Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7219
Country/Region: Côte d'Ivoire
Year: 2008
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $500,000

Funding for Health Systems Strengthening (OHSS): $500,000

The political situation in Cote d'Ivoire has left only two primary donors for HIV/AIDS: PEPFAR and the

Global Fund (GF). Côte d'Ivoire is the recipient of a Round 2 GF grant for HIV/AIDS in the amount of

$46,139,043, beginning Dec. 1, 2003, and ending Nov. 30, 2008. The principal recipient of this grant was

the United Nations Development Program (UNDP), with PricewaterhouseCoopers as local fund agent. The

GF withheld funds from a Phase 2 disbursement planned for Oct. 31, 2006, after UNDP failed to meet

conditions (described in a modification-to-grant agreement) that included a revised procurement plan,

transparency and accountability regarding the cost-recovery system for care and treatment, and revised

guidelines for selecting sub-recipients and monitoring sub-recipients' activities.

Earlier, in August 2006, PEPFAR had to issue an urgent order using country funds to avoid an imminent

stock-out of ARVs due to a previous GF disbursement withholding. Cote d'Ivoire's Minister of Health

requested assistance from funding partners to provide ARVs during this crisis period. In response, the USG

PEPFAR team in Côte d'Ivoire and the Office of the U.S. Global AIDS Coordinator (OGAC) authorized the

Partnership for Supply Chain Management (SCMS) to procure ARVs for six months (three months of stock

until March 2007 plus three months of buffer stock), at an estimated cost of $3 million. As of Jan. 25, 2007,

SCMS had committed $2,343,902 to purchase ARVs.

In FY07, the USG country team worked in close collaboration with the GF Geneva team to engage Cote

d'Ivoire's CCM in transparent processes for the nomination of a new PR and for reform of the CCM. A

Management Sciences for Health (MSH) team concluded the first part of the CCM reform assignment in

May 2007. It recommended the following steps:

• Change of the CCM (through modifications in its establishment decree) from an organization that is by

default associated with the Ministry of Health (MOH), with the minister as CCM chair, to an organization that

is associated with a technical section of the prime minister's office or the Ministry of Planning. This is the

most feasible intermediate step to address the immediate, inherited conflict of interests while the CCM

works toward a longer-term solution that would include establishing the CCM as an independent NGO.

• A transition process led by the current CCM, with milestones that include CCM members' election by their

own sectors and dissolution of the current CCM and constitution of the new CCM.

PEPFAR plans to continue to fund technical assistance through the MSH team. In FY08, technical support

will focus primarily on the Oversight Committee to ensure that quarterly oversight is provided and that

committee members and resource persons acquire experience in identifying and resolving problems

surpassing the authority of the PRs. Technical support will also focus on the Executive Committee and its

relations with the full CCM, emphasizing transparency and referral of decisions to the full CCM and fostering

open discussion and debate by all members. Support to the CCM will be directed to ensure that the CCM

makes a timely and informed decision about a Round 8 submission based on a thorough and high-quality

gap analysis for each disease.

Regarding support for a quality-controlled, capacity-building proposal-development process, MSH will

provide a technical support team of facilitators and finance and targeting experts, as well as support for

budgeting, partnership mobilization, and design. The team will guide the CCM/CI through a transparent

proposal-development process mobilizing civil-society partners and based on gap analysis. Skills building

with CCM members will focus on key decisions of themes, objectives, principal recipients, sub-recipients,

size of project, and review of drafts. Skills building with national program managers and future partners will

focus on producing a high-quality, multisector proposal that includes explicit grants-management and

capacity-building activities.

MSH will scale back its support as the CCM demonstrates skills and transparent decision-making and

acquires a strong local expert pool. This phase will end with a one-year evaluation of the CCM