GUADALAJARA, Mexico — The fight against tuberculosis is the latest effort to investigate innovative financing instruments for vital funding. The Global Fund to Fight AIDS, Tuberculosis and Malaria and the International Union against Tuberculosis and Lung Disease (The Union) last week announced a new partnership to spur investment among the private sector to help end the TB epidemic by 2030.
Efforts to combat TB have been hampered by a lack of new diagnostic tools, a lack of investment, and increasing multiple-drug resistance.
Missing cases are another growing concern. Every year 10.4 million people get sick with TB, 40 percent of whom are never diagnosed or treated. In response, the Global Fund, along with partners including the World Health Organization and Stop TB Partnership, last week also launched a new “catalytic funding” program to find and treat an additional 1.5 million “missing” people with TB in 13 high-burden countries by 2019. The catalytic funding for TB seeks to support innovative programs, promote better use of data, and expand successful approaches.
Tuberculosis experts and advocates are setting ambitious goals for the first U.N. high-level meeting on the disease, to be held next year.
Devex sat down with Dr. Christoph Benn, director of external relations at the Global Fund, to discuss the two new initiatives and what they will mean for combating the disease. Our conversation has been edited for length and clarity.
How did your partnership with the Union come about?
The Union and the Global Fund have been working together for many years, but in the way that the Union is one of our implementers in a number of countries. The Union and the Global Fund are working on private sector fundraising and innovative financing to complement the funding that we receive. We had a successful replenishment last year, but it’s still not sufficient. So we’re asking ourselves: what can be done in addition to that? We’re exploring together innovative financing mechanisms like impact investments, social impact bonds, blended finance modalities, and so on.
How will these new innovative financing tools work in practice?
For a number of years, we’ve seen increased interest, particularly from high-level individuals, their foundations, and their trusts. They’re interested to invest in development, but they’re often not quite sure how to do that and how to find the right channel. It’s a new area we’ve been exploring successfully. In India for example we’ve partnered with Tata Trusts, and we created the India Health Fund. This is an example of Indian business leaders coming together and wanting to do something for TB.
Others are interested in impact investments — so they won’t provide you with cash grants for a program, but they will invest in a particular fund. The blended finance model is where there are opportunities from development banks to provide loans to countries, but in order to make that attractive for a government to take a loan for a health program, you usually need to combine that with grants so you reduce the interest rates. That’s where we can partner with the Union to explore in our network who might be seed funders, impact funders for a particular program.
Why do you think new models of financing are required?
On the one hand, TB has been for many years what you would call a neglected disease. It hasn’t been high on the political agenda of funders, one reason being that TB is very concentrated in middle-income countries, and those are not the countries that development aid funders would consider a priority.
On the other hand, we all know TB is the infectious disease with the highest mortality rate in the world. We have to address the TB burden, because it’s a health security threat, particularly with multi-drug resistance. The development community and the donor community cannot neglect TB any longer. It is a high priority, but the traditional sources of development aid will not be sufficient to cover these needs, particularly in middle-income countries such as India and Indonesia. Some international funding is available, mainly through the Global Fund, but we now need to complement that with other instruments.
At the conference in Mexico last week, the Global Fund announced a new global effort to find an additional 1.5 million missing TB cases. You said that $190 million had been set aside to do this by 2019 in 13 high-burden countries, including Myanmar, India, and Nigeria. How will the money be spent? How will missing TB cases be found?
After replenishment last year, we allocated $1.8 billion for TB, but we kept aside a certain amount of money for this catalytic funding. With that money, we can incentivize innovative approaches and we can incentivize countries to spend more on TB themselves. This means that if countries come up with interesting, innovative proposals, particularly on case finding, for the amount that they put in, we will match that.
We’ve set aside $190 million outside the country allocation that is available if countries want to invest in innovative approaches — like the latest diagnostic tools such as the GeneXpert — but also if its innovative approaches involving community-based health care to identify the patients. That’s where we need to go. We can’t rely on the formal health system where people go to a hospital and present themselves with symptoms of TB. We need to go to the community level to identify people who show symptoms and detect them early. We also want to encourage multi-country grants to support migrant populations, which is one of the big issues these days. TB is particularly prevalent among migrant populations.
At this point in time, do you think the global goal to end the TB epidemic by 2030 is realistic?
If you look at the curve, you see infection rates have gone down, but too slowly. It’s not going at the speed we need to achieve the 2030 goals. We have to accelerate progress if we want to achieve those goals. We won’t reach the goals without better tools, better diagnostics, and better and easier drugs. Not only that, but we need innovation in terms of how we reach the people. The main thing for TB is the missing cases — those that never reach the health system. For that we need new tools and technology to reach people.
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