Presentation Mk 21 May2007

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Presentation Mk 21 May2007

  1. 1. NY-070626.001/020419VtsimSL001 The Global Fund to Fight AIDS, TB and Malaria – A model for International Development Cooperation? Berlin, May 21, 2007
  2. 2. NY-070626.001/020419VtsimSL001 • Health is strongly linked to poverty • Health is strongly linked to globalization • Addressing health is a priority for development 1
  3. 3. NY-070626.001/020419VtsimSL001 • Change in paradigm in the relationship between health and development • Mobilization of public opinion, civil society and affected communities • Mobilization of the political world • Mobilization of specific resources • Progress in research; emergence of operational research • Integration of prevention and treatment • Large scale programs now being implemented 2
  4. 4. NY-070626.001/020419VtsimSL001 !quot; • The human, demographic, economic, societal and developmental impact of AIDS • The political impact of AIDS and impact on global security • The inequality between the rich and the poor with regard to access to treatment and care appears unacceptable for a « global » public opinion 3
  5. 5. NY-070626.001/020419VtsimSL001 # $ % ' () – !$ & * Number of people living with HIV * under 15 years old
  6. 6. NY-070626.001/020419VtsimSL001 New HIV/AIDS Infections 2006 • 4.3 (3.6-6.6) million new HIV infections worldwide • Half among young adults aged 15-24 • Half in women • Children < 15 : 530 000 (410 000-660 000) • 90% in low resource-settings 5
  7. 7. NY-070626.001/020419VtsimSL001 Sub-Saharan Africa: Life expectancy at 46 years 6
  8. 8. NY-070626.001/020419VtsimSL001 + , -& $ + 25,000,000 * i ty tal 20,000,000 r IV mo IDS H lt ith du - A w A ng vi li 15,000,000 s Millions ult Ad 18 million orphans 10,000,000 S ID due to -A ns AIDS in ha rp 2010 O 5,000,000 0 1985 1990 1995 2000 2010 2005 1980 * Mortality is cumulated over 17 years to represent parents that have died. Based on projections of the AIDS epidemic 2004 by UNAIDS/WHO working group on HIV/AIDS/STI surveillance 7
  9. 9. NY-070626.001/020419VtsimSL001 $ $ . ! !quot; &/ 0 ' () 1 180 160 Cases per 100,000 population 140 Africa 120 100 80 World 60 40 20 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Source: World Health Organization. Global tuberculosis control: surveillance, planning, financing. WHO Report 2005. Geneva, WHO, 2005. 8
  10. 10. NY-070626.001/020419VtsimSL001 quot; 2 • World realizes that health should not be considered anymore as a consequence of development but as a factor for development, particularly through preservation of human capital • Access to health increasingly accepted as a human right; control of pandemics increasingly considered as a “global public good” • Originally considered as a non-profitable source of expenditure, health becomes increasingly understood as a necessary investment in development and security 9
  11. 11. NY-070626.001/020419VtsimSL001 quot; 2 • Global health has become an issue for foreign policy • New models of governance of global health proposed and implemented 10
  12. 12. NY-070626.001/020419VtsimSL001 2000 : Health brought to the agenda of the G8 in Okinawa 2000 : Three of the Millenium Development Goals (MDG Summit) relate to health 2001 : UNGASS 2002 : Global Fund to Fight AIDS, Malaria and TB 2003 : PEPFAR 2005 : Declaration on Universal Access to treatment of HIV/AIDS by 2010 : Gleneagles G8 and MDG summit in New York 2006 : UNITAID 11
  13. 13. NY-070626.001/020419VtsimSL001 Traditional international development cooperation - Limits in the face of HIV/AIDS • Donor Driven – Policies set in donor capitals, often not reflecting country realities/knowledge and lacking country- ownership • Limits to accountability – Insufficient incentives and transparency to ensure effective use of aid investments • Government focused – Unable to cope given weak health systems • Inadequately financed – Lack of scale necessary to have significant impact
  14. 14. NY-070626.001/020419VtsimSL001 The Global Fund to Fight AIDS, TB and Malaria • Called upon by UN Secretary General and endorsed and financed by G8 in Genoa (over $1.5 billion) • June-September 2001 : Designed by governments from the developed and the developing world, civil society,people affected by the diseases and private sector as an international organization with focus on financing, not implementation • April 2002 : GF Board approves first round of grants • By May 2007: US $ 10. 4 billion raised (cumulative) US $ 7.6 billion approved in grants by the Board 450 programs in 136 countries US $ 3.5 billion disbursed
  15. 15. NY-070626.001/020419VtsimSL001 ! ! + 3 $ 4 • Inclusive Public-Private Partnership • Demand-driven and country owned • Transparent • Performance-based 14
  16. 16. Public-Private Partnership: Involvement of stakeholders built NY-070626.001/020419VtsimSL001 into governance and implementation • Governance: - Board governance: 5 of 20 votes are held by Civil Society and Private Sector - Local Governance: Local bodies applying to the GF and responsible for grant oversight include civil society and private sector • Implementation: - 32% of Principal Recipients are non-governmental or multilateral organizations (expected to grow further with separate funding window) - Partnership with other multilateral organizations is key • Financing: - Private Sector contributes to financing and goods/services (just beginning - potential to expand) 15
  17. 17. NY-070626.001/020419VtsimSL001 Demand driven: Countries are in control from design to implementation of programs The Global Fund Board • Entirely demand driven Approval of Review & funding Funding recommendation • All donor contributions flow into a common pool Independent Technical Review Panel •No targeting/earmarking Grant by country, region or development intervention and application Principal • Competitive selection, Recipients based solely on technical merit and feasibility (~60% rejection rate) Sub- recipient(s) 16
  18. 18. NY-070626.001/020419VtsimSL001 Performance Based: disbursements depend on attainment of programmatic results and financial expenditures Performance- Programmatic Financial Based monitoring monitoring Funding
  19. 19. NY-070626.001/020419VtsimSL001 Performance-based: Disbursements depend on attainment of programmatic results and financial expenditures 100% % of grant amount disbursed at Phase 2 79% 80% 72% 64% $300 Million 60% reallocated from poor review performers 38% 40% 20% 0% Very strong Strong Challenged Unacceptable Grant performance 18
  20. 20. NY-070626.001/020419VtsimSL001 5 $ PEOPLE REACHED HIV: ARV 128% treatment 770,000 3000 lives TB: DOTS 167% 2 million treatment saved per day 120% MALARIA: ITNs 18 million 0% 50% 100% 150% 200% % OF END-2006 TARGETS 19
  21. 21. NY-070626.001/020419VtsimSL001 Transferable lessons from the Global Fund for International Development Cooperation 1. Governance beyond governments – ensuring involvement of all stakeholders on decision making and implementation 2. Country ownership balanced with accountability and rigorous performance management is at the core of achieving results 3. Non-political decision making and radical transparency – creates legitimacy and is critical to performance based model 4. Vertical, focused interventions catalyze financing and focus. There is a need for them to be combined with systems strengthening 5. Lean structure building on global and country partnerships
  22. 22. NY-070626.001/020419VtsimSL001 Areas requiring focus • Further strengthening civil society involvement • Further strengthening of accountability systems • Addressing the high prices of second line drugs • Increasing the global effort in research and development • Addressing the Human Resources and Health Systems crisis • Increased and sustainable Financing – $ 6-8 billion for the Global Fund by 2010

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