Wednesday, January 11, 2012

Looking at Nepali Health Through Nepali Eyes

The United States is a very wealthy nation. Addressing the health issues of the United States is a very specialized task. Improving the healthcare system of the United States takes a very deliberate effort. The United States system of healthcare is so advanced that for every percentage of improvement you want to make of that system, you have to successively put large amounts of funding.

Compared to the United States System of Healthcare, Nepal's system is relatively underdeveloped. So it has a lot more room for improvement with relatively less effort and resources. There are factors that contribute towards health in Nepal that someone in the United States wouldn't even consider. The United States is focussed on a lot more specific issues in relation to healthcare.




For example, I was looking at a project in Nepal. The project addresses issues that someone living in the United States wouldn't even consider to be health issues. Clean drinking water? Clean bathrooms? Smokeless stoves?

All these small details contributes considerably towards improving the health of the Nepali people.

Tuesday, January 10, 2012

How is the Global Fund Organized?

 At country level, the Country Coordinating Mechanism (CCM) is a partnership com­posed of all key stakeholders in a country’s response to the three diseases. The CCM does not handle Global Fund financing itself, but is responsible for submitting proposals to the Global Fund, nominating the entities accountable for adminis­tering the funding, and overseeing grant implementation. The CCM should preferably be an already-existing body, but a country can instead decide to create a new entity to serve as CCM.
The Global Fund Secretariat manages the grant portfolio, including screening proposals submitted, issuing instructions to disburse money to grant recipients and implementing performance-based funding of grants. More generally, the Secretariat is tasked with executing Board policies; resource mobilization; providing strategic, policy, financial, legal and administrative support; and overseeing monitoring and evaluation. It is based in Geneva and has no staff located outside its headquarters.
The Technical Review Panel (TRP) is an independent group of international experts in the three diseases and cross-cutting issues such as health systems. It meets regularly to review proposals based on technical criteria and provide funding recommendations to the Board.
The Global Fund Board is composed of representatives from donor and recipient gov­ernments, civil society, the private sector, private foundations, and communities living with and affected by the diseases. The Board is responsible for the organization’s gover­nance, including establishing strategies and policies, making funding decisions and setting budgets. The Board also works to advocate and mobilize resources for the organization.
The Global Fund signs a legal grant agreement with a Principal Recipient (PR), which is designated by the CCM. The PR receives Global Fund financing directly, and then uses it to implement prevention, care and treatment programs or passes it on to other organizations (sub-recipients) who provide those services. Many PRs both implement and make sub-grants. There can be multiple PRs in one country. The PR also makes regular requests for additional disbursements from the Global Fund based on demonstrated progress towards the intended results.
The Global Fund’s Trustee manages the organization’s money, which includes making payments to recipients at the instruction of the Secretariat. The Trustee is cur­rently the World Bank.
Since the Global Fund does not have staff at country level, it contracts firms to act as “Local Fund Agents” (LFAs) to monitor implementation. LFAs are responsible for provid­ing recommendations to the Secretariat on the capacity of the entities chosen to man­age Global Fund financing and on the soundness of regular requests for the disburse­ment of funds and result reports submitted by PRs.
Source: How is the Global Fund Organized? Core Structures

Why is the Global Fund important to Nepal?

Nepal's Country Coordination Mechanism (CCM) operates according to the principles defined by Global Fund.

The Global Fund is a unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, TB and malaria. This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing. The Global Fund’s model is based on the concepts of country ownership and performance-based funding, which means that people in countries implement their own programs based on their priorities and the Global Fund provides financing on the condition that verifiable results are achieved.

Since its creation in 2002, the Global Fund has become the main financier of programs to fight AIDS, TB and malaria, with approved funding of US$ 22.6 billion for more than 1,000 programs in 150 countries. To date, programs supported by the Global Fund have saved 7.7 million lives by providing AIDS treatment for 3.3 million people, anti-tuberculosis treatment for 8.6 million people and 230 million insecticide-treated nets for the prevention of malaria. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts in dealing with the three diseases.
Vision:

A world free from the burden of AIDS, tuberculosis and malaria
Mission:

Investing the world’s money to save lives
Values:

INTEGRITY: Be consistent, honest and transparent in what we say and do.

