Solthis' Report: “Managing Risk in Fragile States: Putting Health First! Optimising the Efficiency of the Global Fund’s Grants”
2014 | Scientific Papers | financial risk management, Fragile states, Global fund
GUINEAMALINIGERSIERRA LEONEADVOCACYHEALTH FINANCINGHIV / AIDSMALARIATUBERCULOSIS
“Managing Risk in Fragile States: Putting Health First!
Optimising the Efficiency of the Global Fund's Grants”
This evidence-based report is the result of a work over several months, including 4 missions (Guinea, Mali, Niger and Sierra Leone) and interviews with 140 stakeholders. Through this work, we identified bottlenecks in the implementation of the Global Fund's grants in the field, showing that the Global Fund's Risk Management Policy is not well-adapted to fragile states. The additional safeguard measures which have been put in place by the Secretariat after the investigations of the Office of the Inspector General were meant to mitigate the financial risks and to reassure donors. However, experiences in challenging operating environments clearly show that these measures are mainly focused on financial risks and have caused significant malfunctions that jeopardise both the impact and the sustainability of the programmes.In order to make progress and to cope with the challenges specific to fragile states, we think it is now time for the Board members and the donors of the Global Fund to opt for an ambitious and innovative policy, which would put financial risk at its proper place: behind risks to public health.The main recommendations we are addressing in the report aim to place the public health risk at the centre of the mechanism, by:
Full version of the report in English hereYou can also read our 4-pages booklet hereThe article of Altermondes dedicated to this topic and the interview of the author Hélène Roger Download resources
- Improving the balance between the analysis and the management of the different risks.
- Simplifying and clarifying the control procedures: limit the number of contractors and the levels of validation.
- Defining indicators or objectives for terminating additional safeguard measures to encourage appropriation and capacity building.
- Investigating the possibility of an increased presence of the Global Fund in the field, by missions of several weeks or several months.
- Adapting the indicators and procedures of performance-based funding and accountability measures to fragile states.
AFRAVIH – Geneva, Switzerland, march 2012
2012 | Oral presentations
MALIADVOCACYHEALTH FINANCINGHIV / AIDS
Le processus de contrôle fiduciaire du Fonds mondial vu du terrain : l’exemple de la composante VIH au MaliAuthor(s) : Louis Pizarro, S. Tchiombiano, S. Calmettes Download resources
Séroprévalence des virus de l’immunodéficience humaine et des hépatites B et C chez les donneurs de sang à Ségou au Mali
2012 | Scientific Papers
Author(s) : M.C. Koné, E.T. Sidibé, K.K. Mallé, S. A. Beye, G. Lurton, M.T. DiarraJournal : Médecine et Santé Tropicales 2012; xx : 1-2. doi : 10.1684/mst.2012.0016 DOI : 10.1684/mst.2012.0016
Solthis’ Scientific Day 2011
2011 | Conferences
GUINEAMALINIGERADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCH
Prof. C. Katlama, Prof. G. Brücker et S. Calmettes
On the occasion of its General Assembly, Solthis held Wednesday, July 6 at the Pitié-Salpêtrière, the 4th day meeting. Teams Solthis and partners in the field were present, especially from Mali, Guinea, Niger and Haiti.The presentations are available below on this page.
HIV testing: a challenge?
Y. Yazdanpanah, F. Huber, R. Tubiana, M. Idé
At the "Test and Treat", screening is an important theme in African contexts, as in Western countries. Also, the first workshop of the Scientific Day Solthis it was dedicated, moderated by Dr. M. Ide (Niger) and Dr. R. Tubiana (Paris).In his introduction, Dr. F. Huber (Solthis) presented the technical aspects of "rapid tests" raising the question of the limits of these tests, and the problem of lack of due process and the frequent inability to meet the temperature conditions recommended by the suppliers. This presentation was followed by a review of different screening strategies and the historical evolution of paradigms: the screening called "voluntary" to "provider-initiated testing for carers" as advocated by WHO and the various authorities health. Aspects of "cost effectiveness" of screening were then analyzed by Prof. Y. Yazdanpanah (Tourcoing). Dr. F. Lamontagne (Solthis Guinea) and Prof. M. Cisse (Guinea) have supported these statements by the West African experiences Solthis on screening in the care environment "opt out". If this type of screening "at the initiative of the caregiver" has made great advances in PMTCT or in tuberculosis centers, much remains to be done in other departments of medicine, where a high proportion of patients is not detected, not supported. Mobilization on this issue is more strategic than ever.
