What is you expectation for Congress Starting in january . Caller one of the biggest things i hope our congress will do is this get rid of waste in washington. The biggest enemy we have in washington is waste. If our government would get together and say, hey, every department, lets look at the waist weve gotten our department and start cutting it. Department, what do they do . It costs millions of dollars to operate and they do exactly nothing. I would like to see our congress get together and get rid of the waste. Eone will have to start stay after this waste. Weve got money. Wasting andis government. Host out of time for calls. Thanks to all of our callers and your thoughts on the expectations of the 115th congress, set to get to work after the first of the year. From dr. Span, remarks debra birks, among those speaking about the role of finance in the global fight against hiv and eight. This recent discussion in washington, d. C. It runs just under 90 minutes. The global fight against hiv and aids. I think we are going to get started. We have an allstar panel coming up. Event is of todays challenging. We are getting closer to ending hiv aids as a Public Health threat. The u. S. And its partners happen that have been essential in providing lifesaving assistance, providing care and support. We also have to recognize that our current approach to financing this fight against hiv aids is not created clear support or incentives to reduce the fiscal burden of the epidemic or to encourage partners to take on more direct responsibilities to financing an effective in response. Only 56 of hivinfected people are currently on treatment. Even if we reach the other 44 , we are going to have a growing number of hivinfected people acquiring treatment for the foreseeable future. Have chocolate did that there will be a doubling of the population every 25 years. Thats have calculated there will be a doubling of the population every 25 years. Funders currently shoulder an important chair of the financing for hivaids programs in their partner countries. Greater efficiencies is essential. Greater domestic funding should this new partnership between the u. S. Department of treasury and the program to effectiveness of the end hivaids. To an we will start with dr. Burke. We will follow with the assistant secretary from the u. S. Treasury. End with the economic counselor for zambia. Thank you, amanda. We have lots of great people. I will be quick. We willt slide what be talking about today and its really important in the way we model our program is very much around accountability, transparency and impact. Negotiations the with ministries of finance, is a level of transparency and a very clarity about where those dollars are going and the impact to expect that this extra nearly important. Thats that is extraordinarily important. We put all of our data up online. Any minister of finance can quickly utilize the totals to see the impact the program has had. We really felt like we needed to model what behaviors we thought all ministries should have in , reallyreally your work around transparency, accountability and impact. This world aids day, we will be announcing the first three you will find those results very exciting. Impactad a tremendous fighting infections. Pediatric new infections are down by 70 . We also realize we did not have the same impacts on our adult new infections. We were talking with our colleagues from the department of treasury a year and a half ago. What they believe the hivaids epidemic was was their family members and employees dying from hivaids. Once people werent dying anymore, there was no real visibility to the epidemic. We were not clear about our numbers. You see in 2000, you have 80,000 infections. In kenya. 80,000 new infections last year. The makeup of this 80,000 infections has dramatically shifted. 290 adults. 5050 infants and adults to 90 adults. We spend a lot of time working with governments to see where the resources where. Theres this real issue between equal versus equity. We work hard to create equity. Equity means those in need of services receive the services. That is not equal because diseases are not equally represented. Every Health Center does not have the same makeup, the same diseases. Same essentialhe medicines come in some clinics, those will fit, and in some clinics, you will not have enough. Kenya, there is a Geographic Area that has had expanding epidemic while the other ones have been increasing. Thanks to the world bank and their data, weve been looking at the demographics of subsaharan africa. In the decade since the hiv epidemic started between 1990 2020, there are twice as many 1524yearolds. That becomes a real issue when you have this new data out of south africa. The number of infections in young women in the 1524yearold age range are particularly high. Data shows 24yearold men and 1 17yearold girls. When you start looking at these , you can see that in our group under 25, they dont other status. Whereas we are reaching over 80 of people over 30 know the status 80 of the Adult Population know their status. But less than half under 25 no other status. Their status. You have the pediatric epidemic which is decreasing. You have the over 30 epidemic here you are approaching rd community of vaccination. And you have the 1524yearolds who have this huge demographic number ongoing transmission. A help system where there is no binding site. Needis the connections we of trainingscussion and Job Opportunities for 24yearolds. The discussion is bigger than health. Why we are excited about the program we have in the field called dreams. Amazingve