What is Global Fund’s role on the ground?
The Global Fund raises and invests money to support programmes run by local experts in countries and communities most in need. One of the principles of the Global Fund is country ownership. This means that countries and people determine their own solutions to fighting the three diseases, and take full responsibility for them. The Global Fund does not have offices outside its headquarters in Geneva and does not implement programmes on the ground.
Any specific reason to choose India which is an implementing country to kick start the sixth replenishment meeting ? Will this continue in the coming years? Reasons.
India is a strategic partner of the Global Fund, both as an implementer and as a donor. The Government of India has shown extraordinary leadership and commitment in the fight against infectious diseases, especially tuberculosis. The Preparatory Meeting of the Global Fund’s Sixth Replenishment marked the first time an implementing country hosted such a meeting. Without India, we are not going to achieve Sustainable Development Goal 3 “health and well-being for all.” If we are going to win the battle against TB, for example, we need to win the battle in India, so it makes a lot of sense to kick off the Global Fund’s Sixth Replenishment in India.
How much will be the total fund required to combat these three diseases globally and specifically for India?
The Global Fund is seeking at least $14 billion to fund programmes to fight the three diseases and build stronger health systems in the next three-year cycle. Raising $14 billion for the Global Fund, when combined with sustained levels of other external funding and significantly scaled-up domestic financing, would help us to get us back on track toward the Sustainable Development Goal 3 target of ending the epidemics by 2030. The total funding needed to meet the SDG target of ending the epidemics by 2030 globally is estimated to be $101 billion over the 2021 to 2023 period. This comprises $53.9 billion for HIV; $27.1 billion for TB; and $19.9 billion for malaria.
How much of the fund goes towards treatment and how much would be the mobilisation and administration costs?
The Global Fund’s operating expenditures in 2017 were $295 million, which represents slightly more than two per cent of grants under management. In recent years, the Global Fund has been highly effective in containing operating expenses while improving and expanding its scope of operational work, through disciplined cost control and adherence to the budgeting framework. Since 2012, the Global Fund has succeeded in keeping operating costs within $300 million per year.
What will be the role of India as an implementer and as a donor nation?
The Global Fund has disbursed $2.1 billion in programmes to fight HIV, TB and malaria and strengthen health systems in India. India has contributed a total of $39.5 million to the Global Fund as of end 2018.
Is India spending enough on all these three communicable diseases?
India has been significantly stepping up its domestic financial resources in the fight against HIV, TB and malaria, and the Global Fund encourages these efforts. During the current allocation implementation period (2018-2020), India has more than doubled its financial commitments to the three programmes compared to 2015-2017. On TB, to give an example, domestic resources have increased to $ 740 million from $ 333 million. The Government of India has very strong national programmes on HIV, TB and malaria. The central government budget for the National AIDS Control Programme, Central TB Division and the National Vector Borne Disease Control Programme in fiscal year 2018 is about $ 1 billion. This figure does not include state governments, which provide a major share of the total budget. The Global Fund financed about 17 per cent of the central government’s budget for the three disease programmes in fiscal year 2018. Like many other countries in the world, India can do more. As the Government of India has acknowledged, India needs to increase its investments in health to meet its goals, particularly TB.
What is more challenging, getting the funds, treatment or getting people to the point of treatment?
All the aspects you mention are challenging. We cannot underestimate the challenge of raising at least $14 billion, nor making sure that all the people who need quality prevention, care and treatment are getting equitable access. To achieve our mission, we must step up the fight with more innovation, more collaboration and more effective execution. And we need more funds.
Can you state us the biggest challenge—in each communicable disease in terms of HIV prevention, TB identification and diagnosis?
A main challenge on TB is finding the missing cases. Every year, more than a million people with TB in India are ‘missing’, meaning they are not diagnosed, treated or reported. This is a serious problem, and contributes to the growing problem of drug-resistant TB. India is home to a quarter of all estimated patients with drug-resistant TB. This is why Global Fund grants are geared toward supporting India’s goal of ending TB by 2025 through many aspects of work, including active case finding and the purchase of Gene Xpert machine equipment, which is used for early detection of drug-resistant TB. Global Fund investments are also being used to expand programmes aimed at engaging private healthcare practitioners to ensure proper diagnosis, treatment and support is provided to patients using private services, and to increase case notification among private care practitioners. It is estimated that up to 70 per cent of patients in India go to a private physician as their first point of contact for tuberculosis, so closer public-private engagement is essential to make progress.
When it comes to HIV, the Global Fund is acutely aware that gender inequality and human rights barriers to health fuel the spread of the epidemic. We need to look beyond biomedical solutions. Removing human rights- and gender-related barriers to health, so everyone can access the health services they need, is a key principle of the Global Fund. The Global Fund supports community outreach and engagement as an important component to ensure equitable access to health services. In India, we are helping local groups to build awareness of health issues and providing support to marginalised groups such as transgender communities, men who have sex with men and people who use drugs, who would not otherwise be able to access the services they need. This human rights work increases the effectiveness of Global Fund grants by providing health for all. The Global Fund recognises that civil society has played a key role in the fight against HIV in India and is partnering with civil society to reach out to key affected populations, to ensure that the needs of people living with HIV are adequately addressed.
What is India’s status in all the three communicable diseases? In which area should we focus more in each of the diseases?
TB is a major challenge in India. India has the world’s highest burden of TB, with 27 per cent of all global cases. It is also home to a quarter of all estimated patients with drug-resistant TB. The Global Fund is supporting India’s goal of ending TB by 2025. India has the third largest number of people living with HIV in the world, with an estimated 2.1 million people. India has an estimated 88,000 new HIV infections and 69,000 AIDS-related deaths. Since 2010, new HIV infections have decreased by 46 per cent and AIDS-related deaths have decreased by 22 per cent. And on malaria, India accounts for four per cent of the estimated global malaria cases and 68 per cent of reported cases in the WHO South-East Asia region. Since 2000, malaria cases have halved. The last WHO world malaria report singled out India for its impressive gains against the disease: the country recorded a 24 per cent reduction in cases in 2017 compared to 2016.
Do you think our target to eliminate TB by 2025 is achievable? How do you find India’s efforts to tackle these diseases?
The Global Fund commends India for its plan to end tuberculosis by 2025, five years ahead of the targets set in the Sustainable Development Goals. It is an ambitious goal, but you need to be ambitious to defeat epidemics. India has significantly increased its domestic financial resources and is taking up more responsibility in the fight against the three diseases. India has more than doubled its financial commitments to the three programmes during the current allocation implementation period (2018-2020) compared with 2015-2017. On TB, for example, domestic resources have increased to $740 million from $333 million. The Global Fund strongly commends India for these efforts.
How does Global Fund view the Indian government’s recently launched Prime Minister Jan Arogya Yojana (PMJAY – Ayushman Bharat) the health insurance scheme?
The Global Fund applauds India’s efforts to improve the health needs of its citizens, particularly the poor, and advance towards the delivery of universal health coverage.
Ayushman Bharat does not include HIV. But it does cover TB, Malaria and other ‘opportunistic infections’ that anyone can have because of HIV. How do you see this?
The Global Fund applauds India’s efforts to improve the health needs of its citizens. Countries determine their own solutions to fighting the three diseases.
Should we spend more on treatment or on prevention?
We should not see this as a dichotomy. We need both. We need an integrated and person-centered approach to fight these diseases. We should step up investments on both treatment and prevention.
prathiba.raju@expressindia.com