Global Fund TB Investments: Accelerating Progress Towards Impact

Eliud Wandwalo

Senior TB Coordinator, Global Fund

47th Union Conference, Liverpool, 27th Oct, 2016

Content Overview

• TB investments

• Current implementation and lessons

• Future: Next implementation period

1

2

Component Disbursements

HIV $ 16,558,711,312

Malaria $ 8,770,344,260

TB $ 4,923,850,080

TB-HIV $ 480,972,856

Other $ 591,129,247

Total $ 31,325,007,755

Global Fund Disbursements by Disease Component

NUMBER OF LIVES SAVED THROUGH GLOBAL FUND-SUPPORTED PROGRAMS

People tested and treated for TB

4

5

Where are we investing? (1)

Top TB countriesIndia

Nigeria

Philippines

Myanmar

Indonesia

Bangladesh

Ethiopia

Kenya

Pakistan

Congo (Democratic

Republic)

All Others

$-

$100'000'000

$200'000'000

$300'000'000

$400'000'000

$500'000'000

$600'000'000

$700'000'000

$800'000'000

TB Funding

The Global Fund is a major source of international funding for TB activities, including those for MDR-TB

0%

5%

10%

15%

20%

25%

30%

35%

40%

0

50

100

150

200

250

300

350

400

450

500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

% o

f E

xpe

nd

itu

re o

n M

DR

-TB

Exp

en

dit

ure

(U

S$

) m

illi

on

MDR-TB Total TB Percent MDR-TB

Proportion of Global Fund cumulative expenditure for MDR-TB among all TB expenditures - has reached 30%

NFM: Where are we investing?-Modules (2)

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TB care and prevention

34%

MDR-TB34%

Program management

16%

HSS10%

TB/HIV3%

Results-based

Financing2%

Community systems

strengthening

1%

TB

0%

5%

10%

15%

20%

25%

30%

35%

40%

0

50

100

150

200

250

300

350

400

450

500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

% o

f E

xpe

nd

itu

re o

n M

DR

-TB

Exp

en

dit

ure

(U

S$

) m

illi

on

MDR-TB Total TB Percent MDR-TB

NFM: Where are we investing?-intervention (3)

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Treatment63%

Case detection and

diagnosis29%

Community TB care delivery

3%

Prevention2%

Other MDR-TB

interventions2%

Key affected populations

1%

Case detection and diagnosis

38%

Treatment30%

Community TB care delivery

10%

Other TB care and prevention interventions

8%

Engaging all care providers

6%

Key affected populations

6%

Prevention2%

MDR-TBDS-TB

Childhood TB: low investment (0.8%)

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Diagnosis: Contact tracing,

Screening and Equipment

32%

Human Resource for

Health, program

management, meetings

3%

Operational Research 1%

Paediatrics TB Medicines 29%

Support Services and associated

costs

10%

Technical Assistance,

Mentorship and

Supervision

5%

Training and Capacity Building

20%

10

Cross-cutting HSS investments

RSSH investments 38% of the total portfolio

Cost groupings of

disease investments with effects on systems for health

RSSH investments 40.26% of the total portfolio

12.50%

6%

32%

27.76%

Pre-NFM NFM

0.18% HEALTHCARE FINANCING

1.92% FINANCIAL MANAGEMENT

2.42% POLICY & GOVERNANCE

8.63% SERVICE DELIVERY

13.41 HCW

22.19% PSCM

51.24% HMIS

0.07% HEALTHCARE FINANCING

0.77% FINANCIAL MANAGEMENT

0.97% POLICY & GOVERNANCE

3.48% SERVICE DELIVERY

5.40% HCW

8.94% PSCM

20.63% HMIS

40.26%

TB/MDR-TB Interventions relay heavily on strong functional health systems

Current implementation and lessons

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0

200000

400000

600000

800000

1000000

1200000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Trends in TB Disbursements 2002-2016 and Projections 2016/17 (in $1000s) (including TB/HIV)

Speed-up implementation and absorption of the current grant

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Implementation Through Partnership: Where are bottlenecks?

DOTS PMTCT Each boxplot represents one priority country and shows distribution of % grant target met in each reporting period over 2012-2015

TB: Level of ambition: Good grant performance are we making progress?

modest

targets?

But global case detection is stagnating

Joint TB/HIV CN lead to joint implementation?

15

17 Concept Notes

57 Grants

26 HIV Grants

US$ 2.3 bn

18 TB Grants

US$ 0.78 bn

13 TB-HIV Grants

US$ 0.80 bn

8 HIV Grants and 8 TB Grants managed by same PR

0

100

No. of Grants Budget

TB-HIV

TB

HIV

20.2%

20.6%

45.6%

31.6%

22.8%

59.2%

Source: GAC 2 budgets€ values from Burkina Faso and Togo converted using grant specific exchange rate

Total: US$3.88bn

Little progress in some TB/HIV indicators

16

17

17

15

8

16

17

12

5

14

14

6

0

0 5 10 15

TB/HIV-1

TB/HIV-2

TB/HIV-3

TB/HIV-4Number of countries targeting coverage rate of90% or higher in final grant year

Number of countries including a baseline

Number of countries including indicator

HIV community lagging behind: Budgets for GeneXpert where does it come from?

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83%

14%

3.0%

TB grants TB/HIV grants HIV grants

Source: GAC 2 budgets€ values from Burkina Faso and Togo converted using grant specific exchange rate

Preparation for next cycle

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Global Fund Strategy 2017-2022“Investing to End Epidemics”

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Innovate and Differentiate along the Development Continuum

Support Mutually Accountable Partnerships

Strategic Enablers

Maximize Impact Against HIV, TB and

malaria

Build Resilient & Sustainable

Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased Resources

• Differentiated access to funding-support and process for pre-application stage?

• No major changes on TB specific tools and materials (eg modules etc)

• Major focus on finding missing cases both DS and MDR-TB (ie.Catalytic funding)

• Emphasis on program quality and efficiency

• Finalizing TB strategic investment information (ie. role of X-ray etc)

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Key messages

• Scale up implementation and absorption of funds in 2016 and 2017

• While preparing for the next cycle 2017-2019 use lessons from the current implementation period

• Focus on implementation and maximizing impact;• Differentiation-in accessing funding and implementation• Improving program quality and efficiency

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Thanks

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