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The Director's Corner

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There is an urgent need not only for increased financial investment from all sectors and but also for innovative financing mechanisms.

A message from the Executive Director, José Luis Castro

In February, the spotlight in the effort to end the tuberculosis (TB) epidemic falls on India as the government hosts the preparatory meeting for the Sixth Replenishment of the Global Fund, where health leaders from around the world will share views on how to end TB through increased investment, innovation and a sharper focus on results. Their aim is to secure US$14 billion in new commitments from donors to fight AIDS, tuberculosis and malaria when French President Emmanuel Macron hosts the replenishment meeting in October 2019.

This preparatory meeting in India brings to the foreground the urgent need not only for increased financial investment from all sectors, but also for new, innovative financing mechanisms that attract investment from a broader set of stakeholders.

Funding for TB care still falls short of the total US$ 13 billion needed by more than US$ 3 million. The same can be said for investment in TB research and development (R&D), which reached new highs in 2017 but still totalled just 30 percent of the US$ 2.2 billion necessary to develop the medicines, diagnostics and vaccines that are urgently needed to end the epidemic.

The United Nations High-Level Meeting on TB this past September saw world leaders commit to a number of ambitious targets aimed at eliminating TB, including mobilising US$ 15 million annually.

Because the majority of Global Fund contributions come from governments, it is essential to keep HIV/AIDS, tuberculosis and malaria high on the political agendas of national leaders, even as countries increasingly grapple with rising rates of noncommunicable diseases like diabetes, cancer and heart disease.

National leaders need to see contributions to the Global Fund as a strategic investment in the health and safety of whole populations. A 2017 study commissioned by the Global TB Caucus found without urgent action, tuberculosis is poised to cost the global economy US$1 trillion between 2015 and 2030.

Just as donors need to do their part, we must look for ways to better incentivise progress and encourage domestic funding for TB in countries with rapidly developing economies like India and other BRICS nations.

As The Union hosts the TB-Free India Summit on 2-3 February in Delhi, stakeholders, partners and members of parliament will gather to discuss how to bring about an end to TB in India.

A key focus of the summit will be on building partnerships between the public and private sectors to ensure capital is invested where the country’s need is greatest.

One innovative partnership which serves as a model is Project Axshya, an extensive civil society initiative, implemented by The Union and financed by the Global Fund. By working with a network of thousands of community volunteers and several local NGO partners, Project Axshya supports India’s Revised National TB Control Programme (RNTCP) to expand its reach, visibility and effectiveness.

Project Axshya looks at barriers to care and develops responses to improve outcomes. In India, upwards of 50 percent of people access health services through private clinics where quality of treatment varies greatly and healthcare workers are often not formally licensed to practice medicine. Through their vast network, Project Axshya ran a targeted engagement programme across 40 cities that reached out to private healthcare providers with TB information and improved the links between the RNTCP and private health centres. Over the course of just one year, Project Axshya was able to connect with 3,700 private practitioners, resulting in more than 63,000 being notified and connected to the RNTCP.

This sort of innovative programming, along with new funding models are essential if we are to continue to progress against TB. As the Global Fund’s Investment Case for the Sixth Replenishment lays out, we must “step up the fight” or risk “slipping back”.

As Indian and international health leaders gather for the TB-Free India Summit and the preparatory meeting of the Global Fund, I hope we see enthusiastic support for creative solutions, increased partnerships and an emphasis on innovation to drive progress.