AMFm Overview and Case Management Observations RBM Case Management Working Group (CMWG)

Discussion Overview Overview of the AMFm Country Level Challenges & Mitigations Cross-Cutting Private Sector Issues Operationalizing 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 1Stage 2Stage 3 MayAprilMarchFebruaryJune 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 Applicant Country WHOMMVPSI RBM SRNs UNICEFCHAIRBM Other Partners

Country Level Challenges & Alternatives Some of the risks to the successful implementation of the AMFm that countries identified are outlined below: Potential RisksCountry 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 SupplyEngagement of private sector wholesalers and distributors through advocacy and training Inappropriate use of ACTs by patientsProvider 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 outs Operational research around non-financial and financial incentives for wholesales to reach remote areas; detailing services

Operationalizing the AMFm HWG AMFm Country Support AMFm Begin Existing Initiatives 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. Discussion Discussion 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