Debbi Birx, MDPEPFAR/CDC

WORKSHOP - Mini Room 7

Center for Global Health

Division of Global HIV/AIDS

Getting to Six MillionPEPFAR Track 1.0 Treatment Partners

& Shared Vision for Sustainability

1Focus on sustainability from day 1: local FBO and pubic sector partnerships with international partners

CDC/DGHA FY 11 Funding – All SourcesMajority of funding invested in Cooperative Agreements

Cooperative Agreements

$1,284,453,152 82%

Contracts $74,955,081

5%

Technical Personnel and

all Management &Operations $204,451,274

13%

CDC Extramural & IntramuralInvestments in FY 2011

Benefits of investing in CoAgs

• Allows CDC technical experts maximum engagement & partner oversight

• Facilitates side-by-side planning and implementation, allowing for mentoring & transference of skill

• CDC experts ensure programs are of highest quality while preserving local ownership

Investment Strategy by Partner TypeCDC/DGHA FY11 Budget

Faith-Based Organization

(FBO)/ International,

$8,708,501

Local Indigenous Faith-Based Organization

(FBO), $84,062,166

Ministry of Health (MOH), $287,720,833

Local Indigenous

Non-Governmental Organization

(NGO), $243,402,610

Local Indigenous University, $81,627,269

Multi-Lateral, $13,463,503

NGO/ International-

U.S. Based, $260,235,760

University/ International-

U.S. Based, $305,232,510 Financial Investments Reflect

DGHA Priorities

DGHA builds local capacity by investing in Ministries and indigenous partners

DGHA promotes science & innovation by investing in universities

Scale-up of investments in MOH must be deliberate and strategic

For the past 20 years CDC has had the sole USG/MoH agreements in Sub-Saharan Africa

We have built agreements carefully and strategically over time – scaling-up slowly and pairing funding with extensive technical support to ministries

Many CDC offices are co-located with MOH to facilitate mentoring and the transference of skills

Standing up these funding mechanisms is initially very resource intensive – both at HQ and in the field – but ultimately cost effective and sustainable

Stepwise Approach to Building MOH Capacity The cornerstone to realizing country ownership

2004 2005 2006 2007 2008 2009 2010 20110

50

100

150

200

250

300

International Indigenous

Number of CDC Cooperative Agree-ments in PEPFAR Focus Countries

(FY04-FY11)

Investing through Cooperative AgreementsCDC is scaling up the number of CoAgs with indigenous partners

2004 2005 2006 2007 2008 2009 2010 2011$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

$500,000,000

$600,000,000

$700,000,000

$800,000,000

Indigenous International

CDC Program Funds through Cooperative Agreements with Local PartnersFY 2004 – FY 2011

In 2011, CDC invested more resources in

local/indigenous organizations than

international

Investing through Cooperative AgreementsCDC is investing more resources in CoAgs with indigenous partners

2Saving lives together: Implementing OGAC’s vision for PEPFAR

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

2005-2010

35

40

45

50

55

60

65

70

BotswanaSouth AfricaSwazilandZambiaZimbabwe

PEPFAR2004-present

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2010 Revision, http://esa.un.org/unpd/wpp/index.htm For definition of variables, check the link Glossary of Demographic Terms Saturday, May 05, 2012; 11:17:16 AM

Life Expectancy at Birth in Selected Countries Affected by HIV/AIDS

Dramatic impact of HIV on life expectancyImpact of HIV on 5 High-Burden Countries – Model Updated in 2010

New UNAIDS Global Report : Together We Will End AIDS

The end is in sight: Maintaining momentum is critical

Current ART Coverage at CD4 of 350

3Saving lives and changing the face of the epidemic : commitment of providers and patients

Incremental Progress : Saving Lives and Changing the Epidemic

2003 2004 2005 2006 2007 2008 2009 2010 20112,200,0002,300,0002,400,0002,500,0002,600,0002,700,0002,800,0002,900,0003,000,0003,100,000

01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,0009,000,000

New HIV Infections and Number of People on ART, 2003-2011

# of New HIV Infections (Global)# of People on ART (Low and Middle Income Countries)

# of

New

HIV

Infe

ction

s

# of

Peo

ple

on A

RT

UNAIDS Global Report 2012

4Towards virtual elimination of new HIV infections in children: PMTCT

New Pediatric Infections from MTCT

2009 20110

10000

20000

30000

40000

50000

60000

70000

80000Nigeria

South Africa

NigeriaSouth AfricaMozambiqueTanzaniaUgandaMalawiKenyaEthiopiaZimbabweZambiaCameroonAngolaChadCote d'IvoireLesothoGhanaBurundiSwazilandNamibia

Source: UNAIDS. Together We will End AIDS, 2012.

New Pediatric Infections from MTCTAmong Sub-Set of Countries with High Contribution to Global Burden

2009 20110

5000

10000

15000

20000

25000

30000

MozambiqueTanzaniaUgandaMalawiKenyaEthiopiaZimbabweZambiaCameroon

Source: UNAIDS. Together We will End AIDS, 2012.

Aggressively pursuing the virtual elimination of pediatric AIDS

UNAIDS Global Report 2012

5The end of AIDS is in sight, and our success will depend on our mutual commitment

Programs are People

• Financial resources are important but the key to the progress to date has been the commitment of each person on the ground

• Importance of local innovation and focus on the sustainability and impact from day one

• Shared commitment to transition and quality with embedded monitoring and evaluation