UNITAID Operations report to EB13


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  • Update
  • Additional US$29 million was approved by the Board of the extension of PMTCT 1, which is not included in this amount as the signature of the MoU is pending. UNICEF have developed the Mother Baby Pack which will be rolled as of the 29 th October of this year in Lesotho, Zambia, Cameroon and Kenya
  • Recent achievements reported by partners indicate that: 1. ACT treatments: 25.47 million ACTs delivered as of July 2010; additional 4.23 million ACTs expected to be delivered under ACT Scale up by October 2010 . Further 2.06 million people treated as of December 2009 through Round 6. 2. A2S2: financial facility for production of target 40 metric tonnes of Artemisia on track 3. 20 million LLINs delivered to countries as of January 2010. This represents the total number expected to be delivered;
  • Update with new TB agreements: As of September 2010, the total value of signed Legal Agreements: US$191,194,254 Update with TB new SIGNED agreement. 3. TOTAL TB Portfolio with SIGNED AGREEMENTS since September 2010 with the value of US$191,194,254 Key achievements in the number of treatments delivered: Pediatric TB: The original target set was 750,176 patient treatments to be delivered by 2011. Since 2007 813,294 treatments were achieved, or 63.000 above the target (June 2010). First Line: 785,080 treatments delivered since 2007 MDR-TB: ~ 407 treatments delivered first 6 months of 2010 (since 2007 3,499 ). Project has achieved 61% of its treatment target for 2012.
  • Transversals include crosscutting investments in the 3 diseases. Three projects fall into this category: Prequalification of diagnostics, Prequalification of Medicines and Global Fund Round 6 support. Of the US$ 93 million support allocated to transversals, 92% of funds go to 2 projects: 1) Prequalification of Medicines Programme and 2) Global Fund Round 6
  • This is the same repartition of funds, by country, as presented to EB12 and is in line with the UNITAID constitution requirement.
  • 1. Top ranking DALY country (by numbers, not rates) is South Africa which opted out from the Pediatric and Second Line ARV projects at the beginning of UNITAID's support for the CHAI programs.
  • Top ranking DALY country (by numbers, not rates) is Nigeria, followed by DRC, Ethiopia, Tanzania and Uganda. AMFm expenditures are not yet allocated to countries so this picture will improve once AMfM rolls out.
  • Top TB DALYS are India, China, Indonesia, (Nigeria), (Bangladesh), Pakistan, Ethiopia, South Africa, Philippines. Countries need to have GLC or TRC approval to have treatments assigned to them. The UNITAID funding picture will look much better with the start of the Expand Diagnostics Project which includes large amount of spending in India, the highest TB burden country.
  • PMTCT and TB Paediatric: Project plans are being developed by partners TB SRF: Assessment by the Secretariat being finalized ESTHER: Phase I country assessment have been finalized, and project plan and agreement being elaborated.
  • HIV/AIDS Pediatric ARV transition is expected to occur in the period of 2011 and 2012. Out o f 40 countries in 2010, 27 countries will remain in 2011 and 16 countries in 2012. Second Line ARV transition is ongoing since 2010, and expected to be concluded in 2012. Out of 25 countries in 2009, 19 countries are currently (2010) part of the project. PMTCT: Bridge funding has been approved by EB12 to extend the support to 7 countries for 12 months TUBERCULOSIS First Line TB: All country deliveries have been completed. 18 of the 19 countries have successfully transitioned to alternative sources of funding. Since 2009 the project was extended to facilitate that countries have access to the Strategic Rotating Stockpile (SRS) . The SRS is in it sunset period as the Project lifecycle ends in December 2011. 1 country, Cote d'Ivoire is expected to transition to the Global Fund by the end of 2010. Peds TB: Phase out of UNITAID support -, 3 countries have concluded their UNITAID funded support and have been able to identify an alternate source of funding whilst using the GDF Direct Procurement service to sustain the gains (and continuity of treatments) achieved through UNITAID investment in this nascent market. MDR TB SRS : Project is due to end 2011. The partner has requested an extension until 2016 which is currently being assessed by the Secretariat. MDR TB Scale Up (project due to end 2012: 3 of the 17 countries have completed their UNITAID's grant and have transitioned to alternative sources of funding (Global Fund), whilst an additional 4 of the remaining countries have achieved 75% of their patient treatment target and are seeking alternative funding sources (mainly from the GF). Other countries have applied for Global Fund Round 10, and outcome will be known in December. MDR TB Diagnostics (project due to end 2013): The Project has started implementing a phase out of UNITAID's financing through discussions with the respective MoH. Transition is built into the project plan. MALARIA Ongoing malaria projects are time-limited interventions and transition has not been raised as an issue. CROSSCUTTING Round 6 UNITAID is funding treatments for 42 Global Fund grants under Round 6 Phase 1 (HIV/AIDS, TB and malaria). Continuation/exit strategy depends on the GF architecture which includes Phase 2, Rolling Continuation Channel and new funding Rounds. Prequalification of Medicines and Diagnostics are multi-year agreements, and support beyond their termination in 2012/2013. (Support to the Prequalification Medicines and diagnostics will be provided in accordance to the UNITAID constitution).
