One Person, Multiple Diseases — Reimagining Integration and Sustaining Progress to the End of AIDS, TB and Malaria

Good afternoon, everybody. Thank you very much for choosing to be with us during your lunch hour. We're about 10 minutes behind, so we've got quite a lot of catching up to do. I want to welcome everybody here to this One Person, Multi Diseases: Reimagining Integration and Sustaining Progress to the End of AIDS, TB, and Malaria, and to acknowledge our 4 co-conveners: the governments of the Philippines and Georgia, UNAIDS, Stop TB Partnership, RBM Partnership to End Malaria. I'm James Chan, the President of the China-United States Exchange Foundation, which is a nonprofit in Hong Kong, and I also serve as a WHO Goodwill Ambassador previously for UNAIDS. Today, we're going to be looking at one-person multiple diseases, and it's a really novel way of reimagining the challenges that we have, which are multifold. Health systems built around a single disease miss the whole person, but integration is how we put the person, not the diagnosis, at the center. The Global AIDS Strategy sends a really powerful message at this time. The future of the HIV response is obviously going to be reshaped by bold reforms, stronger partnerships, and decisive action to strengthen systems that are truly multisectoral, self-reliant, and sustainable within countries, but also we take that broader picture right around the world as well. And at the heart of the transformation that we're talking about is integration. Countries are already moving forward, as we know, at different paces, at different stages of their journey, but also forging new pathways to connect HIV responses with broader health and development systems to address that whole person that we're here to speak about. Now, at the same time, in parallel, there is the financing landscape, which of course is fast, rapidly changing. An era that was once defined by more predictability, by abundant donor funding for HIV, is obviously shifting, creating an an urgent need for countries to all step up to domestic investment and diversify financing sources. While substantial international resources for HIV, TB, and malaria remain available, ending these epidemics by 2030, which as I said yesterday is only 4 years away— we keep on talking about this magic number, but it's right around the corner— is less and less likely and is going to depend on how countries mobilize new funding to tax reforms, health taxes, insurance schemes, dedicated health funds, and other innovative financing strategies. Now, at the same time, we're going to go back to integration, how it's redefining health services so they can deliver for better, more integrated, person-centered care. And let's not forget that close linkage between HIV and TB, which has already shown in many situations the power of coordinated response. Sponsors, providing a strong underpinning foundation of experience and guidance. The challenge is obviously there. It's even bigger building resilient primary healthcare systems that can develop prevention, treatment, and care for HIV, TB, malaria, and other diseases. This is the idea of the multiple diseases through people-centered services that meet communities wherever and whenever they are. I would like to invite first the Ambassador Enrique Manolo, Permanent Representative of the Philippines, to welcome us here today. The Philippines, of course, is playing multiple important roles at chair and vice chair level, and that will be followed by a video message from the Honorable Dr. Teodoro Ebosa, the Secretary of Health of the Philippines. Ambassador.

Thank you very much, James. Good afternoon, colleagues, partners. On behalf of the Philippines and our partners in UNAIDS, the Stop TB Partnership, and the RBM Partnership to End Malaria, it is my pleasure to welcome all the distinguished panelists, delegates, and participants this afternoon. We gather at a pivotal moment. While remarkable gains have been achieved against HIV, TB, and malaria, Shifting financing realities, persistent inequalities, and growing demands on health systems require us to rethink how we deliver health services and sustain progress. The answer lies not in working in silos, but in building integrated, people-centered, and resilient health systems that respond comprehensively to the needs of the human person and the communities to which they belong. For the Philippines, this approach is both practical and necessary. We continue to confront one of the faster growing HIV rates in the Asia-Pacific region while also carrying a high tuberculosis burden. These challenges have reinforced the importance of strengthening primary healthcare, expanding universal healthcare coverage, integrating HIV and TB services and addressing the social determinants that shape health outcomes. Through increased domestic investments, national insurance benefit packages, innovative screening technologies, community-led responses, and partnerships with organizations and bilateral partners, we are working to ensure that no one is left behind. Integration is not merely a technical solution. It is a political commitment to equity, sustainability, and dignity. It recognizes that people do not experience diseases in isolation and therefore our responses must be targeted and multidimensional. During discussions today, let us look forward to learning from one another's experiences and identifying concrete actions that will help sustain gains and accelerate progress towards ending AIDS, TB, and malaria. So in closing, let me once again thank all the participants and the sponsors and wish you a fruitful exchange this afternoon. Thank you very much.

Thank you very much to the Permanent Representative from the Philippines, Ambassador Enrique Manolo, and we will now listen to a video message from the Honourable Dr. Theodore Eboso, the Secretary of Health of the Philippines.

Excellencies, distinguished colleagues, and partners, warm greetings from the Philippines. I thank UNAIDS, the Stop TB Global Partnership, the Rollback Malaria Partnership to End Malaria, and all our partners for convening this important discussion on integration, sustainability, and the future of the global response to HIV, tuberculosis, and malaria. Today, I speak not only as the Secretary of Health of the Philippines, but also as the chair of the Stop TB Partnership board and vice chair of the UNAIDS Program Coordinating Board. These roles have been given to me as a unique perspective on a simple but profound reality. People do not experience diseases in silos, and therefore our health systems should not respond in silos. A person living with HIV may also be at risk for tuberculosis. A pregnant woman seeking maternal care may need HIV testing. A child screened for malnutrition may require TB evaluation. A traveler returning from an endemic area may present with malaria. Health systems must be designed around people, not programs. The Philippines continues to face significant challenges across all three diseases. We are confronting one of the fastest growing HIV epidemics in the world.— with approximately 50 new HIV reported every day. Tuberculosis remains one of our leading public health concerns, and we continue to rank among the world's highest TB burden countries. At the same time, while malaria cases have fallen dramatically over the past two decades, we remain vigilant as active Transmission persists in limited areas, particularly in the island of Palawan. Yet, these challenges have also taught us valuable lessons. First, integration works. In the Philippines, we are increasingly integrating HIV services with primary care, maternal and child health services, and tuberculosis programs. Our active TB case finding initiatives are being linked with HIV services, nutrition programs, non-communicable disease screening, and community-based care. We are moving away from fragmented service delivery towards a more person-centered approach that meets people where they are. Second, Communities are indispensable. No government can end HIV, TB, or malaria alone. Community organizations, civil society, faith-based groups, and people with lived experience are often the first to reach those left behind. They build trust, fight stigma, support treatment adherence, and ensure accountability. Sustainability is not only about financing, it is also about sustaining community leadership. Third, domestic ownership and South-South cooperation matters. The global financial landscape is changing. While international solidarity remains essential, countries must strengthen domestic investments and build resilient systems capable of sustaining gains over the long term. In the Philippines, we are working to strengthen social health insurance, improve procurement and supply chains, expand digital health systems, and enhance local government ownership of health programs. These investments benefit not only HIV, TB, and malaria responses, but the health system as a whole. Finally, political leadership remains the most important ingredient. Progress does not happen by accident. It requires leaders willing to invest, reform, innovate, and make difficult decisions. It requires sustained commitment. Even when resources are constrained and priorities compete for attention. The Philippines stands ready to work with all partners in advancing this shared vision, a future where integrated, people-centered, and sustainable health systems enable us not only to control HIV, tuberculosis, and malaria, but ultimately definitely to end this epidemic as public health threats. I wish you a productive and meaningful discussion ahead. Maraming salamat.

