1. The Global Fund to Fight AIDS, Tuberculosis and Malaria: Results and Innovation in Development Cooperation for Health Silvia Ferazzi Manager, Donor Governments Team Action for Global Health Conference “Health Warning: Health MDGs and ODA” Madrid, 26th and 27th May 2008

2. Contents The Global Fund in the health and development scene Contribution of the Global Fund to aid effectiveness Funding scenarios and policy developments

3. 2000July Sept. G8 Okinawa: AIDS, TB and malaria targets Millennium Summit - MDGs 2001April June Abuja Summit of African leaders UNGASS endorsement of need for “global fund” 2002January March April Creation of the Global Fund Monterrey Conference on Financing for Development Report of the WHO Commission on Macroeconomics and Health The Global Fund in a historical context of committment to health and development

4. Buenos Aires The Global Fund is mandated to contribute to achieving the MDGs MDG 1: Eradicate extreme poverty and hunger MDG 2: Achieve universal primary education MDG 3: Promote gender equality and empower women MDG 4: Reduce child mortality MDG 5: Improve maternal health MDG 6: Combat HIV/AIDS, malaria and other diseases MDG 7: Ensure environmental sustainability MDG 8: Build a partnership for development

5. Spend it A core set of principles inform the working framework of the Global Fund BG/100407/1  Focus on financing  Additionality  National ownership  Participation  Performance  Independent review mechanism

6. The Global Fund is a key multilateral funder of health for development  572 grants in 136 countries approved with a value of US$10.7 billion  60% of Global Fund resources committed to AIDS; 15% to TB; 25% to malaria  Over 2/3 of international financing for tuberculosis and malaria; 22% of the international commitment to AIDS  60% per cent of funding to sub-Saharan Africa  93% to support low-income and lower middle income countries  50/50 proportion of government and non-government implementers (principal recipients and sub-recipients)

7. European ODA is the core funding source of Global Fund Pledges and contributions 2002-2010 and beyond: USD 19.5 billion

8. The Global Fund in the health and development scene Contribution of the Global Fund to aid effectiveness Funding scenarios and policy developments

9. Indicators of grant performance show broad coverage and acceleration of results Coverage at end-2006 % increase over 2006 Coverage at end-2007 HIV: People on ARV treatment 770,00088%1,400,000 TB: People treated under DOTS 2,000,00065%3,300,000 Malaria: Insecticide-treated nets distributed 18,000,000175%46,000,000

10. A number of implementing countries show early signs of impact on the MDGs CountryEvidenceInterventions MalariaKenya 61% decline in malaria in children (coastal districts,1999-2006) Mass distribution of bed nets, Treatment Rwanda 64% decline in child malaria cases 66% decline in child malaria deaths (Facility data, 2005-2007) 2.4 million bed nets distributed, Treatment Tanzania50% decline under 5 mortality in some districts 86% decline in malaria cases in Zanzibar Bed nets, Treatment Indoor Spraying, Bed nets, Treatment Zambia90% decline malaria deaths southern provinces, 2001- 5 Bed nets, Treatment Tuberculosis ChinaDeclining TB prevalence, case detection 20%-79%, TB success rate increase to 91% Treatment (DOTS) PhilippinesDecline TB mortality 57 to 47/100,000Treatment (DOTS) LaosDecline TB prevalence 327 to 306/100,000Treatment (DOTS) HIV Malawi44% decline in mortality in workers, community mortality decline in rural district, HIV prevalence decline in youth HIV prevention and treatment EthiopiaHIV prevalence decline 8.6% to 5.6% among ANCHIV prevention and treatment

11. The Global Fund invests in the harmonization and alignment agenda  Global Fund includes participation and harmonization concerns in its model: multi-stakeholder Board and Country Coordinating Mechanisms representing donors, recipients, NGOs, private sector, civil society, people living with diseases  Signatory of the Paris Declaration on aid effectiveness - Self-assesses against Paris principles (Accra process) - Delegated responsibility for global initiatives in measuring follow-up  Actively involved in international harmonization efforts (H8, IHP) Paris Declaration on aid effectiveness SE/290607/1 National Strategy Financing (2009)

12. The Global Fund in the health and development scene Contribution of the Global Fund to aid effectiveness Funding scenarios and policy developments

13. The Global Fund is not contributing yet at full potential to global resource needs

14. The gap between existing resources and funding potential is still huge 3.5 4 4.5 Global Fund expected income

15. Sustaining demand requires mobilization of partnerships and opens new funding windows  Promote alliances and harmonization with partners for capacity building  Respond rapidly and effectively to new threats  Strengthen alignment with national processes and funding of national plans  Reach out to less accessible areas and most vulnerable groups – civil society and communities  Widen window for health system support

16. Support to health systems: 1. Funding components with HS effects

17. Support to health systems: 2. Providing relief to health services ITN scale up ACT treatment

18. Support to health systems: 3. Broadening opportunities – Round 8 Rationale: HSS interventions can be funded when they show clear outcome for the three diseases How to include HSS interventions in a funding proposal:  Cross-cutting interventions through a separate section  Health system component within one or more disease components, or

19. 19 HSS window to support gender mainstreaming  Disaggregated data in the epidemiological background and in the indicators of performance  Gap analysis that allows funding specific gender needs of beneficiaries (e.g. through integration of sexual and reproductive health)

20. HSS window to support community systems 20 Community systems strengthening  Proposals have to include gap analysis highlighting how communities are involved in service delivery  Funding window for community based organizations, including physical infrastructure, organizational needs and partnership opportunities Dual track financing Recommendation for inclusion of both government and non-government actors as Principal Recipients for Global Fund financing