Foreign Affairs Committee on Oct. 27th, 2011

[The Chair, Conservative, Dean Allison]

Good morning, everyone, and welcome to meeting number nine of the Standing Committee on Foreign Affairs and International Development.

Pursuant to Standing Order 108(2), we have a briefing on the Global Fund to fight AIDS, Tuberculosis and Malaria. To all of those who were able to make it in, even though there's only one elevator working, welcome. It's always amazing when you have a brand new building that we could actually have only one elevator working so soon.

Here's what we have in terms of business today. We have witnesses that we're going to hear from for the first hour or so, then we'll get into some committee business and go from there.

I'm not going to do any more talking. I'm going to turn it over to the witnesses. Once again, I want to welcome everyone and thank them for taking the time to be here this morning.

We have with us Svend Robinson. I think pretty much everyone should know Svend. He's a senior adviser on parliamentary relations.

Welcome back, sir.

We also have with us Christoph Benn, the director of the external relations and partnerships cluster.

Both of these gentlemen are with the Global Fund to Fight AIDS, Tuberculosis and Malaria.

From CIDA, we welcome two gentlemen: Paul Samson, acting vice-president of the multilateral programs branch, and David Stevenson, who is the director general of the global initiatives directorate.

I believe each group has an opening statement, after which we'll proceed with questions, like we normally do.

Why don't we start with you, Christoph? Welcome. I'll turn the floor over to you.

[Dr. Christoph Benn, Director, External Relations and Partnerships Cluster, Global Fund To Fight AIDS, Tuberculosis and Malaria]

Thank you very much, Mr. Chairman.

Thanks so much to all of you for being here this morning and for your continued interest in the Global Fund. It's always a pleasure for me to be here.

I will present to you some of the most recent results in the fight against the three big infectious diseases--AIDS, tuberculosis, and malaria--and also will make a few comments on where the Global Fund stands right now.

Let me first of all express my sincere thanks to Canada. Canada has been one of the founding members of the Global Fund. As we will hear later on, some of the important meetings leading to the creation of the Global Fund happened here in Canada.

Canada is one of the largest donors to the Global Fund and is represented on our board. I'm delighted to be here with Mr. Stevenson, who is representing Canada on our board. Canada is involved in the Global Fund in many different ways. We want to thank you for your continued support.

I have prepared a couple of slides. I will not talk to all of them. I just want to focus on a couple of key results. Also, just over the last couple of weeks, there have been some important reports coming out that are worth focusing on.

The Global Fund was created exactly 10 years ago to mobilize significant resources to support countries in their comprehensive programs against these three diseases. I think we've made significant progress over the years.

We have three so-called top indicators. That means we measure continuously how many people we support on treatment and what we do on prevention. In current numbers, we are supporting 3.2 million people on AIDS treatment, people who would otherwise not be able to survive without that support. We have managed to treat more than 8 million people suffering from tuberculosis. We have helped to distribute almost 200 million insecticide-treated bed nets in the prevention of malaria. We also support many more activities. You will also see from our slide how these numbers have been going up over the last couple of years as countries have implemented very successful programs.

I have a few comments on each of the three diseases. To begin with AIDS, a report from our partner organization, UNAIDS, showed that in many countries the infection rates are finally going down now. Not only is treatment successful—many people who are receiving this treatment can lead a normal life, look after their families, and be productive members of their societies—but prevention is also working. Treatment and prevention are going hand in hand. New infections have fallen by nearly 20% in the last ten years and AIDS-related deaths are down by 20% in the last five years. I think these are significant, measurable results.

We are also strongly focusing on the prevention of mother-to-child transmission. As you know, the virus can be passed on from a pregnant woman to her baby. We have the means to prevent this and we are applying it in many countries. Altogether, we have supported one million women for the prevention of this transmission, and that has saved countless lives of children who have not become infected with HIV.