RESPECT: Treat ourselves and each other with consideration, dignity and open-mindedness.

PASSION: Sustain our energy and enthusiasm to focus on the people we serve while enjoying our work and our families.

COLLABORATION: Work together and communicate in ways that build a climate of cooperation to leverage our collective talents.

INNOVATION: Find new and creative solutions, challenge each other to be ambitious, and take measured risks.

EFFECTIVENESS: Hold ourselves to the same level of accountability, efficiency and performance that we ask of our recipient

About the Global Fund

How Nepal's Country Coordinating Mechanism (CCM) Came to Life

Aiding Aids: Squabbling and apathy jeopardise Nepal s AIDS fund
By Naresh Newar
Original article from NepaliTimes.com


Last August when Nepal was granted $11 million by the Global Fund to fight AIDS, TB and malaria, there was considerable euphoria. 

But since then, the government has been unable to find a Nepali organisation capable of managing such a large project and the money looked like it would never reach Nepal. The government advertised twice, but failed to find a partner to administer the funds to go to the National AIDS Centre and other non-profits working to combat AIDS. 

"It's a messy job, which is why many INGOs did not apply," says a development agency representative, requesting anonymity. 

As the deadline approached this month, the government decided at a Country Coordinating Mechanism (CCM) meeting in Kathmandu, to hand over management responsibilities to the UN system in Nepal. Donor, multilateral agencies, INGOs, NGOs and activists are members of the Mechanism that endorses proposals to the Global Fund for approval. One member told us the group had no option but to get the UN to help out. "It was the next best thing to returning the money to the Global Fund, but it won't be an easy project to manage, even for the UN," says activist Rishi Ojha, a CCM member. 

Some activists and NGOs are fuming over the decision and suspect the UN will only fund NGOs that are its cronies, a fear dispelled by Pramod Kafle of the charity, ActionAid Nepal: "The UN will not have control over the money, organisations that had already been selected years back for funding will benefit." 

At least 19 NGOs, INGOs and government agencies have already qualified for the Global Fund grants and the first tranche of about $4 million is expected soon. "There is more than enough money, and I don't think the fund will be limited to a select few. More organisations can apply," says Ojha. The $4 million will have to be used within the first two years of the grant period and if the UN and development agencies fail to disburse it, the chances of getting the rest of the $11 million for the remaining three years will diminish. 

The Global Fund has already approved grants for four rounds across the world. Each round consists of five-year grants. Nepal's $11 million is from the second round and we missed funding opportunities during the third round as the government and CCM failed to send any proposals. For the fourth round, a group of agencies like Action Aid Nepal, Harm Reduction Council and Family Planning Association of Nepal decided to take their own initiative and sent in proposals bypassing the government-dominated CCM. 

The Global Fund recently complimented proposals sent from Nepal by non-CCM organisations as among the best in the world. There is a strong chance that proposals worth $45 million will be approved in the fourth round. "I think the government should realise that it can't bear all responsibilitie. Civil society is also capable of working in the national interest," says Kafle. 

Nepal's CCM has come under heavy criticism for lack of urgency in addressing the country's AIDS threat. Most of the members selected by the government have little knowledge of HIV/AIDS issues. AIDS activist Rajiv Kafle is one of the most vociferous critics, saying more HIV-infected activists should be included in the body. 

The representation by the donor and multilateral agencies in CCM is also minimal and there are fears Nepal may lose opportunities for future resources for the anti-AIDS campaign from the Global Fund. (Naresh Newar)

CCM: Nepalese Uniting For a Healthier Nepal

There is a lot of money flowing into Nepal in the form of aid. But not all the money reaches the targetted audience for whom the money was provided.
There is no shortage of NGOs asking for money from international organizations. There is no shortage of NGOs getting money from international organizations. But there is a huge shortage of oversight in seeing that the money that NGOs get is being utilized properly.

