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Africa: AIDS Treatment Progress Reports
AfricaFocus Bulletin
Jul 1, 2006 (060701)
(Reposted from sources cited below)
Editor's Note
Newly-compiled performance results show that as of end April,
544,000 people have begun antiretroviral (ARV) treatment through
Global Fund-supported programs - up from 384,000 six months ago.
And despite the pressures for competition between the U.S.
bilateral PEFPAR program and the Global Fund, reports from
implementing agencies say the stress on operational level is on how
to use resources from both programs to maximize action against
AIDS. But sustainability of funding is a looming obstacle, with
the projected overall funding gap for this year at some $5 billion.
This AfricaFocus Bulletin contains excerpts from a press release
from the Global Fund to Fight AIDS, Tuberculosis, and Malaria
(http://www.theglobalfund.org) and a report from AIDSMAP on the
recent PEPFAR implementers' conference in Durban.
For earlier AfricaFocus Bulletins on health issues, see
http://www.africafocus.org/healthexp.php
Note: AfricaFocus Bulletin will be taking a break for the next two
weeks. Publication will resume in the third week of July.
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
New Global Fund Grant Results Show Substantial Impact
More than 40% Increase in People Reached Over Six Months
June 29, 2006
Global Fund to Fight AIDS, Tuberculosis, and Malaria
http://www.theglobalfund.org
Johannesburg - With nearly 400 grants approved to combat HIV/ AIDS,
TB and malaria, Global Fund-financed programs are proving that
where money is invested, treatment and prevention efforts are
working.
In its latest progress report published today, the Global Fund
outlines the latest program results and looks at the initial data
on how its grants affect health systems and indications of global
impact in the fight against the diseases.
Newly-compiled performance results show that as of end April,
544,000 people have begun antiretroviral (ARV) treatment through
Global Fund-supported programs - up from 384,000 six months ago.
The new figures show a more than four-fold increase since December
of 2004 in the number of people started on ARV treatment with
support from the Global Fund.
Taken together, programs providing DOTS (Directly Observed Short
Course Treatment) have detected and treated more than 1.4 million
cases of tuberculosis worldwide. In addition, Global Fund-supported
programs to combat malaria expanded distribution of
insecticide-treated bed nets to 11.3 million, up from 7.7 million
in December 2005.
Early indications of impact on the three diseases show both that
the additional funding of the Global Fund bears a promise of
substantially reducing the prevalence of these diseases. The
potential for most rapid progress is in the field of malaria, where
concentrated investments have drastically reduced mortality within
periods of less than two years and carry promise for a global
turnaround in the prevalence and mortality rates. ...
"This latest set of performance figures comes as very good news,"
said Richard Feachem, Executive Director of The Global Fund to
Fight AIDS, Tuberculosis and Malaria. "These results demonstrate
that where countries are given the resources they need, progress
against this pandemic is possible. It shows that with sufficient
global resources, we can drive back this scourge."
The report finds that the Global Fund's system of performance-based
funding does appear not to penalize poor countries, as countries
with the lowest wealth, health systems or human resources for
health have no worse performance during their first two years of
grant implementation. Even countries known as "fragile states" (due
to extreme poverty, recent armed conflict or weak governments) do
not fare significantly worse than other countries, with two thirds
of them showing satisfactory performance. Many of these "fragile
states" have developed a close collaboration between government and
civil society in implementation of national health programs,
compensating for weaknesses in public sector.
Civil society organizations are strong implementers, with 30
percent of their grants over-performing and the remaining 70
percent showing satisfactory performance. There are strong
indications that countries can drastically increase their national
absorptive capacity by channeling more of its health spending
through non-governmental and faith-based organizations.
Global Fund support for efforts to combat AIDS account for 56
percent of the total US$ 5.4 million committed to date for programs
in 131 countries to fight the three diseases. Of the US$ 3 billion
allocated to AIDS, half is dedicated to prevention activities while
the other half is allocated to treatment.
In 2005, the Global Fund was responsible for an estimated 20
percent of all international funding in support of efforts to
combat HIV/AIDS, and approximately two-thirds of global funding for
programs against TB and malaria.
