URU, Alm.del - 2009-10 - Bilag 158: Baggrundsmateriale fra Global Fund to Fight AIDS, Tuberculosis and Malaria til brug i forbindelse med foretræde den 22. april 2010

by the Global Fund were providing antiretroviral therapy(ART) to 2.5 million people.Approved HIV proposals havetotaled close to uS$ 10.8 billion covering 140 countries.The Global Fund is estimated to have contributed about one-fifth of all disbursements by bi- and multilaterals for theHIV response in low- and middle-income countries in 2008.In addition to providing ART, programs funded by theGlobal Fund have also distributed 1.8 billion male and femalecondoms and have provided 790,000 HIV-positivepregnant women with treatment to prevent mother-to-childtransmission of HIV, as well as 4.5 million basic care andsupport services to orphans and other children made vulner-able by AIDS, and 105 million HIV counseling and testingsessions. There is a growing body of evidence showing thatGlobal Fund financing – alongside that of other financiers– has resulted in declines in AIDS mortality in countries inwhich provision of ART has been scaled up rapidly, accom-panied by other significant impacts, such as improvedsurvival and productivity of key professionals and other work-ers, and systemwide improvements in health care delivery.

Malaria isa public-private partnershipestablished in 2002to mobilize and intensify the international response to threeglobal epidemics and thereby help achieve the MillenniumDevelopment Goals (MDGs). From its founding throughDecember 2009,the Global Fund Board approved propos-als totaling US$ 19.2 billion, and disbursed US$ 10 billionfor HIV, tuberculosis (TB) and malaria control efforts.To maximize impact, every dollar donated goes to fundprograms in country. The Global Fund has no countryoffices, and its operating expenses are almost entirelycovered by the interest earned on the Trustee accountat the World Bank.3.The results and impact outlined in the report arethe

theGlobal Fund have provided treatment to 6 millionpeople who had active TB.The Global Fund provides63 percent of the external financing for TB and multidrug-resistant TB (MDR-TB) control efforts in low- and middle-income countries. Approved TB proposals have totaledclose to uS$ 3.2 billion covering 112 countries, contribut-ing 48 percent of the projected coverage required to achievethe Stop TB Partnership targets for the detection andtreatment of new smear-positive TB cases. TB programssupported by the Global Fund have also provided1.8 million TB/HIV services.In many countries in whichthe Global Fund supports programs, TB prevalenceis declining, as are TB mortality rates.6.Malaria.By the end of 2009,Global Fund-supported

malaria are having a much wider impact – beyond individu-als, their families and communities.They are majorinvestments in health systems– bolstering infrastructure,strengthening laboratories, expanding human resources,augmenting skills and competencies of health workers, anddeveloping and supporting monitoring and evaluation(M&E) activities. These enhancements, in turn, improve thesustainability of services, increase national capacity toexpand programs further and increase countries’ abilityto improve services for other health issues. ultimately,the investments translate into a healthier population andincreased productivity, enabling countries to furthertheir development.10.These investments have helped accelerate progresstowards the MDGsby contributing directly to MDGs 4, 5, 6and 8, and indirectly to the others. The uS$ 19.2 billionof approved investment by the Global Fund is a direct con-tribution to MDG 6 (“Combat HIV/AIDS and malaria andother diseases”). In addition, major contributions have alsobeen made to MDG 4 (on child mortality) and MDG 5(on maternal mortality) by reducing the largest causes ofmortality among women and children. This is particularlythe case in sub-Saharan Africa, where HIV, TB and malariaare responsible for 52 percent of deaths among womenof childbearing age and malaria alone accounts for 16 to18 percent of child deaths.

programs had distributed 104 million insecticide-treatednets (ITNs) to prevent malaria.They also supported indoorresidual spraying of insecticides in dwellings more than19 million times and treated 108 million cases of malaria inaccordance with national treatment guidelines.Approvedmalaria proposals have totaled US$ 5.3 billion covering83 countries.In 2008, the Global Fund contributed57 percent of international disbursements for malariacontrol. Global Fund investments have played a criticalrole in introducing and expanding coverage of novel, effec-tive malaria treatments in many countries where drugresistance to older treatments is high. In conjunction withre-energized national and international efforts to com-bat malaria,increased Global Fund financing is havinga substantial impact on malaria morbidity and mortalityworldwide, with an increasing number of countriesreporting a reduction in malaria deaths of more than50 percent.7.The Global Fund supports community-based interven-

