Reality Check for Global Fund

Julian Meldrum
Published: 29 November 2001

As the Global Fund to fight AIDS, TB and Malaria (GFATM) emerges from earlier proposals for a Global AIDS and Health Fund, it is clear this new "funding mechanism" still has a long way to go to prove itself. Difficult questions remain unresolved, though the means to resolve them may be getting clearer.

The global context and prospects for increased international aid – especially in the wake of the 11 September attack on New York and Washington – are unclear, though not hopeless.

Finally, as reported at the end of this story, a new campaign is emerging in the UK to ensure that the UK plays its full role in the global effort, including support for the Global Fund.

Transitional Working Group makes progress

Progress, according to Dr Macharia Kamau*, who has been seconded from Botswana by the UN Development Programme to work in Brussels with the Fund’s Transitional Working Group (TWG), has been exceptionally fast. From the final decision to set up the fund, in July 2001, it would take no more than six months, compared to between 18 months and two years to set up UNAIDS, in which he had also been involved.

The 46 member TWG had first met in October and would hold its final meeting in mid-December, after which a new board (see below) would be recruited and then an executive staff. Decisions that still had to be made included the legal form of the GFATM (would it, for example, be an NGO?) and the country in which it would be based for legal purposes.

To make sure that money starts moving as soon as possible to where it is most needed, there would be a "quick start" procedure for funding programmes that had already been planned through schemes such as Roll Back Malaria or Stop TB or existing national multisectoral HIV/AIDS control plans. These grants would need to be made with care, but might not follow precisely the priorities and procedures that would be developed for the longer-term work of the Fund.

Among the issues dealt with by the TWG were the management of the fund, which would involve a board split 7 / 7 / 3 / 1 between donor governments, recipient governments, NGOs and one private sector organisation (probably a non-pharmaceutical multinational company). However, this arrangement would not be "written in stone" and could change over time.

Issues such as technical review of funding proposals, eligibility of countries and other organisations to receive money, and who would be accountable for the way money is spent had required detailed work. But some of the thornier issues have been excluded from the Fund’s immediate remit by deciding that they should be decided inside countries receiving funds.

The "in-country interface"

The basic idea of the Fund is to provide resources for country programmes, led by national governments, but expecting and requiring that other agencies are actively involved in drawing up and implementing plans. It was for countries, not the Fund, to decide on the balance between prevention, treatment and care, and measures to look after children affected by HIV/AIDS. As part of the process, they would need to show how the Fund could be used to support other resources, including "leverage" of extra funding from other sources.

In order to reinforce government’s roles in strategic planning, the Fund would not normally make grants without government involvement. However, there would be exceptions where countries are in conflict, where central government has broken down, or where government has shown itself incapable of working with other agencies. (The question of who would finally make that judgement is clearly important, and to be resolved.)

Funding antiretrovirals

The funding of antiretroviral treatment is definitely not ruled out by the Fund and would depend on the priority it was given within particular countries. Countries were expected to take an integrated approach to prevention, treatment, care, support and impact alleviation - as supported by the Declaration of Commitment of the UN General Assembly Special Session on AIDS.

However, as Dr Kamau observed, the drugs bill for just a couple of the smaller countries in Africa could "wipe out" the whole Fund as it presently stands. The Fund would not implement programmes itself and neither would it be a “procurement agency” for drugs or other products, although it would definitely support country programmes that would then include purchases of such things.

It remains to be seen how the “technical review” process would respond to a country making a major new commitment to antiretrovirals, if those were not already available in that country. One way forwards might be through funding for "operational research" in this area, which is clearly included in the Fund’s remit (although basic research and development of new products such as drugs, microbicides and vaccines is excluded).

Next steps

Pledges so far to GFATM amount to between USD 1.4 and 1.7 billion, some of them spread over three years or more. Dr Kamau said everyone involved knew that this "won't cut it". However, it would have been unrealistic to expect contributions on the scale needed, simply against a promise on a piece of paper. It was essential to get the programme up and running, and to show that it could deliver results, to catch the imagination and secure the confidence of major donors and their electorates. In doing this, organisations of people living with HIV and AIDS and the wider network of community-based and non-governmental organisations had a vital role to play, to "keep the fund honest" and to make sure it was focussed on those in most need.

The fund has targets of USD 7 to 10 billion every year simply to respond to HIV/AIDS – plus at least two billion dollars needed to support the WHO-sponsored campaigns to Roll Back Malaria and Stop TB.

It is recognised that there are wider health needs, many of which can only be addressed by alleviating poverty. The Fund would take account of the need for linkage between health programmes and poverty reduction strategies, but it would not and could not solve such problems directly. "The Fund will not be all things to all people because it can't be."

Dr Godfrey Sikipa, UNAIDS coordinator for Central and Southern Africa, observed that some countries were recognising that they needed to strengthen their monitoring and reporting capability before they would be in a position to make effective use of extra funds, and had decided to delay applications until they had achieved this. NGOs, community-based organisations and people living with HIV and AIDS themselves had a crucial role to play in helping to devise effective monitoring and evaluation systems.

The broader context

In a 16 November speech to the US Federal Reserve Bank in New York the UK’s Chancellor of the Exchequer Gordon Brown called for a massive expansion of international aid for health, education and other public investment for poverty reduction.

Specifically for health, the Chancellor spoke of the need for an additional USD 10 billion a year in international development aid, alongside similar funds to cover other priority areas. In doing this, he was picking up some of the recommendations of a report on financing for international development prepared for the UN by former Mexican President Ernesto Zedillo.

The Zedillo report is in preparation for an International Conference on Financing for Development, due in Monterrey, Mexico, on 18 – 22 March 2002. The report says this should lead to a renewed effort to achieve the long-declared target of 0.7 per cent of GDP for international development assistance, which would mean a global increase of 100 billion dollars. It also argues for more use of international mechanisms (global funds), to ensure it is not tied to the supply of goods or services from donor countries but is focussed on meeting the needs of recipient countries.

Stop AIDS Campaign Launched

A group of leading international development agencies, including aidsmap partner the International HIV/AIDS Alliance, together with the UK’s National AIDS Trust and African HIV Policy Network, have combined to launch a campaign on Britain’s role in responding to the global HIV/AIDS pandemic.

Their website at features an online petition to Chancellor of the Exchequer Gordon Brown calling for a five-fold increase in the UK’s contribution to addressing HIV/AIDS globally, including through the Global Fund.

*Dr Kamau was speaking at a meeting organised on 29 November by the UK’s All-Party Parliamentary Group on AIDS and Population Concern.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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