The LifeTrust Initiative

471 views
386 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
471
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

The LifeTrust Initiative

  1. 1. Health, equity and globalization Prof. Michel D. Kazatchkine Executive Director The Global Fund to Fight AIDS, Tuberculosis and Malaria Lancet Lecture, University College, London November 24, 2008
  2. 2. Outline (1) • Globalization has contributed to poverty reduction in developing countries; however there are also growing inequities • Health has become a key focus of international action to address such inequities between the global north and south • The Global Fund is an innovative instrument for helping to reduce global health inequities • Significant challenges remain to sustain global health efforts
  3. 3. Globalization: more wealth, but also more inequity • Unprecedented global economic growth in the past decade (BRIC bloc) • Increased inequities within countries and between the richest and poorest countries • Financial crisis could further exacerbate such inequities
  4. 4. •The proportion of people living in extreme poverty (<$1 a day) in developing countries has declined from 32% to 19% between 1990 and 2004 •But this has been accompanied by rising inequality within developing countries overall Poverty reduction has been accompanied by rising inequality MDG Report 2007 (UN)
  5. 5. Increasing income inequality between richest and poorest countries Gross National Income per capita in nominal US dollars Year Richest countries Poorest countries Ratio 1980 $ 11 840 $ 196 60 2000 $ 31 522 $ 274 115 2005 $ 40 730 $ 334 122 WHO Commission on Social Determinants of Health 2008
  6. 6. Unstable relationship between economic growth and progress in life expectancy
  7. 7. Global economic downturn could increase inequities • Developing country economy growth projection marked down from 6.4% to 4.5% in 2009 •An additional 40 million people in poverty in 2009
  8. 8. • 90% of the burden of infectious disease is concentrated in developing countries, whereas those countries account for only 20% of the world’s wealth and only 12% of global expenditure on health • AIDS, TB and malaria are the major infectious diseases and still kill over 4 million people a year The inequitable burden of infectious disease
  9. 9. Why health funding can no longer be so “soft” • Health is a key investment for development • Investments in health are showing results and impact • AIDS treatment and health systems challenges highlight need for long-term effort and lifetime commitments • Sustainability is a responsibility shared by countries and the international community • Convergence of donor political and economic interests with global health outcomes
  10. 10. Breaking the silence “I exist as a living embodiment of the inequity of drug availability and access in Africa … ... I stand before you because I am able to purchase health and vigour. I am here because I can pay for life itself.” - Justice Edwin Cameron International AIDS Conference, Durban, 2000
  11. 11. Outline (2) • Globalization has contributed to poverty reduction in developing countries; however there are also growing inequities • Health has become a key focus of international action to address such inequities between the global north and south • The Global Fund is an innovative instrument for helping to reduce global health inequities • Significant challenges remain to sustain global health efforts
  12. 12. Key developments • Millennium Development Goals • Social mobilization • Political commitment • New resources • New instruments
  13. 13. Buenos Aires Millennium Development Goals (2000) MDG 1: Eradicate extreme poverty and hunger MDG 2: Achieve universal primary education MDG 3: Promote gender equality and empower women MDG 4: Reduce child mortality MDG 5: Improve maternal health MDG 6: Combat HIV/AIDS, malaria and other diseases MDG 7: Ensure environmental sustainability MDG 8: Build a partnership for development
  14. 14. Social mobilization and political commitment
  15. 15. Total health ODA commitments, 2001-2006 $7.2 $7.6 $11.2 $13.3 $16.5 $20.1 2001 2002 2003 2004 2005 2006 US$ Billions
  16. 16. UNAIDS
  17. 17. New instruments in global health • World Bank Multi-country AIDS Program (2000) • Global Alliance for Vaccines and Immunization (2000) - International Finance Facility for Immunization • Global Fund to Fight AIDS, TB and Malaria (2002) • US President’s initiatives - AIDS (2003), Malaria (2005), Neglected Tropical Diseases (2008) • Unitaid (2005) • (PRODUCT) Red (2005) • World Bank Malaria Booster Program (2005) • Debt2Health (2007) • Advanced Market Commitments (2008) • Affordable Medicines Facility for Malaria (2009)
