Transcript Core slide set for the Organisation

The Global Fund and the Affordable
Medicine Facility-malaria (AMF-m)
Dr Stefano Lazzari
Senior Health Advisor
The Global Fund to Fight AIDS, Tuberculosis and Malaria
APPMG London
9 October 2007
1
The new context of malaria control
• After decades of neglect, there is renewed interest in malaria
• This has led to establishment of major global initiatives
including the RBM Partnership in 1998, the Global Fund in 2002
and the US President Malaria Initiative in 2005.
• An effective, integrated strategy has been developed, based on
evidence-based approaches and taking advantage of new
technical solutions. The strategy is based on a combination of:
–
Indoor residual spraying (IRS),
–
Long-lasting insecticide treated nets (LLINs),
–
Intermittent preventive treatment for pregnant women (IPTp),
–
Effective treatment for malaria according to the national treatment guidelines
• The importance of strengthening health systems and of the
role of non-public sectors in the delivery of interventions has
been fully ecognized.
Challenges
– Strengthen national malaria programs while also
addressing health systems bottlenecks to malaria control.
– Ensure the continuous availability of essential
commodities, including drugs, diagnostics and LLINs.
– Make optimal use of the non-governmental and private
sector
– Achieve universal access to prevention and treatment by
the population at risk, including the rural poor.
– Delay the emergence of drug resistance
– Ensure sustainable, long-term financing
– Continue the research and development of new drugs,
diagnostics and effective vaccines
– Coordinate efforts, align with national priorities and
harmonize international support
What is the Global Fund?
The Global Fund is an
independent public-private
partnership mandated:
Raise it
- To raise and to disburse
substantial new funds
- To operate transparently and
accountably
Prove
it
Spend
it
- To achieve sustained impact
on HIV/AIDS, TB, and malaria
BG/290607/1
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
Resources
September 2007
Funding to the Global Fund
• Total pledges available through 2008 = US$ 10 billion
• Approximately US$ 8.6 billion has been paid in
Global Fund funds approved and disbursed
• Total proposals approved
 2-year budget of US$ 4.7 billion
 5-year budget of US$ 11.7 billion (proposed total)
• Grant agreements signed
 2-year agreement of US$ 4.4 billion
 Phase 2 agreement of US$ 2.4 billion
• US$4.4 billion disbursed
BG/011007/5
The Global Fund and malaria
• In 6 rounds the Global Fund has approved funding for
117 malaria grants in 85 countries (41 in Africa).
• To date, $2,600 million has been approved and $ 950
million disbursed. Malaria grants represent 22% of the
GF portfolio.
• Support provided for the initial two years includes:
– ACTs:
– ITNs:
– IRS:
$285 million
$109 million
$ 82 million
• Commodities represent about 40% of GF malaria
grants
GF malaria grants performance
Treatments or bednets
delivered
Millions
Malaria treatments and bednets delivered,
December 2004 to December 2006
35
30
25
Malaria treatments
Bednets
20
15
10
5
0
Dec 04
Jun 05
Dec 05 Jun 06
Time Period
Dec 06
juin.07
Initial results in malaria prevention
Tanzania:
In pilot districts ITN coverage has reached 60%,
resulting in under-5 mortality decline of up to 50%
Zambia:
Distribution of 900,000 ITNs and access to ACTs
has resulted in 90% decline in malaria deaths.
Lubombo region of Southern Africa: A multi-country programme
has contributed to 90% reduction in malaria
incidence and 53-94% reduction in malaria
prevalence in some areas.
Kenya:
LLNI coverage rose from 7% in 2004 to 67% in
2005. This was associated with a 44% reduction in
child mortality.
Rwanda:
Reports of rapid decrease in ospitalization in
pediatric wards and reduced uptake of ACTs
associated with increased coverage with ITNs.
Barriers to scaling-up ACTs
• High cost
• Limited number of products and
manufacturers
• Prescription Only Drug
• Only available (fully subsidized) in public
health facilities with limited coverage of
population
• Prescribers and consumers habits
Rationale: to increase the availability of ACTs and replace
monotherapies across all sectors
2006 Antimalarial Treatment volumes (M)
100%
~400
~150
Other
CQ
80
SP
CQ
60
40
ACTs
20
SP
Artemisinin monotherapies
0
Private
ACTs
Note: Other category includes MQ, AQ, and others. ACT data based on WHO estimates and manufacturer interviews.
Source: Biosynthetic Artemisinin Roll-Out Strategy, BCG/Institute for OneWorld Health, WHO, Dalberg.
Public
Total = ~550
AMF-m +2 years
A scenario for ACTs coverage taking into consideration the different subsectors, the impact of prevention and the expansion of home-based care
Malaria cases prevented
100%
CQ or SP
90%
Coverage by ACTs
80%
CQ or SP
CQ or SP
70%
60%
CQ or SP
50%
ACTs
ACTs
40%
ACTs
30%
20%
ACTs
10%
0%
Informal Private
Sector
Formal Private
Sector
Total malaria treatments = 440 million
ACT treatments = 286 million
ACT coverage = 65%
NGOs/FBOs
Home-based treatment of malaria
Public
AMF-m Objectives
• Increase the overall use of ACTs and
drive out monotherapies and ineffective
drugs from the market by:
• Reducing end-user prices to an affordabel level
through a properly supported global subsidy of
ex-manufacturer prices (CIF basis) – in line with
IOM recommendations
• Introducing (in country) supporting interventions,
including the support for the proper use of ACTs.
Benefits of the AMF-m
• Ensure a regular supply of cheap and effective
antimalarial drugs to all sectors
• Facilitate the involvement of the private sector
in ACT distribution
• Promote, through the supporting interventions,
the strengthening of national capacities in
–
–
–
–
Procurement and drug management,
Drug quality assurance
Pharmacovigilance
Drug resistance monitoring.
• Improve forecast of ACT needs, stabilize the
ACT market and reduce ACT price.
Several issues still need to be addressed
• Improved analysis of what the facility can actually achieve, in what
timeframe and at what cost.
• Approach to defining, managing and financing of supporting
interventions for a “responsible introduction” of the facility.
• Making sure that the benefits of the facility are carried forward to the
consumer, the rural poor in particular.
• Definition of operational model for distribution of ACTs through the
informal private sector (through further operational research)
• Definition of a clear operational model for price negotiation with
manufacturers, that would reduce prices while encouraging
innovation and the entry of new manufacturer in the ACT market.
• Sources and sustainability of financing for the AMF-m.
Global ACT Subsidy / Affordable Medicines Facility - malaria
PSC Discussion Summary
• RBM Partnership has requested the Global
Fund to consider hosting the AMF-m
• Initial analysis shows strong
complementarity and potential synergies of
between Global Fund and AMF-m
objectives and design.
• Global Fund Board to consider at its
November meeting whether to support
hosting the subsidy as an integrated
business line within the Global Fund
16
Eighth Policy and Strategy Committee Meeting
Geneva, 19-21 September 2007