Overview of L’Initiative’s 2023 Activity Report

A year of challenges and successes

Before we dive into the intricacies of L’Initiative’s 2023 Activity Report, let’s remember that it’s always good to know who’s making the coffee, especially if some of you haven’t yet tuned in. It’s like setting the scene before serving the main course, isn’t it? So, let’s get started.

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Launched in 2011 by Expertise France, L’Initiative (The Initiative) is a program supported by France to contribute to the Global Fund to fight HIV/AIDS, tuberculosis and malaria. Its ambitious goal is the elimination of these pandemics in 40 countries by 2030, in line with the United Nations’ agenda for the Sustainable Development Goals (SDGs).

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L’Initiative stands out for its crucial role in providing technical support to the most vulnerable countries. It helps these countries to optimize the use of Global Fund grants, thus ensuring effective and sustainable implementation of health programs. By strengthening local health systems, L’Initiative ensures that the results achieved last beyond the initial interventions.

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In the interests of transparency and recognition, we would like to point out that L’Initiative is a long-standing partner of OFM. For at least three years, it has played a central role in the development of your OFM newsletter, thanks to its ongoing financial support. This partnership has enabled OFM to expand and improve the quality of its analysis and information, contributing to a better understanding of and more effective response to global health challenges.

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The year 2023 marked a crucial milestone for L’Initiative. Under the leadership of éric Fleutelot, Technical Director of the Major Pandemics cluster, L’Initiative stepped up its efforts to meet the needs of the most vulnerable populations, while strengthening local healthcare systems. The year saw record commitments, strategic partnerships and bold innovations (Figure 1).

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Figure 1: A year of record commitments

Increased mobilization and support

During his speech at the seventh replenishment in New York, French President Emmanuel Macron marked a decisive turning point in the fight against the major pandemics. Not only did he increase the amount allocated by France to this noble cause to 1.6 billion euros, establishing an unprecedented level of funding for the period 2023-2025, but he also considerably strengthened specific support for L’Initiative. Initially endowed with 5% of French contributions at its inception, L’Initiative’s share has now risen to an impressive 20% for the 2023-2025 triennium.

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By way of illustration, expenditure on skills mobilization and technical assistance missions has risen from €5,232,370 in 2022 (Figure 2) to €15,618,148 in 2023 (Figure 3).

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Figure 2: Expenditure on skills mobilization and assistance missions in 2022

Figure 3: Expenditure on skills mobilization and assistance missions in 2023

Anne-Claire Amprou, French Ambassador for Global Health, emphasizes that this increase reflects the impressive results achieved and reinforces France’s global health strategy. Reading through the report, it is indeed easy to see that it materializes the orientations contained in the France Global Health Strategy 2023-2027 unveiled in October 2023.

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Indeed, the French government has identified several key areas where improvements are needed, including disease prevention, quality of care and coordination between the various healthcare players. To achieve these objectives, concrete measures have been put in place, such as increasing the budgets allocated to healthcare, strengthening the training of healthcare professionals and promoting global research in 2023-2027.

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Jérémie Pellet, Chief Executive Officer of Expertise France, adds that this increase follows a rigorous evaluation demonstrating the added value of L’Initiative and providing avenues for improvement. It’s fair to say that L’Initiative has received a significant boost to continue its essential work.

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2023 results: the figures speak for themselves

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In 2023, L’Initiative supported 37 countries in their applications for Global Fund Grant Cycle 7 (GC7), an all-time record. This support is not only financial, but also technical, enabling better preparation and higher-quality applications.

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L’Initiative not only provides funding, but also improves the governance and effectiveness of national programs, with a focus on inclusivity and sustainability. In other words, L’Initiative doesn’t just put band-aids on wounds, it actively works to prevent future infections and pandemics.

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Crisis response: agility, responsiveness and sustainability

L’Initiative has proven its ability to respond effectively to crises in Burma, Ethiopia and Ukraine. Its flexibility and speed of action are major assets in supporting healthcare systems in often very difficult contexts. In Burma, for example, L’Initiative has maintained equitable access to essential health services, despite political and social upheaval. In Ethiopia, it has ensured continuity of care in conflict zones, while in Ukraine, aid has focused on managing displaced populations and preventing epidemics in the midst of war. A real feat worthy of the greatest action films, but with a humanitarian twist.?

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Figure 5: Spending by region

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Human resources for health are at the heart of L’Initiative’s concerns. Investing in the training and support of local health professionals is essential to guarantee the effectiveness of health systems and the sustainability of actions undertaken. Specific objective 3 of France’s Global Health Strategy (pp. 25-27) takes a similar approach. The document states very precisely: “Human resources for health (HRH) are the cornerstone of any health system. They guarantee the availability, continuity, access and quality of services, the resilience of health systems, health security and UHC [Universal Health Coverage]“.