tions.Since 2003, these efforts have delivered 138 millioncommunity outreach prevention services for at least oneof the three diseases and provided 11.3 million “person-episodes” of training for health and community workers.8.These combined efforts saved an estimateddesigned to respond quickly and effectively to the tremen-dous need for funding in the countries with the heaviestburdens of AIDS, TB and malaria, while ensuringtranspar-ency and broad accountability to donors and recipients.This model has continued to evolve, and in 2009 it testednew ways to strengthen country ownership and gover-nance, increase access to lifesaving medicines and otherhealth products, and promote health equity.12.Equitable access to services is fundamental to the4.9 million livesby December 2009 and restored hopefor the 33 million people living with HIV, the hundredsof millions of people who contract malaria or who are atrisk each year, and the 9.4 million who contract activeTB annually. The coming years will see even more results,as half of the total disbursements by the Global Fundwere delivered in 2008 and 2009. Much of the uS$ 5.4 billionof financing approved in Rounds 8 and 9 will reachcountries in 2010 and 2011, and will continue to significantlyboost health outcomes.mission of the Global Fund.In making grants, greatweight is assigned to each country’s needs, as measuredby indicators such as disease burden and poverty level.The Global Fund also works to ensure that the programsit finances address the needs of the poorest, at-risk andmarginalized groups, for instance with itsnew strategieson gender equality and sexual minorities.Further, ithas become the world’s leading funder of harm reductionservices for people who inject drugs, with substantialinvestments in 42 countries.

financing chain is a critical priority for the Global Fund.One of the focus areas is to develop and promote, withpartners, standardized methods for countries to measurethe efficiency and effectiveness of key HIV, TB and malariaservices. The comprehensive performance review whichoccurs by year two of each grant also contributes to valuefor money by allowing for the reallocation of funds frompoorly performing grants to better-performing grants aswell as for the identification of efficiency gains. In 2009alone, nearly uS$ 1 billion was freed up for funding newgrants. Voluntary pooled procurement is reducing the costand improving the quality of pharmaceuticals and healthproducts, and collaboration with technical partners isassessing the efficiency of service delivery models in orderto expand and optimize access to lifesaving interventions.18.Through its portfolio of grants in 144 countries,

of its founders, donors and implementers: it has dramati-cally intensified the fight against HIV, TB and malaria whilecontributing to improving health systems and to progresson achieving the MDGs. Virtual elimination of mother-to-child HIV transmission globally by 2015 can be achieved.Massive scale-up of HIV prevention programs and of provi-sion of ART continues, though universal access to comp-rehensive and evidence-based HIV prevention, treatment,care and support remains distant. Prevalence of TB hassignificantly decreased over the last decade and the inter-national target of halving TB prevalence could be metby 2015. unprecedented coverage with ITNs and effectivenovel treatments have made great inroads in combatingmalaria. The rapid scale-up of prevention, treatment, careand support for these three pandemics has meant hopeand – as the results in this report testify – a positive impacton millions of lives.20. Such unprecedented progress would not have beenpossible without the support of donors and partnerorganizations. In the coming years, continued, substantialincreases in long-term financial commitments by donorswill be needed to consolidate these gains and to reach theMDGs by 2015 and universal coverage of HIV, TB andmalaria services. 2010 is a year that should inspire extraor-dinary commitments from the public and private sectorsto safeguard and build upon the already substantial achieve-ments made over the past decade.

23. Malaria used to be a neglected disease. Today, at leastten of the most endemic countries in Africa have reporteddeclines in new malaria cases and an impressive declinein child mortality of 50 to 80 percent.24. Prevalence of TB was 220 per 100,000 in 2000. Today,the world is on track to meet the international target ofhalving TB prevalence by 2015. TB is being diagnosed muchmore effectively and 6 million additional people havegained access to DOTS (the basic package that underpinsthe Stop TB strategy) with the support of the Global Fund.25. Much more remains to be done, but significant reduc-tions in mortality and suffering, as well as in the economicand social toll these pandemics have inflicted on familiesand societies, have been achieved.26. The world has an extraordinary opportunity to comeclose, reach or even exceed the health-related MDGs – theeight goals that every united Nations member state agreedto pursue in 2000 (see Box 1). Many of the internationaltargets with regard to MDG 6 (Combat HIV/AIDS and malariaand other diseases) could be met, significant progresscould be made on MDGs 4 and 5 (reducing child mortalityand improving maternal health), and the other MDGs couldalso be positively impacted.

health through overseas development assistance andother sources during the past years has begun to changethe trajectory of AIDS, TB and malaria, and more broadly,of the major health problems that low- and middle-incomecountries have been confronted with. The results andemerging signs of impact presented in this report painta hopeful and encouraging picture.22. Ten years ago, virtually no one living with AIDS inlow- and middle-income countries was receiving lifesavingART, although it had been available since 1996 in high-income countries. At the end of 2008, over 4 million peoplehad gained access to AIDS treatment, representing over40 percent of those in need. AIDS mortality has sincedecreased in many high-burden countries. For example,in Ethiopia’s capital, Addis Ababa, the rollout of ART hasled to a decline of about 50 percent in adult AIDS deathsover a period of five years.

