Global Fund Observer Newsletter Issue 236: 06 February 2014
Regional outreach to migrants to complement service delivery in five Southeast Asian countries
A $100-million grant to avert the spread of artemisinin resistance in five malaria endemic countries in the Greater Mekong sub-region has been signed by a full complement of stakeholders, signalling the successful achievement of a first regional application under the Global Fund’s new funding model (NFM).
The Regional Artemisinin Resistance Initiative (RAI) will support purchase of long-lasting impregnated nets, malaria case detection and provision of directly observed antimalarial treatment in Cambodia, Laos, Myanmar, Thailand and Vietnam, as well as regional and national advocacy and awareness campaigns.
A disease burden and financial gap analysis led funds to be allocated as follows: 15% to the regional campaigns; 15% to Cambodia; 5% to Laos; 40% to Myanmar; 10% to Thailand; and 15% to Vietnam.
Central to the outreach component of RAI is work to reach migrant populations living and working in border areas who are normally overlooked and often marginalized. Each country has committed to complementary national campaigns targeting these populations.
Parasite resistance to artemisinin has been detected in all of the RAI countries, which has provoked concerns among malaria clinicians and researchers that a currently small problem could multiply exponentially and become a grave danger both within the region and beyond.
The risks presented by this growing resistance to artemisinin – the primary ingredient in combination therapies that have demonstrated the greatest success in treating malaria – drove the speed and deliberation with which the RAI proposal was achieved, according to RAI program manager Izaskun Gaviria.
“Artemisinin resistance is regarded as a global threat by the international community, which allowed the team to benefit from great support from key partners,” Gaviria said in an emailed response to Aidspan questions.
The split between regional behavior change and outreach activities and national-level service delivery was also a product of wide consultations with a variety of stakeholders including civil society groups, Gaviria said. It also reflects national and international priorities to coordinate with other regional initiatives on malaria funded by donors including The Bill and Melinda Gates Foundation, AusAID and DFiD.
While the ultimate goal is to contribute to the elimination of falciparum malaria in the Greater Mekong Sub region, and to prevent the emergence or spread of artemisinin resistance to new areas, incremental success for RAI will be assessed against the progress in: :
- Reduction of malaria falciparum cases per country and progress towards national malaria elimination targets (up to 50% in some countries)
- Ensuring high coverage with vector control and treatment interventions in designated areas and in particular among mobile/migrant populations
- Elimination of oral artemisinin-based monotherapies
RAI is one of three regional early applicants under the NFM. The other two are a malaria initiative in Mesoamerica and Hispaniola, EMMIE, that will strengthen malaria surveillance in Dominican Republic, Haiti, Panama, Costa Rica, Nicaragua, Guatemala, Belize and El Salvador; and a regional HIV harm reduction initiative stewarded by the Eurasian Harm Reduction Network in Eastern Europe and Central Asia.
A total of $116 million was initially envisioned under the transition phase for these three regional initiatives.
Global Fund News Release
KIGALI, Rwanda – The Government of Rwanda and the Global Fund are taking the lead on an innovative approach to health financing that is expected to significantly contribute to improving the efficiency of the fight against HIV in Rwanda and achieve greater impact.
A new grant agreement signed today will be used to implement Rwanda’s national strategic plan for HIV (2013-2018) with sharply reduced oversight. Rwanda and the Global Fund designed this new approach that is aligned with existing national systems and strategy, ties future disbursements directly to outcome and impact indicators, and lessens administrative burden and cost, in a framework of harmonization and mutual accountability.
It is the first time that the Global Fund is using this approach, and Rwanda has been chosen to pioneer this innovative model, because of its track record of success in health program and financial management.
Rwanda has emerged as a special success story for global health, having built a health care system, by coordinating development partners around one national plan, to give all citizens access to quality care. It has made tremendous gains against HIV and AIDS, and has already achieved a more than 50 percent reduction in HIV incidence rate among the adult population since 2000. If the current trends continue, Rwanda will go beyond the Millennium Development Goal target. As His Excellency President Paul Kagame said “MDGs are a ceiling not an end.”
Under the terms of the agreement signed here today, Rwanda and the Global Fund agreed that future disbursements will be directly tied to achievement of key outcome and impact indicators. This new flexible, Performance Based system emphasizes mutual accountability and greater country ownership of the national response.