Thank you very much to the Secretary and the Ambassador, more so to the Philippines for its action that the Philippines' own people-centered integration and universal health coverage journey, and also how it's using these to bridge upwards to the global picture. Ambassador, I very much noted what you said, that integration is not just a technical point, but it's a commitment to individual and collective human dignity. It gives me great pleasure now to invite the Ambassador David Baratseidze from Georgia, the Permanent Representative of Georgia, to say a few words to us. Of course, this is a very important couple of hours ahead for everybody, and You as one of the co-facilitators, the other co-facilitator, thank you very much for joining this session today.

Thank you very much. It's a pleasure to be here. Apologies for being a little late. It's, as you have mentioned, it has been quite an important couple of hours left as we look ahead for the coming 4 or 5 years of the work. Well, Excellencies, dear colleagues, and dear friends, first of all, let me Let me share that with my esteemed colleague from Botswana, Ambassador Masole, and myself. We have spent the last several weeks facilitating the negotiations on the political declaration for the high-level meeting on HIV and AIDS, and we are not technical experts in this field, but— so it has been quite a crash course for us on many things. Among many important things that we have learned is the effort to end the global AIDS epidemic, the efforts to end TB and malaria are at a critical juncture. On the one hand, so much has been achieved since the turn of the century, driven first by Millennium Development Goals and later by Sustainable Development Goals, and we should all be proud of this, but on the other hand, we have not achieved our goals and there is more to do. And that is why we gather together this week to show the progress. Meanwhile, the global context is changing. Some of these changes are positive. We have made great progress on socioeconomic development, global health, global extreme poverty, and inequality between countries have been greatly reduced. As have global deaths from HIV and TB. However, inequality within countries is rising. Our progress on global health was severely disrupted by COVID-19, and the resources available through traditional development cooperation mechanisms and assistance are declining as countries grapple with the climate change conflicts. So some suggestions that I wanted to to make some points that I wanted to make about moving forward. First, leveraging the HIV infrastructure as a blueprint for universal health coverage. The response to HIV has built robust, resilient primary healthcare infrastructure spanning laboratory networks, community-led delivery channels, data tracking, and supply chains. Transitioning from siloed disease-specific Specific funding to integrated care models allows countries to use the proven HIV foundation to tackle broader health priorities, effectively turning HIV investment into a bridge for universal health coverage. Second, multi-epidemic defense network. By embedding HIV services within broader clinical networks, healthcare systems can simultaneously combat overlapping syndemics, including tuberculosis, hepatitis C, non-communicable diseases, and emerging pandemic threats. Patient-centered integrated system screens, prevents and treats multiple conditions during a single visit, drastically improving overall population survival rates. Third point is human rights and community-led responses as essential public health pillars. The global HIV response proved that public health initiatives only succeed when built on equity, human rights, and destigmatization is present. Championing this integration means bringing vulnerable marginalized populations into the formal healthcare ecosystem, establishing a trust-based model essential for controlling any future epidemic. For driving sustainable health financing and economic resilience, Shifting from parallel disease-specific programs to integrated healthcare models eliminates costly duplications, optimizes workforce distribution, and offers a higher return on donor and domestic investments. Integrated systems are fundamentally more financially sustainable and safeguard national economies against the shock of the future health emergencies. And 5, Georgia's leadership opportunity in regional health security. As a country that has made significant strides in managing HIV, TB, Hep C, Georgia is uniquely positioned at the UN to champion the transition from crisis-driven funding to resilient integrated national health system. Advancing this agenda cements Georgia's role as a strategic leader in the global health security and the driving force to end both current and future epidemics. And I want to thank you all for active contribution to this discussion and with the best of the hopes for the outcome of today's high-level meeting. With this, I will stop and looking forward to further discussion. Thank you.

Thank you very much, Ambassador. We're going to move swiftly on to a couple of keynotes, starting with Winnie Byanyima, then Dr. Lucika Dithiu and Dr. Michael Akapo. Koenig-Charles. Let's start with Winnie Byanyima, the Executive Director of UNAIDS.

