Responset the [indiscernible] the partnership between these ministries has been fairly typical. Havee Civil Society groups played an Important Role in getting governments to do the right thing. This is very important in the context of a longterm financial agreement. Our own programs are about information and financing an increase [indiscernible] a country that is only raising a percentage of gdp of national revenue. If countries are only spending , what needs tore be done to support better domestic tired visitation of budgeting . They need external resources. Many countries are not putting in the necessary domestic resources to help. Right combination of pressure and controlling dust could drilling. Ng. Cajolihn negotiations that , itmpany large agreements needs to be bolstered. There are initiatives among various countries. Support for National Health financing strategies. Providing additional funds who are making domestic efforts. A better focus on highlevel negotiations. Me stop there for the moment. Thank you. Tell us a little bit about the partnership. What it takes to accomplish and how it will work. All, we need to situate this in a wider context. We have a comprehensive view of how we are going to achieve epidemic control and maintain it over time. This new treasury partnership, we are very excited and it is part of that provider effort. It is not that we did not have contact with the ministry before but this is an opportunity for that. Give structure to drive for this stability. And sustainability. Thiseveloped world, new arrangement allows us to do that. I am reminded of a conversation from early on. Sometimes, we do not talk the same language but we very quickly got to commodity problems. The health side was talking about the commodity in the wasnce ministry side talking about the copper and gas and oil prices. Together by partnering with treasury we can use their unique here relationship that they have an leverage the goodwill that they to get use program talking on the same page. We know from a longterm sustainability standpoint, we need finance. We have seen weaknesses in the Financial System as one of the reasons why this has failed. We also need them for shortterm. Lara, would you like to comment on oca . The office of Technical Assistance has been around for 25 years. Working withd on countries that are interested in reforming their systems. We are invited by the countries to calm rather than be demand driven. Invited, we put together an Assessment Team and we go out and assess the needs of the country. And together with the country design terms of reference that focus on their needs and how we mutually agree to address them. The programs we have put together, we try to be very ,ractical, very targeted focusing on the basics. At the root of it, that they be sustainable. That once we are done, the country can pick up the tools that we have transferred to them. Our advisors, we select them from practitioners. Financeto hire directors, budget directors. People that have actually work in these jobs, been responsible to their executive leadership as well as responsible to the legislative leadership. And can craft Practical Solutions with the counterparts. Once they have been identified, we want to make sure they are a good fit the country. With the country. We want the advisor in the counterpart to have a fair understanding of what is expected on both parts. Within 60 f in 90 days of arrival in the country, the general terms of the terms of reference are expanded into annual work plan where the counterpart and the advisor are mutually responsible for the work getting done. It is not the advisors work program. It is a program to implement a reform in the country. And then the execution of the sittingis the advisor sidebyside with their counterparts on a daytoday basis, working through the problem. And transferring knowledge with handson working together, some formal training. But a lot of it is peertopeer mentoring that its not separate from their work. They are incorporateing what we are trying to achieve within their work product. We realize its sustainable reform isnt quick. Its what we expect in a year. Often systematic reform is a three to fouryear process and thats treasurys engagement. We are patient. So the counterparts that we have daytoday jobs. And they may not be working in the most efficient manner, but for us to come in and impose changes to their activities takes them away from their work and we ultimately have to shift that work into more efficient models. So treasury does have the patience to do that. Ok, nan da, youre involved with the Sustainable Finance initiative and even if were very successful, the fiscal burden will increase on the most effective countries in the near term. You have any sense of tell us about sustainsable financing and what is the time frame for this . More resources required in the immediate future. External funding will be in an ideal world, the same, it wont increase. Whats the outlook on this . What are we asking our partner countries to do . Lets give you a couple so what we all know is and so what we what we observed was that there is a parts of the economic transition taking place but over time what we have done is donor money has come in and crowded out spending on health which is a rational response from the ministry of finance. But as the countries evolve and pull back very quickly. And they differential is made out by outofpocket increases. It takes some time for Public Financing to make up this gap. And our sense was that in order to leverage the Economic Growth of countries, one had to have a Strategic Engagement that focused on four specific importance. One was mark and others have said that really good data that can be used to go and have a dialogue with he ministry of finance and health. The