Resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) constituted almost 17 per cent of India’s health budget for HIV, TB and Malaria in the fiscal year 2018. With the Global Fund Replenishment round coming up in October, and India hosting a pre-replenishment round for the first time this February, Bharathi Ghanashyam, Founder/Editor, Journalists Against TB, explains why an added commitment from India’s political leadership, in terms of an increased pledge to Global Fund is crucial for the country’s progress towards better health outcomes and human rights
When I first mooted the idea of the Global Fund, people said I was dreaming… I love dreams. It always starts with a dream — Kofi Annan, former Secretary-General of the United Nations
Changing lives
On December 12, 2013, the Supreme Court of India overturned a Delhi High Court verdict that had set aside a law framed in 1860 and decriminalised consensual sex among adult homosexual men. Justifying its ruling, it said, “The High Court overlooked that a miniscule fraction of the country’s population constitute lesbians, gays, bisexuals or transgenders and in last more than 150 years, less than 200 persons have been prosecuted for committing offence under Section 377.
Rajesh Srinivas, Executive Director, Sangama (an organisation that works for the rights of individuals oppressed due to their sexual preference and gender identity), Bengaluru, says, “In one stroke, the judgment had erased our existence. Miniscule though we may be in terms of numbers, each of these numbers has a face, a body and the capacity to feel joy, pain and sorrow. And yet, this judgement had negated our space on earth. It also shattered lives as there were people who had declared their sexual orientation after the Delhi High Court judgment and began to feel threatened again. We then launched 207 against 377, where 207 grassroots organisations protested and fought for the judgment to be set aside. It took five years but the Supreme Court of India ruled in our favour and decriminalised a part of Section 377 of the IPC which criminalises consensual unnatural sex. The Global Fund stood by us during this fight.”
Saroja Puthran, Treasurer, Karnataka Network of Positive People, expresses similar sentiments. She says, “India has provided for everything that PLHIV require. The gaps, however, occur in access. We still face a lot of stigma, even at healthcare settings and while accessing our other entitlements. It helps that we are empowered to demand our rights. I attribute this to our association with projects of the Global Fund and others, which have strengthened our capacities to face challenges.”
Saroja and Rajesh are but two but they echo the voices of millions of people like them who have benefitted from partnerships such as the Global Fund.
A bit of history
The year: 2001: The then UN Secretary-General Kofi Annan proposed the creation of a Global Fund dedicated to the battle against HIV/AIDS and other infectious diseases at the African Summit on HIV/AIDS, tuberculosis (TB) and other infectious siseases in Abuja, Nigeria. Established in 2002 as a unique partnership between governments, civil society, affected communities and the private sector, the Global Fund to Fight AIDS, TB and malaria (Global Fund) has since achieved impressive results and changed lives. It has mobilised and invested nearly $4 billion a year to support programmes run by local experts in countries and communities most in need. Health programmes supported by the Global Fund had saved 27 million lives by the end of 2017. In 2017, 17.5 million people were on ARV treatment, five million people with TB were treated and 197 million bed nets were distributed to prevent malaria.
India in particular has benefitted greatly from the Global Fund. Having contributed a total $39.5 million to the Global Fund as of 2018, it has received $2.1 billion in programmes to fight HIV, TB and malaria and strengthen health systems.
Partnerships are important
India is a high burden country for HIV, TB and malaria. To illustrate, a quarter of global TB cases occur in India i.e. 2.79 million cases. While the Government of India has very strong national programmes, backed by resources for all three, it is still not on track. Public spending on health is still around 1.2 per cent of GDP, which is significantly lower than countries of similar income levels. With low priority accorded to health by the government, a majority of the Indian population pays out-of-pocket for healthcare.
“The Government of India needs to take progressive steps immediately and increase health expenditures from 1.2 per cent to 2.5 per cent of its GDP by 2025 and increase state sector health spending to over 8 per cent of the budget by 2020 to reach the targets set by the National Health Policy adopted in 2017,” says Dr Sonal Mehta, Chief Executive, India HIV/AIDS Alliance.
The future lies in strengthening partnerships
Against this background, it is important to note that Global Fund resources constituted almost 17 per cent of the health budget for HIV, TB and malaria in India in the fiscal year 2018. Dianne Stewart, Head, Donor Relations of Global Fund says, “We complement efforts made by the Government of India to fight the three diseases. Global Fund grants in the last few years supported the establishment of laboratories and Gene Xpert machine equipment for early diagnosis of drug-resistant TB. The grants have also supported the purchase and distribution of insecticide-treated nets in seven North Eastern states, and Jharkhand, Chhattisgarh, Odisha and Madhya Pradesh, which accounted for 87 per cent of reported malaria cases in India. Global Fund grants also complement investments by the government to achieve the 90-90-90 targets for HIV and elimination of mother to child transmission of the virus.”
Most importantly, Global Fund grants go beyond drugs and diagnostics. The support is at several levels and includes patient support for MDR TB to help adherence, and engagement of private healthcare providers to ensure proper diagnosis, treatment and support. Human rights and gender-related barriers to health are addressed, so access to health services is equitable. This work greatly enables health for all.
Abhina Aher, Associate Director, India HIV/AIDS Alliance, who has worked on HIV/AIDS issues for 24 years says, “I have built my own capacities tremendously and am an example of how Global Fund resources can help to position key communities not as beneficiaries, but as equal stakeholders in the fight against HIV/AIDS and TB.”
Time to step up
2019 marks the Sixth Replenishment Pledging Conference of the Global Fund to be held in October in Lyon, France. The Government of India has announced it would host the Global Fund’s Preparatory Meeting of the Sixth Replenishment in February 2019. The meeting is an important milestone to mobilise funds to end AIDS, TB and malaria and build stronger health systems.
Jagat Prakash Nadda, Minister of Health and Family Welfare, Government of India, has observed, “India has long been a strategic partner of the Global Fund, both as an implementer and as a donor. The government of Prime Minister Modi is honoured to further deepen this collaboration by hosting the Preparatory Meeting of the Sixth Replenishment in our country.”
This move is one of many that the Government of India has made towards better health outcomes. Prime Minister Narendra Modi earlier this year called for India to end TB by 2025, five years ahead of the global target.
On a closing note, it is evident that India is committed to achieving better health outcomes for all. The Supreme Court has added its voice by including the ‘miniscule population’ into the larger landscape. The ground is set. What remains now is added commitment in terms of an increased pledge to Global Fund. Dianne adds, “The Global Fund is aiming to raise at least $14 billion for the next three years to help the world get back on track to end HIV, TB and malaria and accelerate progress toward Sustainable Development Goal 3, health and well-being for all. The Global Fund welcomes India’s political leadership and we hope that India would continue to invest in the way promised. India is a key partner of the Global Fund.”
Bill Gates in a recent tweet has said, “I look at a lot of global health data and one trend stands above the rest. Global health groups like Global Alliance for Vaccines and Immunisation (GAVI), Global Fund (GF), Global Polio Eradication Initiative (GPEI) and the Global Financing Facility (GFF) are some of the best investments the world can make.” India, are you listening? We the people are waiting for you to step up for us!