Transcript Slide 1

Action for Global Health
Policy Conference, London, 28 June 2010
Session 4: The Changing Global Health
Architecture and Implications for the MDGs
Presentation by Richard Manning, Vice-Chair of
the Replenishment of the Global Fund
Health Financing Architecture
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Health Aid a laboratory for aid architecture
Major scaling-up
Major results
Major controversy
In Theory.....
• Could envisage a pure ‘horizontal’ aid delivery
model, leaving recipients entirely free to allocate
according to their own priorities
• Meets ‘ownership’ and ‘alignment’ goals of
Paris/Accra
• Poses problems of enabling governments to be
held to account
• Risks major problems when decisions appear
arbitrary or wrong
• Hard to maintain donor public support
Also in theory.....
• Aid could be entirely ‘pre-packaged’ in favour
of one objective or another, by sector, subsector, type of recipient etc
• Some attractions in terms of results focus: eg
results being achieved by GAVI and GF
• But poses serious issues around local
ownership, sustainability, arbitrary donor
decisions
In practice.....
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Mix of aid instruments is appropriate
Differences of donor and recipient priorities need to be tackled
Donors should be consistent in bilateral and multilateral fora
A portfolio approach, involving considered priority-setting, should be
adopted
This should recognise the inter-relationships among MDG outcomes
Advantages of multilateral approaches need to be highlighted, not least
for scaling up actions known to be highly-effective
Special-purpose funds need to apply aid effectiveness criteria, notably on
alignment; but equally have much to teach, eg on results focus
Locally-led decision-making the best means to rationalisation: the overall
package has to ‘make sense’ at country level (and, for health, at patient
level)
Think twice before adding new special purpose funds
So....
• “Global funds are an important, legitimate, and growing part
of our assistance portfolio. They have strengths and
weaknesses – weaknesses that are in part the unintended
consequences of our own decisions. We need to help them
increase their effectiveness. We need also to strike a better
balance between global funds and “horizontal” assistance,
and between bilateral and multilateral aid, if we are to
increase the impact of our development portfolio as a whole.
To do so, we will need to develop and implement, with the
involvement of our political authorities, a clearer strategy that
takes account of the incentives facing key stakeholders.”
(Donor Schizophrenia and Aid Effectiveness: The Role of
Global Funds Paul Isenman and Alexander Shakow – IDS
2010)
Global Fund’s added value?
• The Global Fund has become the main vehicle
through which donors have channeled massive new
resources to address the three diseases.
• By the end of 2009, the Global Fund had approved
proposals totaling US$ 19.2 billion, making it the
largest multilateral contributor to the health-related
MDGs.
• The Global Fund has created a development
financing model that works.
Global Fund’s role in contributing to
MDGs by 2015 (1)
• The Global Fund is well-positioned to continue to make a
major contribution to progress toward the health-related
MDGs.
• The Global Fund is making by the far the largest multilateral
contribution to MDG 6 (combat HIV/AIDS, malaria and other
diseases).
• It provides about two thirds of international funding for
malaria and TB and about one fifth of international funding
for the response to HIV.
Global Fund’s role in contributing to
MDGs by 2015 (2)
• Global Fund supported programs are reducing
under-5 mortality by:
– Preventing and controlling malaria
– increasing access to pediatric HIV treatment
– supporting more comprehensive care, support
and treatment for infants and children exposed to
and infected with HIV
– funding PMTCT programs.
Global Fund’s role in contributing to
MDGs by 2015 (3)
• The GF is also contributing to improved maternal health through programs
scaling up prevention and treatment of HIV, TB and malaria.
– reducing the largest causes of mortality among women of childbearing
age, as well as reducing major causes of maternal deaths.
• Almost all Global Fund-supported HIV programs provide sexual and
reproductive health-related services, thereby contributing to universal
access to reproductive health – the second target under MDG 5.
• Global Fund investments are also contributing to maternal and child
health by strengthening health and community systems, which has
enabled countries to expand the delivery of primary health care services.
Broadening the role of the Fund to
become ‘Global Fund for Health’?
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The GF’s programs work across the continuum of health care and make a significant
contribution to public health.
Its disease focused interventions, as well as its investments in public health are contributing
to MDGs 4 and 5 and improving basic health services.
