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Washington, D.C., Center for Global Development, 2015. 68 p.Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3-$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses -- and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results -- referred to in this report as next generation financing models -- offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts -- all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models -- that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. (Excerpts)
Geneva, Switzerland, UNAIDS, 2013.  p.The 2013 report on the global AIDS epidemic contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. This report, which follows the endorsement of the 2011 United Nations Political Declaration on HIV and AIDS outlining global targets to achieve by 2015, summarizes progress towards 10 key targets and reviews commitments and future steps. While recognizing significant achievements, UNAIDS warns of slowing progress in meeting some targets. In 2012, there were 35 million people living with HIV (PLHIV), and 2.3 million new infections-a 33 percent decrease from 2001, including significant reductions in new infections among children. More people than ever are on antiretroviral therapy (ART). Twenty-six countries have achieved the global target of halving sexual HIV transmission by 2015, but other countries are not on track to meet this target, hence the need to enhance prevention efforts. Globally, countries have made limited progress in reducing HIV transmission by 50 percent among people who inject drugs. While ART coverage is high, and approaching the target of 15 million PLHIV on treatment, coverage in low- and middle-income countries represented only 34 percent of 28 million eligible PLHIV in 2013. Stigma, discrimination and criminalization towards PLHIV continue; specifically, 60 percent of countries report laws that inhibit access to HIV services by key populations. The results of this report should be used by countries to refocus and maintain their commitments. The authors urged strengthened global commitment to achieve the goal of zero new HIV infections, discrimination, and AIDS-related deaths.
Ten targets: 2011 United Nations General Assembly Political Declaration on HIV / AIDS: Targets and elimination commitments.
Geneva, Switzerland, UNAIDS, 2011.  p.Ten targets in the campaign to achieve universal access to HIV prevention, treatment, care and support by 2015 are listed. Targets include: Reduce sexual transmission of HIV by 50% by 2015; Reduce transmission of HIV among people who inject drugs by 50% by 2015; Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths; Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015; Reduce tuberculosis deaths in people living with HIV by 50 percent by 2015; Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries; Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV; Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realization of all human rights and fundamental freedoms; Eliminate HIV-related restrictions on entry, stay and residence; Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts.
Geneva, Switzerland, UNAIDS, 2010 Dec.  p. (UNAIDS/10.12E/JC2034E)This Strategy has been developed through wide consultation, informed by the best evidence and driven by a moral imperative to achieve universal access to HIV prevention, treatment, care and support and the Millennium Development Goals.
Engaging informal providers in TB control: what is the potential in the implementation of the WHO stop TB strategy? a discussion paper.
World Health and Population. 2011; 12(4):5-13.The World Health Organization (WHO) Stop TB Strategy calls for involvement of all healthcare providers in tuberculosis (TB) control. There is evidence that many people with TB seek care from informal providers before or after diagnosis, but very little has been done to engage these informal providers. Their involvement is often discussed with regard to DOTS (directly observed treatment - short course), rather than to the implementation of the comprehensive Stop TB Strategy. This paper discusses the potential contribution of informal providers to all components of the WHO Stop TB Strategy, including DOTS, programmatic management of multi-drug-resistant TB (MDR-TB), TB/HIV collaborative activities, health systems strengthening, engaging people with TB and their communities, and enabling research. The conclusion is that with increased stewardship by the national TB program (NTP), informal providers might contribute to implementation of the Stop TB Strategy. NTPs need practical guidelines to set up and scale up initiatives, including tools to assess the implications of these initiatives on complex dimensions like health systems strengthening.
Lancet. 2010 May 22; 375(9728):1757-8.This article describes several urgent actions that are needed to promote rapid scale-up of effective and integrated services for tuberculosis and HIV and to tackle the factors that increase vulnerability and put people at risk of HIV-related tuberculosis. These include: bold national leadership, health system restructuring to foster greater integration of tuberculosis and HIV services that provide routine tuberculosis screening, treatment, and prevention to people living with HIV; and to offer HIV counseling and testing to all patients with signs and symptoms of tuberculosis, decentralized care to ensure improved access, investment in new tools and better use of existing tools, and global leadership from donors, countries of the global south, and key health agencies.
The Global Fund 2010: Innovation and impact. Global Fund-supported programs saved an estimated 4.9 million lives by the end of 2009.
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.The substantial increase in resources dedicated to health through overseas development assistance and other sources during the past years has begun to change the trajectory of AIDS, tuberculosis (TB) and malaria, and more broadly, of the major health problems that low- and middle-income countries have been confronted with. The results and emerging signs of impact presented in this report paint a hopeful and encouraging picture. Ten years ago, virtually no one living with AIDS in low- and middle-income countries was receiving lifesaving antiretroviral therapy (ART), although it had been available since 1996 in high-income countries. At the end of 2008, over 4 million people had gained access to AIDS treatment, representing over 40 percent of those in need. AIDS mortality has since decreased in many high-burden countries. For example, in Ethiopia’s capital, Addis Ababa, the rollout of ART has led to a decline of about 50 percent in adult AIDS deaths over a period of five years.
