When Mama Tlou and Mama Museveni talked zero HIV

By Esther Nakkazi

When mama Tlou visited Uganda recently, she called on mama Museveni. The two chatted away about children, goats, rain, harvest, the normal chitchat that African women usually engage in. 

But the conversation then got serious, as mama Tlou or officially Prof. Sheila Tlou, is the UNAIDS director of the Regional Support Team for East and Southern Africa and Mrs. Janet Kataaha Museveni, is Uganda’s first lady, minister for Karamoja Affairs and Ruhaama county MP.

Mama Tlou appealed to mama Museveni to champion prevention of pediatric HIV infections particularly the Prevention of Mother to Child Transmission of HIV (PMTCT). One of the key issues to halting the epidemic is leadership but lately it has waned both nationally and internationally.

In Africa leadership made a difference earlier on in Uganda and in Botswana. In South Africa new leadership has given rise to a much expanded and effective AIDS treatment and care program.

So Tlou's mission was to revitalize the leadership in the context of getting to: Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths with special focus to elimination of Mother To Child Transmission.

“We should strive to keep the mothers alive so that we do not create more orphans. We should also enroll them on antiretroviral therapy as soon as possible so that they can safely continue breastfeeding and ensure that the babies are healthy,” Tlou pleaded.

Studies show that new HIV infections among children have already been virtually stopped in high-income countries, with the number of new infections among children falling dramatically due to the effective use and availability of antiretroviral drugs.

Comparable results can be achieved in low- and middle-income countries. Transmission of HIV infection from mother to child can be reduced to less than 5 percent if pregnant women living with HIV have access to health programs involving antiretroviral drugs.

“Mama,” Tlou urged, “Uganda was one of the countries that inspired US even before the advent of ARVs. The leadership is still right here. We need you to champion PMTCT like you have done with the youths.”

Mama Museveni is recognized for her programmes among the youths, which have greatly reduced HIV prevalence and new infections in this group. She founded Uganda Women’s Initiative to Save Orphans, and is the patron for the National Youths Forum plus several youth’s initiatives in HIV and sexual reproductive health. Her campaigns have focused much on Abstinence and Being Faithful.

In Uganda, 150,000 children below 15 years in Uganda are HIV positive, with 98,000 needing treatment but only 24,000 are accessing it. Of the ones on treatment, 38% do not return after being diagnosed or after the first treatment.

Mama Museveni decried complacency calling on government leaders to ‘re-energise their efforts in the prevention response.’ “I think the campaign relaxed and people forgot that HIV is still with us. We need to continue drumming HIV prevention messages, especially regarding PMTCT, so that people wake up,” she said assuring that she was also talking to papa Museveni about it.

“I have been speaking to the president to talk about HIV. He used to and it worked.” “My traditional area was the youths. But now I’m scattered. It has really distracted me from my calling but I know we really have a challenge. I’m willing to come back on board,” she pledged.

Mama Tlou’s visit to Uganda was to engage in high-level advocacy with Government of Uganda leadership, to revitalize the national HIV and AIDS response.

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First Microsoft Innovation Centre opens at Makerere University

By Esther Nakkazi

A new Microsoft centre designed to promote the development of innovation and growth of the Ugandan software economy has been opened in Makerere University. 

The facility, an extension of the global Microsoft Innovation Centre network, is the result of a partnership agreement between United Nations Industrial Development Organization (UNIDO) and Microsoft.

The Microsoft Innovation Centre will act as incubator for innovation; technology training and industry skill transfer and actively contribute to economic growth and prosperity in Uganda.

“I am pleased to note that this Centre is yet another deliverable within the UNIDO–Microsoft partnership. I am confident that prospective employers from both, the public and privates sector, will value the contribution that this Centre can make to skill development, particularly for the youth,” said the UNIDO Regional Director for East Africa, David Tommy.

The centre will provide assistance and resources to small and medium sized enterprises to create new and innovative products and services, bring those products to the market and improve their business competitiveness. 

It will also provide support to small and medium enterprises and independent software vendors, as well as develop better student collaboration, provide support for new start-up companies, and act as the test laboratory Centre for the development of software projects.

“Offering these opportunities to the local community is an important step to encouraging innovation and entrepreneurship,” said Louis Otieno, General Manager for Microsoft East and Southern Africa.

“We envision that the Centre will boost the local software developer industry, driving increased availability of highly skilled and proficient ICT users as well as developer skills in the country. By fostering innovation, together we can ultimately drive growth in the local and regional economy.”

Microsoft works globally with partners from the public sector, academic institutions and industry to promote innovation. The Microsoft Innovation Centres- more than 90 of them world-wide- are a central component of this innovation drive, which provides effective support for the local software markets.

