Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Shipley Excerpts

Thursday 12th December 2013 Lords Chamber

[Lord Shipley (LD)]

My Lords, I, too, am grateful to my noble friend, Lord Chidgey, for securing this debate, just 10 days after the Global Fund’s replenishment conference. I join others in congratulating my noble friend Lord Verjee on an excellent maiden speech. I want, too, to congratulate the Government on their commitment to the fund, which has raised a remarkable $12 billion for the next three years and made unprecedented strides against HIV, TB and malaria.

When the Economic Affairs Committee took evidence a couple of years ago on the economic impact and effectiveness of development aid, I noted in particular the evidence of Professor Jeffrey Sachs of Columbia University, who said he was,

“a big fan of well targeted, well defined programmes that can accomplish well designed and specified purposes”,

such as delivery of bed nets or vaccines. This is what the Global Fund helps to achieve: as we have heard, 11 million cases of TB have been diagnosed and treated, 360 million bed nets have been distributed to protect against malaria, and 6 million people have received life-saving antiretrovirals.

However, huge gaps remain. Every year, there are 3 million people around the world who develop TB and are not officially diagnosed or treated and remain infectious. That number has not changed for six consecutive years.

There is one initiative which would help: a Stop TB Partnership project called TB REACH, created with a grant from the Canadian Government amounting to $120 million. It is important because, while the Global Fund provides more than 80% of international financing of TB treatment, it is unable to fund projects that do not have a track record of proven success, which inhibits innovation.

TB REACH undertakes feasibility studies for donors such as the Global Fund. It incubates innovations in TB care delivery; for example, using mobile phone technology, developing public/private partnerships and rolling out new, rapid diagnostic tests. That is exactly what it did in Ethiopia, where it supported a project that saw 1,200 community health workers team up with motorbike riders to get TB samples from remote villages.

The project put a comprehensive package of measures in place to improve access to TB care. Health workers identified people who had been coughing for two or more weeks and collected sputum samples, prepared smears and supervised treatment, leading to a doubling of case detection and a 93% treatment success rate. That scheme has since been supported and scaled up by the Global Fund and the Ethiopian Government. It now has a sustainable future.

However, I understand that there may have been concerns about the number of small projects that TB REACH funds, and about their sustainability and their scalability. Inevitably, with any initiative that funds innovation, not all projects will be a success and not all can be scaled up, and that is the price of innovation. But TB REACH is broadly successful, providing fast-track funding so that projects can deliver results within six months of a proposal being received. Its outputs seem impressive. In the past three years, TB REACH has contributed to the detection and treatment of more than half a million people with TB, through more than 100 grants in 44 countries targeting key groups including TB in mining communities and childhood TB. In addition, TB REACH projects have prevented 750,000 people becoming infected.

I am aware of two reports that have the Government’s seal of approval. The first is the high-level panel report on the post-2015 framework, co-chaired by the Prime Minister. The report found that TB interventions offered the best return on investment of any health intervention. The other report is the recent DfID Health Position Paper, which identified the critical importance of innovation in solving the world’s most intractable health problems. I think that the Government are right to identify the importance of TB interventions, and the importance of innovation. I therefore hope that they will look very carefully at the strong case for extra funding for TB REACH.