27. If the momentum of the last decade is maintained andcountries continue to scale up programs at the current rate,malaria could be eliminated as a public health problem inmost endemic countries and indeed there would be hopefor a world without malaria deaths by 2015. Millions moreHIV infections may be prevented and lives otherwise lostto AIDS saved. The growing threat of MDR-TB may becontained. And it might be possible to virtually eliminatetransmission of HIV from mothers to their children. In theprocess, health systems would be further strengthened sothey can take on the many other health-related challengeslow- and middle-income countries face.28. It is rare in the field of international development tosee such rapid correlation between investment and desiredresults and impact as has been the case in the past years’efforts to fight the three pandemics. Increased internationalinvestments have, with great speed and efficiency, beenturned into health services on the ground, benefitting hun-dreds of millions of people. Despite a lack of facilities,hundreds of thousands of health workers around the worldhave used new resources to save millions of lives.29. The efforts to provide ART for HIV or effectivetreatment for TB and malaria to people in poor and ofteninaccessible areas, to provide insecticide-treated nets(ITNs) to millions of families and to undertake other effortsto prevent the spread of the three diseases are significantfar beyond the health benefits they provide. They have beenuniting the world around a common agenda and human-itarian purpose.

ing”. From its application process to the decisions todisburse money and continue funding at key milestonesof each grant, the measurement and assessment of resultsremains the sole deciding factor.33.Chapter 2 of the full report, “Results and Progresson International Targets”,summarizes the results ofprograms supported by the Global Fund, globally and in theregions in which it funds programs, and highlights thechallenges that remain. The chapter – like the report in gen-eral – summarizes the results achieved by December2009, drawing on analysis that uses the Global Fund’s eval-uation framework on operational and grant performance,system effects and evidence of impact. Chapter 2 alsoaddresses the extent to which the Global Fund contributesto the international effort to respond to HIV, TB andmalaria, showing that soon after its founding, the GlobalFund became the world’s leading multilateral investorin HIV, TB and malaria efforts. It now provides 63 percentof all external financing for TB, 57 percent of externalfunding for malaria, and about one-fifth of all HIV fundingfrom donor countries. The chapter then discusses howGlobal Fund investments to combat HIV, TB and malariahave wider impact by strengthening health systems andcontributing directly to MDGs 4, 5, 6 and 8, and indirectlyto the other MDGs; it examines some of the results of theGlobal Fund’s performance-based funding model and itdescribes a variety of approaches the Global Fund employsto achieve greater equity in access to health services,and to improve health outcomes where inequities persist.

34. The Global Fund closely tracks the results flowing fromits direct investments in 144 countries – but also the resultsand signs of impact of the national programs it supports.The results and impact presented in Chapter 2 of the reportdo not in any way claim to represent a full picture ofprogress in health over the past few years. However, theydemonstrate the changes and improvements global healthinvestments are achieving.35. The Global Fund is a partnership in the fullest sense.Its success relies on the financial pledges of donors, thetechnical guidance of – and collaboration with – multilateralpartners, and particularly the management and implemen-tation of programs by in-country partners including govern-ments, civil society organizations and the private sector.Whenever “the Global Fund” is mentioned in this report, thisshould therefore be read as including the collective effortsof all partners who together provide resources and turn theminto services on the ground.All partners should take fullcredit for their role in making these services possible.36.Chapter 3, “Improving Effectiveness”shows how thescale and nature of its work as a global financial institutionhave enabled the Global Fund to position itself as a keypartner of other agencies working towards effective invest-ment in health and development. The Global Fund is asignatory of the Paris Declaration on Aid Effectiveness, andworks in close collaboration with countries and partneragencies to promote the Declaration’s principles of owner-ship, harmonization, alignment, managing for results andmutual accountability. The chapter describes a number ofinitiatives taken by the Global Fund in 2009 to improveaid effectiveness and to increase value for money at everystage of the financing chain, including by instituting sys-tems to increase value for money by cost-benefit analysesof the Global Fund’s investments in key interventions.37.Chapter 4, “learning and Innovating”,shows howthe Global Fund, taking advantage of the rich experiencesand lessons learned through its investments in everypart of the world, constantly learns, evolves, undertakesnew initiatives and innovates, ensuring that it can respondquickly to demand and to the changing health and develop-ment challenges. The chapter summarizes how the GlobalFund is responding to the results of the Five-year Evalu-ation that were reported to the Global Fund’s Board in 2009.It then describes some of the initiatives and innovationsthe Global Fund has undertaken since it was established,with a focus on initiatives that started or were approvedin 2009, including the move to a new grant architecturethat will establish a single stream of funding per PrincipalRecipient per disease.

