UNDP Liberia

Malaria is the main cause of death in Liberia. An estimated 4 out of every 1,000 person in Liberia has tuberculosis. In 2003 alone, AIDS, tuberculosis (TB) and malaria caused more than 6 million deaths worldwide. The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) is an innovative, multi-partner initiative designed to bring additional financing to these global challenges. GFATM and UNDP Liberia have signed 3 separate agreements for program implementation to strengthen the capacity of government, civil society organizations, and the private sector to respond appropriately and collaboratively to these 3 deadly issues.

Designated as the Principal Recipient (PR) of a US$24 million grant, , UNDP Liberia’s main responsibilities are to: oversee the implementation of the 3 projects, applying UNDP’s rules, regulations and procedures to ensure accountability and transparency; and the procurement of all drugs, medical and non-medical supplies. The Global Fund activities are implemented under the UNDP DEX Service Center modality.

UNDP works collaboratively with the Liberian Coordinating Mechanism (LCM), a 27-member body comprised of national and international NGO’s, UN Agencies, and government ministries. The LCM performs the day-to-day coordination and monitoring of implementation activities; serves as the highest policy and decision-making body in the implementation of the Global Fund in Liberia; reviews, approves and submits all project proposals to the Global Fund; mobilizes materials and financial resources for the Global Fund; liaises with and ensures the Government of Liberia’s commitment to the Global Fund.

Funding from the Global Fund is distributed to sub-recipients who carry out the active implementation activities of the program. The sub-recipients are national government programs, as well as national and international NGOs. At present, there are 15 sub-recipients of the Global Fund: 9 for the Malaria component, 4 for HIV/AIDS (1 national government program and 2 NGO’s), and 1 for the TB program (national government program), and 1 for the National Drug Supply.

The Global Fund includes the following 3 initiatives:
• Malaria: The aim of the Malaria Project is to bring the most effective malaria control and prevention to Liberia by introducing new efficacious drug therapies, including making available combination therapies to trained health staff, and preventative measures targeting vulnerable groups such as pregnant women and children less than five years of age.

The objectives of the project are to increase access of drugs and treatment at health facilities and community levels, including IDP camps; increase the use of intermittent preventative treatment (IPT) among pregnant women; increase coverage and use of personal protective measures including Indoor Residual Spraying; increase awareness and practice of malaria control and prevention in the community; and increase effective and efficient coordination and utilization of resources available.

• Tuburculosis (TB): The aim of the Tuberculosis Project is to support the expansion of Directly Observed Treatment Short Courses (DOTS), and to assist the Government of Liberia to improve case management at all levels; to establish selective TB/HIV collaborative activities with the National AIDS Control Programme; and to strengthen community participation and monitoring and evaluation of the TB project. The TB project serves only one sub-recipient, the National Leprosy and Tuberculosis Control Programme (NLTCP), a program of the Ministry of Health and Social Welfare. The NLTCP has the overall responsibility of implementing the TB program in all fifteen counties.

• HIV: The aim of the HIV Project is to strengthen national capacity to enable them to ensure a safe blood supply at all of the 33 strategically selected health facilitates; to establish blood banks in 3 of these facilities; to provide prevention, care, and treatment; to empower communities to provide home-based care by 2006; to improve information, education, and communication (IEC) and behaviour change communication (BCC) skills for STI/HIV/AIDS prevention and control by 2006.

The first step towards implementation of the HIV Project is the establishment of a Blood Safety Committee (BSC), which will study and revise blood safety and transfusion guidelines. The guidelines will form the baseline to help health facilities to screen blood samples before transfusion. The BSC will guide NACP, a sub-recipient and a national government program, in the establishment of 3 blood banks. With support from an international consultant, an anti-retro viral (ARV) treatment protocol will also be developed in which to facilitate NACP in administering drugs to HIV/AIDS infected patients. The home based care project will provide OVCs with assistance to continue their basic education and health care; and caregivers to these OVCs will be provided with livelihood skills. The grant will further strengthen capacity of the NACP and partners to design and implement IEC/BCC messages.

PROGRAM ACHIEVEMENTS
Malaria Project (total budget: US$ 12,140,921)
• 519 health facility staff and workers, 30 laboratory technicians, 1551 community health workers, 386 peer educators, and 100 teachers were trained in malaria case management, the use of IEC/MBB material, and participated in awareness workshops;
• 9,165 insecticide treated mosquito nets (ITNs) were distributed to vulnerable households.
TB Project (total budget: US$ 4,534,017)
• A countrywide assessment on the status of TB facilities in Liberia was completed;
• 428 TB patients have successfully completed treatment;
• 48 health workers and 59 community health workers have been trained in DOTS;
• 85 out of 95 laboratory technicians available countrywide have been trained in DOTS;
• Over 50,000 fact sheets, 50,000 leaflets, and 5,000 posters have been printed;
• 56 patients with HIV co-infection have been identified and put under treatment.
HIV/AIDS Project (total budget: US$ 7,658,187)
• 20 medical doctors, laboratory technicians, and paramedics have been trained on blood safety;
• 12 doctors and 17 nurses were trained in the use of ARV management of patients with HIV/AIDS and opportunistic infections;
• A national protocol for HIV-ARV was developed; Blood Safety Guidelines were developed and awaiting finalization; STI Guidelines have been upgraded; VCCT Guidelines were concluded;
• HIV/AIDS awareness has been conducted in 40 communities by 10 CSO’s;
• Tam-Tam social mobilization was conducted in 4 counties;
• Over 30 educators, church and health institutions have been sensitized on HIV/AIDS related messages;
• 16 persons have been supported with agricultural activity;
• 20 families who have taken care of OVCs have been supported with livelihood skills, such as tie-n-die and fish preservation; tuition fees for 202 OVCs have been provided; 200 OVCs have received health care; 186 OVCs and 76 families have received counseling;
• Over US$ 2.25 million worth of equipment, medical and non-medical items, vehicles and computers have been procured and distributed to sub-recipients;
• 29 OICs, 27 registrars, and 25 dispensers from 25 clinics have been trained in record keeping, careful management of drugs and medical supplies, and proper use by patients.