Over the past three years, Global Fund financing has enabled nearly
53 countries to change from malaria drugs which have become
increasingly ineffective to the new artemisinin-based combination
therapy (ACT), which has the potential to drastically reduce
mortality from malaria among children and pregnant mothers. In some
countries, Global Fund grants have also provided blanket coverage
of new, long-lasting insecticide-treated bed nets, which afford
more durable, effective protection against malaria to vulnerable
populations. The roll-out of ACT or other effective combination
therapies and bed nets - in combination with targeted insecticide
spraying and strengthening of expertise, infrastructure and
training - is expected to reduce malaria mortality in large parts
of Africa in the coming years.
On average, data compiled shows that grants to combat all three
diseases are exceeding targets set out in their respective grant
agreements, which serve as the basis of the Global Fund's
performance-based grant evaluation. The new results released today
represent the aggregation of numbers issued directly from reports
on progress by individual grants.
While the new treatment and prevention figures demonstrate the
Global Fund's expanding track record in saving lives, raising
awareness among vulnerable populations and preventing further
infections, the Global Fund's funding gap for years 2006 and 2007
threatens to curtail the momentum of funded programs as well as
funding for new rounds of grants.
"New rounds of grants in 2006 and 2007 will provide the opportunity
for countries to expand the considerable progress we are seeing
against the three diseases", said Carol Jacobs, Chair of the Global
Fund Board. "Donors need to make long-term commitments of
sufficient resources to enable developing countries to plan for the
future with confidence that funding for their lifesaving activities
will not trail off." ...
PEPFAR and Global Fund both highly effective, but is the funding
sustainable?
Theo Smart, June 23, 2006
AIDSMAP
http://www.aidsmap.org
[Excerpts only. For full text of this report and other reports from
the conference, visit http://www.aidsmap.org]
At the 2006 Annual Implementers' Meeting of the US President's
Emergency Plan for AIDS Relief (PEPFAR), last week in Durban, South
Africa, the 'implementers' (the teams working on the ground in
PEPFAR's focus countries) reported success after success and gave
numerous examples of just how rapidly effective smart and strategic
investments in AIDS care and treatment can be. In a little over two
years since disbursements began, PEPFAR has supported
antiretroviral treatment (ART) for hundreds of thousands and care
for literally millions of people infected or affected by HIV in
resource-constrained settings.
And yet a shadow loomed over the meeting, held just ten days after
the US delegation to the United Nations (UN) refused to set
financial targets for universal access to prevention, care and
treatment at UN High Level Meeting on AIDS and just two weeks
before the continually cash-strapped Global Fund to Fight AIDS,
Tuberculosis and Malaria (the Global Fund) will be holding its own
"Replenishment Conference," also in Durban, where the Global Fund
board will be begging national, institutional and individual donors
for enough money to hold a grant cycle this November - - much of
which is desperately needed simply to sustain ongoing programmes
whose earlier grants will soon be expiring.
This appears to be part of a growing pattern, according to the UN's
Global Report on HIV/AIDS, which notes that after years of funding
expansion, "existing pledges, commitments and trends suggest the
rate of increase may be declining and that available funds will be
US$ 8.9 billion in 2006 and US$ 10 billion in 2007. Those amounts
will be far short of meeting the estimated requirements of US$ 14.9
billion in 2006, US$ 18.1 billion in 2007 and US$ 22.1 billion in
2008."
"The financial shortfalls that we are facing around the response to
AIDS are ever more significant and calamitous," Stephen Lewis,
Secretary-General's Special Envoy for HIV/AIDS in Africa said
during the UN High Level Meeting.
"We are facing a shortfall overall of $5 billion this year, of $8
billion next year, of $10 billion in 2008. We are facing a minimum
overall shortfall of $23 billion dollars which is, quite frankly at
this moment in time, a scandalous betrayal of the commitments that
the G8 made at Gleneagles in July of 2005."
In light of such financial uncertainty, a number of participants at
the PEPFAR meeting expressed grave concerns about the long-term
sustainability and expansion of the scale up of treatment and care
globally, and whether there will continue to be reliable ongoing
funding for both PEPFAR and the Global Fund. The presence at the
PEPFAR meeting of activists from the American religious right, who
have been attempting to drive a wedge between the two generally
complementary organisations, only heightened worries among some
participants that support for one or the other donor agency could
be held hostage to American partisan politics.
