Thank you so much, Mr. Chair, Vice-Chairs O'Toole and Laverdière, and honourable members of the committee. I'm pleased to meet you. It is indeed a distinct honour and privilege for me to be here, particularly today.
I have a couple of personal words before I start my comments.
I know that all of you know my colleague Svend Robinson. Some of you will also have heard that he retired recently from the Global Fund, but he kindly joined us for this trip today. I'm also here with his successor in the Global Fund, responsible for parliamentary affairs, and that is Mr. Scott Boule, who will be more the counterpart in the future. I hope you will work as well with Scott as you have with Svend while he was at the Global Fund.
I also have other information to share with you. This will be my last trip in this function as director of external relations of the Global Fund. I've decided, after more than 15 years with the Global Fund, to transition out during the course of this year. I have to say that I've been in this position testifying to this committee many times over the last 15 years, and it has always been a particular pleasure and really a privilege to engage with you and to have this interaction. I want to thank you at the beginning for these many years of very good interactions. I hope you will extend the same kind of support and hospitality to my successor, once that person has been appointed. This is not the case yet, but it will happen in due course. I just wanted to inform you about that at the beginning of my statement.
I have a couple of points to share with you.
The first one is really one of deep gratitude to Canada. You were one of the founders of the Global Fund when we were created in 2002. You have been one of the most important donors to the Global Fund. Canada, to date, cumulatively, has contributed more than $2.3 billion Canadian, and I would like to thank you for that.
It's not just the financial support; it's also the strong political commitment that we always receive from Canada. That was expressed very much in our last replenishment that was hosted by Prime Minister and the Canadian government, in Montreal, in 2016.
It was really a collective effort. It was the most successful replenishment in the history of the Global Fund. In fact, it was the largest replenishment for any global health issue ever in history. It was a collective success for the and the government, but also for parliamentarians. You were present, and I am always very conscious of the fact that no government in the world can commit these amounts of monies without strong multi-party support in Parliament. This is as much your success as it is ours.
We also had very strong support from Canadian civil society, from many community groups from around the world. They made it possible, at that time, to mobilize almost $13 billion for the years 2017 to 2019. We are extremely grateful to Canada and to all of you for that great success.
Now, you are also entitled to learn what the Global Fund is doing with these resources, because that's the key. You have to be in a position to also report back to your constituencies about how this money is invested and what kinds of results are being achieved.
Very briefly, these are the headlines of the results.
The Global Fund is now supporting 11 million people with life-saving antiretroviral treatment every day. This is a lifelong treatment, and we are able to provide 11 million people with this treatment, particularly in the poorest countries in Africa, where we have our major investment. Actually, about 70% of the Global Fund investment goes to Africa because that's where you have the highest disease burden and also the poorest countries.
Also, tuberculosis is a very important disease and one of the priority areas for the Global Fund. In fact, the Global Fund provides about two-thirds of all international funding for tuberculosis worldwide. With that, we have been able to support 17 million people with tuberculosis treatment. That is a global public good. This disease is affecting all countries around the world, including Canada. We are also addressing the increasing challenge of multidrug-resistant tuberculosis, which is a very serious global public health threat. We will have this year a high-level summit hosted by the UN General Assembly that will look at this in more detail. You can assume that the Global Fund, as a major funder of tuberculosis programs around the world, will play an important role in that.
The third disease is malaria. With your support, we've been able to purchase and distribute about 800 million mosquito nets around the world so that families, and particularly children, who are most affected by malaria, are protected from this disease.
All of that has led to quite dramatic and very welcome decreases in the disease burden from AIDS, tuberculosis, and malaria. On average, globally, the number of cases of AIDS, tuberculosis, and malaria has gone down by about one third, but also the mortality, the number of people dying from these diseases. In certain countries you can see much more improvement than that, and in many countries we can move towards the elimination of malaria, particularly in Southeast Asian countries such Vietnam. Also many African countries, such as Tanzania, have seen decreases in malaria mortality of 70% or more.
These are, by all historic standards, huge achievements over a relatively short period of time. They have been achieved also with the generosity of Canada and your citizens, and I want to thank you for that.
We are part of the movement to achieve the sustainable development goals. That is our focus. That is the new framework in which we operate. We're working towards providing universal health coverage for people around the world. The mandate that has been mentioned in the SDGs is specifically to end AIDS, tuberculosis, and malaria as epidemics by the year 2030. We have very concrete plans in terms of how we work towards these goals. That can only be done collectively, because these are very ambitious targets, and we have to be aware of that.
We need many partners: governments such as yours, but also the private sector. Again, I'm pleased to report that at the replenishment here in Montreal we had the highest level of contributions from the private sector ever. The Global Fund has mobilized altogether more than $2.2 billion from the private sector, and at the recent replenishment held here in Canada, the private sector doubled its contribution to the Global Fund. It's an important topic, because we will not solve the development issues through only one sector alone.
