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the Global Fund to fight AIDS, Tuberculosis and Malaria
Issue 37 - 12 February 2014

Global Fund News Flash

Rwanda Shows the Way

Rwanda has a remarkable track record of innovation and advancement in public health, with the results to prove it. Rwanda’s leaders have ambitious goals, and the determination to reach them. In recent years, they registered one of the most drastic declines in child mortality anywhere, ever. They are setting up universal health coverage for Rwandan citizens through community-based health insurance. Health professionals who visit Rwanda all seem inspired by what they see.

This week, Rwanda and the Global Fund took another step forward, launching a partnership to support Rwanda’s national strategic plan for HIV with more funding, but using national oversight to a larger extent. By relying on the country’s strong accountability over public money, a new grant will proceed with investment in HIV treatment and prevention that is in line with Rwanda’s existing plans, but with fewer restrictions on the use of Global Fund money. Financing from the Global Fund will be tied to impact achieved in key areas of the national strategic plan, measuring important indicators such as the percentage of infants born HIV-free to mothers who are HIV-positive.

It is a significant departure from the approach used in all other Global Fund grants, and it is built on the partnership and proven results that Rwanda has already achieved. Rwanda is confident that over the next five years, it will reduce new HIV infections by two-thirds, and halve the number of AIDS deaths.

The Global Fund sees Rwanda’s role as a pilot for an idea that can someday be implemented in other countries, and with tuberculosis and malaria grants, too. But Rwanda will not be an easy case to replicate. Recent history in the Land of a Thousand Hills, as the country is popularly known, has not been like any other. In April, Rwanda will mark the 20th anniversary of the start of a devastating wave of mass killing.  “Our country sank so low, we couldn’t go lower,” said President Paul Kagame in a recent televised address, referring to that time. “The only place to go was up.” Up the country went. Rwanda has traveled a remarkable distance over two decades, with a fast-growing economy, and visionary leadership in the health field that has led to tremendous gains. But there is more work to do, and Rwanda is responding with more innovation.

Willingness to Pay

A core feature of the new funding model that the Global Fund is implementing this year is a “willingness to pay” policy that seeks to encourage additional government investments in national disease programs. The idea is to ensure the sustainability of the response to HIV, TB and malaria, and to encourage countries to reach more people in those efforts. Under the new policy, the final 15 percent of an allocation can only be accessed by a country if it commits additional government spending to programs supported by the Global Fund.  The commitments over a minimum three-year period should be beyond current levels of government spending and minimum threshold requirements of the Global Fund. It should be invested in strategic areas of national disease programs supported by the Global Fund. And it should be verifiable. The Global Fund will carefully track counterpart financing each year, and grant budgets will be adjusted downwards if commitments are not met.

The level of financial commitment required to access the willingness-to-pay sum will be agreed upon during country dialogue, the series of discussions and consultation that must precede an application for funding. Among other things, the willingness-to-pay amount will depend on existing commitments, past spending trends, national income and fiscal capacity. These additional government commitments do not have to be specific to a disease program. If minimum threshold requirements and existing commitments to each program are met, governments can set their own priorities in terms of which disease program they want to invest in. They can include a health systems strengthening component relevant to these programs. Existing government commitments that are sufficiently high will count towards “willingness to pay.” In other cases, new commitments will be required from the government to access the total allocation. In the big picture, commitments need to serve the principles of country ownership, the additional nature of Global Fund financing, and the sustainability of programs to defeat AIDS, TB and malaria.

Who is Eligible?

As the Global Fund prepares to fully implement its new funding model, it has published the list of countries that are eligible to apply for funding. Eligibility is determined in accordance with a policy designed to ensure that available resources are allocated to countries and regions with the highest disease burden and least ability to pay. The policy was revised in November 2013 to align with the Global Fund’s new approach to funding.

The Global Fund Eligibility List identifies which country components are eligible to receive an allocation of funds, and will be used to determine allocations for the 2014-2016 period. Allocation amounts will be calculated and communicated to countries in March 2014. While the Global Fund will update the list on an annual basis for information purposes, allocations will only be made once every three years. 

The Eligibility List is available on the Global Fund website. If you have any questions regarding this list please contact: AccesstoFunding@theglobalfund.org

Belarus: Cruising to Sustainability

Belarus has the highest burden of drug-resistant TB in Europe, and is still afflicted by high HIV prevalence among groups most vulnerable to the disease. The Belarus government has been approving high levels of domestic financing to programs fighting the diseases, and the country now expects to transition to fully funding its HIV and TB programs over the next three years. These efforts will facilitate a changeover from Global Fund-supported programs to government-supported ones, says George Sakvarelidze, Fund Portfolio Manager for Belarus at the Global Fund. The progress towards full domestic financing is remarkable, he says, a result of serious policy measures. In 2011, the government declared resistant TB a national emergency, allowing it to dedicate more funds to fight the disease. Today the government funds all first-line treatment of TB together with more than 70 percent of second-line treatment of the disease.

The government has also shown a high level of commitment to gathering quality epidemiological data. The data is critical in order to provide disease intelligence and high compliance with prevention, diagnosis and treatment of patients. The country, with the support of the Global Fund, is moving from a hospital-based approach to one that is patient-based, bringing care closer to the people. “The country is the tomorrow of the region,” says Sakvarelidze. 

The Belarus government has provided space for civil society to help in fighting the disease, which is mostly concentrated among most-at-risk populations. The government is also putting together plans to take up full financing of procurement of all ARV drugs in the country. Even then, more reforms will be needed to defeat the diseases, says Sakvarelidze. There will be a need for more allocation of resources to support key populations, creation of a supportive policy environment for most vulnerable groups, and help with a modified budget that will target high impact programs. 

As the Global Fund makes plans to phase out its support for health products to fight the diseases, it will continue to support national and international partners to enable them to advocate for more reforms, which if achieved, would enable Belarus to effectively control HIV and TB before long, says Sakvarelidze. 


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