The Global Fund’s grant proposal guidelines are being sharpened to focus more explicitly on
gender considerations and on the integration of maternal and child health.
At its April meeting the Global Fund Board asked the Secretariat to elaborate options for
enhancing the Global Fund’s contribution to maternal and child health.
– Papers on the issue will be provided to the Policy and Strategy Committee this autumn
for a decision by the Board in December.
It is clear from the Board discussions that an expansion of the Global Fund’s mandate to
incorporate maternal and child health can only happen if additional resources are made
available.
– one option could be the ring-fencing of funding provided for an MCH initiative.
The global fund
Progress to date and likely progress
under 3 funding scenarios ($13 bn,
$17 bn, and $20 bn)
Results: Malaria in Rwanda
• -By end 2007, more than 2.4 million
Insecticide Treated Nets were distributed,
achieving 60% coverage
• -National ACT roll-out
• Results:
– 64% decline in child malaria cases
– 66% decline in child malaria deaths (Facility data,
2005-2007)
– Declining treatment demand
If we succeed...
• By 2015, we can:
– eliminate malaria as a public health problem in most malaria endemic
countries;
– prevent millions of new HIV infections;
– dramatically reduce deaths from AIDS;
– virtually eliminate transmission of HIV from mother to child;
– substantially reduce child mortality and improve maternal health;
– contain the threat of multi-drug resistant TB;
– achieve significant declines in TB prevalence and mortality;
– further strengthen health systems.
And if we fail.....? 1. Malaria
• malaria morbidity and mortality would increase
again and anti-malarial drug resistance would
become a major problem;
• the goal of eliminating malaria as a public health
problem would become unattainable.
And if we fail....? 2. HIV/AIDS
– millions of people in urgent need of HIV treatment would
be denied such treatment, resulting in much increased
morbidity and mortality, greater spread of HIV, and
devastating impact on families (including orphans),
communities and countries;
– the yearly number of new HIV infections, which has
decreased in recent years in every region with the
exception of Eastern Europe and Central Asia, would rise
again, resulting in millions of additional HIV infections;
– hundreds of thousands of children would be born with HIV
every year
And if we fail....? 3. TB
• drug- and multidrug-resistant TB would
become a major global public health problem,
threatening the success of TB control efforts
achieved to date and leading to substantial
increases in TB prevalence and mortality
Progress of Replenishment
• Pledging conference, New York, 4-5 October
• The current economic situation – including austerity measures
and funding cuts in many donor governments to address high
levels of public debt – has increased the challenge
• some encouraging signs (such as Japan’s recent
announcement of a 27% increase for 2010 and the draft EC
budget that includes an increase for the Global Fund) but the
overall picture is mixed
• In my view as Vice Chair, it will be a major challenge to get
close to any of the three scenarios without some major and
positive last-minute decisions by key donors.
Role of innovative Financing and FTT as
potential source
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Innovative Finance can play an important role.
For example, in GF:
– the Debt2Health initiative, through which creditors forego repayments if part
of funding spent through Global Fund approved programs
– the development of exchange-traded funds (ETFs) through which the Global
fund receives a portion of fees generated by the Funds.
Contributions from traditional public sector donors still provide about 95 per cent
of funding for the Global Fund.
Need to be realistic about the scope for a financial transactions tax as a source of
major new funding for the Global Fund or other development institutions in the
near term.
But a tax of this nature, if structured appropriately, could provide the large-scale
sustained funding in the orders of magnitude required to have a sustained impact
on public health in developing countries.
So....
• civil society friends and allies of the Global
Fund, and of public health generally, need to
make their voices heard in donor capitals.
• Particular importance of UK, as donor
maintaining increases in aid and focused on
results, to come to Replenishment meeting in
October with a significantly increased pledge.
Postscript: G8 Muskoka Summit
• We reaffirm our commitment to come as close as
possible to universal access to prevention,
treatment, care and support with respect to
HIV/AIDS. We will support country-led efforts to
achieve this objective by making the third voluntary
replenishment conference of the Global Fund to
Fight AIDS, TB and Malaria in October 2010 a
success. We encourage other national and private
sector donors to provide financial support for the
Global Fund.