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Global Fund Observer


Issue 236: 06 February 2014

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1. NEWS: $100 million grant signed for Southeast Asian malaria initiative

A first regional grant under the new funding model has been signed, bringing $100 million to the Greater Mekong sub-region for a wide-ranging initiative to avert the spread of artemisinin resistance within five malaria endemic countries.

2. NEWS: Russia in transition from recipient to donor of Global Fund grants

Russia is transitioning from recipient to donor of Global Fund grants, prompting concerns from civil society about potential gaps in service delivery, specifically related to prevention and harm reduction activities.

3. NEWS: Civil society, government and affected populations join HIV country dialogue in DRC

Democratic Republic of Congo has concluded a first inclusive country dialogue to develop a roadmap for an HIV concept note under the new funding model.

4. NEWS: LFA paper released

With a budget of $65 million annually, Local Fund Agents (LFAs) represent a significant and critical element in the Global Fund’s architecture and reflects about 20 percent of its total operating budget. A review paper written by Frank Wafula and published by Aidspan explores the nature of the relationship between LFAs and the Fund and the lessons learned over the last 12 years.

5. NEWS: Botswana pilots Aidspan’s CCM assessment tool

Botswana’s country coordination mechanism is the first to pilot a self-assessment tool created by Aidspan, Southern African AIDS Trust (SAT) and partners in Southern Africa.

6. COMMENTARY: Watchdogs or critical friends?

Robert Bourgoing narrates his experience facilitating a meeting in Nairobi with representatives of about 30 organizations from East and Southern Africa involved in the monitoring of global health programmes.

7. NEWS: Global Fund lifts suspensions of net suppliers caught in Cambodia case

Two suppliers of mosquito nets implicated in corrupt practices in Cambodia see their suspensions lifted by the Global Fund and will be required to accede to a series of compliance conditions in order to continue as contractors.

See section near the end of this newsletter listing additional articles available on GFO Live.

1. NEWS: $100 million grant signed for Southeast Asian malaria initiative

Regional outreach to migrants to complement service delivery in five Southeast Asian countries

A $100-million grant to avert the spread of artemisinin resistance in five malaria endemic countries in the Greater Mekong sub-region has been signed by a full complement of stakeholders, signalling the successful achievement of a first regional application under the Global Fund’s new funding model (NFM).

The Regional Artemisinin Resistance Initiative (RAI) will support purchase of long-lasting impregnated nets,  malaria case detection and provision of directly observed antimalarial treatment in Cambodia, Laos, Myanmar, Thailand and Vietnam, as well as regional and national advocacy and awareness campaigns.

A disease burden and financial gap analysis led funds to be allocated as follows: 15% to the regional campaigns; 15% to Cambodia; 5% to Laos; 40% to Myanmar; 10% to Thailand; and 15% to Vietnam.

Central to the outreach component of RAI is work to reach migrant populations living and working in border areas who are normally overlooked and often marginalized. Each country has committed to  complementary national campaigns targeting these populations.

Parasite resistance to artemisinin has been detected in all of the RAI countries, which has provoked concerns among malaria clinicians and researchers that a currently small problem could multiply exponentially and become a grave danger both within the region and beyond.

The risks presented by this growing resistance to artemisinin – the primary ingredient in combination therapies that have demonstrated the greatest success in treating malaria – drove the speed and deliberation with which the RAI proposal was achieved, according to RAI program manager Izaskun Gaviria.

“Artemisinin resistance is regarded as a global threat by the international community, which allowed the team to benefit from great support from key partners,” Gaviria said in an emailed response to Aidspan questions.

The split between regional behavior change and outreach activities and national-level service delivery was also a product of wide consultations with a variety of stakeholders including civil society groups, Gaviria said. It also reflects national and international priorities to coordinate with other regional initiatives on malaria funded by donors including The Bill and Melinda Gates Foundation, AusAID and DFiD.

