0 Sustainability, Transition and Co-financing - Investing to End Epidemics - PowerPoint Presentation

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0

Sustainability, Transition and Co-financing - Investing to End Epidemics

Dr Ade Fakoya

10

th

IAEN Preconference, July 2018Slide2

Contents

BackgroundGlobal Fund investmentsSustainability, transition and co-financing policy

Key bottlenecks and challenges

Country examples

Catalytic Funding initiatives to support Key Population programmingSummary

1Slide3

Significant Progress Made -- 22 million lives saved to date

2Slide4

Understanding sustainability

3Slide5

Four Pillars of

Global Fund Strategy 2017-22

P

laces

a strong emphasis on the need to support sustainable responses for epidemic control and successful transitions away from direct grant supportS

tresses

the need to support countries to use existing resources more efficiently and to increase domestic resource

mobilization

BUILD RESILIENT

& SUSTAINABLE

SYSTEMS FOR

HEALTH

MAXIMIZE IMPACT

AGAINST

HIV, TB AND

MALARIA

PROMOTE & PROTECT

HUMAN RIGHTS AND

GENDER EQUALITY

MOBILIZE INCREASED

RESOURCESSlide6

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

b

Catalytic investment

=

US$

200

m

HIV

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 financingSlide7

*Based on windows 1-5 submissions by countries (as of May 2018); does not include Nigeria and South Africa that are among top ten HIV allocations.

HIV

Catalytic investment (

US$

200

m

)

million

for HIV

Global Fund investment by modules in windows

1-5

*

:

almost

US$ 3.1 b

so far in this funding cycle

HIV

Matching funds

=

US$

150 m

Multi-country proposals

=

US$

50 m

Matching funds

=

US$

150

m

Scale-up

evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and vulnerable populations disproportionately affected by the three diseases (US$ 50M) – 9 countriesScale-up programs to support women and girls, including programs to advance sexual and reproductive health and rights (US$ 55M) – 11 countriesIntroduce

and scale-up programs that remove

human rights barriers

to access to health

services (US

$

45M) – 20 countries

Multi-country

(Sustainability

of services for key

populations) = US$50 mLAC region (17 m; 2 grants anticipated: 1 for Latin America, 1 for Caribbean)EECA region (13 m) SEA region (12.5 m)MENA (7.5 m)Slide8

Goal of STC – Investing to end HIV, TB, and Malaria

The desired outcome

Sustainability

A process

Transition

One of the tools

Co-financing

Goal:

Investing to End the Epidemics Slide9

The STC policy outlines a

more proactive, comprehensive, structured approach to supporting countries to address transition bottlenecks and prepare for transition from Global Fund financing, in line with other approved Board policies.

The STC Policy instituted a number of changes to explicitly

mitigate

transition related risks, including: 1) Formalization of Transition Funding, 2) Tailored Co-Financing Requirements, 3) Greater emphasis on early transition planning and GF support for transition planning, 4) Increased attention to sustainability across the entire portfolio to mitigate long term transition risks

Under the STC policy, the Global Fund is working closely with countries to address transition and sustainability challengesSlide10

Why the STC Policy and the Global Fund’s focus on transition?

The changing nature

of global health financing

To ensure impact,

the need to increasingly focus GF resources and investments on those countries with greatest need and least ability to payChallenges with previous Global Fund transitions

, particularly for key and vulnerable populations

Recognition that

successful transitions are hard and require resources

Commitment of GF to partner with countries

to more proactively prepare for transition

in order to

sustain the gains

and continue to scale even beyond Global Fund financing

9Slide11

1

A need to embed sustainability across the portfolio

, regardless of where a country is on the development continuum

Enhanced focus on domestic

financing (overall increases of funding) and

co-financing of core interventions

(greater uptake of Global Fund financed interventions) across the entire GF portfolio

Accelerating efforts to prepare for transition

as a country moves to higher income status and/or lower disease burden, particularly for UMICs (all disease burden) and LMICs (less than high burden)

Recognition that efforts to address sustainability and transition

need to be flexible

, given the varied

financial and epidemiological context of countries

across the development continuum

3

2

4

Key

pillars/principles

of our work across the S, T, and C

10

Systematic efforts to work with partners

(including technical agencies, bilateral partners, development banks, civil society partners, and others) to leverage capacity, collaborate on joint priorities, and accelerate STC efforts

5Slide12

Fully

transitioned

Funding request based on Transition Work-plan

Co-Financing requirements along the development continuum work towards enhancing financial and programmatic sustainability, eventual transitions and gradual, progressive absorption of key program costs

LICs

LMICs with

high / extreme / severe disease

burden

LMICs

with less than high

disease burden and

all UMICs

Ineligible

“Final Grant”

Focus on long-term

sustainability planning,

including:

Strengthened National Strategic Plans

Increased focus on health financing and development of health financing strategies

Enhanced alignment with country systems

Efficiency and Optimization

Gradual absorption of key program costs

Focus on sustainability and

transition preparedness,

including:

All sustainability activities +

Transition planning

Directly addressing transition challenges in grant design

Increased focus on interventions for key populations

Accelerated

co-financing

of all key interventions

Maximum 3 years transition funding

95 components

*

90 components

69

components

12

components

*

Note: numbers are based on disease components that received a country allocation and exclude multi-country grants (except RAI initiative). While there are certain flexibilities for COEs under the STC policy, they are included here.

