AMFm Overview and Case Management Observations

09.07.09

RBM Case Management Working Group (CMWG)

Discussion Overview

Overview of the AMFmCountry Level Challenges &

MitigationsCross-Cutting Private Sector

IssuesOperationalizing the AMFm

AMFm Summary

What

How

Where

When

Who

The AMFm co-finances ACT orders from public and private buyers with 95%, paid directly to approved manufacturers.

Any nationally registered first-line buyers in both public and private sectors may purchase subsidized ACTs. The co-payment applies to all ACTs that comply with Global Fund Quality Assurance policy

12 proposals were submitted for Phase I*: Benin, Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zanzibar

Applications were due July 1, 2009 and subsidized ACTs are expected to flow into countries beginning in February 2010

Eligible countries were invited to submit a proposal to the Global Fund to access the AMFm

*Phase I countries were selected based on a set of criteria, among them malaria mortality rates, experience with large-scale or private sector ACT programs, status of private sector distribution, existing GF malaria grants, and a conducive regulatory environment

Proposal Process and Timeline

Inform & engage

Identify critical

choices & decide

Define key interventions & implementation planAgree on final

proposal

Stage 1 Stage 2 Stage 3

MayAprilMarchFebruary June

Stage 4

• Nairobi meeting: AMFm overview, application framework, proposal writing approach discussions

• Country Application Decisions: Countries who decided to apply reflected on critical policy, intervention, and resource considerations

• HWG Technical Assistance: Collaborative approach of the HWG supported countries by providing technical assistance for the preparation of proposals

• HWG Mock Technical Review Panel: held in Dar-Es-Salaam in June to review proposal progress to date and provide broad feedback

• Ongoing Mock Reviewer Feedback: A range of partners provided feedback to countries on proposals throughout the final weeks of writing

• Timely Submission: All applications were submitted on time and currently in review

• Global Fund Review: TRP currently reviewing country proposals, first decisions expected in October

HWG Support To Countries

The collaborative approach of the HWG supported countries by providing technical assistance for the preparation of proposals

Country Level Challenges & AlternativesSome of the risks to the successful implementation of the AMFm that countries identified are outlined below:

Potential Risks Country Mitigation Examples

Poor diagnosis and inappropriate supply of ACTs by providers

OR and pilot studies to understand relevant diagnostic activity scale-up

Lack of supply of ACTs through supply chain

Provider training, detailing and supply management support, incentive schemes

Lack of Supply Engagement of private sector wholesalers and distributors through advocacy and training

Inappropriate use of ACTs by patients

Provider training expanded to private sector; increased IEC/ BCC for education to patients on proper drug usage

Some Cross-Cutting Private Sector Issues

Diagnostics in the Private Sector• Implementation challenges to scaling up

• Intensive BCC required to impact practitioner and patient behaviour

• Country and community context of RDTs relative to existing health facilities

9 / 12 AMFm applicants will pilot RDTs or do RDT OR

to improve diagnosis; studies are

specifically targeted at understanding

how to operationalize RDTs in the private

sector

Private Sector Training

• Challenges to building capacity and maintenance of skills

• Dynamics for community based treatment may change; as private sector is scaled up it will become more competitive

8 / 12 countries will strengthen

community level treatment through a scale up of HMM by training more health

practitioners and Community Health

Workers

Sufficient Drug Supply and Distribution• Coordination required with preventative initiatives

• Poor forecasting and order management practices in public and private sectors may result in stock outsOperational research

around non-financial and financial incentives for

wholesales to reach remote areas;

detailing services

Operationalizing the AMFm

• Increased partner support and guidance welcomed, especially in terms of providing implementation assistance.

• Regular HWG meetings and calls already taking place; however, involvement scope has changed now that proposal have been submitted.

• There is now an opportunity to target country support at new relevant issues and all ideas on how to best do so, including improving coordination across existing partner efforts, are welcome.

Discussion around key operational issues and suggested approaches related to Case Management in the private sector is encouraged.

Private Sector Case Mgmt. DiscussionDiscussion Context• AMFm should operate in a coordinated manner with in-progress and planned initiatives

Discussion Scope • Case Management within 18 month Phase 1 of the AMFm

Discussion Objectives• Identify the most pressing private sector case management issues

• Define practical alternatives that can be operationalized

• Provide recommendations on CM priorities to countries and partners