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Author: David Garmaise
The Fund invoked a clause in its Eligibility Policy concerning a resurgence of malaria in countries not normally eligible for support
Venezuela will be eligible for an allocation for malaria in the next allocation period, 2020-2022. The Global Fund Board announced its approval of this decision late on 15 August, after a round of electronic voting.
In its decision, the Board cited a clause in the Global Fund’s Eligibility Policy whereby the Fund’s malaria partners may recommend, in certain situations, that a country such as Venezuela, which is normally not eligible for Global Fund support, become eligible for malaria-related support in the event of a significant resurgence in malaria cases.
There is ample evidence that malaria is experiencing a significant resurgence in Venezuela, and the Fund’s malaria partners have recommended that Venezuela be considered eligible for support to combat this.
According to the World Malaria Report 2018, the estimated number of malaria cases in Venezuela has increased from 57,257 in 2010 to 519,109 in 2017.
In a paper prepared for the Board, the Global Fund Secretariat said that the 519,109 figure is likely an under-estimate because of significant under-reporting. The malaria partners said that in 2018 there were 404,924 malaria cases reported; the Board paper noted that some sources estimate actual cases in 2018 may have exceeded 1.0 million.
According to the World Malaria Report 2018, Venezuela accounted for 53% of all malaria cases in Latin America in 2017.
Malaria partners told the Global Fund that the overall regional risk is considered high because of the large numbers of people fleeing Venezuela. “The export of sporadic cases to countries free of malaria poses a challenge for the early detection and prevention of complications associated with the disease,” the partners stated.
The resurgence in malaria cases has been accompanied by a steady deterioration of the health system. According to the Board paper, the resurgence is expected to continue in 2019. The paper stated that there is limited capacity in the country – of both financial and human resources – to respond to the upsurge, which has been steadily increasing in the last three years and has affected other countries in the region. The on-going socio-political and economic crisis makes it unlikely that there will be additional domestic or international resources to support the response to malaria in the near future, the paper said.
The partners said that the epidemic in Venezuela “calls for a comprehensive response including prevention actions, early access to diagnostics and treatment, and management of social determinants – without which there remains a high risk to the population of Venezuela and the region.”
The situation is not expected to improve in the short-to-medium term, the partners said, which has potential negative implications for malaria elimination in the region. “While providing Global Fund resources for malaria would help alleviate the situation, significant additional financial resources from other sources and changes in the political situation will be required before malaria can be controlled again in Venezuela,” they said.
The Secretariat noted that the decision to make Venezuela eligible with respect to its malaria component will not affect the Secretariat’s ability to request an additional year of exceptional funding for Venezuela HIV and TB under the Global Fund’s approach to non-eligible countries in crisis.
In September 2018, the Board approved a one-year donation of $5.0 million to finance the procurement of critical HIV treatments for Venezuela. In June 2019, the Secretariat told Aidspan that the Board will consider a future request under the ‘non-eligible countries in crisis’ approach “in the coming months.” (See GFO article ‘Global Fund donation reaches Venezuela amid worsening humanitarian crisis’.)
While it supported the recommendation for Venezuela to become eligible for a malaria allocation, the Secretariat noted that the operating context in Venezuela is likely to remain extremely challenging and that the design of implementation arrangements for any grants emanating from the malaria allocation will need to reflect this.
The Secretariat said that any decisions regarding implementation arrangements will be made in accordance with existing processes –– i.e. during country dialogue and the development of the funding request. Based on current external risk indices, the Secretariat said, Venezuela would likely be classified as a challenging operating environment (COE) and be managed under the Additional Safeguard Policy (ASP).
The Secretariat noted that the $5.0 million donation provided to Venezuela to purchase ARVs is managed directly through the Pan-American Health Organization (PAHO) and UNAIDS, and that there are currently no dedicated Secretariat staff for Venezuela. Should Venezuela become eligible for malaria and receive an allocation, there will be resource implications for the Secretariat, it added.
Most of the information in this article is based on GF/B41/ER04, “Recommendation on Eligibility of Venezuela Malaria for the 2020-2022 Allocation Period.” When we went to press, this paper was not available on the Global Fund’s website.