second was improving Financial Management systems and planning period. The third was we cant ask for money without focusing on efficiency. And the fourth one was how can we leverage the private sector to play a more Important Role . And we did all these analysis and i had the pleasure of representing for ambassador burks all the modeling and all this stuff . I asked him if he could give us the opportunity and she looked at me and said thats fantastic. Tell me what you can do in three years. [indiscernible] [laughter] she is known for her patience. The result that are sustainable over too long. Vietnam comes to mind where what we found was that h. I. V. Is highly insurable in the vietnam context. And the and it is going to lead to major efficiencys and the net value of over 200 now the link of the finance because eventually not what this Economic Cost of investing in h. I. V. , it was what is the Economic Cost of not investing in h. I. V. . This is a very different question to answer and we ran some models and we were able to demonstrate Significant Impact to g. D. P. Growth rate, through labor markets and direct investments and this is the kind of information and data that ministries of finance like to see. So what we are observing is that this concept of shared responsibility is something that countries are in favor of, countries want to do, countries want to take on and what they want is more strategic and more focused assistance or support to help them. And this is where really getting the treasuries involvement is fantastic from a u. S. A. Perspective. Because the credibility that the treasury has and what the ministry of finance is something that is important. And we worked closely with treasury on this and its not about h. I. V. Its about improving systems as a whole and then talking about increased investments going to help but with a clear line of sight to h. I. V. Great. That helps a lot. David, do you want to Say Something about the role of the world bank in all of this effort . Sure. I think i would just say is my mic in . Yes. This is extremely timely and i think because the ultimately challenged if we can get a lot right and the first thing we need to stress is what an extraordinarily successful Emergency Response h. I. V. Has been and how we can be proud of it but we do need to move from an emergency to a longterm developmental approach and i think that is going to be why this initiative is so important. To me, the single greatest challenge is if we compare the share of International Assistance for health in general with h. I. V. Specifically. And in lower to middle Income Countries is about 20 including t. B. It can be as high as 90 for h. I. V. And ultimately, those figures need to converge and we need to help promote that convergence. I think the next important point to stress is one thats been touched on and that is how we can balance things across the International System base and if we can do that right, we can be prepared for some buffers and shocks. And the reality is that upper middle Income Countries needs to be progressing for paying nearly all of their responses and thats happening. Lower middle Income Countries need to stiff change up, not 100 , but probably closer to 50 to 75 and within a relatively compressed time frame and there are a category of countries that are poor for which we have no exit and we need to be frank about that. So what do we need get right . Well first, Economic Growth is going to be important and there will be no surprise to people in the world that our Economic Growth forecast for africa are not as good as they were. The second storm has stormed. And the rest of the africa has downgraded to 4 which looks good until we consider population growth which is approximately 4 . So, clearly, we need to focus on the growth thats not simply commodity driven. The second point we really need to do is focus on improved revenue efficiency and the opportunity we have in africa is kafka is a region collect less and spends more. So this is why the Treasury Initiative can really help. But beyond that, weve also got to ensure that a greater share of resources are al call ited to health. And it might be rational the short term to pull out of health but its very hard to reallocate an entire budget if International Funding goes down. And i think to do that, advocacy has to change because our sense of the world bank is finance ministries are against single issue arguments. Its really hard to find a good argument for focusing on one disease or teaching algebra as opposed to trigonometry. Its not the question that Ministry Finance is going to but beyond that, our since that Ministry Finance tends to think of the social sectors. Which includes Health Education and welfare. We have put it in a broader context. I do think we have to face the issues that have been touched on is that is that outside help not considered an efficient ministry. The efficiency argument becomes essential. I would close by saying that i think this initiative is an important opportunity to move from an Emergency Response to a sustained response. Thank you. We have about half an hour. Maybe i will go through one round with you and well bo the audience to prepare your questions. So, you know, given that we are at the cusp of a new administration and the uncertainty is that involves, i wonder if you could reflect on scenarios for pepfar going further what, you would hope the globe fund would be doing differently Going Forward as a result of any uncertainty that we have, any thoughts about that . Maybe ill start, mike, with you. So i mean, i think from our standpoint, were really in the midst of what david is talking about, this moving from that emergency to sustained response and i think that theres just broad agreement that these are the things that we should be