Partners in Impact: Innovative Partnerships to fight disease HEI 2008 Daniel Low-Beer, Director Performance, The Global Fund to Fight AIDS, TB and malaria

1.Introduction –The Global Fund –Performance Based Funding 2.Managing for Results –Measurement –Managing for disease results 3.Partners in Impact –Joint Learning –Investing in Impact Contents

The Global Fund is an independent public-private partnership mandated: - To raise and to disburse substantial new funds - To operate transparently and accountably - To achieve sustained impact on HIV, TB, and malaria Raise it Spend it Prove it BG/290607/1 A. What is the Global Fund ? “make a sustainable and significant contribution to the reduction of infections, illness and death.. as part of the Millennium Development Goals.”

Guiding Principles 1.Operate as a financial instrument, not an implementing entity 2.Make available and leverage additional financial resources 3.Support programs that reflect national ownership 4.Operate in a balanced manner in terms of different regions, diseases and interventions 5.Pursue an integrated and balanced approach to prevention and treatment 6.Evaluate proposals through independent review processes 7.Establish a simplified, rapid and innovative grant-making process and operate transparently, with accountability BG/290607/2

A Partnership Approach: wide country ownership Donors Recipients ● Private Sector Private Foundations ● NGOs North ● NGOs South ● Communities living with the diseases ● WHO ● UNAIDS ● World Bank Civil Society Technical Partners Private Sector Public Sector (Governments) A partnership of stakeholders

History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa

Apr: African leaders commit to greater response in Abuja Jun: Endorsement of the need for a “global fund” at UNGASS Jul: Over $1.5 billion in pledges made by G8 in Genoa History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa

Apr: African leaders commit to greater response in Abuja Jun: Endorsement of the need for a “global fund” at UNGASS Jul: Over $1.5 billion in pledges made by G8 in Genoa History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa Jan: Global Fund created at 1st Board Meeting Apr: Round 1 proposals approved Nov: First disbursements commence

Feb: Board approved the first wave of Phase 2 grant renewals Sep: 1st Replenishment completed Apr: African leaders commit to greater response in Abuja Jun: Endorsement of the need for a “global fund” at UNGASS Jul: Over $1.5 billion in pledges made by G8 in Genoa History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa Jan: Global Fund created at 1st Board Meeting Apr: Round 1 proposals approved Nov: First disbursements commence

Feb: Board approved the first wave of Phase 2 grant renewals Sep: 1st Replenishment completed Apr: African leaders commit to greater response in Abuja Jun: Endorsement of the need for a “global fund” at UNGASS Jul: Over $1.5 billion in pledges made by G8 in Genoa Sep: 2nd Replenishment completed; US$9.7bn pledges realized History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa Jan: Global Fund created at 1st Board Meeting Apr: Round 1 proposals approved Nov: First disbursements commence

Feb: Board approved the first wave of Phase 2 grant renewals Sep: 1st Replenishment completed Apr: African leaders commit to greater response in Abuja Jun: Endorsement of the need for a “global fund” at UNGASS Jul: Over $1.5 billion in pledges made by G8 in Genoa Sep: 2nd Replenishment completed; US$9.7bn pledges realized History and key milestones Jul: G8 endorse new AIDS, TB and malaria targets in Okinawa Jan: Global Fund created at 1st Board Meeting Apr: Round 1 proposals approved Nov: First disbursements commence Oct: Round 9 launched

Resources as of June 2008 Support to 136 countries Funding to the Global Fund –Pledges available through 2010: US$ 19.8 billion –Received: Approximately US$ 11.2 billion Funds approved and disbursed by the Global Fund –Proposals approved: US$ 11.7 billion –Disbursed: US$ 5.9 billion BG/110608/5

Countries with Global Fund grants BG/261107/6

B. What is Performance Based Funding ? Programmatic monitoring Financial monitoring Performance Based Funding Linking ongoing disbursement to program results Measuring and managing for results

Evaluation framework of the Global Fund BG/300606/11 Operational performance Grant performance Systems effects Impact Sample Measurements e.g. declining mortality from HIV, TB and malaria e.g. effects on health systems and improving aid effectiveness e.g. coverage, people reached by services e.g. actual against target disbursements Global Fund contribution

