A global health partnership

Transcription

1 A global health partnership Dr. Akram Eltom Director of Partnerships Dli Delivered at ILO side event, Palais des Nations Geneva 1 st June 2011

2 The Framework document of the Global Fund to Fight AIDS, Tuberculosis and Malaria The purpose of the Fund is to attract, manage and disburse additional resources through a new public private partnership that will make a sustainable and significant contribution to the reduction of infections, illness and death, thereby mitigating ii i the impact caused by HIV/AIDS, tuberculosis and malaria in countries in need, and contributing tib ti to poverty reduction as part of the Millennium Development Goals.

3 A new Public Private Partnership 1. Operate as a financial instrument, not an implementing entity 2. Make available and leverage additional financial resources 3. Support programs that reflect national ownership and respect country led formulation and implementation 4. Operate in a balanced manner in terms of different regions, diseases and interventions 5. Pursue an integrated, balanced approach to prevention, treatment and care 6. Evaluate proposals through independent review processes 7. Establish a simplified, rapid and innovative grant making process and operate transparently, with accountability. The fund should make use of existing international mechanisms and health plans. 8. Focus on performance by linking resources to the achievement of clear, measurable and sustainable ti results.

4 Partnership Approach to Governance A diverse partnership reflected in the Board and Country Coordinating Mechanisms Donors Implementers Public Sector (Governments and Agencies) Civil Society NGOs North NGOs South Communities living with and affected by the diseases Private Sector Private Foundations Private Sector Technical Agencies and Partnerships WHO UNAIDS World Bank UNITAID RBM Stop TB Partnership

5 Global Governance Structure Technica al Review Panel Advisory 40+ members Approved by Board Meets once a year and via e for a review proposals for funding Makes funding recommendations to the Board BOARD Supreme governance body of Global Fund 26 members Meets twice a year Forum Part tnership Advisory Convened every 2.5 years 400+ ad hoc participants Reviews Progress of GF objectives AdvisesBoard on policies and strategies Secreta ariat Administrative Executive e Director appointed by Board Management of day to day operations of the Global Fund

6 Country Coordinating Mechanisms Coordinate the development and submission of national proposals p Submit grant proposals to Approve any reprogramming the Global Fund based on and submit requests for priority needs at the CCMs are continued funding national level Ensure linkages and consistency between Global Fund grants and other national health and development programs. country level, multistakeholder partnerships Nominate the Principle Recipient Oversee progress during Grant implementation

7 The Process Used by the Global Fund Global Fund calls for proposals CCM collaborates to prepare proposals CCM submits proposals to the Global Fund and recommends principal recipients Secretariat screens the proposals for eligibility Technical review panel reviews proposals and submits to the Global Fund Board for approval

8 The Process Used by the Global Fund Global Fund appoints a Local Fund Agent (LFA) LFA assesses capacity of principal recipients (PR) Secretariat negotiates a grant agreement with PR Global Fund signs a two-year grant agreement Disbursements are made to PR on the basis of performance in a form of progress updates PR may disburse to sub-recipients as implementers

9 Performance Based Funding at the Global Fund Performance based funding (PBF) ensures that funding decisions are based on a transparent assessment of results against time bound targets PBF is integrated t dinto every phase of the lifecycle l of a Global l Fund grant: 1. Country owned owned proposal development: 2. Grant negotiation: Funding requests comprising program activities, indicators and time bound targets defined by the countries themselves. Legal contract with performance targets to measure the achievements of the grant. Investments are made to strengthen M&E systems. 3. Performance based disbursements: Periodic disbursements (every 3, 6 or 12 months) based on programmatic results, financial performance and program management. 4. Grant renewal: Continued funding decisions based on a comprehensive program review incorporating an evaluation of outcomes and impact.