ARV supply and Stock-outs
Z. Ankourao (Niger)
Despite the investment of Solthis on supply issues (ARV, all health products ...), stock-outs, especially for ARVs, are still common in the field and directly threaten the health of patients. The session dedicated to these issues was conducted by two doctors Dr. B. Diallo (Mali) and Dr. PM Girard (Paris).E. Guillard (Solthis Pharmacy Manager) said the overall functioning of the supply before presenting the main causes that lead to situations of stockouts. The threat of disruption of Guinea in February 2011 was taken as an example to highlight the failures at different levels of decision making. Teams in the field of pharmacy Solthis and their partners then described their daily actions, emphasizing the mode of intervention or Solthis tools developed together, such as coordinating groups and committees for monitoring supplies, tables edge compilation, analysis, alerting, quantification tools ... Finally, J. Langlois (Sidaction) and F. Foguito (TAW), representing civil society, concluded the session by the role of associations to fight against breakage, and more widely to improve the quality of care.
Prof. V. Calvez (Pitié-Salpêtrière, Paris) presented the situation of primary resistance throughout the world, before recalling the consequences attributable to virological choice of first-line treatments. He raised the problem of low genetic barrier of molecules commonly used in countries with limited resources (especially NNRTIs), especially when access to viral load is small or nonexistent.
Maintaining in the circuit of care
This session, moderated by Prof. M. Cisse (Guinea) and Dr. G. Breton (Paris), addressed the issue of retention of patient care in the circuit, through various initiatives. After a general introduction of G. Lurton (Solthis), Dr. M. Ide (National Hospital of Niamey) lamented the difficulties of long-term monitoring of HIV patients in Niger, based on the experiences of ambulatory treatment center and day hospital in Niamey. The experience of Medecins du Monde, supporting marginalized populations in integrated centers in Asia, was reported by Dr. N. Luhman. Finally, Dr. Claude Pean, Haitian Institute Pereo Fame, introduced the operation of the center of Port-au-Prince, who has built an international program based on improving the encrypted performance.
International AIDS Society – Rome, July 2011
2011 | Posters
MALIOPERATIONAL RESEARCHHIV / AIDSMOTHER AND CHILD HEALTH
The prevention of mother-to-child transmission of HIV in Mali: HIV-positive pregnant women and loss to follow-up in the Segou region (Mali)Author(s) : T. Mutel, A. Akondé, A. Doumbia, D. Coulibaly Traore, M. Diarra, F. Maiga, B. Coulibaly, L. Pizarro, F. Perez Download resources
Days scientists Bamako – January 2011
2011 | Conferences
MALIADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCH
The Scientific Days of Mali experts have gathered several members of the Working Group Solthis: Christine Katlama, Roland Tubiana and Gilles Brucker. Solthis co-organized the National Day which brought together over 300 Malian professionals involved in the fight against HIV. For Solthis and its partners, it was an opportunity to present the results of the management and discuss immunological and therapeutic advances.