Yet, the philosophical differences between the two donor
organisations seemed relatively minor in light of the importance of
their shared objective fighting the pandemic. For the most part,
the true implementers (many of whom receive support from both
funders) at the PEPFAR meeting appeared more interested in getting
the work done than wasting too much time on ideological
controversies or religious polemics. ...
PEPFAR background
President Bush established the Emergency Plan for AIDS Relief in
July 2003 to increase the total US commitment to the effort to
combat the HIV across the globe to an $15 billion over a five year
period.
Only about $9 billion really represents new money, the lion's share
of which is being directed to efforts in 15 focus countries that
are burdened with about half of the world's HIV infections. Over
the first two years, under two billion dollars of the new funds
have actually been disbursed but the proposed funding is scaling up
rapidly over the next few years, as more programmes come online and
develop greater capacity to actually absorb and spend the money
effectively.
Nevertheless, the results so far have been impressive. According to
statistics put together by the US Office of the Global AIDS
Coordinator (OGAC) as of March 31, 2006, PEPFAR has:
- Directly supported ART for 366,800 people and contributed to the
support (by strengthening local systems and capacity) making ART
possible for 194,200 more.
- Directly supported efforts to prevent mother to child
transmission for about 4.5 million women, and preventive therapy
for about 340,000 women - - preventing HIV transmission to an
estimated 65,000 infants.
- Provided HIV-related care and support to nearly 3 million people
across the world, including more than 1.7 million people living
with HIV/AIDS and more than 1.2 million orphans and vulnerable
children.
While the funding has come from the US, these achievements are
equally due to the dedication of PEPFAR's in-country partners - -
both governmental and non-governmental - - implementing the
programme on the ground.
Global Fund worries
But efforts supported by the Global Fund are under even more
imminent danger of losing support.
"The Global Fund spends an immense amount of time and energy in a
yearly begging exercise to get some donors to fulfil their
commitments," Javier Hourcade Bellocq, who serves as an Alternate
Board Member to the Global Fund (representing communities living
with diseases) said at a press conference held during the UN High
Level Meeting on AIDS.
"And even that seems not to be enough," he continued. "We are now
facing the risk of not having sufficient resources to fund the 6th
round of proposals that the board needs to approve in November
2006. We immediately need a new round to scale up prevention,
treatment, care and support in our countries, and also to renew the
first round of grants that's coming to an end real soon."
Since its creation in January 2002, the Global Fund has disbursed
more than $2.2 billion to public and private recipients in over 127
countries (and promised more than $3 million more, which will be
disbursed only after countries reach performance targets).
As of June 2006, according to their own statistics, Global Fund
supported programmes have:
- Distributed around 11.3 million insecticide-treated bednets to
prevent malaria
- Provided millions of courses of malaria treatment and enabled 53
countries to begin offering artemisinine-based combination therapy
(ACT) (rather than older drugs which malaria resistance has
rendered ineffective)
- Detected and treated more than 1.4 million TB cases
- Supported HIV care and prevention for hundreds of thousands of
people and orphans in resource-limited settings
- Provided ART for 544,000 people
Actually, Global Fund and PEPFAR must share credit for some
patients on ART, because often each donor organisation supports
different aspects of the same ART programme. For example, PEPFAR
may provide support for the laboratory monitoring or staff
training, while the Global Fund may purchase the actual
medications, or vica-versa.
Speaking at the opening of the PEPFAR meeting, the Global Fund's
Deputy Executive Director, Helen Evans, stressed this sharing of
the burden of treatment: " Together, programmes financed jointly or
separately by PEPFAR and the Global Fund have put 875,000 people on
ART... this is a more than 40% increase in the last six months and
more than a doubling within the last year."
To do its part to maintain this momentum of scale-up, the Global
Fund announced a Sixth Call for Proposals in April this year. But
shortfalls in funding commitments are now jeopardising a new round
of grants - - and even the funding of the second phase of grants
for projects already up and running. If there is to be one new
grant cycle each year, in 2006 there will be a shortfall of $0.9
billion, and in 2007, a shortfall of $1.2 billion.