World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
New England Journal of Medicine. 2008 Mar 13; 358(11):1089-1092.Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by a generalized human immunodeficiency virus (HIV) epidemic and compounded by weak health care systems, inadequate laboratories, and conditions that promote transmission of infection, this devastating situation has steadily worsened, exacerbated by the emergence of drug-resistant strains of tuberculosis. Africa, home to 11% of the world's population, carries 29% of the global burden of tuberculosis cases and 34% of related deaths, and the challenges of controlling the disease in the region have never been greater. The World Health Organization (WHO) estimates that the average incidence of tuberculosis in African countries more than doubled between 1990 and 2005, from 149 to 343 per 100,000 population (see maps) - a stark contrast to the stable or declining rates in all other regions during this period. In 1990, two African countries, Mali and Togo, had an incidence greater than 300 per 100,000; by 2005, 25 countries had reached that level, and 8 of them had an incidence at least twice that high. (excerpt)
Obstetrics and Gynecology. 2007 Nov; 110(5):999-1002.Family planning plays a pivotal role in population growth, poverty reduction, and human development. Evidence from the United Nations and other governmental and nongovernmental organizations supports this conclusion. Failure to sustain family planning programs, both domestically and abroad, will lead to increased population growth and poorer health worldwide, especially among the poor. However, robust family planning services have a range of benefits, including maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts. Family planning is a prerequisite for achievement of the United Nations' Millennium Development Goals and for realizing the human right of reproductive choice. Despite this well-documented need, the U.S. contribution to global family planning has declined in recent years. (author's)
Global Fund-supported programmes' contribution to international targets and the Millennium Development Goals: An initial analysis.
Bulletin of the World Health Organization. 2007 Oct; 85(10):805-811.The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. Results for Global Fund-supported programmes total 544 000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009. (author's)
The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals.
Geneva, Switzerland, World Health Organization [WHO], 2006. 22 p. (WHO/HTM/STB/2006.37)Since the development of the DOTS strategy, WHO and partners have worked on complementary policies and strategies to address the remaining major constraints to achievement of global TB control targets. These include expanding access to diagnosis and treatment through community TB care, and public--private mix (PPM) approaches aimed at engaging all care providers -- state and non-state -- in DOTS implementation. Innovative mechanisms such as the Global Drug Facility and the Green Light Committee have been developed to improve access to quality-assured and affordable drugs in resource-poor settings. The collaborative activities that need to be implemented by TB and HIV/AIDS control programmes have been defined, and strategies for managing multidrug-resistant TB (MDR-TB) have been developed and tested. Impact assessment is being pursued as a means of evaluating progress towards the MDGs. New partnerships and academic research initiatives for development of new tools are beginning to produce results and several new diagnostics, drugs and candidate vaccines are in the pipeline. (excerpt)
Online Journal of Issues in Nursing. 2006 Jan 31; 11(1): p..In Zambia, the incidence of tuberculosis (TB) has greatly increased in the last 10 years. This article describes Zambia and highlights the country's use of the United Nations Millennium Development Goals as a framework to guide TB treatment programmes. An overview of TB in Zambia is provided. Data related to TB cases at the county's main referral hospital, the University Teaching Hospital (UTH), is discussed. Treatment policies and barriers are described. Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. (author's)
Bulletin of the World Health Organization. 2006 Sep; 84(9):688.Tuberculosis (TB) has been a major killer disease for several thousand years. Despite intensive efforts to combat the disease over the past twenty years, TB remains one of the leading causes of morbidity and mortality in many settings, particularly in the world's poorest countries. TB is primarily a disease of poverty, but is a significant public health problem also in wealthier countries where pockets of poverty and marginalized population groups exist. It is estimated that around 1.7 million people die each year from TB; and in 2004 figures indicate that approximately 8.9 million people developed the disease. (excerpt)
Geneva, Switzerland, WHO, 2005.  p. (WHO/HTM/TB/2005.349)The goal of this series of annual reports is to chart progress in global TB control and, in particular, to evaluate progress in implementing the DOTS strategy. The first targets set for global TB control were ratified in 1991 by WHO’s World Health Assembly. They are to detect 70% of new smearpositive TB cases, and to successfully treat 85% of these cases. Since these targets were not reached by the end of year 2000 as originally planned, the target year was deferred to 2005.4 In 2000, the United Nations created a new framework for monitoring progress in human development, the MDGs. Among 18 MDG targets, the eighth is to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”. Although the objective is expressed in terms of incidence, the MDGs also specify that progress should be measured in terms of the reduction in TB prevalence and deaths. The target for these two indicators, based on a resolution passed at the 2000 Okinawa (Japan) summit of G8 industrialized nations, and now adopted by the Stop TB Partnership, is to halve TB prevalence and death rates (all forms of TB) between 1990 and 2015. All three measures of impact (incidence, prevalence and death rates) have been added to the two traditional measures of DOTS implementation (case detection and treatment success), so that the MDG framework includes five principal indicators of progress in TB control. All five MDG indicators will, from now on, be evaluated by WHO’s Global TB Surveillance, Planning and Financing Project. The focus is on the performance of NTPs in 22 HBCs, and in priority countries in WHO’s six regions. (excerpt)
The Global Plan to Stop TB: a unique opportunity to address poverty and the Millennium Development Goals.