Thank you. Thank you, Moderator James Chow, a leader in the HIV response who we've worked so closely with. Thank you for being here for us. Excellencies, colleagues, and friends, thank you for being here. I must start by thanking the co-conveners of this session, the government of the Philippines, Stop TB, and the Rollback Malaria Partnership, and us at UNAIDS. Thank you for putting this together. I have to make a special mention of Ambassador Bakradze, co-facilitator of the negotiation of the political— of this high-level meeting, together with Ambassador Masole. You're amazing. I can't even imagine that you can be here when all this is still going on and we don't know whether we're going to have it gobbled in, but thank you for all that you have done. We are talking about integration. This session is about integration. Why integration and why now? Because the world is in a very particular complex political situation here at the United Nations because agreements, past agreements that were reached here at the United Nations, member states, Trustees Solo, hardly able to agree to keep them going. They are unraveling them. It's a difficult political context we are in. Development financing has disappeared suddenly, and that has created a very special situation for those countries that were still dependent on external assistance for their HIV programs. My colleagues from Roll Back Malaria and Stop TB will be experiencing the same. So this has created a new situation where developing countries must step in and quickly find resources to fill gaps where external assistance was helping. Hence the discussion on health sovereignty. Hence the discussion on integration, 'cause integration is the way to bring together many strategies to address different diseases together to achieve cost efficiencies and be able to deliver. So we're talking about integration. It's a particular context for developing countries that were depending a lot on assistance to be able to roll out strategies, responses for HIV and other diseases. I thought I should put that context there. Now, I would like to talk about our disease, HIV. We've come 25 years of a global HIV response, making progress steadily and putting now 32 million— 32.1 million people living with HIV on treatment, able to live long lives, healthy lives, out of 40 million. Still a job to do, but great success coming out of the world coming together. It came together to do what? It came together to close the gaps for every country so that every country can give its people what they need to stop this disease, new infections and deaths. So, how did this happen? It was about closing the inequalities that drive the HIV pandemic. Three key areas of inequality that were addressed by member states coming together and agreeing. One was inaccess to medicines, agreeing to work with companies to bring new innovations for testing, for prevention, for treatment, and ensuring that those new innovations are priced affordably so that everyone in the world, wherever they are, can get the best for testing, for prevention, for treatment. Today, if you are in Ouagadougou, Bukina Faso, or you are in London, UK, you can access the same pill for prevention. It does not matter the economy of your country, the size of your country, and so on. You can access the same. That was an important agreement reached by member states to work together to bring prices down to get everyone to access. It's still an issue of discussion here. The second was to agree to close the gap on financing, that those countries, developing countries, that can't put the money down to build these huge, beautiful health systems that address every issue can have resources to fight this disease. So Global Fund was created.— and we raised money and the American program, PEPFAR, was created and financing was brought in to help developing countries. This is what is now going off the table, financing, closing the gap on financing. The third was closing the gap on rights, agreeing that everyone, whatever your identity, whatever sex, kind of sex you have, However you define yourself sexually, that you, whatever you work, you do, if you're a sex worker, whether you inject drugs, that you are a human being with a right to access what you need to save your life. Human rights. We agreed and we moved the framework of human rights to ensure that all those at risk and people living with HIV can have their rights to get what they need to test, to prevent, to treat. Those are the 3 areas. Now, I want to quickly come to integration because integration now is about how to manage with limited resources. Here, some— we are concerned as as UNAIDS, because we see that as integration is happening, as HIV responses are being brought into broader health systems, some things are not happening, and this is dangerous, and this is going to cost lives, if not already. We are seeing that while we built success based on communities creating their own organizations and delivering services to their own people in dignity, that these are not being integrated. They are being closed off and not being brought into the system. Communities are the backbone of the success of the HIV response. People living with HIV, gay men making their own organizations, LGBTQ people, sex workers in their own organizations, young people, girls and young women, youth creating organizations where people can safely come, not feel discriminated, not experience stigma, not fear harsh laws, criminal laws, come and get what they need. These services have been cut. The cuts have almost, say, eliminated community responses. Now, integration must be about bringing them back. Governments finding resources, social contracting communities to continue serving their people because if I'm a gay man in Uganda and I'm afraid of the criminal law there— I'm a Ugandan, I'm talking about my country— I will not show up to a government clinic because I'm afraid I'll be identified, I will be arrested. But I can show up at a gay center where other gay men are handing out the condoms, the ARVs that I need. It's not rocket science. This is simple. We need human rights, we need communities, Integration must mean that guaranteeing human rights, bringing communities into the health system. Without that, we will not end AIDS. The second thing about integration that I want to mention is that HIV is not just a health issue. It's an issue of inequality and poverty and exclusion. If you do not address all the sectors that touch on these issues, you will not end AIDS, if you consider it just as a disease. So we've always had multi-sector approaches. Integration must go beyond integration in health sector. It has to be integration across sectors. That means you're addressing the real issues that drive vulnerability. These are in households, in communities, in classrooms, in the economy itself, in the workplaces. So we need multi-sector approaches. We need integration across sectors. So keeping girls In school is a major prevention strategy for HIV. So we must look at integration as looking at education, look at social protection, look at law and rule of law, so across the sectors. That is really my last point here, that integration for us means integration across sectors, a multi-sector approach, maintaining that. Integration means integrating communities as service deliverers in the lead in fighting HIV. Integration means integrating human rights in the response to HIV. In conclusion, as we are here together with my colleagues from Stop TB, Roll Back Malaria, We also have Global Fund, perhaps in this room, Africa CDC. We all need each other. We need to work together. Each has a role to play. We need to support countries to achieve their health sovereignty, each in the space that we have, but we also need to be bold in our advocacy about what needs to be done. Thank you very much. Mudrita, I probably have taken more time than I should have. I apologize.

Well, thank you very much, Winnie Byanyima, Executive Director of UNAIDS. And I think that acknowledgement recognizes not only the extraordinary work of the people of UNAIDS, but going to the core of what you said regarding dignity, human rights, it being at the core of everything that we're here to discuss. I'm going to move very quickly to the part that you just mentioned, Stop TB, to Dr. Lucica Ditiu, who is a longtime leader of this organization and someone who— and she says I can say this— who uses her loud voice or her outside voice to be a noisy advocate for people, not only TB, and for recognizing that co-infections like TB are core to the AIDS agenda. They're not not simply side issues or footnotes. Luchika.

Thank you.

Thank you very much, James, and very esteemed panel, and Winnie and co-host from obviously the Philippines, and Ambassador of Georgia and Philippines being with us here, but also all the countries. I'm really happy to have Nigeria, Eswatini. I know Kenya is in the room, and partners who chose, as you, James, said, chose to be here. You could have been on the corridors doing some global health architecture mapping. That's what everybody does these days, but you chose to be here to listen to what we have to say. And we know each other for a long time. Our partnership aims to end TB by 2030. 2030 is around the corner. We speak for a long time about TB-HIV integration. I look in the room and we actually grew together in a lot of this, including you, James, including the amazing team of UNAs that worked on this, because indeed, you know, we speak for so long about TB-HIV integration, right? And we all know that TB is the biggest killer for people living with HIV/AIDS, and it remains like that. And we all know that you could do much more together, but actually, as we all know, it worked very well in some places, it didn't work in others. This integration of TB-HIV didn't work in some countries, And it was not necessarily bad will or people didn't want to do. The systems in the countries were not constructed for this intervention. The funding going for TB and for HIV are going through different channels to different departments in the ministries of health. The communities working and advocating for TB, HIV, and malaria and others are also funded through different streams. There is a lot to be unpacked when we discuss about integration, you know, and it is a lot to understand why it, in some instances, didn't work and what can be done to make it work and much better now. We are all— I was listening to what Winnie was saying yesterday and today as well on the achievements on the HIV/AIDS and we know the achievements on malaria as well, on TB as well, We are at a phase in which I think we reached with services the low-hanging fruits, if I can say, people that are easier to reach, people that we can easier engage. I can speak for TB. It's much more difficult to reach the people that are most vulnerable. It's— are those that for which we have to do the extra mile to be reached out. And they are probably the same living with all the three diseases. Thinking of the way in which that can be done and listening to what countries did and do is the right way to go. I don't want to go into what countries should do because we will listen from the plenary here, but I can tell you that from the global level, and as I said, people these days are more busy to discuss what organization should be merged with the other, who will sunset, who will grow, I can say that from the global level, we here did this event, 3 groups, as we know, UNAIDS, Stop TB, and Roll Back Malaria, because we believe that things can be done differently. We all built strengths and capacities that we are very good at, and I really hope that we have, all of us, the maturity to maintain that and not immediately throw things out, because it's very difficult to lose those expertise. In Stop TB, we are very proud of the innovation work. We basically scope the landscape, identify startups and private sector companies, and help them navigating the system till they are getting introduced in countries. We are not scaling up, but introduce. We are working very much with communities and civil societies, and we brought them up, including the TB survivors, and the civil society organizations in a huge number, as unheard before, and we do a lot of procurement and supply. So what I'm trying to say is we should look at everybody's strength and put this together, but we need to avoid two things, and these are my last points to try and gain some time. We need to ensure we don't duplicate and see where we can aggregate some things, But also, we need to listen to the countries. Too often, from the big capitals in the North, we dictated some directions to countries. That was maybe not the best one for countries, but countries, in a desire to have more visibility, support, finances, listened to that, and that's where the lack of sustainability came for. So we have to listen and not impose to the country the direction. The last thing I want to say about the integration, which is so vast area to discuss, and we all know about that, is I want to use an example for all of us. Is, you know, when you paint and you put different colors on a palette and you have red and purple and blue and green, when you integrate all these colors, you get a muddy color. Just try it. And you lose the beauty of each of the colors. And then you remain with this muddy thing that can be messier and uglier. So while we look for the future, I think it's extremely important to leave from here with a political declaration that I know our colleagues from Georgia and Botswana and many of you worked so hard to have and make sure that we lead— we leave the countries to lead and we behind them try to support their efforts. Towards ending these diseases. Too much money, effort, sweat, tears, and joy went into trying to end these diseases so far. We are not far from it, and I believe very strong that together, the three of us here, but also with our friends from communities in the frontline and the survivors, we are able to end these diseases by 2030, if we choose to. Thank you.

