PAST COLLABORATION   FUTURE COLLABORATION

The USAID West Africa regional mission is responsible for technical and operational support to twenty-one countries within two of the Global Fund's regional groupings: Middle East and North Africa (Chad, Mali*, Mauritania and Niger) and West and Central Africa (Benin*, Ghana*, Guinea*, Nigeria*, Senegal*, Sierra Leone*, Burkina Faso, Cameroon, Cape Verde, Cote d'Ivoire, Equatorial Guinea, Gabon, Guinea-Bissau, Liberia, Sao Tome & Principe, The Gambia and Togo). USAID maintains a permanent presence in seven countries in this region, highlighted with an asterisk in the list above. The USAID West Africa's mission focus is on the fourteen "non-presence" countries, although attention is paid region-wide to health issues with cross-border impacts. The current fiscal year budget (FY07) for the regional health program is $13.6 million.

The Global Fund for AIDS, Tuberculosis and Malaria (the "Global Fund") has ninety on-going grants in the twenty-one countries covered by the USAID West Africa region valued at $1.08 billion. The US Government contributes over 28% of these resources. The USAID West Africa regional health therefore has a keen interest in helping the implementers of these projects succeed. USAID's technical support partners have been able to quickly respond to requests for help in the areas of proposal development, pharmaceutical procurement and supply chain management, program monitoring, data quality assurance and institutional governance.

A critical factor in rational use of technical assistance resources is active coordination among country programs and CCMs needing assistance and the growing pool of donors and regional institutions with resources to help. Non-negligible assistance is available in a range of technical areas, and all parties are working to improve communication and coordination to make the best use of available funds, and to ensure assistance is available when needed. CCMs can improve this system by identifying TA needs early and coordinating through the UNAIDS or GIST mechanisms. USAID West Africa and other donors will participate in this coordination effort to support TA where gaps exist.

The strategic objective of the USAID West Africa regional health program is to promote the adoption of selected high impact health policies and approaches in the areas of HIV/AIDS, Child Survival, Maternal and Reproductive Health. It does this by promoting best practices across the region, and by building the capacity of regional institutions to provide South-South technical assistance and cooperation and by influencing the health policy environment in West Africa. The regional health program also maintains on-the-ground resources to catalyze and coordinate responses to regional health threats and infectious disease.

USAID West Africa has a number of mechanisms and limited funding available to it to support the Global Fund: the centrally-managed mechanism targeting a limited number of countries globally; various global "field support" projects such as the Rational Pharmaceutical Management plus (RPM+) and projects; or separately funded bilateral or regional activities with a technical focus. In the USAID system, these are already funded mechanisms, so countries could access needed support quickly.

Since October 2003 when the "Action for the West Africa Region" (or the AWARE projects) were launched, USAID/WA has had a continuing interest in Global Fund activities through its implementing partners. Mission staff and project representatives have attended six regional Global Fund meetings and have offered their services in support of Country Coordinating Mechanisms (CCMs) and Principal Recipients (PRs). The strategic importance of leverage was specifically noted and reinforced in the July 2006 mid-term evaluation of the USAID/West Africa Health Program.

USAID/WA has also provided networking and liaison support to Global Fund processes on a demand basis. The development of Liberia's successful Round Six, $44.3 million HIV/AIDS proposal was in a large part facilitated by a consultant who was recruited by USAID/Monrovia through a contact provided by USAID/West Africa and USAID/Ghana who had contracted the same consultant on Ghana's successful Round Five HIV/AIDS proposal. A technical officer from USAID/WA also assisted Guinea to prepare its successful $27 million Round Six malaria proposal.

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Initially, there had been a disappointing regional up-take of its offers of technical assistance. The encouraging exception to this followed the Global Fund's requirement that Procurement and Supply Management Plans (PSMPs) be approved before grant signing. As pharmaceutical quantification, supply chain management and procurement is a core focus area for USAID field support, the demand for training and assistance in these areas surged in the proposal preparation period prior to the Sixth Round submissions and four separate regional trainings were organized between November 2005 and November 2006. Following a specific request made at the Global Fund MENA meeting in November 2006 a USAID field support partner will provide specific supply chain management systems support and advice to the CCM and PR in Niger.

USAID/West Africa-sponsored training took place in April and May 2007 to establish a core group of West Africa regional consultants familiar with new Global Fund monitoring and evaluation protocols: the M&E Systems Strengthening Tool, and the Data Quality Audit Tool. The current Global Fund funding round requires analysis of an M&E Systems Capacity Assessment to identify the major gaps in the monitoring and evaluation framework and to incorporate a plan to overcome those gaps. Regionally based consultants are well positioned and cost effective to assist Global Fund Country Coordinating Mechanisms finalize their proposals. The M&E Systems Strengthening Tool was developed by USAID's Global Health Bureau MEASURE Evaluation project as a diagnostic self-assessment check-list to identify major gaps in an implementing partner's monitoring and evaluation framework in order to lead implementers to defining concrete actions to resolve these constraints.

This is a new area of collaboration, beginning in June 2007 with CCMs in Guinea and Cote d'Ivoire. The program will use a participative diagnostic and management improvement approach to help the CCMs strengthen their own management capacity, along with their oversight and decision-making role. This work draws from experiences in several countries, and aims to develop a standardized approach and set of management tools that could then be applied by other technical assistance partners to assist other CCMs in the region.

USAID/West Africa recognizes the great strategic importance in helping existing grant implementation in West Africa go smoothly. It also has the capacity to facilitate proposal development in the upcoming Round Seven. Existing and funded support mechanisms are in place for the Procurement and Supply Management Plan and in the M&E Plan areas. USAID/West Africa and its partners can also provide responsive support in other areas.

Discussions in December 2006 with the Global Fund identified an initial short-list of four priority areas for technical assistance (Guinea, Cote d'Ivoire, Togo and Public-Private partnerships). An impediment to moving forward even in clear cases like these where the need has been identified by the Global Fund itself is the need to find a point of entry or invitation to establish a positive working partnership with the CCM to address specific technical or management areas together in a sustainable fashion. CCMs have hesitated in the past to work closely with other donors on Global Fund issues, but the creation of the Technical Support Facility (TSF) and other donor technical assistance initiatives and several positive experiences of collaboration have greatly enhanced this partnership environment.

Despite partner representation on 75% of the CCMs in the region, these institutions in themselves are facing serious challenges in defining or articulating the country's technical assistance needs to support Global Fund programming. These institutions may be broadly participatory their large and diverse memberships make their oversight and decision-making role much more challenging. CCM reform has been proposed by the Guinea CCM as an area of need, and USAID/West Africa is moving to help. USAID/West Africa recognizes that a process designed to assist countries to better understand the limits and flexibility of the Global Fund's CCM guidelines might be an effective approach to further improving the country-level management and oversight roles that need to be played by this institution.

Difficulties with CCM functioning as a result of misunderstanding of Global Fund guidelines are experienced by many countries in the region. USAID/West Africa prefers to propose a regional approach whereby well-performing CCMs from one country could share experiences and mentor others. To make this approach work, active Global Fund involvement is critical to ensure appropriate participation, but also to empower CCMs to make changes in their structures and operating procedures as appropriate. USAID/West Africa's role will be to provide the appropriate technical expertise required to facilitate this learning process.

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