Identifier
Created
Classification
Origin
08RANGOON844
2008-10-29 09:48:00
CONFIDENTIAL
Embassy Rangoon
Cable title:  

BURMA: ANALYZING 3D FUND'S OPERATIONS

Tags:  SOCI EAID PHUM KHIV PGOV SENV BM 
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TO RUEHC/SECSTATE WASHDC IMMEDIATE 8334
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
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RUEHBJ/AMEMBASSY BEIJING 2090
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RUEAIIA/CIA WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
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RHEHNSC/NSC WASHDC
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RUEKJCS/JOINT STAFF WASHDC
RUCNDT/USMISSION USUN NEW YORK 2073
RUEHBS/USEU BRUSSELS
C O N F I D E N T I A L SECTION 01 OF 03 RANGOON 000844 

SIPDIS

STATE FOR EAP/MLS, G, S/OGAC, OES
PACOM FOR FPA
BANGKOK FOR USAID HEALTH OFFICE; REO FOR HHOWARD
DEPARTMENT PLEASE PASS TO USAID/AME

E.O. 12958: DECL: 10/29/2018
TAGS: SOCI EAID PHUM KHIV PGOV SENV BM
SUBJECT: BURMA: ANALYZING 3D FUND'S OPERATIONS

REF: A. RANGOON 308

B. RANGOON 309

RANGOON 00000844 001.2 OF 003


Classified By: Economic Officer Samantha A. Carl-Yoder for Reasons 1.4
(b and d)

Summary
-------

C O N F I D E N T I A L SECTION 01 OF 03 RANGOON 000844

SIPDIS

STATE FOR EAP/MLS, G, S/OGAC, OES
PACOM FOR FPA
BANGKOK FOR USAID HEALTH OFFICE; REO FOR HHOWARD
DEPARTMENT PLEASE PASS TO USAID/AME

E.O. 12958: DECL: 10/29/2018
TAGS: SOCI EAID PHUM KHIV PGOV SENV BM
SUBJECT: BURMA: ANALYZING 3D FUND'S OPERATIONS

REF: A. RANGOON 308

B. RANGOON 309

RANGOON 00000844 001.2 OF 003


Classified By: Economic Officer Samantha A. Carl-Yoder for Reasons 1.4
(b and d)

Summary
--------------


1. (C) The Three Diseases Fund (3DF),the single largest
health donor in Burma, has successfully worked for the past
18 months to reduce the morbidity and mortality rates of
HIV/AIDS, tuberculosis (TB),and malaria, according to 3DF
Manager Mikko Lainejoki. The 3DF's mandate prevents it from
funding, either directly or indirectly, the GOB's national
health programs or Ministry of Health officials. The GOB
clearly dislikes the 3DF's mandate, but has allowed it to
operate, while imposing some operational challenges: the GOB
continues to play games with visas for 3DF staff; the
Ministry of Health requires that any 3DF grants be provided
only to registered local NGOs; and the Minister of Health has
requested that several 3DF partners curtail their programs
for political reasons. Nevertheless, donors consider the 3DF
to be a successful program that has saved many lives,
providing necessary treatment to HIV/AIDS, TB, and malaria
patients that otherwise would not have been available. End
Summary.

Filling the Global Fund Gap
--------------


2. (SBU) In 2006, a consortium of six donors - Australia,
the European Commission, the Netherlands, Norway, Sweden, and
the United Kingdom - established the Three Diseases Fund
(3DF) to reduce the burden of morbidity and mortality from
HIV/AIDS, malaria, and tuberculosis (TB) in Burma and to
cover the gap left by the pull out of the Global Fund in

2005. Donors have pledged $104 million over five years to
assist national health programs at the township level, and
they disbursed more than $23 million to 26 implementing
partners during the first year. According to Mark Canning,
British Ambassador and 3DF Board Chair, the 3DF's

implementing partners, which include UN organizations,
international NGOs, and local NGOS, use the fund to support
38 different projects in more than 300 townships throughout
Burma (Ref A).


3. (C) 3DF Manager Mikko Lainejoki told us that the 3DF
Board established strict criteria that prevented the 3DF from
providing money, either directly or indirectly, to the
Ministry of Health's (MOH) national programs (Ref B).
According to Lainejoki, the 3DF only works at the township
level and below, strengthening local capacity to better meet
the needs of the Burmese. Additionally, the 3DF does not pay
honorariums or salaries to government officials who conduct
training on behalf of the 3DF. While the Ministry of Health
allows the 3DF to operate, it resents the mandate, Lainejoki
said. The MOH has raised the salary issue with the 3DF
Board, explaining that most GOB officials rely on honorariums
to make ends meet. Canning told us that the 3DF Board will
not change its policy, despite GOB pressure.

