Global Fund Work on HIV/SRH Linkages 09 March 2015 Olga Bornemisza New York, USA IAWG Meeting on HIV/SRH Linkages

Health Systems Strengthening (HSS) and Reproductive, Maternal, Neonatal and Child Health (RMNCH) at the Global Fund The mandate of the Global Fund continues to be on HIV/AIDS, TB and malaria The main goal of HSS support is to ensure added value to addressing and reducing the spread of the three diseases

What has Global Fund committed to? The Global Fund Strategy Strategic Action 1.3: Maximize the impact of Global Fund investments in strengthening health systems > Ensure strategic targeting of HSS investments towards most-in-need countries and high-impact interventions >Enhance effectiveness of HSS investments through better alignment, harmonization and tracking of HSS outcomes and impact Strategic Action 1.4: Maximize the impact of Global Fund investments on improving the health of mothers and children Every Woman Every Child : Global Strategy for Women’s and Children’s Health

Investing for impact Official development assistance to MNCH for the 74 Countdown priority countries, 2003–2010 Contribution of 3.12bn In 2010, share of Global Fund contribution of total ODA for MNCH was estimated at12%. Need to ensure that how we invest leads to optimal RMNCH outcomes

“Exploring options to maximize synergies with maternal and child health, the Board strongly encourages Country Coordinating Mechanisms to identify opportunities to scale up an integrated health response that includes maternal and child health in their applications for HIV/AIDS, TB, malaria and health systems strengthening.” Board Recommendation, Global Fund’s (new) funding mechanism is a key opportunity for driving and investing in increased integrated service delivery, especially through country dialogue process and inclusion of HSS and RMMCH leadership in CCM discussions the promotion of innovative partnerships (e.g. MOUs with UNICEF and UNFPA). New opportunities at the Global Fund

Thematic Review of the Global Fund’s contributions to MDGs 4 & 5 In 2013, TERG commissioned evaluation of Global Fund’s contribution to RMNCH –To identify enabling factors, bottlenecks and missed opportunities to integrate disease-specific and RMNCH interventions –To provide practical recommendations in the context of the NFM Conducted a rapid evidence review examining benefits of integration over non-integrated approaches Produced 8 case studies with an analysis of how Global Fund has supported integrated service delivery

Challenges and opportunities for scaling-up integrated service delivery Imbalances in overall capacity and resources between well funded HIV, TB and malaria programs and poorly resourced RMNCH programs barrier to integrated service delivery. Opportunities to amplify the impact of integration. Needs harmonized support for creation and development of linkages between disease-specific programming and RMNCH. Build on opportunities to integrate procurement and supply chain management (PSM), management of Human Resources for health (HRH) and health management information systems (HMIS). Significant opportunities for operational research in the area of integrated service delivery.

MoU with UNICEF (signed April 2014) Aim: To maximize availability of essential medicines and commodities Strengthen: –diagnosis and treatment for pneumonia, diarrhea to complement GF malaria inputs –ANC platform to complement GF inputs in HIV and malaria Jointly identify countries and integrate packages of care Support governments to revise national strategies to strengthen alignment and donor support MoU with UNFPA (signed August 2014) Aim: To improve sexual and reproductive health through universal and integrated SRH services, including HIV services Jointly identify countries to increase access to SRH commodities Mobilize additional funding to target barriers to delivery, including human resources; forecasting, procurement and supply chain management. Establish joint M&E tools and modalities. Innovative Partnerships: Promoting Integration

Technical guidance notes The Global Fund Information Note: “Maximizing the Impact on Reproductive, Maternal, Newborn and Child Health (RMNCH)” WHO Technical Guidance Note: “Strengthening the inclusion of reproductive, Maternal, Newborn and Child health (RMNCH) in concept notes to the Global Fund” WHO AFRO Guidance: “Guidance tool for Integration of RMNCH into GF ATM and HSS concept notes” - July 2014

Questions? 9

Lessons from TERG review: key facilitators for integration Reliable funding for HTM and MNCH components crucial for sustaining integration Integration of training from outset helps to avert “missed opportunities Addressing demand-side barriers critical to uptake of integrated services Integrated, well-functioning supply chains central to successful service integration Integrated HMIS and M&E creates efficiencies and can improve program impact

Designing Programs to Maximize the Impact on Mothers and Children Step 1: Ensure RMNCAH stakeholders are part of country dialogue Step 2: Include RMNCAH in the situational and gap analyses Step 3: Prioritize key RMNCAH interventions in concept notes, and then ensure implementation *Steps from the RMNCH Information Note