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)
7
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)
8
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%)
9
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
11
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 $1000s) (including TB/HIV)
Speed-up implementation and absorption of the current grant
13
Implementation Through Partnership: Where are bottlenecks?
DOTS PMTCT Each boxplot represents one priority country and shows distribution of % grant target met in each reporting period over 2012-2015
TB: Level of ambition: Good grant performance are we making progress?
modest
targets?
But global case detection is stagnating
Joint TB/HIV CN lead to joint implementation?
15
17 Concept Notes
57 Grants
26 HIV Grants
US$ 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?
17
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)
20
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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