doing. So the work that were doing here with the Treasury Department is part of anybodys package of what we need to do to make that pivot. Indeed, this is just part and parcel of a larger sustainability plan that we have. We talk about financial and programic sustainability for emphasis but theyre part of the same thing that were doing. Weve created a sustainsable framework. We chart progress against that with our sustainability index and the dashboard that thats created. Weve taken a further step to look at how we can take whats now is really a plateaued International Dollars of further. Were very much looking at efficiency of spending, Going Forward and hoping that Ministry Finances can be a good partner in that effort. The efficiency drive is really the key to making that going. And locating that within the context of the finance ministry is key. And thats just a pieces of it. Getting us to look at the totality whether its education or in the labor market, we have to pull all of those pieces together. And working with the Health Ministry themself to show that they are a useful place to invest in over time. And so, again, this is much this is part of a much broader set of packages. The pepfar program even though were h. I. V. Specific, we understand that we need to get to for the long term sustainability and response. And, you know, here at the center for global development, we talk more about direct financial incentives for greater domestic cofinancing. Have you considered that . Whats your role of the global fund in that effort . When we look at the composition of pepfar financing, you know, if we want to leverage a domestic spend on this or greater domestic spend, especially in those lower middle incomes that have some capacity, nots to finance everything but they do have some capacity, what strategies would you see Going Forward . Either from pepfar or from global fund or from others . Nanda, lets just brainstorm. [laughter] the fact remains that donor financing is not going to be sufficient. To meet the needs of financing of health and h. I. V. And so that is no option but to work with countries on a shared responsibility agenda. And the bulk of the financing has to come from domestic resources. The other question is how do you make that happen . So its what modality one uses has to be what we have to do is manage for results, and the results have to focus in two areas. One is more money and better use of money and measurable impact of what the money invested brings. So i think what we would have to focus on Going Forward whether its pepfar, global fund, u. S. G. Or anyone ills on this three dimensions. And having the data and the evidence really to demonstrate this increasingly. Unless we can demonstrate the value proposition, arguing for more money by itself is not going to get us very far. And i agree that there are significant deficiency gains that can be achieved. And ill give you one example inch kenya, you work with the finance ministry and they put in money for the response. The first question they said was can you ensure that the money is properly spent . Then the its to ensure that this money was properly spent and the next year, they put 24 million. So if you can demonstrate success, you are going to see that finance ministry will get more responses. But its going to be the countries that will have to put in 50 , 757 of the responses. Mark, let me ask you, if you can still hear us, what us the i size of the fiscal challenge that south africa is facing . And do the new reform strategies that youre thinking of deal with this adequately . What do you see is the outlook in south africa . Well, theyre facing quite a difficult period at the moment. We do have a very low growth scenario. But i think we do have a strong sense of responsibility that this is our problem as a country and that we need to deal with this problem. I think we have a strong sense of ownership. I think it lays out sustainable parkway. I think pepfar did use the incentives. They were happy with the way that the partners are performing and thaw felt they want to support intervention for young women and young girls. So that was an incentive. But i think it does recognize other countries that are much poorer than ourselves, for example the g. D. P. Of malawi compared to ourselves. Its clear that changes do need to happen over a lengthy time period. We are on a period of massive expansion. We need expand from about about six Million People on treatment. But we will do what we need to do. So i think well do our best in a difficult climate with the valued help of our partners. So doubling the number of people on there, maybe were all in being too polite but this is an extraordinary fiscal ask from partner governments and so well look forward to following that. Its a very major challenge to think about what has to be youll have some growth in your health budget, maybe not and youll have to real accumulate from other reallocate other uses. We want to raise 25 billion additional revenue. We have to make 25 billion of tax to achieve repriorization. A lot of that repriorization is in the Higher Education sector. We have a very active fees in south africa at the moment. And we want young people who want to be able to enter into tertiary education. So a combination of different strategies, but we need to try and get all of these to fit together. And i think we do have a fair amount of reassurance to our partners that they will transport us to the best extent they can. Even if they are not able to, well continue to do what we think needs to be done. Excellent. So laura, do you want to comment a little bit about what youre seeing as you partner with ministries of finance and treasury and your partner countries . Theres a lot of talk about efficiency but how does that manifest itself . There