Blog by Dagfinn Høybråten, the Chair of the GAVI board
With its natural beauty and breath-taking scenery Lao is without a doubt one of the brightest jewels of Southeast Asia. However it is also one of the poorest nations in Asia with a weak health system and stark geographical disparities in health outcomes. Last week I was privileged to visit the country with a group of Australian parliamentarians. It was a chance to witness first hand the critical work Gavi, the Vaccine Alliance, is doing to fight preventable disease in this captivating, land-locked Southeast Asian country, and also to meet with national political leaders.
One of the institutions we visited was the Sethathiraj Hospital and Cancer Centre in the capital Vientiane. Here we learned of the scourge cervical cancer represents to local women. Medical specialists told us that the hospital treats many women with this type of cancer, but that they struggle to deal with the number of patients presenting with large, late-stage tumours.
Part of the problem is that people in remote rural areas have little or no access to diagnosis in the early stages and so need to travel a long way to the capital for medical help. To make matters worse, for most of these villagers the necessary medical treatment is prohibitively expensive.
This is part of a sad story we witness in most developing countries, where cervical cancer kills more than a quarter of a million women every year, or roughly one every two minutes. More than 85% of those who die from the disease live in the poorest parts of the world where access to screening and treatment is limited, and often non-existent. Most simply do not receive the treatment they need.
Although the trip to Lao was a stark reminder of these realities, we also witnessed how this situation is changing. Lao People’s Democratic Republic (PDR), to use its official name, now aims to protect Lao women against most cases of cervical cancer by implementing the human papillomavirus (HPV) vaccine, with the help of Gavi.
My travel companions the Australian Members of Parliament (MP) witnessed the results of this when visiting Ban Akad Primary School. As we arrived, the schoolyard was filled with young girls in school uniforms waiting in line to get their HPV vaccination as part of a demonstration HPV vaccination program currently being carried out. Prevention is better than treatment and this is never more true than the form of a simple vaccination, especially when diagnosis and treatment is, in too many cases, simply not available.
Given that the HPV vaccine was first developed at the University of Queensland, for the Australian MPs it must have been inspiring to see first hand how an Australian innovation, together with Australian investment of aid money in the Gavi partnership, was protecting lives in Laos.
Laos has a growing economy and is determined to increase its spending on health and on vaccines. But the Gavi assistance with low cost vaccines and funding to help strengthen Lao’s health systems is crucial now, to get the vaccines rolled out to those in need.
The case of HPV is an example of how the Vaccine Alliance model can help shape a market to ensure a high quality vaccine reaches the people who need it, and at an affordable price. It is also a compelling case of equity. Vaccines have generally been available in the world’s richest nations, despite a greater disease burden in developing countries. However, HPV vaccine is now being rolled out in countries where people previously had no access to this powerful public health tool. By 2020, we estimate more than 30 million girls in 40 countries will be immunised against cervical cancer.
Globally, one-in-five children born each year still do not have access to the most basic vaccines, and 1.5 million children die each year of vaccine preventable diseases.
But visiting Laos gave inspiring examples of the change that is taking place.
Gavi has supported the immunisation of almost half a billion children already, saving six million lives. In January next year, the Vaccine Alliance will ask for funding from government and other donors to help vaccinate a further 300 million people by 2020, to save a further 5-6 million lives. There can be no better investment than that.
Global Fund News Release: 23 September 2014
NEW YORK – A passionate call for low and middle income countries to increase their spending on health was launched by Kenyan President Uhuru Kenyatta at the United Nations General Assembly on Monday evening.
Hosting an event called “Domestic Financing for Health: Invest to Save,” President Kenyatta laid the groundwork for a strong partnership for increased investments in health, bringing together leaders from several African countries, the African Union, United Nations Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Ethiopian Prime Minister Hailemariam Desalegn and Rwanda Minister of Health Dr. Agnes Binagwaho joined President Kenyatta and other African leaders at the event, signalling a unity of purpose in a bid to sustain momentum against the world’s most challenging diseases.
Countries implementing health programs financed by international funders are playing a bigger role in financing health. This has led to a tremendous impact on global health. Last year during the Global Fund replenishment conference, which galvanises resources for the fight against HIV, tuberculosis and malaria, several African countries made significant commitments to increasing their investments in response to the diseases and in strengthening health systems in their countries.
In the coming years, these countries are expected to take a leading role not only in urging the world to spend more in fighting diseases but also in investing more of their own money toward saving lives of their people. Yesterday’s meeting, led by Kenya, signals an accelerated effort toward that end.