Thank you very much to— such an enthusiastic audience today. Thank you very much to Dr. Lucica Ditiu. And on this note, because you mentioned the political declaration, we would excuse the Ambassador of Georgia to get back to the last-minute preparations for the adoption of that declaration, as said by Winnie Byanyima. We really thank you for your personal and country's leadership, as well as that of your co-facilitator, Ambassador Mosole of Botswana. Let's go now to our final speech from the co-convener, Dr. Michael Adekunle-Charles from RBM Partnership to End Malaria. These are his pre-recorded comments that he sends to us.

Good day, ladies and gentlemen. My name is Michael Adekunle-Charles and I'm the RBM Partnership First and foremost, I would really like to thank the government of Philippines that is convening this important discussion together with us as RBM, UNAIDS, and STOP TB, and to really thank the other partners that are in the room. The conversation around integration is important now more than ever. Integration has to be done in a sustainable way. Sustainable manner and in a manner that really builds on the communities and is country-led. From an RBM perspective, integration is key, and I, together with the malaria ecosystem, we firmly believe in integration. Integration we've actually been doing for many years. We've had bed net campaigns that are integrated with immunization vaccination campaigns. We've had bed net campaigns that are integrated with vitamin A distribution. We've had intermittent preventive treatment in pregnancies that is really tuned and integrated with maternal care, antenatal care. Recently I was in Nigeria where I witnessed firsthand a bed net distribution a distribution in the communities that was integrated with screening for tuberculosis between children, children between the age of 0 and 14. To my surprise, out of all the children that were screened, 10% actually had symptoms of tuberculosis, and these were referred to the nearest health facility. This is what integration means in practice.— it has to be community-led, it has to be what the country wants, and we as partners need to commit to ensuring integration happens where it makes sense. And that is why the RBM partnership have come up with a framework called the Big Push to End Malaria by 2030. This is again really talking about integration at the community level, integration from, from the global health actors, integration when it comes to our collective collaboration and coordination, when it comes to finances, when it comes to data, when it comes to surveillance, when it comes to access. We really need to ensure that we work together behind a common goal, and that goal is the country agenda and the agenda of the communities. I firmly believe there's a lot we can continue to do together to ensure that we are working in a holistic manner. A person that is sick is not only sick from one disease, so we shouldn't verticalize it and we shouldn't look at diseases in silos. One thing is clear for me: collaboration is now and not in the future. Within the malaria ecosystem, we are ready to collaborate, we are ready to work together with all of you, and to ensure that we are supporting the country's agenda and the community's agenda. Once again, I really like to thank you for being part of this conversation. Thank you for your ongoing guidance, support, as we continue to work together to bring our collective support to countries and to communities. Together we can, together we must. Thank you.

Thanks very much to Dr. Michael Adekunle-Charles from the RBM Partnership to End Malaria. We are now going to transition into our first debate, which is looking at the external funding declines and the drive for self-reliance. As these conditions grow and as the challenges grow with them, we are going to ask about national leadership, how it has never mattered more This panel is the journey from that vision to action on the ground. We're going to introduce you now to Dr. Kelechi Ohiri, who is the Director-General and CEO of the National Health Insurance Authority of Nigeria, and Dr. Nonumiso Ncube, who is the Executive Director of NESHA, the National Emergency Response Council on HIV and AIDS in Eswatini. Welcome to you both. Dr. Ohiri, I'll just go to you first. I mean, my question here is, How is the Health Insurance Authority helping to deliver an integrated response, and what will it take to make that reform sustainable, embedding HIV, TB, and malaria in primary healthcare, and giving real financial protection to the poorest of the poor and the most marginalized in our world?

