What was the added value of these studies in the writing process?
These studies made it possible to better scale the response by taking stock of the reality of the HIV epidemic in Niger by providing data on the prevalence of HIV within the general population and among key populations. They also made it possible to better understand the scale of the response, in particular with regard to testing issues, through a study on non-clinical testing. Following recommendations from the study carried out on the national strategy for differentiated HIV testing and its implementation, a community testing strategy and the resulting activities were incorporated into the funding request.
An audit of the patient cohort and an evaluation of the 27 large care sites were carried out, as was a study on “lost to follow-up” cases, which made it possible to analyze the gaps and the needs, then make recommendations on the management of HIV-positive patients in the country. On this basis, an improvement plan for 25 sites will be developed subsequently with support from Expertise France. An amount of XOF 500 million (approximately €762,200) has been earmarked for this purpose out of the amount allocated in the funding request.
The comprehensiveness and quality of these studies greatly facilitated the work for members of the writing team responsible for contributing to the development of modules included in the funding request. Under the Health Systems Strengthening (HSS) component, a large number of activities relating to community health, the supply system, or even the health information system stem directly from these studies carried out in advance. The proposed activities were validated for community health (3 M €), the health product supply system (3 M €), the health information system, and the laboratory management system (2 M €).
Finally, certain proposed activities that had not been included in prior studies were carried over to the prioritized above-allocation request (PAAR) in the funding request. These include, for example, activities relating to HIV self-testing, pre-exposure prophylaxis for key populations, etc.
What do you consider to be the advantages of this advanced planning?
Planning in advance allows all stakeholders to agree and to have sufficiently recent and convincing data that can allow for effective planning. I would advise other countries to always plan for writing funding requests by planning studies in advance that address the various program gaps and to have up-to-date and convincing data. This will allow them to define their objectives and expected results and to better target their performance.
Were members of the CCM, civil society representatives in particular, meaningfully involved in the process of preparing the funding request?
Civil society representatives were involved in the CCM assignment teams responsible for organizing the country dialogue in all regions, and they also participated in regional workshops.
L’Initiative awarded the Niger CCM a grant to improve the involvement of civil society representatives in the process. It should be noted that following advocacy initiatives by civil society representatives during this country dialogue process, the community civil society observatory was included in the “prevention” module of the funding request. They were, therefore, involved in the funding request writing team and heavily involved in writing the prevention, differentiated testing, and care modules.
In addition, with funding from L’Initiative, the key populations consultant and the national programmatic consultant organized a workshop to present the first version of the funding request at the Nigerien Network of People Living with HIV and AIDS (RENIP +) head office. The workshop enabled civil society representatives to check whether the concerns they raised during the country dialogue had been incorporated into the funding request.
Personally, I am truly grateful for L’Initiative’s adaptability and flexibility to be quick to react and to take into account the COVID-19 pandemic. This facilitated the work of experts and the continuity of interactions with members of the writing team.
In the future, what should be in place to ensure that the CCM and its members can actively participate in deciding the content of the funding request?
The Niger CCM office should involve civil society representatives in developing the terms of reference for the grant funding request process. Civil society needs expertise in advance to help them become more involved in the process of developing requests. Civil society representatives on the CCM possess coordination capacity that must be capitalized on by the office of the CCM and its Permanent Secretary to better monitor the process and be able, when required, to mobilize the necessary expertise (internal or external) to include their legitimate concerns in the funding request.
There must also be a country dialogue process to discuss and validate the first version of the funding request by civil society representatives at the regional level.
“Too often, requests are developed at the central level, although implementation takes place at the local level. If local stakeholders do not take ownership of the planned activities and strategies, we run the risk of failure during implementation.”
What next? Once the funding request is approved by the global fund, what would you recommend to ensure effective implementation of the grant?
Before the grant is signed, the CCM should always schedule an expert assignment to develop a technical assistance plan to improve the implementation of Global Fund grants.
L’Initiative could also ask international and national experts responsible for supporting the country with funding requests to develop an action plan for the technical assistance necessary to ensure effective grant implementation.