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The Global Fund: Improving the Quality and Efficiency of HIV Program Implementation
Dr. Ade Fakoya, Aji-Mallen SannehSenior Disease Coordinator HIV, The Global Fund10 November 2019
The CQUIN Project
Topic
1 The Global Fund: Now
2 Next Funding Cycle
3 Highlighting and Investing in DSD
4 Sustainability of HIV Programs
5 Opportunities
2
Outline
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
The CQUIN Project
The World Stepped up.Merci.
2019
• US$14.02 Billion pledged to Step Up the Fight against the Epidemics
• Helps save 16 million lives & end AIDS, TB and malaria by 2030
• Yield a return on investment of 1:19, contributing to overall SDG agenda
• Catalytic funding to stimulate more innovation, collaboration and execution
• 2002-2018:The Global Fund invested US$ 19.6 Billion to prevent & treat HIV/AIDS; 20% of all international funding
The Global Fund
The CQUIN Project 4The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
1
HIV
1%2% 3%
4%
5%
5%
11%
14%
16%
39%
GF ALLOCATION BY REGION (HIV): 2017-2019
AELAC-SEA MENA EECA LAC WA
CA HIAs AME-SEA HIA 1 HIA 2
408 407
371
318 290
256 247 240
194 184
-
50
100
150
200
250
300
350
400
450
500
USD
Mill
ions
Top 10 HIV grant allocations: 2017-2019
The top 10 countries with HIV grant allocations account for 57% of GF investment in HIV & 67% of the estimated global HIV burden (UNAIDS data 2017)
Global Fund accounts for 8% of global HIV funding and 20% of international financing
Other Int'l Domestic
Other Int'l
Global Fund is investing in HIV/AIDS in > 100 countries globally in the current allocation cycle (2017 – 2019)
Total GF HIV investment (2017-2019)> US$ 5.2 Billion
Allocation amount ≈ US$ 5.1 BCatalytic investment = US$ 200 M
5
Cabo Verde
Cameroon
CARCongo
Gambia
Liberia
Niger
Senegal
Sierra Leone
TogoBurkina Faso
Côte d'Ivoire
DRC
GhanaMali
Nigeria
EthiopiaKenya
Mozambique
South Africa
UgandaTanzania
Zambia
Zimbabwe
Algeria
Eritrea
LebanonMauritania
Morocco
South SudanSudan
Angola
Botswana
ComorosEswatini
Lesotho
Madagascar
Malawi
Mauritius
Namibia
Rwanda
Chad
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
PLHI
V O
N A
RT (%
) 201
8
PLHIV WHO KNOW THEIR STATUS (%) 2018
WCA+HIA1+HIA2+SEAF+MENA: PLHIV that know their status vs PLHIV on ART
Targets
*Please note that for Chad first 90, country data have been used in order to include the country in this analysis.
6
Benin
Burundi
Cabo Verde
Cameroon
CAR
Chad
Gabon
GambiaGuinea
Guinea-Bissau
Liberia
Niger
Senegal
Sierra Leone
TogoBurkina Faso
CIV
DRC
Ghana
Mali
Nigeria
Ethiopia
Kenya
Mozambique
South Africa
Uganda
Tanzania
Zambia
Zimbabwe
Algeria
Djibouti
Eritrea
Jordan
Lebanon
Mauritania
Morocco
Somalia
Sudan
Syria
Angola
BotswanaEswatini
Lesotho
Malawi
Mauritius
Namibia
Rwanda
-75-70-65-60-55-50-45-40-35-30-25-20-15-10
-505
101520253035404550556065707580859095
100105110
-80 -75 -70 -65 -60 -55 -50 -45 -40 -35 -30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
CHAN
GES
IN A
IDS
RELA
TED
DEAT
HS S
INCE
201
0
CHANGES IN NEW HIV INFECTIONS SINCE 2010
WCA+HIA1+HIA2+SEAF+MENANew infections vs AIDS related deaths
Targets
Please note that countries in red are out of scale
Zoom
The CQUIN Project 7
Leveraging Efficiency Throughout the Global Fund Grant Cycle2
Guidance Note on Assessing Value for money of Global Fund Requests for Funding, 2019
The CQUIN Project 8
Key Investment Principles
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
2
The CQUIN Project 9
Prioritized HIV Interventions for 2020-2022 Funding Cycle
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
1
23
4
5
Human Rights
HIV Treatment and Care
HIV Prevention
HIV Testing Services
HIV StrategicInformation
• HIV prevention programs addressing KPs in all epidemic settings, and AGYW and adolescent boys and men in high prevalence settings
• Comprehensive condom programming• PrEP programs for populations with substantial HIV risk
1
• HIV testing services strategy that uses up-to-date and regularly reviewed data
• A strategic mix of differentiated approaches, including self-testing, that improve testing coverage, testing yield and efficiency of HIV testing services
• Interventions that ensure people across all age, sex and risk categories are linked to the services they need depending on their test results
2