A very important aspect of our work is also to increase the domestic funding. We are aware that we are talking a lot about how all of this can be sustainable. It cannot only be sustainable by donor money. We are leveraging the resources provided by you and other donors so that countries increase their domestic health budgets, and we use our policies to make part of our disbursements dependent on evidence that they're increasing their domestic budget.
That has worked quite well. Just in the last period, countries that we support have increased their health budgets by $6 billion. That is another very important component, and we will continue to push and work on that.
The Global Fund has been repeatedly evaluated by many international bodies. There are multilateral aid reviews, particularly by the United Kingdom, but also by Australia, and we always score very highly. We come out as an organization that gets the highest scores for these investments.
We've also recently been evaluated by MOPAN, the Multilateral Organization Performance Assessment Network, of which Canada is a member. It regularly evaluates and assesses multilateral organizations. That was concluded, and again we came out as very strongly recommended. I was able to report to our board on that. Thus, I think you should be reassured that not only are there measurable results, but it's also the question of how effectively and efficiently we work, and that's evaluated by these bodies.
We also usually come out among the top organizations in terms of transparency, which is another very important aspect for the oversight that you also conduct. In the aid transparency index, we always score very highly because we make all our disbursements, all evaluations, and all audits and investigations done by our office of the inspector general public on our website, which is a remarkable sign that we believe transparency is one of the best ways to achieve accountability. Without transparency, it's difficult to really make sure that the money is always used to the best possible effect.
I'll say a couple of words on gender. We applaud the Canadian government for the initiative of the feminist policy agenda in development, which will also play a significant role in Canada's upcoming G7 presidency. The Global Fund is very much supportive of that, not just because we believe in gender equality but also because we are aware that we will not be able to be effective and to really overcome these diseases unless we overcome gender inequality. That applies, particularly in Africa, to young women and girls, who are still disproportionately affected by HIV. They often have an HIV infection rate eight times higher than the rate among young men. Therefore we've made that a particular focus of the Global Fund. In fact, we are focusing on 13 priority countries in southern and eastern Africa, where we have these special programs looking at how to address more effectively young girls and women. That is quite in line with Canada's policy.
Recently the world celebrated International Women's Day. A report was launched on that day, the “Global Health 50/50 Report”. The Global Fund was mentioned as one of the organizations with the highest score among all global health organizations, based on seven criteria related to gender equality. I can assure you that this is a high priority for us, and I think we are aligned with the Canadian government on this priority.
However, I also want to leave you with some of the challenges. With all these kinds of results and decreases in incidence and in mortality, we know that we still have huge challenges ahead of us. If we really want to reach our sustainable development goals, if we want to end these epidemics, there is a lot of work that still needs to be done. The biggest risk in international politics is that support for various organizations often comes in waves and that while riding on the back of success the attention might turn somewhere else. The world has many different challenges and problems—there's no question about that—but I think we are at a critical point in time when we cannot afford to relax and move on to other issues. We've been driving these diseases down to a certain level, but unless we really eliminate them to a level where they can't come back, we will pay a very high price. Really, it's a monetary price if we are not driving the epidemics down now, because they often come back with a vengeance, and it will be much more costly and difficult to then resume these programs. Therefore I appeal to you and to others to maintain your support so that we can maintain our progress.
This refers also to Canada's G7 presidency. The G7 has been instrumental in the Global Fund in many different ways. In fact, it was created with the help of the G7. We have been regularly in the leaders' declarations and leaders' summits. I would ask for your support, as Canada has this year's presidency, to maintain this tradition. Even a political statement without any financial commitment helps tremendously to keep the political momentum going. I would ask for your support this year in order to continue with Canada's leadership in global health and on the Global Fund, as you were our last host for our replenishment.
Also, I have a final word on the role of parliamentarians. Certainly from our perspective, we cannot overestimate how important bipartisan and multi-party support around the world is for the Global Fund. I think Canada is an excellent example of that. Global health and the Global Fund traditionally have been above party politics in almost all donor countries—and I visit all of them regularly. That is a very good sign. It is about saving lives, providing services to people, and these things are usually not controversial in terms of party politics. That's very important to maintain. Also, where you have the opportunity to interact with your colleagues, with parliamentarians from other countries, it would be great if you could reinforce this message based on the excellent experience we have in working together.
With that, Mr. Chairman, thank you so much for your support, for all the very good years of collaboration with you.
I trust this will continue in the future and you will extend your support as well to my new colleagues and future colleagues so the relations between Canada and the Global Fund will remain as strong as ever.
Thank you so much.