While the ultimate goal is to contribute to the elimination of falciparum malaria in the Greater Mekong Sub region, and to prevent the emergence or spread of artemisinin resistance to new areas, incremental success for RAI will be assessed against the progress in: :

  • Reduction of malaria falciparum cases per country and progress towards national malaria elimination targets (up to 50% in some countries)
  • Ensuring high coverage with vector control and treatment interventions in designated areas and in particular among mobile/migrant populations
  • Elimination of oral artemisinin-based monotherapies

RAI is one of three regional early applicants under the NFM. The other two are a malaria initiative in Mesoamerica and Hispaniola, EMMIE, that will strengthen malaria surveillance in Dominican Republic, Haiti, Panama, Costa Rica, Nicaragua, Guatemala, Belize and El Salvador; and a regional HIV harm reduction initiative stewarded by the Eurasian Harm Reduction Network in Eastern Europe and Central Asia.

A total of $116 million was initially envisioned under the transition phase for these three regional initiatives.

[This article was first posted on GFO Live on 06 February 2014.]

To comment on this article, click here.



2. NEWS: Russia in transition from recipient to donor of Global Fund grants

Civil society groups look for other resources to fill anticipated vacuum in program support

Russia has announced its pledge to commit $60 million to the Global Fund’s fourth replenishment cycle ahead of the anticipated end in 2014 of all Global Fund grants to the country.

In an executive order signed in late December 2013, Prime Minister Dmitry Medvedev said that the pledge would signal the completion of Russia’s transition, begun in October 2010, away from receiving Global Fund assistance and towards being exclusively a contributor to the global fight against AIDS, TB and malaria. In total, Russia has contributed some $317 million to the Global Fund since 2002, including $217 million reimbursed under a 2007 agreement with the World Bank.

Russia received five grants in all – worth some $378 million – since the Fund’s inception in 2002, three of which were aimed at strengthening the national HIV response. The country coordination mechanism was abolished in 2013, leaving the remaining two grants the responsibility of independent non-governmental organizations: the non-profit partnership ESVERO, previously known as Russian Harm Reduction Network, and the Open Health Institute (OHI).

ESVERO director Pavel Aksenov told Aidspan that Russia has achieved significant progress in strengthening its HIV response over the last decade, including significantly increased access to HIV treatment and diagnostics and prevention of mother-to child transmission. In the 12 years that anti-retroviral treatment has been available in Russia, the number of people under treatment has grown to 122,446 people, according to a 2013 UNAIDS report. Millions of people are tested annually for HIV, Askenov said, availing themselves of the diagnostic facilities that have been available in Russia for nearly a generation.

Aksenov said that while much of the success achieved in Russia can be attributed to the progressive transition of funding away from the Global Fund and towards domestic resources, there remains a considerable gap in support for essential HIV prevention services among the most-at risk populations: injected drug users, commercial sex workers and men who have sex with men chief among them.

Internationally recommended and evidence-based interventions such as harm reduction programs, condom distribution and opioid substitution therapy are illegal in Russia, illustrating the human rights challenges confronting NGOs working to support these populations.

For these groups, confidence in the state-run system’s ability to fully absorb all of the activities and programs supporting the HIV response is shaky. They cite the lack of a national strategy for HIV response and modifying restrictive legislation that outlaws the use of generic ARVs as two immediate tasks requiring attention. The higher cost of brand-name drugs means that maintaining the state’s claim of 100% coverage could be compromised by limited resources, and has been illustrated by the delays that plague enrollment in ART programs.

Additionally, there remain significant barriers to access to testing, including but not limited to confidentiality concerns.  For injected drug users, for example, the administrative fines levied for ‘non-medical use of narcotics’ has prevented many from even seeking testing for fear of repercussions including jail time. Commercial sex workers also face similar challenges because of the criminalization of their livelihoods.

But it is among men who have sex with men that the institutionalized stigma and fear of persecution – or prosecution – have been the greatest obstacles to access. The risk, according to Open Health Institute contacted by Aidspan is that “if they come out as gay, they risk being injured or even fired from their jobs.”

For the NGOs continuing to work with people living with HIV, the risk of the Global Fund’s departure from Russia is less about the financial resources devoted to the HIV response than it is about the priorities emphasized by Global Fund-supported programs. “Although Global Fund program coverage is relatively small, it has helped to demonstrate the urgent need to expand prevention programs,” Aksenov said.

Examples of programs likely to be completely shut down once the state takes over include syringe and needle exchange activities and counseling services targeting IDUs, raising the risk of infection within this population.

