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Total health ODA commitments, 2001-2006 US$ Billions

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New instruments in global health World Bank Multi-country AIDS Program (2000) Global Alliance for Vaccines and Immunization (2000) -International Finance Facility for Immunization Global Fund to Fight AIDS, TB and Malaria (2002) US Presidents initiatives -AIDS (2003), Malaria (2005), Neglected Tropical Diseases (2008) Unitaid (2005) (PRODUCT) Red (2005) World Bank Malaria Booster Program (2005) Debt2Health (2007) Advanced Market Commitments (2008) Affordable Medicines Facility for Malaria (2009) National Strategy Applications (2009)

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The Global Fund: an innovative instrument in health and development A financial instrument, not an implementing entity Supports programs that reflect country ownership Evidence-based Performance-based

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A unique partnership

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The Global Fund and civil society OP/290607/5 Estimates Rounds 2-6 proposals About 40 per cent of Global Fund-supported implementers are NGOs/CBOs Governance (Board and CCMs) Implementers Dual track financing Community systems strengthening

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Global Fund portfolio $14 billion in approved financing $7 billion disbursed 600+ grants in 140 countries

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Global Fund portfolio: AIDS

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Global Fund portfolio: malaria Private/Other US$ 4.4 million (1%) Multilateral US$ 62.7 million (13%) Bilateral US$ 106.7 million (22%) Global Fund US$ 308 million (64%) Global Fund portfolio: TB Grants from other sources US$ 66 million (33%) Global Fund US$ 133 million (67%)

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140 countries with Global Fund grants BG/261107/6

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Targeting the poorest countries: Global Fund approved amounts by country per capita income, September 2008 $m

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Resources go where they are needed Regions 60% of approved funds in Rounds 1-8 are for sub-Saharan Africa 65% of funding for orphan support is for southern Africa Diseases AIDS: 35% of Global Fund financing for ART is for southern Africa Malaria: $1.5 billion approved for 19 African countries that account for 90% of malaria burden in Africa TB: More than $1 billion approved for 22 high burden countries that account for 80% of global TB incidence

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e.g. Global Fund support to harm reduction programmes Reaching the vulnerable

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Number of people receiving ARV therapy in low- and middle-income countries, 20022007

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Global Fund results: June 2008 GP/110608/9

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AIDS impact: Malawi Initial decline in workplace mortality at Escom (national electricity company) after roll-out of antiretroviral treatment Source: Global Fund

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Decline in adult mortality with introduction of ART: Botswana

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Increase in TB financing and new sputum positive cases detected and treated

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Incidence~64% 2004 2001 2002 20032005 2007 2006 Declining malaria in health facilities after scale-up of bed nets and anti-malaria treatment: Rwanda, 2001-2007 WHO national database

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Addressing health systems challenges Human resources Procurement systems for drugs and health commodities Infrastructure Laboratory equipment Monitoring and evaluation systems

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Direct funding of health systems through Global Fund grants

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Direct funding of health systems through disease interventions (approximately $945 million for Round 8; more than $4 billion overall) Health systems support across more than one disease $186 million approved in Round 7 $ 290 million approved in Round 8 (health workforce, information systems, supply chain management, community service delivery) Expanding health system capacity -Non-government actors (NGOs, FBOs, communities, private sector, people living with the diseases) are recipients of 50% of Global Fund funding -Dual track financing Majority of Round 8 proposals included community systems strengthening The Global Fund and health systems strengthening

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Human resources Increasing the number of health workers Salaries for health workers & community health workers Salary top-up Training (96% of grants have a training component) Saving lives of health workers to return to work Reducing AIDS, TB and malaria burden so that health workers can focus on other health needs

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Mukoma Health Centre, Rwanda (Source: PEPFAR) Infrastructure: Support for renovation of existing health centres *Photo courtesy of FHI

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Laboratory strengthening 67% of TB grants included laboratory strengthening Examples: Chad: Newly equipped laboratories Philippines: Training in sputum microscopy (public and private) Yemen, Sri Lanka: New laboratories established

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Sustainability: more than resources alone Increased and more predictable resources (domestic, external, further innovation) Build demand for resources Address health systems challenges Promote evidence-based interventions effectively targeted to those in need Promote human rights Strengthen social protection Strengthen global and local partnerships Learn and apply lessons: research and evaluation

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Resource needs for AIDS, TB and malaria (2009 to 2015) Sources: UNAIDS, STB, RBM

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Resources: increasing both availability and demand $ US billion Available resources Demand EstimatedN eed Available resources and demand Estimated Need

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Global Fund requested and approved 2-year funding (Rounds 2 8) 40%34%39%22%34%47% 53% Approval rate

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