The Global Fund Board approved a recommendation from the Secretariat to extend a two-year extraordinary grant to Central African Republic in order to continue essential service delivery to TB patients in the strife-torn capital.
The decision approved on 6 June would use funds allocated to CAR under the new funding model (NFM) but would waive a number of the requirements associated with NFM grant applications, due to the humanitarian emergency in the country.
In making its recommendation, the Grant Approval Committee said that the "acute emergency, complex operating environment and continuation of the political crisis in CAR necessitate exceptions to the full new funding model process linked to the current funding request". It follows an expedited process to approve the installation of a new principal recipient: the International Federation of the Red Cross, which will now administer HIV and TB grants in addition to malaria ones.
It is expected that when the security situation in CAR improves the country will be able to access remaining funds under its allocation, in accordance with the new funding model process.
The response to the crisis that has left thousands dead and forced the displacement of hundreds of thousands of others represents an emerging flexibility in the way the Fund operates at country level. In past humanitarian crises elsewhere, the Fund has faced criticism from humanitarian actors and national governments for being unable to adapt to the prevailing conditions on the ground.
A long-awaited report from the Technical Evaluation Reference Group (TERG) laying the groundwork for a new policy on fragile states is expected to take this new flexibility a step further in order to ensure that service delivery is uninterrupted even in the face of conflict or crisis.
The Board has also approved the establishment of a Humanitarian Emergency Fund, worth some $30 million, to be deployed as needed to support service delivery in emergencies.
CAR has been identified as a priority country for the TB response in sub-Saharan Africa. Even prior to the civil conflict that erupted in March 2013, CAR suffered from one of the world's highest TB mortality rates, estimated at 50 per 100,000 population. Incidence was estimated in 2012 at 327, with 520 prevalent cases per 100,000 population.
Already low case detection, poor treatment outcomes and high default rates have only been compounded by the crisis and the ensuing displacement of a vast majority of the population, both internally and across the country's many borders. The collapse of the health system has meant that international agencies are now responsible for virtually all of the service delivery needs -- a situation that shows no signs of changing for the next two to three years.
In approving the extraordinary grant, the Board effectively shelved a request for a renewal made by the country coordinating mechanism (CCM) in November 2013, considering it to no longer be "well-grounded in the country context, requiring strategic refocusing and prioritization to address the major impediments to effective TB control in an evolving humanitarian crisis".
The EUR 4.6 million ($6.27 million) grant will be consolidated with an existing EUR15 million ($20.45 million) HIV grant to leverage operational efficiencies, streamline the supply chain and ensure the widest possible provision of services beyond the capital, through a handful of non-governmental organizations still able to operate in, and reach, outlying provinces.
Delivery of essential life-saving services will be emphasized in the grant's implementation, rather than longer-term goals of health system strengthening, capacity-building or program expansion. Some EUR 500,000 of the grant will be withheld in order to preserve some resources for specific outreach in key populations, once the situation has stabilized enough for those populations to be identified.
Risk mitigation measures in place since December 2013 include the additional safeguard policy and a targeted zero cash policy for sub-recipients, which means that the PR will make direct payments to vendors instead of transferring the funds to SRs for this purpose.
Other oversight mechanisms include the addition of an emergency advisory committee for the CCM and the emplacement, co-funded by the UN High Commissioner on Refugees, of a public health and humanitarian assistance expert in the capital.