July 26 - August 1: The first of US$35.6 million in approved grants from the Global Fund to fight AIDS, Tuberculosis and Malaria is expected to begin flowing into Myanmar in September under a process that will see a major expansion of healthcare resources.

The $35.6 million, which includes about $7 million to fight tuberculosis, $9.4 million to combat malaria and $19.2 million for the campaign against AIDS, will be disbursed over two years.

Mr Thomas Hurley, the Global Fund’s Geneva-based team leader for East Asia and the Pacific, said he hopes the grant for tuberculosis funding will be signed by the end of July and begin being disbursed on September 1. The grants for HIV-AIDS and malaria could take effect as soon as October.

The United Nations Development Program will be the principle recipient of the funds, which will be distributed to government agencies, non-government organisations and international organisations. The list of partners includes Population Services International, the Myanmar Red Cross and Red Crescent Society, and the Myanmar Maternal and Child Welfare Association.

As a recipient of the funding, Myanmar will join more than 100 nations that are part of a global experiment to halt the spread of three deadly diseases. The Global Fund is a public-private partnership that receives most of its funding from donor governments. It has pledged $5.4 billion to poor and middle income nations, and is accepting even more requests in a fifth round of calls for funding proposals.

The fate of the funds is generally decided by a “country coordinating
mechanism” which operates like a board of directors. In Myanmar, the CCM comprises members of the Ministry of Health, the Department of Health, the International Health Division and the Myanmar Red Cross.

“We’re trying very hard to be country driven,” said Mr Hurley.

“Our philosophy is that the countries themselves have a much better
knowledge of how the funds should be spent than we do. Provided they put together a proposal that passes the technical review, we more or less support the wishes of the CCM.”

The World Health Organisation in Myanmar was instrumental in preparing the original proposal to the Global Fund two years ago, and will act as a technical advisor as the funds start coming in. Dr Agostino Borra, the WHO’s country representative, says the funds answer a longstanding need in Myanmar and elsewhere.

“For twenty years, people have been crying out that these three diseases are under-funded. This will help,” he said.

Dr Borra said the funds would not lead to major strategic changes in
Myanmar’s fight against these three diseases, but would add resources to “what we are already doing.” Programs such as the national Tuberculosis Control Program, which is under-funded, will be expanded and provided with new equipment.

While the grants will not initiate an overhaul of existing healthcare
policy, the Fund has already has some effect on the way Myanmar fights the three diseases. The national malaria policy advocates use of artesunate combination therapy as a first line of treatment, a considerably more expensive ” and effective ” treatment than chloroquine, which was used formerly. Experts say the change was made partially in anticipation of Global Fund grants.

Worldwide, 54 per cent of the Global Fund’s money is targeted to the fight against HIV/AIDs, and the AIDs provision is by the far the largest of Myanmar’s three grants. Mr Eamonn Murphy, the country coordinator for UNAIDs, says the grant will allow the Fund for HIV/AIDS in Myanmar (FHAM) to expand its programs.

“It will add significant resources to the response,” he said.

Mr Murphy said the grant would be used to strengthen prevention programs, increase access to treatment and provide training for using antiretroviral (ARV) treatments.

He said FHAM has been forging ahead with an expansion of treatment options regardless of Global Fund involvement.

“We’re not waiting for the global fund to move on that,” he said.

Dr Borra said that the HIV/AIDs grant proposal did not earmark funding for ARVs, but when Myanmar reapplies for more grants from the Global Fund, the country will request funding specifically for the drugs.

“The proposal was prepared two years ago, when ARV treatment per person per year was $12,000 - we couldn’t dream of asking anyone for that much,” he said.

“Now the price has fallen to $250 per person per year, so it’s possible. In the next round we will concentrate more on ARVs.”

The Global Fund’s grants are performance based, and countries are required to achieve certain objectives to acquire the full grants.

The WHO will share the responsibility of demonstrating efficacy and
accountability. Dr Borra said the WHO in Myanmar would hire two more experts to help oversee the implementation of the Global Fund grants.

Healthcare professionals say that while a shortage of funds impedes
treatment of HIV/AIDS, malaria and tuberculosis in Myanmar, the grants are not a panacea on their own.

“If the Global Fund provides funds, the correct implementation of the activities are as important,” said Dr Frank Smithuis, the country manager for Artsen Zonder Grenzen (Medicins Sans Frontieres-Holland).

“It is not only money that matters.”