Evidence of meeting #134 for Foreign Affairs and International Development in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was hiv.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Françoise Vanni  Director of External Relations, Global Fund To Fight AIDS, Tuberculosis and Malaria
Loyce Maturu  Network Speaker and Advocacy Officer, Africaid Zvandiri, Global Fund Advocates Network
Scott Boule  Senior Specialist, Parliamentary Affairs, Global Fund To Fight AIDS, Tuberculosis and Malaria

9:35 a.m.

Director of External Relations, Global Fund To Fight AIDS, Tuberculosis and Malaria

Françoise Vanni

Out-of-pocket payments are a very big issue, because, of course, either you can pay for your individual treatment or you can't. It's difficult to say how much that would be because it varies so much from one country to another.

I don't know what Ms. Maturu's personal experience has been with accessing treatment that she can speak of, but globally one of the things I want to share with the committee is that we have a very effective pool procurement mechanism set up at the Global Fund that has allowed us to drive down the prices for those critical drugs quite dramatically. If I take the example of antiretroviral therapy, back then, the cost of one year of treatment would have been around $10,000 U.S. a year per person, and it is now down to as low as $72 U.S. a year per person, so imagine.

It's a dramatic decrease that has been enabled by these globally pooled procurement mechanisms that we drive and that have been supported, by the way, by Canada. We have an online platform call wambo that benefits from your support to facilitate those pooled procurements.

9:35 a.m.

Conservative

Erin O'Toole Conservative Durham, ON

That really brings it into perspective. For a relatively small amount you're actually changing lives, and then those lives can transform the wider challenges facing their country.

We found that as well with the Muskoka initiative of the G7 hosted by Prime Minister Harper, where the child and maternal initiative, in some cases, was a few dollars and produced health outcomes that were remarkably positive.

Thank you for being part of this and bringing a personal touch to it. I'll pass it back to my colleague, Mr. Aboultaif.

April 4th, 2019 / 9:35 a.m.

Conservative

Ziad Aboultaif Conservative Edmonton Manning, AB

Thank you. That was a good question.

You mentioned that a quarter of the investment is going into sustainable health systems. That is on page 42 of your report. Also in the report, in figure 12, I have the investment case document, labelled “Direct and Contributory Investments in Building Resilient and Sustainable Systems for Health, 2014-2016 Funding Cycle”. The first part shows a total allocation of 28% and then shows us another of 72%.

You also mentioned prevention as a solution or as one of the plans that you have. It definitely makes sense. What other measures are there? What are you doing beyond prevention to improve the system, again going back to the graph here on this page? I would really like to hear, beyond prevention, what other stuff you think you will be doing to deal with this whole problem.

9:40 a.m.

Director of External Relations, Global Fund To Fight AIDS, Tuberculosis and Malaria

Françoise Vanni

To be very specific, in strengthening health systems we invest about 28%, about $1 billion U.S. a year. What we do within that, again, varies greatly from country to country. There is no one-size-fits-all. That's very important to understand. It's not that we come into a country and say they need to do A, B, C and D. It really varies, bearing in mind that we invest in countries that are stable, middle-income, and we also invest in countries that are not stable and very low-income.

In the menu of things that are super important to strengthening health systems, you would have to make sure that the health workforce is well-trained, particularly the primary health care workforce, the ones going to the villages, to the most remote areas, to make sure that people are diagnosed and treated if they need to be treated. Most of the investment goes to that area.

The other one is data. It's extremely important as well, because if we don't know what is going on in epidemics in a country, it's very difficult to target the investment and make sure we get the most impact out of that. Of course, when we strengthen data systems, it's not only for the three epidemics. It serves their entire health system and, therefore, also the prevention and treatment of other diseases and other health issues, such as vaccines and otherwise.

Procurement and supply chain management are extremely important as well. It's not that we build completely separate systems to procure ARVs, antiretrovirals, for a country. Normally we work very closely with national authorities and the other health partners to make sure that we build a supply chain system that works across the health sector.

A lot of effort will be put into building financial management capacity in the countries. This is obviously essential to ensure that the investment is well spent, and that we follow the money. There is investment in that space as well.

