New Initiatives To Finance Health Care Best Practices within the RBM Partnership

1. New Initiatives To Finance Health CareBest Practices within the RBM Partnership Regional Ministerial Meeting on Financing Strategies for Health Care Colombo, Sri Lanka 16-18 March 2009 Thomas Teuscher Senior Advisor rollbackmalaria.org

2. Achieving the MDGs • Progress on targets significantly accelerated by effective malaria control • MDG 11% GDP growth loss, 40% health spending, • Eradicate Extreme Poverty30% household expenditure on illness • MDG 2Absenteeism, cognitive damage • Achieve Universal Primary Education • MDG 4Contained in top 3 causes of child death, • Reduce Child Mortality20% mortality reduction • MDG 5Pregnant woman at increased risk • Improve Maternal Health • MDG 6 GMAP promotes malaria elimination • Combat HIV/AIDS, Malaria, Other • MDG 8 PPPs and PDPs for universal access • Develop a Global Partnership for Development

3. Copenhagen Consensus 2008http://www.copenhagenconsensus.com • “What would be the best ways of advancing global welfare • and particularly the welfare of the developing countries? “ • Leading economists were asked to address ten key global challenges. • How to allocate an additional $75 billion over four years? • 1 Micronutrient supplements for children (vitamin A and zinc) Malnutrition • 2 The Doha Trade agenda Development • 3 Micronutrient fortification (iron and salt iodization) Malnutrition • 4 Expanded immunization coverage for children Disease ($ 1,000 - 5.3%) • 5 Bio-fortification Malnutrition • 6 De-worming and other nutrition programs at school Malnutrition / Education • 7 Lowering the price of schooling Education ($ 5,400 – 28.8%) • 8 Increase and improve girls’ schooling Women ($ 6,000 – 32%) • 9 Community‐based nutrition promotion Malnutrition • 10 Provide support for women’s reproductive role Women • 11 Heart attack acute management Diseases ($ 200 – 1%) • Malaria prevention and treatment Diseases ($ 500 - 2.6%) • 13 Tuberculosis case finding and treatment Diseases ($ 419 – 2.2%) • Malaria control is 3rd most cost effective health intervention

4. Global Financing for Malaria Control

5. Increased Global Funding

6. Access to malaria medicines by populations at risk Public sector 30-40% Licensed private sector 40-50% Unlicensed private sector 80-95% Drugshops Public Health Clinic Drug vendors

7. Market shares public & private sector Note: "Other" includes Mefloquine, Amodiaquine and others. ACT data based on WHO estimates and supplier interviews. Source: Biosynthetic Artemisinin Roll-Out Strategy, BCG/Institute for OneWorld Health, WHO, Dalberg. 6

8. Innovative Financing Mechanisms • New sources of funding • 1. Airline solidarity levy UNITAID • Subscribing countries • Benefitting countries • Maximizing benefits of new financing for health • 2. Affordable Medicines Facility for Malaria (AMFm) • Global co-payment to ensure universal access for treatment in public and private sector Objective: • Make available combination therapy in public & private sector at no or low cost to end-user

9. UNITAID contributors(from http://www.unitaid.eu/ 14.3.2009)

10. Who benefits from UNITAID(from http://www.unitaid.eu/ 14.3.2009)

11. Pricing for ACTs in private and public sector Under AMFm Today Manufacturers Sales price 0.80 $ or less) USD 0.75 Manufacturers AMFm 4 $ 0.80 $ 0/05$ 0.05$ Private wholesalers Public wholesalers Private wholesalers public / NGO wholesalers Free/ prime free/ prime 5-6 $ 0.2-0.4$ Retail pharmacies Public pharmacies Retail pharmacies Public pharmacies Free/ prime free/ prime 6-10 $ 0.2 – 0.5 $ Patients Patients Patients Patients 10

12. New Initiatives To Finance Health CareBackup Slides rollbackmalaria.org

13. National Financing on Health

14. End user prices reflect landed costs or CIF prices (en USD):ACTs 4 --> 8 m-ART 3 --> 6,50 SP 0.15 --> 0,50 CQ 0.08 --> 0,30 Note: Ranges indicate variance across countries and products excluding outliers; N (observations): (ACT, 222); (AMT, 227) ; (CQ, 37) ; (SP, 118). Source: Dalberg field research (Kenya, Uganda, BF, Cameroon), Observations by World Bank and Research International (Nigeria). Smaller pricing observations were also performed in Ghana, Rwanda, Burundi, Niger and Zambia), but due to low n not included. SP and CQ data complemented with HAI and IOM observations 13

15. Objectives and principles • Objectives: increased use of ACTs • Promote ACT use • Chase mono-therapies and ineffective drugs • Through • Reduced ACT end-user price • Supporting interventions • Principles • Offer ACTs to whole salers at CQ price • All countries, all sectors: public, private, NGO • Light secretariat • Eligibility of ACTs: WHO recommended • Eligibility of manufacturers: quality, price • Eligibility of wholesalers: MOH • Eligibility of countries • Supporting interventions for responsible introduction and launch • Monitoring & Evaluation – RBM 2015 Goals 14

16. AMFm activities: 3 packages CORE AMFm FUNCTIONS (Executed by Facility) • Negotiation of terms for low-cost antimalarials • Setting prices and terms for international distribution • Processing co-payments • Transparent sharing of information and forecasts ELIGIBILITY CRITERIA / REQUIREMENTS (Set by RBM, applied by Facility) • ACT treatment requirements • Buyer eligibility requirements • Country preparedness requirements PARTNER / SUPPORTING INTERVENTIONS (Ensured and facilitated by Facility) • National policy and regulatory preparedness • Wholesaler incentives and pricing / margin control mechanisms • Public education and awareness (IEC) • Provider training • National monitoring and quality preparedness (resistance monitoring, pharmacovigilance, and quality surveillance)

17. AMFm Phase 1 is targeted to launch in May 2009 • Phased launch starting with a first group of countries to facilitate learning and help guide adjustments to the AMFm design before global implementation • Phase 1 will launch in May 2009 and run until the end of 2010 • An independent technical evaluation will be commissioned by the Global Fund to assess the AMFm • Expansion from Phase 1 to full roll-out in all malaria-endemic countries will occur unless clear failures are observed from the evaluation findings • Resources required for launch: • Co-payment: ~USD 212 million • Supporting interventions: ~ USD 100-125 million