Lancet. 2006 Mar 18; 367(9514):955-957.The Millennium Development Goals (MDGs) provide the guiding framework within which the Stop TB Partnership's Second Global Plan to Stop TB has been conceived, and poverty is rightly recognised as a key cross-cutting issue for tuberculosis control. This explicit pro-poor focus, although important in itself, will only make a difference to the individual lives of the poor if practical steps are taken to address the obstacles that these people face in accessing good tuberculosis services, and if programme implementation takes account of the distribution of poverty within target communities as a whole. That the Plan goes beyond the rhetoric and lays out the practical steps that tuberculosis programmes can take to address poverty is encouraging (panel). (excerpt)
Lancet. 2006 Mar 18; 367(9514):952-955.Government commitment, diagnosis through microscopy, standardised and supervised treatment, uninterrupted drug supply, and regular monitoring, which together constitute DOTS--the WHO recommended tuberculosis control strategy--are all essential for controlling tuberculosis. DOTS has helped make remarkable progress in global control of the disease over the past decade. The gain is evident: nearly 20 million patients have been cured of tuberculosis. However, global statistics suggest that DOTS alone is not sufficient to achieve the 2015 tuberculosis-related Millennium Development Goals (MDG) and the Stop TB Partnership targets. The need for a new strategy that builds on, and goes beyond, DOTS has also been recognised by the Second Ad-hoc Committee on the Global TB Epidemic and the 2005 World Health Assembly. (excerpt)
Lancet. 2006 Mar 18; 367(9514):951-952.In the early 1990s, the global public-health community woke up to the reality that despite the availability of effective diagnostic and therapeutic tools, tuberculosis was one of the world's leading killers. The strategy that was subsequently devised, DOTS, was based on decades-old principles and technologies, but was engendered by new energy and political will (panel); the aim, to achieve 70% case detection and 85% cure rate by 2005. Although these goals were not achieved on a global scale and implementation of the programme has been patchy and sporadic in places, overall its roll-out has been rapid and effective. That said, DOTS can only be the foundation for global tuberculosis control; to truly contain the disease, much more is needed in the control of multidrug-resistant tuberculosis (MDR-TB) and the development of drugs, diagnostics, and vaccines. (excerpt)
Journal, Indian Academy of Clinical Medicine. 2005 Oct-Dec; 6(4):268-274.At the Millennium Summit held at the United Nations (New York) in September 2000, 189 countries reaffirmed their commitment to working towards a world in which sustaining development and eliminating poverty would have the highest priority. Eight Millennium Development Goals (MDG) were adopted by a consensus of experts to measure progress in all the major areas related to the well-being of people. These included extreme poverty, education, health, gender equality, and the environment. All goals are interlinked, and efforts to achieve one goal will have positive spillover effects on several others. 18 Targets and 48 Indicators have been adopted to monitor the Eight Millennium Development Goals. Of these, 8 Targets and 18 Indicators are directly related to health. While many health indicators are "truly health indicators" such as prevalence and death rates associated with malaria and tuberculosis, some are related to critical factors for health such as access to improved water supply or dietary energy consumption (health-related indicators). India is committed to achieve the Targets under the MDGs by 2015. Incidentally, certain targets have been set under the National Population Policy 2000 (NPP-2000), National Health Policy 2002 (NHP-2002), National AIDS Prevention and Control Policy 2004, and the Tenth Five Year Plan. This paper compares goals and targets mentioned in these documents vis-a-vis selected Millennium Development Goals and Targets. This also highlights the current progress towards attaining the MDGs as well as the challenges ahead. (excerpt)
Emerging Infectious Diseases. 2004 Sep; 10(9):1523-1528.The World Health Organization’s goal for tuberculosis (TB) control is to detect 70% of new, smear-positive TB cases and cure 85% of these cases. The case detection rate is the number of reported cases per 100,000 persons per year divided by the estimated incidence rate per 100,000 per year. TB incidence is uncertain and not measured but estimated; therefore, the case detection rate is uncertain. This article proposes a new indicator to assess case detection: the patient diagnostic rate. The patient diagnostic rate is the rate at which prevalent cases are detected by control programs and can be measured as the number of reported cases per 100,000 persons per year divided by the prevalence per 100,000. Prevalence can be measured directly through national prevalence surveys. Conducting prevalence surveys at 5- to 10-year intervals would allow countries with high rates of disease to determine their case detection performance by using the patient diagnostic rate and determine the effect of control measures. (author's)