• Scaled-up DSD models that offer a mix of interventions at both facility and community levels
• Rapid initiation for all people diagnosed with HIV and strong mechanisms to retain people across the cascade
• Introduction at scale of optimal ARV regimens in line with WHO recommendations
• Advanced HIV disease pathways• Optimized VL testing at scale as preferred treatment monitoring.• Monitoring of drug resistance through WHO-recommended surveys • TB preventive treatment (TPT) at scale in countries with high burden of
TB/HIV
3
• Routine review of data tracking people along the HIV prevention, testing and treatment cascade
• HIV case surveillance
4
• UNAIDS-endorsed key human rights components, scaled up and integratedinto prevention and treatment programs
5
2
The CQUIN Project 10
Linking programmatic and financial data in performance frameworks & budgets
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
3
The CQUIN Project 11
Prioritization, quality & innovation across the cascade in West & Central Africa
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
3 Regional Example
The Global Fund investment approach to HIV programming in West and Central Africa, July 2019
The CQUIN Project 12The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
Board approved Catalytic Investments for 2020-2022 allocation cycle (amounts in millions)*
12
Catalytic Funding Scenarios
3
The CQUIN Project 13
Elements of Sustainability
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
4
Ensuring continued engagement of people affected by HIV and KPs in decision-making processes related to HIV
Governance
Efforts to strengthen political will to increase overall sustainability of national disease responses
Political
• Program Quality• Differentiated Service Delivery (DSD)• Integration of services into primary
care
Programmatic
• Domestic financing for interventions, for key populations and for treatment scale-up, strengthening efficiency to decrease long term costs
Financial
• Ensuring that formal health systems work effectively with CSOs,
• Ensuring that health reforms (including those related to social health insurance) strengthen access and financial protection for PLHIV
• Improve data systems and sustainable access to and use of data
Systems-Related
• Addressing barriers to access to services• Employing effective interventions to
reduce stigma and discrimination
Human Rights
The CQUIN Project
• All countries to consider elements of sustainability in funding requests, grant and program design
• Principles to consider:• Country-owned & led• Plan for sustainability from start• Bottom-up led, top-down supported• Ways to develop integrated platforms• Continuous improvement process
• Greater consideration of sustainability can:• Strengthen health systems• Support HIV outcomes• Increase long-term domestic financing (NSPs)• Strengthen overall efficiency of service delivery• Gradual and effective transition
14
Strengthening the Sustainability of National Disease Responses
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
4
The CQUIN Project
What does this mean for countries?
• Costed DSD implementation plans need to be ready for submission within GF grant applications ( check your country submission date )
• Funding proposals and implementation plans need to include:• Scale up plans for differentiated ART delivery models to achieve coverage and impact
• Funding can be requested for:• Activities that will support differentiated ART delivery model implementation scale up
including especially procurement and management supply systems and specificdata improvement needs
• Community-based organisations setting up and running community-based ART delivery models (CSS is within RSSH so don’t miss it)
5
The CQUIN Project 16The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
Thank you. Merci.
The Global Fund
The CQUIN Project 17
Investment Case for HIV
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
• Together with partners, the Global Fund could:• Reduce (from 2017 to 2023):
• New HIV infections by 61%, from 1.5 M to 565,000
• AIDS-related deaths by 52%, from 866,000 to 413,000
• Incidence and mortality rates by 64% and 56% respectively
• HIV incidence among AGYW in 13 priority countries by 72%
• Provide ARV therapy to 27 M people in 2023
6th Replenishment1