Global Fund News Flash

Issue 16 – 21 March 2013

New Funding Model Hits the Ground Running

The Democratic Republic of Congo is one of the countries taking the lead in implementing the Global Fund’s new funding model that was launched last month. Among the 50 or so countries that will access new funding in a transition phase this year, the DRC  is one of a handful invited to participate fully, going through all steps of the application process from submission of a concept note to creation of a new grant. At a gathering in Kinshasa, senior officials from DRC and the Global Fund discussed the context and dynamics of the new funding model, where US$130 in additional funding has been identified for HIV programs and US$ 85 million for malaria. Those investments will support programs that provide a significant amount of antiretroviral drugs to HIV patients and provide millions of replacement mosquito nets to people trying to prevent the spread of malaria. The DRC’s Minister of Health, Dr Felix Kabange, cited the flexibility and the inclusive dialogue in the new funding model, and said he had already seen signs of it in preparatory work in recent months. “I have seen things change significantly, both in our way of discussing things and in the way of dealing with problems and defining priorities,” Kabange said. The DRC and the Global Fund had established a true partnership, he said. “We are engaged in a constructive dialogue, which cannot fail to lead to advances.”

Mark Edington, Head of Grant Management at the Global Fund, who was also in Kinshasa for the event, said that partnership is most effective in countries which are already investing significant amounts of their own resources in fighting disease. He highlighted Kabange’s strong personal commitment to increased domestic funding of health programs, but said that the DRC’s government needed to make more health financing available for HIV, TB and malaria to match the grants. “We need to see the leadership of the Democratic Republic of Congo recognize the importance of investing in health and we need to see them put money into fighting the three diseases,” he said. “There is so much to do in the DRC and, while the Minister of Health is extremely committed to putting sufficient amounts in the budget, to date, the National Assembly has not upheld his budget lines.” Only 12 percent of people who need antiretroviral therapy are getting the medication in DRC and only 6 percent of pregnant women receive antiretroviral therapy that prevents the transmission of HIV to their child, he added. Kabange and Edington both promised to work to succeed in getting the DRC to invest more in health services given its high disease burden.

To Stop Tuberculosis In Its Tracks, Urgent Global Action Is Needed

An Article from Forbes Posted 3/19/2013 @ 8:00AM
By John Lechleiter, Contributor

One of the most severe cases of drug-resistant tuberculosis in the United States has been reported in southern Texas: a strain of TB resilient to at least eight of the 15 drugs used to treat this deadly airborne disease. This report comes hot on the heels of news that South Africa has become the fourth country – after India, Iran and Italy – to register strains of TB that can overpower at least 10 of these drugs.

As we mark World TB Day on Sunday March 24, there can be no denying that TB, fueled by drug resistance, continues to pose a serious global health threat – one that must be urgently addressed. An outbreak of drug-resistant TB in New York City in the early 1990s cost more than $1 billion and killed 29 Americans. With resistance spreading, we need a renewed global commitment that combines public and private efforts to defeat TB.

According to the World Health Organization, more than eight million people became infected with TB and 1.4 million died in 2011 – that’s about the entire population of Greater Indianapolis, the city where I live. And between 2009 and 2011, drug-resistant TB cases doubled in the 27 most-affected countries.

Yet there are plenty of reasons to be optimistic. New partnership models are marshaling the resources and knowledge required to produce new TB innovations that can outflank the disease – and ensure that patients benefit from them.

For example, Cepheid has developed a rapid diagnostic test, GeneXpert, which can identify TB – and the presence of drug-resistant bacteria – in about two hours. The U.S. government and the Bill & Melinda Gates Foundation are now collaborating in countries with high TB burdens to subsidize the purchase of these state-of-the-art tools.

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How Funds Are Allocated in The Global Fund’s New Funding Model

The Global Fund launched its new funding model in late February, and since then we have received a lot of questions about how funding decisions were made. There is considerable interest in how to access the US$1.9 billion available for the new funding model’s transition period, in 2013 and 2014. The main criteria give priority to countries positioned to achieve rapid impact, to countries facing service interruptions and to countries that have received less than they should under new allocation principles that look primarily at disease burden and national income level. Adjustments are also made to take into account external financing levels provided by other donors. And for the six countries invited as “early applicants” to go through all steps of the application process (from submission of a concept note to creation of a new grant) region and country size are considered, too. We need a diversity of programs and settings and conditions so we can see how the new funding model works during the transition this year and next. That way, we can make refinements and changes as needed.