Journal of the Pakistan Medical Association. 2004 Apr; 54(4):175-181.Objectives: There are two objectives: (a) to clearly articulate the Millennium Development Goals (MDGs) adopted by the United Nations in 2000 and their implications for developing countries like Pakistan; and (b) to critically review the challenges faced by Pakistan in achieving the health-related MDGs. Methods: A critical review of secondary data and information generated primarily by multilateral agencies and United Nations organizations. Results: The MDGs represent a global consensus on the broad goals of development to be achieved by 2015. Of the eight Millennium Development Goals, three are specifically health related - reducing infant (under-5) and maternal mortality; and combating HIV/AIDS, tuberculosis, malaria and other significant communicable diseases. According to various studies, many developing countries will not achieve the MDGs without concerted efforts and commitment of additional resources. Like many other developing countries, Pakistan is also faced with an enormous challenge in reaching the Millennium Development Goals and targets set by the United Nations. For Pakistan, perhaps the most challenging MDG is that of reducing "by three-quarters the maternal mortality ratio." Maternal mortality is so intertwined with other "social" factors - including the status of women - that a comprehensive holistic approach is required. Conclusion: In order to achieve the MDGs, Pakistan would require a fundamental shift in its policy and strategic directions. Along with allocation of significant additional resources for health, it needs to review and reprioritize the use of existing resources, focusing more on primary health care. Pakistan must also adopt a holistic integrated approach that views health, education, and other social sector development as intrinsically interrelated and interwoven. Without such an integrated approach, achieving the health-related MDGs is likely to remain illusive for Pakistan. There is a critical need to foster a healthy debate on the health-related Millennium Development Goals in Pakistan so as to inform and, hopefully influence, public policy. (author's)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2004. 19 p. (WHO/HTM/TB/2004.330; WHO/HTM/HIV/2004.1)This policy responds to a demand from countries for immediate guidance on which collaborative TB/HIV activities to implement and under what circumstances. It is complementary to and in synergy with the established core activities of tuberculosis and HIV/AIDS prevention and control programmes. Implementing the DOTS strategy is the core activity for tuberculosis control. Similarly, infection and disease prevention and health promotion activities and the provision of treatment and care form the basis for HIV/AIDS control. This policy does not call for the institution of a new specialist or independent disease control programme. It rather promotes enhanced collaboration between tuberculosis and HIV/AIDS programmes in the provision of a continuum of quality care at service-delivery level for people with, or at risk of tuberculosis and people living with HIV/AIDS. While there is good evidence for the cost effectiveness of the DOTS strategy and several HIV prevention measures, the evidence for collaborative TB/HIV activities is limited and is still being generated in different settings. Existing evidence from randomized controlled trials, non-randomized trials and other analytical and descriptive observational studies, operational research and expert opinion based on sound clinical and field experience was used for this interim policy document. It is a rolling policy, which will be continuously updated to reflect new evidence and best practices. (excerpt)
Lancet. 2003 Jul 26; 362(9380):333-334.Despite well documented and successful HIV-prevention programmes in a few countries, the HIV/AIDS epidemic continues to spread in Asia and the Pacific. Moreover, without wishing to detract from the achievements of Cambodia and Thailand, recent developments show that success might be relative. Despite well funded, comprehensive programmes, one in every 100 people in Thailand is infected with HIV, and AIDS has become the leading cause of death in that country. Now is hardly the time to divert much-needed political commitment for confronting the major microbial killers. The diluted sense of urgency about tackling these diseases in the UN report’s sections on policy discussion can be attributed to flawed assumptions underlying the progress analysis. HIV/AIDS and tuberculosis pose clear and present danger to development in the Asia-Pacific region. The UN’s high-profile report is making its way toward the desks of the policy makers in the region. The public-health community has the duty to set the record straight and protect public-health interests. (excerpt)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
Lancet. 2002 Oct 12; 360(9340):1108-1110.This paper reports on the organization and administration of WHO under the management of Director-General Gro Harlem Brundtland. It describes the three broad categories of the work of WHO and the several areas that are considered to be organization-wide priorities for WHO.