Getting TB Resources to Local Government Units

 After an introduction to the Tuberculosis Implementation Framework Agreement (TIFA) Project and tuberculosis (TB) commitment grant (TCG) co-design process, USAID Philippines asked TIFA to help the Department of Health – National TB Control Program (DOH-NTP) to identify local government units (LGUs) to implement TCGs. Together the team developed selection and co-design processes tailored to the needs identified in the Philippines. 

 Transparent Selection 

The NTP team and USAID Philippines opted for a two-step process to identify potential recipients through an open call to interested LGUs in selected regions. 

“We chose to pre-qualify LGUs through a transparent and competitive process,” explained Tito Rodrigo, Project Management Specialist and Infectious Disease Team Lead, USAID Philippines. 

A total of 21 LGUs submitted proposals. The selection committee—which consisted of the DOH-NTP and Bureau of Local Health Systems and Development, USAID Philippines, and USAID Washington— considered 11 of the proposals ineligible. Based on the developed evaluation criteria, the committee reviewed the 10 qualifying applications and selected six semi-finalists to submit a TCG concept paper. The NTP and USAID ultimately selected three to co-design a TCG. 

Narrowing the Focus 

The NTP and USAID Philippines determined four key areas: 1) TB case finding and caseholding; 2) TB case detection and diagnosis of pediatric TB; 3) quality improvement of drug resistant TB treatment; 4) scale up of contact investigation and uptake of TB preventive treatment. 

TIFA created an online application seeking proposals from interested LGUs in the four key areas. Eligibility criteria included geographical targeting and commitment to sustain activities beyond the life of the grant, with a preference for innovative activities in local communities. 

“For USAID with our current existing geographical focus, our projects exist only in regions NCR, 4A, and 3. So this mechanism is an opportunity to expand and to work directly with local government units. We have worked with LGUs before, but this is the first time that we have a mechanism that will directly channel funds to them,” explained Mr. Rodrigo. 

LGUs Own the Ideas, Propose the Solutions 

The NTP team assigned the semi-finalists a mentor to guide concept paper development. 

“We were very careful to make sure that the proposal, the ideas really came from the LGUs. However, we also wanted to ensure that their recommendations or proposals were in line with what the National Strategic Plan recommends. The mentors provided technical input for this,” said Dr. Allan Fabella, USAID/TASC Advisor, NTP Philippines. 

The selection committee identified three LGU teams—health office teams in Mandaue City, Puerto Princesa City, and Samar Province—to move on to full co-design and develop a TCG activity plan and corresponding budget. 

“Before the pandemic, our TB team had been successful in finding missing TB cases in the community and initiating treatment immediately. The team was interested in applying for a TCG because we considered it as a stepping stone in progressively achieving our targets. We consider a TCG as an avenue to reach our goal,” said Carl Gerard Cuyos. 

A Different Co-design Approach 

USAID was grateful for the very highest levels of the NTP management team. Close communication and collaboration was achieved throughout the co-design process between the DOH-NTP, USAID, and TIFA. 

The co-design process in the Philippines differed from other countries. The Philippines team opted to award TCGs at the decentralized level, and through a competitive selection process. And the NTP each applicant team a mentor who participated throughout the selection and co-design processes. 

While previous co-design processes focused on one organization, in the Philippines TIFA conducted joint virtual sessions with all LGUs which allowed them and their mentors to learn with and from each other. 

“The orientations are focused and after each co-design session it was clear what we needed to do and when—the next steps and the timeline were outlined. I really appreciate the feedback and orientation that TIFA provided,” said Dr. Anna Marie Celina Garfin, NTP Manager. 

After each LGU team developed an activity plan and budget using the TCG templates, TIFA drafted feedback, shared comments with the NTP and USAID, and sent consolidated suggestions that the LGUs used to finalize their plans. 

“On behalf of the NTP, I would like to say thank you for the support, it’s something new and an opportunity that we’d like to provide to all LGUs,” said Dr. Garfin. 

Going Forward 

TIFA starts discussions early in the co-design process to help grantees identify priorities and opportunities to sustain TCG-funded activities. In the Philippines, the grants include the development of sustainability plans to identify actions to continue TCG activities, as appropriate, beyond the life of the grant. 

“USAID supports sustainable and transparent development projects that enable partner countries to be resilient. We look forward to on-going discussions as we implement. There will be lessons along the way that we hope to document for other USAID Missions that are considering the TCG mechanism,” concluded Ms. Michelle Lang-Alli, Office of Health Director, USAID/Philippines.