Very easy question there. Excellencies, good afternoon. I thank you for the opportunity. I believe the fact that, you know, the Chief Executive of the National Health Insurance Authority is here today really underscores some of the challenges, the financing challenges that face us. I'll respond to that by, first of all, giving a contextual background as to where we were as a country, what we've done so far, and then some reflections in terms of the way forward and the challenges that we have faced in dealing with this. In Nigeria, I mean, we know that conversations have been going on about country ownership, around the need to reform a lot of our programs, and this preceded, you know, some of the recent changes in the global health landscape. The decline in multilateralism and global solidarity didn't come as a transition. It came quite as a shock, and it was sudden and it was immediate. And so many countries like ours had to really confront this new reality. And this reality started, you know, during the era of COVID um, et cetera, that many countries began to learn from. What was clear to us was that Things had changed. Nostalgia and hoping to go back to the status quo ex ante was not really a responsible strategy for us as a country. And so we had started some reforms. When the government changed, there was a health sector renewal investment initiative that was led by the minister, and this created a sector-wide approach where we began to look at different sources of financing for programs.. And this was why Nigeria, with 22 other countries, sponsored a resolution at the WHO last year, looking at how we track financing globally, but also at the country level. And so what it meant was, for the first time, we began to speak to all the partners. In Nigeria, we have a decentralized, fiscally devolved government. So at the federal level, the states, the local governments, the partners as well as civil society coming together to row in one strategic direction, and that was a sector-wide approach that had started. And it was auspicious that this had started, because when these shocks came, there was already a platform for convening the different stakeholders and bring them around the table to discuss. So what happened was immediately we needed to know, okay, where were the funding sources and what was being funded? And it wasn't as clear as one would expect because there was a lot of opacity in the way things were done. With a lot of advocacy, the Nigerian government mobilized about $200 million extra-budgetarily, with the Senate and the House of Representatives coming on board., and then we began to integrate roughly 20,000 health workers that were just let go of into the health system. And that was immediately, because first of all, it was to stop the bleed and, you know, do no harm, bringing a medical parlance into it. And then secondly, we began to look at how we could build back better, because certainly things were not going to happen one for one. So we started looking at budgetary allocations. We started with negotiating different memoranda of understanding with some of the critical stakeholders. We began to pilot some integration of HIV and TB care into the National Health Insurance Scheme. Started with about 5 states in the country to see the feasibility of actually integrating this. We began to redefine the benefit package in insurance, including TB, and launched actuarial studies to look at what it would cost to fully integrate HIV and TB care into the benefit package that was being offered to Nigerians. And this had started a journey for us that's now culminated in we see the Senate in Nigeria doubling the amount. About 1% of the consolidated revenue in Nigeria goes towards primary care and towards caring for the poor and the vulnerable. And recently, the Senate actually passed a bill doubling that amount to 2% and it's taken off the top in addition to the healthcare budget that has also been increased. In addition to that, fiscal policy reforms were ongoing., and recently again, sugar and sweetened beverage taxes that will be channeled and earmarked for healthcare has been passed. All these were attempts to, first of all, mobilize additional resources towards health, but also secondly, to look at more efficient ways of allocating these resources. It was not— it dawned on us that it was not enough to just fix the financing and the demand side, it was also important to begin to shape the markets and look at the health sector from a value chain perspective. So things like the way we procured had to change. Whereas before we depended on procurement systems that were really external to our system, we began to build things like a Medi-Pool through a presidential mandate so that we can consolidate and pull procurement to drive down some of the costs of services, because whatever system we build can't be as expensive as what existed before. We've also begun to look into realistic local manufacturing, whether it's for bed nets— we're the largest consumers of bed nets— and now for test kits for HIV. So we've had companies come to Nigeria and break ground on these things. Now, I think, looking at all this, there are a few reflections that we need to think about as we go forward. One is, it's not been easy, and it's not a case of where we— this has not been a transition, and this has been a disruption, and so your strategy has to be quick, It has to be realistic, and it has to be context-specific. The second thing was that it's not just enough to spend and to bring more money. We need to get more value for what we spend. So issues around public financial management have jumped to the fore, where it's not just enough to allocate the budget, it's also important to implement it and to ensure that it is appropriately directed. The third thing is, as we redesign health systems, there was a comment made earlier on that health systems must be designed around people and not around programs, and that very much resonates with how we see things. We need to ensure that as we integrate, that we don't continue any form of zero-sumness in our approach to financing. It may be messy, it has to evolve, and it must be responsive to the needs of people. It must ensure that it's equity-focused and that rights are important and upheld, and that it also brings multiple stakeholders together from both the public sector, the private sector, and the communities. So in conclusion, what we've seen has been the importance of preparing being realistic, looking inwards to mobilize more resources, but also realizing that there are opportunities in this crisis to actually benefit from an actuarial dividend where we can expand benefit packages and ensure that priority conditions are integrated into it, and also ensuring that equity continues to be the organizing principle around which we rebuild the health system. The health systems that we had before may not necessarily be the health systems that will serve us in this future. And so that means that on the table, all the critical stakeholders have to come together to ensure that indeed the health system that we're building and the way we finance it must be designed around the person and not programs that were vertical the way we were doing it before.

Thank you.

Thank you very much to Dr. Kelechi Ohiri. I would like to link his comments now to Dr. Nonumiso Mkhube, who, if we're just reminded, is from Eswatini's National Emergency Response Council on HIV and AIDS. Dr. Eswatini reached 95-95-95 and has developed a roadmap to sustaining impact, to maintaining life-saving services during a period of funding disruptions. As you shift to reduce dependence and affirm greater ownership of all of this, how are you pursuing integration not as a way to absorb cuts, but as a pathway to sustain gains with people remaining at the center? We keep on hearing about this, about what it means to have people at the center, at the core of everything that you do.

Thank you, Chairperson. Excellencies, distinguished guests, and colleagues. The Kingdom of Eswatini's experience shows that real progress is possible when leadership, partnerships, community engagement, coordination, and integration come together. We are led by a King who is at the forefront of HIV issues. We were very much excited to launch Lenacapavir last year in December, and in January he came out publicly to invite EmaSwati to test for HIV and protect themselves from acquiring HIV by using Lenacapavir. Despite being a small resource-constrained country, we have achieved the UNAIDS targets and we are currently standing at 98, 98, 98, and we have done this through strong political commitment, community ownership, and collaboration with both local and international partners. A key lesson we would like to share is that sustainability must be built early. Over the years, Eswatini has increased domestic financing by ring-fencing funding for antiretroviral therapy. Currently, we are procuring 94% of our ART commodities. We actually have enough funding to procure all commodities, but our pediatric quantities are small, and as such, we utilize other pooled procurement mechanisms for price negotiation. Also, most of our healthcare workers are government-funded, another important step toward long-term sustainability. The second lesson I would like to share is that integration works. We have moved beyond parallel systems by integrating HIV, TB, malaria, non-communicable diseases, mental health, and other services into primary healthcare. With support from the Global Fund, we have procured mobile trucks equipped with X-ray machines and AI-powered diagnostics. Those trucks are helping us to bring people-centered services, including TB, and cervical cancer screening to rural and underserved communities who need the services the most. Another lesson is that strong coordination matters. As a country, we have maintained the model of having a National AIDS Commission, which operates as a coordinator for the HIV response. The NAC has helped us integrate through cross-ministry coordination with clear roles, shared priorities, in one common results framework. Our message to other countries is this: invest in country ownership, strengthen domestic financing, integrate services into resilient primary healthcare systems, and also build strong coordination mechanisms. These are essential not only to sustain HIV gains but also to respond effectively to broader broader health challenges with limited resources. As I close, I want to say that we celebrate with the successes with caution because we witness about 402,000 new HIV infections per year, and most of those are recorded amongst young people, particularly adolescent girls and young women. Working with various stakeholders, sectors, ministries, communities in a multi-sectoral approach, we are strengthening our prevention programs, including addressing social and structural barriers that continue to disadvantage our populations. As a collective, let us continue to strengthen interventions that have proven to work while we embrace new technologies that will lead us to ending AIDS as a public health threat by 2030. I thank you.

Thank you very much, and thank you also to all of our speakers in this first panel. As they leave the stage, we ask all the Panel B speakers to come up as we listen to Ambassador Mark Dybul of Georgetown University, where he serves as a professor of medicine. Let's listen to his comments now.

