SUBJECT: The President's Malaria Initiative and Proposed Major Restructuring of Other USAID Malaria Programs

Transcription

1 U.S. AGENCY FOR INTERNATIONAL DEVELOPMEN T DEC 1 2u01.;- ACTION MEMORANDUM TO: The Administrator FROM: AA/GH, Kent R. Hill SUBJECT: The President's Malaria Initiative and Proposed Major Restructuring of Other USAID Malaria Programs ISSUES FOR DECISION Whether to approve : (1) The position of a Malaria Coordinator, reporting to the USAID Administrator, with full authority over all USAID malaria programs, including both the President's Malaria Initiative (PMI) and USAID non-pm I malaria programs and policy. The position description includes definitions of the authorities, roles, and responsibilities of the Malaria Coordinator. (2) The designation of the Assistant Administrator for Global Health as the Acting Malaria Coordinator. (3) New requirements for programming the portion of the USAID malaria sub-account that is not directly attributable to programs in the PMI target countries or congressionally directed for research. (4) Whether to send an Executive Message (see attachment ), including the rationale and explanation of changes, and notification of decisions taken PENNSYLVANIA AVENUE, N.W WASHINGTON, D.C

2 2 ESSENTIAL FACTORS The PMI represents a significant increase in the total funding for global malaria programs; a significant new requirement for central policy and programming control under a coordinator ; and a requirement for strategic, target-driven, results-based programming. To meet the requirements as lead agency for implementation of the PMI and for all malaria prevention, treatment, and operational research assistance programs worldwide, USAID must take immediate steps to budget, plan, and restructure all USAID malaria programming into a single, strategic, global malaria program that addresses the President's expectations and meets his targets. The current malaria programming and policy structure for the non- PMI malaria programs is not sufficient to meet the President's requirements and effectively address Congress' concerns. - The USAID non-pmi funds are allocated diffusely across Africa and other affected regions, thus limiting the number of country programs that can reach a size and breadth necessary to effect change on an acceptable and measurable scale. The process and structure for the decision of request levels for malaria programs, and for the allocation of those resources, is divided among bureaus and entities based on a recommendation by the Population, Health and Nutrition Sector Council to PPC, and then by the bureaus themselves, in such a way that perceptions of equity have had more influence on the distribution of funds than clearly articulated targets for results. No single person or office is in charge of the complex and critical policy issues for malaria programs-such as, the policy surrounding the use of DDT for vector control-possibly leading to confusion or ad hoc or conflicting decisions at several levels. Likewise, no clear line of responsibility and accountability for malaria programs exists in the agency below the level of Administrator. Combined with the growth in total funding for malaria programs over the past five years, the non-strategic allocation of resources has

3 3 contributed to an imbalance in the proportion of funds dedicated to the provision of lifesaving commodities and services, versus that expended on technical assistance, communications, logistics, training, administration, and indirect costs. These commodities and services include : indoor residual spraying; intermittent preventive treatment for pregnant women; the provision of insecticide-treated nets ; longlasting insecticide-treated nets; life-saving medicines ; and the provision of artemisinin combination therapies. Of the approximately $80 million appropriated for international malaria programs in FY 04, for example, $6.2 million purchased commodities. In FY 06 appropriations language, Congress instructed that "considerable" support be provided for the purchase of commodities to fight malaria. USAID has not required reporting on program obligations, spending, and results in a way that allows the Agency to identify and communicate results clearly and link such results to program funding. Such strategic information management and the ability to track outcomes is a hallmark of the President's Emergency Plan for AIDS Relief (PEPFAR) and is a clear expectation of the President and Congress for PMI. In order to meet the President's targets and expectations and to achieve the level of accountability and balance of spending demanded by Congress, USAID, as the lead agency on implementation, must make immediate, corrective adjustments to the programming and policy structures for malaria assistance. The necessary changes will be guided by the directives of the President, by proven principles of development, and by experience in the implementation of the PEPFAR. The President articulated the principles of accountability and transparency, targets, and results-based programming for the PMI. These requirements must be applied to all malaria assistance. In addition, other critical principles of development must also guide the changes required for success, including: an emphasis on building country or local ownership of the problem and the solution; a clear ability to build capacity in the affected countries, including strengthening of local institutions, transfer of technologies and skills, and adoption of appropriate policies; sustainability of programs to endure through funding or political changes in out-years ; and allocation of resources and personnel selectively and in such a way as to maximize the impact of all programs.