Hope for the future of these types of programs could come from the re-application of the NGO rule (see article here) under which ESVERO and OHI have already received funding. The rule, established in 2011, allows upper-middle income countries with high disease burdens to apply for funding to be managed by NGOs, rather than CCMs, to target key services or populations.

 Aksenov said that groups were convening a country dialogue to tailor a proposal under the revised eligibility and counterpart financing policy that would allow Russian NGOs to apply for one more allocation period after 2014.

"Now more than ever, NGOs working in HIV in Russia need to consolidate and work together in close coordination," said Aksenov.

[This article was first posted on GFO Live on 06 February 2014.]

To comment on this article, click here.



3. NEWS: Civil society, government and affected populations join HIV country dialogue in DRC

The meeting was an opportunity to plot priorities for DRC’s HIV concept note

Stakeholders representing civil society, government, key affected populations and technical partners met on 14-15 January in Kinshasa for the final country dialogue meeting for Democratic Republic of Congo to validate the content and priorities of an HIV concept note under the Global Fund’s new funding model (NFM).

The country dialogue has been identified as a requisite first step in the grant application process under the NFM, which aims to allocate the greatest possible funding to countries with the highest burden of disease and least ability to pay. Country dialogue should establish priorities and strategies in line with a country’s national strategic plan while focusing on vulnerable populations with targeted prevention, treatment and care activities.

Input from a range of stakeholders into the country dialogue process should inform the development by the country coordination mechanism of a concept note: the initial funding request. Under the DRC concept note for HIV programming, some $226 million was requested from 2015-2017, which includes a $96 million ’above’ indicative amount.

All 11 provinces in DRC were represented at the stakeholders meeting in the capital Kinshasa, which was heralded as an historic bringing together of all constituencies involved in the effort to reduce the impact of HIV on the sprawling Central African country.

With a population density of roughly 29 people per square kilometer and vast swaths of the country inaccessible due to ongoing insecurity or lack of infrastructure, there are a host of challenges in DRC impeding the collection of comprehensive data about national prevalence of HIV as well as treatment options available to the population. Prior to the country dialogue, the Global Fund worked closely with government and technical partners to develop a clearer picture of the disease burden and agree to set indicators that would generate baseline data for future interventions.

National HIV prevalence was determined through demographic and health surveys supported by UNAIDS and the World Health Organization (WHO) at 1.1%, although some regional analysis suggests that in some parts of the country, generalized prevalence is as high as 8%. Among men who have sex with men (MSM), that figure crests to above 31%, although data is limited to predominantly urban centers. Some 75,000 people in DRC are under anti-retroviral treatment.

Given the challenges of distance and terrain and the diverging prevalence figures, the notion of inclusive national dialogue was considered especially appropriate for DRC. However participants in the meeting in Kinshasa repeatedly noted how difficult it would be to turn regional recommendations into a cohesive national strategy. Aidspan understands from many who attended the meeting that it led to some criticism that the concept note developed from the meeting would not be ambitious enough, and working estimatesof target figures too low to adequately tackle the disease in accordance with recommended guidelines.

The inclusive nature of the country dialogue process also underscored how different this way of working is compared to past proposal development for Global Fund grants in DRC. Centralized decision-making in the past, while imperfect, did occur in line with timelines imposed during the application process.

Now, however, by mandating participation from across the country, the Fund placed an additional burden on the CCM which, while not onerous and generally welcomed, brought with it considerable logistical and budgetary complications. These considerations have been at the root of significant delays in convening the country dialogue, stakeholders told Aidspan.

The transition into the NFM has also brought with it a raft of changes in procedures that have also been difficult to fully explain to all of the parties in the process due to the complicated geo-political terrain in DRC. This has prompted a wider call for technical partners to improve their roles of providing clarification and guidance during the NFM grant application process. The CCM has itself faced challenges in fully integrating the new requirements and procedures in order to prepare the necessary documents and plans upon which to base the concept note.

DRC has until the end of 2014 to finalize its proposal, when current funding, worth some $130 million, will expire. The next steps for the HIV concept note require an assessment of the CCM’s eligibility and the validation of the selection of the principal recipients. Currently, there is dual-track financing for HIV, with organizations including CORDAID and Santé Rurale (SANRU) joining the government as PRs. Barring any requests for amendments to the concept note, DRC should receive notification of its funding allocation for HIV by mid-April.

Read the article in French. Lire l'article en français.

