Malawi: Challenges and Opportunities – Enhancing Strategic Collaboration for more Effective Programs Edith Mkawa, Principal Secretary for HIV/AIDS and Nutrition, Office of the President and Cabinet, Malawi Beth Tippett Barr, HIV Prevention, CDC-Malawi Ritu Singh, HIV Cluster Lead, USAID-Malawi Plaikessi Kouadjani, Fund Portfolio Manager, Malawi-GF

PEPFAR in Malawi Annual funding through 2008: Approx. $22m Annual funding: FY09-11: Approx. $65 million Focus on: – Improving quality of care and treatment – Basic health systems strengthening Human Resources Laboratory District Planning and Program Implementation – Behavioral and biomedical prevention – Orphans and community-based care

Global Fund in Malawi HIV Rounds & Funding levels – Round 1: Treatment, Care and Support: US$316m – Round 5: Orphans and Vulnerable Children: US$13m – Round 7: BCC, Community Care & Prevention service for Young people: US$17m – HIV SSF: RCC Phase II consolidated with Round 7 Phase 2 to form the SSF grant with a retrospective starting date on 1 st April Grant will be signed before 31 st July 2012: (US$ 208 million) Funds all ARVs & some HIV related Commodities as well as improving CMS Funds Malawi’s innovative PMTCT Option B+ regimen Malaria: – Consolidated Rounds 2&7: US$57 million – Round 9 US$ 25 million TB: Round 7 US$ 9 million HSS: Round 5 US$ 52 million MGFCCM: Malawi Global Fund Country Coordinating Mechanism

Symbiosis…. A relationship of mutual benefit or dependence

PEPFAR & GF: A Symbiotic Relationship HIV: Wraparound complementary programming – GF provides test kits, ARVs, and other HIV commodities – PEPFAR facilitates implementation of the program across all levels: Central: Program funding to MOH Zonal: Support to zonal offices to strengthen planning District: Support to DHMTs in annual planning, with direct and indirect financial support for implementation Facility: Supportive Supervision and Clinical Mentoring Community: two-way referrals, mobilization and demand creation for HIV programs

Making GF Work in Malawi: CMS HIV Commodities currently go through a parallel supply chain because of weak CMS system Global Fund: Investing in upgrading warehouses PEPFAR: Technical and Financial Support for the organizational overhaul of CMS, and upgrading of stock management system

Making GF work in Malawi: MOH PEPFAR supports coordination and communication between GF, NAC and MOH through hiring of a GF Liaison; embedded in MOH HIV Dept: – Technical Advisors: PMTCT/ART Logistics Monitoring and Evaluation – Fellows PMTCT/ART Logistics M&E IT

A Symbiotic Relationship: Funding & Technical Support PR for HIV (NAC) PR for TB (MOH) PEPFAR Implementing Partners / GF- SRs PEPFAR (OGAC) Implementing Partners PEPFAR-MW USAIDCDC Global Fund PR for Malaria (MOH) Sub-Recipients (SR)

Communication CCM – USG Representation – CCM Executive Committee – CCM Adhoc Committee HIV/AIDS Donor Group (HADG) Health Donor Group (HDG) Global Fund Liaison

Our Symbiotic Relationship: Successes Donors cooperate with each other Roles are fairly well defined for national program support PEPFAR maximizes their comparative advantage – On-the-ground – Direct support for GF proposal development – Eyes and ears to support the program which GF is funding Ie. Option B+: GF funded ARVs; PEPFAR trained all health workers for implementation, and supports ongoing M&E True opportunity for country ownership as the national system is funded to deliver HIV services GF/PEPFAR shared belief in ‘country ownership’ and ‘shared responsibility’ investing in strengthening national systems

Our Symbiotic relationship: Areas for ongoing collaboration Joint effort needed to: – Advocate: GF/PEPFAR common ideal of ‘country ownership’ and ‘shared responsibility’ for investing in national systems Additional GoM resources for HIV response – Implement: Regular mapping of all donor resources – Strengthen: Coordination and sharing of workplans & activities Supply chain management institutions, processes and tools Storage capacities and quality Financial Management Systems of PRs and SRs

Our Symbiotic relationship: Looking to the… …Immediate future: High-level delays in SSF signing combined with imminent switchover to VPP = high risks of stock-outs at facility level before end of 2012 Malawi is still functioning on Round 1 RCC GF HIV grants to finish in March 2014 … Mid- to Long-term future: Global financial crisis; limited GF resources Complete uncertainty after 2014 How to diversify the resource pool in a time of dwindling resources Avoid duplication of efforts and maximize efficiency Support high-impact interventions Alignment of priority strategic investment in Malawi

Conclusions PEPFAR and Global Fund have built a very successful collaboration with NAC and MOH to implement HIV, TB, and Malaria Programs PEPFAR and GF have mutually benefitted from each other’s presence in the national HIV response in Malawi After years of financial and technical support from us both, the National HIV Program is threatened by our mutual limits in funding