Download PDF - Field Exchange - Emergency Nutrition Network

Agency Profile
Name: Clinton Foundation
Address:
Email address:
Website:
55 West 125th Street, New York, NY
10027
sarora@clintonfoundation.org
www.clintonfoundation.org
Founded: 1970
OTP centre located in a rural region several hours outside
Addis Ababa, Ethiopia, supported by the Clinton Foundation.
Director:
No. of HQ staff
No of staff worldwide
(40 countries):
Anil Soni, CEO
4
1,100 staff and volunteers
Foundation HIV/AIDS Initiative (CHAI) is to
increase access for HIV/AIDS care and treatment
in the developing world through lowering
prices for drugs, diagnostics and other
commodities. When CHAI began in 2003, the
ARV market was fragmented and suppliers were
unable to take advantage of economies of scale
and therefore, unable to lower the price of drugs.
To address this, CHAI has worked to increase
coordination between the demand and supply
sides of the AIDS treatment market in order to
catalyze significant price reductions for ARVs.
Because ARV access for children has historically
lagged far behind that of adults, CHAI
began to focus on paediatric HIV treatment
with the launch of its Paediatric Initiative in
2005. This was effectively the entry point for
CHAI’s work in nutrition, as the relationship
between HIV and severe acute malnutrition
(SAM) is so pronounced in many developing
countries. The Foundation quickly came to
realise that there are many strong linkages
between SAM and HIV, and that in addressing
SAM the quality of care for HIV treatment
could be significantly improved. CHAI was
subsequently chosen by UNITAID (a donor
organisation supported by many national
governments and seated within the World
Health Organisation (WHO)) to be an implementing
partner for a large scale donation of
paediatric commodities. At CHAI’s request,
RUTF was included in this donation with 25
countries eligible to receive it. Since the inception
of the UNITAID programme, CHAI has
become the third largest purchaser of RUTF
globally (behind UNICEF and Medecins sans
Frontieres).
CHAI has established memoranda of understanding
(MOUs) with a number of governments
to provide RUTF. Programme implementation
support is offered via national governments
in select countries where local partners
are strong. CHAI-procured RUTF is used to
treat SAM-affected children whether HIV positive
or not. In countries where CHAI is offering
programmatic support in addition to the donation
of the product, this can include assistance
with development of treatment protocols, offering
forecasting and supply chain management
support, supporting trainings and seconding
staff, or clinical mentors for paediatric and
CMAM facilities.
The significant growth seen in the past year
in RUTF production capacity has reduced the
supply-side bottlenecks associated with the
scale up of CMAM programmes. In CHAI’s
experience, the stumbling block is now on the
programmatic side, with a lack of capacity to
implement CMAM. CHAI has been working
closely with UNICEF and governments to identify
implementing partners for CMAM and has
been strongly advocating to get more funding
for CMAM implementation and roll out.
Another focus of CHAI’s work in RUTF has
been in looking at whether price reductions for
RUTF are possible. CHAI has conducted significant
analyses of supplier cost structures to
determine if there are areas where costs can be
cut. These analyses have revealed that in
general, RUTF suppliers are operating with
slim margins and there is minimal potential for
price reduction if the RUTF formulation
remains unchanged. To address this, CHAI is
working to generate funds for research into
alternative formulations involving industry
partners. Other supply side initiatives are
centred on addressing concerns of new regional
and local suppliers. CHAI have worked to form
a consortium for purchasing milk powder,
thereby cutting out intermediaries and extra
costs, and has also mapped out solutions to
other commonly faced barriers to market entry.
CHAI is optimistic that as new products and
new suppliers enter the market, prices will
come down to a level that governments can
eventually afford so that programmes become
domestically sustainable.
CHAI have endeavoured to strengthen
government capacity to actually implement
CMAM although with a growing evidence base
of success in some countries, the political buy in
is likely to increase demand and create sustainable
resources and capacity for implementation.
CHAI believe that decentralisation of CMAM to
community level may be more challenging at
this stage, but that with greater funding for HIV
programming and home based care
programmes, there is the potential for CMAM to
piggy-back onto these existing programmes.
This is already occurring in countries like
Cameroon and Nigeria. Greater integration with
Integrated Management of Childhood Illness
(IMCI) will also help with decentralisation.
The Clinton Foundation obtains funds from
a number of foundations, private donors, and
governments. President Clinton is still very
involved in fund-raising and is an excellent
spokesperson for the Foundation. As UNITAD
funding for RUTF winds down over the coming
years, CHAI has been working with agencies
like PEPFAR, the Global Fund and others to
ensure a smooth transition of CHAI RUTF
procurements beyond the UNITAID
programme. The Global Fund has begun to
consider RUTF procurement in their grants, so
funding for the commodity could become
secure in the short-term. The Foundation is
very aware of issues around RUTF supply
sustainability and transition funding. For example,
in Malawi where government is significantly
decentralised and CMAM is being rolled
out nationally, an agreement has been reached
for each district to provide a certain percentage
of resources for RUTF procurement. This
percentage should increase each year by that
percentage annually until most, if not all costs,
are ultimately paid for by the districts.
Both Seema and Rebecca see CHAI as
unique in that it works on both the demand and
supply sides of commodity marketplaces.
Although CHAI began its work in RUTF as a
procurement body with little intention of being
‘hands-on’, it has had to roll up its sleeves and
get involved in overseeing programme implementation
in certain countries. This has necessitated
forging strong relationships with government
and often providing consultants and
specialists seconded to government. CHAI has
also supported government proposal writing to
the Global Fund so that some programmes are
now successfully funded.
When asked about major gaps and challenges
in the nutrition sector from a Clinton
Foundation perspective, Seema and Rebecca
cited a number of areas. The lack of comprehensive
care for SAM children leading to fractured
programme implementation is a big
worry. This is caused by lack of funding for key
implementation components, with the problem
most pronounced in development rather than
emergency settings. They also expressed
concern about high default rates in outpatient
therapeutic programme and supplementary
feeding centre facilities, especially in urban
areas, as well as weak monitoring and evaluation
of these phenomena. In connection with
this they wondered about the appropriateness
of SPHERE standards in some contexts and
whether there may be a need to re-think these.
The Clinton Foundation has now grown into
a global non-governmental organisation with
1,100 staff and volunteers in more than 40 countries.
Its rapid expansion and diverse funding
sources suggests that the Foundation will
continue to grow in scope and engagement. It
will be fascinating to see how the Foundation
chooses to engage with the humanitarian
community, as well as how big a player it
becomes.
34