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By Natasha Hsi, Abt Associates Katherine Wolf, Emory University Global Health Council June 2, 2005

Sustainability of the introduction of new globally funded initiatives: examples from Hib vaccine and artemesinin combination therapy. By Natasha Hsi, Abt Associates Katherine Wolf, Emory University Global Health Council June 2, 2005.

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By Natasha Hsi, Abt Associates Katherine Wolf, Emory University Global Health Council June 2, 2005

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  1. Sustainability of the introduction of new globally funded initiatives: examples from Hib vaccine and artemesinin combination therapy By Natasha Hsi, Abt Associates Katherine Wolf, Emory University Global Health Council June 2, 2005

  2. Learning objective: to provide concrete examples of how externally driven and funded interventions are affecting country health budgets • Outline of presentation: • Global Health Initiatives • Specific examples from the GFATM and GAVI • Magnitude of resources needed and resources available • Impact on interventions in 2 countries • Future financial sustainability of program beyond global health initiatives

  3. Influx of donor funding from Global Health Initiatives • Global Fund to Fight AIDS, Tuberculosis, and Malaria • Global Alliance for Vaccines and Immunization (GAVI) • PEPFAR • World Bank MAP • World Bank Booster Program for Malaria control

  4. Global Fund: Anti-retroviral therapies Artemesinin Combination Therapy GAVI: Yellow fever Hepatitis B Hemophilus influenzae type b Auto-disable syringes Funding for the introduction of “new” technologies and commodities

  5. Global Fund Initial 2 year support Subsequent support is contingent on meeting performance indicators established by country Maximum of 5 years of support GAVI 5 years worth of new vaccines 3 years of injection supplies Cash based on performance, up to 5 years Time limited support

  6. Two country specific examples • GAVI: Introduction of Hib vaccine in Rwanda • Switch from DTP vaccine to DTP-HepB+Hib vaccine • 2002 introduction, 100% of country • Global Fund: Introduction of artemesinin combination therapy in Democratic Republic of Congo • Consider switch from SP to an ACT • Roll out late 2005, early 2006 • Phased approach depending on implementing partners and international supply of drugs

  7. Resources available through GAVI for new vaccines • $815 million committed out of $1.3 billion for new vaccines. • Yellow fever, Hepatitis B and Hib vaccines • Other vaccines in the pipeline include rotavirus and pneumococcal vaccines

  8. Financial impact of the introduction of the Hib vaccine • New birth cohort ever year that needs to be vaccinated • DTP: $0.09 per dose or $0.27 per child • DTP-HepB: $1.25 per dose or $3.75 per child • DTP-HepB+Hib: $3.60 per dose or $10.8 per child

  9. Impact of Hib introduction in 22 countries • Cost per capita in 22 countries rose from $0.14 to $0.27 • Cost per DTP3 child in 22 countries rose from $7.8 to $12.50 • Cost of routine program tripled for countries introducing the DTP-Hepatitis B-Hib pentavalent vaccine • Cost of routine program doubled for countries introducing the DTP-Hepatitis B vaccine Lydon, Patrick. Financial Sustainability Plan Analysis. WHO. 2004.

  10. Prior to Hib introduction: Routine program would consume 4% of government health resources for EPI Cost per capita: $0.31 Cost per DTP3 child: $7.90 After Hib introduction: Routine program would consume on average 8% of government health resources Cost per capita: $0.92 Cost per DTP3 child: $23 Example of Hib introduction in Rwanda

  11. Impact of Hib introduction if government were to pay 100% of costs

  12. Global financial resources for malaria • To meet the MDGs and the Abuja targets for malaria, the Global Fund estimates: • The global annual resource needs to combat malaria to be $2.9 billion. • The global annual resource needs for ACTs to be $1.180 million. • The Global Fund contributes to approximately 45% of international resources available for malaria control.

  13. Wide scale introduction of Artemesinin Combination Therapy • 11 countries have introduced ACTs with GF funds. • GF advocates for the reprogramming of previously awarded malaria grants for the procurement of ACTs. • Another potential 30 countries could be introducing ACTs using GF funds. • Countries have the opportunity during round 5 to apply specifically for ACTs.

  14. Financial impact of treatment costs for malaria • Yearly recurrent costs • Cost per adult treatment episode • CQ or SP = $0.08 • Artesunate-Amodiaquine: $1 • Arthemeter-Lumenfrantine (Coartem): $2.40

  15. Example of ACT introduction in DR Congo • Comparison of SP at 100% uptake to artesunate-amodiaquine or arthemether-lumenfrantine at 20% uptake • SP: $3 million per year or $0.05 per capita • Artesunate-amodiaquine: $12.7 million per year or $0.21 per capita • Arthemether-lumenfrantine: $21.7 million per year or $0.36 per capita

  16. Financing gap after reprogramming of GF round 3 grant in DR Congo

  17. Current funding sources for ACT in DR Congo • Implementing agencies at the Health Zone level • USAID through SANRU, CRS • European Union • World Bank • MSF • Global Fund

  18. Planning for future financial sustainability • What does sustainability mean? • GAVI recipients required to develop a Financial Sustainability Plan (FSP) • How are countries planning to pay for ACTs? • Likelihood of countries being able to afford these new technologies is very low without a reduction in the cost of the technology of commodity or a global subsidy.

  19. Future financial sustainability of program beyond global health initiatives • Challenges ahead • How to sustain funding beyond current donor commitment • How does each country weigh which intervention to fund as technologies and commodities increase in cost • Do no harm principle • Irresponsible not to plan for future financing • Resistance to anti-malarials • Opportunity costs in training of health workers • Exogenous factors • Macroeconomic stability • Budget ceilings • What can countries truly afford?

  20. Thank you The PHRplus Project is funded by U.S. Agency for International Development and implemented by: Abt Associates Inc. and partners, Development Associates, Inc.;Emory University Rollins School of Public Health; Philoxenia International Travel, Inc. Program for Appropriate Technology in Health; SAG Corp.;Social Sectors Development Strategies, Inc.; Training Resources Group; Tulane University School of Public Health and Tropical Medicine; University Research Co., LLC. URL: www.PHRplus.org

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