theres shortterm opportunities with this new direction we have in dialogue with department of treasury. We dont always get all the words correct. We bring in the heavy hitters who understand the words and understand how to make the business case. But these kinds of investment in secondary edi education will decrease the risk. No matter where you are in the that demographic does not interact well with the health system. It has to be a better interaction. These discussions are an exciting juncture to recognize the progress weve made and hone in on the areas where work to be done. Thank you. [applause] good morning, everyone. Thank you for attending todays discussion. I would like to thank Amanda Glassman for hosting this forum. Andalso ambassador burke all members of our panel for sharing the important insights. I want to expand on ambassador burkes opening remarks. This is a collaboration that was launched in may of 2015 to support finance ministries in low and middle Income Countries andmprove the efficiency effectiveness of Health Resources to fight hivaids. First of all, let me address this issue of why this partnership. Achieving in a three generation by 2030 will require efforts improve the coordination, efficiency and effectiveness of resources devoted to combating hivaids. To strengthen the longterm sustainability of these efforts. We are all aware of the need for more resources to finance the hivaids response. Some estimates come a annual spending will need to increase by almost 40 from 19 billion to 26 billion by 2020. Donor and partner countries alike must do their part to fund this effort. Partner countries will need to take on an increasing share of the response and over time mobilize domestic resources. Its more important than ever to maximize the effectiveness of every dollar of limited resources. The collaboration is motivated by the premise that finance ministries have a key role to play in achieving these outcomes. Today, finance ministries have been less involved in decisions around hivaids, primarily because the majority of the financing from donors has been channeled through Health Ministries and other nongovernmental organizations. Finance ministries and Health Ministries often do not seek the same language or policymaking, which can inhibit collaboration. Given the current financing environment and the key role of finance ministries in managing Financial Resources, it is urgent that these institutions coordinate more closely with their health counterparts. In doing so, they will be better positioned to promote efficiencies that maximize money in the hiv response. Central to these efforts will be to overcome challenges for how Financial Systems including hiv resources including from donors are properly tracked and integrated into the regular institutional process of government. In many cases this requires strengthening the Management Resource Systems themselves with an eye toward improving the budget formulation process, transparent and efficient allocation of resources, strengthening strengthening capacity and lincoln linking it to system one improvements, Strategic Planning areas and aids and the Broader Health care sector. Governments are already taking steps in this area. Ministry, the finance adapted sustainable financing for hiv that will better track resources from development workers. Partnership leverages the Treasury Departments deep institutional relationship and diet that policy dialogue with treasury as well as providing technical experience to governments to improve overall resource mobilization and Public Financial Management. To firmlyeeks establish three key pillars of a sustainable and successful financial response to hiv and aids. Andoved engagement coordination between health and finance ministries and third, effective mobilization of domestic resources over time in close collaboration with donors. Partnerships lunch, the u. S. Treasury has advanced these efforts by regularly incorporating the set of issues into our dialogue with finance ministries, most recently in october. In addition, the treasury has sent factfinding teams to andral countries to assess diagnose the challenges facing their efforts. Weve also held discussions with country teams, u. S. Embassy country teams and other partners to discuss have treasury can complement ongoing in country work. As these assessments continue, the partnership is entering its next and most exciting phase involving the formal establishment of Technical Assistance programs between the u. S. Treasury and Partner Companies which will a little ash allow the treasure ship to u. S. Treasury and Partner Companies which will allow the treasureship to Start Building committees. This Technical Assistance partnership has multiple executives. Hivims to bolster ugandas response through greater coordination and improvement of Public Financial Management finish as well as working group of dedicated Business Units to monitor holisticallyurces and optimize programming dispute decisions in data availability. And to address other gaps that prevent you government from using the impact of scarce Financial Resources in the fight against aids. As part of this effort a treasury resident advisor will be working alongside staff within ugandas ministry of finance. The resident advisor will help develop the ideology for oversight and review for all of these resources. Develop the ministrys capacity and recommend ways in which to incorporate on and off budget donor sources into the natural Management Systems. We hope this collaboration will support ugandas effort to make the most informed decisions possible