Transition preparedness prioritiesSlide13

12

Understanding Transition -- Which disease components are transitioning now?

ALBANIA

ALGERIA

BELIZE

BOTSWANA

CUBA

DOMINICAN REPUBLIC

PANAMA

PARAGUAY

SRI LANKA

SURINAME

TURKMENISTAN

12 disease components

in 11 countries are transitioning / exiting

from Global Fund support in the 2017-2019 allocation cycleSlide14

Significant Progress and Significant Challenges

Significant progress made to strengthen the sustainability of national programs,

and to support transitions (both

before

and since the development of the STC Policy)Countries approaching transition are assuming a significant amount of the overall disease response, and now fund / manage most of the national programs (including health products, service provision, human resources, etc.)

I

ncreasing

focus on sustainability and preparing for transition

in the day to day “business” of the

Global Fund

– from

the proposals submitted, to the independent review by our technical review panel (TRP), to our efforts to incentivize and support country planning and domestic financing

13Slide15

…Planning

Key transition bottlenecks and challenges

14

This list is not exhaustive and will always be determined by country context

…Financing

…Enabling environment

…Health systems

…Civil Society

…Efficiency

Early, robust identification of country specific bottlenecks and

country owned

transition and sustainability planning

Improved domestic financing and sufficient co-financing of GF supported interventions, with a particular focus on services for key and vulnerable populations

Addressing RSSH related challenges that link with health reforms and service integration

Strengthening and aligning monitoring, evaluation, and data systems

Strengthening procurement & supply chain systems, including ability to access quality health products

Addressing enabling environment and human rights related barriers to access services

Strengthening the capacity of civil society, including the ability to contract with governments to provide services, to engage in advocacy, and to mobilize additional resources

Strengthening the efficiency (allocative, technical, cross-programmatic) of national programs

Significant Progress and Significant ChallengesSlide16

15

Transition Readiness

Assessments

Development of

sustainability and transition strategies and work plans

Updating of National Strategies and documents

Alignment

of Systems (on budget, on system)

Creation of National Working Groups on sustainability and transition

…Planning

Ukraine

:

agreed

Transition Plan, which aims at gradual takeover of funding for TB and HIV programs (20

% -50

% -80

%)

El Salvador

:

the

recently developed National Strategic Plan for TB includes a specific section on Sustainability and Transition, describing the strategic direction on this area, including legislative and policy changes, operationalization of efficiencies and budget advocacy, among others. Kosovo: government endorsed the National HIV Strategic Action Plan 2018-2022, which was based in part on the TRA and has committed to funding 100 % of commodities for key populations by 2021Slide17

16

Emphasis on co-financing commitments to cover key transition risks,

including uptake of services

for key populations and critical health system investments

Support Health Financing Strategies at country level

Support National Health Accounts reporting

Fiscal space analysis support

…Financing

Sri

Lanka

:

grant in the form of budgetary support to align with national systems and

priorities

Kazakhstan

:

the share of government in total HIV funding increased from 70% in 2009 to 87% in 2016, and projected to reach 94-95% in the next implementation period. The incremental investment will support care and ARV scale up and key population programs (including harm reduction

)

Suriname

:

coordinated support with partners for completion of National Health Accounts and tracking of co-financing commitments as part of grant agreementSlide18

17

Support the definition and costing of HIV and TB service packages and their inclusion in mandatory coverage

Advocacy for health reforms to improve costs and quality of service provision

Strengthen national capacities for procurement of quality affordable drugs

Strengthen M&E system, including integration of reporting

…Health Systems

Azerbaijan

:

TB drugs and laboratory

services have

been included in the

mandatory health insurance scheme

Armenia, Azerbaijan,

Belarus, Tajikistan

,

Ukraine

:

Pilots

and their evaluations to use

performance based funding schemes

for scaling up TB and HIV case finding, OST

schemesMoldova: The new approach

proposed under 2018-2020 grant for implementation of prevention programs, ARV adherence programs, and OST programs provides implementing agencies’ funding based on results achieved (beneficiaries covered by services)Slide19

18

Assessment of legal and regulatory barriers for access to services for key affected populations

Support to CSOs for advocacy towards improved access and service quality monitoring

Support CSOs inclusion in decision-making

…Enabling Environment

Armenia

:

Planned assessment of legal and regulatory barriers, as a result of prioritization discussions under the transition planning

