Friends on the Frontline Third Quarter 2014

Investing to Save: Next Steps in the Fight

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

Friends of the Global Fight participated in several important global health events over the last quarter, notably including July’s International AIDS Conference (IAC) in Melbourne, Australia.

Despite the conference’s tragic start, with the downing of the Malaysian air flight carrying several members of our community, there was a strong message of hope and a commitment to winning the HIV/AIDS fight. IAC leaders, including Dr. Deborah Birx, Ambassador of the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR), stressed the need to transition the fight against HIV/AIDS to a more sustainable and targeted approach. Dr. Birx issued a call to action, emphasizing in her presentations that to gain epidemiological control of HIV/AIDS, global health partners must work to do the right things in the right places at the right times. This means providing combination prevention methods and holistic services; targeting neglected, hard-to-reach and highly vulnerable populations; strengthening health systems; focusing on the highest burden regions and countries; and performing such interventions earlier and more effectively.

I also had the opportunity to attend the United Nations General Assembly (UNGA) this past week in New York, where Secretary of State John Kerry gave a rousing speech, praising the contributions that the United States has made through PEPFAR and the Global Fund, and the incredible global progress that has been made against HIV/AIDS. He encouraged continued — and strategic — efforts in the fight, including support of UNAIDS’ 90-90-90 targets, financial efficiencies, a focus on vulnerable populations such as women and children, and continued investments in countries that are working toward health sustainability. “The United States’ commitment to fighting HIV/AIDS is undiminished, just as our work is unfinished,” he told global health partners. “And our commitment has only been strengthened by the progress that we’ve made, the lives we’ve saved, and the fact that we’ve learned we know what to do.”

At an UNGA side event co-hosted by Kenya and the Global Fund, Kenyan President Uhuru Kenyatta put out a call to low- and middle-income nations, urging them to increase domestic investments in their own health systems. He cited Kenya’s recent efforts to raise domestic financing in the health sector (including $2 million that the country contributed at the launch of the Global Fund’s Fourth Voluntary Replenishment) and its plans to explore trust funds, social insurance mechanisms, public-private partnerships and innovative financing. Along with Global Fund Executive Director, Dr. Mark Dybul, Harvard University Professor Larry Summers also participated in the discussion, encouraging developing nations to contribute proceeds from their economic growth to help close the health gap between poorer and richer nations in what he is called “a grand convergence in health.”

A common refrain emerged from these gatherings — in order to move forward in the fight against HIV, tuberculosis and malaria, implementing countries must increase their domestic investments and build innovative financing mechanisms; and global health leaders such as the Global Fund must direct investments more strategically, collaborating with partners to increase financial efficiencies through new procurement mechanisms that save money and help to prevent drug diversion and fraud, and must increase focus on interventions to benefit key populations at high risk for the diseases.

In addition to these events, there are some key updates from the Global Fund:

  • In July, the organization announced strong gains against the diseases through its mid-year results.
  • Also in July, the government of Germany increased its pledge to the Global Fund by more than 20 percent to €245 million (approximately $334 million) for 2014, reaffirming a strong commitment to global health and unlocking about $30 million in additional funds from the United States.
  • Just this week, the Global Fund announced an additional pledge of €500,000 by Luxembourg to the Global Fund for 2014, adding to its earlier pledge of €2.5 million and unlocking more contributions from the United States and the United Kingdom.
  • Throughout the summer and fall, implementing countries have been submitting concept notes to the Global Fund that reflect greater participation by key affected populations and steadily increasing in-country investments through a willingness-to-pay provision, which has already boosted implementing countries’ investments in health by approximately $850 million.

I look forward to a very busy final quarter of 2014. This includes Friends of the Global Fight’s upcoming 10th anniversary event on Dec. 2 in Washington, D.C., where we’ll commemorate our collective successes in fighting the HIV/AIDS epidemic globally. As we prepare to honor the advocates who contributed to the world’s enormous and impressive gains against the disease, we will simultaneously maintain our focus on efforts to defeat not only AIDS, but also tuberculosis and malaria once and for all.

A View from the Hill 

Friends of the Global Fight and other global health advocates are engaged in two simultaneous budget discussions here in Washington, D.C. We are monitoring the FY 2015 appropriations bills and continuing resolution(s), and engaging on the Administration’s development of its FY 2016 budget. As part of these efforts, we are working with partners, like InterAction and the Global AIDS Policy Partnership, to help maximize funding for AIDS, tuberculosis, malaria and the Global Fund.

Our biggest effort in September was arranging and preparing for a trip to Washington, D.C., by the Executive Director of the Global Fund, Dr. Mark Dybul. Included was a Capitol Hill briefing that Friends arranged with the American Enterprise Institute on “Saving lives through innovative solutions: What’s being done to secure and protect U.S. government investments in fighting AIDS, TB and Malaria?”The event provided information to Capitol Hill on recent efforts by the Global Fund, the President’s Malaria Initiative (PMI) and the Office of the Global AIDS Coordinator to improve procurement processes, save money, and improve the quality, safety and delivery of lifesaving drugs. Dr. Dybul participated, as did Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator, and Julia Martin, Deputy Global AIDS Coordinator for Program Quality at OGAC.