The Global Fund’s approach to allocation carefully follows decisions on the new funding model made by the Global Fund Board. One important requirement made by the Board was that allocations in the new funding model consider both committed and uncommitted funds, so that the Global Fund’s investment as a whole covers the major gaps and needs across the three diseases in a more strategic way. In addition to the US$1.9 billion in uncommitted funds that will be available in 2013-14, allocations also factor in the much larger amount of funds that were already committed in previous years, and may be disbursed in 2013-2014.

A related point about the new funding model may be relevant to the 47 countries that can apply for funding as “interim applicants” for grant renewals, grant extensions or redesigned programs that can rapidly make use of funds in 2013 and 2014. The Global Fund is taking both committed and uncommitted funds into account as it determines allocation amounts for the 2014-2016 period. In practice, that means that funds that come in 2014 will be considered part of a country’s overall 2014-2016 allocation. In all cases, applicants are encouraged to look at how to use all funds in a way that best delivers impact. Continue Reading.

Australia and the Global Fund: Partnerships That Pay Off

Executive Director of the Global Fund, Mark Dybul, is currently visiting Australia to thank Australian leaders and legislators in person for their support, and to underscore how their investment is paying off across the Asia-Pacific region.

He is reassuring Australians that the Global Fund is committed to a continued partnership in responding to HIV and AIDS, tuberculosis and malaria in the Asia-Pacific region. Dybul writes on the Huffington post why it is so important to invest in these partnerships, and equally, why these partnership pay off.

Anyone who makes an investment hopes to see a healthy return.

In the arena of global health, when we talk about value for money, we mean an investment that gets a superior return in preventing and treating infectious diseases like AIDS, tuberculosis and malaria.

Australia’s government has consistently named its primary concern in global health as effective intervention in the Asia-Pacific region. And the Global Fund has delivered.

Australia taxpayers are investing AUD$100 million in the Global Fund in 2013, and the Global Fund is investing more than AUD$300 million in the Asia-Pacific region.

In the investment world, that’s called “leverage.”

This week, I am visiting Australia for the first time since becoming Executive Director of the Global Fund. I plan to thank Australian leaders and legislators in person for their support, and to underscore how their investment is paying off across the Asia-Pacific region.

I want to reassure Australians that we are committed to a continued partnership with their government in responding to HIV and AIDS, tuberculosis and malaria in the Asia-Pacific region.

In Myanmar this year, the Global Fund is backing a regional initiative with US$100 million that will tackle artemisinin resistance in the fight against malaria. In Papua New Guinea and in the Solomon Islands, we are supporting programs to prevent and treat tuberculosis. Each of these countries was invited to take part in a new funding model that we launched in February.

Our new funding model starts with dialogue among partners who are working together in each country. The partners and the approach will be tailored to each country because no one size fits all.

The new funding model also provides countries with more flexibility around when they seek support so it aligns with their own timing and needs. It also provides more predictability while encouraging a full consideration of the latest understanding of current trends in new infections, district by district, and the interventions that are most likely to have the greatest impact in each. At the same time, we will be catalyzing and coordinating key technical and implementing partners so countries have support to deliver highest impact programs. This will include working closely with AusAID in countries of interest to them.

For too long we have been constrained by the tyranny of averages rather than focusing on areas of high transmission and those most at risk. The new funding model strives to break free from those constraints to ensure that those most in need and at risk are reached with the highest quality services and programs.

Australia, as a strong supporter of the Global Fund, stands to see more return on its investment. Australia was one of the pioneer countries to adopt the Global Fund’s Debt2Health initiative, which resulted in a significant increase in support to tuberculosis programs in Indonesia. Under the initiative, Australia cancelled AUD$75 million of Indonesia’s debt. In return, Indonesia is investing half of this money in national programs to combat tuberculosis through the Global Fund.

Through Australia’s support and that of other donors, the Global Fund has been able to work with partners and together we have changed the lives of millions of people around the world.

The programs we have supported are providing AIDS treatment for 4.2 million people, anti-tuberculosis treatment for 9.7 million people, and 310 million insecticide-treated nets for the prevention of malaria. In effect, the Global Fund has saved more that 8.7 million lives in its 10 years of operation.

