Foreign Affairs Committee on Oct. 27th, 2011

[Dr. Christoph Benn]

I think Canada for many years has strongly supported the provision of generic drugs, which indeed have all the kinds of prices I just mentioned. These are, of course, generic drugs that we are able to purchase. Many of those are now being produced in emerging economies, particularly India, but also in a number of other countries. It is very important that we continue to be able to purchase these generic drugs at the lowest possible price. That's a question the World Trade Organization has had about the TRIPS agreement.

I think we need Canada's support in protecting those rules. I understand that Canada has been quite outspoken on that for a number of years, but it is indeed very important that we maintain the principle that, for these life-saving treatments, there should not be a profit margin. They should allow generic producers to enter the market and to compete, because competition between generic producers is really what has in the end brought prices down. Prices continue to go down a little bit also because of the economies of scale and improved technology in the production of the drugs. We need to preserve that. Only that will enable us, with the resources we have, to fund these successful programs.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Very quickly, I was wondering also if you've heard about Bill C-393, which is intended to improve our access to medicine within the TRIPS context and improve on the law we already have, which is an established mechanism that is not used very much.

Do you think it would be useful for Canada to become a more important player in this provision of generic drugs?

[Dr. Christoph Benn]

I've heard about the bill, although I must admit that I don't know much about the details.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Yes, I'm not expecting....

[Dr. Christoph Benn]

But I think, indeed, the point is, I believe, that the more you increase competition in the generic drug market, the better it is, normally, for the affordability of and access to the drugs. If Canada were to play a role in that and could thereby help lower the cost further, that would be very welcome.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Thank you.

[The Chair, Conservative, Dean Allison]

Thank you.

We'll go to Mrs. Grewal.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Thank you, Chair.

Thank you to the witnesses for taking your time to come here, especially Mr. Svend Robinson.

It's nice to see you.

I have a very short question. Mr. Benn, you mentioned that the Global Fund does not have an in-country staff presence. So how is technical assistance provided and implementation supported once a grant has been approved for a recipient country? Could you tell us about that, please?

[Dr. Christoph Benn]

That is an excellent question.

There are two ways in which technical assistance is made available--or even three. First is through partner organizations. It is very important that our partner organizations, such as the UN, the World Health Organization, the Stop TB Partnership, and others help the countries by providing technical assistance and capacity building, because that's their mandate. That is less our mandate.

I would also like to mention--which is why I am saying that there are three ways--that there is an important role for the bilateral partners, such as CIDA, in providing that kind of technical assistance and capacity building. CIDA is sitting on a number of our country coordinating mechanisms in countries, and they are helping, with their programs, to build capacity.

Third is the provision that countries can budget for technical assistance in the proposals they submit to the Global Fund. We say that up to 5% of what they are asking for can be used for technical assistance. Again, it's not all going into drugs and the direct provision of services. We recognize that the countries also need support in building their capacity. We ask them to include that in the proposal, and then it can be paid out of that grant.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Could you also please tell us what the current gap is between the pledged commitments from donor governments and actual disbursements to the Global Fund?

[Dr. Christoph Benn]

I cannot give you a precise number because that is a very complex calculation, and we are monitoring that quarter by quarter, in a sense. As I said, we are trying to provide long-term support to these countries. In some cases, we commit for several years in advance, and that's where a lot of the money goes.

We have a policy that says we only sign an agreement with a country if we have the money available for two years in advance. But at the moment, because of the situation in a number of donor countries, we are indeed coming under increasing pressure, so for the next year I would foresee a shortfall in the order of a few hundred million dollars, at least.

We are going to have what we call a mid-term replenishment review. We have regular donor conferences. The last big conference was last year in New York, under the leadership of UN Secretary-General Ban Ki-moon, but we will also have a conference next year. There is one slide in my presentation on that. The UN General Assembly has already taken that up and has alluded to there being a new forecast, if you like, of resources coming up next year. Then we will be much more precise in this forecast of what is required so that we can maintain the programs.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Chair, do I have more time?

How long does it take for the Global Fund to move from grant proposals to actual implementation on the ground?

[Dr. Christoph Benn]

There are several steps.

The country works on a proposal. They submit the proposal. It goes to the technical review panel I spoke about and then to the board for approval. Once the board approves, it goes to the secretariat, which enters into a contractual relationship with the country, with clear indicators of what is going to be achieved and how.

That process, from board approval to the actual signing so that the money can flow, takes 11 months, on average.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Do I have 30 seconds?

[The Chair, Conservative, Dean Allison]

Yes.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

How does the Global Fund work to maximize the impact of its investments on national health systems and the health of women and children? Could you please tell us, in a nutshell?

[Dr. Christoph Benn]

Over the last couple of years, we have developed what we call a gender equality policy, which provides very clear guidelines to the country coordinating mechanisms, the country round tables that submit the proposals and discuss the strategy. We are requiring them to put the concerns of the health of women and girls very much at the top of their priorities so that they include it in their programming. That's the role the Global Fund can play: we can give guidance. In the end, the decisions are with the countries.

