Maximizing the Impact Of Global Fund Investments by Improving the Health of Women & Children

Viviana MangiaterraSenior Technical Coordinator, MNCH & HSSThe Global Fund

Presenter:

October 7, 2014

THE GLOBAL FUND’S COMMITMENT TO WOMEN & CHILDREN

What has Global Fund committed to?

• The Global Fund Strategy 2012-2016• Global Fund Strategic Action 1.4

• Maximize the impact of Global Fund investments on improving the health of mothers and children

• Every Woman Every Child • Global Strategy for Women’s and Children’s Health

• Supporting the achievement of MDG 4,5,6

Can the Global Fund show progress in what we committed to?

Between 2003-2010 the Global Fund has Contributed Approximately $3.2 Billion to RMNCH

2003 2004 2005 2006 2007 2008 2009 20100

1000

2000

3000

4000

5000

6000

7000

Official Development Assistance to *MNCH for the 74 Countdown Priority

Countries 2003-2010

Total

Global Fund

GAVI

US$

(mill

ions

)

Mills et al. 2012. Lancet

• In 2010, it is estimated that the Global Fund share of contribution in the total ODA for *MNCH was 12%

• Need to ensure that how we invest leads to optimal MNCH outcomes

*The study did not include “Reproductive health”

Impact of Global Fund Investments

• Global Fund investments have been associated with reduced maternal mortality, an effect seen in an analysis including 150 countries.

• There were some associations between levels of Global Fund funding and subsequent declines in infant mortality and under-5 mortality.

Health impact measures

• There was a consistent positive relationship between Global Fund disbursements and subsequent accelerated improvement in coverage of antiretroviral therapy, PMTCT and insecticide-treated nets.

Intervention coverage measures

New Funding Model: Opportunities to Maximize Synergies

• Concept note development • Aligned with national strategic

plans• Basis for identifying areas where

support is needed• Programmatic guidance is

available • Key entry points for RMNCH

integration in disease-specific and HSS concept notes

• Inclusiveness of CCM and Country Dialogue, including women’s organizations/networks

Building In-House Capacity

• A new RMNCH/HSS Team has been created to:• Support countries through NFM• Provide strategic guidance on investing for greater

impact on women & children• Develop closer collaboration with partners• Provide technical support to country teams

• Strong collaboration/coordination w/ Disease Teams & Community, Rights, and Gender Department

Innovative Partnerships: Scaling-up Programmatic & Investment Opportunities

Co-Investment Opportunities with UNICEF

World Bank RBF Collaboration

World Bank Health Results Innovation Trust Fund (HRITF)

• Multi-donor trust fund that supports Results Based Financing (RBF) approaches in the health sector for achievement of the health-related focus on MDGs 4 & 5

Global Fund is in process of entering into a partnership agreement with UNICEF to maximize availability of essential medicines and commodities:

• For pneumonia and diarrhea treatment (antibiotics, ORS and zinc) to complement GF malaria inputs (e.g. DRC)

• Strengthening the ANC platform (iron, folic acid, deworming pills, syphilis screening and treatment for pregnant women) to complement GF inputs in HIV and malaria

LINKING HIV, TUBERCULOSIS & MALARIA WITH BROADER RMNCH SERVICES

AIDS

• PMTCT (Prong 1-4)• Pediatric HIV• Adherence support-

Nutrition• Adolescents and HIV• RMNCH linkages and

gender-based violence (GVB)

TB

• Case detection and diagnosis (including women and children)

• Key affected populations (including children and pregnant women)

• Collaborative activities with other programs (e.g. RMNCH)

Malaria

• LLINs distribution• Facility-based

treatment• iCCM • Prevention of Malaria

in Pregnancy (MiP with IPTp

• Treatment of MiP• IPTi

Identifying Opportunities: Interventions in Disease Modular Tools

Identifying Opportunities: Synergistic RMNCH Activities

Highly Synergistic RMNCH Integrated Service Packages Relevant Modules

Screening and treatment of Syphilis in pregnancy

HIV: PMTCT/Prong 1

Family planning HIV: PMTCT/Prong 2Integrated Community Case Management (iCCM) for non-malaria fever

