TIFA Accelerator Series: Zimbabwe

In July 2020, Zimbabwe initiated four Tuberculosis Implementation Framework Agreement (TIFA) Project-funded TB Commitment Grants, part of USAID’s Global Accelerator to End Tuberculosis. The Accelerator supports the global goal of enrolling 40 million people on TB (tuberculosis) treatment, as endorsed at the September 2018 United Nations General Assembly High-Level Meeting. These TCGs address an urgent need within Zimbabwe’s national TB strategy, according to Dr. Charles Sandy, Manager of the National TB Program (NTP). “The interventions were in our national [TB] plan, but they were not funded.”

The TIFA Process

TIFA TCGs are fixed-amount awards that are short-term (typically no more than 12 months), performance-based awards focused on achieving specific, measurable goals before the funds are delivered. Country actors plan and implement the grants. The short grant duration, and the highly collaborative planning required for TCG activities, support the USAID Accelerator approach of moving countries forward toward achieving national TB targets. “By design, TCGs are meant to put the country in the driver’s seat,” says Dr. Samuel Kasozi, a STAR advisor seconded to Zimbabwe’s NTP

Zimbabwe received TIFA TCGs for four activities: 1) adopting the TrainSMART database to track TB training; 2) establishing a National Technical Working Group (TWG) on TB Research; 3) developing a TB ECHO, and 4) scaling up the NTP’s Making Sense of TB Data (MSTB Data) approach (Figure 1). The TCG process entails several steps. Once a USAID Mission has secured buy-in from the NTP and a range of stakeholders, TIFA and the local team begin a co-design process that includes a concept paper, a detailed activity plan with milestones, and a budget.

The TIFA Experience

During the co-design process in Zimbabwe, stakeholders agreed to award the four grants to an academic institution, Africa University (AU), a private pan-African university located in eastern Zimbabwe, in collaboration with the Ministry of Health. AU’s Dr. Fadzai Mutseyekwa says that the TCG activities presented new pathways for AU. “Most of the grants AU handled previously were research-focused. But here, we are working with MOH on implementation,” she says. The planning was demanding, she says; but the close collaboration it required ultimately helped the grant activities move ahead smoothly. “With all the preparation we’ve done in the proposal development process, working together…has really been very easy. When we contact the person at the Ministry, they are ready to run with [the next activity]—it’s like they’ve been expecting our call.”

However, she adds, that the TCG’s requirement of meeting milestones before receiving grant funds was a learning experience. “Milestones are totally new. None of our previous grants have involved milestones. There are advantages and challenges. An advantage is that the milestones make us accountable. We have to reach the milestones before the funds come in, so that’s an incentive to get on with it.”

Dr. Eltony Mugomeri, also of AU, emphasizes the benefits of the meticulous planning carried out for each activity receiving a TCG. “The grants require precise planning well ahead of implementation, with very little room for changes later. This has strengthened our ability to plan for other types of grants as well. We’ve been working on a TB/malaria program in a different activity, and AU has been providing that technical assistance. The grant has also strengthened the relationship between AU and the national program.”

Flexibility and Sustainability

Besides the sharp learning curve, implementing the TCGs in Zimbabwe presented other challenges— including the restrictions on meetings and travel imposed by the COVID-19 pandemic—which, in turn, led to further learning. “The COVID-19 situation is very unpredictable,” Dr. Mugomeri says. “But it enabled us to use technology that we hadn’t used before.”

TIFA is designed to build in sustainability—for one thing, by tackling challenges that are already a national priority. “Most of what we’re doing is part of the National Strategic Plan,” Dr. Kasozi says. “Once those activities are underway, that does mobilize resources.”

Further, the TCG process leveraged the NTPs existing skills and organizational expertise, helping to institutionalize skills in transferring their own knowledge. “The MOH provided technical assistance from day 1,” Dr. Mugomeri says. “The skills from the TrainSMART program will build up by the end of the activity. And I have observed that we can sustain the effort of training districts on data quality assurance, using the blending training of the ECHO model.”

TIFA’s emphasis on collaboration also supports sustainability, Dr. Mutseyekwa adds. “You have many stakeholders, and many great minds coming together, and also many resources. So outside TIFA there are many resources, including financing and technical resources. For example, in the TWG [on TB] we have parties with skills in project design and rollout.”

The short timeframe of the TCGs have led to challenges—unforeseen logistical problems, for example, as well as the barriers and risks posed by COVID-19. Nevertheless, it is a promising practice for accelerating country ownership of the TB response. “This is a special project that is teaching us about precise planning and giving us skills we hadn’t had,” Dr. Kasozi says. “Having seen the implementation of these TCGs, I think that they ensure that money is well spent. This is a good approach moving forward.”