That is where a body like the CCM: Country Coordinating Mechanism comes in. 

In countries where the government is not powerful enough to create laws and hold organizations accountable, a body like the CCM, with the right balance of people, can fill a severely unmet need.  

For all intensive purposes, what the CCM does is provide oversight. By it providing oversight, it ensures quality assurance to Nepal's healthcare industry.

How would this practically work?

When an NGO would approach the CCM for funding, the CCM would explain it's expectations and desired result to the NGO. It would explain the criteria the NGO needed to meet to qualify for funding. It would explain the guidelines that the NGOs need to work in to achieve it's mission. It would assigns the resources and hold the NGO that it gives money to accountable through performance criteria. This performance criteria would be explained in detail in advance to the NGO receiving any money. And the CCM would explain the consequences to an NGO that doesn’t fulfill its responsibility and obligations.

The website of Nepal CCM is quite impressive. These are the principles that they are trying to govern themselves by. The CCM is designed to provide high level leadership to health care organizations with the idea of leaving the day to day management to the individual organizations themselves.

Nepal CCM provides oversight to make sure that valuable donor money reaches the target it was intended to in the healthcare sector in Nepal. In many ways it seems that are holding the NGOs based in Nepal accountable for what they are professing to international donor agencies.

CCM Nepal has an executive Committee composed of 33 voting members representing different sectors and constituencies; Government of Nepal (GoN), civil society/NGOs working in HIV/AIDS, TB and Malaria, people living with or affected by HIV/AIDS, TB and Malaria; community organizations; the private sector; professional associations; research institutes, universities, media and international agencies including multilateral or bilateral agencies, international donors and international NGOs.

Nepal's CCM was created based on guidance from the Global Fund.They have created a CCM for every nation that is receiving internal funding.

"Hello 102"

Original article from NepaliTimes.com
By Bhrikuti Rai
A voluntary group is upgrading Kathmandu's ambulance service and saving lives 

The Americans have 911, the British have 111, Kathmandu residents can now dial 102 in an emergency, and a state-of-the-art ambulance with life-saving medical care will appear on the street outside.
Private hospitals have mushroomed in Kathmandu over the past decade, but many do not have professional and well-equipped ambulance services. Even ambulances that are on the roads do not meet minimum requirements like cardiac equipment, oxygen or emergency medicines.
A recent study by Patan Hospital revealed that only 10 per cent of patients use ambulances in emergencies. Getting the sick to hospital in private cars or taxis not only increases trauma in patients, but often leads to dead-on-arrival cases.
It was to address this crying need that a group of Kathmandu-based professionals established Nepal Ambulance Service (NAS) in April 2011. "We strongly felt Nepalis themselves can initiate professional ambulance services without seeking foreign donor funding," explains Ranjit Acharya, a founding member of NAS.
Acharya, whose full-time job is at Prisma Advertising, says NAS is an independent non-profit initiative which offers ambulances equipped with specialised life-saving equipment and trained emergency medical technicians in Kathmandu and Patan. NAS's dispatch center provides emergency pre-arrival instructions and there are 14 on-call emergency physicians for medical consultations.
Emergency personnel on NAS ambulances are trained to treat everything from spinal chord injuries, excessive bleeding, attending to breathing problems, starting IV fluids for patients in shock. NAS's general secretary, Mahesh Nakarmi, says his ambulance attendants have received specialised training in emergency medicine.
Right from its inception, NAS has received support from various corporate houses. Golchha Organisation was among the first to donate an ambulance to NAS. "We feel that NAS is working for a great cause and believe that it will successfully address the problems of emergency medical care in Nepal," says Shekhar Golchha, director of Golchha Organisation and also a member of NAS's National Advisory Board.
NAS planned to start with five ambulances around the Ring Road and then gradually increase the number to 20 to cover the entire valley. However, only two ambulances are currently in operation since three others are still stuck at customs. As per the law each medical institution can operate only one ambulance, and NAS has been lobbying to release the remaining three vehicles. For now, NAS is partnering with 11 other ambulance networks to handle growing demand.
NAS benefits from having professionals from various fields involved in this voluntary work.
"Members bring their unique perspective and expertise," explains Acharya. The monthly operational cost of the organisation is managed through financial contributions made by patrons, corporate members and board members like Golchha and Acharya.
Despite budget constraints and limited resources, members of NAS are positive about the services they have delivered so far and hope to expand their network throughout Nepal.
[For more information call 4286821 or visit nepalambulanceservice.org]

