International Development CommitteeWritten evidence submitted by Roll Back Malaria Partnership
1.0 Introduction
1.1 The Roll Back Malaria (RBM) Partnership, hosted by the World Health Organization, is the global framework to implement coordinated action against malaria. It mobilises action, resources and forges consensus among partners. The Partnership is comprised of more than 500 partners, including malaria endemic countries, their bilateral and multilateral development partners, the private sector, nongovernmental and community-based organizations, foundations, research and academic institutions.
1.2 RBM’s Malaria Advocacy Working Group (MAWG) welcomes the opportunity to input into this important inquiry and will be happy to answer questions or expand upon this submission at the oral evidence session on 17 April 2012. We will be represented at the session by Alan Court, Senior Advisor to the United Nations (UN) Secretary General’s Special Envoy for Malaria and Chair of the RBM Board’s Resource Mobilisation Committee.
1.3 The key points RBM would wish to make are:
The Global Fund to Fight AIDS, TB and Malaria (GFATM) is the largest single source of international financing to tackle malaria: currently representing more than half of the global malaria budget. As such, its continued funding is critical to sustaining the gains achieved since its inception and to realising the UN Millennium Development Goals for health.
The achievement of DFID’s own malaria goal to, “contribute to at least halving malaria deaths in at least ten high burden countries by 2014–15,”i relies on a well funded and well managed GFATM. Without it, the goal cannot be met.
DFID should honour its public commitment to provide increased funding for GFATM; and use this announcement to influence and encourage other donors (including the G20) to do likewise by supporting the creation of a pledging opportunity for global leaders.
2.0 The Current Funding Situation of the Global Fund and DFID’s Contribution to the GFATM
2.1 The Global Fund to Fight AIDS, TB and Malaria (GFATM) is the largest single source of international financing to tackle malaria: representing more than half the global malaria budget. DFID is the second largest bilateral donor for malaria after the US. Together the UK, US and GFATM’s support for malaria control is key to our prospects of achieving the international community’s goal of “reducing malaria deaths to near zero by 2015” set under the framework of the UN Millennium Development Goals.
2.2 In December 2010, DFID published “Breaking the Cycle: Saving Lives and Protecting the Future” which details the UK’s Framework for Results for its investment in malaria. The Framework states DFID’s overall goal as: “we will contribute to at least halving malaria deaths in at least ten high burden countries by 2014–15.”ii
2.3 The Framework for Results made it quite clear that GFATM will, “remain an important channel for UK aid in supporting malaria results.” It attributed 26% of the UK’s contribution to GFATM (£13 million in 2008–09) to malaria.iii DFID has been a key supporter of the innovative Affordable Medicines Facility for Malaria which is managed by GFATM. Overall DFID’s Framework committed the government to invest up to £500 million per annum on tackling malaria by FY 2014–15.
2.4 Since 2005, there has been a dramatic rise in the overall international spend on malaria and a significant portion of that has been thanks to the GFATM (see attached power point slide 1). This international support has contributed to a significant reduction in malaria cases and deaths over the same period. WHO figures tracking progress since 2000 show a 26% drop in malaria mortality rates globally and a 33% drop in Sub Saharan Africa. This is a tremendous achievement and one that would not have been possible without the GFATM, DFID and partners including those represented here by the Roll Back Malaria Partnership.
2.5 There is, however, a significant projected funding gap for malaria between now and 2015: GFATM should continue to be a vital source of additional funds to close this gap (see slide 2). However, the GFATM anticipated funding for malaria has been significantly cut and is currently very hard to project (see slide 3).
2.6 Originally Round 11 was expected to generate country proposals worth around US$1.8 billion for malaria in Africa. After the cancellation of Round 11, funding requests had to be slashed to the bare minimum to sustain existing services through the Transitional Financing Mechanism (TFM). It is now not yet clear if sufficient resources are available to fulfil the TFM level of requests for support. In order to further prioritise future GFATM funds, a Continuity of Services (CoS) funding window has been established. This current CoS does not include provision to fund any malaria interventions whatsoever: a position both RBM and DFID believe should be reversed.
2.7 In 2012, we now face an unprecedented challenge. Without an increase in GFATM funding or a viable alternative resource, we will not be able to sustain universal coverage of malaria prevention, diagnosis and treatment tools; putting lives in danger and risking a significant resurgence of malaria cases and deaths.