“This is a great approach,” said Dr. Agnes Binagwaho, Minister of Health of Rwanda, adding that it is testimony to the achievements Rwanda has made in managing grant funding, and the partnership we enjoy with the Global Fund. We are confident that we will sustain the universal access to treatment and care, reduce new infections by two-thirds, and halve the number of AIDS deaths in the next five years.
The agreement, which includes funding of US$204 million, gives more flexibility on how funds are spent, and allows for savings to be re-invested in the national response. Grant funds will be part of a joint investment framework with financial assistance from the Government of Rwanda and other development partners.
Under the agreement, Rwanda will continue to monitor the achievement of universal access to HIV treatment and care for people living with HIV, and the reduction of new infections for key affected populations. The Global Fund will jointly verify the results with Rwanda.
“The main idea of this approach is to empower high-performing countries like Rwanda to further invest for higher impact,” said Dr. Nafsiah Mboi, Chair of the Board of the Global Fund. “They have proved this is possible, building on an outstanding HIV program, a robust HIV and AIDS national strategic plan, and strong financial and monitoring systems. We are proud to be their partners, and admire their accomplishments.”
The Global Fund will be looking into extending the approach to other countries, and also consider it for tuberculosis and malaria grants.
SEATTLE – The Bill & Melinda Gates Foundation has selected Susan Desmond-Hellmann, M.D., M.P.H., as its next chief executive officer. Currently the chancellor of the University of California, San Francisco (UCSF), Desmond-Hellmann will assume her role on May 1, 2014.
“We chose Sue because of her scientific knowledge and deep technical expertise on the foundation’s issues, as well as the organizational and leadership skills required to lead a large, growing and dynamic global organization. Sue shares our commitment and passion to create a more equitable world,” said Melinda Gates, co-chair of the foundation.
“I am honored by the opportunity that Bill and Melinda have extended to me. I’m excited to join such a dynamic and ambitious organization, with such a clear and focused mission—improving the lives of the world’s most vulnerable,” said Desmond-Hellmann.
“Sue’s background in public health policy, research and development, and higher education, make her an exceptional fit for this role. She impressed us as an innovator and an outstanding leader and manager,” said Bill Gates, co-chair of the foundation.
An oncologist by training, Desmond-Hellmann is a recognized leader on issues of higher education, public health, drug development, regulatory innovation and health policy. She has led UCSF since August 2009, when she became the first woman to serve as the university’s chancellor, overseeing all aspects of the university and medical center’s strategy, academic programs and operations. She has extensive experience in product development, and a deep understanding of how to bridge applied research to delivery of product. Prior to her tenure at UCSF, she was President of Product Development at Genentech, where she led the development and introduction of two of the first gene-targeted therapies for cancer, Avastin and Herceptin.
Desmond-Hellmann also served as a member of Genentech’s executive committee, beginning in 1996. She sits on the boards of directors of Procter and Gamble and Facebook, and was previously a member of the Federal Reserve Bank of San Francisco’s Economic Advisory Council.
Desmond-Hellmann will take over from Jeff Raikes, who announced his retirement from the foundation in September 2013 after five years at the helm. He was the foundation’s second CEO, and served after a long and successful career as a senior executive at Microsoft.
Global Fund News Release
CAPE TOWN, South Africa –Mark Dybul, Executive Director of the Global Fund, said the paternalism overshadowing relations between rich countries and poor in global health is giving way to an era of partnership that owes much to the vision of Nelson Mandela.
In a closing speech at the 17th International Conference on AIDS and sexually transmitted diseases in Africa (ICASA), Dr. Dybul paid a rousing tribute to the late South African leader, saying Mandela “broke the silence on HIV in Africa and he broke the silence on HIV in the world.”
“This week, let us finally end the paternalism in the world,” said Dr. Dybul.
Instead, he urged everyone to embrace Mandela’s vision for a world where every human being was a master of his or her destiny. A meeting of the International AIDS Society in Durban in 2000, which Mandela addressed, was widely seen as a turning point in the fight for wide access to treatment for HIV and opened the way to the creation of the Global Fund two years later.
The theme of the ICASA conference in Cape Town was entitled “Now More Than Ever: Targeting Zero,” underscoring a mood of growing optimism that the HIV pandemic can be turned into a low-level endemic that no longer poses a public health risk.
