Investing to Achieve the Health Millennium Development Goals
Achieving the health Millennium Development Goals by 2015 will require a significant financing increase for both the Global Fund to Fight AIDS, Tuberculosis & Malaria and the GAVI Alliance in 2010. Through their innovative approaches, broad-based partnerships and targeted investments, each of these mechanisms is working in a unique and complementary way to improve health in the world’s poorest countries. As the largest financer in the fight against infectious diseases, the Global Fund is the top distributer of insecticide-treated bed nets and TB treatment, and the second biggest distributer of antiretroviral treatment for HIV/AIDS. GAVI, on the other hand, has brought together immunization stakeholders to dramatically expand access to underused vaccines (such hepatitis B and Hib) and accelerate the availability of new vaccines (especially against pneumococcal disease and rotavirus) in low-income countries.
The Global Fund and GAVI’s success in helping countries to strengthen their plans and proposals has created a growing demand for financing, and as a result, both mechanisms will face significant funding shortages in 2010 and beyond. Facing a cumulative gap of approximately $20 billion for the period 2010-2013, over the next year the Global Fund and GAVI are coordinating to mobilize the resources they need to maintain successful programs and meet demand for new ones. Without this critical support from the international community, MDGs 4 and 6 will not be met by 2015.
Signs of Impact
The Global Fund’s Role in the Fight against Malaria
The Global Fund has been a leading contributor to the reduction of malaria deaths and cases registered in many countries in the past few years. InRwanda, for example, Global Fund grants worth $356 million have contributed to a 64% decline in child malaria cases and a 66% decline in child malaria deaths between 2005 and 2007. The country has achieved a 60% coverage rate of insecticide-treated bed nets and anti-malarial drugs have been rolled out nationally. Similar results have occurred in Ethiopia, Zambia and Ghana, countries whose malaria control programs are major recipients of Global Fund financing.
Both the Global Fund and the GAVI Alliance have achieved remarkable results since their establishment. The Global Fund has committed $22 billion, of which $9.3 billion has been disbursed to programs in 150 countries, which has enabled it to save an estimated 8.7 million lives since 2002. The GAVI Alliance has contributed $1.9 billion in financing for 72 countries, which has been used to reach 213 million children with vaccines and prevent an estimated 4 million deaths.
Specifically, these two mechanisms have delivered the following:
- Antiretroviral treatment for 2.5 million people with AIDS;
- DOTS treatment for 6 million patients with TB;
- 104 million insecticide-treated bed nets to protect families from malaria;
- DTP3 (diphtheria-tetanus-pertussis)vaccinations for 50.9 million children;
- Hepatitis B vaccinations for 192.2 million children;
- Haemophilus influenzae type b (Hib) vaccinations for 41.8 children.
Effective and accountable financing mechanisms
Innovative Approaches to Health
GAVI’s Role in Shaping the Global Vaccine Market
GAVI’s pioneering, market-based strategy has helped to reduce the price of existing vaccines and accelerate the introduction of new ones in the world’s poorest countries. New data shows that by 2012 the price of the pentavalent, or “five-in-one,” vaccine will have fallen by 22%. This drop is the result of GAVI’s work encouraging and pooling the demand for the vaccine in poor countries to attract three new manufacturers and increase global supply.
GAVI has also harnessed the power of the private sector through its Advanced Market Commitment (AMC) and the International Finance Facility for Immunization (IFFIm). Through the AMC, GAVI encouraged the development of a pneumococcal vaccine for low-income countries by committing to purchase the finished product at a rate that was economically viable for manufacture. The IFFIm, on the other hand, has accelerated funding to countries by frontloading long-term donor commitments on capital markets.
The approach and design of the Global Fund and GAVI help to ensure their effectiveness and maximize results through the following features:
Focus on transparency and results with a proven track record: The Global Fund’s model of demonstrated results and targets (e.g. delivering tangible services such as bed nets or anti-AIDS drugs). Financing is stopped, reduced or accelerated based on performance against these targets. In recent years, evidence of misused funds in countries like Uganda, Mauritania and Chad has prompted the Global Fund to suspend or cancel financing. Similarly, in 2007 GAVI’s Immunization Services Support program was halted following concerns over the quality of national immunization data. The program was re-launched in 2009 after a detailed review and reform.
Coordination to increase efficiencies: By serving as a point of coordination for donors, recipients and other partners, the Global Fund and GAVI are able to maximize results in their respective areas. At the global level, GAVI has reshaped the vaccine market by acting as a pooling agent to expand and accelerate vaccine supply and stimulate country demand in a way that no single actor can do alone. At the country level, the Global Fund’s country-coordinating mechanisms (CCM) work with all partners to submit proposals, oversee the implementation of funded programs, and ensure results by reviewing reports from the Principal Recipient.
Investment in local capacity: As the Global Fund and GAVI grow to meet increased demand, they are increasingly forced to address system-wide barriers to their core missions. GAVI has also taken steps to increase country ownership and ensure financial sustainability through its co-financing scheme, which gradually increases countries’ share of the cost of vaccines based on the countries’ ability to leverage their own resources.
The Global Fund and GAVI are facing new challenges as they grow. Reform efforts are underway at the Global Fund to accelerate the disbursement process, link all active grants, and utilize pooled procurement. It is critical that both mechanisms continue to undergo regular and rigorous independent evaluations to promote innovation and improvement and to ensure that mechanisms are working at an optimal level.