In his report to the Board as part of its 33rd meeting, Global Fund executive director Mark Dybul reflected on his travels in the first quarter of 2015 and how his interactions at the country level demonstrated that, for all the growing pains experienced initially, the new funding model is doing what it was supposed to do ensure investment for impact.
Echoing the Office of the Inspector General’s assessment that the Global Fund was maturing, he said that it was right and appropriate for the Fund to begin embedding strategy in its design and development work, “to ensure management for impact”.
While acknowledging that there have been delays in submission by country coordinating mechanisms of the concept notes to access the $14.82 billion in available funding for HIV, TB, malaria and health systems strengthening, Dybul sounded an overall positive note about progress towards ending the three diseases.
In meetings with CCM, PR and government representatives in Papua New Guinea, Honduras, Haiti, Swaziland, South Africa and Zambia, Dybul said he heard consistently that the new funding model was easier — though still bureaucratic — to navigate. In recounting a meeting with a nun who has been engaged in Global Fund-supported work in PNG since the outset, he noted that she said, “finally the Global Fund is a humane organization, clearly focused on human beings”.
The formula, he said, is still a work in progress, but there are clear signs that it is moving in the right direction as in Haiti, where public hospitals are using health system strengthening funds to improve services available to TB patients. A hospital in Mirebalais, some 60km northeast of the capital Port-au-Prince, can claim a 100% cure rate for TB.
The “21st century partnership led by countries is moving beyond health towards sustainability,” as in Honduras, where faith-based and community-based organizations are being tremendously effective in delivering services for malaria.
By integrating Global Fund investments into a full slate of activities, programs and behavior change campaigns, both Zambia and Swaziland are tackling the rising threat of HIV infection among women and girls: the populations most vulnerable to transmission.
“We are not just leveraging resources for disease [response] but for health,” he said, also congratulating governments for committing some $3.9 billion in domestic financing to help support the full slate of envisioned activities across the Global Fund portfolio.
In painting a rosy picture globally, Dybul did also move to try and preempt some of the concerns that have been repeatedly raised by constituencies at the Board level, specifically related to the $1.1 billion anticipated gap due to shortened grant duration and the likelihood that the register of unfunded quality demand — currently sitting at around $1.9 billion — will not be fully funded.
He also acknowledged the challenges about the sustainability of programs that have traditionally been the purview of the Fund in countries preparing to graduate from Global Fund eligibility and agreed that the pace at which the Fund is moving towards transition has not been completely matched by countries themselves.
He called for efforts, worldwide, to continue “aggressive relationship-building” between civil society and government, in order to link communities to the health system at all levels.
Such linkages were imperative, many constituencies noted in their reactions to Dybul’s presentation, evidenced by the current Ebola crisis still gripping three west African states — which demonstrates the need for integration of disease-specific programs into basic primary health care, wider deployment of community-based initiatives and a mobilization of local resources that goes beyond the financial.
To reach more than three million people who are affected by tuberculosis but not diagnosed or treated, the world needs community champions like Timpiyian Leseni, from the Maasai community in Kenya. She is a survivor of abdominal TB. In 2012, she developed a bulging belly that mystified her and her doctors. It got so serious it required surgery that lasted six hours, and drained copious amounts of fluid from her intestines.
Unfortunately, the really hard part came when she started her TB treatment. It was long, tiring and nauseating. She endured daily injections for the first month and daily pills for seven more months. As she lived through the pain of TB, Timpiyian decided to dedicate her life to helping her community fight the disease.
The Maasai live in villages with huts that have little or no ventilation, providing fertile grounds for TB infection. They like unpasteurised milk and uncooked meat and blood, which can serve as a source of tuberculosis.
As she recovered, Timpiyian formed a community group of barefoot doctors who walk for miles to track and trace new TB patients. She called the community-based organisation Talaku – which means “set them free” in her language. With her fellow community workers, Timpiyian journeys through boulder-strewn dirt roads, climbing hills, descending valleys and crossing plains in search of people suffering from TB.
Sometimes they trail people who have been exposed to TB and have not been tested. Other times they look for people who started treatment but dropped off, and find them in drinking dens in small towns, or deep in the bush, since the Maasai often move in search of pastures and water for their animals. Timpiyian’s team goes on foot or motorcycle taxis known as boda boda. It is not always easy to persuade people with TB to come back to the hospital.
Just last week, she tracked two people who had defaulted on treatment. One said he was too busy; the other lied that he had completed his treatment. Timpiyian felt she had no choice but to involve the authorities – who arrested the men, and put them behind bars until they complete their medicine.
When Timpiyian tells her patients to get treatment, she often talks about living through the same pain, and losing ten months of her life. She has a warmth and a wisdom that earned her the nick name “Mama TB.” “Fighting TB is my life,” Timpiyian said. “It is so satisfying to reach somebody who is almost dying and after six months see them walk again.”
On 1 April, Norbert Hauser became Chair of the Board of the Global Fund, and Aida Kurtovic became Vice-Chair. Each of them will serve a two-year term.
Norbert and Aida are well-known in the Global Fund partnership, with significant experience in governance and global health. Norbert served as interim Inspector General of the Global Fund in 2012-13, and was a member of the High-Level Panel in 2011 that recommended a series of reforms. Aida served as a Board member of the Global Fund from 2012-2014, and has been involved with the Global Fund in numerous capacities, serving on Bosnia’s Country Coordinating Mechanism and on Board committees.
At a Board meeting held in Geneva that concluded on 1 April, Board members gave warm thanks to outgoing Chair and Vice-Chair, Dr Nafsiah Mboi and Mireille Guigaz.