Another element that I didn't mention, which is absolutely key, is that we very much strengthen the integrated service delivery, meaning most of the time we get the question of how we coordinate with other global health actors: WHO, GAVI and others. When we train a health extension worker in Ethiopia, say—a woman who is going to the remote areas—she is not going to treat only the three diseases. She needs to be able to provide a package of primary health care and be able to integrate the different services that are needed. That's also a way through which we strengthen health systems.

The last part is that we contribute greatly to strengthening community response to these diseases and to these health issues more generally. In many countries where we work, this is absolutely essential to fighting the three diseases.

These are the different elements, and their proportion varies according to the needs and the contexts.

9:40 a.m.

Conservative

Ziad Aboultaif Conservative Edmonton Manning, AB

Thank you.

9:40 a.m.

Liberal

The Chair Liberal Michael Levitt

Thank you.

I'm going to take a couple of minutes to ask you a final question. It's related to a topic raised by my colleague earlier, which was around crisis management and the ability of the Global Fund to activate in humanitarian crisis situations.

I want to reflect for a moment on the situation in Venezuela. A report jointly authored by Human Rights Watch and the Johns Hopkins school was covered in the news this morning in the U.K. It's reflecting on the need for the UN to declare a humanitarian crisis in Venezuela, because of the complete meltdown of health care services there.

In particular as it relates to the areas covered by the Global Fund, the cases of malaria have increased over tenfold over the last number of years, with over 400,000 reported cases in 2018, I think it was. Again, we know there's a focus and when we look at the dispersal of services, sub-Saharan Africa certainly seems to be the largest area. I know quite a small amount was going to South America, Latin America.

Can you talk to us a little about the availability of the Global Fund to react in a crisis situation, maybe even particularly in the case of Venezuela? As we heard in this committee just the other day about the situation facing the population, both those fleeing the borders—and we know that borders don't matter where these sorts of diseases are concerned—and those under the repression of the Maduro regime. The health impacts on the population have been dramatic and horrific.

9:45 a.m.

Director of External Relations, Global Fund To Fight AIDS, Tuberculosis and Malaria

Françoise Vanni

It's obviously extremely important for the Global Fund to be able to respond to emerging crises and changing environments, such as the case you are referring to in Venezuela.

I would say a few things before going back to the specific crisis. One is that we do have the ability to work in challenging operating environments, where we invest about a fourth of our total investment. That's very significant. Borders do not matter. We try to make sure that we follow the people who need the support and treatments. Even in massive displacement crises like the one in the Middle East, for example, we are able to ensure that people get the treatment they need.

In the case of Venezuela, we have checked. In September of last year, the Global Fund approved $5 million U.S. in grants, to ensure the procurement of critical health products, including antiretrovirals to treat HIV. The donation has arrived in Venezuela and has already been distributed to ARV dispensing sites. People have started to receive those drugs. We are constantly monitoring the situation and working with partners on the ground to see what else would need to be done to address this particular crisis.

Venezuela is a good case where we have been able to intervene despite the fact that Venezuela is not an eligible country for Global Fund grants anymore. It graduated a long time ago, as did many of the countries in Latin America. Despite the fact that it's not eligible in principle, we have the ability to be flexible and to intervene in these sorts of emerging crises, to ensure continuity to the treatments.

I do have the answer on Ukraine as well. There is indeed a program, run by Alliance for Public Health, an NGO working with development partners and the Ukrainian government to ensure the continuity of services—pretty much in the same line as what we're doing in Venezuela—and in particular, bringing services to people living with or at risk of HIV and TB. The executive director of that organization is a member of our board, so there is intervention in that particular context as well.

9:45 a.m.

Liberal

The Chair Liberal Michael Levitt

Thank you very much for being here today. I know there were a number of other individuals, representing other interested parties, who came to hear your testimony as well, so we thank them for their presence too.

This was certainly a very important reflection and analysis of Canada's contribution and the incredible work being done by the Global Fund. That was reflected in the questions from all members.

With that, we are going to suspend, because we have some other committee business to handle.

I would like to thank you all. In particularly, Ms. Maturu, thank you for your contribution, and for telling us your story here this morning.

9:45 a.m.

Network Speaker and Advocacy Officer, Africaid Zvandiri, Global Fund Advocates Network

Loyce Maturu

Thank you.

9:45 a.m.

Liberal

The Chair Liberal Michael Levitt

We will now suspend.

[Proceedings continue in camera]