A global health partnership Dr. Akram Eltom Director of Partnerships - - PowerPoint PPT Presentation

A global health partnership

• Dr. Akram Eltom

Director of Partnerships D li d t ILO id t Delivered at ILO side event, Palais des Nations Geneva

1st June 2011

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 i i i h i d b HIV/AIDS mitigating the impact caused by HIV/AIDS, tuberculosis and malaria in countries in need, and t ib ti t t d ti t f th contributing to poverty reduction as part of the Millennium Development Goals.”

A new Public‐Private Partnership

• 1. Operate as a financial instrument, not an implementing entity
• 2. Make available and leverage additional financial resources

g

• 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,

bl d t i bl lt measurable and sustainable results.

Partnership Approach to Governance p pp

A diverse partnership reflected in the Board d C t C di ti M h i

• NGOs North

and Country Coordinating Mechanisms

• Donors
• Implementers
• NGOs South
• Communities living

with and affected by th di

Civil Society Public Sector (Governments and Agencies)

the diseases

and Agencies)

• Private Sector
• Private Foundations
• WHO
• UNAIDS
• World Bank

Technical Agencies Private

• UNITAID
• RBM
• Stop TB Partnership…

Agencies and Partnerships Sector

Global Governance Structure

w Panel

Advisory 40+ members

BOARD

Supreme governance body of Global Fund

Forum

Advisory Convened every 2.5 years

al Review

Approved by Board Meets once a year and via e‐for a

B

26 members Meets twice a year

tnership

years 400+ ad‐hoc participants

Technica

review proposals for funding Makes funding

Part

Reviews Progress of GF objectives Advises Board on Makes funding recommendations to the Board Advises Board on policies and strategies

ariat

Administrative Executive Director appointed by Board

Secreta

ecut e ecto appo ted by oa d Management of day‐to‐day operations of the Global Fund

Country Coordinating Mechanisms

Coordinate the development and submission of national proposals p p Submit grant proposals to the Global Fund based on priority needs at the Approve any reprogramming and submit requests for

CCM

priority needs at the national level and submit requests for continued funding

CCMs are country‐ level multi‐

Nominate the Ensure linkages and consistency between

level, multi stakeholder partnerships

Principle Recipient Global Fund grants and

• ther national health and

development programs. Oversee progress during Grant implementation

The Process Used by the Global Fund 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

The Process Used by the Global Fund 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

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

Performance Based Funding at the Global Fund g

Performance‐based funding (PBF) ensures that funding decisions are based on a transparent assessment of results against time‐bound targets PBF i i t t d i t h f th lif l f Gl b l F d t PBF is integrated into every phase of the lifecycle of a Global Fund grant:

1 Country owned proposal development: 2 Grant negotiation:

• 1. Country‐owned proposal development:

Funding requests comprising program activities, indicators and time‐bound targets defined by the countries themselves.

• 2. Grant negotiation:

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

• n programmatic results, financial performance and

t

• 4. Grant renewal:

Continued funding decisions based on a comprehensive program review incorporating an evaluation of outcomes d i t program management. and impact.

Global Fund portfolio, December 2010

$

Composition of portfolio by disease, R1-10

• $21.7 billion approved

$13 billi di b d

• $13 billion disbursed
• 829 grants (479 active)
• 829 grants (479 active)
• 140 countries (117 active)

Composition of portfolio by region, R1-9

• 140 countries (117 active)
• 58% sub‐Saharan Africa
• 58% sub‐Saharan Africa

Success rates by disease, Rounds 5 ‐ 10

70% 80% 90%

Round 10

50% 60%

• 79 proposals recommended
• 32 HIV

(41%)

20% 30% 40% HIV Tuberculosis l

32 HIV (41%)

• 26 TB

(54%)

• 19 MAL

(79%)

0% 10% Round 5 Round 6 Round 7 Round 8 Round 9 Round10 Malaria Overall

• Phase 1 $1.73 billion

Global Fund results for selected prevention b interventions, December 2010

HIV prevention intervention Cumulative results (end 2009) Cumulative results (end 2010) % increase (end 2009) (end 2010) ARV prophylaxis

790 000 1 illi 26%

ARV prophylaxis for PMTCT

790,000 1 million 26%

HIV counselling & testing sessions

105 million 150 million 38%

Condoms distributed

1.8 billion 2.7 billion 48%

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) to‐child transmission of HIV (PMTCT)

• 4.5 million basic care and support services provided to orphans and other children

made vulnerable by AIDS y

• 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

North Africa USD 1.2 billion* West and Central Africa East Africa and Indian Ocean USD 5.3 billion USD 3.5 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

Evidence of impact: declining HIV prevalence in Tanzania declining HIV prevalence in Tanzania

5

ears Women

Between 2003 and 2009:

• 103,000 HIV-positive pregnant

mothers received complete ARV

3 4

aged 15‐24 ye Men

mothers received complete ARV prophylaxis for PMTCT*1

• 5.4 million people were

counseled and tested for HIV

2

ce (%), adults

counseled and tested for HIV At the end of 2009:

1

Prevalenc

At the end of 2009:

• 200,000 adults and children

(46% of those eligible) were receiving ART*2

2003‐4 2007‐8 Year

receiving ART*2

*1 Up from 1,800 in 2003 *2 U f 1 500 i 2003 The Global Fund Results Report 2010 *2 Up from 1,500 in 2003 The Global Fund, Results Report, 2010

Key Results in Asia by end 2009

• US $ 4.5 billion approved, US$ 2.2

billion disbursed; billion disbursed;

• Funded 2/3rd of Asia’s 570,000 people
• n ART;
• n ART;
• 4 million smear positive TB cases

treated; good MDG progress; treated; good MDG progress;

