Opening Remarks by Ambassador Eric Goosby at PEPFAR Smart Investments Meeting

February 10, 2011

Remarks as prepared

I’d like to welcome all of you to today’s event. In particular, I’d like to offer a special welcome to our colleagues who have traveled here from overseas. Thank you all for taking the time for this important conversation.

In addition, I appreciate our valued partners at the World Bank making this space available to us for the day.

From its inception, PEPFAR’s focus has always been, and continues to be, saving lives.

So let me frame our discussion today by talking about one life in particular. In the Democratic Republic of Congo, a little girl named Nguya was born several years ago.

She was born in a maternity hospital, but the facility was not equipped to offer services to prevent mother-to-child transmission of HIV, also known as PMTCT. Neither Nguya nor her mother were tested for the virus.

When Nguya fell sick during her first year of life, she went to another clinic, where she tested positive for tuberculosis and began TB treatment – but with disappointing results.

At last, on another visit to the clinic, a nurse suggested HIV testing for the mother and child, and both tested positive.

To this point, this has really been a story of uncoordinated, inefficient care. But after their diagnosis, the mother and child were transferred to another site, and at last the story gets better.

The new site is a primary health center. With support from PEPFAR, it meets the range of needs its clients face. It offers integrated HIV care and antiretroviral treatment for HIV-positive pregnant women, and to HIV-positive and -exposed children. And it also offers TB testing and treatment for its HIV-positive clients.

By having so many services available in one place, it’s increasing its health impact. But it’s also creating efficiency savings that can be used to care for more people.

The health center is a faith-based facility, run by the Salvation Army. But it’s also an integral part of the Democratic Republic of Congo’s national health system. So PEPFAR investments there are helping the country meet its people’s wide-ranging health needs, not just their HIV needs.

Of course, efficiency is not an end in itself – saving lives is the goal. So after just a few months of care and treatment, here’s what Nguya looked like.

Now that’s what I would characterize as a smart investment!

Let me step back to the larger picture. I am proud of the commitment our nation has made to respond to HIV/AIDS through PEPFAR. Over its first seven years, PEPFAR proved that it is possible to overcome health systems barriers and resource limitations to deliver HIV prevention, treatment and care to areas hardest hit by the HIV epidemic.

PEPFAR programs have resulted in millions of lives saved, and it has also put people back to work in their productive years, fostering stability and security for whole nations – and even hope.

There have been wide-ranging economic, workforce, societal and national security benefits. I believe all of these have been important to the program’s continued strong bipartisan support in Congress, and from Presidents Bush and Obama.

2010 was an extraordinary year in the global response to HIV, with dramatic expansion of treatment and care, growing number of countries showing progress on prevention, and the hope of new prevention tools on the horizon.

Support from the American people was central to all of this progress.

Yet there is a large and continuing unmet need, and the world is in a different economic environment than in PEPFAR’s early days. The global economic crisis has forced all partners to do more to meet unmet needs with finite resources.

In this difficult time, the world – and the American people in particular – are right to challenge all of us in global health and ask if we are saving as many lives as possible with the resources entrusted to us.

So we must be more explicit and intentional than ever before about stretching each dollar as far as it can go, and ensuring that we are truly making smart investments.

Our commitment to the American people is this: in return for your support to help the Nguya’s of the world, we will meet our duty to spend every penny effectively and efficiently.

We will do this through greater transparency, rigorous independent evaluation, and a continued unrelenting focus on results.

We will use every tool at our disposal to improve the quality of services delivered, achieve greater efficiencies, accelerate innovation, and fully leverage the resources of other funders and programs.

And as we pursue this vision, we must keep our eye on our overarching mission – which is saving lives, like that of Nguya.

Today’s discussion is really a workshop, focusing on the ‘how’ of this vision. We are already aggressively focusing on certain key areas, and we know that many of you have so much to offer to strengthen and sharpen the efforts we have under way.

Let me briefly highlight areas we have identified for focus. You’ll be hearing more about each of these today.

  • We are strengthening use of economic and financial data to ensure efficient use of resources.
  • We are incorporating innovations that promote efficiency and allocate resources based on impact.
  • We are increasing collaboration with governments, the Global Fund and other stakeholders to align programs and target investments.
  • We are reducing costs by streamlining our U.S. Government operations and supporting increased country ownership.
  • We are achieving the best available, all-inclusive commodity pricing.
  • We are leveraging creative mechanisms for healthcare financing, in order to bring additional resources to bear.
  • And finally, we are developing an evaluation and research agenda that will show all global health how to improve efficiency and impact.

I’d like to preview just a few of the smart investments you’ll learn about today. Joining us live by video link, our colleagues from South Africa, Drs. Pillay and Blecher, will describe a key investment made by PEPFAR. South Africa identified the need for additional funding that would help to fill some urgent short-terms gaps in drug availability and drive changes in procurement policies, while greater South African investments could be marshaled. We made an additional one-time $120 million dollar investment over 2 years.

Using some of this money we were able to buy drugs at 50% of the cost of their existing prices in South Africa. This investment, along with substantial work by the South African Government, led to an historic change in South Africa’s policies that enabled the Government to purchase ARVs at 50% of its existing costs. This allowed the Government to save an estimated $600 million dollars over the next two years alone.

The PEPFAR investment had a multiplier effect. It will immediately allow hundreds of thousands to receive lifesaving treatment that they would not otherwise have received, and prevent the vertical transmission of HIV to thousands of additional infants.

There are other compelling examples drawn from the treatment area. As you’ll hear in the presentation on the Supply Chain Management System established by PEPFAR, ARVs purchased through that mechanism are now over 98 percent generic – an amazing achievement that saved us over $380 million dollars in 2010 alone.

And through SCMS, we’re increasingly moving those drugs and other products in more cost-effective ways. SCMS estimates we’ve saved almost $40 million dollars to date just by using sea rather than air freight, for example. All of these commodity savings lead directly to being able to serve more people, and save more lives.

Let me turn briefly to HIV prevention, where PEPFAR is leading the world in support for rapid scale-up of male circumcision. Studies show that if we rapidly scale up circumcision to 80 percent coverage over 5 years in Eastern and Southern Africa, we can prevent 20 percent of all new HIV infections in that region – an incredible 4 million infections averted. And doing so would also save over $20 billion dollars over a 16 year period.

Once again, by stretching each dollar through smart investments, we can save even more lives. That’s what this is all about, and that’s why you are all here today.

We look forward to learning more and working together to make even more progress in meeting the significant unmet need still facing all of us fighting the battle against HIV/AIDS.

Thank you.

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