The Global Fund is evolving towards more differentiation and tailored partnerships. In the Middle East, a new initiative aims to increase coverage of HIV, TB and malaria care for people affected by conflict.
Differentiated approaches are required to increase the impact of health investments, particularly in settings that face special challenges, such as armed conflict or an influx of refugees. To improve efficiency and offer more flexible and simplified responses, the Global Fund is launching an initiative in the Middle East that will use one integrated grant management platform. The Global Fund currently has separate grants through country allocations in Syria, Iraq, Palestine and Yemen, and provides emergency funding to support TB care among Syrian refugees in Jordan and Lebanon. By managing all grants through one system to be managed by a qualified international organization with experience on the ground, the Middle East HIV, TB and Malaria Response aims to increase coverage of HIV, TB and malaria services and reach key and vulnerable populations.
Preventable diseases like HIV, TB and malaria strain health systems that are already overburdened, leaving fewer resources to provide basic health services or prepare for emerging health threats. In refugee situations, stopping diseases from spreading not only protects already weakened refugees from falling ill, it frees up critical resources to treat other illnesses or provide other health services – care that is desperately needed for families who have lost everything, and for communities that may be struggling to host them.
Mark Dybul, Executive Director of the Global Fund, said the Middle East initiative marks a fundamental shift from the way the Global Fund has managed grants in the past.
“To reach the people we need to reach and have more impact, the Global Fund needs to change the way we engage in challenging operating environments,” Dybul told a recent meeting of donors, technical partners, government representatives and civil society organizations in Amman, Jordan. “Tailored approaches are the future of the Global Fund.”
Joseph Serutoke, the Global Fund’s Regional Manager for Middle East and North Africa, said the new approach fits the needs and challenges of the region. Advantages of bringing the grants together include increasing efficiency through consolidated reporting, a more integrated approach, and supporting stronger regional partnerships that can deliver in hard to reach areas. Because of conflict these countries face constantly shifting needs, limited capacity and severe constraints to provide essential services. In Yemen, Iraq and Syria, most of the health facilities have been destroyed. Health infrastructure in countries hosting displaced populations is overstretched. As part of the new approach, typical Global Fund procedures and in-country coordinating measures will be adapted to meet the individual situation of each country. “The whole idea of this grant is to be agile and to adjust to the changing situation in the countries we serve,” Serutoke said.
The Global Fund is calling for proposals from qualified international organizations to assume the role of Principal Recipient. The grant is expected to start in July and will have a duration of two years, with the possibility of an extension.
The Global Fund is putting a stronger focus on challenging operating environments with the aim of increasing coverage and reaching key and vulnerable populations affected by HIV, TB and malaria.
Challenging operating environments, which may experience disease outbreaks, natural disasters, armed conflicts and weak governance, has been identified as an important priority for the Global Fund. Challenging operating environments account for a third of the global disease burden for HIV, TB and malaria, and for a third of Global Fund investments.
By Jane Andrews
I arrived at the Johns Hopkins University campus with a sense of déjà vu; it was my first visit to my alma mater in years. I had travelled to Baltimore for a meeting about the licensing of sutezolid, a much-awaited drug candidate for treatment of Mycobacterium tuberculosis. The research faculty, technology transfer officers, university administration, and advocates at the meeting felt the weight of the responsibility. We knew that licensing a tuberculosis drug candidate could be a historic event. Frustratingly, in the past 40 years the world has added only two new drugs to the arsenal against tuberculosis, the second most deadly infectious disease on the planet. The statistics are infuriating: more than 9 million people developed tuberculosis in 2013, and an estimated 44% of those in countries such as the Philippines, Thailand, and South Korea have resistance to at least one of the second-line agents for tuberculosis treatment.
Horrifically, only one of two people treated for multidrug resistant (MDR) tuberculosis are cured, and the toxic 2-year treatment regimen involves thousands of pills and hundreds of injections. For extensively drug resistant tuberculosis (XDR-TB) the cure rate drops to 20%. With new agents like sutezolid being used in combination with other drugs, we might be on the brink of being able to save more lives with less toxicity. Sutezolid, originally U-100480, began development alongside linezolid in 1996. Even then it showed favourable pharmacokinetic properties, efficacy against drug-resistant strains of tuberculosis, and low toxicity in rat models. After lying undeveloped for several years in the hands of Pfizer and others, there is a new window of opportunity for the drug. Sequella, a pharmaceutical corporation, acquired the licence for the development and commercialisation of sutezolid from Pfizer in 2011. However, Johns Hopkins University still owns some key pieces of the intellectual property.