Francophone Conference – Casablanca, march 2010
2010 | Oral presentations
GUINEAMALINIGERADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCHHIV / AIDS
Evolution de la prise en charge du VIH à Ségou entre 2003 et 2009Author(s) : L. Diakité, D. Katilé, , N. Diallo, A. Doumbia, MS. Koné, B. Coulibaly, A. Sidibé, Y. Coulibaly, A. Akondé, G. Lurton, F. HuberDownload the presentation Evaluation de la mise en place du dépistage et de la prise en charge du VIH au centre antituberculeux Carrière, à Conakry (Guinée)Author(s) : LM. Camara, B. Bah, D. Touré, P. Kourouma, L. Hajouji, C. Katlama, F. Huber, O. SowDownload the presentation Délégation de la prescription des antirétroviraux aux paramédicaux dans la PTME à Ségou (Mali)Author(s) :A. Doumbia, A. Sidibé, AT. Traoré, A. Akondé, F.Z.T. Sangaré, DC. Traoré, M. Maiga, AM. Soumaré, F.D. Cissé, SD. Naman, G. Lurton, C. Katlama, F. HuberDownload the presentation Charge virale en routine dans un pays à ressources limitées : le cas du NigerAuthor(s) : Dr Hanki, H. Yahayé, S. Mamadou, I. Aboubacar, R. Ali Maazou, I. Dillé, C. Dézé, S. Diallo, F. Huber, M. Amadou, F. MaïgaDownload the presentation L'épidémiologie des perdus de vue dans les programmes VIH/SIDAAuthor(s) : E. Poulet, M. Pujades-RodriguezDownload the presentation L'approche anthropologique des ruptures de suivi médical des personnes vivant avec le VIH : l'exemple de Kayes (Mali)Author(s) : S. Carillon, V. PetitDownload the presentation Les patients sous ARV perdus de vue : l'expérience de l'ONG WALEAuthor(s) : D. KatiléDownload the presentation
Level of viral load and antiretroviral resistance after 6 months of non-nucleoside reverse transcriptase inhibitor first-line treatment in HIV-1-infected children in Mali
2010 | Scientific Papers
MALIOPERATIONAL RESEARCHHIV / AIDSMOTHER AND CHILD HEALTH
Author(s) : D. Germanaud, A. Derache, M. Traoré, Y. Madec, S. Touré, F. Dicko, H. Coulibaly, M. Traoré, M. Sylla, V. Calvez, AG. MarcelinJournal : Journal of Antimicrobial Chemotherapy - 2010 Jan;65(1):118-24 Download resources
Seminar on viral load and ARV resistance – Bamako, December 2009
2009 | Conferences
MALIOPERATIONAL RESEARCHHIV / AIDS
Solthis, GIP Esther and the Point G Hospital, organized the seminar "resistance" on 10 and 11 December 2009 in Bamako. More than fifty doctors and biologists from all over the country attended this training on viral load and resistance to ARVs patients living with HIV / AIDS. Several clinical cases were presented by the Malian and discussed with national medical authorities, also attended by experts from the Pitie-Salpetriere Hospital in Paris: Professor Christine Katlama, Prof. Vincent Calvez, Dr. Anne Genevieve Marcelin and Dr. Roland Tubiana .
Solthis’ Scientific Day – Paris, June 2009
2009 | Conferences
MALIADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCH
Over a hundred people came to attend the Scientific Solthis Day on June 26. Players on the field of SOLTHIS, France or Paris, they met for the highlight of the association. Also, many distinguished guests were present: representatives of national and international institutions, the Global Fund, civil society actors ... Today, all teams SOLTHIS wishes to thank those who were able to attend this day to the quality of exchanges, the wealth of information and their demonstrated interest in our actions.Scientific Day of Solthis is also an opportunity to give voice to field to present the projects implemented and to share their thoughts on the challenges of HIV disease. See you in 2010!
Project presentations Solthis
Proceedings of the Round TableWhat future for international funding of HIV programs?
In the current economic crisis and crisis funding, SOLTHIS wanted to set up a reflection on this vast subject. The roundtable, chaired by Professor Gilles Brucker, gave rise to two questions, firstly that of continuous funding for the fight against HIV and the effectiveness of such funding. This debate was thus the occasion for Prof. Patrice Debré, new Ambassador in charge of the fight against HIV AIDS, to outline the challenges and the strategy it intends to introduce. Dr. Florence Veber, Assistant Director for Health and Human Development (MFA) has expressed his current thinking on innovative financing and recalled in place of the fight against HIV in health policy. Representatives of civil society were also at the table. Marie-Alexia Delerue, of Action for Global Health, called for a mobilization of governments for development of new sources of funding in addition to their official development assistance. As for Khalil Elouardighi, Coalition of More, he warned of the serious short-term decline in funding from the Global Fund, particularly for patients néceisstant treatment of second and third line.