3.0 The Prospects for DFID Achieving its Development Objectives if Current Funding Shortfalls at GFTM are Not Addressed
3.1 DFID’s overall malaria goal is to: “contribute to at least halving malaria deaths in at least 10 high burden countries by 2014–15.”iv These 10 countries will be taken from an overall group of 18 countries where the Framework for Results states DFID is committed to funding malaria programmes.v
3.2 DFID’s goal is rightly a collaborative one and the country plans developed to implement its goal note the different partners with which DFID is working. GFATM is a significant, if not the leading, source of malaria prevention, diagnosis and treatment support in many of these countries and the threat to GFATM funding for malaria means DFID may not be able to achieve its own malaria goal.
3.3 For example, the following DFID priority countries planned to submit comprehensive Round 11 GFATM proposals for malaria: Afghanistan, Burma, Ethiopia, Rwanda, Tanzania, Yemen, and Zambia. With the cancellation of Round 11 there will likely be serious funding gaps in malaria prevention and control moving forward. Five of these countries (Burma, Ethiopia, Zambia, Yemen and Afghanistan) will now be submitting proposals to continue existing activities through the Transitional Financing Mechanism. However, any expansion plans to increase the number of people able to access malaria prevention, diagnosis, treatment and care measures with support from the GFATM have had to be put on hold. With additional cuts of at least 25%, to phase II budgets for existing GFATM grants, malaria programmes in many other countries will also be affected by the funding restrictions.
4.0 The Impact on People in Developing Countries from the Delay in Funding of New Global Fund Grants
4.1 The UN goal of reducing malaria deaths to near zero by 2015 requires:
Universal coverage of vector control interventions: Insecticide Residual Spray (IRS) and Long Lasting Insecticide treated Nets (LLINs).
Case management and diagnostic testing with Rapid Diagnostic Tests (RDTs) or microscopy.
The treatment of uncomplicated malaria with Artemisinin Combined Therapy (ACTs) and the treatment of severe malaria.
Health System Strengthening to ensure adequate health professionals to diagnose and treat patients.
Monitoring and surveillance to improve health services and monitor and act to prevent insecticide and drug resistance.
4.2 RBM has estimated that with sufficient funding and political will, we could collectively save up to 3 million lives from malaria by 2015. However, there are significant funding gaps for each of these interventions (see slide 4).
4.3 A reduction in global funding for malaria could reverse the recent decade of progress and repeat the previous experiences witnessed in the 1960s when dwindling political will and financial resources led to a massive resurgence in malaria in Sri Lanka and other countries.
4.4 Therefore there are a range of potentially very damaging effects including:
4.5 Reversing success in malaria prevention, diagnosis and treatment
GFATM is a key source of funding for different malaria commodities. Malaria interventions need to be sustained for their effects to continue: many of the nets, that have proved so effective in preventing malaria, will need to be replaced before the next anticipated opportunity for GFATM funding in 2014–15. If the identified funding gaps are not filled, we will expect to see significant resurgence in malaria including outbreaks and epidemics such as was seen in Rwanda in 2010 (see slide 5).
4.6 Increasing the likelihood of drug resistance
A reduction in funding for malaria drugs, particularly Artemisinin Combined Therapy (ACTs), could well:
Encourage drug misuse through self-rationing of pills rather than completing the full treatment course and hoarding under unsuitable conditions which diminish efficacy.
Reverse progress to end the practice of using monotherapy drugs (which are now subject to high levels of resistance) in favour of the more expensive ACTs.
Expand drug resistance beyond the Mekong area of South East Asia. For example, Myanmar had a relatively small Round 9 grant for malaria but was hoping to secure a Round 11 grant with a particular focus on artemisinin resistance containment as well as general malaria control programmes.
Expose more patients to fake drugs. If drugs are no longer available in the public sector, more will be purchased in private markets, already infiltrated with falsified and substandard drugs in most malaria-endemic countries. This increases the risk of side-effects, resistance and death, both from malaria or from the ingredients in falsified drugs.
4.7 Diminishing the Capacity of Health Systems
Already, National Malaria Control Programmes (NMCPs) are struggling to maintain adequate surveillance and case management. With reduced funding, monitoring and evaluation programmes will be curtailed or cease and will result in the loss of vital information to NMCPs against which the impact of interventions and investment in malaria control and elimination efforts is judged. This will open the door to a spread of the parasite, and further insecticide and drug resistance.