Now, for a few words about tuberculosis, on October 11, just this month, the Stop TB department of the World Health Organization issued a new report, “Global Tuberculosis Control in 2011”. That was an historic report, because for the first time in decades they could report that TB cases worldwide are falling. That was a difficult achievement. It had not been the case previously, but now we see that the number of people newly infected with tuberculosis has been falling, as has the number of people dying from tuberculosis, because we can successfully treat and cure this disease.

This success, by the way, started mainly in Asia. Many of the big Asian countries have a huge burden of tuberculosis, but now also in Africa we have the dual burden of HIV and TB infection, which is one of the big challenges in addressing tuberculosis.

Finally, probably the most dramatic is the success in malaria control. A very recent report from the Roll Back Malaria Partnership of the WHO was issued in September. It also shows that the number of deaths is going down. Numbers of countries are now reporting the elimination of malaria or reporting that they are approaching the elimination of malaria. That is a huge success. It is possible with combined treatment, distribution of nets, and mosquito control. I've personally witnessed that in a number of countries I visited this year. My background is in tropical medicine, and I've worked for more than 20 years on malaria, so to see that this deadly disease is dramatically going down in so many countries is extremely encouraging.

Last week, at a big summit hosted by the Gates Foundation, there were reports about successful trials on a malaria vaccine. That still needs to be confirmed, and it will take a few years to develop so the vaccine will be on the market, but for the first time, a vaccine candidate has proven to be effective to prevent 50% of the infections. It's an additional tool that we might have a few years from now and it really might lead to the elimination of malaria in many countries.

Altogether, these programs are having an effect on all the health-related MDGs, including child mortality: MDG 4. I have one slide here that shows the example of Tanzania, where the combined programs are now leading to a reduction in the mortality of children.

I would also like to point out here how interconnected MDGs 4, 5, and 6 are, particularly as Canada has taken the lead on maternal and child health. We would really like to applaud Canada's leadership on that. The Global Fund is contributing to all three millennium development goals: children, women, and infectious diseases.

In closing, I have just a few words about the Global Fund itself. It is exactly 10 years old. It was created after a UN General Assembly meeting in 2001 and started operating in early 2002.

We are now, in this particular period, following some reports about corruption in a number of countries that the Global Fund has been supporting, which the Global Fund itself had actually detected. It was the inspector general of the Global Fund who found out about these cases. They were reported in the media. That led us and the Global Fund board to appoint a high-level panel of eminent persons to look into the best fiduciary controls, and how the Global Fund, in its second decade, can strengthen that part of its operations.

We very strongly believe in transparency and accountability, which go hand in hand. On transparency, we make public all our disbursements and all our reports of the inspector general. We think this is one of the best preventions of corruption, but that's also why there was a lot of public discussion.

We therefore initiated a reform agenda, following the recommendations from this high-level panel. That will be discussed at a board meeting that we will hold in Ghana next month. Then we will implement the recommendations, which hopefully will strengthen the operations of the Global Fund further so we can continue to make really good progress on the three diseases.

I'll stop here. I very much welcome the discussion we are going to have later on.

Thank you very much, Mr. Chair.

[The Chair, Conservative, Dean Allison]

Thank you very much.

We'll now move to Paul Samson, from CIDA.

[Paul Samson, Acting Vice-President, Multilateral Programs Branch, Canadian International Development Agency]

Thank you, Chair.

Thank you and welcome everybody.

As you know, CIDA's mission is to lead Canada's international efforts to help reduce poverty in developing countries. The Global Fund is aligned with Canada's international development commitments, including the Muskoka initiative for maternal, newborn, and child health.

Nearly nine million children under the age of five are dying every year, mostly from preventable and treatable conditions. In the developing world, the focus on child survival requires an equal focus on maternal health. A child whose mother has died is 10 times more likely to die within the first two years of her death.

To support child survival and maternal health, investing in prevention and treatment of HIV/AIDS, malaria and tuberculosis is key.

In 2009, there were 1.8 million AIDS-related deaths, including an estimated 260,000 children and youth. HIV slows economic activity, causes severe financial strain on affected households, and places the physical and emotional well-being of orphaned children at risk.

Malaria is one of the leading killers of children worldwide, with 90% of all malaria deaths occurring among children.