President Kenyattaurged African countries to explore ways to galvanize local resources for health, to build health systems and sustainable interventions against diseases. “We have depended on external help for health services, but we have to mobilise domestic resources to find our own solution instead of moving from one crisis to another,” President Kenyatta said.
The President’s keynote remarks led to a panel discussion that made a strong case for spending more local resources on health as a way to saving lives as well as strengthening economies.
A report published last year by the AU and UNAIDS said that from 2001 to 2011, health budgets in AU Member States increased from 9 percent to 11 percent of public expenditures. Six AU Member States – Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia – have achieved a target set in Abuja in 2001 to allocate 15 percent of public expenditure to health.
President Kenyatta said Kenya is making plans to hit this target. Saying that the fruits of Africa’s economic growth would only be beneficial if proper investments were channeled toward health, the president urged African countries to invest in their own solutions to keeping their people healthy.
In a spirit of shared responsibility and global solidarity, the meeting focused on the need to pool local and global resources to garner substantial wherewithal to enable the world to achieve victory over the world’s deadliest infectious diseases – HIV, tuberculosis and malaria. The meeting also explored what leaders from low and middle income countries can do to accelerate wide-ranging and innovative investments in health.
Lawrence H. Summers, Professor and President Emeritus at Harvard University, who now chairs the Lancet Commission on Investing in Health, GlobalHealth2035.org, also spoke at the event. He argued that today we have the technology and financial means to close the health gap between poorer and richer nations, to achieve what he is calling “a grand convergence in health.”
“The grand convergence would dramatically reduce infectious, maternal and child deaths within one generation, averting 10 million deaths in 2035,” Dr. Summers said. “Governments in low and middle income countries must invest in health. Just 1 percent of their economic growth over the next two decades would fund the grand convergence. The global community must support poorer countries and spearhead the search for new technologies.”
Other panellists included Dr. Mark Dybul, Executive Director of the Global Fund, and Tumusiime Peace, the Commissioner for Rural Economy and Agriculture at the African Union.
Global Fund News Release: 23 September 2014
JUBA, South Sudan – Ecobank Group and the Global Fund to Fight AIDS, Tuberculosis and Malaria are expanding a partnership to include South Sudan after collaborating since 2011 on capacity-building programs for Global Fund implementers in Cote d’Ivoire and Nigeria.
Building on this successful experience, the two parties announced in Juba they have concluded a three to five years’ agreement to formalize Ecobank’s support for the Global Fund’s work and programs in a number of countries in Africa, including South Sudan.
The Global Fund program in South Sudan is being implemented through the United Nations Development Programme (UNDP) and Population Services International (PSI).
In South Sudan, the Global Fund/Ecobank partnership seeks to strengthen the financial management capabilities of Global Fund’s Sub-Recipients and Sub-Sub-Recipients (SSR) through the provision of technical assistance and capacity building expertise and services. Assessments were carried out for three national program Sub-Recipients under existing grants: Ministry of Health/HIV; the National Tuberculosis, Leprosy and Buruli Ulcer Control Program (NTP); and the National Malaria Control Program (NMCP). Subsequent work plans have been developed.
Through a partnership with Accounting for International Development (AfID), of the United Kingdom, Ecobank South Sudan has used the information and analysis provided by the Sub-Recipients and the Global Fund to design and implement a project plan to provide financial management capacity building for the national entities above through Ecobank’s own training and through placement of AfID volunteer accountants. The capacity building programme is expected to take about 12 weeks.
In his remarks at the launch of the program in Juba, the Chairman of the Board of Directors of Ecobank South Sudan, Mr. Simon Akuei, said its benefits will among other things include: improved financial management of public resources; wider coverage of donor funding which will lead to improved public welfare; and leveraging private and public partnerships with donor support to enhance delivery of public services.
He said the partnership is one way through which Ecobank gives back to the public through its Corporate Social Responsibility program.
Marion Gleixner, a Senior Fund Portfolio Manager at the Global Fund, said the partnership between Ecobank and the Global Fund was strategic and innovative and would result in increased program effectiveness and more saved lives. “This partnership springs from fruitful collaboration between the Global Fund, Ecobank, the UNDP and implementing entities, who have worked closely on developing projects that will enhance financial management capabilities of the three national programme Sub Recipients in South Sudan.”
Ecobank South Sudan is part of the Ecobank Group, now present in 36 countries across Africa; with 4 International representative offices. Ecobank South Sudan is situated at Koita complex on Ministries Road and offers a range of financial services that span across Personal Banking, Corporate and Investment Banking and Treasury Solutions.