  • PSC and Board can expect updates following this schedule for validation of UNITAID's statistics related to partner project implementation. I. Project reporting cycle for UNITAID Partners report to UNITAID twice a year, semi annual and annual reports. Project cycles are being aligned now so that all partners report on a calendar year, from 01 January to 31 December. The calendar year cycle means that Annual Reports from partners are due in March/April for the previous year (i.e. 01 January-31 December 2010 reports will be due in March/April of 2011). The Secretariat assesses the information provided by the partner and verifies whether it is consistent the information with partners' semi-annual reports, order trackers, market intelligence, financial reports and any other information available about the project. UNITAID statistics (trends in treatments, costs, price reductions etc…) are put together, analysed and used in the Annual KPI Report to the Board. The statistics are finalized on 30 June of each year. The final KPI report is released on 30 June of each year. Partner reporting, Secretariat assessment, and KPI data feed into the Market Intelligence system.
  • Reflects estimated second-line patients treated as of 31 December in each year, including first-line patients on tenofovir in Namibia, Uganda and Zambia for 2008 and first-line patients on tenofovir for Uganda and Zambia (only) for 2009. HIV+ Pregnant women receiving ARVs for PMTCT and/or ART (for their own health).
  • When fully distributed, 20 million LLINs will serve an estimated 30 to 40 million people in the beneficiary countries.
  • In this slide it is noted that there the First Line project was mostly implemented in 2008, which resulted in significant increase of treatments followed by a decrease in 2009 when less than 10% of the number of treatments were identified. On the other hand the paediatric project significantly nearly doubled the number of treatments in 2009.
  • A2S2: target 2010: 10 metric tones
  • UNITAID Operations report to EB13

    1. 1. Operations and Market Dynamics UPDATES Raquel Child Director MDO
    2. 2. <ul><li>Summary </li></ul><ul><li>A. Portfolio Overview </li></ul><ul><li>B. Projects Updates </li></ul><ul><ul><li>Trends </li></ul></ul><ul><ul><li>D. Market levers </li></ul></ul><ul><ul><li>E. Challenges and Outlook </li></ul></ul>
    3. 3. <ul><li>A. Portfolio Overview </li></ul>
    4. 4. Allocation of Funds by Niche
    6. 6. ALLOCATION OF FUNDS: Malaria
    9. 9. RECIPIENT COUNTRIES INCOME CLASSIFICATION WB Classification 2009 (based on quantities)   LI LMI UMI WB 2009 87.2% 9.6% 3.2%
    10. 10. PRIORITIZED FUNDING: Top 10 UNITAID supported countries-51% of global HIV/AIDS burden (in DALYs, numbers, 2004) DALY rank DALY Rank 12 4 24 2 6 9 3 5 7 11
    11. 11. PRIORITIZED FUNDING: Top 10 UNITAID supported countries-50% of global Malaria burden (in DALYs, numbers, 2004) DALY Rank 19 40 31 13 30 20 11 6 2 1
    12. 12. PRIORITIZED FUNDING: Top 10 UNITAID supported countries-20% of global TB burden (in DALYs, numbers) DALY rank 25 43 15 17 18 27 47 12 4 5
    13. 13. B. Projects Update