THE wAY FORwARD38. This report should inspire hope, but first and foremostit should inspire every sector of society – public and private– and every individual to make a commitment to continuescaling up the response to HIV, TB and malaria, to safeguardand continue building upon the substantial achievementsalready made.39. In recent years, the world has made remarkableprogress in many areas of global public health. In particular,there are signs of a dramatic turnaround in the fightagainst AIDS, TB and malaria.The coming years will doubt-less seeeven more positive results and greater impact,given the recent intensification of efforts – more than halfof all the services financed by the Global Fund so farwere delivered in 2008 and 2009 and are only just nowstarting to show results in terms of lives saved and infec-tions averted.

CONClUSION40.The global effort to fight AIDS, TB and malaria hasa wider impact and benefits everyone.The three diseasesare directly responsible for enormous burdens of deathand disability, but they also have major repercussions forhuman development and society. Global Fund programscontribute substantially to the achievement of the MDGs.The MDG 6 targets for combating HIV, malaria and otherdiseases can be met, and some can even be exceeded,if progress is allowed to continue at the current rate.Malariacan be eliminated as a public health problem in mostendemic countries, the growing threat of MDR-TB can becontained, and transmission of HIV from mothers to theirchildren can be virtually eliminated.41.Global efforts to fight AIDS, TB and malaria,as chan-43. For the last eight years,the Global Fund has beena major engine driving dramatic advances in the fightagainst HIV, TB and malaria.The programs it has fundedhave saved 4.9 million lives and improved the qualityof life of many of the some 33 million people living with HIV,hundreds of millions of people who contract or are atrisk of contracting malaria each year, and 9.4 million whocontract active TB annually. The Global Fund has alsobeen a driver for increased funding. It has proven itself asan efficient channel for this funding to health programsin 144 countries. It has focused international efforts of doz-ens of public, private and multilateral institutions towardsachieving ambitious, measurable targets.neled through the Global Fund,also contribute to achievingMDGs 1, 4, 5 and 8,addressing extreme poverty and hun-ger, child health, maternal health and global partnership,respectively. The efforts supported by the Global Fundto improve children’s and women’s health are particularlyimportant, as they support the scale-up of basic servicesfor women and children, in addition to fighting AIDS andmalaria, two of the main causes of death among womenand children in many regions of the world.42.Investments that have been made have also strength-ened health systems.By setting ambitious targets andmaking funding flows dependent on achieving these, theperformance-based funding model of the Global Fundhas exposed health systems’ weaknesses and providedan incentive and the funding to address them. Investmentsundertaken, while focused on achieving progress in thefight against the three diseases, have helped strengthenthe overall capacity of health systems by expanding com-munity and district health facilities, improving procurementand administration capacity and retaining health workers.

44. In this sense,the Global Fund is driving a majorglobal effortthat is on the road to achieving impressivesuccesses in the fight for global health. All partners andstakeholders should take considerable pride in the role theyplay in this work.45. As the economic crisis of the past two years has ledto considerable pressure on government budgets and totremendous hardship for hundreds of millions of peoplearound the world,the Global Fund’s work to improve valuefor money, increase efficiency and to channel resourcesto where they achieve the best results has become evenmore importantthan before.46. The past year’s economic crisis dropped millions ofpeople below the poverty line. It followed a period of solideconomic growth in many places that lifted millions outof poverty. Through its programs,the Global Fund and itspartners can help provide a safety net for some of thepoorest and most vulnerable populations,thereby partlyalleviating the impact of the financial crisis. These programscan also help bridge the health gaps that often accompanyincome gaps, for example by helping to retain health work-ers in impoverished areas where they are needed most,and by providing prevention, treatment and care servicesto people who are otherwise unable to afford them. In addi-tion, the Global Fund brings together North and Southin decision-making, thereby encouraging them to createa shared vision and common purpose.

47.The Global Fund strives to be a 21st-century interna-tional development agency – efficient, transparent andadaptable.Established as a public-private partnership,it has introduced numerous major advances and best prac-tices to its systems, policies, infrastructure and operations,allowing it to leverage its resources substantially in scalingup the fight against HIV, TB and malaria. The Global Fundis country-focused, and its organizational structure allowsit to rapidly respond to the needs of its partners and thepeople affected by the three diseases.48. This report describes the gaining of great momentumin global health. Goals that only a few years ago seemedutopian are within reach.Now is the time to further inten-sify effortsand to make a commitment to continue scalingup the response to HIV, TB and malaria, to safeguardand continue building upon the substantial achievementsalready made. While the results and impact describedin this report should be cause for optimism, the progressmade in the last years is fragile. A reduction – or evenstagnation – of efforts would lead to reversals of recentprogress. Continued, increased investments in healthgenerally and in HIV, TB and malaria specifically, are needed,not only to reach or exceed the health-related MDGs, butalso to preserve global stability and protect countries andcommunities at risk of disease.

The Global Fund to Fight AIDS, Tuberculosis and Malaria

ISBN: 978-92-9224-212-1

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