Dr. Dybul also called for the next ICASA meeting to add tuberculosis — the leading cause of death among those with HIV — to its name so that the disease “receives the emphasis it deserves.”
“HIV and TB are like two evil twins and we have the power and the responsibility to release them and we have the power and the responsibility to defeat them,” he said.
The time was long gone for “people from somewhere else” to tell countries in Africa how to tackle the AIDS, tuberculosis and malaria. “Your results have shattered the paternalistic myths of what should and can be done,” Dr. Dybul said.
Earlier in the day, Edwin Cameron, who serves as a justice on South Africa’s constitutional court, said stigma was one of the biggest obstacles to defeating the HIV pandemic.
“Stigma remains the most intractably resistant force in the epidemic,” Justice Cameron said. “It spreads blame, fear, inhibition, inaction and silence.”
Justice Cameron, who became the first senior official in South Africa to state in public that he was living with HIV, said men who have sex with men were shamefully treated in Africa: “Thirty-eight countries in Africa still persecute those who, like me, are oriented towards our same sex.”
The chair of the ICASA conference, Robert Soudré, said African countries could not continue to rely indefinitely on external support for HIV treatment.
“More than 80 percent of medicines are financed from external sources and that cannot continue,” said Soudré. “Our countries will have to make available their own resources and governments will have to rely above all on themselves.”
He added: “Zero stigma is what we should aim to achieve everywhere in the world, but also on our African continent.”
Dr. Dybul said although there was no single “silver bullet” that could end the HIV pandemic it was essential to deal with strongholds of infection among young women and girls; men who have sex with men; sex workers; people who inject drugs and prisoners.
“If we are going to address this epidemic we must deal with the strongholds. We must have our tools available for the most vulnerable and that means creating an inclusive human family,” he said.
“Let’s end silver bullet approaches to this epidemic and let’s just end the epidemic.”
Global Fund News Release
31 January 2014
Geneva – The International Federation of Red Cross and Red Crescent Societies (IFRC) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have signed a grant agreement to fund universal treatment for tuberculosis (TB) in Niger, a country with one of the worst rates of TB in West Africa.
A new two-year Global Fund grant of 10 million euros will allow the population of Niger, estimated at around 17 million, to access quality TB diagnosis and treatment services. The grant will expand and enhance TB services for more than 26,000 people in 200 treatment centres by 2015, targeting vulnerable populations, including those in nomadic communities, migrant groups and prisons.
TB is a major global health concern, killing 1.3 million people every year and infecting a further 8.6 million, despite being an entirely preventable and curable disease. In Niger, while overall numbers of people with TB have fallen in recent years, incidence of the disease is still high. The vast majority of TB cases can be easily cured when medicines are provided and taken as prescribed.
”Access to sustainable diagnosis and treatment services is a burning priority in a country like Niger, where a lack of predictable funding, sustained technical support and health care workers have seriously undermined the government’s capacity to regularly provide quality TB services and distribute drugs” says Bekele Geleta, Secretary General, IFRC. “With support from the Global Fund, we will be able to ensure access to treatment for people living in the most underprivileged areas, especially those facing discrimination and living on the margins of society.”
In Niger, despite a high degree of political commitment and local ownership of the TB response, the disease is putting a heavy strain on an already overburdened health system. Treatment can take up to six months and requires extensive supervision and patient support by a health worker or trained volunteer. Without this, treatment adherence can be difficult and the disease can spread further.
“This grant will support and strengthen existing in-country capacities, working closely with the National Tuberculosis Program of the Ministry of Health” said Mark Dybul, Executive Director of the Global Fund. “The IFRC is an excellent partner combining a unique community perspective and experience that will accelerate scale-up of TB interventions and provide faster screening of at-risk populations.”
In Niger, only 46 per cent of people with TB are ever tested for HIV. HIV and TB form a lethal combination, each speeding the other’s progress. Someone who is infected with HIV and TB is much more likely to become sick with active TB. The grant will ensure that all TB patients will access HIV testing and early treatment services.
“We believe that no one should be left behind in the fight against TB” said Geleta. “Equitable access to quality diagnosis and treatment services, combined with skilled community volunteers – is the winning formula to accelerate progress towards zero TB deaths, infections and suffering.”
Global Health News
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.