We believe very much in country ownership: the countries need to own these programs. But through this policy, we have emphasized very strongly that the health of women and girls, particularly with HIV—I think that's what we're talking about here—is extremely important, because all of the evidence shows that without that, the HIV prevention programs in particular will not be successful.

[The Chair, Conservative, Dean Allison]

Thank you.

I would like to know if it's all right with the committee.... I know we were going to go for an hour, but I sense that there are still a few more questions.

Is it okay with the witnesses to go another round?

We'll do one more round.

I'll begin with you, Ms. Brown and then we'll head over to the other side for the final question. How does that sound?

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

Thank you very much, Mr. Chair.

My question is for our CIDA representatives. Canada's government has decided that we need to focus our aid. We have decided that we need to take on some thematic priorities.

Could you give us some insight into the thematic priorities we've chosen and how our participation in the Global Fund meets those priorities?

That's kind of an essay, isn't it? I'm sorry.

[Voices]

Oh, oh!

[Paul Samson]

Thanks very much, Parliamentary Secretary.

The three thematic priorities the government has defined for development assistance are: food security, sustainable economic growth, and children and youth. All three of those are relevant here.

First, on children and youth, for some of the reasons just mentioned, the maternal and child health relationships are fundamental to that priority. On the food security side, nutrition is an important part of that element connecting to health. Sustainable economic growth is fundamental to livelihoods in general. Without that, there's really nothing else. We see all of those as interwoven.

Clearly, the children and youth priority and the Muskoka initiative on maternal, newborn, and child health align very strongly with the Global Fund's objectives.

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

So we've developed a very strong partnership there is what we're saying. The Global Fund is really the vehicle through which much of our aid money is being directed to achieve these three goals that we've looked at.

As I said before, I've spent some time in Africa. I've now been in eight different African countries and have visited some of our CIDA projects in each one of them. My observation is that with this money that we're putting into building capacity in particular, Canada is having some incredible effects on what's happening in these emerging countries.

Dr. Benn, going back to you, could you give us some insight into how you're working with the partners? You say you don't have any people on site who are working for the Global Fund, that you work with national partners. Is there some involvement from the private sector in that basket of organizations with which you work? Can you give us some feedback on how that works as well?

[Dr. Christoph Benn]

I'd be happy to.

First of all, yes, I emphasize that we don't have any country offices. However, I should mention one point. Obviously we have teams that are responsible for these countries, operating from Geneva but visiting these countries regularly, and it was one of the recommendations of the high-level panel that they should probably spend more time at the country level.

It's not that we should open offices, because that would increase the administrative burden, but that they should be more available there. That's one of the reform areas: that we focus more on these teams and allow them to spend more time visiting those countries and talking to the countries.

The private sector plays an increasingly important role in the implementation of these programs. They do that in many different ways. Providing resources is one thing, and we do mobilize resources from companies. They have also become more important in the implementation. They often have the capacity at the country level to implement programs, and they do that often very efficiently. In a number of countries now, the money goes to a private sector company for the implementation of a grant. That is very helpful, particularly in situations where the governments, as I said, are particularly weak.

Thirdly, maybe the most interesting one is what we call co-investment. We invite the private sector to support our programs with their capacity, with their expertise, and with their strength. The largest bank in Africa is providing free services for many of our implementers and is training them in financial management, helping them to manage currency exchange risks, and so on. That's worth several million dollars per year in services that they are providing.

We are working with Coca-Cola now on improving the supply chain management, the logistics. How do you get drugs and bed nets from the point of entry to the remote villages? No company knows that better than Coca-Cola. Again, they are not giving us money. They are giving us their expertise and training government officials how to do that.

We have recently quantified this kind of input by the private sector. It amounts to $80 million to $100 million per year in free services that they are providing. I think that's probably also a very good model for future development. We need what we call this public-private partnership, because it is only if we have these partners working together--the governments, donor agencies, civil society, and the private sector--that we will have a good chance to achieve the full success that we want to achieve, namely, to reach the millennium development goals and to really eliminate these diseases.

[The Chair, Conservative, Dean Allison]

Thank you very much.

We're going to move to Madam Groguhé for five minutes, please.

[Sadia Groguhé, NDP, Saint-Lambert, QC]

Thank you, Mr. Chair. I thank the witnesses for their very informative presentations.

I believe the fund contributes to very positive results in the prevention and reduction of the number of deaths.

In one of its reports, the fund establishes a link between the criminalization of homosexuality and the spread of HIV-AIDS. It also reports that two factors contribute to the increase of mortality rates among homosexuals: the criminalization of homosexuality and the fact that education on HIV-AIDS is not linked to education on sexual orientation.

Do you believe that Canada is doing enough internationally to encourage countries to decriminalize homosexuality? Should Canada insist on decriminalization as a condition of providing assistance?