"I hate to even begin to imagine the day that the Global Fund will
fail to meet its commitments," said Elizabeth Mataka, Executive
Director of Zambia's of National AIDS Network who also serves as
Global Fund board member on behalf of Developing Countries NGOs at
the UN press conference. "If round six is not renewed in November,
we will lose all the momentum we've worked so hard to gain."
"It is unthinkable that the global fund should have to make this
appeal, and is a sad commentary on the G8 countries," said
Ambassador Lewis. "Where is the sense of crisis? What is happening
here?"
Is PEPFAR competing or cooperating in treatment scale-up?
Given the political climate in which the PEPFAR Implementers
meeting and the UN High Level meeting took place, it would be only
natural for some working in the respective funding organisations to
become a bit competitive - - and yet publicly at least both appear
to be striving for closer cooperation.
Given the fact that both organisations are funding similar work in
the same areas, without close communication there is a capacity for
overlap and creating redundant, parallel systems. In some cases,
duplications of effort have led to competition for the same
patients. In one case, a free PEPFAR ART site was established near
an established fee-for service Global Fund site, and inadvertently
siphoned patients away - - contributing to the failure of one
country [Nigeria] to have the second phase of its first round
Global Fund grant renewed.
According to Ms. Helen Evans, Deputy Executive Director of the
Global Fund, such poor coordination ultimately led to a meeting in
January 2006, between PEPFAR, the Global Fund and the World Bank to
improve communications amongst country teams and to identify
challenges to successful implementation as well as come up with
concrete actions to tackle those challenges. ...
In her address at the start of the Implementers meeting, she asked
participants to focus on closer cooperation, insisting that it is
in both organisations' best interests to "convince tax payers and
law makers that this effort is worth increased effort, predictable
and long term investments in order to sustain and further scale up
our work."
"How do we strengthen health systems to allow the scale-up to occur
and to ensure that the scale-up is sustainable?" she said. "One of
the obstacles to increasing access to treatment is the frailty of
basic health systems in many countries."
In this regard, the Global Fund has certain advantages over PEPFAR
because the Global Fund favours a country-driven approach which
brings the key stakeholders (governmental and non-governmental
organisations) in a country together to flesh out what they believe
the country should ask for in its grant (and hammer out what they
believe they can deliver). ...
Good examples of this process were presented from Kenya and
Tanzania, where two different approaches to coordination have been
followed.
In Kenya, coordination of donor activities takes place at the
provincial level, where the word of the provincial ART officer is
final. Lennah Nyabiage of the Kenyan Ministry of Health explained
her role: coordinating all donor activities, including
PEPFAR-funded programmes in Nyaza province.
"Partners often want to go to particular districts, but the
Ministry of Health has to tell them to go to places without ART
coverage. The provincial officer has to try to get partners to
direct money where it is needed, rather than according to the
preferences of partners."
Ms. Nyabiage has a lot of partners to coordinate in Nyaza province:
the US Centers for Disease Control, Mildmay International, MSF,
Catholic Relief Services and the German development agency GTZ are
all directly supporting antiretroviral treatment in Nyaza province,
largely through PEPFAR grants. ...
In Tanzania on the other hand, the division of labour has been
coordinated at the national level, with provinces allocated to
different consortia of organisations, even though most of the
programmes are funded by PEPFAR. These consortia are responsible
for all aspects of scale-up in a particular province. ...
But coordination doesn`t always work - - at least not as quickly as
people living with HIV really need. Governments often drag their
feet, lack competent leadership or are corrupt. Local stakeholder
representation may be inequitable (with some groups being
completely shut out) or negotiations between stakeholders can be
influenced by politics or simply inefficient. As a result, the
proposals the Global Fund receives, or the implementation of the
funds on the ground, are not always as good as they could be.
It is in these situations where PEPFAR is particularly useful - -
whenever Global Fund efforts meet an impasse which PEPFAR-funded
programmes, by virtue of feeling less obliged to work through local
government-led coordinating bodies, can more rapidly address. One
advantage PEPFAR has is its ability to bypass government
coordinating bodies, red-tape and logjams to direct funding to
groups, community-based or otherwise, that can rapidly mobilise and
get the work done. But this works especially well when PEPFAR and
Global Fund keep each other informed of each others efforts and
challenges in implementation. ...
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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