They do not carry out research themselves but offer a research and development platform for partners working in innovative sectors, helping to foster innovation in their local country, in their region and across the globe.

Uganda’s first Microsoft Innovation Centre will focus on skills development, aiming to educate local students to help improve their professional IT knowledge and gain real project experience before graduating.

“It will provide young entrepreneurs, students, developers and researchers in the local community access to expert information and high-tech equipment for testing and developing the latest technologies built on the Microsoft platform,”said Otieno.

Another key goal of the Centre will be helping developers and IT professionals learn about the latest technologies, stimulating technology innovation and driving the local software economy to boost national competitiveness.

“This is a major milestone for our country particularly for the young people who now have a world-class facility to hone their ICT skills. Uganda has continued to experience significant growth in terms of GDP, investment, employment and tax revenue in the ICT sector and the Microsoft Innovation Centre is definitely going to play a big role in bolstering the continued growth of the sector.” said the Minister of Information and Communications Technology, Ruhakana Rugunda.

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Global Fund Board Cancels Round 11 and Introduces Tough New Rules for Grant Renewals

GFO Newsletter  Issue 167


The Global Fund Board has cancelled Round 11 in light of the Global Fund's financial difficulties. This difficult decision was made at a stressful two-day Board meeting in Accra, Ghana, that ended yesterday evening, 22 November.

The original decision to launch Round 11 in August 2011 was made at a Board meeting in December 2010. At its meeting in May 2011, the Board did not make any changes to its plans for Round 11, having been told by the Secretariat that sufficient funding (an estimated $1.6 billion) would be available for that round. But the estimate of funds available for Round 11 declined to $0.8 billion in September 2011, and then to a negative amount this month. The decline was caused primarily by some donors changing their minds regarding their so-called pledges, and other donors saying that they would delay payment of their pledges.

The Global Fund has long had a policy that the financing of Phase 2 renewals of existing grants has a higher priority than the financing of new grants. As a result, the Board concluded that almost all of the $8.2 billion in revenues that is now projected to arrive by the end of 2013 will be needed for renewals, leaving no money for Round 11.

The next replenishment period will be 2014-2016. Given that there is no money for Round 11, the next opportunity for countries to apply for new grants will be during the 2014-2016 period. They will be able to do so using a new funding model that is called for in the Fund's new Strategy 2012-2016, also approved at this Board meeting.

Some countries have existing grants that will reach the end of Phase 2 well before 2014. Many of those countries have been hoping to be approved for Round 11 grants. Because that will not be possible now, the Board has agreed to put in place a Transitional Funding Mechanism that will provide for continuation of essential prevention, treatment and/or care services by current grantees. Details of this mechanism will likely be announced in the coming weeks.

However, even with the cancellation of Round 11, the Global Fund did not have enough money to pay for the Transitional Funding Mechanism, and for some Round 10 grants, unless further savings could be found. (The Fund stopped signing Round 10 grant agreements about a week ago because of its financial problems.)

The Board decided to find some of the required savings in the following ways:
The one-year Grace Period provision for changes in country income classification will be rescinded. (See explanation in GFO 80.)
The "counterpart financing" and "focus of proposal" requirements that already apply to new grants will also apply to Phase 2 renewals. (See description in GFO 146.)
Instead of Phase 2 financial commitments being made in two tranches (i.e., the first two years, and then the third year), they will be made one year at a time ("1+1+1").

But even more money had to be freed up. The Board discussed two options for this. One was to say that all eligibility rules that apply to new proposals would also apply to Phase 2 renewals. The other was to say that countries are not eligible for Phase 2 renewal of their current grants if they are Group of 20 (G-20) upper-middle-income countries "with less than an extreme disease burden." Following a difficult discussion, the Board chose the second option. This means, for example, that Argentina, Brazil, China, Mexico and Russian Federation will not be eligible for Phase 2 renewal. (South Africa is a G-20 country, but it has an "extreme" disease burden, so it will be allowed through.)

China is, by far, the country that will suffer most from this decision, because China had been expecting to be eligible for some $880 million in grant renewals.

Now that the above measures have been agreed, the Fund will temporarily be able to resume signing Round 10 grant agreements. However, because the signing of new grant agreements can only be done when the required funds have been received by the Global Fund from its donors, and because Phase 2 renewals take priority over new grants, it is always possible that the signing of Round 10 agreements will be put on hold again. It all depends on whether donors deliver their 2011 pledges during 2011, and whether at least some of them deliver their 2012 pledges earlier rather than later in 2012.

The Global Fund Board's decisions concerning Round 11 are contained in the decisions point document for the Accra meeting, which is due to be posted at www.theglobalfund.org/en/board/meetings/twentyfifth.

