The fight against major pandemics

The Global Fund, front-line player in the fight against AIDS, tuberculosis and malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria, created in 2002, is a global financial institution whose mission is to collect and allocate additional resources for the prevention and treatment of these three pandemics. This partnership between governments, civil society, the private sector and affected communities is part of an innovative approach to international financing for health.

Since its creation, the Global Fund has made the effective prevention and treatment of these diseases a reality for millions of people. HIV transmission rates have fallen substantially in almost all regions of the world, including in the most affected countries. Mortality rates are decreasing with improved access to treatment. The number of deaths caused by tuberculosis has decreased by over one third since the 1990s. By maintaining these efforts, malaria could be curbed in the countries where it is endemic and a public health issue.

From the time of its creation until October 2013, the Global Fund had committed a total of $26.9 billion in 151 countries to support large-scale prevention, treatment and care programs concerning these three diseases. Thanks to payments by the Fund, over 6.1 million people benefited from antiretroviral therapy for AIDS, 11.2 million were screened and treated for tuberculosis and 360 million insecticide-treated mosquito nets were distributed to fight malaria. Money from the Fund also helped to strengthen national health care systems, through the improvement of infrastructure and the training of service providers and health professionals in several countries.

France played a key role in the creation of the Global Fund: it is the 2nd leading contributor to the Fund (€3.8 billion, 13% of the Global Fund’s total budget since its inception) and is the leading European donor.

This financial support comes with ongoing political support, especially in the promotion and preservation of the Global Fund’s core values, which include the key role given to communities affected by pandemics, to civil society and to recipient governments in governance of the Global Fund.

Since 2011, 5% of France’s contribution to the Fund (€18 million per year) has been devoted to technical heath assistance in Francophone countries.

The 5% Initiative supports countries in implementing Global Fund grants

Since late 2011, the 5% Initiative has been supporting mainly French-speaking countries, in the design, implementation, monitoring and evaluation of Global Fund grants. With an annual budget of €18 million (which is part of France’s total contribution to the Global Fund), the 5% Initiative is implemented by the French public agency France Expertise Internationale (FEI) under the administrative supervision of the French Ministry of Foreign Affairs and International Development and a steering committee bringing together the State, its operators and civil society. It is divided into two complementary mechanisms:

  • Channel 1 calls on short-term expertise to respond to ad hoc country needs. In just two years, some 100 short-term expertise missions have been approved in 27 different countries, for over 7,500 working days of expertise and a budget of almost €10 million. These missions, lasting a maximum of twelve months, focus mainly on building capacity for Country Coordinating Mechanisms (CCM), provision of medical supplies, financial management, programmatic needs and the monitoring and evaluation of programs. They also support the implementation of the Global Fund’s new financing model, through support for the drafting of national strategy plans, country dialogues or the drafting of concept notes.
  • Channel 2 finances projects that are complementary to those receiving Global Fund grants. In 2012 and 2013, 28 projects concerning 23 countries were selected, for a budget of €24 million. These projects cover issues that are vital to strengthening the effectiveness of Global Fund grants: governance, management of supplies and stocks, operational research and strengthening health systems.

Through its rapid bilateral intervention and its ability to mobilize expertise from both North and South, the 5% Initiative helps to enhance complementarity and synergies between activities in the fight against pandemics, these activities being supported by France, both multilaterally and bilaterally.

Action on market-based mechanisms: the UNITAID initiative

UNITAID was launched in September 2006, on the initiative of France and Brazil. Its resources mainly come from solidarity levies on air tickets, even though some countries have decided to earmark budget contributions instead.

UNITAID seeks to correct market imperfections (high prices, inadequate supply, monopoly situations, etc.) to create an impact on public health by facilitating access to medicines). In practice, the effect of UNITAID actions is to lower prices, accelerate the development of new and better medicines, and to improve the quality and availability of health products.

Its programs have contributed to the development of medicines adapted to children with HIV, to the decrease in second-line anti-retrovirals and treatment for multidrug-resistant tuberculosis, and to widespread access to the most adequate malaria treatments. To date, UNITAID has helped divide the cost of AIDS treatment by 100, double the detection rate of resistant tuberculosis and half the malaria mortality rate since 2000.

The African continent benefits largely from this insofar as at least 85% of its health products go to low-income countries.