Belize, Bolivia, Peru

:

Social dialogues in countries to better prepare civil society for engaging on sustainability and transition discussions and planning, developing civil society priorities, and identifying key technical assistance gaps Slide20

19

Capacity building for CSOs to access public funding

Support to MOH/CCM in the assessing optimal arrangements for public procurement of health services delivered by CSOs

Budget advocacy for CSOs

Step-by-step support to organizing public procurement of health services delivered by CSOs (from technical specifications, to contracts, to M&E)

…

C

ivil Society

Kazakhstan

:

Piloting

a social contracting model using government scheme & NGO

model

Costa Rica:

Transition

grant

provides institutional

support

to advance public contracting of health services for key populations implemented by CSOs

Moldova

: In

2017 the National Health Insurance Fund has for the first time contracted 2 NGOs for the delivery of HIV prevention activities for gay, MSM & PWIDMontenegro: With the support of

partners, grant will use country mechanism to strengthen sustainable financing of CSOs service provision to key populationsSlide21

20

Support allocative efficiency studies

Supporting technical efficiency (costing) studies

Treatment and service

delivery integration and optimization

Encouraging cross-programmatic integration analysis

…Efficiency

Belarus

:

Used OPTIMA HIV results in allocation of resources for the next National

Strategy (shifted resources from general population prevention to PWID services) or using OST costing studies to support scale-up advocacy

Montenegro

: Technical support with costing of HIV prevention packages to inform the public purchase of health services provided by CSOs

Lao, Mongolia, Nepal and PNG:

Integration

of service delivery at primary level and integration of support

services and/or

Integration of communicable disease programs with other vertical programsSlide22

21

Background

What we do

Review of 2017 – 2019 allocation period

Recommendations

HIV

Distribution of KP investment as % total value of combined HIV grants of countries

within the same income level

(17-19) demonstrating alignment with focus of proposal requirements

PEPFAR and the Global Fund are the largest funders of key population programs and services in low and middle income countries

the Global Fund is the most prominent external funder of key population programs across much of EECA, LAC, SEA and MENA and a number of countries in west and central Africa.Slide23

22

Matching Funds

Multi-country Approaches

Strategic Initiatives

C

atalytic

funding

2017-2019: 2/3 supports Key populationsSlide24

Multi-country proposals to support sustainability and transition23

= 50million USDSlide25

Summary

Sustainability is multi-dimentional and relevant for all countries across the development continuumFocus should be broader than a financing dialogue and involve a variety of stakeholders

There are several key bottlenecks and challenges in transitioning from external donor support

Need to start early in partnership for success

24Slide26

Acknowledgements and Thanks

Matthew McGregor Obinna Onyekwena

Aji-Mallen Sanneh

David Traynor

Ed Ngoksin Malgorzata Matysek

25Slide27

Back up

26Slide28

27

Source: Global Fund Eligibility List 2017

UMI Components

Albania (HIV,TB), Algeria (HIV), Angola (HIV,TB, Malaria), Azerbaijan (HIV,TB), Belarus (HIV,TB), Belize (HIV,TB), Botswana (HIV,TB, Malaria), Colombia (HIV), Costa Rica (HIV), Cuba (HIV), Dominican Republic (HIV,TB), Ecuador (HIV), Gabon (TB), Georgia (HIV,TB), Iran (HIV), Jamaica (HIV), Kazakhstan (HIV,TB), Malaysia (HIV), Mauritius (HIV), Mongolia (HIV,TB)

,

Montenegro (HIV),

Namibia (HIV,TB, Malaria), Panama (HIV,TB), Paraguay (HIV,TB), Peru (HIV,TB), Romania (TB),

Serbia (HIV),

South Africa (HIV,TB), Suriname (HIV,TB, Malaria), Thailand (HIV, TB, Malaria), Tunisia (HIV),Turkmenistan (TB)

LMI

components with low or moderate

disease burden classification

Armenia (HIV,TB), Bangladesh (HIV), Bhutan (HIV, Malaria), Bolivia (Malaria), Cabo Verde (Malaria), Egypt (TB), El Salvador (TB), Guatemala

(TB, Malaria),

Honduras (TB, Malaria), Kosovo

(HIV, TB),

Lao (HIV), Nicaragua (TB, Malaria), Philippines (Malaria), Sao Tome and Principe (HIV), Sri Lanka (HIV, TB, Malaria), Swaziland (Malaria), Timor-Leste (HIV)

Upper Middle

Income Countries (UMICs)

Low

and Middle Income Countries (LMICs)

with at least one

disease component with low /moderate DB

Transition preparedness priorities under the STC policy

All UMI countries (regardless of disease burden) and LMI countries (with low or moderate disease burden

), not including COEs

Note: This list is based on only countries that received a country allocation in the 2017-2019 allocation cycle and excludes multi-country grants and COEs.