Global Fund: Progress Report 2010 - unaids

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