    14. 14. EB APPROVAL STATUS Since EB 12 <ul><li>Board Approved Projects </li></ul><ul><li> TB: 1 (Peds TB) </li></ul><ul><li>HIV: 1 (PMTCT1) </li></ul><ul><li>Signed MoUs </li></ul><ul><li>TB: 1 (First Line for India) </li></ul><ul><li>Pending MoUs </li></ul>End November 2,207,486 TB Paediatric 68,737,414 Total Under negotiation 22,232,201 TB SRF 15 December 15,498,374 ESTHER End of November 28,799,353 PMTCT Extension Expected Signature Amount Project
    15. 15. Project completion - End Project completion - Transition Transition Current Portfolio Status HIV/AIDS Paediatric ARV – CHAI Second line ARV – CHAI PMTCT – UNICEF PMTCT – Extension UNICEF PMTCT RUTF component UNICEF Safeguarding availability of ARV treatment - ESTERAID Tuberculosis First line TB - GDF Paediatric TB - GDF MDR TB SRS - GDF MDRTB Scale up – GLC GDF TGF MDR TB diagnostics – GLI FIND GDF Malaria ACT Scale up initiative TGF UNICEF ACT Scale up Burundi and Liberia LLINs – UNICEF AMFm - GFATM Assured Artemisinin Supply - A2S2 i+solutions Cross cutting Round 6 - GFATM PQ Medicines – WHO PQ Diagnostics- WHO Current portfolio 2007 2008 2009 2010 2011 2012 2013
    16. 16. UNITAID Project Reporting Cycle <ul><li>Partner Reporting </li></ul>KPI Report - 30th June each year Consolidation and analysis of partner data <ul><li>Market Intelligence </li></ul><ul><ul><li>Analysis of project impact; </li></ul></ul><ul><ul><li>Setting priorities for the future. </li></ul></ul>OPERATIONS MARKET DYNAMICS UNITAID semi-annual reporting update 31 December <ul><ul><li>Annual (due March April </li></ul></ul><ul><ul><li>12 months) </li></ul></ul><ul><ul><li>Semi-annual (due September – October 6 months) </li></ul></ul>
    17. 17. <ul><li>C. TRENDS in Treatments: </li></ul><ul><li>2007-2009 </li></ul>
    18. 18. Trends in patient treatments
    19. 19. Trends in patient treatments and LLINs
    20. 20. Trends in patient treatments
    21. 21. <ul><ul><li>D. MARKET LEVERS 2010 </li></ul></ul>
    22. 22. MARKET LEVER: ACCESS <ul><li>HIV/AIDS </li></ul><ul><li>Pediatric ARV: 25,836 new children in treatment </li></ul><ul><li>Second-Line ARV cumulative treatments delivered: </li></ul><ul><li>- 63,000 Second-Line </li></ul><ul><li>- 48,000 First Line ARVs </li></ul><ul><li>PMTCT I : 184,170 new treatments </li></ul><ul><li>Malaria </li></ul><ul><li>ACT treatments: 25.5 million ACTs delivered </li></ul><ul><li>A2S2: 16 metric tones of Artemisia produced </li></ul><ul><li>TB </li></ul><ul><li>Pediatric TB: 123,103 treatments delivered </li></ul><ul><li>First Line: 785,050 treatments delivered </li></ul><ul><li>MDR-TB: ~ 407 treatments delivered </li></ul>
    23. 23. MARKET LEVER: AVAILABILITY <ul><li>HIV/AIDS </li></ul><ul><li>Mother-Baby Pack : developed by UNICEF and rolled as of the 29 th October in Kenya, and later in Lesotho, Zambia and Cameroon </li></ul><ul><li>TB </li></ul><ul><li>Pediatrics TB : > 2 suppliers for 3 of 14 product formulations, additional supplier for the key paediatric products </li></ul><ul><li>First-Line : > 4 generic suppliers </li></ul><ul><li>MDR-TB drugs : from 7 to 11 manufacturers, 14 MDR products </li></ul><ul><li>MDR-TB Diagnostics : 2 additional suppliers identified for each category of TB diagnosis </li></ul>