Throughout his visit to Washington, D.C., Dr. Dybul emphasized advances that the Global Fund has made regarding procurement practices and savings, financial management and quality assurance. He discussed an e-marketplace platform that is being developed by the Global Fund, PEPFAR and the United Kingdom’s Department for International Development (DFID). This will entail an open-sourced, cloud-based system that countries and global health partners will be able to access to order commodities and access pooled-procurement savings. He also focused on the increased domestic buy-in of low- to middle-income countries. In so doing, he referenced African countries like Kenya, Nigeria and Tanzania, where leaders are acknowledging that domestic resources must increase as external aid declines, and Asian countries like Indonesia and Vietnam, where trust funds for health have been established. Similar mechanisms are expected to come out of Nigeria and South Africa in the future, he said.

Donors Save Lives: Political Will Drives Turnaround in South Africa’s AIDS Response

South Africa has the largest HIV epidemic in the world, with a prevalence rate of 17.3 percent. The country also suffers from a high incidence of tuberculosis, largely due to cases of co-infection. Prior to 2008, the South African government seemed to be in a state of denial -questioning the causes of the disease in ways that were, at best, unproductive and, at worst, dangerous.

Between 2002 and 2008, the Global Fund and PEPFAR provided substantial resources to address the crisis, allocating support to critical interventions that the country’s government was not willing or ready to address. Despite the best efforts of external groups, including the Global Fund, little progress was made.

The situation changed in 2008 with incoming President Jacob Zuma and his Minister of Health, Aaron Motsoaledi. Within a year, a series of reforms designed to prevent HIV and tuberculosis infections were announced. By the end of 2011, the country also unveiled a National Strategic Plan for these diseases. South Africa’s commitment to fighting HIV/AIDS and tuberculosis in the past several years has led to sizeable results — AIDS-related mortality has gone from 257,000 deaths in 2005 to 194,000 in 2010. The financial responsibility has also shifted, with the South African government now covering more than 70 percent of the national HIV/AIDS expenditures.

The government has set very aggressive short- and long-term targets. There is commitment at the highest levels of leadership to achieving a 20-year vision of zero new HIV and tuberculosis infections, zero preventable deaths and zero discrimination associated with the diseases. Although the fight is not over in South Africa, the country — with its strong commitment and increasing level of domestic financing, along with help from external organizations like the Global Fund — is paving the way for an AIDS-free generation.

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

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:

  • Upcoming: Please join Friends for our Oct. 7 webinar, entitled “Maximizing the Impact of Global Fund Investments by Improving the Health of Women & Children.” Friends President Deb Derrick will be joined by Dr. Viviana Mangiaterra, Senior Technical Coordinator for Maternal, Newborn and Child Health and Health System Strengthening at the Global Fund.
  • In advance of the United Nations General Assembly the week of Sept. 22, Friends interviewed Shu-Shu Tekle-Haimanot, Senior Specialist on Advocacy and Partnerships at the Global Fund, about progress in domestic financing for health among implementing countries.
  • On Sept. 18, Science Speaks reported on the Friends and AEI co-hosted event, “Saving Lives Through Innovative Solutions: What’s Being Done to Secure and Protect U.S. Investments in Fighting AIDS, Tuberculosis and Malaria?”
  • In the first of a two-part series in the Health Affairs Blog on Aug. 25, Friends President Deb Derrick and Peter Yeo, the UN Foundation’s Vice President of Public Policy and Advocacy, highlight partnership and progress in achieving Millennium Development Goal 6 — combatting HIV/AIDS, malaria and other diseases.
  • In August, Friends interviewed Silvio Martinelli, the Global Fund’s Regional Manager for Latin America and the Caribbean, who provided an overview of the Mesoamerica and Hispaniola Regional initiative to be malaria-free by 2025.
  • In the Lancet Global Health Blog on Aug. 8, Deb Derrick discussed the Global Fund’s commitment to addressing the social, legal, cultural and biological issues that underpin gender inequality and contribute to poor health outcomes.
  • Also in August, Friends sat down with Kate Dodson, Vice-President of Global Health for the United Nations Foundation, to discuss the 500 day milestone to reaching the UN’s Millennium Development Goals.
  • On Aug. 6, as President Barack Obama hosted the first ever U.S.-Africa Leaders Summit in Washington, D.C., Deb Derrick wrote a piece in Huffington Post on African countries’ expanded investments in health.
  • In Skoll World Forum on July 29, Deb Derrick highlighted how the Global Fund’s procurement approach extracts more value for money and fosters a healthy marketplace for lifesaving commodities.
  • On July 3, The Council on Foreign Relations 2014 Global Governance report card commended the Global Fund for changes made under the new funding model. CFR also applauded the Global Fund for what it deemed “a highly successful” Fourth Voluntary Replenishment Conference in December 2013.

This post was originally published in October 2014.