4 4 PEPFAR is the standard for the President for implementation of large, multi-agency international health assistance programs. Successful implementation of the PMI and successful integration of USAID non-pmi programs into a comprehensive, strategic malaria program will require USAID to institute new structures and practices similar to those for PEPFAR. The first necessary adaptation from PEPFAR is a leadership and decision-making structure with a strong coordinator at USAID, reporting directly to the Administrator, and supported by a high-level, consultative interagency policy and program steering committee structure. Many of the necessary interagency structures are already determined; affirmation by the White House of the authorities as they apply to other agencies will be necessary. This definition of authorities follows those of the Global AIDS Coordinator (GAC) and effectively mirrors the relationship between the GAC and the Secretary of State. The second necessary adaptation from PEPFAR is a concentration of funding in select countries for programming on a scale that allows us to set and meet ambitious, demonstrable numerical targets. Likewise, correcting the current imbalance between commodities and services, and the technical assistance to make them effective, will require the development an d strengthening of integrated programming processes here in Washington and in the field that have typified PEPFAR's rapid progress in the past two years. RECOMMENDATIO N That you approve the following changes to Agency policy and procedures with respect to malaria programs, and that these changes take effect immediately or as otherwise specified. (1) Pursuant to the President's intent and subsequent interagency implementation discussions, there shall be established in USAID a position of Malaria Coordinator, reporting to the USAID Administrator, with direct authority over both the PMI and USAID non-pmi malaria programs and policy. The authorities, roles, and responsibilities of the Malaria Coordinator include :

5 5 All malaria policies, planning, and budgeting ; Direct supe rvision over and hi ring authority for all USAID/Washington malaria staff; All malaria budget allocations to bureaus and countries, as well as malaria staffing levels in bureaus and countries ; Approval of all malaria-related acquisition and assistance plans, with the authority to approve or disapprove any proposed malaria-related acquisition or assistance action or obligation within countries and by USAID/W bureaus, subject to governing laws and procuremen t regulations ; Approval of all Monitoring and Evaluation (M&E) requirements and reporting requirements, with the authority to approve or disapprove any malaria-related M&E or reporting plans ; Approval of all direct hire and non-direct hire travel to count ri es for malaria programs, regardless of the funding source ; All malaria-related communication and outreach strategies and activities, in coordination with LPA ; Lead representation at all international malaria prevention and treatment fora and meetings, including those sponsored by Roll Back Malaria, the World Bank, the World Health Organization, and UNICEF ; Consult and work closely with appropriate bureaus and missions on policy, programming, and budget matters affecting the implementation of the program. The Africa Bureau will be the main implementing entity for the PMI and a majority of non-pmi programs.

6 6 The Coordinator may delegate any of the Coordinator's authorities, roles, and responsibilities to senior staff to the fullest extent permitted by law and USAID policy. Approve : Date : 9 b~pc'~i~p Z 11 (2) That you approve the designation of the Assistant Administrator for Global Health, Kent R. Hill, as the Acting Malaria Coordinator, until such time as a Malaria Coordinator is appointed. Approve : Date : l &P' - (3) Beginning in FY 06, a centrally-managed commodity fund shall be established, containing at least 40 percent of USAID non-directed malaria sub-account funds for the sole, express purpose of providing to country programs life-saving commodities: environmentally sound and effective insecticide-treated nets and insecticides and equipment for spraying; artemisinin-combination therapies and diagnostics ; drugs for intermittent preventive treatment of pregnant women; and, drugs for severe malaria. In FY 07, the intention will be for this fund to achieve at least 50 percent of non-directed malaria sub-account funds. The Malaria Coordinator or Acting Malaria Coordinator, in consultation with the appropriate bureaus, shall establish the operating procedures for the use of the commodity fund. The commodities will be procured by the GH Bureau or missions, whichever i s most appropriate. Approve : Date :