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The report points out that a well-trained and equipped nurse in a remote area can make all the difference between a contained epidemic and a health catastrophe. In other words, prevention is better than cure, and for that you need well-prepared teams.

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In 2023, innovative training programs were introduced to enhance the skills of healthcare workers. These initiatives aimed to strengthen not only medical knowledge, but also management and leadership skills, essential for effective response to health crises.?

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Figure 6: Human resources in health (HRH) support

Children, sexual and reproductive health and rights and pandemics: a major challenge

L’Initiative also focused on pediatric care, which is often neglected in the fight against pandemics. It is imperative to integrate services for children into primary healthcare. As the saying goes, “Children are our future”. And if that future is to be a healthy one, we need to start now with appropriate, accessible care.

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L’Initiative’s pediatric programs have provided life-saving treatment for thousands of children suffering from HIV, tuberculosis and malaria. Awareness and vaccination campaigns have also been stepped up to prevent the spread of these diseases among young populations.

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L’Initiative is also fully committed to the defense of sexual and reproductive health and rights (SRHR), which are linked to human rights, gender equality and the sustainable development of societies, as well as to public health. “Gender inequalities directly influence access to SRHR. Women and girls face social, cultural and economic barriers, while men are held back by norms of masculinity. L’Initiative fully integrates gender into its projects to change social norms and promote equality. Currently, 50% of projects financed take gender into account, with a target of 75% for the coming years. L’Initiative supports project leaders in integrating this dimension in a prescriptive manner and within the framework of an ongoing dialogue.” It also focuses its efforts on the fight against HIV and for SRHR, enabling an integrated approach to these issues.

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At this level, L’Initiative’s approach is in line with France’s International Strategy on Sexual and Reproductive Health and Rights 2023-2027 (Figure 7).

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Figure 7: Overview of France’s International Strategy on Sexual and Reproductive Health and Rights 2023-2027?

Operational research: a valuable tool in the fight against malaria

In the fight against malaria, L’Initiative relies on operational research to find innovative and effective solutions. Projects in Burma, for example, show how research can be a powerful tool for curbing this disease. Imagine Sherlock Holmes in a white coat, tracking down every parasite-carrying mosquito: that’s operational research in action.

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The emphasis is on adapting interventions to local contexts, using field data to guide malaria control strategies. Advanced surveillance techniques and rapid diagnostic tools have been deployed to improve case detection and treatment. All in all, it’s a real detective game on a grand scale, but with mosquito nets and drugs as magnifying glass and pipe.

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Enhanced international collaboration

One of the pillars of L’Initiative’s strategy is collaboration with other international players. In 2023, strengthened partnerships with organizations such as the STOP TB partnership, the Global Fund and other health agencies have enabled L’Initiative to optimize resources and coordinate efforts on a large scale.? As the old saying goes, “There’s strength in numbers”. And in this case, it has led to significant advances in the fight against pandemics.

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These collaborations result in exchanges of best practices, synergies in program implementation and harmonization of interventions to maximize their impact. L’Initiative plays a central role in this global network, facilitating knowledge sharing and innovation. By way of example, the report explicitly states that, “L’Initiative joins forces with Stop TB Partnership, a key organization in the fight against tuberculosis, to synergize their complementary expertise, thereby helping to roll back the disease. This action takes shape notably through support for civil society and the awarding of grants to communities and local organizations, in order to support the development of technically sound and innovative interventions”. This collaboration recently took shape thanks to the financial support of L’Initiative for the organization of the Yaoundé meeting on the integration of the ‘Community, Rights and Gender’ approach in the fight against tuberculosis, organized by STOP TB from June 11 to 13, 2024. (Read our article on the highlights of this meeting here).

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Conclusion: an Initiative that goes right down to the last mile

In short, L’Initiative continues to stand out for its commitment, responsiveness and innovation. It is an example of how coordinated, well-funded efforts can have a significant impact on global health. As Jérémie Pellet puts it, “L’Initiative knows how to go to the last mile to strengthen health services and ensure their quality”. And in this marathon against pandemics, every kilometer covered is a victory for global health.

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The year 2023 was a year of challenges, but also of successes for L’Initiative (Figure 8). Thanks to increased resources, a dedicated team and strong partnerships, the organization was able to not only respond to immediate crises, but also to lay the foundations for sustainable improvements in healthcare systems. With a clear vision and ambitious goals, L’Initiative is well placed to continue playing a key role in the global fight against pandemics. It’s a marathon where every mile counts, and L’Initiative shows no signs of slowing down.

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Figure 8: Summary of L’Initiative’s Interventions