The Global Fund's new funding model for more strategic investment
Symposia Session - Trends in AIDS Financing and Effectiveness of Current Investments
Melbourne, July 2014Dr Christoph Benn
Director, External Relations Division
Global Fund
Content Overview
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Financing trends
Addressing unmet needs
Towards more strategic investments
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Update on resource mobilization 4th Replenishment: $ 12 B in pledges – 30% above 3rd Replenishment level
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• Pledges & contributions to the Global Fund have been increasing over time
• As of Q2 2014:
• Total pledges have reached US$ 12.3 billion, with donor government pledges accounting for US$ 11.6 billion or 94.7%
• US$ 3.844 billion of total pledges have been signed into contribution agreements of which US$ 1.580 billion have been paid in
2006-2007 (London) 2008-2010 (Berlin) 2011-2013 (New York) 2014-2016 (Washington) -
2,000
4,000
6,000
8,000
10,000
12,000
14,000
3,380
8,400 9,200
12,006
4,717
9,826 10,521
12,284
4,740
9,414 10,120
1,580
in USD million
Original Pledges Actual Pledges Cash Receipt
3,844
2006-2007 (London) 2008-2010 (Berlin) 2011-2013 (New York) 2014-2016 (Washington) -
2,000
4,000
6,000
8,000
10,000
12,000
14,000
3,380
8,400 9,200
12,006
4,717
9,826 10,521
12,284
4,740
9,414 10,120
1,580
in USD million
Original Pledges Actual Pledges Cash Receipt
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Disbursements to programs total $24.4 billion to date, including $13.1 billion (54%) for HIV/AIDS
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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140.12 B0.36 B
0.58 B 0.70 B
1.07 B1.33 B 1.29 B
1.58 B 1.46 B1.76 B
2.10 B
0.73 B
0.23 B 0.63 B 1.05 B 1.33 B 1.73 B 2.25 B 2.75 B 3.07 B 2.63 B 3.34 B 3.96 B 1.45 B
Annual disbursements in US$ Billion
HIV/AIDS Malaria Tuberculosis
Total Annual Disbursements:
Total HIVDisbursements:
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Total Funding from Global Fund is Increasing• The total funds for allocation are 20% higher than in the past:
- The total funds allocated to countries, available as of January 1, 2014 and including existing funds: $ 14.7 billion for three years or on average $ 3.7 billion per year;
• In addition:
- $ 950 million to be awarded as incentive funding to ambitious programs that deliver impact in country, which increases the average implied funding level to above US$ 3.9 billion per year;
- $ 200 million for new regional grants and $ 91 million to finish existing regional grants.
64% 10% 9% 8% 4% 4%
- Allocations by Region (billion and %) -
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Content Overview
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3
Financing trends
Addressing unmet needs
Towards more strategic investments
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Largest funding increases are targeted at the regions with the least recent funding relative to burden
East Asia & the
Pacific
Eastern Europe & Central
Asia
Latin America
& the Carib-bean
North Africa &
the Middle East
South Asia
East Africa
Southern Africa
West & Central Africa
0%
5%
10%
15%
20%
25%
30%
Disease Burden Recent Funding
Disease burden and recent funding share
Country allocations relative to recent funding
75% 100% 120% 170%
Allocation as a percentage of recent funding:
0% >170%
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0 m
50 m
100 m
150 m
200 m
250 m
300 m
350 m
400 m
450 m
Malaria - Prevention: Nets dis-tributed (ITNs & LLINs)
2006 2007 2008 2009 2010 2011 2012 2013 mid-20140.0 m
2.0 m
4.0 m
6.0 m
8.0 m
10.0 m
12.0 m
14.0 m
0.8 m1.5 m
2.0 m 2.4 m3.0 m 3.3 m
4.2 m
6.1 m6.6 m
HIV - People currently on ART
TB - New smear-positive TB cases detected and treated
Global Fund results - 6.6 million people on antiretroviral therapy, an 8% increase over 6.1 million in 2013
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Source: Global Fund Grant Data, mid-2014
Cur
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AR
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S u
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ns)
Cum
ulat
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Inse
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ide-
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nets
dis
trib
uted
(m
illio
ns)
Results in HIV/AIDS at a glance:
• 6.6 million people on ART, with gains driven by higher numbers in Nigeria, Mozambique, India, and Uganda, among others.