7 (4) Proven principles of development shall guide all malaria programs. Such principles include, but are not limited to : an emphasis on country or local ownership of the problem and the solution ; a clear ability to build capacity in the affected countries, including strengthening of local institutions, transfer of technologies and skills, and adoption of appropriate policies; sustainability of programs to ensure continuation through funding or political changes in out-years ; and, allocation of resources and personnel selectively and in such a way as to maximize the impact of all programs. Approve :" 1, Date : c V-PCey_ n- 7o s / (5) For FY 06, 25 percent of all non-pmi malaria funds ($15 million) shall support exclusively indoor residual spraying activities in malariaaffected countries, as directed by the Malaria Coordinator or Acting Malaria Coordinator. Approve: V. ~ _ Date : Oe_ C ; " Zoo c- (6) Beginning in FY 06, all non-pmi country and regional malaria allocations shall be approved by the Acting Malaria Coordinator, and thereafter by the Malaria Coordinator. Approve : A46k) ~J - Disapprove: _ Date :

8 8 (7) Beginning in FY 06, no country malaria program or regionallymanaged country program shall be funded at less than $1.5 million of malaria funds. In FY 07, the minimum funding for country programs will rise to $2.5 million, or such other level as is determined by the Malaria Coordinator. When the consequences of this requirement are not in the best interest of the malaria program, the Coordinator may make exceptions on a case-by-case basis. Approve : Date : 4 0@ Z (8) All regional funding for USAID malaria programs is capped and shall not exceed the level of FY 05 funding. Approve : Date : J ' ce~ 7o -5 (9) All operating units shall report according to the new malaria data management system, transmitted to the field by PPC and GH in November, The posting on the PMI website will include all procurement documents under the PMI (e.g., contracts, grants), after "redaction" by the contractor/grantee. GH and its support contractor are responsible for managing this process. Approve : J Disapprove: _ Date :

9 9 (10) No Agency malaria funds shall fund non-malaria activities, including cross-cutting programs or initiatives, "taxes" to cover non-malaria costs or common costs, or any other mechanism, regardless of past practice, without the express consent of the Malaria Coordinator or Acting Malaria Coordinator. Approve : 1141.*1 c U Date : g Pee x,, (11) That the Malaria Coordinator be an SES-level AD appointment, approved by the White House. Approve : S, Date : q I).Q e (12) That you send to USAID an Executive Message communicating the ten decision items related to changes in USAID's malaria program. Attachment : Executive Message Approve: aa6)w S. l~~ tci - Disapprove: - Date :

10 1 0 SUBJECT : President ' s Malaria Initiative USAID is the lead agency for the President's $1.2 billion, five-year initiative to control malaria in Africa. The goal of the initiative is to reduce malariarelated deaths by 50 percent in 15 countries by achieving 85 percent coverage of proven preventive and curative interventions. Activities are already underway with spraying preparation and other high-impact interventions in the three, first-year target countries of Angola, Uganda, and Tanzania. This initiative will be focused, results-based, and will exhibit a high level of financial and programmatic accountability. A minimum of 50 percent of this funding will be devoted to life-saving commodities. While the President's Malaria Initiative (PMI) ramps up over the next five years to cover 175 million people, expectations of both the White House and Congress are that all malaria prevention and treatment programs will function in the same results-based and accountable fashion as the PMI. To this end, I have approved ten actions that effect fundamental changes to the structure and conduct of USAID's malaria programs, which take effect immediately, or as otherwise indicated. These changes include : 1. Pursuant to the President ' s instructions and subsequent interagency implementation agreements, there is established a position of Malaria Coordinator, reporting to the USAID Administrator, with direct authority over both the President 's Malaria Initiative (PMI) and USAID non-pmi malaria programs and policy. The authorities, roles, and responsibilities of the Malaria Coordinator include : All malaria policies, planning, and budgeting ; Direct supervision over and hi ring authority for all USAID/Washington malaria staff ; All malaria budget allocations to bureaus and countries, as well as malaria staffing levels in bureaus and countries ; Approval of all malaria-related acquisition and assistance plans, with the authority to approve or disapprove any proposed malaria-related acquisition and assistance action or obligations within countries and

