Global Fund: Progress Report 2010 - unaids

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2.2.3 LATIN AmerICA ANd CarIBBEAN 23. TB. The Asia region accounts for 11 of the 22 countries with a high TB burden worldwide, with India, China and Indonesia reporting the highest number of new smear-positive TB cases. Ten of these 11 countries have made good progress toward achieving the Stop TB Partnership targets for case detection. The region has seen significant progress in achieving the MDG 6 target of halting and reversing the TB epidemic. 26. The Latin America and Caribbean region consists of 33 countries with a total population of 559 million. Approximately 25 percent of the population lives on less than US$ 2 a day (5). Between 2002 and December 2009, the Global Fund approved proposals in all 33 countries (see Annex 2), with a total budget of US$ 1.4 billion, of which US$ 822 million had been disbursed by the end of 2009. 24. Since the first Global Fund grants were awarded in the region, steep increases in TB case detection and cure rates have been observed. Global Fund-supported programs have treated a cumulative total of 4 million smear-positive TB cases. 25. Malaria. Between 2003 and the end of 2009, Global Fund-supported programs distributed 21.7 million ITNs in the region – an increase of 45 percent over the number distributed by the end of 2008. As a result of this and other interventions, the incidence of both probable and confirmed cases of malaria declined sharply, with substantial declines in malaria morbidity and mortality (see section 2.4.4 for more details on one country: Bhutan). 27. HIV. Latin America and Caribbean is the region with the highest HIV treatment coverage, thanks in large part to Brazil, which has been providing ART to people in need for many years. As of December 2008, 445,000 (54 percent) of the 820,000 people in the region estimated to need ART were receiving it (1). Global Fund investments are helping countries in the region to provide ART to 76,000 people. 28. The Global Fund has also fostered close collaboration between governments and civil society organi zations, especially those working with mostat-risk populations. Sixty-one percent of the total committed amount of funds in this region has been allocated to grants in which the Principal Recipients were civil society organizations. 29. TB is a major public health threat in many Latin American and Caribbean countries. Thanks to programs supported by the Global Fund, 152,000 people in the region have been treated for TB. Peru has the largest TB program in the region, with one of the world’s greatest number of clients requiring MDR-TB and second-line treatment. By December 2009, the Global Fund had supported treatment of more than 10,000 people for MDR-TB. 30. In Bolivia, which has the third-highest incidence rate of TB in the region, about 70 percent of the Bolivian farmers whose mother tongue is not Spanish live in extreme poverty, which makes them especially vulnerable to TB. Their socioeconomic status, coupled with cultural and language barriers, often hinders their access to health services. The Global Fund TB grant in Bolivia targets indigenous peoples and, by the end of 2009, treatment had been provided to 3,500 people newly detected as smear-positive for TB. 31. Malaria. Programs supported by the Global Fund distributed more than 1.2 million ITNs in the region. Country partners in Guatemala – one of the countries with the highest incidence rates of malaria in Central America – distributed 419,465 ITNs and provided universal access to malaria treatment in 552 Guatemalan communities. 32. Malaria is also endemic in Guyana. As of December 2009, 41,000 nets had been distributed with Global Fund support in the country, covering an estimated 74,324 people.
2.2.4 mIddLE EAST ANd North AfrICA 33. The 21 countries of Middle East and North Africa have a total population of 313 million, with 16.9 percent living on less than US$ 2 a day (6). The Global Fund’s Middle East and North Africa region, which comprises 16 of these 21 countries and territories (see Annex 2), represents a broad range of cultural and human development profiles. Three countries in the region – Chad, Mali and Niger – are among the ten lowest-ranking countries on the Human Development Index (7). 34. Despite conflict and turmoil in countries such as Chad, Somalia and Sudan, the Global Fund has successfully engaged national stakeholders and development partners in countries throughout the region to fight HIV, TB and malaria. 35. Between 2002 and 2009, the Global Fund ap proved proposals with a total budget of US$ 1 billion, of which US$ 591 million had been disbursed by the end of 2009. For some national control efforts, the Global Fund provides most of the financial resources (e.g. for TB in most countries and for malaria in some of the countries in the Sahel), while in countries such as Morocco, Tunisia and Algeria the Global Fund has leveraged funds from other sources. 36. Some countries in the region – including Algeria, Jordan, Morocco, Syria and Tunisia – have fairly welldeveloped health systems, but others suffer from poor health infrastructure and capacity, exacerbated in some cases by conflict and state failure. In almost all the countries, people living with HIV, women, men who have sex with men and members of other vulnerable groups must contend with high levels of stigmatization and discrimination. 37. HIV. The Global Fund has provided critical support to the response to HIV in the region and helped break the silence about HIV and AIDS. Nevertheless, much remains to be done to achieve universal access targets and reduce stigma and discrimination. Through the end of 2009, Global Fund-supported programs distributed 62 million condoms (an increase of 24 million from the end of 2008), delivered close to 9.3 million community outreach services for HIV, enabled more than 35,000 people to start ART, and provided 162,000 “person-episodes” of training to health and community workers. 