10 Global Fund portfolio, December 2010 $21.7 billion approved $13 billion disbursed d Composition of portfolio by disease, R grants (479 active) 140 countries (117 active) Composition of portfolio by region, R1-9 58% sub Saharan Africa

11 Success rates by disease, Rounds % 80% 70% 60% 50% 40% 30% 20% 10% 0% HIV Tuberculosis Malaria Round 5 Round 6 Round 7 Round 8 Round 9 Round10 Round proposals recommended 32 HIV (41%) 26 TB (54%) 19 MAL (79%) Overall Phase 1 $1.73 billion

12 Global Fund results for selected prevention interventions, December 2010 HIV prevention intervention Cumulative Cumulative results results (end 2009) (end 2010) % increase ARV prophylaxis 790, million 26% for PMTCT HIV counselling & testing sessions Condoms distributed 105 million 150 million 38% 1.8 billion 2.7 billion 48%

13 Key Results from GF Supported Programs (by end 2009) Provided antiretroviral therapy (ART) currently to 2.5 million people 1.8 billion male and female condoms distributed 790,000 HIV positive pregnant women provided with prophylaxis to prevent mother to child transmission of HIV (PMTCT) 4.5 million basic care and support services provided to orphans and other children made vulnerable by AIDS Provided treatment to 6 million new smear positive TB cases Distributed 104 million insecticide treated nets (ITNs) to prevent malaria Over 19 million indoor residual sprayings of insecticides in dwellings conducted 108 million cases of malaria treated in accordance with national treatment guidelines

14 North Africa USD 1.2 billion* West and Central Africa USD 3.5 billion East Africa and Indian Ocean USD 5.3 billion Southern Africa USD 3.3 billion Total Grants for AIDS, TB, Malaria and Health Systems Strengthening approved in Africa (all regions) Round 1 10: USD 13.3 billion *not including approved R10 Multi country grant for North Africa and Middle East totaling USD3.2 million

15 Evidence of impact: declining HIV prevalence in Tanzania Between 2003 and 2009: 103,000 HIV-positive pregnant mothers received complete ARV prophylaxis for PMTCT* million people were counseled and tested for HIV At the end of 2009: 200,000 adults and children (46% of those eligible) were 0 receiving ART* aged ye ears Prevalenc ce (%), adults Year Women Men * 1 Up from 1,800 in 2003 * 2 Up from 1,500 in 2003 The Global Fund, Results Report, 2010

16 Key Results in Asia by end 2009 US $ 4.5 billion approved, US$ 2.2 billion disbursed; Funded 2/3 rd of Asia s 570,000 people on ART; 4 million smear positive TB cases treated; good MDG progress; 21.7 million ITNs distributed (45% > than in 2008), sharp malaria case incidence; mortality decline ; Substantial support to expand harm Substantial support to expand harm reduction services for IDU and services for MSM;

17 LAC Funds allocated by disease HIV/AIDS LAC Total lifetime budget by disease in millions USD (Total $2,141 M) 45% 319 TB 15% 55% Latin America Caribbean 28% Tuberculosis 322 Malaria 15% HIV/AIDS 70% Malaria Caribbean Latin America 72% 1,500 26% Caribbean Latin America 74% Source: most recent available data from Global Fund:

18 LAC Latin America Vs Caribbean region Number of Countries Total lifetime budget in millions USD ($2,141 M) 15 Caribbean Latin America Caribbean 39% Latin America 61% 1,314 Number of Grants (Total 123) * Total disbursed funds in millions USD ($1,003M) 36 Caribbean Latin America 429 Caribbean 43% Latin America 57% * Including Round 9 and Round 10 unsigned proposals Source: most recent available data from Global Fund:

19 Summary Latin America and the Caribbean (LAC) 123 number of Grants in 33 countries 2,141 millions USD total lifetime budget 1,003 millions USD disbursed to date 61% Latin America & 39% Caribbean region (total lifetime budget) 70% HIV 15% TB 15% Malaria (total lifetime budget) 26% Governmental PR for 15% of the total lifetime budget ** 74% Non Governmental PR for 85% of the total lifetime budget ** 6LFA companies contracted*** Source: most recent available data from Global Fund: theglobalfund org/en/commitmentsdisbursements/ Source: most recent available data from Global Fund: ** Excluding Round 9 and Round 10 unsigned Grants as information is not available yet *** PWC, KPMG, Grant Thortnon, Swiss Tropical Insitute, Deloitte, EMG

