1	"Milton B." Milton B. Amayun, MD, MPH (iaimilton@aol.com) Sr. Technical Advisor, The Hope Initiative World Vision International Global Missions Health Conference CCIH Workshop, 7 Nov 2003
2	Seven Principal Causes of the Global Disease Burden In 2001, nearly two-thirds of all diseases in children and young adults (0-44 years) were caused by a few diseases, mostly infectious. Close to 60% were due to AIDS, Maternal and Perinatal Conditions, Acute Respiratory Infections, Diarrheas, Malaria, Measles, TB. The combined death toll for AIDS, TB and Malaria alone was six million! Most of these deaths were in the developing world.
3	Major Causes of Death and Disease, 0-44 years, in 2001
4	Death is only Part of the Story For every death, there are many more cases Disability can be disfiguring for life – e.g., polio, lymphatic filariasis Stigma is associated with AIDS, TB Millions of carriers do not know their status Orphans – innocent victims by the millions Costs of treatment and/or burial: worse levels of poverty Missed opportunities to meaningful and productive lives
5	Implications to Christians Millions missing the abundant life due to illness Major opportunities for Christian witness with Jesus as our model Necessity for medical missions to focus on where the needs are Training in public health programs for clinicians Re-definition of the emphasis on prevention Resources needed for reduction of global disease burden: people, information, treatment, logistics
6	Focus on AIDS, TB, Malaria
7	HIV/AIDS: Basic Facts 90% of 42 million cases at the end of 2002 were in sub-Saharan Africa and South Asia. Half of 39 million adult PLWHAs are women. If no drastic measures are taken, HIV/AIDS will have been the largest epidemic of all time by 2020. Up to 40 million orphans and vulnerable children by 2010. HIV/AIDS is major cause of poverty and food insecurity in rural Africa.
8	TB: Basic Facts Infects many organs; pulmonary form common Two billion carriers worldwide 8.8 million develop active TB each year 1.9 million deaths each year, mostly young adults in productive stage of life Between 2000 and 2020, 35 million deaths projected Increasing rates of co-infection with HIV/AIDS 10 million TB-HIV co-infections today
9	Malaria: Basic Facts Transmitted by mosquitoes. Falciparum malaria is most virulent strain. One million deaths per year, mostly in young children 0-5 years. That is 3000 child deaths per day! Pregnant mothers can become anemic, or have stillborn and stunted babies, in addition to abortions. Surviving babies may have impaired growth and development.
10	What is lacking? We know the treatment, and we have the technology to fight the diseases of poverty. TB and Malaria medicines can cure. We have ARVs to prolong and improve the quality of lives of PLWHAs. We lack the resources equal to the magnitude of the problem. We lack the political will to implement the task. Goal: 100% coverage of the need. Christian medical missions can lead the way!
11	HIV/AIDS: Tools for Prevention and Treatment
12	TB: Tools for Prevention and Treatment
13	Malaria: Tools for Prevention and Treatment
14	Can We Afford It? $9.2 billion annually for HIV/AIDS; as costs of ARVs come down, this is becoming lower. $1-1.5 billion annually for TB $1 billion for Malaria Total of $12 billion to save millions of lives and improve the quality of life of many more! If the global community had the political will to do it, the costs are within reach. $12 billion is a fraction of the $87 billion request to maintain US troops in Iraq in 2004.
15	Costs of Interventions
16	Goals for the New Millennium Deadline for the following goals is 2010: HIV/AIDS: to reduce the number of newly infected young people (15-24 years) by 25%. TB: to reduce by 50% current level of TB deaths and prevalence. Malaria: to reduce the malaria disease burden by 50%.
17	Global Program Initiatives International Partnerships against AIDS in Africa (IPAA) Stop TB Initiative Roll Back Malaria Global Fund to Fight AIDS, TB and Malaria Massive Effort Campaign Global TB Drug Facility and the Global Alliance for TB Drug Development International AIDS Vaccine Initiative
18	Introducing the Global Fund to Fight AIDS, TB and Malaria Set up in 2001 as a public-private partnership to manage funds for the fight against AIDS, TB and malaria; independent of the UN Goal: to scale up interventions to improve the health of the poor Small secretariat in Geneva, Switzerland 18-member Board of Directors from recipient and donor countries, civil society and private sector Works through Country Coordinating Mechanisms or CCMs
19	Proposal Mechanism CCMs are composed of representatives from government, multilaterals, bilaterals, FBOs, CBOs, academia and the private sector Two rounds of proposals per year CCMs prepare proposals in response to RFAs Technical Review Panel (TRP) reviews and selects proposals for funding Board approves TRP recommendations Secretariat negotiates with Principal Recipient
20	Funding Mechanism Funding sent from Geneva to Principal Recipients, who manage work plans and supervise sub-recipients First two years of funding given in advance Performance on first two years determine funding for remaining three years Local Fund Agents supervise performance of Principal Recipients
21	Current Status of Global Fund Receipts and firm commitments of $4.7 billion 150 programs in 93 countries approved Some countries are in second tranche of funding Programs implemented provide: -HIV/AIDS prevention and treatment expansion -bednets to 30 million families -care and support to 500,000 orphans
22	Lessons Learned Stakes are bigger, more visible. Technical expertise required. Needed to be comfortable with political processes at national level. In spite of uneven performance, CCMs are still the Global Fund’s preferred route for grant approvals. Multi-country proposals are difficult: they must demonstrate strong rationale and require time. Some poor countries cannot afford technical assistance. Role in advocacy, resource mobilization.
23	Other Funding Opportunities World Bank: Multi-Country AIDS Program: Rounds 1 and 2 allocated $1 billion to high prevalence developing countries USAID: $15 billion for the next five years EU: NGOs have yearly proposal competition; focus on AIDS and poverty reduction SIDA (Sweden), CIDA (Canada) Various private foundations Pharmaceutical companies, e.g., Axios
24	Conclusion Poor people will only be able to emerge from poverty if they enjoy better health. Health should be at the heart of our struggle for sustainable development.” Dr. Gro-Harlem Brundtland, MD, MPH Director-General, WHO, 1998-2003
25	For further information… Global Fund to Fight AIDS, TB and Malaria – www.theglobalfund.org Global Health Council – www.globalhealth.org International Union Against TB and Lung Diseases – www.iuatld.org Massive Effort Campaign – www.massiveeffort.org Roll Back Malaria – www.rbm.org UNAIDS – www.unaids.org UNDP – www.undp.org World Bank – www.worldbank.org World Health Organization – www.who.org Christian Connections for International Health – www.ccih.org World Vision International – www.wvi.org