  18. 18. Outline (3) • Globalization has contributed to poverty reduction in developing countries; however there are also growing inequities • Health has become a key focus of international action to address such inequities between the global north and south • The Global Fund is an innovative instrument for helping to reduce global health inequities • Significant challenges remain to sustain global health efforts
  19. 19. The Global Fund: an innovative instrument in health and development • A financial instrument, not an implementing entity • Supports programs that reflect country ownership • Evidence-based • Performance-based
  20. 20. A unique partnership
  21. 21. The Global Fund: an innovative instrument in health and development • A financial instrument, not an implementing entity • Supports programs that reflect country ownership • Evidence-based • Performance-based
  22. 22. Global Fund portfolio • $14 billion in approved financing • $7 billion disbursed • 600+ grants in 140 countries Malaria 25% HIV/AIDS 61%TB 14%
  23. 23. Global Fund portfolio: AIDS
  24. 24. Global Fund portfolio: malaria Private/Other US$ 4.4 million (1%) Multilateral US$ 62.7 million (13%) Bilateral US$ 106.7 million (22%) Global Fund US$ 308 million (64%) Global Fund portfolio: TB Grants from other sources US$ 66 million (33%) Global Fund US$ 133 million (67%)
  25. 25. 140 countries with Global Fund grants BG/261107/6 1 2 (new) 3 (new) 4 (new) 5 (new) 6 (new) 7 (new) 0 5,0002,500 Kilometers ´
  26. 26. Targeting the poorest countries: Global Fund approved amounts by country per capita income, September 2008 0 500 1000 1500 2000 2500 3000 3500 US$ 0-1000 US$1000-2000 US$2000-5000 US$5000-10000 Other $m
  27. 27. Resources go where they are needed • Regions – 60% of approved funds in Rounds 1-8 are for sub-Saharan Africa – 65% of funding for orphan support is for southern Africa • Diseases AIDS: 35% of Global Fund financing for ART is for southern Africa Malaria: $1.5 billion approved for 19 African countries that account for 90% of malaria burden in Africa TB: More than $1 billion approved for 22 high burden countries that account for 80% of global TB incidence
  28. 28. 0 2,2001,100 Kilometers ´ No Global Fund grants Global Fund grant, with financing of harm reduction e.g. Global Fund support to harm reduction programmes Reaching the vulnerable
  29. 29. 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6 2.8 3.0 end 2002 end 2003 end 2004 end 2005 end 2006 end 2007 PeoplereceivingARVtherapy(inMillions) North Africa and the Middle East Europe and Central Asia East, South and South-East Asia Latin America and the Caribbean Sub-Saharan Africa Global Fund supported programs Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007
  30. 30. Global Fund results: June 2008 GP/110608/9 Accelerating Results 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Dec-04 Jun-05 Dec-05 Jun-06 Dec-06 Jun-07 Dec-07 Jun-08 ARVsandDOTS(millions) - 5 10 15 20 25 30 35 40 45 50 55 60 ITNs(millions) DOTS ARVs ITNs
  31. 31. AIDS impact: Malawi Initial decline in workplace mortality at Escom (national electricity company) after roll-out of antiretroviral treatment Source: Global Fund
  32. 32. Decline in adult mortality with introduction of ART: Botswana 0 1 2 3 4 5 6 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 RegisteredDeaths(Thousands) 0 10 20 30 40 50 PersonsonARV(Thousands) on ARV Deaths aged 25-54
  33. 33. Increase in TB financing and new sputum positive cases detected and treated 0.5M 41M 107M 127M 196M 276M 1.4M 0.6M0.38M 1.9M - 50,000,000 100,000,000 150,000,000 200,000,000 250,000,000 300,000,000 2002 2003 2004 2005 2006 2007 Annualamountdisbursed (inUS$) - 500,000 1,000,000 1,500,000 2,000,000 NewSS+casestreatedunder DOTS(annual) Amount disbursed (US$) New SS+ cases treated under DOTS
  34. 34. 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 Jan-01 Feb-01 Mar-01 Apr-01 May-01 Jun-01 Jul-01 Aug-01 Sep-01 Oct-01 Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Month Malariain-patientandout-patientlaboratory-confirmed cases 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Non-malariain-patientcases Malaria in-patient cases Out-patient confirmed cases Non-malaria in-patient cases Interventions Incidence↓~64% 20042001 2002 2003 2005 20072006 Declining malaria in health facilities after scale-up of bed nets and anti-malaria treatment: Rwanda, 2001-2007 WHO national database
  35. 35. Impact: malaria Tanzania accelerating reduction of child mortality (MDG 4 & 6) Masanja et al, Lancet, 2008 Interventions: ITNs and malaria treatment with integrated management of childhood illness MDG targets
  36. 36. Addressing health systems challenges • Human resources • Procurement systems for drugs and health commodities • Infrastructure • Laboratory equipment • Monitoring and evaluation systems