• counselling and testing sessions for HIV increased by more than 50 million to 360 million from 306 million at year-end 2013
• number of OVCs that received basic care and support for HIV increased to 7.1 million from 6.5 million over the past 12 months.
• condoms distributed grew by 155 million to reach the total of 4.7 billion, more than a third of the increase from campaigns in Rwanda and Ghana
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Most countries are under-funded relative to need & are encouraged to be ambitious in what they plan to achieve
In most countries, the allocation amounts (regardless of whether a country is over- or under-allocated) will still be insufficient to cover the gaps vs. real need
- Most countries are under-funded relative to their needs.
- This should not limit planning and ambition – to defeat the diseases, countries need to think creatively on how to use all resources available
Stronger resource prioritization is critical to achieving impact
- Existing grants should be used as effectively as possible, ensuring programs are regularly evaluated and grants reprogrammed for maximum impact
- Any additional funding should be harmonized with existing funding; disease programs should be viewed in a holistic manner
Strategic investment for maximum impact
- Resources are focused on targeting the right populations
- Decisions on allocation of resources are based on evidence/data
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Context of the 5th Replenishment
ODA projected to increase in 2014 & then stabilize
10July 2014Melbourne
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
80.13 B
108.30 B 105.42 B
104.92 B
122.78 B
120.56 B
129.07 B134.67 B
126.95 B
2013 2014 2015 2016
138.4 B
Net official development assistance 2004-13 & projections for 2014-16 (in current US$ billions)
OECD: http://www.oecd.org/newsroom/aid-to-developing-countries-rebounds-in-2013-to-reach-an-all-time-high.htm
ODA in 2013 rebounded & reached $ 134.8 B despite economic pressure on donors but likely to stabilize after 2014 critical to ensure appropriate share for health
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Content Overview
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3
Financing trends & Results
Addressing unmet needs
Towards more strategic investments
• Focus more strategically on areas of greatest impact
• Support increased investments from domestic sources
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Example of investing for impact: Targeting ‘hot spots’ achieves greater impact in Kenya
Source: [i] Williams BG, Lloyd-Smith JO, Gouws E, Hankins C, Getz WM, et al. (2006) The potential impact of male circumcision on HIV in Sub-Saharan Africa. PLoS Med 3: e262. doi:10.1371/journal.pmed.0030262
…lends itself to improve efficiency of HIV prevention spending through prioritization
In Kenya, geographic variation in HIV prevalence …
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Shared responsibility through increased domestic resources
Mandatory minimum requirements of counterpart financing
• Minimum threshold contribution (LI-5%, Lower LMI-20%, Upper LMI-40%, UMI-60%)
• Increasing government contribution to disease programs and health sector
• Reliable disease and health expenditure data
‘Willingness-to-pay’ commitment to further incentivize
• Additional co-investments by government in disease programs in accordance with ability to pay
• Realization of planned government commitments
• 15% of allocation is contingent upon meeting WTP commitments
Core Global Fund principles: Sustainability, Additionality, Country Ownership
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Update on resource mobilization
GF Domestic Financing Strategy
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GF strategy for increased domestic financing for health
1. Implement NFM policies linked to domestic financing
(Counterpart financing & willingness-to-pay)
3. Advocate for political leadership & for realization of
Government commitments
2. Support domestic resource mobilization efforts (priority
countries) with help of partners
1. Implement NFM policies linked to domestic financing (CF & WTP)
• Country needs assessment/ target-setting & support the buy-in process
• Options of tools/mecha-nisms for innovative financing
• Documentation & dissemination of Best practices
• Advocacy plan with key messages by GF, Donors, partners, private sector and CSOs
• Revive co-champion-ships and identify other champions
• Leverage key national/ international events & platforms
• Support countries on CF/WTP (guidance & tools, country dialogue)
• Review country compliance with CF & monitor WTP commitments
• Track at grant & portfolio levels
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Conclusions
Health expenditures should keep pace with economic growth
There is no single blueprint for increasing domestic funding for health
Lessons learned and best practices should
THANK YOU
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