Family Planning Access Will Deliver for Women In Uganda BY: Dr. Jotham Musinguzi

BY: Dr. Jotham Musinguzi, Regional Director, Partners in Population Development; Jill Sheffield, President, Women Deliver

Next week, leaders from across Africa and around the world will meet at the 2011 International Conference on Family Planning in Dakar, Senegal . This meeting comes at a critical time, as we examine how to navigate a world with increasingly constrained resources and create a future that fosters health and development worldwide. The meeting also occurs during World AIDS Day. Women now comprise the majority of those living with HIV in Africa, and access to male and female condoms to prevent both HIV and unwanted pregnancy is crucial.

The benefits of family planning are plentiful and powerful. Simply put, family planning saves lives. Currently, more than 215 million girls and women who want to avoid or delay pregnancy don’t have access to family planning. Each year, 358,000 women die from pregnancy- and childbirth-related complications. Universal access to family planning could reduce these deaths by up to one-third.

Providing girls, women, and their partners with family planning information and services empowers them to decide the number, timing, and spacing of their children – and whether they want to become pregnant at all. Wanted pregnancies are safer and healthier pregnancies. Access to family planning prevents up to 1 in 3 maternal deaths and 1 in 11 child deaths, and is a critical strategy to reaching Millennium Development Goals 4 and 5.

In Uganda, a woman will have an average of six to seven children in her lifetime. This poses a serious health risk to her and her children, and has financial implications for families. When couples manage their own fertility they can better plan to care for their family by investing their resources in education, health, savings, and business opportunities. This is how we can end the cycle of poverty.

At the national and global levels, family planning is immensely cost-effective: satisfying the unmet need for contraceptives would reduce overall health costs, saving over US$1.5 billion a year. The cost of protecting a couple from unintended pregnancy ranges between US$10-$15 per year, making it one of the most affordable and effective life-saving solutions available.

The Ugandan Minister of Health, Dr. Christine Ondoa, will be present at next week’s meeting. Joined by numerous health and finance ministers from across Africa, Dr. Ondoa will discuss the importance of increased access to family planning in Uganda and region wide. Currently, only 18% of married women in Uganda report contraceptive use. This number can and should be higher.

The good news is that we have family planning solutions; we just need to make them more accessible. Providing variety is critical: voluntary family planning works best when women have a full range of contraceptive options and can choose, access, and afford the method best suited to their needs. We need strategies to reach marginalized and remote communities, and for that reason community health workers need to be supported. And finally, knowledge is power: we need to provide girls, women, and their partners with the information they need to make informed decisions.

The time is now to put words into action. Our world’s population recently reached a staggering seven billion. As we debate how to handle a world of this size in the face of growing global inequity, one thing is clear: we must empower girls and women everywhere. According to the World Bank’s 2012 World Development Report, gender equality is critical to improving development results. Research shows that engaging women’s skills and talents around the world will lead to significant productivity and economic gains. Uganda should continue to lead in efforts to demonstrate this in reality.

In March, Partners for Population and Development and Women Deliver will convene regional experts, policymakers, researchers, and activists in Kampala to share success stories and lessons learned around women’s health. The conversations will include a variety of voices, as every sector has a role in making a difference for girls and women in Uganda and worldwide.

At the International Conference on Family Planning , we will discuss ways we can accelerate action to deliver life-saving results for women and girls, with far-reaching benefits. Reproductive rights, including family planning, are a fundamental stepping stone to gender equality. It is now more important than ever to ensure that all children are wanted, and all citizens have the resources they need to realize their full potential.

The Global Fund troubles

COMMENTARY: The Most Important and Difficult Global Fund Board Meeting Ever
by Bernard Rivers
Snapshot from 2002: The Global Fund's Framework Document describes the Fund as "simplified," "rapid," "innovative" and "efficient." The goal is to raise billions of dollars and then disburse it rapidly to implementers, telling them, in effect, "OK, get on with the job."
Fast forward to 2011: The Fund's bureaucracy is far from "simplified" and "efficient." The Fund's image has been tarnished by findings of corruption among grant implementers. And the Fund's donors have become alarmed by significant weaknesses in Global Fund systems and among senior Global Fund management - and, of course, have been suffering from their own economic problems. The net result is that some donor pledges have been cut and the delivery of others has been delayed. Money is tight. Round 11 is in danger of being cancelled.

This morning, (Nov 20th) the Global Fund starts the most important and difficult Board meeting it has ever held. The only options for action involve causing pain. And the "no action" option will merely compound the problems.

There are five problems that the board needs to deal with. Some must without question be tackled at this meeting. Others could be deferred; but the sooner they are tackled, the better.

