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. 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
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
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. 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. 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. 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. 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. 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. 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
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. 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
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. 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. 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. 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
