 $0.50-1.99 $2.00-2.99 $3.00-4.99 $5.00-9.99 $10.00-52.00 Mauritania Mauritania Niger Niger Mali Mali Eritrea Chad Chad Senegal Senegal Sudan Sudan The Gambia Burkina Faso Djibouti Guinea Bissau Guinea Guinea Benin Nigeria Nigeria Sierra Leone Sierra Leone Ethiopia Ethiopia Togo Cote d'Ivoire Ghana Liberia Liberia Central African Rep Cameroun Somolia Eq Guinea Uganda Uganda Kenya Kenya Congo Congo Rwanda Congo, DRC Congo, DRC Burundi Tanzania Tanzania Angola Angola Malawi Malawi Zambia Zambia Mozambique Mozambique Zimbabwe Zimbabwe Madagascar Madagascar Botswana Botswana Namibia Namibia Swaziland South Africa Lesotho

  8. ARE WE POSITIONED TO SUCCEED? • Consensus and Board Approval on Essential Interventions - YES: Especially: • Transmission reduction with ITNs and IRS • Prevention of Malaria in Pregnancy • Prompt and Effective Case Management • This is the easy part…thanks largely to WHO

  9. ARE WE POSITIONED TO SUCCEED? • Consensus and Board Approval for Harmonization and Implementation Support? • Country-led “Three-Ones” • One National Plan • One Implementation Coordination System • One Monitoring and Evaluation System • This is not the easiest part…we must learn by doing

  10. Millennium Project: Awash Teklehaimanot; 1 Additional academic partner engaged in implementation TBD by Board Member UN Foundation: Kevin Starace; 2 Additional foundation partners to TBD by Board Member Private Sector: To be determined Representatives of active RBM Working Groups (To be determined/adjusted) Representatives of RBM SRNs: 4 Malaria Endemic Countries (3) RBM HWG MEMBERSHIP • World Bank: Suprotik Basu (Co-chair) • UNICEF: Melanie Renshaw (Co-chair) • WHO: Sergio Spinaci, Valentina Buj, Robert Agyarko • GFATM : Mabingue Ngom • US/PMI: Trent Ruebush, Rob Newman - 1 additional bi-lateral TBD • UNDP: Sandii Lwin • MACEPA (Rick Steketee); VOICES (Matt Lynch); 1 Additional NGO partner to be determined by Board member

  11. RBM HARMONIZATION WORKING GROUP: TERMS OF REFERENCE Coordinate a process to support the development of and adherence to the “3-ones” concept at country level Assist countries to identify support needs for scaling-up through comprehensive gap analyses (including tool development for gap analyses) Track and Facilitate resource flows from partners to countries Harmonize partner efforts to fill country-identified gaps Facilitate the development of a “rapid-response” mechanism to support countries to overcome implementation bottlenecks (reactively and proactively) Secure additional resources from the Global Fund, PMI, World Bank and others in support of country scale-up

  12. PRIORITY AREAS OF WORK • GAP ANALYSIS AND IMPLEMENTATION SUPPORT • MATCHING RESOURCES TO IDENTIFIED GAPS • INFORMATION DISSEMINATION &TOOL DEVELOPMENT

  13. GAP ANALYSIS AND IMPLEMENTATION SUPPORT • Key challenge facing RBM in many countries is making the money work. In other countries, resources are the rate-limiting factor • >US$800 million in outstanding financial commitments are available for malaria control scale-up in Africa. • Recognizing that malaria endemic countries are not homogeneous in the type of support required, each endemic countries in Africa was placed into support category • HWG recognize that endemic countries need different types of support and developed a categorization for African countries • Countries that are categorized into one group will move to other groups (potentially quite quickly)

  14. HWG: COUNTRY CATEGORIZATION CRITERIA Emergency: Countries with urgent action required including those: with no external financial support; at high risk of losing GFATM second phase funding and with limited/no other funding sources; with 'conditional go' for their phase 2 Global Fund grants that will need to quickly improve programme implementation and countries suffering from complex emergencies Validation: Countries performing well but constrained by available finances. These countries need assistance to validate their strategic and operational plans to secure additional resources Implementation: Countries with adequate financing in the short term, but unable to fully utilize them Funding and Implementation: Countries with both financial and implementation constraints No action required: Countries without short and medium term assistance needs

  15. GAP ANALYSIS AND IMPLEMENTATION SUPPORT: ACTIVITIES TO DATE • Support mission to Nigeria led by WHO in response to alert from Global Fund on possible loss of grant • Outcome: Grant maintained • HWG Review mission to Mozambique to review technical soundness of strategic plan and catalyze development of operational plan • Participation in Zambia comprehensive program review

  16. Gap Analysis and Implementation Support: Proposed Activities from May 2007-2008 • Development and Implementation of Early Warning System and Implementation Assistance Hotline to proactively alert HWG to implementation bottlenecks • Linkages with other RBM structures and partners • Implementation Support mechanism to respond to bottlenecks, nested in existing partners but requiring additional support • Develop special package of assistance for emergency countries (3 countries, as per demand) • Gap Analysis and Partner Mapping in at least 7 countries (based on initial demand) • Once gaps are identified, the HWG will work to fill resource gaps – both financial and technical • Provided 12 months of in-country assistance to 4-5 NMCPs to assist in partnership coordination, adherence to three-ones, implementation support Once gaps are identified, the HWG will work to fill resource gaps: financial and technical

