Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2012 2013 2014 2015

Details for Mechanism ID: 12109
Country/Region: Malawi
Year: 2013
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $1,100,000

TB CARE II will improve TB case detection in targeted districts by implementing a comprehensive TB service package that enhances and expands Directly Observed Therapy Short Course. In particular, TB CARE II will improve diagnostic network, decentralize access to TB treatment in line with ART scale-up, improve facility-level and community-based TB case finding and management, contact tracing and treatment adherence. TB CARE II will also enhance TB/HIV programmatic integration, particularly at the health-facility level. Three GeneXpert machines will be procured which will ease diagnosis of TB in HIV-positive patients. Guidelines for programmatic management of drug-resistant TB will be developed and disseminated. TB is an important cause of pediatric morbidity and mortality. TB case detection and quality services for pediatric clients will be prioritized. Attention to Health systems including infrastructure upgrades, human resources development and support to the NTP will be provided. These priorities are in concert with those contained in Malawi's Global Health Initiative strategy. Project activities are aligned with the NTP strategic plan and are well-positioned to be absorbed by NTP and MOH after the project has phased out. TB CARE II will also support the NTP in formulating proposals to secure funding from the Global Fund. A substantive monitoring and evaluation (M&E) plan has been created, including a list of key programmatic indicators that will be used to monitor the project progress. Implementing partners require three motor vehicles to support the implementation of project activities. Currently, both partners are leasing vehicles in anticipation of vehicle purchases in FY2013. Five motorcycles are required to support community sputum collection initiative.

Funding for Care: TB/HIV (HVTB): $600,000

TB CARE II supports implementation of integrated TB/HIV services in high-volume health facilities in 6 target districts. The activities are in concert with the 2010 Ministry of Health (MOH) TB/HIV Operational Framework, the 2011-2016 HIV/AIDS National Strategic Plan and the 2011-2016 National TB Control Program (NTP) Strategic Plan. TB CARE II seeks to strengthen implementation of the new Malawi HIV Treatment guidelines, which emphasize intensified case finding (ICF) and Isoniazid Preventive Therapy (IPT) for people living with HIV. TB CARE II works closely with other USG agencies and partners in strengthening the TB diagnostic network and piloting novel TB diagnostics to improve TB case detection among PLHIV such as GeneXpert. TB CARE II employs a mentorship model to improve MoH human resources capacity. Its Technical Officers work alongside government counterparts at district level, providing on-the-job mentorship in the process. It is hoped that MoH staff will carry out these activities independently after phase-out of the project. TB CARE II has significant internal M&E capacity to review and monitor district, regional and national data to track project performance. Each District Coordinator has over 5 years M&E experience in TB at Zonal or National level. A Senior M&E Officer sitting at NTP provides overall M&E strategic direction for the NTP and TB CARE II. All M&E tools have been developed in consultation with local and USG partners and reflect the latest understanding of TB/HIV logic models. Accomplishments to date include facilitating a stakeholder meeting to develop national GeneXpert roll out plan and algorithms for prioritizing patients; conducting comprehensive baseline assessments at district level; providing Technical Assistance for developing guidelines for community management of Multi-Drug Resistant -TB (MDR-TB); supporting NTP in drafting its new 5-year Strategic Plan; supporting mapping exercise of the national microscopy centers; and providing 29 LED fluorescent microscopes.

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

TB CARE II will leverage TB activities to strengthen the overall health system at district and national levels, focusing particularly on improving health services delivery, human resources capacity and medical technologies for TB diagnosis. At the district level, TB CARE II will seek to overcome limited infrastructure for health service delivery by renovating laboratories at the district hospital and health centers to accommodate introduction and expansion of microscopy services and GeneXpert. Additionally, TB CARE II will renovate clinical space to overcome barriers to integrated TB/HIV care at the health service delivery level. TB CARE II will infuse needed diagnostic equipment and other medical technologies into public sector laboratories, including multi-objective LED fluorescent microscopes that allow lab technologists to perform both TB and malaria microscopy using the same microscope. Fluorescent microscopy not only permits more sensitive detection of TB bacilli but also enables lab technologists to make a diagnosis of smear-positive TB in one-fifth the time, freeing up critical HRH time for other health activities. TB CARE II will fund important trainings for health workers, including refresher trainings on TB microscopy, novel diagnostics, and integrated TB/HIV care provision. TB CARE II funds will leverage funds from GFATM R7 for peripheral health facility-level microscopy center renovation, expansion of community-sputum collection points and training of microscopists.

Subpartners Total: $0
Partners in Health: NA
Project HOPE: NA
Cross Cutting Budget Categories and Known Amounts Total: $273,500
Gender: Gender Equality $80,000
Human Resources for Health $80,000
Motor Vehicles: Leased $6,000
Renovation $107,500
Key Issues Identified in Mechanism
Child Survival Activities