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The Global Fund to Fight AIDS, Tuberculosis and Malaria held its two-day 35th Board Meeting on April 26-27, 2016, hosted by the Government of Côte d’Ivoire in Abidjan. Côte d’Ivoire Prime Minister Daniel Kablan Duncan opened the meeting and was joined by the Honorable Raymonde Goudou Coffie, Côte d’Ivoire Minister of Health.
The partnership between the Global Fund, the Government of Côte d’Ivoire, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), France and civil society has saved 160,000 lives in Côte d’Ivoire since 2004. The partnership supports programs to treat and prevent HIV/AIDS, tuberculosis and malaria and to build more resilient and sustainable systems for health. The Global Fund partnership currently supports the following in Côte d’Ivoire: 150,000 people have been put on antiretroviral therapy for treatment of HIV; 83,000 people have received testing and treatment for tuberculosis; and 26 million insecticide-treated nets have been distributed to protect against malaria.
The Board deliberated on important issues, including the Global Fund Strategy for 2017-2022: Investing to End Epidemics; the allocation methodology for 2017-2019; and policies related to sustainability, transition and co-financing, and operating in challenging environments. The Board agreed to a number of key decisions during the 35th Board Meeting, including:
- Global Fund Strategy 2017-2022: Investing to End Epidemics;
- Allocation Methodology 2017-2019;
- Action Plan to Advance Risk Management and Internal Controls;
- 2015 Annual Financial Report & Financial Statements; and
- Policies on Eligibility; Sustainability, Transition and Co-financing; and Challenging Operating Environments;
End It For Good: The Global Fund’s Fifth Replenishment—8 Million Reasons to Invest in Global Health
Later this year, the Global Fund will host its Fifth Voluntary Replenishment Pledging Conference to raise funds for the 2017-2019 funding cycle. The Global Fund is seeking $13 billion, pledged from the public and private sectors, which would enable the Global Fund partnership to save an additional 8 million lives and avert 300 million new infections of HIV, tuberculosis and malaria, as well as advance our shared goal of ending these diseases as epidemics by 2030. The Global Fund forecasts that a $13 billion Replenishment would allow the partnership to achieve the following:
- An additional 8 million lives saved through programs supported by the Global Fund, leading to 30-32 million lives saved cumulatively by 2020;
- Up to 300 million new infections averted across the three diseases;
- Allow the Global Fund to make substantial contributions towards building resilient and sustainable systems for health;
- Support partner countries’ own domestic investments in health programs to fight the three diseases;
- Support strengthened responses for women and girls, key populations and human rights; and
- Lead to broad economic gains of up to $290 billion over the coming years and decades, based on partner estimates.
Update from the Office of the Inspector General
In 2015, the Office of the Inspector General (OIG) celebrated its 10th anniversary as well as one of its most productive years. The OIG’s 2015 Annual Opinion shows a positive trajectory of the Global Fund’s organizational maturity on issues of governance, risk management and internal controls, as demonstrated by the following:
- Twenty-four (24) reports were published in the interests of full transparency and accountability;
- Ninety (90) percent of the OIG Investigations Unit’s 2015 Work Plan and 87 percent of the OIG Audit Unit’s 2015 Work Plan were achieved;
- Fieldwork for all 17 audits in the 2015 Work Plan was completed;
- Sixty (60) investigations were completed and 178 allegations of wrongdoing screened; and
- Eighty-two (82) new Agreed Management Actions were created and 91 were implemented to correct and strengthen the Global Fund.
In response to the OIG’s 2015 Annual Opinion on Governance, Risk Management and Internal Controls, the Global Fund Board acknowledged “that while in-country partnerships are in place and significant initiatives and measures have been implemented to improve programmatic, fiduciary and risk-management processes, immediate and heightened efforts are needed to accelerate progress and advance risk management systems and processes.” The Board directed the Global Fund Secretariat to develop a detailed action plan to advance risk management and internal controls with measurable and time-bound targets, and submit a report on progress to the Board in June 2016.
In 2016, the OIG plans to pursue three main strategic focuses: i) better leveraging knowledge and skills between the audit and investigation functions to exploit synergies and produce more insightful outcomes; ii) bulletproofing its operations through more rigorous management practices and a strong focus on quality through the Quality Assurance and Improvement Program (QAIP) implementation; and iii) having greater impact in its work by improving stakeholder engagement and the depth of OIG products. With a budget of $16.3 million approved for 2016, a fully-staffed OIG, and the above strategic focuses, the OIG has the resources and the independence to continue to be a reliable assurance provider and a catalyst for continuous improvements in the efficiency and effectiveness of the Global Fund in 2016 and beyond.
The Global Fund Strategy 2017-2022: Investing to End Epidemics
The Global Fund Strategy 2017-2022: Investing to End Epidemics (“Strategy”), was developed over a two-year period in 2014 and 2015. The Board’s Strategy, Investment and Impact Committee (SIIC) led a consultative process to collect the strongest ideas, perspectives and guidance to formulate the Strategy. The consultations included three regional Partnership Forums with more than 300 participants from 128 countries, in addition to a 12-week consultation with over 1,200 participants from 143 countries, and dozens of focused meetings and discussions on specific aspects of the new Strategy. The Board-approved Strategy sets a bold agenda for the next six years, 2017-2022. It is based on an ambitious vision, mission and four strategic objectives, which are outlined below:
- Vision: A world free of the burden of AIDS, tuberculosis and malaria with better health for all.
- Mission: To attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria and to support attainment of the Sustainable Development Goals.
- Strategic Objectives (as outlined in the graphic below):
To achieve strategic objective one, maximize impact against HIV, tuberculosis and malaria, the Global Fund partnership will scale up evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and vulnerable populations that are disproportionately affected by the three diseases. To help build resilient and sustainable systems for health (strategic objective two), the Global Fund partnership will work on the following: strengthen global and in-country procurement and supply chain systems; strengthen financial management and oversight; work with implementing country governments to align national health and disease-specific strategies; and leverage critical investments in human resources for health. For objective three, promote and protect human rights and gender equality, the focus will be on scale up of programs focused on women and girls, and to invest in reducing gender- and age-related health disparities, and to remove barriers to access to treatment. Lastly, on objective four, mobilize increased resources, the Global Fund partnership will work to attract additional funding from current and ne
w public and private donors, as well as work with implementing countries to increase domestic resources for health programs and use existing resources more efficiently. Progress on implementation of the Strategy will be tracked through reporting on Key Performance Indicators measured at all levels of the Global Fund partnership. The Global Fund plays a critically important role, and it is imperative that funding is invested for maximum impact, supporting the implementation of programs in the most effective way possible.
The Global Fund Allocation Methodology 2017-2019
At its 34th meeting in November 2015, the Board recognized that the Global Fund’s allocation methodology was successful in shifting the Global Fund toward a more predictable, active and impactful approach to financing, but that aspects of the model require evaluation and potential refinement to deliver on the aims of the 2017-2022 Strategy and further enable differentiated investments along the development continuum. The Board advised that adjustments should strive to ensure greater impact, simplicity, flexibility and predictability, and that any modifications should be considered in a holistic manner to ensure a coherent approach to achieving the aims of the allocation methodology. Thus, the recommended approach for the 2017-2019 allocation period aims to achieve the following: increase impact by directing a greater portion of the funding to countries with the highest disease burden and least economic capacity; retain significant funding for catalytic investments in strategic priorities, including for key and vulnerable populations, women and girls, human rights, multi-country approaches and strategic initiatives; and improve the Global Fund’s ability to flexibly address the needs of countries on a case-by-case basis.
- Country Allocations: This approach seeks to maximize funding through country allocations. It would move significantly more toward the formula-driven financing for countries than the current approach, resulting in a distribution of resources that is increasingly in line with disease burden and country economic capacity. This is based on a major challenge of the 2014-2016 allocation methodology, through which $1.25 billion was set aside for incentive funding, multi-country and strategic initiatives, yet many country allocations were insufficient—at least 10 of the highest burden country components had to shorten grants to maintain efforts against the three diseases, and incentive funding had to be appropriated largely to fill programming gaps. As such, with the exception of up to $800 million for catalytic investments, all funding available will be run through the allocation formula to ensure more robust and predictable country allocations.
- Catalytic Investments: As laid out in the founding principles of the allocation-based funding model, a portion of overall resources may be retained for programs, activities and strategic investments not adequately accommodated through country allocations. This need remains for the 2017-2019 allocation period, in particular to deliver on the 2017-2022 Strategy. The funding for catalytic investments and to ensure scale up, impact and paced reductions is limited to 15 percent of funding available to ensure robust allocations.
Impact modeling conducted to inform the Global Fund’s Investment Case for the upcoming Fifth Replenishment has also been used to estimate the impact of the allocation approaches. The modeling estimates that the recommended country allocation approach would save an additional 38,000 lives and avert an additional 16 million new infections when compared to the current policy approach. A significant number of additional lives saved and infections averted would be anticipated through the critical use of catalytic funds to incentivize and drive country allocations for greater impact.
Focus on Women and Girls
One of the major challenges for the Global Fund and other partners is that adolescent girls and young women are disproportionately vulnerable and at high risk for new HIV infections. Additionally, maternal mortality is the second leading cause of death of girls ages 15-19, and malaria during pregnancy creates further challenges for this population. Adolescent girls and young women also face significant barriers in accessing sexual and reproductive health and rights (SRHR), comprehensive sexuality education (CSE), and general health services. Finally, the global health community has virtually no data – or bad data – on issues that disproportionately affect adolescent girls and young women. The Global Fund previously put forth the Global Fund Gender Equality Strategy (2008) and the Gender Equality Action Plan (2014). The Global Fund is also planning the following additional investments in programs to help protect adolescent girls and young women: integration of HIV and tuberculosis services with reproductive, maternal, newborn, child and adolescent health; HIV prevention for adolescents, young people, female sex workers and transgender women; gender-based violence services; prevention of mother-to-child transmission services; and malaria prevention among pregnant women.
The Global Fund is committed to investing in women and girls through their Strategic Actions to Advance Gender Equality (SAGE) objectives, as outlined below:
- Quality investments across the three diseases addressing gender equality, gender and age related disparities, and health needs of women and girls in all their diversity;
- Scaled-up investments for adolescent girls and young women in 13 sub-Saharan African countries to reduce HIV incidence;
- Data systems that respond to programmatic and investment decision making, including sex and age disaggregated data;
- Strong partnerships with national governments, civil society, communities, technical partners and private sector that will ensure quality and sustainability at country level; and
- Increased capacity to address gender equality in Global Fund-supported countries.
Update on the E-marketplace (Wambo.org)
An update on the e-marketplace was presented to the Board. The objective of the e-marketplace, which is now known as Wambo.org, is to increase the Global Fund’s impact and value for money by streamlining procurement operations, optimizing costs, and supporting countries that are transitioning out of Global Fund financing by facilitating continued access affordable prices for commodities to treat and prevent HIV/AIDS, tuberculosis and malaria. Wambo.org became technically operational on January 26, 2016, marking the start of the phased launch and roll out to Global Fund Principal Recipients (PRs). During phase one, which lasts until mid-2017, the Global Fund aims to provide its PRs with a tool to streamline procurement of products for Global Fund-supported HIV/AIDS, tuberculosis and malaria programs. The Global Fund was pleased to announce to the Board that the first Wambo.org transaction was successfully processed by the National Malaria Program in Bangladesh in mid-February. The second and third orders were processed in Mozambique and Zambia, respectively. The operations have not encountered any major issues, and learnings to further improve future transactions have been identified.
Prior to Wambo.org, PRs of Global Fund financing had to allow up to 21 days to place an order, but this new platform will drastically reduce wait time by giving PRs instantaneous access to comparisons on price, lead time and quantity across suppliers. Data on transactions will be available to PRs immediately, compared to the six-month gap that exists under the current procurement system.
Board Chair Norbert Hauser and Vice Chair Aida Kurtovic closed the meeting by thanking the Board members for their work during the 35th Board Meeting. The next key milestone of 2016 will be the Global Fund’s Fifth Voluntary Replenishment Pledging Conference, which is expected to be held in September 2016 (exact date/time to be confirmed). This will be followed by the 36th Board Meeting on November 16-17, 2016, in Montreux, Switzerland.