Additional information may be found at: www.ecobank.com
Since the Global Fund began, it has been working with countries and partners to support health system strengthening as a way to maximize impact of its core investments in HIV, TB and malaria. The Ebola outbreak is highlighting the critical role of this work.
By their nature, investments in health systems strengthening, known as HSS, are cross-cutting and aimed at bolstering national systems to benefit multiple disease program outcomes. With better health systems, the current Ebola outbreak in West Africa could have been easier to control and contained in rural areas.
The countries affected by Ebola experience acute shortage of qualified health workers. In Liberia, for instance, there are fewer than one health worker per 1,000 people, far below the minimum threshold recommended by WHO. A lack of routine data collection, ineffective logistics and supply chain, and insufficient healthcare infrastructure are common. With the Ebola outbreak, things only get worse, with health professionals failing to report to work.
The long-term solution for preventing, detecting and responding to disease outbreak is to strengthen health systems. The Global Fund has been reinvigorating its focus on HSS work this year, encouraging all grant applicants to include a significant HSS component in any application. Such investments are key in helping maximize the impact of disease-related interventions, increasing value for money, and in contributing to sustainability of health programs. Through country dialogue, partners are identifying many gaps and weaknesses in health systems, before investing strategically under the same platform. Investments can be most effective when needs are assessed well, as part of a country’s national health strategy and disease-specific plans, said George Shakarishvili, Senior Advisor for HSS at the Global Fund. The new funding model allows flexibility in reprogramming funds to invest in areas of emerging concerns in HSS.
Guinea, the country where the first case of the current Ebola outbreak was recorded, is seeking funds to invest in strengthening its information and procurement systems. To increase the benefits of our HSS investments under the new funding model, the Global Fund’s country team will seek the opportunity to work with Guinea’s Ministry of Health and partners to create a coordination platform for HSS investments in the country. Lyne Soucy, Fund Portfolio Manager for Guinea, said it will allow strategic investments in health systems for better responses to all diseases, including Ebola. “A stronger health system is part of the solution to win the fight against Ebola and all the other diseases in countries like Guinea,” Soucy said. “We are keen on working with all partners to support stronger health systems as a real way to respond to HIV, tuberculosis and malaria and many other health concerns.”
Global Fund News Flash: Issue 49
The Ebola outbreak in West Africa is causing concern all over the world. Unlike previous outbreaks of the disease, limited to villages and rural settings, this outbreak is spreading to more populous urban areas. It has captured global attention by killing more than 50 percent of those who get infected, and swiftly. More than 2,000 deaths have been reported so far, and those numbers are likely to grow. Beyond the need for an emergency response, the Ebola outbreak is also drawing attention to the longer-term need for health systems strengthening. The Global Fund is not a key organization in WHO’s Ebola Response Roadmap but we are closely monitoring the outbreak and engaging with our partners in affected countries.
Programs that are supported by the Global Fund in Guinea, Liberia and Sierra Leone have been put under strain by the outbreak. Fear of infection from the Ebola virus, which can spread to anyone coming into physical contact with the blood or bodily fluids of infected people, is holding back some patients from seeking care for other diseases at hospitals and health clinics. Many health professionals are themselves afraid to report for work, with more than 240 healthcare workers infected, reducing the already low capacity of health systems and forcing some clinics to close. Strict travel restrictions are also preventing Global Fund country teams from visiting West Africa, where monitoring and oversight of grants has been affected and preparations for the new funding model delayed.
Liberia’s Health Ministry and Sierra Leone’s country coordinating mechanism have informed the Global Fund that they will be formally asking for flexibility and possible reprogramming of Global Fund grants to help them respond to the Ebola epidemic. The Global Fund will respond swiftly to such requests and will seek to provide support to countries affected by Ebola within the mandate of the organization. It will try to support continuity of essential HIV, TB and malaria services and retention of people on treatment. It will share public health information and also provide services, following WHO guidelines, which educate partners and protect them from contracting the Ebola virus.
The Global Fund’s actions will follow the lead from each affected country, from WHO, and from other organizations with expertise in Ebola. In affected countries, there are several areas where the Global Fund may be able to contribute to the response: providing protective gear for staff in programs supported by the Global Fund; training of staff on how to protect themselves from Ebola; assigning available people or equipment in HIV, TB or malaria programs to temporarily assist in controlling the Ebola virus; providing special travel allowances to enable Global Fund beneficiaries to be reached. Extraordinary outbreaks call for extraordinary measures. We can all benefit by focusing on necessary tasks, under the guidance of leading agencies and experts.
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Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.