Worldwide, enormous advances have been made. AIDS-related deaths have decreased from 2.1 million per year in 2001 to 1.7 million in 2011. There were more than 700,000 fewer new HIV infections globally in 2011 than in 2001. The absolute number of annual TB cases has been falling since 2006 and TB incidence rates have been falling since 2002. Similar gains have been made in malaria, with progress towards eliminating malaria occurring in every region of the world.

Just ten years ago, nobody thought we could achieve these milestones. It is now evident that we have a historic opportunity to get HIV, tuberculosis and malaria under control. This will transform the lives of millions of people around the world.

To complete the job, we need to keep the momentum going, but we cannot underplay the challenge ahead. We need a Big Push to defeat these diseases. We also need political commitment and scientific knowledge to invest the funding in the right areas effectively.

We know that if we work together, with shared responsibility, with clear mission focus and with passion and compassion as global health citizens we can completely control these maladies. This is a message we know Australians understand. We are confident that they will continue to offer us the help we need to complete the mission.

An Optimistic Era for Global Infectious Disease Control

The newly appointed director of the Global Fund to Fight HIV, Tuberculosis, and Malaria believes international health efforts are at the cusp of containing these epidemics.

The following article is by John-Manuel Andriote, republished from The Atlantic

The world has an “historic opportunity” to contain and end three of humanity’s deadliest scourges by focusing on their “hot zones,” according to Mark Dybul, the newly appointed director of the Geneva-based Global Fund to Fight HIV, Tuberculosis, and Malaria.

“We have this unique moment in history where the science and implementation advances of the last 10 years are at a point where, if we just invest a little more and stick with it, we can contain the epidemics and have the next generation be free of HIV, tuberculosis, and malaria,” Dybul told me.

Dybul said that a better understanding of the epidemiology of the diseases makes it clear there aren’t what have been called “generalized” epidemics, even in hard-hit countries, but there are what he called “micro-epidemics.”

For example, although South Africa has more people living with HIV that any other country in the world — the United Nations Joint Programme on AIDS (UNAIDS) estimated 5.6 million in 2011 — more than half of them live in KwaZulu-Natal and Gauteng provinces.

“If we can concentrate in these geographies,” said Dybul, “we can interrupt new transmissions, getting new transmissions down to very low levels. And we can do it in a rapid time frame, effectively containing the epidemic.”

Dybul said today there is “a remarkable series of confluences.” Besides a better scientific understanding of the diseases, new tools offer the opportunities to make a tremendous impact. These include the understanding that antiretroviral therapy (ART) for HIV is highly effective at lowering viral load in infected individuals, making them far less likely to transmit the virus; pre-exposure prophylaxis — the use of ART to prevent infection in individuals who engage in high-risk sexual behavior; and male circumcision.

Since its formation in 2002, the Global Fund has been the world’s main multilateral funder of global health, channeling about $3 billion annually from its government and other partner organizations to countries most in need. The U.S. government provides approximately one-third of its funding. It provides 82 percent of all international financing for TB, 50 percent for malaria, and 20 percent of international financing for HIV/AIDS.

Dybul, who previously directed the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. government’s global HIV/AIDS program, said the Global Fund represents the leading edge of the new approach to international health and development efforts. He said that while the “old approach” was based on donors and recipients and “a sense that we in the north knew the answers and were just coming to help,” the new approach is a “switch from paternalistic to partnership.” Countries are now expected to assume responsibility for the health and development of their people.

This “paradigm shift” — first modeled in the PEPFAR program — also focuses on delivering measurable results, such as how much mortality has declined and how many new infections have been averted. Dybul said there is also a new recognition that “everyone needs to be in the game,” that the traditional country-to-country approach wasn’t effective. Not only governments, but civil society, faith-based groups that in Africa provide substantial levels of health care, even businesses, need to be engaged.

Dybul said a fourth cornerstone of the new paradigm is an intolerance of corruption. “All countries, not just those we support, have to have zero tolerance for money-shifting,” he said.

At this point, said Dybul, “We can either seize this moment and save countless lives and billions of dollars down the road by containing these epidemics, or we can tell our grandchildren why we didn’t when we had the chance.”