The Council of the World Fund for Combating HIV, Tuberculosis (TB) and Malaria discussed the development of its next strategy at its 44th Council meeting. The discussion was based on the GF / B44 / 07 document issued by the Secretariat. The strategy is a multi-year roadmap that will guide the actions of the Global Fund. The current strategy will expire in 2022. The Board focused on the high – level schedule and issues related to the development of the strategy.
The Global Fund plans to complete the strategy framework after 2022 by the first quarter of 2021, so that the partnership can use it to develop a case that will serve as a basis for mobilizing resources, culminating in the 7th Supplement for the scheduled for the third time. quarter of 2022. The Global Fund seeks to raise the input of all stakeholders. Constituencies and an external evaluation emphasized the ongoing relevance of three elements of the current strategy: the maximum impact on the three diseases, the strengthening of health systems and the promotion of human rights and gender equality. While some constituencies have emphasized new elements such as global health security, climate change or social health determinants, others have warned against unnecessarily increasing the scope of the Global Fund. Critics explain that the Global Fund must focus on its core mandate: to fight HIV, TB and malaria.
Information for this article comes from the documents that the Global Fund Secretariat shared with the constituencies of the Council before the 44th Board meeting of the Global Fund, as well as some statements from the constituencies that Aidspan saw.
Schedule for strategy development after 2022
Constituencies have been discussing the Global Fund Strategy since the beginning of the year 2020. (Aidspan previously wrote in the Global Fund Strategy on the African, Latin American and Caribbean Islands and the Southeast Asian constituencies).
The Board discussed the strategy development strategy (Figure 1). The rest of 2020 will weigh the Global Fund Board with the input into the second Board Retreat, which will be held before the end of the year. (The Council’s previous withdrawal took place in early November 2020.) Partnership forums, which are meetings with representatives of different constituencies, and other Global Health stakeholders will take place in the first quarter of 2021. The input of these forums will be summarized in a strategy framework that will be discussed by the strategy committee in the first quarter of 2021 and submitted to Council in the second quarter of 2021. The secretariat will develop the strategic narrative for the rest of the year. In early 2022, the Global Fund will develop an investment case that will be used for the 7th Supplementary Conference in the third quarter of 2022.
Figure 1: Schedule for strategy development
Source: Global Fund Secretariat
Current situation with the three diseases and funding of the Global Fund
The Global Fund has adjusted its objectives and timelines in line with the Sustainable Development Goals (SDGs). SDG 3.3 aims to end HIV, TB and malaria as epidemics by 2030. The report says that the world is not on track to reach the target; To reach the target, about 90 percent reduction in new infections will be required to achieve the incidence and mortality targets. The mortality rate due to the three diseases decreased faster than the incidence (new cases per year).
For HIV, there are still major gaps in the prevention of adolescent girls, young women and key populations. More than 60 percent of new infections occur among key populations, including men who have sex with men, sex workers and people who inject drugs. According to the report, progress towards prevention of mother-to-child transmission (PMTCT) and pediatric treatment is uneven in regions.
As far as TB is concerned, the report states that the focus will be on detecting missing cases. There are also gaps in the detection and treatment of multi-resistant TB (MDR-TB). There is a need for shorter and oral MDR-TB regimens. (Current MDR-TB treatment lasts between 18 and 24 months.)
In terms of malaria, the number of cases worldwide has decreased since 2013. The flat curve hides increase in almost every high-burden area, offset by declines in some countries like India. Malaria deaths remain concentrated: the ten countries with the highest burden are responsible for two-thirds of all deaths. The number of deaths from malaria is stagnant or increasing in five countries: the Democratic Republic of Congo (DRC), Burkina Faso, Tanzania, Uganda and Angola. Insecticide resistance is also increasing: in 2017, about a quarter of the 80 countries reporting announced that mosquitoes had become resistant to all four current insecticide classes.
In terms of funding, the Global Fund is responsible for 8 percent of global funding for HIV and TB, but 40 percent of global malaria funding. Government funding accounted for about 60 percent of global health spending.
However, domestic and international resources will be limited by the COVID-19 epidemic.
Emphasize resilient health and community systems in the new strategy
The following Global Fund strategy will focus on the comparative benefits or strengths thereof. The Global Fund was established to fight HIV, TB and malaria; it will continue to do so in a way that helps build health and community systems and promote equality, human rights and gender equality. While some voices added global health protection, the effect of climate change, others warned against an overly broad scope.
Some voices also called for innovation and flexibility in implementation, as the Global Fund implements its sustainability, transition and co-financing in the wake of COVID-19. Other voices have suggested that health security worldwide should be strengthened to combat current and future pandemics that could derail the fight against HIV, TB and malaria. They highlighted the potential for better partnerships with multilateral and international organizations and institutions in the country such as civil society, communities, other government sectors and the private sector.
Many constituencies said the COVID-19 pandemic underscored the dual importance of health and community systems. Strengthening health systems will help fight HIV, TB and malaria and reap the benefits of fighting the three diseases over the past two decades. Community systems allow other members of the community, including people affected by or through the three diseases, to reach out, educate and diagnose or care for other members of the community, especially the vulnerable and marginalized. Strengthening health and community systems will help the Global Fund Partnership improve quality of care and save lives.