Hi. Sorry I can't be with you in person. Thanks for including me. When we talk about transition, I think it's important to always begin with what are we trying to transition to, and that is country sovereignty, but in a new international system with solidarity of equality of partners and partnerships. And in health, that means transition to universal health coverage, sharing of ideas, sharing of technology, sharing of, of how we grow together, not with— to achieve less health with less money, but more health with less money across all categories, across all things— HIV, TB, malaria, maternal-child health, non-communicable diseases, everything. And that can be done, as you've been talking about, I'm sure, through integrated systems, country-owned systems. How do we get there for transition? 5 quick points. One, we have to recognize that countries are at different stages on their journey to independence from external financing. Some can do it within 5 to 7 years and there are about half— a dozen or so that can. Others will take 7 to 12 years and some will be in humanitarian crises and it's not linear. Countries that are doing well could slide back. So we have to have flexibility as we move along but how we have to understand that countries are starting in a different position and therefore the— what we— how we transition and how the countries transition will be quite different. Second point is how transition happens will look fundamentally different in each country depending on their own governance structures, their— how government and non-governmental actors work together, their current mix of international partners, finances, debt, many other things. So we can't have a one-size-fits-all. Third, one thing each country does need is some all-of-government, some all-of-society mechanism to act in real time to data and respond, react, pivot so that they can achieve their goals. And that mechanism has to be embedded within some structure, likely the government, so that it survives changes in personnel. We have so many strong personnel in office right now, but they're going to change. And they'll change down to the director level, down to the regional officers, down to the people managing districts. And so, it has to be an all-of-government, all-of-society system that also responds and ensures that the most at risk are covered and that the whole system is moving together. Otherwise, transition won't happen. Pieces might happen, but the whole transition won't. Fourth, a community of practice across countries to learn from each other, to share lessons that will accelerate the ability to transition. Especially if failures are shared, which we're not very good at. The fifth is an independent accountability mechanism. And this is critical and probably where we failed in the past. The accountability mechanism has to include countries. What are countries responsible for? International organizations. What are international organizations for? And in that, I would include philanthropies and many others. And the third is that an account— that accountability mechanism. What are they responsible for? And importantly, civil society needs to be deeply engaged in that or we will fail. In the end, it's going to take a lot of flexibility, a lot of learning, a lot of willingness to change. And a willingness to change is essential to all of this. But this period reminds me of 2000 when all these massive things happened that so much has been achieved through that almost everyone thought was impossible. So as we look to transition, many people are saying, "Oh, that's impossible, can't be done." It absolutely can be done. And just like 2000, if we all work together, if we're all united in solidarity again, we can achieve a better world and in fact the world we've been promising for 25 years. Thank you very much for allowing me to be with you and have a great meeting.

Thank you to Ambassador Mark Dybul. We're going to jump straight into our next panel and because of the shortage in time, I'm going to skip the overall introductions and go straight to them one by one. We're going to start with Dr. Bill Steiger, who is the CEO of Malaria No More, whose experience spans diplomacy, partnership building, finance, and program integration, both across infectious diseases but also health systems. Dr. Steiger, a disease that rebounds fast if attention slips is malaria, of course. As the programs integrate international systems, How can partners bridge the financing and innovation gaps to protect the most vulnerable and hold the line on progress? And we're going to ask everyone to keep their comments only to 2 minutes, please.

Great, thank you so much, Chair. I will give you 5 quick big ideas in 2 minutes. The first is that if you only remember one thing that I have to say, it should be that we will know whether integration is working or not because of malaria. Malaria is the barometer. As the chair alluded, it is the disease that bounces back first, that responds the best and the fastest to both action and interaction. Idea 2: Integration will not work without the deliberate application of innovation. We've seen greater innovation in HIV, TB, and malaria in the last 18 months than we have in the previous 30 years, but we are not planning or budgeting properly to deploy these breakthroughs efficiently and at scale. Idea number 3: community health workers are the integrators who will bring innovation—these innovations—to families. They are the delivery platform for primary health care, as we've heard again and again this afternoon, as part of a broader package of care. There are excellent models across the African continent, and they have the linkages, the ties and increasingly the knowledge to be not only the line of defense for individual families, but the line of defense for all of us in health security, because the common denominator that they see and understand, and when properly equipped can differentiate, is fever. They know and see and deal with fever faster than anyone. Idea number 4: The public sector is not enough. We need to include and activate private sector channels, community pharmacies and drug shops, among others, because they're the greatest access points, the first access points for the people who need these interventions most quickly. But also, as we heard the Executive Director of UNAIDS say, community-based and faith-based organizations are essential. I will quote her again: 'Integration must be about bringing them back.' Idea 5: Integration will only work if it saves time, and eventually money. Integration most importantly must save the time of clients, including by bringing services to them, as we heard in the example from Ms. Watini, and of the health system as a whole. But integration might not save time for every provider, like community health workers, as we ask them to do more things in each visit. And integration might not save money right now, right away, as there are upfront costs to many of these reforms. But they will lower costs going forward. So, what needs to happen? Four quick ideas. We need to empower frontline health workers, especially community health workers, even more. Have them do more. We need transparent publication of disaggregated data on impact, not process, to allow, as Mark Dybul said, governments and partners to identify and fill gaps and understand progress and challenges. Even as we integrate services across conditions, we must continue to track results by conditions and diseases. We need to use new technologies that combine and analyze data to target new tools to the areas and communities where they can have the greatest impact. We will not have the resources to do everything everywhere, and the data suggests we do not need to. And finally, we need regulatory reform at the national level and at the international level, including at the World Health Organization, to speed access to innovations that lend themselves to integration. Thank you, Chair.

Thank you very much to Bill Steigers. If you may or may not notice, the nameplate's not quite in the right order. Bill's not obviously not Mareike, unless you haven't told us something else and there are typos in these names as well. But there is— there are, due to some capacity challenges today here, please excuse these nameplates and use your imagination to integrate us into different names. Thanks very much, Dr. Steiger. Let's give 2 minutes now to Janet Guinard. Janet, you're the Director of Strategy at UNITAID. How can multidisease testing platforms break the silos between HIV, TB, and malaria at community level? And when you really think about it, what are the main regulatory or supply chain bottlenecks towards scaling them up?