  37. 37. Direct funding of health systems through Global Fund grants Health Systems 35% Administration 10%Other 10% Commodities, Products, Drugs 45% Infrastructure and Equipment 9% Monitoring and Evaluation 3% Human Resources 23% Direct Funding of Health Systems through GF Grants (2007) • Estimates from Global Fund Rounds 2- 7 proposals • 100% = $5.2 billion USD
  38. 38. • Direct funding of health systems through disease interventions (approximately $945 million for Round 8; more than $4 billion overall) • Health systems support across more than one disease – $186 million approved in Round 7 – $ 290 million approved in Round 8 (health workforce, information systems, supply chain management, community service delivery) • Expanding health system capacity - Non-government actors (NGOs, FBOs, communities, private sector, people living with the diseases) are recipients of 50% of Global Fund funding - Dual track financing • Majority of Round 8 proposals included community systems strengthening The Global Fund and health systems strengthening
  39. 39. Human resources • Increasing the number of health workers – Salaries for health workers & community health workers – Salary top-up • Training (96% of grants have a training component) • Saving lives of health workers to return to work • Reducing AIDS, TB and malaria burden so that health workers can focus on other health needs
  40. 40. Mukoma Health Centre, Rwanda (Source: PEPFAR) Infrastructure: Support for renovation of existing health centres *Photo courtesy of FHI
  41. 41. Laboratory strengthening • 67% of TB grants included laboratory strengthening Examples: • Chad: Newly equipped laboratories • Philippines: Training in sputum microscopy (public and private) • Yemen, Sri Lanka: New laboratories established
  42. 42. Outline (4) • Globalization has contributed to poverty reduction in developing countries; however there are also growing inequities • Health has become a key focus of international action to address such inequities between the global north and south • The Global Fund is an innovative instrument for helping to reduce global health inequities • Significant challenges remain to sustain global health efforts
  43. 43. Resource needs for AIDS, TB and malaria (2009 to 2015) Estimated resource needs 0 10 20 30 40 50 60 2009 2010 2011 2012 2013 2014 2015 US$bn HIV/AIDS TB Malaria Sources: UNAIDS, STB, RBM
  44. 44. Total ODA commitments, all sectors, 2001-2006 $90.6 $98.3 $121.8 $120.9 $55.4 $64.8 2001 2002 2003 2004 2005 2006 Note: Amounts in gross US$ commitments. Source: Analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS) during the period June 13-17, 2008. US$ Billions
  45. 45. Resources: increasing both availability and demand $ US billion Available resources Demand Estimated Need Available resources and demand Estimated Need
  46. 46. 2137 1853 2512 3298 2519 2398 5791 860 968 847 726 1119 3059 620 0 1000 2000 3000 4000 5000 6000 7000 Round 2 Round 3 Round 4 Round 5 Round 6 Round 7 Round 8 Millions,US$ Phase 1 request, million US$ Phase 1 upper ceiling request for TRP recommended proposals, million US$ Global Fund requested and approved 2-year funding (Rounds 2 – 8) 40% 34% 39% 22% 34% 47% 53% Approval rate
  47. 47. Sustainability: more than resources alone • Increased and more predictable resources (domestic, external, further innovation) • Build demand for resources • Address health systems challenges • Promote evidence-based interventions effectively targeted to those in need • Promote human rights • Strengthen social protection • Strengthen global and local partnerships • Learn and apply lessons: research and evaluation
  48. 48. Increasing Coverage of Health Care in Rwanda 300,0007,800 900,000 3 million 1,3 million 2 million 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000 Private health insurance Civil servants/M ilitary Genocide survivors, prisoners Community health insurance (398 mutuelles) Numberofbeneficiaries Global Fund subsidy Global Fund co- finance subsidy Out-of-pocket and/or Government subsidy 44% 40% 35% 72% 49% 43% 0% 20% 40% 60% 80% Population coverage with health insurance Population with at least one consultation in health center Utilization rate of district hospitals 2005 2006 Improving Access to Health CareScaling up Health Insurance
  49. 49. Strengthening partnership • Global and local • Harmonization and alignment Paris, Accra, IHP • UNAIDS • WHO • World Bank • UNICEF • Stop TB • Roll Back Malaria • Bilaterals • GAVI • Civil society • Private sector
  50. 50. • Organizational efficiency • Effectiveness of the Global Fund as a partnership • Impact studies in 16 countries Study areas of the 5-year evaluation of the Global Fund (2008)

×