There are some big donors, like some neighbours of Canada, that cause some concerns. We're watching that very carefully. I would say that, yes, it's probably a difficult environment. Although the advantage of having done this job for 15 years is that I've seen many crises—political, financial—and the Global Fund has always survived that because there has been this strong commitment and the belief that we are achieving results, so we maintain the confidence and trust, even when the external environment has not been conducive.
The same applies, so far—let's be very open—with the current U.S. administration. I mentioned before that the reason is due to the very strong bipartisan support in the U.S. Congress. We have very strong support from Democrats and Republicans and so far, they have not allowed a single cut to the Global Fund. That is a very important factor.
I'm not underestimating the pressure and I'm not saying that this will always remain the case, but so far, it has been because of this strong support. Scott is an expert on that because Scott is coming from the U.S. and has huge experience working with the U.S. Congress. He is working very hard to keep it that way, so that we maintain this bipartisan support.
We are watching all of that very carefully and we trust that, in the end, the confidence, the results, and the functioning of the Global Fund will prevail.
We talked a little bit about migration and the challenges for some countries. Of course, one other effect of migration, not so much in Canada...but we've seen in Europe where the wave of migration into a number of European countries put a lot of pressure on government budgets and, in some cases, also on development budgets. Fortunately, some of that has been reversed. There were major donor countries to the Global Fund that diverted some of the development aid money to refugees in their countries, but currently that trend has been reversed. We have to keep an eye on that as another effect of international migration. It sometimes puts development budgets under pressure and we have to defend that collectively, also because I deeply believe that, by improving the living conditions in these countries, we are also addressing some of the motivation for migration.
Health is a very tangible one. People do feel whether they have access to health care or whether their children have access to health care....if not, they will try to go somewhere that they might. I think this is a contribution to making sure that people have the right living conditions wherever they are born and where they normally want to live.
Generally we've learned and had confirmed by many CEOs with whom we talk.... What we are asking from these companies is not CSR. CSR is simply too small. It's a small kind of charitable budget, and that's not the magnitude that would help the Global Fund.
When we are successful with private sector partnerships, it is because they realize it's part of their business. That could be the extractors. They saw in the countries where they invest, where they have their mines, that their workers and their communities are heavily affected by the diseases, and then they gave us money.
This is not just charity; this is part of the core business. That's more and more how we are appealing to companies and, in some cases, quite successfully, so yes, this is part of that. Also, it's that they are more committed to the SDGs. They say that part of their mission as a company is to help achieve the SDGs, and the Global Fund might be the way to do that.
What we're also doing more and more is working with funds—equity funds, philanthropic funds. If they are, for example, investing in Africa, they might be interested in sharing some of the management and performance fees with an organization that helps people in Africa because that's what their investors and their stakeholders expect.
We had a pledge here in Canada at the replenishment of such a fund that is investing in Africa. We said we were looking for a partner where we could show to our investors that part of the proceeds are then reinvested in the social sector, in this case in health.
Those are the models we are pursuing with the private sector, but you need to appeal to their core interests rather than, if you like, charity kinds of interest.
That's an excellent question, Anita.
The answer is absolutely yes. A big part of my role with the Global Fund over the past decade has been engaging with parliamentarians, not just in donor countries, but also in the countries in which we partner.
We do that in a variety of ways. For example, we work very closely with a number of international parliamentary organizations. The Inter-Parliamentary Union is a very strong partner; we have a protocol with them. L'Assemblée parlementaire de la Francophonie, we work very closely with them; the OSCE Parliamentary Assembly; the Commonwealth Parliamentary Association.... We work there because it's a great way of meeting people who are active on these issues.
We engage directly at the country levels. For example, one of the last activities I organized was a meeting of 30 members of Parliament in Kenya, including the chairs of the finance committee, the health committee; all the key parliamentarians made sure there was gender equality, by the way, at that meeting. Sometimes they had to be pushed a little. A big focus of that—and we did a similar one in Tanzania—was very much on domestic financing. You are the elected representatives and you have to step up. There's a real obligation there in sustainability, human rights issues, gender equality; we've worked with them.
Finally, and very importantly, we're bringing parliamentarians to the countries in which we work, and engaging them with other parliamentarians. For example, I brought a delegation of members of Parliament from Canada and the U.K. to Vietnam; , , and have been very much involved in the past as well. It's great because they have a chance then to engage with parliamentarians in those countries and raise some tough questions, in many cases, about domestic financing, human rights issues, and so on.
Those are the main ways that we've engaged. I know Scott's looking forward to continuing that engagement in the future.
Mr. Chair, could I bootleg in for 30 seconds to say thank you for the great privilege? For almost a decade I've been able to work with you as parliamentarians across party lines. I sat on this committee for over a decade, a few years ago now. It's an excellent committee. To be able to then continue my work has been a great privilege. I point to Canada as a beacon, an example of the kind of cross-party solidarity that has really made a difference to the Global Fund. I can thank you for that privilege as well; it's been great.