Prof. Patrice Debré: Patients and international partnerships
Prof. Patrice Debré is the new Ambassador in charge of the fight against HIV / AIDS and infectious diseases. There is also a co-founder of Solthis.
Professor Debre presented the characteristics of the epidemic: 33 million people infected with HIV, 2.7 million new infections per year, two million deaths 75% in Saharan Africa. A disease that affects both women that man ... In countries é low or middle income, the access to ARVs is limited: only 31% of global demand for ARVs are covered. .. HIV was the illness that led to the concept of "Global Health" to emerge, this awareness of global health has led to considerable social and political commitments for which new resources and new funds were needed .
Then, the Ambassador outlined the contribution e franéaise the fight against pandemics based financing channels in 2007:
- For HIV: 363 million euros, 20 million for bilateral (AFD, Esther, ... AT MFA) and 26 million for Research (ANRS, IRD, CNRS ...).
- For malaria: 100 million for multilateral and bilateral for zero.
- For TB: 31 million for multilateral and bilateral 3 million for.
Finally, Professor Debré expressed challenges in the fight against HIV at international level:
1. Harmonization of the Governance of International Health
2. Cooperation among the multilateral organizations
3. Complementarity between the bilateral and the multilateral
4. European dimension
5. Support in general
6. Integrated approach between basic and clinical research, opening e other areas such as agronomy
7. Multiplication of innovative financing
Dr. Florence Veber is currently in charge of the Sub-Directorate of Health and Human Development of the Ministry of Foreign Affairs and European.
Dr. Florence Veber presented the new organizational structure of Ministry of Foreign Affairs and European set up to be in phase with the emergence of global issues like climate change or pandemics. She outlined the three main directions:
1. Administrative direction
2. Diplomatic lead (geographical division)
3. Overall direction of globalization development, partnerships and development.
This new direction is divided into four sub-directorates including the Directorate of global public goods including climate, natural resources (forests and water), food security and health and human development. Led by Dr. Veber, this sub-directorate deals with issues of health but also education, employability, gender equality, migration, demography and social protection.To date, this sub-department is particularly sought for the monitoring of commitments in the multilateral franéais since 75% of the budget of the health cooperation through multilateral channels. She is in charge of policy definitions, the Operational being managed by AFD (Franéaise Development Agency). Moreover, the strategy of cooperation policy for health should be reviewed to the end of 2009 with the participation of stakeholders. This new team wants to offer stakeholders greater access and transparency to the data field to promote shared approaches among other NGOs and the Ministry.Dr. Veber has shared his thoughts of two topics:
1. Consequences of funding for HIV / AIDS on strengthening health systems?
2. Efficiency and use of innovative financing in health?
Marie-Alexia Delerue: Health Care Financing
Marie-Alexia Delerue is responsible for advocacy at Medecins du Monde, a member of the NGO network European Action for Global Health.
Marie-Alexia Delerue presented the evolution of financing Development assistance for health:
- International: 4-fold increase between 1990 and 2007;
- At European level: 58% increase from 2001 e 2007;
- In France: 4-fold increase between 2000 and 2007;
- Sources: Public sources of funds, but increasingly the private / philanthropic (26.7% of total international aid health in 2007);
- Channels: increased multilateral channel (GFATM, GAVI).If this international movement, ed through increased international funding, has achieved considerable progress in terms of health (reduction of child mortality, increasing the number of patients having access to ARVs ...), we find that health issues in the South are immense: the eight Millennium Development Goals (MDGs), who increased the least are those for e health. Funding and predictability are still insufficient.In the current economic crisis, health indicators are threatened. The WB report on the global crisis provides that if any international response is urgently adopted to support developing countries, approximately 200 000 e 400 000 children under 5 years and more will lose their lives each year. It is therefore fondammental that donors meet their financial commitments in favor of health.Today, NGOs are calling on international donors and governments in the South:
- Putting health at the heart of development policies (for developing countries, have 15% of their health budget e)
- Respect the commitments made by donors in the framework of the G8
- Promote the strengthening of health systems
- Develop new funding sources, including quickly implement the tax on currency transactions, which could bring in $ 40 billion by annnée and would therefore make a real difference in terms of scale of development finance and accelerate the progress of health indicators. Innovative financing must be additional e the official development assistance and truly predictable.