[This article was first posted on GFO Live on 05 February 2014.]

To comment on this article, click here.



4. NEWS: LFA paper released

With a budget of $65 million annually, the Local Fund Agents represent a significant and critical element in the Global Fund’s architecture and reflects about 20 percent of its total operating budget. Despite this, there has been little reflection or review of this piece of the model. One of the last reviews of the LFA system was commissioned by the Fund in 2006, and published online in 2007.

Due to the rigorous protocols that have been established, the role of the LFA is fairly narrowly defined and confined to interaction with a select group of actors: principal recipients, fund portfolio managers and country coordination mechanisms (CCMs).

The controlled oversight mechanism that is the purview of the LFA brings with it several key advantages for the Global Fund: they are the eyes, the ears and often the nose of the Fund to ensure that grant management and implementation are efficient, efficacious and clean (see article here).

However, that same degree of control limits the transparency of the LFA role within the Global Fund, making it challenging to research or study their roles, their impact and their value for money.

This is one of the main findings of a review paper written by Frank Wafula and published today by Aidspan entitled, The Local Fund Agents: A review of their functions, operations and performance since 2002.

Aidspan intends to publish a series of papers exploring the nature of the relationship between the LFA and the Fund and the lessons learned over the last 12 years. This will be of particular importance going into the era of the new funding model (NFM), as the responsibilities of the LFAs are being adapted to accommodate the Fund’s new direction and ways of working.

[This article was first posted on GFO Live on 06 February 2014.]

To comment on this article, click here.



5. NEWS: Botswana pilots Aidspan’s CCM assessment tool

Team found diversity in voices and commitment to transparency as its key strengths

Botswana’s country coordinating mechanism (CCM) is the first to conduct a performance self-assessment using a tool developed by Aidspan and Southern African AIDS Trust.

As one of six Southern African countries engaged in an Aidspan-led effort to improve engagement and performance at the CCM level, Botswana used the tool during a workshop in late 2013 to map where attention should be paid over 2014.

Self-assessment is one of the criteria that countries will be asked to fulfil as they apply for grants under the Global Fund’s new funding model.  The Fund has now developed its own performance assessment tool, which will be the standard used for diagnostic purposes. Botswana’s decision to carry out the self-assessment in late 2013 was a decision independent of the Fund’s new eligibility requirements.

The workshop in Botswana, part of a training process for new and existing members, was an opportunity for both individual and team assessment. The results shared within the group were a basis for discussion about how to improve engagement at the country level with government and non-government partners, both within and outside the CCM. Members also sought to ascertain how knowledgeable they were about both the Global Fund  and CCM roles, and how easily this information was accessible to those outside the CCM.

The emphasis in Botswana was on a process that would gauge individual understanding of grant data and oversight: central to the responsibilities of CCM members. The tool used was also a useful way to address issues of accountability, both of the CCM to the Global Fund and to grant beneficiaries, but also of CCM members as individuals to the sectors they represent.

Three categories of questions were included in the self-assessment:

  • Adherence to key Global Fund principles such as transparency, accountability and documentation
  • Confidence in the CCM’s ability to meet minimum requirements (for more information about minimum requirements, see here)
  • Other useful indicators of performance, such as, having evidence of members' efforts to build their own knowledge about the Fund; the existence of a clear feedback mechanism from constituents; or ensuring alignment of Global Fund programs to national plans.

The Botswana CCM learned that its strengths included the involvement of a wide range of stakeholders, such as civil society and private sector during proposal development (including those not on the CCM) and the commitment to transparency manifested by individual members and the CCM as a whole.

Areas of improvement were primarily process-oriented, including the need for better outward communication. The lack of a website and a communications strategy were highlighted as critical gaps, while inconsistency in oversight was cited as another area requiring more attention.

“I was a little apprehensive at first... mainly because we hadn’t been very consistent in attending meetings,” said CCM member Nana Gleeson of the Botswana Network of Ethics Law and Human Rights on HIV/AIDS. “[But] taking time to answer the questions on the tool really gave me an opportunity to reflect and critically assess my individual and our collective commitment to being CCM members.”

Added CCM chair Kibelo Ebineng: “As a CCM, we owe it to the investors and the public we serve to be as prepared as we can. That is what ought to drive us.”

