1. The Global Fund's new funding model for more strategic investment Symposia Session - Trends in AIDS Financing and Effectiveness of Current Investments Melbourne, July 2014 Dr Christoph Benn Director, External Relations Division Global Fund

2. Content Overview 2 1 2 3 Financing trends Addressing unmet needs Towards more strategic investments

3. 3 Update on resource mobilization 4 th Replenishment: $ 12 B in pledges – 30% above 3 rd Replenishment level 3 Pledges & contributions to the Global Fund have been increasing over time As of Q2 2014: Total pledges have reached US$ 12.3 billion, with donor government pledges accounting for US$ 11.6 billion or 94.7% US$ 3.844 billion of total pledges have been signed into contribution agreements of which US$ 1.580 billion have been paid in 3,844

4. 4 Disbursements to programs total $24.4 billion to date, including $13.1 billion (54%) for HIV/AIDS 4

5. 5 Total Funding from Global Fund is Increasing The total funds for allocation are 20% higher than in the past: -The total funds allocated to countries, available as of January 1, 2014 and including existing funds: $ 14.7 billion for three years or on average $ 3.7 billion per year; In addition: -$ 950 million to be awarded as incentive funding to ambitious programs that deliver impact in country, which increases the average implied funding level to above US$ 3.9 billion per year; -$ 200 million for new regional grants and $ 91 million to finish existing regional grants. 64%10%9%8%4% - Allocations by Region (billion and %) -

6. 6 Content Overview 6 1 2 3 Financing trends Addressing unmet needs Towards more strategic investments

7. 7 Largest funding increases are targeted at the regions with the least recent funding relative to burden Disease burden and recent funding share Country allocations relative to recent funding 75% 100%120%170% Allocation as a percentage of recent funding: 0%>170%

8. 8 Global Fund results - 6.6 million people on antiretroviral therapy, an 8% increase over 6.1 million in 2013 8 Source: Global Fund Grant Data, mid-2014 Current ART and cumulative DOTS uptake (millions) Cumulative Insecticide-treated nets distributed (millions) Results in HIV/AIDS at a glance: 6.6 million people on ART, with gains driven by higher numbers in Nigeria, Mozambique, India, and Uganda, among others. counselling and testing sessions for HIV increased by more than 50 million to 360 million from 306 million at year-end 2013 number of OVCs that received basic care and support for HIV increased to 7.1 million from 6.5 million over the past 12 months. condoms distributed grew by 155 million to reach the total of 4.7 billion, more than a third of the increase from campaigns in Rwanda and Ghana

9. 9 Most countries are under-funded relative to need & are encouraged to be ambitious in what they plan to achieve  In most countries, the allocation amounts (regardless of whether a country is over- or under-allocated) will still be insufficient to cover the gaps vs. real need -Most countries are under-funded relative to their needs. -This should not limit planning and ambition – to defeat the diseases, countries need to think creatively on how to use all resources available  Stronger resource prioritization is critical to achieving impact -Existing grants should be used as effectively as possible, ensuring programs are regularly evaluated and grants reprogrammed for maximum impact -Any additional funding should be harmonized with existing funding; disease programs should be viewed in a holistic manner  Strategic investment for maximum impact -Resources are focused on targeting the right populations -Decisions on allocation of resources are based on evidence/data 9

10. 10 Context of the 5th Replenishment ODA projected to increase in 2014 & then stabilize 10 July 2014Melbourne Net official development assistance 2004-13 & projections for 2014-16 (in current US$ billions) OECD: http://www.oecd.org/newsroom/aid-to-developing-countries-rebounds-in-2013-to-reach-an-all-time-high.htm ODA in 2013 rebounded & reached $ 134.8 B despite economic pressure on donors but likely to stabilize after 2014  critical to ensure appropriate share for health

11. 11 Content Overview 11 1 2 3 Financing trends & Results Addressing unmet needs Towards more strategic investments Focus more strategically on areas of greatest impact Support increased investments from domestic sources

12. 12 Example of investing for impact: Targeting ‘hot spots’ achieves greater impact in Kenya Source: [i] Williams BG, Lloyd-Smith JO, Gouws E, Hankins C, Getz WM, et al. (2006) The potential impact of male circumcision on HIV in Sub- Saharan Africa. PLoS Med 3: e262. doi:10.1371/journal.pmed.0030262 [i] …lends itself to improve efficiency of HIV prevention spending through prioritization In Kenya, geographic variation in HIV prevalence …

13. 13 Shared responsibility through increased domestic resources Mandatory minimum requirements of counterpart financing Minimum threshold contribution (LI- 5%, Lower LMI-20%, Upper LMI- 40%, UMI-60%) Increasing government contribution to disease programs and health sector Reliable disease and health expenditure data ‘Willingness-to-pay’ commitment to further incentivize Additional co-investments by government in disease programs in accordance with ability to pay Realization of planned government commitments 15% of allocation is contingent upon meeting WTP commitments Core Global Fund principles: Sustainability, Additionality, Country Ownership

14. 14 Update on resource mobilization GF Domestic Financing Strategy 14 GF strategy for increased domestic financing for health 1. Implement NFM policies linked to domestic financing (Counterpart financing & willingness-to-pay) 3. Advocate for political leadership & for realization of Government commitments 2. Support domestic resource mobilization efforts (priority countries) with help of partners 1. Implement NFM policies linked to domestic financing (CF & WTP) Country needs assessment/ target-setting & support the buy-in process Options of tools/mecha- nisms for innovative financing Documentation & dissemination of Best practices Advocacy plan with key messages by GF, Donors, partners, private sector and CSOs Revive co-champion-ships and identify other champions Leverage key national/ international events & platforms Support countries on CF/WTP (guidance & tools, country dialogue) Review country compliance with CF & monitor WTP commitments Track at grant & portfolio levels

15. 15 Conclusions Health expenditures should keep pace with economic growth There is no single blueprint for increasing domestic funding for health Lessons learned and best practices should THANK YOU 15