11 1 1 by USAID/W bureaus, subject to governing laws and procurement regulations ; Approval of all malaria-related Monitoring and Evaluation (M&E) requirements and reporting requirements, with the authority to approve or disapprove any specific malaria-related M&E and reporting plans ; Approval of all direct hire and non-direct hire travel to countries for malaria programs, regardless of the funding source ; All malaria-related communication and outreach strategies and activities, in cooperation with LPA ; Lead representation at all inte rnational malaria prevention and treatment fora and meetings, including those sponsored by Roll Back Malaria, the World Bank, the World Health Org anization, and UNICEF ; Consult and work closely with bureaus and missions on policy, programming, and budget matters affecting the implementation of the program. The Africa Bureau will be the main implementing entity for the PMI and a majority of non-pmi programs. The Coordinator may delegate any authorities, roles, and responsibilities to senior staff, to the fullest extent permitted by law and USAID policy. 2. I have designated the Assistant Administrator for Global Health, Kent R. Hill, as the Acting Malaria Coordinator, until such time as a Malaria Coordinator is appointed. In this capacity he will retain all roles, responsibilities, and authorities of the Coordinator. 3. Beginning in FY 06, at least 40 percent of USAID non-directed malaria sub-account is designated for a centrally-managed commodity fund, for the sole, express purpose of providing to country programs life-saving commodities : environmentally-sound insecticide-treated nets and insecticides and equipment for spraying ; artemisinin-combination therapies and diagnostics; drugs for intermittent preventive treatment of

12 1 2 pregnant women; and drugs for severe malaria. In FY 07, the intention is for this fund to achieve at least 50 percent of non-directed malaria subaccount funds. The Malaria Coordinator or Acting Malaria Coordinator, in consultation with the appropriate bureaus, shall establish the operating procedures for the use of the commodity fund. The commodities will be procured by the GH Bureau or missions, whichever is most appropriate. 4. Proven principles of development will guide all malaria programs implemented or funded by USAID. Such principles include, but are not limited to: an emphasis on country or local ownership of the problem and the solution; a clear ability to build capacity in the affected countries, including strengthening of local institutions, transfer of technologies and skills, and adoption of appropriate policies ; sustainability of programs to ensure continuation through funding or political changes in out-years ; and, allocation of resources and personnel selectively and in such a way as to maximize the impact of all programs. 5. For FY 06, 25 percent of all non-pmi malaria funds ($15 million) are designated to support exclusively indoor residual spraying activities in malaria-affected countries, as directed by the Malaria Coordinator or Acting Malaria Coordinator. 6. Beginning in FY 06, all non-pmi country and regional malaria allocations must be approved by the Acting Malaria Coordinator, and thereafter by the Malaria Coordinator. 7. Beginning in FY 06, no country malaria program or regionally-managed country program will be funded at less than $1.5 million of malaria funds. In FY 07, the minimum funding for country programs will rise to $2.5 million, or any such other level as is determined by the Malaria Coordinator. When the consequences of this requirement are not in the best interest of the malaria program, the Coordinator may make exceptions on a case-by-case basis. 8. All regional funding for USAID malaria programs is capped and shall not exceed the level of FY 05 funding. 9. All operating units will report according to the new malaria data management system, transmitted to the field by PPC and GH in November, The posting on the PMI website will include all

13 1 3 procurement documents under the PMI (e.g., contracts, grants), after "redaction" by the contractor/grantee. GH and its support contractor are responsible for managing this process. 10. No Agency malaria funds are allowed to fund non-malaria activities, including cross-cutting programs or initiatives, "taxes" to cover nonmalaria costs or common costs, or any other mechanism, regardless of past practice, without the express consent of the Malaria Coordinator or Acting Malaria Coordinator. Once these ch anges have been instituted, USAID will be properly positioned to achieve the goals of the President's initiative.

14 1 4 CLEARANCE PAGE FOR ACTION MEMORANDUM requesting decisions on The President' s Malaria Initiative and Proposed Majdi Restructuring of Other USAID Malaria Programs Clearances : AA/AFR :Lloyd Pierson L. Pierson w/comments Date : 12/8/05 AA/ANE :James Kunder Date : A-AA/E&E :Drew Luten Date : AA/LAC :Adolfo Franco Date : AA/PPC :Doug Menarchik w/comments Date : 12/7/05 AA/DCHA :Michael Hess Len Rogers Date : 12/7/05 AA/LPA:Edward Fox Date : AA/EGAT:Jacqueline Schafer David Hess for Date : 12/8/05 GC :Arnold Haiman clears w/comments Date : 12/8/0 5 C/AID : Mosina Jordan Date : ES :Douglas Aller Date :- MMiller:RGreene :KHill :gh/mm/hr:25537 :20970 :12/06/05 :KN AN Memo on Malaria Final 1.doc _c P S: l b