BURMA: URGING THE GOB TO ADDRESS GLOBAL FUND ACCESS

C O N F I D E N T I A L SECTION 01 OF 02 RANGOON 000237 SIPDIS STATE FOR EAP/MLS, G, S/OGAC, OES PACOM FOR FPA BANGKOK FOR USAID HEALTH OFFICE DEPARTMENT PLEASE PASS TO USAID/AME; DEPT OF HHS; NSC E.O. 12958: DECL: 04/27/2019 TAGS: SOCI EAID PHUM KHIV PGOV SENV BM SUBJECT: BURMA: URGING THE GOB TO ADDRESS GLOBAL FUND ACCESS REF: A. RANGOON 207 ¶B. 08 STATE 131926 RANGOON 00000237 001.4 OF 002 Classified By: Economic Officer Samantha A. Carl-Yoder for Reasons 1.4 (b and d). Summary -------------- ¶1. (SBU) With the June 1 deadline fast approaching, the Ministry of Health (MOH) and WHO technical advisors continue to revise the MOH's draft Round Nine Global Fund application. Embassy Rangoon, USAID, and other donors reviewed and provided comments on the first draft; we expect to review the second draft in early May. The proposal is strong technically, but in Embassy Rangoon's opinion fails adequately to address issues of access and the 2005 Global Fund withdrawal. According to DFID, the Minister of Health will write a cover letter to the Global Fund Secretariat that will guarantee the Global Fund grant will be afforded the same treatment, including on access, as the existing Three Disease Fund (3DF) program. Additionally, the 3DF will provide a separate document to the Global Fund Secretariat detailing its operational experience in Burma, including access to project sites, visas, and fund flow. Embassy Rangoon will continue to encourage the MOH and the Country Coordinating Committee (CCM) to address specifically within each disease proposal the issue of access and other concerns that prompted the Global Fund withdrawal. End Summary. Reviewing the Proposals -------------- ¶2. (SBU) Per Ref A, Embassy Rangoon, USAID, and other donors reviewed and commented on the Ministry of Health's first Global Fund (GF) Round Nine draft application. We recommended several technical improvements to the specific disease proposals, although according to U.S. and other experts the proposals generally are sound from a technical standpoint. However, the current drafts of the individual HIV/AIDS, TB, and malaria applications fail to address adequately the issue of access, as well other issues that prompted the Global Fund's 2005 withdrawal. They include no clear commitments from the MOH or GOB and lack specifics on the processes to be followed for visas and in-country travel authorizations, for example. During meetings with other donors and WHO, we reiterated the USG's position on the GOB's Global Fund application (Ref B) and strongly urged them to join us in conveying to MOH the need explicitly to address prior GF experiences and explain how the situation has changed. We also recommended that the final proposal include information on specific GOB commitments and procedures to ensure access. Dealing with Access -------------- ¶3. (SBU) According to Julia Kemp, DFID Health Advisor and donor representative to the CCM, the Ministry of Health is committed to providing "free and unfettered" access to all GF program sites. During meetings with the Global Fund Secretariat in February, the Minister agreed that in terms of access, procurement, financial flows, and exchange rate issues -- with which the Global Fund had problems in 2005 -- RANGOON 00000237 002.4 OF 002 a new GF grant will be afforded the same treatment as the Three Diseases Fund. We noted that this information was lacking from the draft documents and urged the CCM to ensure MOH and WHO incorporate language to this effect into the individual disease proposals to ensure that all implementing partners are on the same page. Kemp agreed to raise the issue with the CCM. ¶4. (C) Kemp also noted that per the Global Fund Secretariat's request, the 3DF will provide separate documentation as part of the MOH application detailing the 3DF operational procedures, as well as experiences working with the Ministry of Health. The Secretariat is particularly interested in evidence that the MOH's procedures have enabled the 3DF to successfully work in Burma. Kemp, who often represents DFID on the 3DF Board, would not confirm whether the 3DF would endorse MOH's procedures, but stated the 3DF is compiling evidentiary documentation to submit directly to the GF, without MOH's prior review. ¶5. (C) Kemp stated that per Global Fund policy, access to program sites must only be guaranteed for implementing partners, the Global Fund, and any third party designated by the Global Fund. Donors do not fall under the GF access requirements, she noted. Comment -------------- ¶6. (C) We understand the GF Secretariat wants confirmed "free and unfettered" access to program sites, not necessarily to the entire country. This approach is understandable, since it is unrealistic to seek access to some of Burma's more sensitive and dangerous regions where no assistance flows. We understand that MOH has already vetted and agreed to the program sites listed in the proposals. However, MOH cannot deliver visas or travel authorizations, which are officially the purview of the Foreign Ministry but are often ultimately approved by others: the Foreign Affairs Policy Committee in the case of visas and the Ministry of Defense and the relevant regional military commander for expat in-country travel. We don't know whether MOH has cleared the list of GF program sites with other GOB entities. In accord with Washington guidance (Ref B),we will continue to work with donors, WHO staff, and MOH to attempt to ensure that the CCM adequately addresses access issues and other Global Fund concerns in each of the proposals. DFID, as donor representative to the CCM, told CCM members that donors would not sign the final proposal until the access issues have been clearly identified and addressed. We expect to review and comment on the second round of drafts in early May, and will forward them to the Department as soon as they are received. DINGER