This is a remarkable time to be in Global Health. The successes we are seeing now would not have been achieved without the shared responsibility and partnerships that have been forged over the years – most important of which are those with our implementing partners. Our implementing partners – in collaboration with civil society, the private sector, communities of faith, host governments, NGOs and many other local institutions – have been at the forefront of and catalyst for these shifts and transitions. And as we near World AIDS Day, we celebrate this collective effort as we get closer and closer to an AIDS-free generation.
But to make an AIDS-free generation a reality, we must continue to come together inclusively – understanding our strengths, contributions and the roles we each play in the response. This is about each player owning their part and sharing in the responsibility of reaching this goal– one that requires partnerships and long-term commitments, including collaborations with organizations like the Global Fund Against AIDS, TB & Malaria .
The U.S. is the largest contributor to the Global Fund, investing to date over $7 billion. The U.S. Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief (PEPFAR), works directly with the Global Fund by helping with grant oversight and implementation, managing the PEPFAR emergency commodity fund that works to respond to stock-out of drugs and other essential HIV & AIDS medicines and supplies, and working with Global Fund stakeholders to leverage resources in country. PEPFAR and the Global Fund are highly interdependent in supporting countries. Since 2011, the two have supported over 70 percent of all persons on treatment in developing countries worldwide.
Sharing responsibility through partnerships and inclusivity is particularly important for host nations as they move up the economic ladder. Many developing countries around the world are seeing unprecedented growth of their GDP, and half the low-income countries in 2000 will be middle income by 2020. A growing number of our partner countries will reach total health spending levels per capita that enable them to cover basic health services for the first time in history. This is a great success in international development and the tax-payers who make it possible deserve credit for this accomplishment.
This transformation is what I refer to as the ‘economic transition of health.’ It is critical that efficient and equitable health systems be in place as this transition occurs. Otherwise, the poor may still not have access to quality services and others may be thrown back into poverty by catastrophic health expenditures. This could have significant negative effects on the work we do in HIV/AIDS and under PEPFAR. It could reverse many years of progress, and squash future gains for an AIDS-free generation, and for an end to preventable child death and maternal mortality. The time to create equitable and sustainable health systems is now.
Last week, I had the privilege of addressing over 42 of USAID’s PEPFAR implementing partner projects at our annual Partners Meeting. We talked about transitions in HIV/AIDS at the country level and the challenges and opportunities we face. The most purposeful transitions we are witnessing today are the shift from a U.S. Government to a country-led approach, from direct service delivery to technical assistance models, and from an emergency response to country-led and country-owned HIV/AIDS programs.
Countries want to step up, are proud of their HIV/AIDS programs and want results. Intensive conversations are being initiated and program reviews are being implemented, including around anti-retroviral treatment and preventing mother-to-child transmission. Tipping points are occurring in many countries, where the number of annual new HIV infections is below the annual increase in new patients on treatment, marking the beginning of the end of AIDS. Shifts and transitions are happening at multiple levels and vary from country to country, and technical area to technical area, increasingly under the stewardship and growing financial support of national governments and local communities. Regardless of where a country or HIV/AIDS program is, our goal has been and will continue to be to move programs toward greater independence and sustainability
We and our implementing partners have a tremendous opportunity to demonstrate our shared responsibility in making smart transitions and identifying strategic partnerships, while still meeting targets. It will require inclusive planning, growing local capacity and some patience. U.S. investments through PEPFAR have delivered extraordinary results. One year after President Obama announced aggressive targets, PEPFAR is on track to meet its goals. By working together at all these levels, we can foster functioning health systems with country ownership and sustainability, and reach our goal of an AIDS-free generation.