HSS: Service delivery

Prevent, measure, and treat maternal anaemia HIV: PMTCT HSS: Service delivery

Integrated Management of Childhood Illness (IMCI) at first-level health facilities   

HIV: PMTCT & Treatment, care and support TB: Key affected populations & Collaborative activities with other programs and sectors Malaria: Case management & Facility-based treatment

Promotion and support for breastfeeding HIV: PMTCT HSS: Service delivery

Nutrition (including iron, folic acid, deworming pills)

HIV: PMTCT HSS: Service delivery

Investing in Children & Mothers = Investing for Impact

Examples: Weak ANC services barrier to scaling up

EMTCT Community health services that offer

comprehensive child illness package are more used than malaria-only services

Investing in children & mothers meansinvesting in country’s economy and future

Service integration improves the delivery of key interventions for

HIV/AIDS, TB & malaria

ATM key interventions

Synergistic RMNCH interventions

Successful service integration

Higher service utilization

Effective coverage of both ATM and RMNCH interventions

Better Health

More Wealth

Childhood health and nutrition has a substantial impact on both physical and cognitive development, and eventual health status and productivity as an adult

Health investments in children and mothers (fetal growth) most important for human capital

Economic development leads to better health of the population, while better health contributes to economic development

1 2

Antenatal care (ANC)

Investing in key challenges such as: late initial contact, low quality of care and inadequate commodities will increase coverage and improve RMNCH outcomes

ANC

Offers tremendous opportunity to reach pregnant women with HTM interventions

Is main point of contact of pregnant women with the health system

Across 22 countries in SSA, the median coverage for at least two ANC visits is 85%

ANC is a “missed opportunity” to further malaria and HIV/TB control

Example: Kenya with Global Fund support

Integration of PMTCT services into ANC Provision of IPTp

Integration of TB screening services into

PMTCT/ANC

Overcoming demand-side barriers: waiver of fees for

skilled-care deliveries

Service delivery integration: Febrile Illness Management

Situation: Malaria, diarrhea and pneumonia are three major causes of post-neonatal, under-5 deaths

Diarrhea

PneumoniaMalaria

ARI*

Overlap in the clinical presentation of malaria and pneumonia

Decreasing burden of malaria in many settings

How to manage non-malaria febrile cases, many of which are due to

pneumonia ?

*ARI: Acute Respiratory Infections

An investment in febrile illness management could eventually reduce the money wasted on overuse of ACTs

• Ensuring non-ATM products are there using same supply chains• Ensuring information systems capture service delivery and health outcome beyond

ATM• Ensuring health workforce capacity to deliver integrated services• Performance indicators in the grants that incorporate these additional RMNCH

services

HSS grant to train Village Health Workers to treat a range of childhood diseases beyond malaria & to develop an integrated HMIS

GF funds malaria & HIV/TB modules of the training for Health Extension Workers including iCCM. Other RMNCH related components are funded by Ethiopian government.

Zimbabwe Ethiopia

Addressing strategic investment in RMNCH is automatically addressing HSS

Illustrative example of making use of complementary resources to address the febrile child

World Bank HRITF:

RBF for referral facilities & CHW stipends

Global Fund: CHW training on iCCM and malaria drugs

UNICEF: Purchase Amox, ORS, Zinc

USAID: Supply chain strengthening, quality of care, etc.

RMNCH Trust fund : Local manufacturing efforts; demand-

generation

Domestic: supply chain, staff, facilities

Key RMNCH questions in the roll-out of NFM

RMNCH

1. Does the country sufficiently support RMNCH interventions that directly address HIV, TB & malaria? (e.g., EMTCT, malaria in pregnancy, etc.)

2. What about the synergistic interventions highly relevant to HIV, TB and malaria? (e.g., ANC strengthening, non-malaria components of iCCM, etc.)

• How are these synergistic interventions funded and implemented?

• For these synergistic interventions, any potential complementarity with government and other donors?

3. Is the HSS funding supporting the key elements of effective RMNCH service integration? (e.g., supply chain management, HMIS)

THANK YOU!

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