Thank you, James, and thank you to the conveners of this event. I'll start by slightly reframing the question, and it's in response to some of the points we'd heard from previous speakers. When we talk about integrated diagnostics, we should start with the person, not the technology. Last week, I was in Nigeria on behalf of Unitaid, together with leadership of the Global Fund and RBM, and we were there on a malaria visit. And what struck all of us was something very simple, that people do not experience HIV, TB, malaria, maternal health, or cervical cancer as separate programs. They experience one health system. So it's been said by several before me, the same person who comes to a clinic or is reached by a community healthcare worker may have needs that cuts across multiple conditions. So members of a community are not living in disease silos. Those silos are largely an artifact, a reflection of how programs and financing has been organized. So the opportunity is not simply to introduce a new diagnostic technology, it's to redesign services around people's needs. So in many ways, this is not new. For years, the HIV response has been demonstrating the value of integration, the need for integration. Lucica said it, we know TB is the biggest killer of people living with HIV. We know that women living with HIV are 6 times more likely to experience or acquire an HPV infection and 6 times more likely to develop cervical cancer. With advanced HIV disease, we see the need for diagnostics and care across multiple opportunistic infections. And of course, elimination of vertical transmission will happen only with antenatal care that delivers care and services across HIV, syphilis, hepatitis, and chagas. So integration can succeed when it builds on where people already seek care and when expansion doesn't dilute the strength of the focused disease programs. What's different today is that we're experiencing— we're seeing a very exciting period of innovation in diagnostics. So, new, near point-of-care and multi-disease testing platforms that have the potential to allow a frontline healthcare worker to screen for several conditions during a single clinical encounter, reducing misdiagnosis, repeating— reducing repeat visits, and reducing loss to follow-up. But one of the lessons that we've learned and embraced at Unitaid is that technology alone doesn't create integration. What creates integration is clear thinking about a clear use case. So a use case, what does that mean? It means understanding where a product will be used, by whom, for which populations, who procures it, with which funds, and how it fits into existing care pathways and services. So, that use case definition is what allows regulators to assess products, manufacturers to invest and remain engaged, countries to plan procurement, and government and financing partners to support sustainable scale-up. So, that does bring me to the barriers, James. The biggest bottlenecks are often not technical. Systems for generating evidence, developing guidance, planning procurement, financing scale-up, but they're still often organized around individual disease programs, and integrated products require a much more coordinated approach. So, manufacturers need that confidence that there will be sustained demand. Countries need evidence that integrated approaches deliver value that saves time, works with current workflows, and increases health outcomes. And procurement and supply systems really have to be able to support products to serve multiple programs rather than just one. So that's exactly why Unitaid is launching new investments to support integrated diagnostics, not because we believe that integration starts and ends with a new test or a new product, but because we believe that innovation can really help accelerate a broader shift towards people-centered care. So if we can define the right use cases, align evidence and guidance around them, and create sustainable pathways to scale, scale, there are technologies that can be powerful enablers of integrated services across HIV, TB, malaria, and beyond. Thank you.

Thank you, Janet. Let's move straight on to Dr. Judith Nkisa Baraso, who's from the Kenya Medical Association and Commonwealth Medical Association. Doctor, what will it take to equip, support, and retain the frontline workforce that makes this transition work, and how can medical associations help safeguard quality of care for the most vulnerable.

All right, thank you, James, and Your Excellencies and distinguished guests, all protocols observed, thank you. From a healthcare perspective, allow me to speak today from the perspective of the Commonwealth Medical Association and also representing the medical associations across the Commonwealth. We all know that the Commonwealth is home to almost one-third of the world's population and carries the disproportionate burden of infectious diseases, recurrent epidemics and pandemics, and also an increasing burden of climate-related health emergencies. Similarly, similarly as well, a lot of our countries still struggle with shortages, maldistribution, and migration of healthcare workers. And the staff that are supposed to see these very technical diseases. We cannot continue to ignore the dynamics of the health workforce, especially in such disproportionate countries. So one lesson is clear: integration is very much welcome, but the health system, whether it succeeds or fails, is solely based on the strength of the health workforce. So what would we want to see as the healthcare workforce? Uh, we need to equip the staff. We need to invest in evidence-based health workforce planning and intelligent systems. We need to train the health workers for an integrated team-based community-oriented primary healthcare. We need to build the competencies in digital health, epidemic preparedness, and management of both TB, malaria, and HIV, and of course with continuous professional development and leadership training. What we see is that the workforce we trained for yesterday's challenges cannot meet tomorrow's health needs. With integration, it has come with a lot of need and uncertainty, especially in the health workforce. And so it is very paramount that we prioritize the healthcare worker, their well-being, and the mental health. We need to ensure safe staffing levels and decent working conditions. A lot of these countries— I will speak about Kenya— I think the doctors, the ratio is 1 to 7,000 patients. And so with integration, that will already poses a challenge to the health staff. We need to strengthen the leadership capacity of this health workforce because, remember, with integration, the areas affected the most came from— is to the patients and also to the health workforce. And I think we've focused so much on how we are going to support the patients, but we tend to forget that there is a very key stakeholder who is the healthcare worker that needs to be in the table, needs to be in the discussions prior on how they're going to integrate the TB, HIV, and malaria. Remember, with integration out of the three diseases, TB is a very unique disease in the aspect of the health workforce because— let me use an example of— one-size-fits-all type of patient care. Please, let's remember that with TB, it is quite different. And so for the health workforce, we need to protect them during any public health emergencies, any outbreaks. We need to address the workplace safety. Remember, TB is really, really strengthened when it comes to IPC measures that are taken into care. And we all know that in most of these countries, or most of our public facilities or private facilities in such countries, are not really well designed or are not equipped to take care of IPC issues when it comes to some of these diseases. So we also need to take that into into care, and it will enable us to build a resilient health system and a resilient health workforce. Finally, as I finish off, we also need to address the inequitable distribution of the health workforce and invest in fair recognition and incentives for this workforce. So how can the medical associations also come in? I believe that the associations advocate for greater investment of the human resources, safeguard the quality through professional standards and continued dedication, and amplify the frontline voices in workforce policy and planning when it comes to the integration of these three diseases. So thank you, and I will end there. Thank you very much.

And finally, let's go to Dr. Marika Weinrocks, Head of Strategic Investment and Impact Division at the Global Fund, a leading donor reshaping how it accompanies transition. And whilst Dr. Weinrocks is speaking, may we invite Philip Nyakwana from the Movement of Men Against AIDS in Kenya to join us up here? You are here. You preempted me. Okay. Let's go first to Dr. Marika Weinrocks, and Philip will provide us with some closing reflections.