TB is a disease of poverty that negatively impacts economic growth, affecting mostly adults in their most productive years. A person with TB loses on average 20 to 30% of annual household income due to illness.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 to dramatically increase the resources to fight these three devastating diseases. In nine years, the Global Fund has become an important financing mechanism, dramatically increasing resources for the three diseases, with the support of numerous donors.

With a grant portfolio of over $30 billion, the Global Fund directs approximately 62% of its resources toward HIV and AIDS, 22% toward the prevention and treatment of malaria, and 16% toward tuberculosis programming.

The fund is a major source of resources to country-level health authorities, resulting in significant increases in availability and utilization of services and a reduction in disease burden. Since 2004 the Global Fund is estimated to have averted 7.7 million deaths. These are important results.

I have another couple of examples. Programs financed by the Global Fund provided AIDS treatment for over 3.2 million people and helped one million HIV-positive pregnant women with treatment, to prevent mother-to-child transmission.

Since 2004 the Global Fund has financed the provision of tuberculosis treatment for roughly 8.2 million people. For malaria, the Global Fund has distributed a reported 190 million bed nets for the prevention of malaria and has provided 210 million treatments against malaria.

Global Fund investments have additional impacts on the wider health system, such as improvements in infrastructure, laboratories, human resource capacity, monitoring, and evaluation activities. These enhancements bolster the sustainability of disease treatment and prevention activities across the health systems of the recipient countries.

Canada was a founding donor to the Global Fund, including convening the first donor meeting, and has supported the Fund since its inception. To date, Canada has committed more than $1.5 billion and dispersed $968.4 million to the Global Fund. Canada currently ranks as the sixth largest donor accounting for over 4% of total funding.

In September 2010, the Prime Minister announced a new pledge of $540 million to the Global Fund for the 2011—13 period. This is Canada‘s largest contribution to a single global health initiative.

To monitor Canada‘s investment in the Global Fund, Canada is an active member of the Global Fund‘s Board of Directors, through the Canada-Germany-Switzerland constituency, and represents the constituency on a key Global Fund committee. Canada is working with partner countries to improve the efficiency and effectiveness of the Global Fund‘s processes and management.

In fall 2010, the Global Fund Management presented to the Board its Reform Agenda for improvements to the operational structures of the Global Fund. In December 2010, the Executive Board also took on a reform process of analysis and consultations to identify short and long-term reforms needed by the Global Fund. This continued the reform agenda, but added further recommendations for reforms that span almost all aspects of the Global Fund. Key areas for immediate action were identified with specific recommendations for action, timelines, and indicators to measure progress. Reform within the Global Fund is important to address lessons learned from the first nine years of existence, and most essentially to insure zero-tolerance towards corruption and fraud.

The Global Fund has an Office of the Inspector General, which has reported on funds unaccounted for due to corruption, insufficient documentation, and extra-budgetary expenditures. The reports from the Office of the Inspector General were made public to media outlets in accordance with the fund's practice of open transparency. A high-level independent review panel was convened in February 2011 by the Global Fund board to review fiduciary controls and oversight mechanisms of the Global Fund in light of the alleged fraud and misuse of funds.

The high-level panel report, entitled “Turning the Page from Emergency to Sustainability”, notes the important achievements and unprecedented results of the Global Fund and concludes that failure of the fund would result in a “global health catastrophe”. The panel underlined that the Global Fund was born out of an emergency response to three diseases, but that as the global response changes, the time is ripe for consideration of how the model operates and how to ensure its sustainability.

A comprehensive list of recommendations is included in the report to improve procedures, institutional responsibilities, and practices. Key recommendations include improving risk oversight at all levels, empowering fund portfolio managers, and better utilizing local partners.

A special board meeting was convened on September 26 this year in Geneva to discuss the high-level panel report and decide on next steps. At the board meeting, the panel presented its key recommendations while reaffirming the report's conclusion:

We are confident that the implementation of our recommendations, together with actions taken already by management and the Board, will protect the Global Fund's resources, provide assurance to donors of the viability and effectiveness of the organization, and position it to sustain its important role in a rapidly evolving international economic environment.