Khalil is a member of the Network Elouardighi Coalition more.
XVth ICASA – Dakar, December 2008
2008 | Posters
MADAGASCARMALINIGERADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCHHIV / AIDSTUBERCULOSIS
HIV/AIDS care and follow-up on a national scale in low resource settings: experience of the Niger Initiative on Antiretroviral Access (INAARV), NigerAuthor(s) : M. Ide, Y. Madec, M. Boubacar, E. Adehossi, C. Dezé, GM. Lawal, O. Amadou, S. Diallo, C. Pizzocolo, IA. Touré, S. Mamadou, C. Katlama and the National Technical CommitteeDownload the presentation Pilot cell comprehensive care: a multidisciplinary service orientation and listening PHAs, NigerAuthor(s) : A. Alzouma, C. Dezé, B. Sabo, M. Bako, S. Maman, I. Mourtala, M. Goundara, F. Djermakoye, M. Ide, F. AeberhardDownload the presentation The impact of prior recourse to traditional medicine on the out-of-pocket expenditure of HIV/AIDS patients in NigerAuthor(s): S. Walker, S. Tchiombiano, A. Maiga, R. Hassane, M. Idé, AH. Souna, V. Bignon, O. Weil, L. PizarroDownload the presentation Incidence and risk factor for tuberculosis (TB) in HIV patients on ART, Niger Author(s): A. Foucher, Y. Madec, S. Diallo, Z. Thiousso, I. Dillé, S. Gambo, HA. Souna, A. Oumarou, A. Manou, GM. Laoual, Al. Touré, C. Pizzocolo, L. Pizarro, A. FontanetDownload the presentation Decentralized access to triple therapy and viral load monitoring in West Africa (Mali)Author(s) : A. Akondé, Y. Madec, AB. Dicko, I. Haidarra, I. Katile, B. Diarra, M. Kye, A. Doumbia, C. Pizzocolo, C. Katlama and the Segou Medical Technical CommitteeDownload the presentation A method of HAART decentralization in rural areas: Solthis' experience in Segou (Mali)Author(s) : P. Teisseire, A. Akondé, C. Pizzocolo, S. Calmettes, S. Dalglish, N. Bodo, L. PizarroDownload the presentation Prevention of mother-to-child transmission of HIV (PMTCT) in a rural setting : the experience of the Segou region in MaliAuthor(s) : CD. Traoré, A.akondé, T. Samake, T. Traoré, Y. Coulibaly, O. Coulibaly, A. Sidibé, D. Germanaud, Z. Traoré, A. Maiga, AG. Marcelin, C. Pizzocolo, C. Katlama and the Segou Medical Technical CommitteeDownload the presentation Appraisal of treatment modification in HIV patient follow-up in the region of Segou (Mali)Author(s) : J. Landier, A. Akondé, C. Pizzocolo, I. Haidara, M. Drabo, L. Pizarro, A. Fontanet, C. Katlama, Y. MadecDownload the presentation Etude virologique chez des sujets VIH-1 suivis à MadagascarAuthor(s) : F. Lamontagne, S. Andriantsimietry, ML. Chaix, JP. Viard, M. Randria, J. Nely, S. Randriamampionona, C. Aguilar, S. Royer, C. Pizzocolo, LR. Razanakolona, C. RouziouxDownload the presentation
International AIDS Conference – Mexico City, August 2008
2008 | Posters
MALINIGERADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCHHIV / AIDS