The first problem is that some donor countries have cancelled or delayed their disbursements to the Global Fund, partly because of their own economic problems, but also because of the corruption that the Fund's Office of the Inspector General (OIG) has identified and that the Fund's transparency policy has caused to become public. The situation is dire. Donors used to honour 100% of their pledges to the Fund. In 2010 this went down to below 80%. This year, the figure is lower still. The "confirmed pledges" that donors had said they would deliver during 2011 through 2013 have gone down from $9.7 billion to $8.2 billion, as a result of about $1 billion having been "un-confirmed" and about $0.5 billion now projected to arrive after 2013.

As a result, estimated funds available for Round 11 have declined from $1.6 billion (in May 2011), to $0.8 billion (in September), to negative $0.6 billion today. Yes, negative. This means that the current prediction is that there will be no money to pay for Round 11, and possibly not enough to pay for some as-yet unsigned Round 10 grants.

The second problem is that two admirable components of the Global Fund model - an OIG that is determined to root out corruption, and a world-class transparency policy - have produced, when combined, some unanticipated consequences. The OIG discovered fraud among certain grant implementers; the Global Fund posted the findings at its website rather than hiding them in a safe; the press went wild; donors worried about how their taxpayers would feel about funding grants for corrupt implementers; donor pledges were reduced or delayed; and Global Fund growth suddenly stalled.

The third problem is that the OIG got carried away, chasing down not only corruption, but also anything else that could be defined as "loss," and then demanding that the loss be returned to the Fund. These "loss" determinations included, for instance, that a principal recipient (PR) in Swaziland must return over $1 million to the Global Fund because the PR, when asked to document how the money was used, could only produce photocopies of invoices rather than originals. Quick, all of you - raise your hands if you have ever been guilty of this "crime." I have.

Thus far, the OIG has identified $17 million in fraud across all grants that it has audited and investigated. But it has identified almost three times as much - $48 million - in other forms of "loss" that must be refunded, including that $1 million in Swaziland.

This has been bad enough for the PRs who are required to return the money - money which they often no longer have because it was long ago passed to sub-recipients who were responsible for the loss. But, again, there has been an unanticipated consequence. PRs are now nervous to pass money to sub-recipients (SRs), and SRs are nervous to spend the money when they receive it, for fear that some determination of loss will be made, possibly years in the future. This paranoia has led, if not to paralysis, at least to a slowing down and disruption of grant implementation. This represents a huge cost for the people that the grants are supposed to benefit.

The impact of this second problem upon the entire Global Fund system, from Geneva headquarters to sub-sub-recipients, is roughly what the impact would be upon your family or mine if government officials, anxious to ensure that we don't mistreat our children or engage in tax-evasion, placed video cameras in every room of our homes, and issued press releases from time to time based on the worst things that those cameras revealed. Not many families would survive the tensions that this would engender.

The Fund has rightly recognised, after a very difficult year, that it must identify, mitigate and manage risk. But it hasn't done enough thinking about the way in which its risk management policies are, at least at present, slowing down the delivery of services and thus the saving of lives.

The fourth problem is that John Parsons, the Inspector General, head of the OIG, has shown, on a number of occasions over a prolonged period of time, a remarkable ability to shoot himself - and therefore the Fund - in the foot. As discussed in Article 4, below, UNDP, the largest implementer of Global Fund grants, is now essentially refusing to work with him; and many other PRs have also expressed serious criticisms. (See the GFO Commentary "Auditing the Auditor," and subsequent letters to the editor here and here.) The Global Fund Board, to whom John Parsons reports, will discuss this evening the year-end evaluation of his work performance that it has just completed.

The fifth problem is that the Fund has some serious management weaknesses at the senior level. This has led to some unpleasant in-fighting, with allegations floating around that range from the worrying to the ridiculous. A year ago, the Board renewed the employment contract of Michel Kazatchkine, the Executive Director, giving him a final three-year term (following his initial term of four years). But, as with the Inspector General, the Board specified that Kazatchkine must undergo an annual evaluation. The first such evaluation has just been completed, and the findings will be discussed by the Board this evening. (Both this evaluation and that of John Parsons were "360 degree reviews" conducted by external professionals under the guidance of the Chair and Vice-Chair. Structured feedback was obtained from dozens of people in each case.)

So: The Fund's growth has stalled. Over the past ten years, Global Fund financing has contributed to the saving of 7.7 million lives. Every one percent increase or reduction in funding or effectiveness will lead to multiple further lives saved or not saved. The Board's decisions today and tomorrow will be crucial; they will ultimately determine the up or down curve in money, effectiveness and lives.

Bernard Rivers (bernard.rivers@aidspan.org) is Executive Director of Aidspan and Editor of GFO.