  17. MATCHING RESOURCES TO IDENTIFIED GAPS: ACTIVITIES TO DATE • Support process to 19 countries to prepare proposals in response to the Global Fund’s 7th Call for Proposals. • Target is to double the success rate from Round 6, going from 34% approval to at least 60% • Each country matched with a local and external consultant to support proposal development and consensus building. • High-level dialogue between RBM Executive Director and Ministers to reinforce HWG support process • Training for all 19 countries plus consultants on proposal development and responding to previous proposal weaknesses identified by TRP • Mock TRP scheduled for June 4-5 in Nairobi. • HWG to brief TRP in August to highlight cross-cutting issues and challenges to bear in mind when reviewing proposals

  18. MATCHING RESOURCES TO IDENTIFIED GAPS: ACTIVITIES TO DATE (CONTINUED) • Support to UNITAID to match ACT resources with identified gaps • Liberia and Burundi identified by HWG as facing ACT emergencies during HWG country review (risk of supply interruption) • HWG prepared “appeals” on impending ACT shortfalls in both countries • Proposal to UNITAID to fill short-term ACT needs in both countries • Approx. US$1.5 million of ACTs provided to avoid interruption • UNITAID in discussions with the Harmonization Working Group on ACT financing • pre-proposal submitted for US$90 million of ACTs over the next 12 months • Extensive consultations with partners and countries for development of the proposal

  19. MATCHING RESOURCES TO IDENTIFIED GAPS: Proposed activities May 07 - May 08 Conduct independent evaluation of HWG Round 7 Proposal Development Support Process (Dec 2007) Support to Global Fund Round 8 Proposals Provide support to PMI, World Bank and others to review projects and propose adjustments as needed in light of identified gaps (6-7 countries)

  20. MATCHING RESOURCES TO IDENTIFIED GAPS: Proposed activities May 07 - May 08 Together with MAWG, support events to ensure World Bank Booster, PMI, and other donor resources are secured to fill identified gaps Provide support to fill agreed technical support gaps in 6 countries (based on gap analyses and HWG Early Warning System) Develop with MERG, a biannual brief update on resource flows and implementation progress. First brief delivered to RBM Board by Nov 07

  21. INFORMATION DISSEMINATION & TOOL DEVELOPMENT • Activities to date: • Modification of GFATM proposal template to assist in malaria proposal development • Tools for malaria program scale up to support: • Planning • Resourcing (money and people) • Implementing • Monitoring and Evaluating • Print, electronic, web-share and CD version of “Essentials of Malaria Control Programming” • Partnership production under the leadership of the HWG with links to MERG, to the Advocacy WG & other WGs as appropriate

  22. Planning-Resourcing-Implementing-Monitoring & Evaluating Planning Tools National Strategic Plan for Malaria Control 3-year Implementation Plan Annual Action Plan -- midterm review Resourcing Tools Costing Financial Management HR assessment Resourcing Planning Scaling Up for Impact M&E Tools M&E Plan Global Fund Attachment A Impact: reduced illness, anemia, death Outcome: coverage and use Outputs, Process, Inputs Gaps assessment Implementation Tools Intervention support ITNs, IRS, Prev of MiPreg, PECM Systems support Procurement & Supply Chain Mgt Calendar of Action IEC/BCC Plan Advocacy Plan Etc. Implementing Monitoring & Evaluating

  23. THE ROUND 7 PROPOSAL SUBMISSION SUPPORT PROCESS: A NEW WAY FOR RBM TO DO BUSINESS

  24. Realistic and publicly announced target with buy-in from all WG partners Prioritization and tailoring of country support given resource realities Exceptionally high level of partner involvement in planning, execution, and fundraising Exceptionally intense level of Secretariat support Aggressive contracting out to expand partnership capacity Support to Working Group members from the HWG’s budget to support fulfilling HWG activities

  25. If you agree with the approach, please consider the implications…

  26. CASE STUDY: IMPLICATIONS OF PROGRESS TO DATE ON ROUND 7 SUPPORT Estimated Time and Monies spent: January – July 2007 Operational Costs • Level of Coordination Required • At least one (2-hour) teleconference per week for the Steering Committee (WHO HQ and AFRO, MACEPA, UNICEF, World Bank, USAID) Estimated Staff and Travel Costs FTE = Full Time Equivalent

  27. CASE STUDY: IMPLICATIONS OF PROGRESS TO DATE ON ROUND 7 SUPPORT Key Cost Centers

  28. THE ROUND 7 PROPOSAL SUBMISSION SUPPORT PROCESS: A NEW WAY FOR RBM TO DO BUSINESS • Early Lessons Learned • Shifting to a focus on implementation support is time consuming, costly, but critical • Contracting out is proving to be essential, but expensive • Dedicated staff time from HWG Members is reaching its limit, as is Secretariat capacity

  29. Greater Focus on Implementation and Coordination will Require: Additional Support to Secretariat AND to Individual Partners

  30. BOARD REQUESTED DECISION POINTS • Endorsement of Terms of Reference and Areas of Focus for 2007-2008: • Gap Analysis and Implementation Support: • Matching Resources to Identified Gaps • Information Development and Tool Development • Endorse the need for incremental financial and staff support to: • HWG Partners (particularly to implement the Implementation Support Mechanism); and • TheRBM Secretariat (for coordination and facilitation) • Guidance requested on role of the Private Sector (manufacturers, consulting firms, etc) in the HWG • Undisputed added value, but reputational risk due to conflict of interest perception • Guidance requested on expansion to other regions outside Africa • Consider name-change of HWG to “Malaria Implementation Support Team” If these actions are taken, the Harmonization Working Group will provide the Board with a comprehensive budget by July 1, 2007

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