HIV-infected children in the context of the Niger Initiative on Antiretroviral Access (INAARV), Niger (West Africa)Author(s) : R. Abdoulaye-Mamadou, I. Adehossi, Y. Madec, C. Dezé, W. Alkassoum, M. Mahamane, I. Daouda, M. Amadou, D. Germanaud, C. Pizzocolo, S. Mamadou, C. Katlama and the National Technical Pediatric CommitteeDownload the presentation Looking for lost to follow-up patients: experiences of Segou (Mali)Author(s) : G. Lurton, A. Akondé, Y. Madec, P. Teisseire, T. Traore, B. Touré, D. Cissé, C. Koumaré, C. Pizzocolo, L. Pizarro, C. Katlama, and the Segou Medical Technical CommitteeDownload the presentation
HIV drug resistance after the use of generic fixed-dose combination staduvine/lamiduvine/ nevirapine as standard first-line regimen
2007 | Scientific Papers
MALIOPERATIONAL RESEARCHHIV / AIDS
Author(s) : AG. Marcelin, B. Jarrousse, A. Derache, M. Ba, ML. Dakouo, A. Doumbia, I. Haidara, A. Maïga, G. Carcelain, G. Peytavin, C. Katlama, V. CalvezJournal : Aids - 2007, 12;21(17):2341-3
Francophone Conference – Paris, march 2007
2007 | Posters
MALIADVOCACYCAPACITY BUILDINGOPERATIONAL RESEARCHHIV / AIDS
Evaluation d'un programme d'accès décentralisé aux antirétroviraux au MaliAuthor(s) : AB. Dicko, MH. Maiga, A. Akondé, Y. Madec, C. Pizzocolo, le Comité thérapeutique de Ségou et le groupe de travail SolthisDownload the poster Mise en place de la numération des lymphocytes T CD4+ par cytométrie de flux et suivi immunitaire des patients sous traitement antirétroviral à Ségou (Mali)Author(s) : A. Maiga, B. Jarrousse, I. Haidara, L. Tegna, G. Carcelain, B. Autran, C. Katlama, le comité thérapeutique de Ségou et le groupe de travail SolthisDownload the poster Evaluation des enfants de moins de 5 ans nés de mères séropositives incluses dans l'INAARVAuthor(s) : R. Abdoulaye-Mamadou, G.M. Lawal, A. Soumana, A. Gali-Yaroh, I. Adéossi, A. Harakoye, A. Diatta, M. Idé, Saïdou, C. Dézé, le comité médical technique du Niger et le groupe de travail SolthisDownload the poster
Evolution of genetic diversity and drug resistance mutations in HIV-1 among untreated patients from Mali between 2005 and 2006
2008 | Scientific Papers
MALIOPERATIONAL RESEARCHHIV / AIDS
Author(s) : A. Derache, Al. Maiga, O. Traoré, A. Akondé, M. Cissé, B. Jarrousse, V. Koita, B. Diarra, G. Carcelain, F. Barin, C. Pizzocolo, L. Pizarro, C. Katlama, V. Calvez, AG. MarcelinJournal : Journal of Antimicrobial Chemotherapy - Sep;62(3):456-63
XIVème ICASA – Abuja, december 2005
2005 | Posters
MALIHEALTH PRODUCTS AND PHARMACEUTICAL SYSTEMHIV / AIDS
Solthis: evaluation of a decentralized program for access to ARV in Ségou (Mali)Author(s) : B. Jarrousse, A. Doumbia, M. Ba, E. Klement, L. Tegna, B. Diarra Sonou, Z. Traore, D. Traore, B. Touré, S. Tchiombiano, B. Dembélé, C. Tétrel, A. Maïga, G. Carcelain, AG. Marcelin, B. Autran, C. Katlama Download resources
Francophone Conference – Brussels, march 2005
2005 | Posters
MALIADVOCACYGOVERNANCE AND HEALTH POLICIESHIV / AIDS
Pour un accès gratuit et décentralisé aux antirétroviraux en Afrique subsaharienne : l'expérience de Solthis dans la région de Ségou, au MaliAuthor(s) : E. Klement, Z. Traoré, B. Jarrousse, L. Tegna, C. Tétrel, C. Katlama Download resources