1.Introduction –The Global Fund –Performance Based Funding 2.Managing for Results –Measurement –Managing for disease results 3.Partners in Impact –Joint Learning –Investing in Impact

A. Global Results: scale up in services Challenge of impact: 30-45% of international targets 1,75 million 59 million 1,750,000 3,900,000 59,000,000 Measurement of Results

Increases in ARV, DOTS and ITN results GP/071207/9

Partners in impact: supporting countries Integrated country strategies to fight diseases Malawi HIV -ARV treatment to 70,000, comprehensive prevention, care -Technical support WHO, World Bank, private companies -Country AIDS coordinators in 15 ministries and 28 districts - Health personnel: exceptional finance DFID, SWAp, GF grant Guatemala malaria -Long lasting ITNs, IRS, Treatment -School program: “malaria memory”, “malaria bingo” -Community diagnosis laboratories, malaria research centre “Before they would wait a week for a malaria test result, so they just get the drugs from the pharmacy and take them if they felt ill. Now it takes 5 minutes, we reduce the drug demand and control resistance. Unlike other countries, we can still use chloroquine” Principal Recipient

Overall 94% of top programmatic targets reached Top 10 targets 215 Board submitted phase 2 grants to 1 Jan 2007

Country owned results – 74% of grants perform well 74% of grants are succeeding 84% of funds are invested in well- performing grants (A and B1) GP/310308/ Phase 2 grants submitted to the Board, Dec 2007

B. Making Performance Decisions on data 1.Accelerate 2.Systems Strengthening 3.Revision where required Management for Results

Investing in robust measurement Building towards impact What?: 5-10% of grant funds ( m US$ p.a.) –Performance based funding: incentives for 11 years Why?: Managing the epidemic –Grants to support country programs –Collective goals with partners: MDGs Capacity strengthening People reached by services Impact (and behaviours)

Learning from Implementation Country support: well defined TB package –Managerial and technical along the grant lifecycle –Partner roles coordinated by Stop TB (learning for malaria and RBM) Learning across the diseases –Strong TB clinical systems, surveillance and follow up –HIV and malaria approaches to tackle community transmission Direct evidence of impact and lives saved –Services delivered to managing the epidemics –TB and HIV/TB in Africa

Flexible finance for services and systems: Focus on results, countries decide how to achieve them Ethiopia: 30,000 community health workers –Coordinated World Bank, GAVI, PEPFAR –Roll out AIDS, TB, malaria services to rural areas “We use the analogy of agriculture, we say they can grow food, and now they can also grow health in their communities” Haiti: HIV/TB services improve primary health –Improved flow essential medications, vaccines, staff morale –Prenatal care increased 4 times “Far from diverting resources, strengthened primary health care throughout Haiti’s lower central plateau”

Management for results: evidence based learning by doing “ What made the difference is that you gave us a clear warning that we were in the red zone, that we could lose our money if we didn’t deliver results. We looked at it, we could focus, and we both saw the problem, and that was the adjustment we made to get the results. Performance- based funding helped us think through implementation ” Minister of Health, Ethiopia

1.Introduction –The Global Fund –Performance Based Funding 2.Managing for Results –Measurement –Managing for disease results 3.Partners in Impact –Joint Learning –Investing in Impact

Investing in impact Partner approach to results –The Three Ones for the Three Diseases How to allocate funds to fill gaps –Proposals: TB or cross-cutting HSS actions –Reallocation of ongoing budget (5-10%) –Phase 2 request (after months), invest with partners Full Force of Partners to achieve impact –Deliver services to those at risk –Engage with behaviour and drivers of epidemics –Ensure accountability

Linking disease impact and health systems Malaria interventions (and possibly AIDS treatment) “Before we dealt with hospitalisations, now we can provide the full package of health” District Hospital Director, Rwanda

Conclusions: partners in impact Managing for Results –Learning, decisions on data, management for results Flexible investments in services and systems –Surveillance, surveys, mortality systems –Country analytical capacity Partner approach to show collective impact –Support national programs, and measure the MDGs “You go to a medical ward and now half of the beds are not occupied, before they were mushrooming. A manager cam to me as Minister of health and said “You are bad for business, our funeral business is going down”. There was a time when every weekend we were burying four to eight people, now weeks go by without a funeral”

Appendix: extra slides

Extra slides History of GF events Finance by A, B1, B2, C