    24. 24. MARKET LEVER: QUALITY <ul><li>25 UNITAID priority formulations prequalified </li></ul><ul><li>- 2010 target: 40 formulations </li></ul><ul><ul><li>15 ARVs </li></ul></ul><ul><ul><li>5 anti-TB </li></ul></ul><ul><ul><li>5 ACTs </li></ul></ul><ul><li>FDC formulations </li></ul><ul><ul><li>TB: First line (EH-400/150 Blister) </li></ul></ul><ul><ul><li>8 out of 9 of the ACTs prequalified since 2007 are FDCs </li></ul></ul><ul><li>6 medicines quality control laboratories were prequalified </li></ul><ul><li>- 2010 target: 4 laboratories </li></ul>
    25. 25. <ul><li>E. CHALLENGES AND OUTLOOK </li></ul>
    26. 26. CHALLENGES <ul><li>Looking for market impact on products of public health importance </li></ul><ul><ul><li>Sustainability of market gains = projects are short term </li></ul></ul><ul><ul><li>Interventions on new and innovative technologies (e.g. malaria RTs, PoC tests, new ARVs) </li></ul></ul><ul><ul><li>Availability of predictable funds </li></ul></ul><ul><ul><li>Monitoring results at country level </li></ul></ul><ul><li>Securing achievements and scaling up , beyond UNITAID support </li></ul><ul><ul><li>Pooled procurement option </li></ul></ul><ul><ul><li>Maintaining interest of manufacturers in low volume products </li></ul></ul><ul><li>Sufficient secretariat capacity to demonstrate UNITAID's results and impact </li></ul>
    27. 27. <ul><li>Implementation of the UNITAID 2010-2012 Strategy </li></ul><ul><ul><li>Organizational approach: </li></ul></ul><ul><ul><ul><li>Full implementation of HR Plan </li></ul></ul></ul><ul><ul><ul><li>Project monitoring data base implemented </li></ul></ul></ul><ul><ul><ul><li>Staff Log frame capacities developed </li></ul></ul></ul><ul><ul><li>Project implementation: </li></ul></ul><ul><ul><ul><li>Funding requirements of ongoing projects (Pediatric HIV/AIDS, Paediatric TB) and new proposals (diagnostics for HIV/AIDS, TB) </li></ul></ul></ul><ul><ul><ul><li>Smooth transition of projects to other sources of funding </li></ul></ul></ul><ul><ul><ul><li>Evaluation of projects: on going process 2010-2011 </li></ul></ul></ul><ul><ul><li>Sustainable impact </li></ul></ul><ul><ul><ul><li>Availability of predictable funds </li></ul></ul></ul><ul><ul><ul><li>Prioritization of project areas </li></ul></ul></ul><ul><ul><li>Demonstrate Value for Money </li></ul></ul><ul><ul><ul><li>Implementation of econometric methods </li></ul></ul></ul><ul><ul><ul><li>Improved project indicators </li></ul></ul></ul>OUTLOOK
    28. 28. <ul><li>E. Market Intelligence Information System </li></ul>
    29. 29. Market Intelligence Database <ul><li>A tool to monitor impact of UNITAID projects </li></ul><ul><ul><li>Monitor treatment markets over time </li></ul></ul><ul><ul><li>Evaluate UNITAID prices against external benchmarks </li></ul></ul><ul><ul><li>Provide strategic information </li></ul></ul><ul><ul><li>Inform decision making </li></ul></ul>A Global Public Good
    30. 30. Market Intelligence <ul><li>ANRS/FIND and Boston University working together on different elements </li></ul><ul><li>MoU currently due to be signed November 2010 </li></ul>
    31. 31. Thank you!