Monday, January 9, 2012

Dialogue between Nepali Bandhars and the Residents of Kathmandu

Nepali Bandhars (the people who cause Bandhs) are like neglected foster children who are starving for their adopting parent's attention and affection. They are so hungry for it that they are willing to do whatever it takes to get it. That is why, in their desperation for their adopting parent's affection, they call Nepal Bandhs.

Unfortunately, their adopting parent, Mama Kathmandu, suffers from a severe case of Attention Deficit Disorder (ADD). Mama Kathmandu is very stressed out these days. She has less and less attention to be able to give to her foster children, the Nepali Bandhars.
Mama Kathmandu is begging for the Nepal Bandhars to not demand for her attention by causing Nepal Bandhs. She wants to be able to keep some of her attention and focus for her own survival. She needs it. She is begging to be able to engage her attention and focus to look out for her own interest and that of her immediate family.
She is pleading to be able focus her attention on her career and her business. After all, who is going to give her anything? She doesn't have a rich inheritance to depend on. She has to look out for her own interest through her own cunning and hard work.
"And," says Mama Kathmandu, if there is any extra attention left over, she would like to use that little extra attention to be able to focus on the future of her whole family--including the Nepali Bandhars.

"Please be reasonable, O Bandhars, my foster children. Please don't harass us in this way and make our life so difficult. We are good people that love you. I am after all, your mother. I may not be your biological mother, but I still love you. Please be reasonable and let us keep some attention to fulfill our own needs? Don't try to grab all the attention all the time with your random Nepal Bandhs," Mama Kathmandu says.

But the Bandhars are resolute and unmoving. They have seen her shed crocodile tears one too many times. And quite frankly, it's getting a bit old.

The Nepal Bandhars sigh and with an air of resigned non-challance say, "Dear Mama Kathmandu, you have ignored our plea for too long. We tried to communicate with you many many times. And what was your response? You pretended to not understand Nepali. You faked it. You acted like a laati. All of a sudden you couldn't understand anything we were saying. That was very uncool. It is not how a loving mother should act to her child. Is it?"

"Mama Kathmandu, we have been hearing your tall stories and promises for development, aid and progress to the villages year after year after year. All you have given us are empty words. We are tired of your lies and painting pretty pictures that don't feed our hungry stomach. Now, with us being rigid in dealing with you, we are finally forcing you to see things from our perspective for a change. In the least we aren't being taken for a ride like we used to be."

"Dear Mama Kathmandu, our villages have been on Bandh for decades. And no matter how much we cried and screamed to you, over the last 60 years, you never listened to us. We don't know how you could have lived with yourselves seeing us in such misery. Did your heart not cry for us? Village life has been shutting down for decades now. Did you not notice that? Oh you didn't notice all those Bandhs that shut down the way the villages function? No, I didn't think you did. Why would you? Our problems aren't your problems, right? You have only taken notice of our words now that we are causing you pain by shutting down your way of life in Kathmandu. Now, suddenly, you understand the words coming out of our mouth."

"Dear Mama Kathmandu, perhaps in all of these years that we have been struggling trying to wave down your attention, maybe...just maybe, we also learn't a thing or two about the way the world functions. Did you think about that? Maybe we're not just the idiotic sojha-sajha Village bumpkins that you had written us off as. Did that cross your mind?"