Operational Success
--------------


4. (SBU) During the 3DF's first annual review meeting, held
in April 2008, donors, implementing partners, and GOB
officials highlighted how the 3DF's assistance has addressed

RANGOON 00000844 002.2 OF 003


Burma's health concerns in the areas of HIV/AIDS, malaria,
and tuberculosis. The 3DF's budget is divided 60-20-20, with
the majority of funds going to HIV/AIDS programs. First year
successes included an expansion of national programs for all
three diseases,; increased number of NGOs providing
anti-retroviral treatments (ART) for HIV/AIDS patients;
improved coordination between implementing partners and
township level health officers; expansion of public-private
treatment for TB; and provision and treatment of more than
100,000 long-lasting bed nets (Ref A). Lainejoki explained
that the 3DF easily procures drugs for its NGO partners,
using its Memorandum of Understanding with the MOH to
facilitate quick entry of these products.


5. (C) Although the GOB often delays travel permits for NGO
expatriates, the 3DF partners believe they have successfully
monitored and evaluated the programs (Ref B),including by
using their local employees. Lainejoki commented that donors
have been able to travel to various project sites, and that
the 3DF hopes to increase travel to more remote areas in
2008-2009.


6. (C) The 3DF Board will conduct a mid-term evaluation of
all programs in June 2009, with an eye for reallocating the
3DF budget to better meet TB and malaria needs. The 3DF also
plans to shift its focus from prevention of HIV/AIDS to
treatment, procuring additional ARTs for NGO distribution.
Working with township level officials, the 3DF and its
partners plan to identify treatment gaps and improve
public-private partnerships to prevent duplication of
efforts. Lainejoki noted that the 3DF will launch its third
round of small grants in 2009, allocating USD 10 million for
local NGOs and Community Based Organizations (CBOs).

Challenges Remain
--------------


7. (C) Lainejoki reiterated that the 3DF has successfully
met its objectives, providing treatment and care to more than
six million Burmese. However, he acknowledged that the 3DF
has faced several challenges during the past six months.
Since June 2008, the GOB has "played games" with visas for
3DF management, refusing to issue extension visas for
Lainejoki and the Deputy Manager. Lainejoki, who departed
for home leave right before his visa expired, was forced to
stay in Bangkok for one month awaiting GOB approval of his
visa. Lainejoki finally received a one-entry visa, which
expires at the end of October. He told us that as of October
28, the GOB has yet to extend his visa.


8. (C) Although the GOB has been more accommodating since
Cyclone Nargis to NGOs working in the Irrawaddy Delta, the
3DF and its partners have not yet benefited from this
opening, Lainejoki observed. In fact, the Ministry of Health
asked several 3DF partners to consolidate their programs and
to limit travel of expatriate staff. During the April 3DF
Annual Review, several partners, including Merlin and
Malteser, complained that the GOB has been slow to allow
travel to project sites (Ref A). The Ministry of Health
accused one 3DF partner, International Alliance for HIV/AIDS
(which also receives funding from the USG),of supporting
pro-democracy movements and demanded that it renegotiate its
MOU with the government. Alliance Director Choo Phuah told
us that the INGO does not engage in pro-democracy work, but
she could not say for certain whether any of her more than
thirty local NGO partners have political affiliations. The
Alliance is currently renegotiating its MOU with the MOH,
which wants to reduce the areas where the organization can

RANGOON 00000844 003.2 OF 003


work. Phuah informed us that, should the new MOU come into
effect, it would severely limit the Alliance's ability to
operate in Burma and would drastically reduce the number of
HIV/AIDS patients who could receive care and treatment.


9. (C) The 3DF in early October launched round two of its
small grants program after a six-month delay. Lainejoki
acknowledged that the 3DF faces problems identifying local
NGO and CBO partners, since the Ministry of Health demands
that local partners must be registered with the government
and have valid bank accounts. So far, the 3DF has identified
13 NGOs and CBOs eligible to submit proposals. Lainejoki
noted that there are an additional nine NGOs that have the
technical capacity for a 3DF grant but are not officially
registered with the GOB. According to Lainejoki, the 3DF
continues to negotiate with the Ministry of Health, pointing
out inherent contradictions in the regulations and practice:
the MOH allows INGOs with expired Memorandums of
Understanding to continue to work in Burma and has allowed an
unregistered local NGO to sit on the Country Coordinating
Mechanism (CCM).

Comment
--------------


10. (C) Of late, UN and NGO representatives have been
stressing to us that the relative success of the 3DF is
evidence that the operational environment today can allow a
successful Global Fund program (Ref B). Per above, the
reality is complex. The 3DF and its partners have found ways
to treat successfully more than six million patients in the
past 18 months, but, as they admit, there have been many
operational challenges to overcome. The cost of doing
business in Burma is high. Lainejoki is among those who
argue that the immense humanitarian need and the large number
of lives saved through health assistance outweigh the
difficulties that an NGO or international organization will
face when operating in Burma.

DINGER