The panel noted that it “has not identified a problem that cannot be fixed”.

The board decided to take forward the recommendations of the high-level panel by developing, with the secretariat and the Office of the Inspector General, a time-bound consolidated transformation plan. The Global Fund board has agreed upon a comprehensive reform agenda, which includes the transformation plan and action points recommended by the high-level panel. The Global Fund executive director has committed to leading the implementation of the plan, with improved collaboration and continued audits and investigation from the Office of the Inspector General. The Global Fund will also recruit a chief risk officer to work with the executive director in the design and oversight of internal risk management actions.

Finally, concerning CIDA's way forward with the Global Fund, a high-performing Global Fund with zero tolerance for fraud and corruption is essential to achieving the objectives of the Muskoka initiative on maternal, newborn, and child health. With the goal of maximizing the Global Fund's impact on the three diseases, CIDA is focusing on three key strategic areas for engagement with the Global Fund: improving the alignment with country-led policies and processes, improving the efficiency and effectiveness of the fund's operations, and simplifying granting mechanisms and procedures.

Thank you very much.

[The Chair, Conservative, Dean Allison]

Thank you.

We're going to start with our first round with Madam Sims.

You have seven minutes.

[Jinny Sims, NDP, Newton—North Delta, BC]

Thank you very much.

Chair, are we going to have enough time to do two rounds of questions?

[The Chair, Conservative, Dean Allison]

Yes, most definitely we will.

[Jinny Sims, NDP, Newton—North Delta, BC]

Thank you.

First of all, I want to thank both of you for the very informative presentation. We all know that the link among AIDS, tuberculosis, and malaria is there. I attended a health care forum recently at which they talked to us about the essential need to connect treatment for tuberculosis with HIV treatments and diagnostics as well. That becomes really critical.

I noticed in the report you have just made that Canada has committed $1.5 billion to the Global Fund, but we have disbursed $978.4 million. Is there a timeline to our disbursements? Could you expand on that for me, please, Paul?

[Paul Samson]

Thank you for the question.

As I mentioned, the Prime Minister made a commitment last year, a pledge for $540 million over three years for the Global Fund, and we're on track to meet that pledge.

[Jinny Sims, NDP, Newton—North Delta, BC]

Okay. Thank you very much.

Given the work you're doing and the need out there in the greater world, has the fund had enough money to fund all of the good proposals that have come to it to date? If not, what kind of global commitment would be needed to fund such proposals? We can all recognize the need for them, but you are the people who know all of this information, so tell us.

[Dr. Christoph Benn]

Thank you.

For the first eight years, I would say, the Global Fund indeed had sufficient resources to fund all the proposals that were presented to it.

I have to say one word on that. We have an independent technical review panel. This means that all of the proposals we receive from countries are independently reviewed not by the Global Fund secretariat itself, but by international experts, and they normally recommend for funding about 50% of the proposals coming from the countries.

We have been able, so far, to fund these kinds of recommended proposals, but obviously the current global economic and financial crisis is also affecting the Global Fund significantly. At the moment, it is difficult to fund those proposals and, given the way it looks, it may become even more difficult in the next few years. We have to realize, of course, that it's also the poorest countries that are suffering from this crisis, and it's the poorest people in those countries who are affected by tuberculosis, AIDS, and malaria.

Therefore, we are trying to communicate to our donors and to the world that it's very important to maintain this commitment, even while we understand the budgetary pressures in many donor countries. It's important to maintain this commitment because the very impressive progress I've just described is obviously also fragile. We need to maintain that, not for only the millions of people on treatment, but because even the impressive progress on malaria could be reversed if we can't maintain that support to the countries.

[Jinny Sims, NDP, Newton—North Delta, BC]

I appreciate that information. We know that Canada has increased its commitment, but what we're hearing from NGOs is that there is need for more and for a longer-term commitment. From your perspective, what might this long-term commitment look like? Please feel free to be very specific, because that really helps us.

