Foreign Affairs Committee on April 4th, 2019

[Françoise Vanni]

If you look at the results achieved by the Global Fund and the challenges ahead, it's very clear that we collectively as a partnership have achieved great results in saving lives but we haven't achieved enough in terms of reducing the incidence rates across the three diseases. This speaks very much to your point about the importance of prevention.

We do invest a lot in prevention. The way we do it varies country to country because we are country-driven. We work according to the needs and the capacity of a particular country, so it varies accordingly. For example, for malaria, most of our investment is actually to provide insecticide-treated bed nets, which is essentially prevention.

To go back to HIV, we have been led to very much diversify the way we operate, because in order to prevent new infections among adolescents and young women, for example, it's not a matter of biomedical intervention. It has to do so much with human rights barriers, gender inequalities, poverty, dropping out of school and so many structural issues that have taken the Global Fund a bit out of its traditional territory.

This is why we have new partnerships, in order to make those linkages with education in particular to the point that we literally provide cash to young girls so that they don't need to drop out of school to work outside school and put themselves in a more vulnerable situation and, therefore, be much more at risk of contracting HIV. That's a long way from biomedical interventions, but this is what needs to be done. There's a lot going on in that area.

The other thing that I would like to highlight is that one of the specificities, one of the unique characteristics, of the Global Fund is that we have the communities living with the diseases and the civil society actors inside our governance, at a global level but also in countries, which allows us really to listen to and take into account and respond to the needs of those communities. This is where the smartest prevention approaches can be designed, listening to how it works and how you take into account the characteristics of the particular communities. I think this is also very important to the success.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Thank you.

[The Chair, Liberal, Michael Levitt]

Thank you.

We'll move to MP Vandenbeld, please.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you, Chair, and thank you very much, all of you, for being here and for the vitally important work you're doing.

In particular, Ms. Maturu, I'm very impressed. Thank you for your courage, particularly for dedicating so much of your time to making sure that others are also able to live their lives in the same way that you have now had a chance. Thank you so much for being here.

I want to follow up quickly on Ms. Duncan's question about the 24% increase that Canada did last year in the Montreal replenishment. Per capita, where does Canada stand if you look at the population compared to some of the other countries?

[Françoise Vanni]

I know Canada is the seventh-largest donor in relative terms. In economic terms, I wouldn't know that off the top of my head.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Perhaps that could be provided.

[Françoise Vanni]

We can come back to you with that.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

That would be wonderful. Thank you.

You spoke about the unequal access to treatment and to health services, particularly for marginalized groups, and particularly for girls and women. I also noted that you've spoken about the need for country ownership and sustainability.

How do you ensure that when there is ownership and it's driven by the local priorities, those priorities do include those marginalized groups, rural people or people who otherwise might not even have access to proper health care, let alone treatment for these diseases? What is the Global Fund doing for that?

[Françoise Vanni]

At the strategic level, addressing human rights barriers to health and gender inequality is one of the four pillars of our strategy. This is really important, because we understand this is one of the key drivers of the three diseases. If we don't tackle human rights barriers, we won't end the epidemic, so this is extremely important for us.

It is part of the way we review the funding requests we receive from the different governments, and it is part of the national dialogue we have within the country coordination mechanisms where all the stakeholders in particular countries are involved, and where it's so important to have the communities' voices and civil society's voices heard as well. This is part of the ground management process, in a way, where we very much encourage and push for those human rights barriers to be addressed.

To be more specific, I want to highlight in that area an initiative we have that is called “breaking down barriers”. It develops baseline assessments of those human rights-related barriers to access to health. We've done those assessments in 20 countries. Based on those assessments, we have started having dialogues with the authorities and in different circles about how to go about it. We have been positively surprised to see the response from the authorities in many of those cases, because when they are faced with the data and they understand the implications in terms of public health, that drives the conversation.

We have allocated an extra $45 million U.S. in matching funds to scale up evidence-based programming, based on those findings and recommendations.

As I mentioned before under prevention, that takes us into new territories such as training for law enforcement officials and health care professionals, as well as legal literacy or know-your-rights programs.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you.

Ms. Maturu, could you put in your own words why you think it is important? When Canadians are looking at all the priorities that Canada has, why is it important for Canadians that we invest in this?

[Loyce Maturu]

In my personal view, I feel that it's really important, because hosting the fifth replenishment was really a success. There is another replenishment this year in October, and it would be really amazing to have the Canadian government continue their promise to invest or pledge within the Global Fund to make sure that there wouldn't be another Loyce who is infected with HIV, that there wouldn't be another child who has to stop school the way I did because they're feeling very sick. We know what needs to be done to make sure that every child has access to treatment and to make sure that no child has to lose a parent or a brother or sister because of HIV or tuberculosis.

That's why it's really important for Canada to continue its investments towards the Global Fund.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you.

Do I have time left?

[The Chair, Liberal, Michael Levitt]

You have one minute.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

I'd like to share with Mr. Wrzesnewskyj.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

Thank you.

There is a misconception that these are strictly diseases of sub-Saharan Africa. About six years ago, prior to the start of the war in eastern Ukraine, I was involved in a project that was about to get off the ground, dealing with the HIV/AIDS epidemic in eastern Ukraine.

Most people don't realize that rates of HIV/AIDS in Ukraine at that time were about 1.4%, similar to rates in sub-Saharan Africa, but in particular in the Donbass, the region that currently has been invaded militarily by Russia and is at war. The rate at that time was approximately 6%, which is close to the rates in some of the worst-hit areas of southern Africa.

I am just curious. In the Donbass itself, a small sliver of land like the region between Ottawa and Toronto, there are approximately 300,000 people infected by HIV. There have been approximately 20,000 babies born with HIV, so I am curious as to whether or not you have any programs targeting that particular region.

It's a difficult region currently because it's in a state of war, but is there anything your organization is doing to target this epidemic in that part of eastern Europe?

[The Chair, Liberal, Michael Levitt]

Ms. Vanni, I'll just get you to give a fairly brief answer to that one. Maybe we can come back to it, but the time is running short.

[Françoise Vanni]

Sure. I will need to come back to you on the specific region you were mentioning, but in general we do have the ability to intervene in conflict-affected areas when the epidemics are growing, linked to circumstances like the ones you are indicating. We have a challenging operating environment policy that allows us to step in and ensure that the most affected populations do get the treatment they need.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

Are there no workers on the ground in that region?

[Françoise Vanni]

We don't have workers on the ground ourselves. We are all based in Geneva, but we have partners.

On this particular region, as I said, I will need to come back to you because this is led by our ground management colleagues. I will need to look at that in particular.

[The Chair, Liberal, Michael Levitt]

Thank you very much.

MP Baylis is next, please.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

I am curious. You touched on this a few times, how there must be a stabilization effect, or the fund.... When you come in and you start helping people on these medical things, how does it impact the political situation? It's sort of a lead-on from what Borys said. How is the interaction, and have you had great wins there?

[Françoise Vanni]

That is a fantastic question.

I would not be able to refer to longitudinal research to document that, but certainly investing in health has a multiplier effect on the wider development prospects of a country. In the investment case, we have calculated that an investment in the Global Fund brings a return on investment of 1:19. That is the rate that we have calculated in terms of health but also of wider economic outcomes for the country, so the—

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

That is a 19 times multiplier.

[Françoise Vanni]

That is 19 times, yes. This is well documented by independent experts.

The contribution that an investment in health and in the Global Fund in particular brings to the development outcomes of a particular country is well documented. I would assume that also has implications in terms of the stability of that—

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

When you come, you come with both money and expertise, I assume. You don't just come with a cheque. Is that right?