38. Since the first grant in the region was awarded to Morocco in Round 1, Global Fund support has enabled the Moroccan National AIDS Control Program to create a positive shift in public attitudes and commitment towards HIV and most at-risk groups, including people who inject drugs and sex workers. The first grant included a treatment component, providing access to ART for 1,200 people living with HIV, and a prevention component including condom distribution and voluntary counseling and testing. A Round 6 grant has since enabled scale-up of ART coverage, with almost 2,500 patients and 120 HIV-positive pregnant women receiving treatment in Phase 1 of the grant. The second phase of this grant provides additional funding to a pioneering Moroccan harm reduction program – funded entirely by the Global Fund – which has mobilized people who inject drugs and supports opioid substitution therapy and injecting kits for 400 people who inject drugs as part of a pilot project undertaken from 2009 to 2012. 39. TB. Global Fund support in the region has contributed to, among other things, the detection and treatment of nearly 178,000 new-smear positive TB cases, and treatment of about 3,900 people for TB/HIV co-infection. Decreases in both TB prevalence and mortality have been observed (see Section 2.4.3 for some country examples). 40. Malaria. Malaria is endemic in countries such as Chad, Djibouti, Mali, Mauritania, Niger and Sudan, where it is the leading cause of maternal and child mortality. To date, Global Fund-supported programs have been able to treat 9 million malaria cases, distribute 8.8 million LLINs and carry out indoor residual spraying in nearly 600,000 locations in the region – despite the fact that some of the countries in which the Global Fund operates are fragile countries. For example, Niger – a country heavily burdened by malaria – has substantially increased ITN coverage to approximately 50 percent of all children under five and pregnant women. Building on this success, the authorities are now seeking to ensure that, by the end of 2012, 80 percent of all children under five and pregnant women sleep under LLINs. The Global Fund is supporting these efforts with a Round 7 grant to fund the provision of an additional 3.5 million nets. 41. Finally, regional efforts by the Global Fund and national and international partners have supported the emergence and strengthening of new social forums, civil society organizations and advocacy groups that have all contributed to the development of social capital throughout the region. One example is the Global Fund’s collaboration with an important network of civil society organizations in Mali involved in providing treatment, care and support to people living with and affected by HIV. National nongovernmental organizations (NGOs) are contributing to this work across Mali with funding from the Global Fund and other partners. 23 THE GLOBAL FUND 2010: INNOVATION AND IMPACT results aND progress ON internatiONal targets
Page 1 and 2: THE GLOBAL FUND 2010: INNOVATION AN
Page 3 and 4: TABLE OF CONTENTS 1 THE GLOBAL FUND
Page 5 and 6: A TRADITIONAL BIRTH ATTENDANT COMFO
Page 7 and 8: 12. Equitable access to services is
Page 9 and 10: 1. INTRODUCTION “The Global Fund
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Page 13 and 14: The way forward 18. Chapter 5, “C
Page 15 and 16: 2. rESULTS AND PROGRESS ON INTERNAT
Page 17 and 18: 1. The Global Fund financed its fir
Page 19 and 20: 2.2 Key results by region “In Zam
Page 21 and 22: TABLE 2.3 CUMULATIVE RESULTS ATTRIB
Page 23: 16. TB. The Global Fund has quickly
Page 27 and 28: 2.3 Contribution to international e
Page 29 and 30: 2.4 The Global Fund’s contributio
Page 31 and 32: 2.4.1 The Global Fund contribution
Page 33 and 34: FIGURE 2.6 PERCENTAGE OF CHILDREN U
Page 35 and 36: 2.4.2 Progress on meeting HIV targe
Page 37 and 38: 82. Reports indicate that the rapid
Page 39 and 40: A YOUNG MAN VISITS a DISPENSARY FOR
Page 41 and 42: 95. However, MDR-TB is increasing i
Page 43 and 44: eceived malaria investments from th
Page 45 and 46: FIGURE 2.15 ANNUAL TRENDS OF MALARI
Page 47 and 48: 2.5.1 Overall program performance 1
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Page 55 and 56: 133. The Global Fund has become the
Page 57 and 58: TABLE 2.15 IMPROVEMENTS IN HEALTH S
Page 59 and 60: 2.7 Challenges 147. Though these re
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3.4 Maximizing impact: costeffectiv
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In RWANDA THE GLOBAL FUND SUPPORTED
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4. LEARNING AND INNOVATING “The G
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6. Grant implementation. In the Sec
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In EGYPT, THE GLOBAL FUND SUPPORTS
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21. Since its inception, the Office
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A SOCIAL WORkER MAkES HOME VISITS T
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41. National Strategy Applications.
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GLOBAL FUND ASSISTANCE TO WOMEN AND
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5. CONCLUSIONS “The Global Fund p
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6. In this sense, the Global Fund i
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21 Lusti-Narasimhan M, Collin C, Mb
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CHAPTER 3 1 2009 key performance in
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THE GLOBAL FUND SUPPORTS HEALTH AUT
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TABLES TABLE 2.1 Global Fund progra
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THE GLOBAL FUND GRANT CYCLE Each co
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LATIN AMERICA AND CARIBBEAN (33 COU
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APPROVED PROPOSALS GRANT AGREEMENTS
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SPECIAL NOTES FOR ROUND 9 (INCLUDIN
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THIS FAMILY IN a MALARIA-ENDEMIC AR
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