Foreign Affairs committee  The way the Global Fund allocates the resources that our donors are providing us is through an allocation methodology that looks at the disease burden. Then obviously the countries that have the largest burden of HIV, TB and malaria get the most resources. Also, there's the economic capacity of the countries themselves to respond to the three diseases.

Foreign Affairs committee  Thank you very much, Mr. Chair and members of the committee, for the opportunity to testify before you today. My name is Françoise Vanni and I lead the external relations and communications team at the Global Fund. I had the honour to testify before this committee three years ago in the context of the sixth replenishment of the Global Fund, and I'm really grateful to have this opportunity again today as we run our seventh replenishment campaign for the Global Fund.

Foreign Affairs committee  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.

Foreign Affairs committee  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.

Foreign Affairs committee  Yes. That would be our ask.

Foreign Affairs committee  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.

Foreign Affairs committee  Yes.

Foreign Affairs committee  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—

Foreign Affairs committee  Yes, we don't come with only a cheque, indeed. If we look at it from the point of view of governance, we have country coordination mechanisms. These are spaces where the different stakeholders in a particular country meet and discuss national health plans in terms of ending the three epidemics and building health systems.

Foreign Affairs committee  Yes.

Foreign Affairs committee  It is a particular focus. That's the multiplier effect of the Global Fund intervention in development outcomes but also in participation from the different actors from those countries.

Foreign Affairs committee  We work through a three-year funding cycle, which allows us and the implementing countries to plan ahead. It's very important to be able to plan a national malaria plan over three years as opposed to one year. Every three years we have this replenishment conference where we expect all of our donors and partners to pledge, which means to commit to provide a certain amount for the following three years.

Foreign Affairs committee  This is our target, to get at least $14 billion in pledges.

Foreign Affairs committee  Last time it was the most successful replenishment ever. It was here in Canada. We are very, very grateful to the Government of Canada for that. We got $12.9 billion in pledges at that time, in 2016. Then you have exchange rate variations, right? So if we applied an exchange rate by the end of last year, that would be equivalent to $12.2 billion, which means to go from $12.2 billion to $14 billion, which is the target this time around, we need a 15% increase across the board from our donors.

Foreign Affairs committee  There are a few things here. One is to remind ourselves that the G7 has seen the birth and has created the Global Fund. As of today G7 members still constitute about 75% of our income. If we are to increase the investment made through the Global Fund by 15%, it needs to come also from the G7 countries.