Thank you, James. And the Global Fund has often been criticized for being too vertical, and you have to acknowledge that the vertical approach has worked, has made tremendous— achieved tremendous results. Since the Global Fund was established in 2002, 70 million lives have been saved. The HIV-related mortality went down 82%, and overall mortality related to HIV, TB, and malaria went down 63%. It also has delivered results beyond HIV, TB, and malaria. We've seen that the investments to fight HIV, TB, and malaria have played a critical role in dealing with other infectious diseases, including COVID-19 and pox, um, and recently Ebola again, and it has resulted in overall system strengthening. With lowering child and maternal mortality as a result. So vertical funds have served an important purpose, but times have changed and we need to change. Programs at country level have matured, as we've heard from all our country speakers. Countries have a real wish to have greater country ownership, and rightly so, and to move towards greater self-reliance and less dependency on external funding. And we have to be realistic, there is less funding, so we have to make sure that we use the available funding the best we can. And then if you look at where we want to be in 5 or 10 years' time, I really would like to see the control of HIV, TB, and malaria is largely funded through domestic resources, and external funding is less, and really catalytic and focused on those elements that national governments can't or won't fund yet. And then integration into primary healthcare is a very logical step forward. And many countries, and we heard from all of the country speakers today, are already moving that direction. So, for the Global Fund, it's really about looking what we can do better and differently to support countries to do that. So, for the grant cycle 8, the integration in primary healthcare is a key strategic shift. And we have aligned all our tools to make that easier for countries, including some greater flexibilities for a subset of countries to decide how they want to spend the funding across diseases. And there's an important linked strategic shift, which is the community systems strengthening and financing. It's important the high level of dependency of community systems dependence on external funding has been a major risk and a major vulnerability. So it's important that those community systems are better linked to the formal health system, but also that increasingly those services are funded from domestic resources. So moving towards social contracting, which a number of countries I heard are doing as they submit their proposal for GC8, to allow for— to make sure that everyone has access. We need to address stigma and discrimination and make sure that access for those who are most vulnerable remains intact. We also have— we will be working with countries to consolidate implementation arrangements so that the program management cost can be reduced and more money will be available for implementation. In most countries, it means working more with ministries of health and funding through national systems and on budget, there'll be default wherever that's possible. We're also working more closely with partners, including GAVI, the World Bank Global Financing Facility, and key bilateral donors to optimize all the available resources for maximum impact and aligned with national country plans. And ultimately, what we really want to achieve is to deliver better coverage of of people-centered services at lower cost and on a more sustainable footing.

Thank you. Thanks. Let's go now, because we need to leave this room very shortly and everyone needs to get back to the General Assembly Hall. Philip Nyakwanes from the Movement of Men Against AIDS— Philip, you know, can help us to ground sustainability in the realities of community. Philip, we're going to give you some time for the closing reflection,, and I know that Winnie Byanyima would like to say a word at the end as well.

Thank you. Thank you very much, Chair of the session, colleagues, those who have spoken before me. I'm Philip Nyakuana, and I want to take this opportunity to speak as someone who has felt the impact of the three diseases and someone who also has been at the center of the response in terms of community engagement and involvement across the TB, HIV, and malaria in Kenya. I come from Kenya. So in my reflection, I will be sharing, at the same time asking some questions, and allow my questions, whether they come out of ignorance or not, because wherever we have the integration conversation, even currently in the GC8, which is ongoing, and I keep on asking questions that why are we talking of the integration now? And most of the time the answer is because Global Fund— it's a requirement for GC8 implementation. Then the question is, whose agenda are we implementing? Integration is whose agenda? Is it a donor agenda? Is it country agenda? Or is it a global agenda? So these are issues that we may need answers around them as we go on with our integration agenda, and that comes with a definition. Again, if you ask people, "What is your definition?" If we close our eyes in this room and ask each one of us their definition of integration, we may end up having different answers for integration. Then why? There's something which is missing in our integration conversation. And the missing point is the framework. Do we have an integration framework at the global level that can be cascaded to respond to the country needs? I think we need to have a conversation by looking at the framework that we have at the global level. I hear people speak here and people talk about nice things— communities at the center, civil societies at the center,— which part of the centre are they? Are they at the front centre, the back centre, or the centre of the centre? Because those are some questions and some issues that we must ask because they define how we engage. But the question again is, if we are at the centre, what community engagement framework are we using that has the indicators that we can come and ask ourselves that our communities are at the centre, and if we can measure those indicators, you can say out of 10, we are at 8, because we cannot have an engagement without the oversight. We cannot have the engagement without the parameters, the indicators. So which are our integration indicators that we can say one year down the line, two years down the line, in terms of maybe resource mobilization, this is where we are. 'in terms of community engagement, this is where we are, and therefore, we are on the right track.' So if we don't have that, then we risk operating like a marketplace where you come and everybody sells the way they want, but we all say we are doing integration. Our integration is based on what? That is a question that we may need to ask ourselves. Most of the times we say that In this integration, who is taking the leadership? Is it UNAIDS? Is it Rollback Malaria? Is it— I can see Winnie is nodding, shaking his head. So who is taking the leadership of integration agenda? Because that must be asked and that must trickle down from bottom or up to bottom or bottom to up. So we must also know that who is leading this conversation and how do we fit in, all of us, as we move. And that comes with the resources. I think I've been reminded that time is not on our side, but listening to our integration conversation, we put a lot of emphasis on systems. They are the system integration, operational efficiencies,— and such kind of things, with very little emphasis on human rights and gender. We risk, if we don't address some of those issues, and if you have integration that focuses only on systems without addressing structural realities, then we risk reproducing the same inequalities within the new health architect. So how do we address human rights issues as we have conversations around integration. Otherwise, we might move there because resources are not there, but by the end of it, we'll have created more damage than good. So how do we integrate human rights? And as we— if you rightly put, Kipo, we need to have communities, we need to have civil societies at different levels of this conversation, at the global, at the country level, and at the community level, where we draw their experiences, we draw There are lessons learnt, we listen to them. But finally, integration is not a 100-meter sprint, it is a marathon. Thank you. Where we must have a way of checking our processes and how they address and respond to the needs of the communities. Thank you so much.

Thank you so much, Philip. As everyone is moving in for the 3 PM session, and to be fair to them, I'm going to wrap up over here. And ask Winnie Byanyima to close. So thank you to everybody as we make our way out and thank you to Winnie.

Good. Thank you very much for excellent moderation and for our panelists for your insights. It's very clear the question was put by the Kenyan delegate that what is integration For me, it's clear from what I've heard, it's really the pathway that a country chooses towards achieving its health sovereignty. So it's a political direction, it's a political agenda. Our role, all of us are there to support governments to achieve that. How we calculate our role and play it is very important. In the support we provide. We have also seen that integration takes us out of the health sector to finding solutions in so many other places. We've heard about procurement systems and how to change those so that there are— there is cost efficiencies realized. We've heard about local production, local production of medicines. This takes us the whole debate on both procurement but also on transfer of technology. So we see that there are many areas of work to support integration. Dibul— Mark Dibul gave us a technical agenda of things to do for integration. Very good, but we know that it's more than those technical aspects. It's a lot of other areas. Outside the health sector. I want to thank everybody who— oh, lastly, that because it's a very political process, it's so important for us to engage with regional organizations that are supporting their countries towards health sovereignty. The Africa CDC, in the case of Africa, is very important in shaping these journeys towards health sovereignty. As we conclude, I want to thank our partners, Roll Back Malaria, Stop TB, and all the others whom we've worked together for this session. Integration is really an issue we must continue this conversation on. As Lucica said, we're spending so much time discussing global health architecture reform. Which is just about ourselves and how we organize ourselves. We could spend more time reflecting on how best to support countries to achieve their health sovereignty through integration. Thank you so much.