[Dr. Christoph Benn]

Thank you for inviting me to be very specific.

There are two elements. There is the level of resources made available by donor countries such as Canada, and then there's predictability. Both are very important.

It's the long-term predictable funding that we need. There are a few countries--such as, for example, the United Kingdom--in a position to make commitments beyond a three-year period. We also have an instrument that is called a multi-year contribution agreement, and we would be very interested in engaging with Canada in long-term predictable funding, which would be very helpful for these programs. Obviously we are appealing to countries that have the means to even increase their contribution if possible, so that we can continue to fund all of the high-quality programs that are submitted to the Global Fund.

Thank you.

[Jinny Sims, NDP, Newton—North Delta, BC]

I have a very quick question specifically for CIDA.

As you know, in Canada we've kept up our commitment, b there is also a kind of a freezing, and no increases, and yet we have a long-term commitment to reach 0.7% of our GDP. So if this government were interested in actually reaching this goal, should it not immediately end the freeze and start increasing ODA?

[Paul Samson]

That's quite a general question that goes beyond certainly the scope of the Global Fund to Fight AIDS, Tuberculous and Malaria. I think we'll just have to wait and see where the budget process takes that question.

[Jinny Sims, NDP, Newton—North Delta, BC]

Just to add something, when we've been talking to different agencies—and I've had a few meetings with them at different venues—one of the things we are hearing is that the freeze on the CIDA funding is beginning to have a real impact on the work they're able to do. That is creating concern, especially when we know that the U.K. at this time has made that commitment and has reached the target.

Thank you.

[The Chair, Conservative, Dean Allison]

Thank you very much.

We're going to move to the government side, with Ms. Brown.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

Thank you very much, Mr. Chair.

Thank you very much for being here today. I think this is a discussion that Canadians need to hear, and I think Canadians will be very proud, quite frankly, to hear about the good work we've done. Contrary to what my colleague has said, Canada has doubled its aid to Africa, and we have been very generous in our contributions in Haiti and Afghanistan. Many of these countries are seeing some real changes because of the contributions Canada is making.

Dr. Benn, this is one of the things I would like to hear about, if I may. It's one thing to contribute to the Global Fund and to continue to give medications to individuals, but unless we see some changes in capacity building in these countries, we are going to be in this constant revolving door of having to make contributions. I'm sure the demand is always going to be greater than the supply.

I've been to Bangladesh and have seen some of the things they're doing there in creating community health services. I was just recently in Ethiopia and saw some of the CIDA work going on there. I wonder if you could speak to some of those issues about how we move these countries from just providing...? It's wonderful what we're doing in getting medication to 3.1 million people. That's an enormous job. How do we move beyond that and how do we help build capacity so there is a long-term goal that we're reaching?

[Dr. Christoph Benn]

Thank you. That's an excellent question.

I also visited Ethiopia earlier this year. Ethiopia is actually the country that has received the highest amount of funding. It's a very large country in Africa, a very poor country, with one of the lowest per capita incomes in the world and with a very high disease burden. Therefore, we allocated big grants to Ethiopia; it has indeed gone significantly beyond the strict funding to the three diseases. It has, with our funding, significantly improved its health systems, particularly at the community level.

Maybe you have seen some of these health outreach workers and the kinds of rural health posts that the Government of Ethiopia has also helped to establish with funding from the Global Fund. These health extension workers hand out malaria drugs and do HIV testing and counselling, but they're also available for other diseases. So it's not strictly limited to the three diseases; it is really strengthening the health system in Ethiopia from the bottom up, and I think that's an excellent example.

Overall we can say that about one-third of our resources go into health system strengthening. It's not just drugs and bed nets. Really, training, health facilities, and management of health programs are supported with this funding. You're absolutely right when you say that it has to go hand in hand, because we need sustainable health systems in these countries, particularly in the low-income countries.

