Friends on the Frontline First Quarter 2014

Impressive progress, more forward motion

A Message from Deb Derrick, President of Friends of the Global Fight

Momentum around the Global Fund to Fight AIDS, Tuberculosis and Malaria’s work continues. As we told you in December, an unprecedented $12 billion was pledged at the Fourth Voluntary Replenishment in December, kicking off the three-year, rolling resource mobilization effort. Since that time, the Global Fund has received $200 million more in pledges with ongoing outreach to governments, the private sector, individual donors and implementing countries continuing to take place.

Now, with the first quarter of 2014 in the rearview mirror, we are excited to see the realization of planning to get this funding out to the field and saving lives.

Specifically, the Global Fund held its 31st board meeting at the beginning of this month. Board members had an opportunity to visit Global Fund sites — one of which I spoke about in a recent Impatient Optimist blog post — and the trip allowed me to see the adoption of a number of new policies designed to extend and improve the impact of the Global Fund’s work.

  • Changes were made to the Comprehensive Funding Policy, which will allow for greater predictability of financial assets and will enable reserve funds to be allocated to country programs on the ground, saving more lives. Allocations were also approved for bands of implementing countries.
  • A good deal of the agenda focused on the rollout of the New Funding Model. In total, $16 billion is expected to be made available for new Global Fund-supported programs between 2014 and 2016, which is a 20 percent increase in disbursement funding from that of the previous four years. This continues an upward trend: grant disbursements increased from $2.6 billion in 2011 to $3.3 billion in 2012, and to an expected $3.9 billion in 2013, meaning that more money will get to those who need it more quickly. As I like to say, the Global Fund is, without question, a “growth industry.”

As always, the opportunity to see the Global Fund’s work firsthand and to hear about the progress being made left me energized and enthusiastic about the work being done to fight HIV/AIDS, tuberculosis and malaria.

A View from the Hill 

This quarter has marked several significant activities and announcements here in Washington:

On Feb. 12, Friends joined U.S. global health partners to pen a letter to President Obama ahead of his budget proposal for Fiscal Year 2015. In it, the request was made for his continued support to the Global Fund and to prioritize U.S. investments in the Presidents Emergency Plan for AIDS Relief, the President’s Malaria Initiative and bilateral tuberculosis programs, increasing them above the FY 2014 baseline. Additionally, it was requested that any decrease in funding from the FY 2014 Global Fund baseline of $1.65 billion be used to increase funding for other global health accounts dedicated AIDS, tuberculosis and malaria.

Three weeks later, President Obama released his budget proposal, requesting $1.35 billion for the Global Fund plus an additional $300 million increase through the new Opportunity, Growth and Security Initiative, if enacted by Congress. This level of funding is consistent with the President’s historic commitment in December 2013 to provide $4 billion to the Global Fund between 2014 and 2016, plus an additional $1 billion if other nations and donors match U.S. funding levels on a 2-1 basis.

The Senate Committee on Foreign Relations held a very positive hearing on March 6, on the nomination of Dr. Deborah Birx to becomethe next U.S. Global AIDS Coordinator. Friends and our partners are now eagerly awaiting Dr. Birx’s confirmation. She brings a wealth of scientific, leadership and implementation experience, and we look forward to working with her and continuing strong Global Fund/PEPFAR collaboration under her stewardship.

In mid-March, Friends supported Global Fund Executive Director Dr. Mark Dybul during his visit to Washington. While here, he met with several members of Congress to provide updates on Global Fund operations and the continued progress of 2014 Replenishment; he also thanked them for their continued support. These meetings included a briefing with the House Appropriations State, Foreign Operations and Related Programs Subcommittee and a bipartisan staff briefing with the Senate Foreign Relations Committee and the Health, Education, Labor, and Pensions Committee. In addition to spreading his messages on continued support for the Global Fund, Dr. Dybul took the visit as an opportunity to speak about the need to maintain a robust level of U.S. funding for global health accounts dedicated to AIDS, tuberculosis and malaria, including increased funding for bilateral programs.