"Dear Mama Kathmandu, we are not happy to have to shut down your way of life to make a point to you. No child enjoys having to hurt their mother in order to communicate to her. We understand it is a very harsh way of communicating to you. And we do apologize for our rudeness."

"But what can we do? It seems that this is the only kind of language, other than money, that you, Kathmanduites communicate in. Jasto desh usto bhesh. If we felt that there was any hope in trying to reach your heart in any other way, we would have given that a shot. But so far, you don't seem like you are open for any kind of serious dialogue."

 

Hearing all of this, Mama Kathmandu shed a tear or two and looked extremely distressed. "Why are you blaming me? Don't you realize how I am the victim through all of this also? The Shah Kings ruled all of us with an iron fist. I was a helpless victim through all of this. If the Rana Prime Minister's hadn't enslaved me, life would have been different for us. Life would have been different for you. But you and I, we both had our karmas to live out. What is done is done. Let us think about how to move forward positively."

Hearing their adopting mother speak, Nepal Bandhars laughed cynically. They had come to expect her guilt trips and her dramatic protests of innocence. It was obvious that she did not have the maturity to take responsibility for the pain she caused and the abuse she dealt out for all those years to her adopted children--the Nepali Bandhars.

Kathmandu Mama looked mournfully at the expression on the Nepal Bandhars faces. But what could she say? She knew that if she said what she felt in her heart, the Nepali Bandhars would jump all over her in anger, outrage and bitterness. She didn't dare say how she really felt.
In some ways she wished she could make up for the mistakes of the past. Yes, she was responsible for causing pain.

But her ego just couldn't allow the admission of a mistake to escape from her lips. She was way too proud of a woman to bend.

Instead she said, "Dear Nepal Bandhars, you guys are like a black hole. You have been seeking the light of my attention for more than a decade now. You have demanded it in many different ways through your Nepal Bandhs that bring Kathmandu to a halt. And I have been giving it in many occasions. But no matter how much I have given to you, you are like an empty quarreling stomach that is never satisfied. Look at you, you are still growling in hunger. Give up your negativity and be positive. Then you might have hope for happiness in the future."

"Dear Nepal Bandhars, if I, Kathmandu Mama, am suffering from Attention Deficit Disorder (ADD), it is all your fault. It is from the stress that you've been causing me. Don't you have a duty towards your mother? Don't you love your mother?"

"Is your own self-interest the only thing you can think about? Haven't you caused enough pain to your parent You have been seeking and seeking my attention so much that I now have a deficit for attention. And despite that, I am still trying to give it to you. But you, you are so ungrateful. I don't have enough attention for my own self-survival. I don't have enough attention for my natural children, their education, our careers."

"My Dear Nepal Bandhars, don't you see how many people you have isolated because of making our family conflict so public? Don't you see how many Nepalese are leaving Nepal just so that they don't have to face your wrath? They want to just be able to look out for their own interest without having to feel guilty to you. They just want to have the peace of mind and space to be able to, at their own leisurely speed, focus on those things that are important to them: their priorities."
"Look at what you've done. You caused the People's War. The whole world is shaking their head in disgust at your behavior. Did you think the world would be proud of you dissing and hating your own mother? You are so misguided."
 "My Dear Nepal Bandhar, unfortunately you associated with the wrong crowd while growing up. You read all those communistic revolutionary books and fed into all that nonsense a little too much. You subscribed to a foreign culture--communism. And now look how you've turned out. The whole world shuns you. People are disgusted at your behavior. What will happen to you?"
"See, I am still your mother, through it all. You have hurt me and insulted me in public. But I still love you. Give up your ways of doing these Nepal Bandhs and surrender to me. I will protect you and love you from all the forces that are trying to hurt you. Trust me, my dear foster children. Trust your mother, Kathmandu." And saying so, Mother Kathmandu fell silent and looked expectantly towards her foster children, the Nepal Bandhars.