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!
www.theglobalfight.org
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