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The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria (often commonly called "The Global Fund") was established in January 2002 to dramatically increase global financing for interventions against the two pandemics (malaria is actually endemic). It is the largest international funder of programs to combat malaria and tuberculosis, providing two-thirds of all financing, and provides 20% of all international funding to combat HIV/AIDS. The Fund asserts that as of June 2007, 1.9 million lives have been saved thanks to efforts in 136 countries supported by the Global Fund.

Founding

The genesis of the Global Fund is with an article published in the British medical journal, The Lancet, by Harvard academics Amir Attaran and Jeffrey Sachs. They in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those which the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream "of $7.5 billion or more ... directed toward funding projects which are proposed and desired by the affected countries themselves, and which are judged as having epidemiological merit against the pandemic by a panel of independent scientific experts". Attaran and Sachs also recommended that the new funding stream "must be based on grants, not loans, for the poorest countries", unlike the World Bank, which was the largest multilateral HIV/AIDS funder then existing.

The decision to create the new funding stream was taken by heads of state at the 2001 G8 Summit in Genoa (Italy), at the urging of United Nations Secretary General Kofi Annan, and largely along the lines Attaran and Sachs described. The first Secretariat was established in January, 2002, and Richard Feachem was appointed as its first Executive Director in July of that year. The September 2005 conference in London mobilized 3 billion euro, just over half the pledges at the Gleneagles G8 summit. In December 2002 the fund made its first disbursement to grantees.

The United States is contributing $700 million to the fund, but has decided to divert the bulk of its AIDS funding to the President's Emergency Plan for Aids Relief, PEPFAR, in order to more closely control the allocation of funds. The Bush Administration has been criticized by the Democrats for allocating funding for abstinence-only prevention programs that are not proven to effectively reduce infection rates, and for refusing to purchase cheaper generic drugs that would allow for more treatments than more expensive brand-name drugs.

The Global Fund is the first organization of its kind, incorporated as a Foundation under Swiss law. It is a new kind of public-private partnership but is often confused as being part of the United Nations family. This may be because the World Health Organization (WHO) provides many administrative services to the Global Fund secretariat and is also based in Geneva, Switzerland.

Operation

A characteristic of the Global Fund that has drawn much praise is the transparency of the organisation. The amount of information available on the Global Fund's processes, including quite sensitive decision making processes, is available from their official website.

Importantly, the Global Fund is a financing mechanism rather than an implementing agency. This means that monitoring of programs is supported by a Secretariat of approximately 250 staff (in 2006) in Geneva. Implementation is done by Country Coordinating Mechanisms which are committees consisting of local stakeholder organizations in-country that include some or all of government, NGO, UN, faith-based and private sector actors.

The Global Fund provides initial grant funding solely on the basis of the technical quality of applications, as evaluated by its independent Technical Review Panel. It provides continued funding to programs based solely on the basis of performance.

Grants are signed for an initial period of two years. Disbursements after the initial 6-month period are only provided after proven performance, and funding for subsequent years after the initial two-year period is only approved after rigorous review of results achieved.

The objective of the Global Fund - to provide funding to countries on the basis of proven performance - makes it different from any other international agencies that fund programs in the developing world. All other organizations, for example, the World Bank, the WHO and UNAIDS and many bilateral donors, provide funds and oversee implementation of programs. The focus is on recording what money has been spent on, rather than what targets have been achieved. Programs can normally be extended, sometimes indefinitely. These organizations have hundreds or thousands of staff which assist with implementation of grants. Due to the apparent lack of progress in stemming and mitigating the effects of the three diseases under existing mechanisms, the Global Fund to Fight AIDS, Tuberculosis and Malaria was set up.

Bilateral donors immediately pledged millions (in some cases billions) of US dollars in support of Global Fund programs. The innovative approach to its financing principles is obviously considered key to its success. Since its inception, the Global Fund has committed US $7 billion to more than 540 grants in 136 countries (as of Dec 2006).

Notable events

In January 2006, Bono and Bobby Shriver announced the launching of the Product Red campaign, proceeds from which would go to the Global Fund.
In August 2006, the Gates Foundation contributed $500 million to the Global Fund, calling the fund "one of the most important health initiatives in the world".
In March 2006, Executive Director Richard Feachem announced his intention to step down, as soon as his successor was determined by the Global Fund Board. In April 2007, Dr. Michel Kazatchkine became the Global Fund's new Executive Director.

References

'Replenishing the Global Fund: An Independent Assessment' by Keith A. Bezanson (2005); website of the Global Fund to Fight AIDS, Tuberculosis and Malaria.