Localization in Action: A Path to Strengthening TB Care

Localization requires experimentation and flexibility. Shifting power to local experts, so they can chart the course for health programs, is the way forward. But to make this happen, we need innovative funding strategies that allow governments and other partners to direct resources where they’ll have the most impact on health outcomes.

Tuberculosis commitment grants are central to the USAID-funded Tuberculosis Implementation Framework Agreement (TIFA) project’s support of national TB programs in 17 countries. TIFA is part of the Global Accelerator to End TB, implemented by JSI in partnership with Open Development (2019-2027). Collaborating closely with National TB Programs (NTPs), TIFA allocates funding through fixed amount awards and other contracts directly to local governments and their in-country partners to expedite progress toward global and national TB targets.

TIFA closely aligns with USAID’s localization framework, emphasizing concepts like building trust with partner governments, leveraging local resources for sustainability, and ensuring mutual understanding and responsibility for outcomes. Through a collaborative co-design process, TIFA works with countries to create fixed amount awards (known as TB commitment grants), contracts, or other awards. Grantees submit milestone deliverables to USAID and TIFA for verification, providing transparency and accountability in the process.

This approach puts trust in the capabilities of governments and other partners to effectively manage funding and implement programming to improve TB care and treatment. TIFA provides the necessary financial resources and then steps aside, granting in-country partners the autonomy to lead the way.

Small Grants, Big Potential

Why is this funding model effective?

Results-Oriented Approach: TIFA’s TB commitment grants prioritize measurable outputs and results through a collaborative co-design process. This emphasis on outcomes and impact encourages grantees to demonstrate progress and accountable use of funds, promoting efficiency and effectiveness within health systems.

Flexibility for Innovation and Collaboration: With lower funding ceilings (up to $250,000 per grant) and limited timelines (to date 6-18 months), fixed amount awards allow NTPs and USAID to explore new approaches and experiment with innovative ideas. Collaborative partnerships between NTPs and other organizations enhance the impact and sustainability of TB interventions. In India, for example, the National TB Elimination Program (NTEP) is using awards to pilot and scale new interventions needed to accelerate progress in its 2025 TB elimination strategy.

Risk Mitigation: The milestone-based payments and short duration of fixed amount awards reduce financial exposure for USAID and the grantee, mitigating the risk of budget overruns. This approach supports better financial management while ensuring the grantee owns their activities and results.

Health Systems Strengthening: TIFA’s TB commitment grants contribute to the strengthening of health systems by addressing critical areas such as health infrastructure, data use, active case finding, and TB contact investigation. Localized grant design and implementation establish a sustainable foundation for TB care and prevention efforts. For example, grantee Africa University in Zimbabwe worked with the NTP to establish a TB ECHO telementoring platform for real-time collaboration between providers. The NTEP in India has tested differentiated TB care models, and Bangladesh’s NTP is setting up a national education and training unit.

Sustainability and Local Ownership: NTPs determine TB commitment grant focal areas in alignment with their national priorities. This partnership approach fosters mutual trust, responsibility, knowledge exchange, and joint problem-solving.

Answering the Call to End TB

The urgency to end the global TB epidemic has never been more pressing, especially with the disruptions caused by the global COVID-19 pandemic. By supporting locally-led programs and catalytic investments, TIFA acknowledges the dedication, expertise, and experience of NTPs and local organizations. Fixed amount awards promote local ownership, innovation, and sustainability. With this funding mechanism, NTPs are paving the way for more resilient TB programs worldwide.