Vice President of Global Health Programs and Access, Eli Lilly and Company
President, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
The world has made great strides in improving global health, including in the fight against tuberculosis. Over the past 20 years, deaths from the disease have decreased by 45 percent and more than 37 million lives have been saved globally. It is not surprising, then, that tuberculosis is often thought of as “a disease of the past,” especially in the United States and Western Europe, where full-blown cases are much less common than in other parts of the world.
Tuberculosis, however, continues to be one of the world’s top health challenges. Each year, about nine million people fall ill, three million don’t get the care they need, and 1.5 million deaths result from the disease. Also of great concern are the rising cases of multidrug-resistant tuberculosis (MDR-TB), with 480,000 new cases in 2013 alone.
There are a couple of fundamental problems with the current treatment regimen for tuberculosis. One is that most medicines are rough on patients, essentially like a small dose of chemotherapy. They often leave patients feeling nauseous and weak, among other, sometimes irreversible side effects. Treatment also takes substantial time – generally six to nine months, but much longer for MDR-TB. In settings where patients are not monitored, they too often stop taking medications once they feel better, putting them at risk for developing drug-resistant tuberculosis.
There is an important role for global pharmaceutical companies to play in addressing these challenges, and work is underway to help expand access to medicines and improve patient care in tuberculosis through philanthropy and product donations. Lilly, for example, shared the technology and know-how for making two drugs to treat MDR-TB to manufacturers in four countries with the highest tuberculosis burden. Yet these efforts alone are not enough.
In 2003, Lilly created a public/private initiative, the Lilly MDR-TB Partnership, to raise the global profile of the disease and offer education, training and improved care to people worldwide. It has become the company’s largest philanthropic effort; Lilly has invested $170 million in it from 2003-2016 and has worked with some 40 partners — including the Bill & Melinda Gates Foundation, the Infectious Disease Research Institute, the Stop TB Partnership and the Global Fund — to create a reliable supply of, and improve local access to, necessary medicines.
Lilly is also part of the TB Drug Accelerator, a collaboration under which pharmaceutical companies and research organizations partner to help develop drug candidates with potential for new treatments, working toward a faster cure. The ambitious target of this initiative is a drug regimen that can cure patients in only one month, as opposed to the six to nine months currently required to treat drug-sensitive strains of the disease. Many other private sector institutions are making impressive contributions through financial support and — in collaboration with other funders, civil society organizations and domestic governments — by providing technical expertise, human resources and commodities. The collective efforts of these partners are achieving impressive results, but more is needed.
As the role of the private sector evolves, Lilly and the Global Fund are especially pleased to be working together to bring investments in tuberculosis to scale. Operating in more than 100 countries and providing over 80 percent of international funding for the disease, the Global Fund is uniquely well-positioned to help the fight. As of December 2014, Global Fund-financed programs detected and treated 12.3 million cases of tuberculosis and treated 150,000 people for multiple strains of MDR-TB. Its programs did so with increasing private-sector involvement.
Lilly sits on the Global Fund’s private sector board delegation, through which it is working with the Fund both in Geneva and in the field. Recently, for example, Lilly had a series of strategic planning discussions with the Global Fund and South Africa’s National Department of Health to determine how the company’s support could complement local efforts against tuberculosis.
Lilly has also been particularly supportive of the Global Fund’s work to apply sound business practices to its institutional operations, especially its procurement function. The Global Fund spends roughly $2.5 billion annually on the procurement of health-related goods and commodities, so the possibilities for cost savings, reduced stock-outs and increased access to vital health products are significant.
The Global Fund also has been working with Lilly and other private sector representatives on a transformative project — Procurement 4 Impact (P4i) — to fundamentally change the institution’s approach to the procurement of goods and services, delivering greater value for money and improved impact. Already, the Global Fund has achieved a savings of $400 million over two years, critical resources that can now be used to further its core mission of saving lives.
Our main message on March 24, #WorldTBDay, is that, although tuberculosis remains a major challenge, there is a remarkable public/private coalition working aggressively to tackle it — and to do so in ways that transcends traditional corporate giving practices. This coalition includes NGOs such as the Stop TB Partnership, multilateral organizations like the Global Fund, and support from governments, research-based pharmaceutical companies, and many other private sector partners. Together, we believe the fight to end tuberculosis forever and save millions of lives is winnable.
The Hon Julie Bishop MP (23 March 2015):
On the eve of World TB Day, I am pleased to announce further support toward the eradication of tuberculosis and malaria in the Indo-Pacific region.
Drug resistant TB and malaria pose a threat to health security in our region and carry a high burden for our Asia-Pacific neighbours. More than half of the global TB cases (56%) occur in our region.
Australia’s new $30 million investment over three years will help bring new diagnostic tests and drugs to market to tackle this threat.
This support will be provided through Product Development Partnerships, an innovative public-private partnership model for co-investing in development of new medical technologies. Bringing together public and private sector funding corrects a market failure to develop medical products needed by those with limited purchasing power.
The TB Alliance will receive $10 million over three years to support late stage clinical trials of new TB treatments. These include the Phase 3 registration trial of a new drug regimen (PaMZ) which is the first to treat both drug sensitive and multi-drug resistant TB. This new oral treatment has the potential to shorten and simplify TB treatment and reduce the cost of treating multi-drug resistant TB by up to 90 per cent.
The Foundation for Innovative New Diagnostics (FIND) will receive $10 million over three years to accelerate the development and uptake of better diagnostic tools and testing for TB and malaria. Accurate diagnosis is essential for prescribing appropriate treatment and has a major impact on disease outcomes.
This new support for TB treatment and diagnosis builds on an additional $15 million package of assistance to support TB control in Papua New Guinea, announced last month.
Medicines for Malaria Venture (MMV) will receive $10 million over three years for development of antimalarial drugs and to facilitate access and uptake of new treatments.
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.