• 21.7 million ITNs distributed (45% >

than in 2008), sharp malaria case than in 2008), sharp malaria case incidence; mortality decline 2003‐9;

• Substantial support to expand harm

Substantial support to expand harm reduction services for IDU and services for MSM;

LAC ‐ Funds allocated by disease LAC Funds allocated by disease

HIV/AIDS 319

LAC Total lifetime budget by disease in millions USD (Total $2,141 M)

45% Latin Caribbean

322 319 TB 15%

55%

Tuberculosis

America 28% C ibb

322 HIV/AIDS 70% Malaria 15%

26%

Malaria

72% Latin America Caribbean

1,500

26% Latin Caribbean 74% America

S

• urce: most recent available data from Global Fund: http:/ / www.theglobalfund.org/ en/ commitmentsdisbursements/

LAC – Latin America Vs Caribbean region g

Number of Countries Total lifetime budget in millions USD ($2,141 M) 15

827

Latin Caribbean 39% L i Caribbean

18

1,314

America 61% Latin America

36 Number of Grants (Total 123) * Total disbursed funds in millions USD ($1,003M) 574 429 36

Latin America Caribbean Caribbean 43% Latin America %

574 87

57%

* Including Round 9 and Round 10 unsigned proposals S

• urce: most recent available data from Global Fund: http:/ / www.theglobalfund.org/ en/ commitmentsdisbursements/

Summary Latin America and the

 123 number of Grants in 33 countries

Caribbean (LAC)

 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 **  6 LFA companies contracted***

S

• urce: most recent available data from Global Fund: http:/ / www theglobalfund org/ en/ commitmentsdisbursements/

S

• urce: most recent available data from Global Fund: http:/ / www.theglobalfund.org/ en/ commitmentsdisbursements/

** Excluding Round 9 and Round 10 unsigned Grants as information is not available yet *** PWC, KPMG, Grant Thortnon, S wiss Tropical Insitute, Deloitte, EMG

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 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: Strategic synergies:

• Linking public goods to market forces strengthens both;
• PS augments public sector’s health system capacity (physical,

g p y p y (p y , 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

Geneva, March 2010

comparative advantages relevant to health (e. g. PSM, financial management, marketing, etc);

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 pathways (social determinants child survival framework/cause-effect pathways (social determinants, child survival framework, etc); Along continuum of care; Across comprehensive range

• f prevention-treatment-care-support interventions; Across all service

d li l l A ll h lth t t At ll l l f delivery levels; Across all health system components; At all levels of health service delivery;etc.

• Across all economic sectors:

PPP opportunities can also be found/created in agrobusiness, f t i t ti t t b ki /fi i IT d ti manufacturing, construction, transport, banking/financing, 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

PPP opportunities at country level (3): Generic options

• Engaging private health care providers to share patient

load enhance access for certain interventions; load, enhance access for certain interventions;

• Engaging PS in consumer-driven resource mobilization
• Engaging PS in consumer-driven resource mobilization

models (cross-subsidy on products, services or transactions (UNITAID), proportion-of-sales-revenue for ( ) p p products/services (RED).

• Engaging private health teaching institutions to help

develop health workforce (both during in- and pre-service d ti /t i i ) education/training)

Geneva, March 2010

PPP opportunities at country level (4): Generic options

• Encouraging PS enterprises to create supportive

workplaces for HIV TB and malaria workplaces for HIV, TB and malaria prevention/treatment/care, preferably within broader

• ccupational 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 Guarantee/Zurich model), (b) reducing out of pocket expenses through risk pooling by offering direct private insurance or participating in joint Government/Employer, p p g j p y , national insurance and/or community-based insurance schemes) for individuals/communities affected by HIV, TB

Geneva, March 2010

and malaria,

• ;

PPP opportunities at country level (5): Generic options

• Encourage direct cash or in-kind (goods or services)

donations as cost-share to public health sector programs; donations as cost share to public health sector programs;

• Negotiate with manufacturers (national, regional or

international) price reduction strategies for health 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) financial incentives (e.g. tax/customs deductions).

• Creatively utilizing trade, regulatory and other market

instruments (e g TRIPS compulsory licensing etc) and 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

Geneva, March 2010

g g production for priority diseases).

• Others ???

PPP challenges at country level

C ti iti l f l d t

• 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 balance between

g g altruistic public social/health policy aims and PS’s profit-orientation;

• Realizing the limitations of PPP;

Realizing the limitations of PPP;

• Learning from local and global

innovation to inform country level PPP policies and practices; PPP policies and practices;

Geneva, March 2010

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

It i l i

• Its inclusiveness

– 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

The Millennium Development Goals p

1. Eradicate extreme poverty and hunger 2 Achieve universal primary education 2. Achieve universal primary education 3. Promote gender equality and empower women 4 R d hild t lit 4. 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

Links

• Progress reports: http://www.theglobalfund.org/en/publications/progressreports/?lang=en
• Results reports 2010: http://www.theglobalfund.org/en/publications/progressreports/2010/

Results reports 2010: http://www.theglobalfund.org/en/publications/progressreports/2010/

• Global Fund 2010 Innovation and Impact, full report:

http://www theglobalfund org/documents/replenishment/2010/Global Fund 2010 Innovati http://www.theglobalfund.org/documents/replenishment/2010/Global_Fund_2010_Innovati

• n_and_Impact_en.pdf
• Global Fund 2010 Innovation and Impact, press release:

Global Fund 2010 Innovation and Impact, press release: http://www.theglobalfund.org/en/pressreleases/?pr=pr_100308

• Global Fund webpage:

Global Fund webpage: http://www.theglobalfund.org