Nearly $17 million has been disbursed to Botswana for two grants: one HIV and one TB.

[This article was first posted on GFO Live on 06 February 2014.]

To comment on this article, click here.



6. COMMENTARY: Watchdogs or critical friends?

I was in Nairobi recently to help Aidspan facilitate a meeting with the representatives of about 30 organizations from East and Southern Africa involved in the monitoring of global health programs. The group brought together health advocates, human rights activists, data experts, journalists, as well as representatives of donor and government agencies: each of whom will be instrumental in using the open data movement to promote positive outcomes in developing countries.

The meeting was the culmination, in many ways, of three years of work laying the foundation for a confluence of people who are not typical allies: members of the Global Fund establishment, including country coordination mechanisms (CCMs), and independent transparency activists. It was also the genesis of a new partnership seeking to send the message that improving accountability in development aid is in everyone’s interest.

An animated exchange among these professionals was central to the three-day workshop as to whether ‘watchdog’ was the right way to describe their common responsibilities. Some felt uncomfortable with the association with a culturally sensitive animal. Others considered it too confrontational; after all, a watchdog doesn’t sound like a man’s best friend. Dogs bite.

Who watches the dog?

The transparency sector is packed with vocabulary that suggests opposition or conflict: people are 'factivists’ -- according to Bono's ONE campaign -- or ‘anti-corruption professionals’ or ‘transparency revolutionaries’. All of these labels imply, somehow, that the watchers are above the watched, like white knights fighting the dark forces of development aid, corruption and incompetence.

'So who watches the dog', one among us dared to ask, triggering a few chuckles in the room. 'How will watchdogs be held accountable themselves?' Those chuckles turned thoughtful, when we considered how to answer the question, which came from a representative of 'power': a member of a CCM.

Sometimes holding people and organizations to account requires teeth, especially in young democracies and fragile states with no mutual checks and balances. Whistleblowing and 'naming and shaming' may be the only option when dealing with corruption. But what Aidspan’s experience suggests is that a core advantage of open data is how it can help to address inefficiencies and mismanagement. In this regard, confrontation may not be the shortest route to achieving results.

Open data’s best chance: people with open minds

Later that evening, my co-facilitator Jeff, a public health governance expert from South Africa, shared some of his experiences with government officials in the region. He managed to encourage change by trying to understand the realities, fears and needs of those people he was trying to influence.

'I would say to them, you managed to achieve a 67% success rate: impressive, given the conditions in which you work. Now how can I help you to do even better,' he told me.

Indeed, advocates and campaigners for transparency and accountability are starting to learn that while there is no one true way to achieve results, collaboration generally offers the best chance to generate positive change. This can include understanding the political context governing the activities you are monitoring, proper targeting of thought- and influence-leaders, and, most importantly, offering solutions as well as identifying problems.

In other words, being a successful aid ‘watchdog’ is all about knowing how to approach different people in different circumstances to achieve mutually beneficial goals.

‘Africa Health Watch’

One of the new group’s first trials, beyond accessing, understanding and processing data, will be to learn to use data strategically, taking into consideration local political dynamics, the reality and psychology of the people whose performance it aims to monitor and improve.

Without such skills in building trust-based relationships, holding aid recipients accountable will be a challenge, even when equipped with the best open data tools and resources in the world. And that means that words matter.

Meeting participants in Nairobi got that and decided to drop the watchdog label. Their new partnership will be called Africa Health Watch. They will surely be tested but together they hope to be able to promote accountability so that every dollar spent on AIDS, TB and malaria in East and Southern Africa contributes to a life saved.

Robert Bourgoing is a strategic communications specialist. The views contained in this commentary are his own.

Read the article in French. Lire l'article en français.

[This article was first posted on GFO Live on 30 January 2014.]

To comment on this article, click here.



7. NEWS: Global Fund lifts suspensions of net suppliers caught in Cambodia case

Suppliers Vestergaard Frandsen and Sumitomo Chemical Co face mandatory compliance regulations to continue as Fund suppliers

The Global Fund Secretariat will lift the suspensions of two major suppliers of long-lasting impregnated nets (LLINs) who were found to have paid kickbacks to government officials in Cambodia.