Donors Save Lives: Strong political will in Indonesia leads to the development of transition plans for tuberculosis aid

As the Friends team saw firsthand while in Jakarta for the Global Fund’s recent board meeting, Indonesia has experienced significant health improvements in recent years, particularly for tuberculosis.

Indonesia’s tuberculosis program, made possible through strong political and financial commitments to improve the country’s health systems, is an undeniable achievement. In 2011, the country achieved a case detection rate of 70 percent, with treatment successful in 90 percent of cases. Current estimates suggest that the overall tuberculosis mortality rate has dropped by close to 50 percent as compared to 1990.[1] In addition, Indonesia is now ranked fifth on the list of 22 high-burden countries, having previously been ranked third and fourth in years past.

In 2012, 66 percent of all funding for Indonesia’s National Tuberculosis Program (NTP) came from the Global Fund. Continued investment is necessary in this high disease burden country, which has been included in the “High-Impact Asia” portfolio of countries where the Global Fund and partners believe they can have the greatest impact.

That said, the country is taking an increased ownership role with respect to the health of its citizens. Since taking office in 2004, Indonesia’s President Susilo Bambang Yudhoyono has shown leadership by establishing national health plans and supporting domestic co-investment. The Indonesian government now purchases all first-line drugs to treat drug-sensitive tuberculosis — as well as malaria and HIV/AIDS drugs — and is contributing to the procurement of second-line treatment for multi-drug resistant tuberculosis. Between 2011 and 2012 alone, the central government’s budget for the NTP increased by 19 percent.

Indonesia is well positioned to achieve results as it increasingly takes over financial responsibility for its own programs. The Indonesian Ministry of Health is now developing strategies to gradually and strategically decrease external aid and increase its own resources. A holistic financing approach is in development that will reach across sectors to include insurance, corporate social responsibility initiatives, government funding, efficient allocation and use of existing funding. Of course, this will not happen overnight. Rather, it will be done slowly and thoughtfully with an eye toward maintaining the same level of health coverage in the country.

This approach dovetails with the Global Fund’s new funding model, which focuses on complementing and strengthening existing national health strategies. Through collaboration, multilateral aid will help strengthen the overall performance of Indonesia’s essential health services – like those for tuberculosis – and will help the country’s government identify where it should increase its own health investments.

For more examples of how the Global Fund is supporting countries as they take control of the three diseases, read the Friends Steps Toward Sustainability report.

[1] Fighting Tuberculosis in Indonesia: Ambiya's Story. The Global Fund, April 2013.

Highlights from the Fight

Below are a few resources where you can learn more about the work of Friends of the Global Fight and the opportunities before us to defeat AIDS, tuberculosis and malaria:

  • On Jan. 13, Deb Derrick reflected on the successful launch of the Global Fund’s Fourth Voluntary Replenishment in the Huffington Post.
  • Friends hosted its first webinar of 2014 on Feb. 13. Dr. Christoph Benn, the Global Fund’s Director of External Relations, summarized efforts to date for the Fourth Voluntary Replenishment. In addition, Abigail Moreland, who heads up the new funding model transition team, provided updates and a view of what can be expected as implementation continues.
  • In a February guest blog post for FCAA, Deb Derrick highlighted the Global Fund’s private sector engagement, continued momentum for the Fourth Voluntary Replenishment, and procurement savings.
  • Also in February, scientists made the exciting announcement that, following a similar case last year, a second baby born with HIV seems to have been cured through aggressive drug treatment within 30 hours of birth, providing greater evidence of the treatment’s effectiveness. It is reported that there may be as many as eight more similar cases globally.
  • On March 6 and 7, Friends attended the Global Fund’s 31st Board Meeting in Jakarta, Indonesia. Upon our return, we shared an overview of the meeting’s highlights.
  • Marking World Tuberculosis Day on March 24, Deb Derrick wrote a post for Impatient Optimists, advocating for increased programming awareness and funding based on the Friends team’s recent site visit to a MDR-TB clinic in Jakarta.
  • The Global Fund recently published a helpful video providing an overview of the New Funding Model.

This post was originally published in April 2014.