UNITAID is behind the innovative community-based mechanism, the Medicines Patent Pool. This mechanism, which involves the voluntary granting of patent licenses by laboratories, facilitates the fast transport of the most recent anti-retrovirals in their generic form for the populations in developing countries.

As a founding country, France has always strongly supported UNITAID. Since it was created in 2006, France has provided more than 60% of its total budget of €1.2 billion.

The ambassador for the fight against HIV/AIDS and Communicable Diseases helps to coordinate French players and is the spokesperson for France in this field

The ambassador is the privileged contact for organisations endeavouring to fight AIDS and communicable diseases. He is regularly in contact with the other donor countries, recipient countries, especially Francophone ones, the private sector, national and international operators, as well as NGOs active in advocacy and the fight against the three pandemics.

The ambassador represents France in the main international organisations involved in this struggle. He is a board member of the Global Fund to to Fight AIDS, Tuberculosis and Malaria, and member of the international drug purchasing facility UNITAID, and of the Roll Back Malaria partnership. He also heads the French delegation within the Programme Coordinating Board of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Lastly, he participates in a certain number of these organisations’ commissions, thus contributing to their political and strategic orientation.

The ambassador voices the political vision of France in the field of HIV/AIDS and communicable diseases and helps to translate this into concrete proposals. He ensures that the interests of priority countries for French development assistance are preserved and that their specific needs are taken into consideration. This is based on regular dialogue with the main Ministries (Ministry of Social Affairs and Health, Ministry of Higher Education and Research, Ministry of Foreign Affairs and International Development) and operators concerned (French National Agency for Research on AIDS and Viral Hepatitis, Institut Pasteur, France Expertise Internationale and the public interest group ESTHER). As part of his field of action, the ambassador not only ensures that human rights, gender equality and the fight against all forms of discrimination are part of all the programmes supported, but he also ensures that innovative solutions and research with heightened effectiveness and impact are implemented.

Hospital cooperation through the public interest group ESTHER

This public interest group, created in 2002, is an operator for the French Ministry of Foreign Affairs and International Development and for the Ministry of Social Affairs and Health and it intervenes in 17 countries situated in Africa, Asia and the Caribbean. ESTHER operates through hospital partnerships to improve the quality of health care practices and provides French expertise (46 French hospitals in 2012) in terms of strengthening health systems, more specifically in the field of HIV, tuberculosis, co-infections and hospital hygiene.

ESTHER’s activities fall within the scope of bilateral cooperation, in partnership with the health authorities of partner countries, and in conjunction with international institutions (WHO, UNAIDS) in the interests of complementarity with multilateral assistance (Global Fund, UNITAID). ESTHER supports national authorities and gives its backing to processes to decentralise patient management, in particular through its training programmes (35,000 people trained in countries of the South in ten years). Civil society is largely associated in the hospital twinning process (approximately 20% of ESTHER’s funds are granted to associations).

The impact of hospital partnerships (173 hospitals supported in 2012) in the management of HIV/AIDS goes beyond this scope and affects the general organisation of hospitals, health systems, the quality and safety of care, and the positioning of the hospital within its living area. This is how ESTHER’s official mandate has been extended to the field of health care safety. In 2012, on a pilot basis, ESTHER also entered into partnerships in maternal, newborn and child health, in three countries, mobilising new teams and new skills, both North and South.

The success of the French initiative helped with the creation of the European ESTHER Alliance. This platform for development cooperation in health brings together 12 European States (Austria, Belgium, France, Germany, Greece, Ireland, Italy, Luxembourg, Norway, Portugal, Spain, Switzerland). It mobilises European health expertise for capacity building in countries with limited resources, mainly through partnerships. It covers a broad range of activities that are in line with the global health agenda, particularly in the area of maternal, newborn and child health (Millennium Development Goals 4 and 5), HIV/AIDS and associated diseases (MDG 6) and the strengthening of health systems (management and supplies of medicines, epidemiological monitoring, human resources for health, etc.).

Since its creation, ESTHER Alliance has developed over 260 partnerships with almost 40 partner countries in Sub-Saharan Africa, Asia, the Middle East, South-Eastern Europe and Latin America. Its European secretariat is based in Paris, within the ESTHER headquarters.

Updated: november 2016