GF Role and Political Commitment
to end TB by 2030

Prof. Osamu Kunii, MD, MPH, PhD

Decline in life expectancy due to HIV(yrs)

Source: UN Population
Division, World Population
Prospects, 2002 Revision

TB Case notification in Sub-Saharan Africa

Global TB Control, WHO Report 2000

GF Disbursements by Disease
22 million lives saved$ 31 billion
Total

HIV
Malaria
Tuberculosis

5

# People (Smear positive) treated for TB (2002-2015)
15 million people treated$ 5 billion

6Trend in donor funding in TB
US$ million

Shared responsibility and collective efforts• TB Mortality rates: fallen 44 % since 2000
• Saved 38 million lives (2000-2015)• TB deaths declined 31 % (2000-2015) in GF

eligible countries8

To achieve the global target by 2035
End TB Strategy

2180

TargetReduce90% Incidence
95% Deaths
2015

2035

Number (millions)Gap between case notifications and incidence
Incidence
10.4

10

4.3 millioncases
6.1

5Case notifications

Underreporting
underdiagnosis

02000

2005

2010

2015
WHO Global TB Report 2016

10 countries = 77% of the gap
3 countries = 50%: India, Indonesia, NigeriaPakistan

China

Bangladesh
India
Nigeria
Tanzania
DR Congo

Circles show the sizeof the gap between
incidence (bestestimate) andnotifications in 2015Mozambique

South Africa

Indonesia

100 000
200 000
500 000

WHO Global TB Report 2016

MDR/RR-TB: 3 countries, 45% cases
Russian Federation

China

India

580,000 drug-resistant TB
Circles shown forcountries with atleast 1000 new casesin 2015455,000 (80%) “missed”
WHO Global TB Report 2016

GF fund allocation 2017-2019
TB- US$ 1.8 billion

MENA, 3%
LAC, 3%
SEA,4%SE Asia,CA, 2%WA, 3%

6%
EECA, 8%

TB, 18%

HIV/AIDS,50%

Malaria,32%

HI Africa 2, 12%70+%
allocated toHigh Impact
countries

Total US$ 10.3 billion

HI Africa 1, 13%HIAsia,
46%
TB ALLOCATIONS BY REGIONS

1330015.3%

Top 10 TB countries
allocation

250
200
150

7.1%
5.9% 5.6%

100

5.3%
4.5% 4.3%
3.1% 2.8%

50

2.7% 2.6% 2.5% 2.5%

2.0% 1.9%

1.4% 1.3% 1.2% 1.2% 1.2%…

UgandaUzbekistan

Somalia

Zimbabwe

Tanzania

South Africa

Korea (DPR)

Mozambique

Kenya

Viet Nam

UkraineEthiopia

DRCPhilippines

MyanmarBangladeshIndonesia

Nigeria

Pakistan-India

MILLIONS

More than 50% of TB investments to 10 countries

14

Countries intransition

GovernancePartnership
Challenging
operatingenvironments

Low incomecountries

Capacity(Source: GAPMINDER)© Google 200815

2017-2022 Strategy “Investing to End Epidemics”

Build Resilient& Sustainable
Systems forHealth

UHC - SDGs

Maximize
Impact Against
HIV, TB andmalaria

Mobilize
Increased
Resources

Promote andProtect Human
Rights &Gender
Equality

1) Community responses and systems
2) RMNCH and platforms for integrated service delivery
3) Procurement and supply chain systems
4) Human resources for health5) Data systems and capacities for analysis and use6) National health strategies and disease-specific strategic plans
7) Financial management and oversight16

Invest for maximizing impact and efficiency• Planning – target setting, allocative efficiency,engagement• Strategic partnership, TA (WHO, UNICEF, WB,OECD, Academia, CSO, etc.)• Catalytic funding ($ 800 mil - gender, human rights,
key pops, insecticide resistance, supply chain, datasystem, human resources, etc.)

17Incremental costs and active TB cases averted(2017 – 2035)(GF, Australian Modelling Network, DOH/Philippines)
18

TB funding landscape in Asia (2015-2017)(US$ mil)
3,500

3,414

3,000

989

1,500
1,000

400
350

395

Global TB financial gap= $2 bil in 2016

130

Funding Gap

90

Global Fund

23

Other external

153

Domestic

300

2,500
2,000

(US$ mil)

760

250

130200
150

1,535

500
0
HI Asia: Bangladesh,
Cambodia, India, Indonesia,
Myanmar, Pakistan, Philippines,
Thailand, Viet Nam

100

500SE Asia: Afghanistan, Bhutan, Fiji,
Korea DPR, Lao PDR, Mongolia,Nepal, Papua New Guinea, Solomon
Islands, Sri Lanka, Timor-Leste
19Source: funding landscape data from Global Fund funding requests

Out-of-pocket (OOP) spending

OOP as %total healthexpenditure≤1516-29
30-44≥45
No data
No ap

Support to Sustainability, Transition and Co-financing• Sustainability assessment and planning (financial,programmatic, governance)• National Health Account: capacity building/institutionalization• Incentives for Co-financing, Innovative finance (Debt forHealth, Social impact bond, matching fund, etc.)• Health sector loan buy-downs• Senior budget officials network for fiscal sustainabilityof health systems

Political commitment• International donor funding (ODA)• Increased domestic/innovative financing• Measures to reduce catastrophic health expenditure• Human rights/ Social protection for vulnerable pops
 No one left behind22