The Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund was established in 2002 to finance programs that combat AIDS, TB and malaria.
The vision of the Global Fund is a world free of the burden of AIDS, tuberculosis and malaria. Its mission is to markedly increase resources to tackle these diseases, which are some of the world’s most devastating, and to channel these resources to areas where they are most needed.
Presently, the Global Fund finances one-quarter of all international funding for AIDS, two-thirds for tuberculosis and three-quarters for malaria—worldwide.
The Global Fund operates as a financial instrument, not an implementing entity. This means that the Global Fund does not set health priorities for a country—a receiving country should already have a national health plan and health priority. The Global Fund then provides the countries with resources to implement their national plans and meet their health goals. These financial resources enable countries to improve their health systems by providing funds for quality medicines, training for health providers and upgrades for health infrastructure.
The Global Fund’s operational model links its financing to the country’s achievement of its objectives and targets, while ensuring that funds are spent on delivering services for people and communities in need.
For more information please visit: http://www.theglobalfund.org/en
Global Fund Malaria Grants in SFH
In 2007, the Society for Family Health signed a Grant agreement with the Global Fund to scale up malaria control activities in 18 states of Nigeria, through the Round 4, Phase 2 grant. Interventions approved under the grant included: Provision of long lasting insecticidal nets (LLINs) for pregnant women and children under five years through antenatal and child welfare clinics; Provision of Artemisinin-based Combination Therapies (ACTs) to children five years and under; Provision of Sulphadoxine Pyrimethamine for prevention of malaria in pregnancy.
In 2008, SFH commenced the implementation of the Global Fund Malaria project through its Maternal and Child Health division. The project employed social marketing strategies to provide quality, affordable pre-packaged treatment for malaria, and increase access to preventive commodities (LLINs and IPT) for pregnant women and children under 5 years old, through private health facilities and outlets.
The Global Fund Malaria project demonstrates a successful model for implementing highly subsidised preventive and curative interventions in Nigeria.
The Global Fund Malaria Division
After SFH underwent restructuring in 2009, the Global Fund Malaria (GFM) Division was established as a separate unit within SFH. The new GF project goal, in line with the National Malaria Strategic Plan, was to scale up malaria prevention and treatment interventions to universal coverage—in other words, the entire population at risk of malaria in all 36 states and the Federal Capital Territory of Nigeria.
The Global Fund Round 8 Grant
With the adoption of a new global focus, ‘Scaling Up for Impact’, the GFM division is now implementing universal coverage of malaria treatment and prevention interventions under the Round 8 program. The broad strategy for malaria prevention among populations at risk has continued to be the use of Long Lasting Insecticide-treated Nets (LLINs).
Treatment of malaria in populations at risk of malaria is with the use of Artemisinin Combination Therapies (ACTs) as articulated in the current malaria treatment policy. With the expansion of coverage to include persons above five years, GFM, in line with the current treatment policy, will also implement diagnosis using rapid diagnostic tests and microscopy. Additionally, the use of Sulphadoxine Pyrimethamine for the prevention of malaria in pregnancy among women will be promoted through behaviour change communication
Behaviour Change Communication (BCC)
SFH is implementing Behaviour Change Communication and social mobilisation activities for the GF Malaria project.
The objective of the BCC activities is toincrease informed demand for ACT, SP and LLINs through advocacy and Information, Education, Communication activities targeted at communities, households, and care givers.
The essential actions needed to reach the intended audiences include mass media campaigns, health provider training, social mobilisation through Community Based Organisations (CBOs), and advocacy for the use of appropriate antimalaria medicines.
THE LONG LASTING INSECTICIDE-TREATED NET (LLIN) DISTRIBUTION CAMPAIGNS
Society for Family Health, through the Global Fund Malaria division, implemented the LLIN distribution campaigns in Niger and Ogun state. The goal was to distribute respectively 1.7million and 1.6million Long Lasting Insecticide-treated Nets (LLIN) to all households in both states.
All communities/settlements, wards and Local Government Areas (LGAs) of the two states were to be covered through stand-alone mass distribution campaigns. The planning process commenced in June 2009, with the final lap culminating in actual net distribution in December, 2009.
The objective of the LLIN campaigns was to contribute to the rapid scale up to universal coverage of the population at risk of malaria in 2010 through 100% coverage and 80% use of LLINs. The strategy to achieve this was to deliver two LLINs to every five persons—the mean size of a household was worked out to be five persons.
The mass campaign was implemented in partnership and with support from the Niger and Ogun State Governments. The states’ traditional institutions also provided immense support.
The concept of State Malaria Ambassadors was introduced as a way to create awareness and acceptance of the campaigns among communities. The selected Malaria Ambassadors were to be people of influence, who have led by example in their communities. In Niger, the Etsu-Nupe, Dr Ibrahim Yahaya, CFR, was the natural choice. In Ogun State, it was the Awujale and Paramount Ruler of Ijebu land.
Etsu Nupe—His Royal Highness, Dr. Ibrahim Yahaya, CFR
The Awujale and Paramount Ruler of Ijebu Land Oba Sikiru Kayode Adetona CFR and SFH MD, Bright Ekweremadu
Besides the initial planning at the National level—macro planning—and subsequent procurement of the LLINs, other major pre-campaign activities included the formation of state LLIN campaign coordinating networks and three campaign work streams--Logistics, Demand Creation and Technical. These teams effectively led the LLIN campaign operations in both states.
Advocacies to relevant stakeholders, including the State Governments and traditional leaders were essential to the campaigns succeeding.
Community social mobilisation led by community-based groups served to inform people of the forthcoming campaigns. All personnel to be involved in the campaign activities at state, LGA, ward and distribution point levels received training prior to implementation. Net cards, which were to be exchanged for LLINs at distribution points, were given to household members during house to house mobilisation. Intensive mass media sensitisation accompanied all these activities so that people were prepared for, and accepting of the intervention that was taking place in their communities.
Robust logistics arrangements ensured the on-time delivery of the nets from ports to designated state stores, and finally to distribution points across the states.
Most distribution point teams would commence distribution as early as 6 a.m., and distribution would usually continue till about 3 o’clock in the afternoon.
Distribution points were mostly Primary Health Centres, schools and homes of community heads.
A period of 21 full working days was used for actual campaign execution starting with state level training of trainers (4 days), cascade trainings (4 days), house to house mobilisation (7 days), net redemption (4 days) and end process evaluation (2 days).
The commitment of health workers at LGA levels and below was overwhelming—many people made personal sacrifices in several instances to see that the campaign was implemented as smoothly as possible. The level of integrity, especially of ward supervisors was impressive and very encouraging. Support from traditional and religious also leaders helped to make the distribution process in many distribution points peaceful. The logistics of net movement was the toughest challenge of the entire process—difficult terrain and the peculiarity of fuel crisis during the implementation period added to the challenges.
However, State commitment and support, the ownership and involvement of traditional institutions and communities, well entrenched community mobilisation processes and a robust logistic framework helped to ensure that the LLIN mass distribution campaign worked!
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