A conversation with UNICEF (Malaria) on June 29, 2012

Participants

Note: This set of notes gives an overview of the major points made by Renee Van de Weerdt and Valentina Buj.

Summary

This was our first conversation with UNICEF about its malaria work. Our conversations with UNICEF Malaria are part of an investigation into where funding gaps in malaria control and specific funding opportunities exist. In short, we learned:

UNICEF's malaria work

Malaria prevention and case-management (which includes treatment and diagnosis) are high priorities for UNICEF. It works on a wide variety of interventions from insecticide-treated bed nets to diagnostics to treatment. UNICEF’s mandate is to work with children, women of childbearing age, pregnant women, and others within the community, and therefore its work is not purely focused on one-age group. 

UNICEF’s programmes include commodity procurement and delivery, as well as ensuring effective use of the commodities which have been delivered. For example, in terms of one malaria intervention, UNICEF will purchase bednets and also provides distribution support. In some cases, it pays for the commodities for internal resources, and in some cases, based on country-request it will facilitate procurement with funds from other sources, such as the Global Fund, the World Bank, and recipient countries (as it does for vaccines). Distribution support can include helping the government plan the distribution, coordinating logistics during the distribution, training health workers, behavior change communications to ensure effective use, and usage monitoring post-distribution.

One example of this “complete package” on malaria is the $81 million malaria project currently being rolled out in the DRC by UNICEF with World Bank financing.

Funding for UNICEF's malaria work

In addition to the funding required to “fill the gap” on malaria commodities, there is often also a need for additional funding to ensure that commodities are efficiently and equitably distributed. To date, some donors have preferred to purchase only commodities, leaving a funding gap for training health workers, training people to do behavior change communications, and training logisticians. There are also some countries that receive less donor support than others, such as the Central African Republic and Chad. 

Globally, much of the big financing push went to nets that were distributed in 2009-2010, which will now need to be replaced. 

The Global Fund is short on funding and is currently working to determine how to use its limited funds optimally. It will likely focus on countries that contribute most to the global malaria burden, and funding may be needed in smaller countries. For countries that do receive nets from the Global Fund, as well as from the President's Malaria Initiative, in addition to purchasing nets to fill the gap, funding will also be needed to support the distribution of the nets.  The decisions on how much and where the Global Fund will allocate its limited resources will affect which countries will be left with proportionally larger gaps and where UNICEF will be seeking additional funds to ensure that those needs are also being met.

UNICEF as an organization

UNICEF's organizational structure is a small headquarters staff and a large number of in-country technical staff. There are approximately 12,000 employees worldwide with 124 country offices serving 150 countries. In countries where greater support is needed the offices will have more staff, for instance there are more than 400 staff in the DRC country office. The procurement center is based in Copenhagen.  In addition to the programmatic direction based out of the New York headquarters one of the evaluation interventions is to publish Multiple Indicator Cluster Surveys (MICS). 

Monitoring and evaluation of malaria programs

UNICEF states that it has strong monitoring and evaluation interventions for all their programs including its malaria programs, however depending on the level of development and financing in the country the information may be more or less readily available and therefore easier or more difficult to share. 

Non-malaria fever

UNICEF has been supporting the scale-up of rapid diagnostic tests for malaria which are more specific in separating out who - including febrile children - are infected with malaria and which are not. In many areas, where there has been successful and sustained scale-up of malaria prevention (including with bednets) the increased use of diagnostic tests can show the hoped for result that fewer fever cases in children are caused by the malaria parasite. There is therefore a need for more funding to treat the other causes of fever, such as pneumonia and diarrhea. There is currently little donor support for antibiotics, ORS and zinc. There are no pre-approved suppliers of child doses of antibiotics, so children are generally given part of an adult dose and may not receive the proper amount of active ingredient. 

Nothing But Nets

​GiveWell asked about UNICEF's relationship with Nothing But Nets (NBN), a group it had previously spoken with. UNICEF has a very good working relationship with NBN, working together to fund projects in countries. Usually about mid-year, NBN will inform UNICEF on how much funding it has available, and UNICEF will prepare a proposal in such a way that the funding is used optimally to fill country gaps. In the past this funding has been used in a catalytic way to ensure that nets are distributed in the most effective and equitable way. It has found the funding to be particularly useful because of its flexibility.​