A female community health volunteer with her daughter in front of their home in Nepal.

A female community health volunteer (FCHV), with her daughter in front of their home. Photo by Nabin Baral for RTI International

As a finance expert, I tend to focus on pluses and minuses. But even when working at banks or other large organizations, I always wanted to go beyond calculations and do work that could have a real impact on communities.

Now I am part of a team that supports local institutions to improve the health and well-being of people in Nepal. The COVID-19 pandemic has only reinforced the importance of this work to me: A community is only as healthy as its local health institutions are strong— and my financial and operational work can help build that resiliency. 

Since 2006, the U.S. Agency for International Development (USAID) has supported the scale up of programs to eliminate common neglected tropical diseases (NTDs) from Nepal and other affected countries. These diseases, which primarily affect poor and vulnerable people, are now being eliminated community by community, region by region, and eventually country by country.

This is an enormous undertaking. For the fight against even just one NTD—lymphatic filariasis (LF)—Nepal needed to reach more than 25 million at-risk people with preventive medicines multiple times, over multiple years. To tackle this community-by-community task and do the important work of health system strengthening, we knew we needed to work closely with local governments and local organizations; we could not and would not do the work ourselves in their place.

The truth is that this approach, which prioritizes strengthening local capacity, can be challenging. It is not easy. It requires a strong commitment to building the technical, managerial, and operational capacities of the organizations with which we work. But the payoff is well worth it.

On USAID’s Act to End NTDs | East program, one ingredient of our recipe for this local-led approach is a sub-granting mechanism called fixed amount awards (FAAs). These awards allow a global program like Act | East to provide funding, directly to frontline recipients for the implementation of largescale NTD activities. They are a funding tool, yes, but fixed amount awards are far more than just a way to move money. By supporting local health institutions to manage funds and implement health interventions directly, we help to build up the backbone of a strong and resilient health system.

In Nepal, since government and civil society need to work together to accomplish NTD elimination goals, we work closely with the government and local NGOs to support mass treatment campaigns for trachoma and LF. For example, we used fixed amount awards to support Nepal Netra Jyoti Sangh (NNJS), a well-established national eyecare organization, to conduct treatment campaigns and surveys for trachoma. Government officials supervised NNJS activities—creating a strong working relationship that will benefit national NTD activities into the future.

Working with organizations who are unfamiliar with what is required to receive USAID support often requires a hands-on approach. We support organizations from the beginning to end: conducting trainings and information sessions, helping develop plans and budgets, providing supportive supervision during activities, and checking in at agreed-upon milestones to ensure the process is running smoothly. We also provide encouragement and assistance along the way. By helping organizations prepare their plans, develop budgets, and ultimately carry out activities, our team helps to build their management, financial, and operational capacities. This is intensive, especially at the beginning, but becomes relatively simple once the activities are underway. An awardee can give their attention to the program, and, if a challenge arises, we can focus together on fixing the problem.  

Since 2012, more than 1,800 fixed amount awards (previously called Fixed Obligations Grants) have been provided to government entities and local organizations for the control and elimination of neglected tropical diseases through USAID support administered by RTI and partners.

This locally-led, locally-sustained approach played a key role in a historic accomplishment that will improve the health of generations to come: In 2018, Nepal eliminated trachoma as a public health problem. And Nepal has used the same approach to support LF treatment in key districts. Now, many of these districts no longer need treatment and the government is independently funding all remaining at-risk areas. Fixed amount awards are one important piece of the complicated puzzle that Nepal’s NTD program puts together daily as it works to control and eliminate these diseases.

A trained grader from NNJS checks the eyes of a woman for clinical signs of trachoma during one of the last surveys before Nepal achieved validation of elimination of trachoma in 2018.

A trained grader from NNJS checks the eyes of a woman for clinical signs of trachoma during one of the last surveys before Nepal achieved validation of elimination of trachoma in 2018. Photo by Nabin Baral for RTI International

The work of a Finance and Grants Manager is not without challenges. Situations out of our control—like work strikes or global pandemics—can always arise, throwing off planned milestones. In fact, fixed amount awards to conduct NTD activities have been delayed in recent months due to COVID-19 and we will undoubtedly have to re-evaluate the costs and structure of our activities going forward.

Although COVID-19 has increased the challenges we face, it has also brought the importance of our work into focus. Now, more than ever, local health departments and local organizations must be empowered to serve their communities and manage health programs that benefit all.  

I am proud to be taking my financial work beyond numbers and figures, working together with health institutions in Nepal to improve the health and well-being of all. With a development approach that supports and enables local health institutions, we can sustain progress against NTDs into the future, going further together.