5.0 The UK’s Role in Influencing other International Donors
5.1 The UK is a critical supporter of GFATM and currently holds the Chair of the GFATM Board. Evidence from UK publications such as the Multilateral Aid Review (MAR), which rated GFATM as “providing very good value for the British taxpayer”,vi are widely disseminated and discussed internationally. Other donors hold the rigor with which the UK assessed the GFATM in high regard and will be looking for the UK’s lead in assessing the quality and impact of the GFATM’s current reform measures—many of which were recommended in the MAR.
5.2 At the launch of the MAR Andrew Mitchell committed to “increase funding” to those organizations assessed as offering good value for money, including GFATM, “because they have a proven track record of delivering excellent results for poor people”.vii
5.3 A significant announcement of increased support from the UK would be a major boost to GFATM and to its reputation as a credible, effective organization delivering good value for money for aid investment. Furthermore, the UK has the opportunity to use its announcement to influence and encourage other donors (including the G20) by supporting the creation of a pledging opportunity for global leaders and through its private bilateral discussions with other potential donor partners.
6.0 Reforms Undertaken by GFATM to its Management and Business Model, and Improve Risk Management
6.1 GFATM has successfully helped to reduce malaria cases and deaths and has, in recent years, improved its performance by:
Reaching out to the RBM partnership to help guide the funding proposal preparation process leading to a doubling of GFATM funding for malaria in the past few years with a greater than 75% success rate in Africa.
Resolving bottlenecks in the approval and funding process which has led to a swifter disbursement of funding.
6.2 The DFID Framework for Results sets out a very helpful list of suggested areas of improvement for the GFATM which RBM would endorse, including:viii
Reducing further the delays in disbursement and transaction costs in grant management: working with partners and countries to help ensure resources already secured are not lost and delays in signature and disbursements are avoided.
Looking for enhanced efficiencies such as: effective pooled procurement and standardized logistics.
Increasing flexibility and responsiveness eg changing the targets for malaria drug use following the scale-up of malaria diagnostics which are thought likely to report lower confirmed malaria cases than previously thought.
Including malaria in the Continuity of Services when there is a shortage of overall funds and GFATM is continuing to evaluate and improve its operations.
7.0 Relevant Comments Not Covered in the Above
7.1 We would like to draw the attention of the IDC to the work of the African Leaders Malaria Alliance (ALMA) and its recent statement on financing malaria efforts.
7.2 In recent years, 42 African Heads of State and Government have joined together to form the ALMA. Together they work to accelerate progress towards the UN malaria goals. The group met on 30 January 2012 to discuss the urgent global malaria funding crisis. The meeting issued a statement in which the ALMA Heads of State and Government strongly urged the UN Secretary General to convene a financing conference in 2012 to bring together the world’s financial leaders to address the urgent gap in funding for Malaria, HIV/AIDs, TB, and Maternal, Neonatal and Child Health. The statement went on to commit the African leaders to explore ways to increase domestic funding and it fully endorsed the recommendations of the GFATM High Level Independent Review Panel, as they relate to partner countries and beneficiaries of the GFATM, including enhanced transparency and accountability.
8.0 Conclusion/Key Asks of DFID
8.1 RBM has estimated that with sufficient funding and political will, we could save up to 3 million lives from malaria by 2015 (see slide 6) and achieve the UN malaria goal of reducing malaria deaths to near zero by 2015.
8.2 In the foreword to DFID’s Framework for Results, the Secretary of State says, “Our Coalition Government is determined to play a full part in helping to achieve the international targets for malaria by 2015.”ix RBM strongly welcomes this and DFID’s specific target to “contribute to at least halving malaria deaths in at least ten high burden countries by 2014–15.”
8.3 To succeed in this effort RBM recommends:
A.
B.
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F.
References
i http://www.dfid.gov.uk/Documents/publications1/prd/malaria-framework-for-results.pdf
ii http://www.dfid.gov.uk/Documents/publications1/prd/malaria-framework-for-results.pdf
iii Ibid, “attribution of UK government spending to malaria” table 5, page 59
iv http://www.dfid.gov.uk/Documents/publications1/prd/malaria-framework-for-results.pdf
v Burma, Zimbabwe, Tanzania, India, Malawi, Ghana, Rwanda, Somalia, Nigeria, Uganda, Zambia, DRC, Burundi, Ethiopia, Kenya, Mozambique, Sierra Leone and Sudan.
vi http://www.dfid.gov.uk/News/Speeches-and-statements/2011/BAR-MAR-oral-statement/
vii Ibid.
viii http://www.dfid.gov.uk/Documents/publications1/prd/malaria-framework-for-results.pdf p47.
ix Ibid page 1.
May 2012