about the allocation and use of the countrys hiv resources and to save more lives. Colleague Laura Trimble can provide upcoming details in the upcoming panel. We hope this in uganda is just the beginning. Cashld like to conclude by as many of you know, global newth and hivaids are frontiers for the u. S. Treasury and we are committed to robust engagement with our counterparts that will inform our efforts and couple meant the work that all of you are doing to save lives. We look forward to continuing this partnership and we look forward to updating you on our joint successes in the future. Thank you very much. [applause] good morning. I would like to thank the center for Global Development for share. G me to come and we want to discuss with the ministry is doing to receive the nical assistance from one key prerequisite to healthy Economic Development is that is efficient and productive. Fully appreciates the need for a healthy labor force and defective production. Of Health Services can impact the productivity of human capital. The minister of finance realized the importance of investing in health and education from the Economic Development perspective. It is clear that domestic resources alone cannot combat h. I. V. Aids, malaria and other diseases and challenges to the Health Sector. Further, the minister of finance is involved in the implementation of programs in hiv aids financing when the Government Funds are provided. It has not been acquainted with sharing accountability that are coming into the sector. It used to get up to the levels of assistance coming through the state. State. There are no systems for use of tracking u. S. Aid and finanancing for aids and hiv Realtime Data on a volution and funding. Arising from the above, the minister of finance working the u. S. Government, came up with the group is working on improving data on resources, extending development on financing, and focusing on points of overlaps. To support this and improve finance involvement, the government has a Second System to a resident advisor. This resident advisor will support the oversight with financing and Financial Analysis. The resident advisor will recommend financial policy, ensure our resources to highimpact activities. They also provide Capacity Development on Financial Analysis, costing, and funding. We also support we will develop and implement strategies at all levels of government in a timely manner. We will improve financial response. We will recommend methodologies and incorporate the owner and budget resources. We provide advice and supporting development. During the course of the tenure, there may be other areas upon which the ministry of finance would advisor expected to be valuable. The ministry of finance is in agreement. The work of the advisor is aligned with the vision Public Financial Management fiscally these are not [indiscernible] thank you. [applause] thank you, minister. We have an invited guest from the ministry of finance who will join us on video. Why dont we change out our panel while the hear from Mark Fletcher. Are there any questions . Maybe i can ask one question before you go. One is a lot of the measures you are thinking of taking with this partnership are really relevant for the hivaids response. It would have huge implications for the rest of the Health Sector as well. Is it the role of this treasury person to look beyond hivaids . Could you Say Something about that . I think one philosophy that needs to be embedded in the overall business of government and the Financial Management, if you look at the terms of reference that have been developed for uganda, basically embedded in a broader look of Financial Management. In other recipient countries, the most sustainable interventions will be ones that is tailored to assessing the effectiveness of employment in the hivaids area. But also the sure the system is compatible with maximizing return on Public Health. I think these interventions will be tailored in greater detail. Often those needs will be the broader context. It will be very relevant. When you think of one result you want to see in the year and financial sustainability, what would you like to see . That we in Civil Society can look at this partnership and the outcome and impact and whether that investment, whether thats invest investment the Health Facility itself or in the laboratory symptoms that we invest in, has to be linked to outcome and and we can help generate that together, it will ok, so much well look out. Do you want to add any . I think the recipient should benefit the most from this plan as opposed to higher levels. The end user should benefit from this plan. Thats a really excellent issue and it goes to the heart of the issue of efficiency. We dont no how were spending necessarily every dollar, etc. So well look into that. Thank you so much for our first panel. If we can get Mark Fletcher on screen and second panel come up. So well start off really asking our panelists to respond a little bit to what theyve heard on the panel based on their work. And maybe we will start with mike at the end. You dont have a youll have to mime your response. Maybe we wont start with mike. Lets start with you, laura. Youre not micd either. Ok. Well start with you, david. Because you are micd. Ok. So why dont we start youre working at the world bank to working on financing issues. When you hear about partnership, do you have any thoughts, responses at the world bank . Maybe, sorry, lets go to mark first. Apologies ok. Mark, can you hear me . Yes. Can you hear me . Yes. Perfect. So do you want to say a few words about this partnership b