20 PPP opportunities at country level (1): why PPP? Shared concerns and interests: AIDS, TB and Malaria: a bottom line issue for the private sector (PS) A robust, profitable PS should be recognized for contributing to productive individuals, healthy families, strong social infrastructure, high country tax revenue, social protection (e.g. through health insurance) and other public sector aims Shared values: corporate social responsibility (CSR); positive public image matters to business; Strategic synergies: Linking public goods to market forces strengthens both; PS augments public sector s health system capacity (physical, human, technological, health care financing, research/innovation, service delivery, etc); extends breadth & depth of outreach, brings comparative advantages relevant to health (e. g. PSM, financial management, marketing, etc); Geneva, March 2010

21 PPP opportunities at country level (2): Where to look for PPP? Within traditional health sector: PPP opportunities can be found/created in elements of the conceptual framework/cause-effect effect pathways (social determinants, child survival framework, etc); Along continuum of care; Across comprehensive range of prevention-treatment-care-support interventions; Across all service delivery levels; l Across all health system components; At all levels l of health service delivery;etc. Across all economic sectors: PPP opportunities can also be found/created in agrobusiness, manufacturing, construction, ti transport, t banking/financing, i IT, education, marketing, insurance. They can also be found in small, medium and large scale enterprises; in both formal and informal economies, within communities and in virtual domains (web-based businesses, social media, etc). Geneva, March 2010

22 PPP opportunities at country level (3): Generic options Engaging private health care providers to share patient load, enhance access for certain interventions; Engaging PS in consumer-driven resource mobilization models (cross-subsidy on products, services or transactions (UNITAID), proportion-of-sales-revenue p for products/services (RED). Engaging private health teaching institutions to help develop health workforce (both during in- and pre-service education/training) i i Geneva, March 2010

23 PPP opportunities at country level (4): Generic options Encouraging PS enterprises to create supportive workplaces for HIV, TB and malaria prevention/treatment/care, preferably within broader occupational health measures for workers and their families (e.g. Thailand various; Heineken, De Beers); Engaging insurance companies to explore/offer range of products, including (a) underwriting delivery delay risks in procurement orders for health products (Net Guarantee/Zurich model), (b) reducing out of pocket expenses through risk pooling by offering direct private insurance or participating p in joint Government/Employer, national insurance and/or community-based insurance schemes) for individuals/communities affected by HIV, TB and malaria, ; Geneva, March 2010

24 PPP opportunities at country level (5): Generic options Encourage direct cash or in-kind (goods or services) donations as cost-share share to public health sector programs; Negotiate with manufacturers (national, regional or international) price reduction strategies for health commodities, using appropriate tools including bulk purchase volume discounts, standardization of commodity specifications (e.g. ARV regimens, fixed dose combinations, reduced/larger package sizes, etc), financial incentives (e.g. tax/customs deductions). Creatively utilizing trade, regulatory and other market instruments (e.g. TRIPS, compulsory licensing, etc) and social enterprise techniques (e.g. to accelerate R&D or bridge market failure/distortions to expedite drug/vaccine production for priority diseases). Others??? Geneva, March 2010

25 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. PPP challenges at country level Creating critical mass of leaders to champion PPP, dispel myths, build trust and illuminate the way; Serious consideration of PPP in national health/economic policies/hss; Researching to determine the full range and scale of PPP potential; Managing g balance between altruistic public social/health policy aims and PS s profit-orientation; Realizing the limitations of PPP; Learning from local and global innovation to inform country level PPP policies and practices; Geneva, March 2010

26 Why is the Global Fund making a difference? Its scale $21 billion committed in 140 countries $13 billion disbursed $31 billion received in pledges and contributions Its model Promotes country ownership Results/performance based Finances evidence based interventions Its inclusiveness i Implementation (Country led including all sectors and stakeholders, multilaterals, bilaterals, NGOs) Governance (Board and CCMs) Finance (G8/G20; Europe 55%; some implementers are also donors; foundations and private sector; innovative sources including Debt2Health, RED, Exchange Traded Funds

27 The Millennium Development Goals 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Rd Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development H lth d C it S t Health and Community Systems Strengthening

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29 Links Progress reports: Resultsreports 2010: Global Fund 2010 Innovation and Impact, full report: org/documents/replenishment/2010/global on_and_impact_en.pdf GlobalFund 2010 Innovation and Impact, press release: GlobalFund webpage: