THE GLOBAL FUND AND ITS ROLE IN THE FIGHT AGAINST TB

1
THE GLOBAL FUND AND ITS ROLE IN THE FIGHT
AGAINST TB
New Delhi, India 24-26 March, 2004
2
Key Facts about the Global Fund

• The Global Fund is a public private partnership.
• The Global Fund is a Financing Mechanism.
• For technical support, the GF relies on partners.
• After roughly 2 years of life, the Global Fund is
  now supporting over 200 programs in 121 countries
  with 2-year commitments worth over 2 billion USD

3
The Global Funds Guiding Principles

• Country-driven interventions
• The GF does not prescribe countries propose
  their own interventions
• Facilitator of technical support
• The GF builds relationships with partners to help
  countries plan and implement their work (this is
  why were here)
• We insist on transparency and inclusion
• Proposals are submitted by multisectorial
  partnerships (CCMs)
• Move large sums of money quickly and efficiently
• Performance-based disbursement
• Poverty and disease-based support
• Eligibility based on poverty and burden of
  disease
• Only technically sound proposals are financed
• Eligibility based on poverty and burden of
  disease

4
Global distribution of GF commitments over two
years By geography and disease, after 3
financing rounds
By geography USD, 100 2,116 million
South East Asia
LAC
11
12
Africa
4
East Med
Africa
58
8
Europe and Central Asia
7
Western Pacific
5
The GF has become the largest international donor
in TB New funds announced for TB control in 22
high-burden countries (HBCs) between March 2002
and July 2003 (02 to 05 timeframe)
Total US 304 million
Global Fund
World Bank
Others
189
66
49
Source STOP TB, WHO
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GF fills a significant part of the TB resource gap
Source STOP TB, WHO
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How can the Global Fund help?

• Type of Gap
• Financing for TB control inputs as identified by
  national programs
• Financing for technical support
• Financing for strengthening health systems (i.e.
  infra-
• structure, staff)

8
Tuberculosis specific distribution by region
Percentage of funds
Tuberculosis 100 US 346 million
Eastern Europe
Latin America
Africa
Asia, Middle East North Africa
Funds from HIV/TB components are divided
evenly between HIV/AIDS and Tuberculosis totals
funds from Integrated components are divided
evenly across HIV/AIDS, Tuberculosis and Malaria
totals
9
Tuberculosis coverage after three rounds of
Proposals
Afghanistan (integrated) Kyrgyzstan Moldova
(HIV/TB) Romania Russian Federation Serbia Tajikis
tan
Bangladesh Cambodia China East Timor India Indones
ia Korea, DPR Laos Mongolia Myanmar Philippines Sr
i Lanka Thailand Vietnam
Benin Cameroon Chad Congo (Dem Rep) Côte
dIvoire Ethiopia Ghana Guinea-Bissau Kenya Lesoth
o Liberia Mauritania Mozambique Namibia Rwanda
(HIV/TB) Sierre Leone Somalia South Africa
(HIV/TB) Sudan Swaziland Tanzania Togo Uganda Zamb
ia
Bolivia Dominican Republic El Salvador Haïti Hondu
ras Nicaragua Panama Paraguay Peru
Includes Cook Islands, Federated States of
Micronesia, Fiji, Kirbati, Niue, Palau, Samoa,
Solomon Islands, Tonga, Tuvalu, Vanuatu
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35 grants have been signed and disbursements made
to 23 of those for a total of 44.3 million
Disbursements through 29 February, 2004, one
or more disbursements have been made to 23 of 55
TB grants, 1 of 2 Integrated and 3 of 7 HIV/TB
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Case Study Consolidation of DOTS and DOTS-Plus
in Peru

• DOTS in marginalized communities
• Goal Decrease the incidence in high-risk
  areas from 285/100K to under 150
• No drugs (these are provided by the state)
• Will require training of health teams and
  upgrading facilities
• Significant community participation breeds an
  army of volunteers trained in DOTS

• DOTS expansion in prisons
• Goal Decrease the incidence from 2,364 per 100K
  inmates to under 1,000
• Treatment with both first and second line drugs
• Major interfaces with HIV/AIDS treatment

• Massive treatment of MDR-TB
• Goal Extend coverage of DOTS-Plus from 45 to
  85
• 2000 new second-line treatments within two
  years
• Will produce the largest single purchases by GLC
  to date
• Will require robust drug management systems

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Projected program outcomes Tuberculosis
treatment with DOTS
Thousands of successfully treated smear positive
cases (over proposal lifetime)
757
2,830
734
1,340
Total DOTS treatments provided by all approved
programs
DOTS treatments financed with Round 1 funds
DOTS treatments financed with Round 3 funds
DOTS treatments financed with Round 2 funds
WHO estimates DOTS coverage in 2000 was 834,000
persons
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Projected program outcomes MDR-TB treatment
with DOTS
Cumulative number of MDR-TB treatments provided
(over proposal lifetime)
Increase relative to current coverage
1,800
11,900
3x
5,800
350
4,000
Treatments finance with Round 2 funds
Treatments finance with Round 3 funds
Total treatments financed through Global Fund
with GLC mechanism
Treatments to date with GLC
Treatments finance with Round 1 funds
Rounds 1-2 figures based on drug purchase
approval by the Green Light Committee (GLC),
consistent with Board policy on procurement of
MDR-TB medicines. Round 3 figures subject to
change based on GLC applications and approvals.
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Intensified Support and Action Countries (ISAC)
An example of potential cooperation with a key
partner

• What is ISAC?
• A special emergency initiative to accelerate DOTS
  expansion under the leadership of the DOTS
  Expansion Working Group (DEWG) to reach the 2005
  targets within the Global Plan to Stop TB, and
  ultimately, the 2010 mortality / prevalence
  reduction targets and the 2015 MDGs

• Why ISAC?
• To maximise the potential of unprecedented
  available funding and political will for TB
  control
• Opportunity to strengthen technical support and
  facilitate presence of DEWG and other partners in
  priority countries
• A chance to speed up DOTS expansion while
  involving all care providers (even those not
  included in the DOTS system)
• To ensure proper management of GF resources at
  country level

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ISAC Objectives

• To identify countries for immediate acceleration
  of TB control efforts
• Countries where
• there is an urgent need for DOTS expansion and/or
  consolidation,
• there is a very significant number of TB cases
  and high incidence rates
• maximum impact is likely to be attained through a
  variety of interventions
• Actively and intensively support such countries
  to achieve the 2005, 2010 and 2015 targets

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ISAC - Countries

• India (already ISAC)
• China
• Indonesia
• Kenya
• Pakistan
• Romania
• Russian Federation
• Uganda
• Peru
• planed but not yet confirmed

A second list of countries is currently being
discussed
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Population in India covered under DOTS and total
TB patients put on treatment each quarter
237,256
In 2003, a globally significant cohort of
900,000 TB patients initiated on DOTS
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Key Clarifications from the Global Fund side

• ISAC is an EXTRAORDINARY and ADDITIONAL effort
  to accelerate TB control
• The GF supports ISAC approach and supports
  country lead decisions to focus financial support
  to ISAC.
• Maintain support to 22 HBCs.

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ISAC Partnership between Stop TB and GF

• A strategic alliance between GFATM and ISAC
  makes sense because
• For the GF It is an opportunity to ensure proper
  tech support for implementation, monitoring and
  evaluation of funded projects
• For DEWG A chance to show that a properly funded
  DEWG is key to achieving results

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ISAC needs more financial support

• Cannot rely solely on the GF, other donors have
  to join
• There is still a significant funding gap for
  technical work in countries and for DOTS-related
  interventions
• Need for immediate resource mobilization to
  start intensified technical assistance and
  other necessary support

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ISAC - Budget Requirements
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What Next

• Increase donor support to ISAC
• Accelerate on-going grants to ISAC
• Speed up Phase II renewal
• Finance Technical Support
• Provide treatment
• Work through CCM and other partners to submit
  technically sound Round 4 proposals.