Bangladesh, by the way, would be another interesting example. TB is a huge problem in Bangladesh, where we have been investing. Fortunately, there are also countries that are now graduating into middle-income country status. That reduces the dependency in the medium term on an institution like the Global Fund, which I think will be helpful. Therefore, we need to focus on the poorest countries with the poorest health systems and strengthen them so that we can see long-term results.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

I was in Botswana two years ago. I know that Botswana, as a middle-income country that is developing very rapidly, has as part of its health care system a whole department dedicated to HIV/AIDS. They are making some tremendous progress on how they deal with that disease. Can you comment on how a country like Botswana is handling it and on what steps they've put in place?

[Dr. Christoph Benn]

I've visited Botswana several times. It used to be the country with the highest HIV prevalence in the world. Ten years ago, Botswana had almost 40% prevalence of HIV in the adult population. We supported some of their early programs, which provided universal access to prevention and treatment on HIV, and now the prevalence rate is down to 22% or something.

It's still high, but it's almost half of what it used to be, and Botswana does not receive any more funding from the Global Fund for that because they say they can cover that themselves; they have diamonds and gold and so on. I think that's an excellent example. The Global Fund was absolutely essential to help them establish these programs. The rates of HIV have gone down and now the government is in a position to maintain those programs by themselves.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

Of course, the impact is that you have young people who are now being educated, and you have parents who have sustainable incomes because they are managing the illness. I think it's a great story that Canada has been part of this; Canadians need to know that we have done some good work there.

Thank you.

[The Chair, Conservative, Dean Allison]

Thank you very much.

We're going to move now to Mr. Eyking.

Go ahead, sir.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

Thank you, Chair.

Thank you for coming, folks.

Svend, it's good to see you back at the foreign affairs committee. It has been a while.

Recently we had a meeting with the World Food Programme and heard a very similar presentation: their results are better, and their objectives, somewhat, were being met. But they had a concern--and I think you alluded to it--about what's going to happen in the upcoming years with this revolving door of money.

They also mentioned the European debt crisis and what's going to be projected in these budgets as the Europeans are going to have to tailor their budgets. The problem is that foreign aid might be some of the stuff that's cut back quite a bit. They are probably your biggest donors.

When you hit that so-called wall of financing, how are you people going to deal with it? The World Food Programme alluded to starting to draw on...they see an opportunity for developing countries, such as China, Brazil, and other countries, to step up to the plate. Are you people doing the same thing? Are you preparing for this so-called diminishing money coming out of Europe? Are you doing your homework with these other countries, the Arab countries and the oil-producing countries, which may have been your recipients once and now could be helping you more?

That's my first question: how are you dealing with that financial wall you're inevitably going to hit?

[Dr. Christoph Benn]

Thank you.

First, I have one comment on Europe. It's true that European donors are extremely important for the Global Fund. We are receiving about 50% of our resources from the member states of the European Union, and therefore we are very closely following the current discussion on the euro crisis. There was some good news last night, I understand, with some decisions there.

But fortunately, many of the main members of the European Union are maintaining or even increasing their ODA. The United Kingdom was mentioned. Germany is also slightly increasing its ODA. The Scandinavian countries are doing very well. It is the southern European countries that are our biggest worry, and they belong to our major donors like Spain and Italy.... So there is some worry there, although I would say that so far we have been able to maintain a very high commitment.

But you're absolutely right; because of that, we are focusing quite significantly on the emerging economies, the G-20. Exactly as you said, the benefit is that many of them also have experienced support from the Global Fund. China, India, and Brazil have received money from the Global Fund and are now turning into donors. The first country to do so was Russia, which has now become a net donor after receiving some funding for their initial HIV and TB programs.

We are receiving some money from China and some from India. That needs to continue, and that needs to grow, because there is not yet this kind of culture, I would say, of international solidarity, of development aid. That's maybe one thing on which I would also ask for your support. I think a country like Canada can be very helpful as a member of the G-8 and the G-20 in talking to these new emerging economies and making the appeal to them that in the future they will probably have to play a more substantial role here in helping poorer countries that have not yet reached the kind of income level and economic growth that they have. That could be quite helpful.

We are working quite a lot on this and see it as a future way of helping us to finance the programs in the poorest countries.