Acting on the recommendations of the Sanctions Panel, the Secretariat also imposed three conditions on Vestergaard Frandsen and Sumitomo Chemical Co in order to remain eligible to compete in tenders for future commodity purchases.

The conditions are:

  • Engagement of an independent compliance monitor to assess internal controls, verify implementation of improvements and report to the Fund by 30 June 2014. A second report will be due at year’s end
  • Donation of one million LLIN to a principal recipient of a Fund grant
  • Subscription to an anti-bribery pact for other manufacturers and commitment to garnering support from other manufacturers for the pact

Both suppliers have agreed to the conditions.

Vestergaard Frandsen and Sumitomo Chemical were, until their suspensions, responsible for nearly 50% of all LLIN purchased by the Global Fund on behalf of their malaria projects worldwide.

They were found to have paid kickbacks worth some $410,000 to two Cambodian officials at the national malaria control program, which was at the time the principal recipient of malaria grants worth $11.8 million from 2006-2011 (see article here).

The decision announced on 5 February emerged from a meeting in January of the Sanctions Panel, which was composed of three Global Fund staff and three external independent members.

[This article was first posted on GFO Live on 06 February 2014.]

To comment on this article, click here.



The following articles have been posted on GFO Live on the Aidspan website. Click on an article heading to view the article. These articles may or may not be reproduced in GFO Newsletter.

NEWS : RDC, dialogue national, nouveau modèle de financement du Fonds mondial

La République démocratique du Congo a conclu son premier processus de dialogue national avec des représentants de la société civile, du gouvernement et des groupes affectés par le VIH. Une réunion à Kinshasa a permis de définir les priorités de la note conceptuelle qui sera développée par l’instance de coordination nationale dans le cadre du nouveau modèle de financement.

NEWS : Zambia and Swaziland develop advocacy roadmap to promote behavior change as central to Global Fund proposals

Zambia and Swaziland have developed an advocacy roadmap to ensure effective implementation of Global Fund grants and have focused on behavior change as a major priority.

NEWS : Dialogue national : les enseignements du Zimbabwe

Candidat de la première phase du nouveau modèle de financement, le Zimbabwe a fait part de son expérience du dialogue national pour sa proposition VIH lors d'une réunion régionale tenue à Lusaka en Zambie.

NEWS : Country dialogue: lessons from Zimbabwe

Zimbabwe has shared the process it went through as an early applicant under the new funding model with its successful HIV grant proposal. The experience was shared with other High Impact Africa 2 countries at a regional meeting in Lusaka, Zambia.

COMMENTARY : Des ‘chiens de garde’ ou des amis qui vous veulent du bien ?

J'étais à Nairobi récemment pour animer une réunion d’individus et d’organisations impliqués dans la surveillance des programmes de santé publique en Afrique de l’est et en Afrique australe, des défenseurs des droits de l’homme et de l’accès aux soins de santé, des experts en données informatiques, des journalistes, ainsi que des représentants d’ONGs, de bailleurs de fonds et d’agences gouvernementales.

NEWS : Naissance d’un nouveau partenariat pour veiller sur l’aide du Fonds mondial en Afrique

A l'invitation d'Aidspan, les représentants de 30 organismes de surveillance de l'aide ont inauguré à Nairobi du 21 au 22 novembre 2013 le partenariat 'Africa Health Watch' pour veiller sur la mise en oeuvre des programmes de lutte contre le sida, la tuberculose et le paludisme dans les pays de l'est et du sud de l'Afrique.

NEWS : African aid watchdogs unite to monitor Global Fund-supported programmes

At Aidspan’s invitation, representatives of 30 organizations from East and Southern Africa met in Nairobi on 21-22 November 2013 to inaugurate the Africa Health Watch partnership to monitor the implementation of global health programs against AIDS, TB and malaria.


This is issue 236 of the GLOBAL FUND OBSERVER (GFO) Newsletter.

We welcome suggestions for topics we could cover in GFO. If you have a suggestion, please send it to the Editor of GFO (see contact information below).

Author: Articles 1 and 7: Lauren Gelfand (, Aidspan’s Editor-in-Chief. Article 2: Tinatin Zardiashvili, Article 3: Daniel von Rege (Aidspan correspondents). Article 4: Kate Macintyre (, Aidspan’s Executive Director. Article 5: Angela Kageni (, Aidspan’s Senior Program Officer.

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