GENEVA – As part of a new framework for procuring health products in the most cost-effective and sustainable way, the Global Fund has reached an agreement to purchase insecticide-treated mosquito nets that prevent malaria with projected savings of US$93 million over two years.
By achieving sharply lower prices for nets – a 38 percent reduction from 2013 – the agreement serves the Global Fund’s goal of accelerating progress against malaria, a preventable disease that most seriously affects young children and pregnant women. Building on the Global Fund’s large-scale purchasing power, the framework improves the supply of an important tool to fight the epidemic.
The Global Fund projects US$350 million in mosquito net purchases over the next two years through its Pooled Procurement Mechanism. A tender process has selected 10 suppliers and includes volume commitments from the Global Fund and performance contracts from the suppliers.
The agreement creates a level of certainty for suppliers, allowing them greater visibility and planning time to manufacture and deliver nets. That facilitates lower prices, and yields significant savings for the Global Fund partnership. The US$93 million in projected savings is equivalent to about 40 million additional nets.
“The money saved here can buy more nets,” said Christopher Game, Chief Procurement Officer at the Global Fund. “We worked closely with partners to strike the balance between achieving cost savings, promoting sustainable supply, and recognizing manufacturer investment in the development of new products to fight malaria.”
A previous Global Fund procurement tender for insecticide-treated mosquito nets was concluded in late 2013 and implemented over 2014-2015. That agreement saw the successful purchase of 170 million nets at a stable price, with a major improvement in delivery times.
The agreement is geared to purchase nets from multiple suppliers, reducing risk and encouraging local production, which reduces transport costs. About one-fifth of the nets to be procured will be manufactured in Africa. For the first time, the nets will be color-coded, allowing their durability to be tested at six-month intervals. The data collected from this research creates the possibility for future product innovation.
International News – Pakistan
By Shahina Maqbool
The Global Fund to fight AIDS, Tuberculosis and Malaria has cautioned Pakistan that if it does not sign, by mid-February 2016, the framework agreement for allocation of a US$255 million grant in support of the country’s national programmes for AIDS, TB, and Malaria, the GFATM will not be able to allocate funds to the country due to its own obligations, ‘The News’ learnt on good authority here Wednesday.
The Global Fund felt constrained to convey its stance to the Ministry of Health in the wake of unwarranted delay on part of Pakistan to sign the framework agreement, which is a generic document signed by all recipient countries. The delay was caused by misinterpretation of and technical objections to some clauses of the agreement by some line ministries that were part of the consultations. And even though the Global Fund made amendments to the agreement in the light of these observations, Pakistan still delayed furnishing an official response on the agreement to the Global Fund.
By Shamika Ravi and Rahul Ahluwalia
India’s health care sector is poised at a crossroads, and the direction taken now will be critical in determining its trajectory for years to come. In a recent Brookings India paper on the Indian government’s health care policy, we argue that it should prioritize expanding and effectively delivering those aspects of health that fall under the definition of “public goods’” for example, vaccination, health education, sanitation, public health, primary care and screening, family planning through empowering women, and reproductive and child health. These are all aspects of health with significant externalities and thus cannot be efficiently provided by markets.
Large gains in the nation’s health, and particularly the health of the poorest and most marginalized, can be made with this limited focus. As just one estimate, a 2010 World Bank study showed that India lost 53.8 billion USD annually in premature mortality, lost productivity, health care provision and other losses due to inadequate sanitation. Importantly, these gains can come very cost effectively, as demonstrated by India’s neighbors Bangladesh and Sri Lanka, which spend less as a percentage of GDP on health than India, but have better outcomes. It is not an expansion in spending that is critical for improving health outcomes. Instead, India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that it is able to deliver on those goals. Evidence gathered globally and within India suggests that without good governance, additional spending would be worth little.