The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) is an international financing organization that aims to "[a]ttract and disburse additional resources to prevent and treat HIV and AIDS, tuberculosis and malaria." A public-private partnership, the organization maintains its secretariat in Geneva, Switzerland. The organization began operations in January 2002. Microsoft founder Bill Gates was one of the first private foundations among many bilateral donors to provide seed money for the partnership.
The Global Fund is the world's largest financier of AIDS, TB, and malaria prevention, treatment, and care programs. As of May 2017, the organization had disbursed USD 33.8 billion to countries and communities in need for these programs. According to the organization, as of 2016 it had financed the distribution of 795 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 17.4 million people, supported 11 million people on antiretroviral therapy for AIDS, and saved 22 million lives worldwide.
The Global Fund is a financing mechanism rather than an implementing agency. This means that programs are implemented by in-country partners such as ministries of health, while the Global Fund secretariat, whose staff only have an office in Geneva, monitor the programs. Implementation is overseen by Country Coordinating Mechanisms, country-level committees consisting of in-country stakeholders that need to include, according to Global Fund requirements, a broad spectrum of representatives from government, NGOs, faith-based organizations, the private sector, and people living with the diseases. This system has kept the Global Fund secretariat smaller than other international bureaucracies, yet it has also raised concerns about conflict of interest, as some of the stakeholders represented on the Country Coordinating Mechanisms may also receive money from the Global Fund, either as grant recipients, sub-recipients, private persons (e.g. for travel or participation at seminars) or contractors.
Video The Global Fund to Fight AIDS, Tuberculosis and Malaria
Creation
The genesis of the Global Fund emerged during discussions between donor and multilateral agencies toward the end of 1999, leading up to the July 2000 G8 Summit in Okinawa, Japan. During that time, under the leadership of the World Health Organization, discussions were initiated with donors and other United Nations agencies concerning the creation of a new global health fund to help achieve these targets. Just prior to the Summit, WHO publicly called for a "massive effort to tackle infectious diseases" and for creation of "a new mechanism to take proven interventions to scale. The mechanism would achieve internationally agreed targets to cut TB and malaria mortality by 50%, and HIV infection by 25%."
The concept for this WHO initiative - initially called the Massive Attack on Diseases of Poverty (or sometimes just "MAD-OP," for its ambitious aspirations) - was shared by the WHO Director-General's office with its Cabinet in December 1999. The original concept suggested tackling "malaria, tuberculosis, unsafe pregnancy, AIDS, diarrheal diseases, acute respiratory infections and measles." It also called for increased efforts to eradicate or eliminate Guinea Worm, polio and leprosy by 2005, and make "monumental improvements in the delivery of effective and responsive health care." In a subsequent memo to WHO Cabinet Members and Regional Directors on March 14, 2000, the concept paper included reference to potentially new resource mobilization possibilities, noting that, "Partners could indicate that they are preparing to be in a position to handle at least (an additional) $15 billion over the next five years." By that time, the concept had evolved to concentrate on a smaller group of illnesses: tuberculosis, HIV/AIDS, malaria, unsafe childbirth and vaccine preventable diseases.
By the time of the G8 Experts' Meeting on Global Health Issues in April 2000 in Tokyo, the group of diseases had been narrowed even further. "The discussion focused on the three major infectious and parasitic diseases, HIV/AIDS, TB, and malaria which were identified as the highest priority areas among others through the G8 process."
At the Okinawa Summit, G8 nations for the first time established measurable global targets for addressing AIDS, TB and malaria. Immediately following the Summit, WHO went on record stating that the G8's commitment to fight AIDS, TB and malaria would cost at least USD 25 billion over the next five years, suggesting that 60 percent of this funding should be spent on HIV/AIDS, and the rest evenly split for campaigns against TB and malaria.
In July 2000 at the XIII International AIDS Conference, 2000 Jeffrey D. Sachs, then Chairman of the WHO Commission on Macroeconomics and Health, called for a global fund to fight AIDS. On September 28, 2000, the European Commission, WHO and UNAIDS announced that they were taking a common stand against the epidemics of HIV/AIDS, TB and malaria in the developing world. "I want to see the EU playing a larger and more effective role in assisting developing countries to confront these epidemics," said the President of the Commission, Romano Prodi.
In October 2000, WHO and the city of Winterthur, Switzerland convened a Massive Effort Advocacy Forum to engage over 200 public agencies, private sector and civil society organization in a process of building ownership and support to massively scale up donor funding to fight diseases of poverty. The city of Winterthur agreed to pay for the venue and lodging of all Massive Effort guests. Speakers included Brundtland and Swiss President Ruth Dreifuss, in addition to Prof. Jeffrey Sachs via satellite. This subsequently led to WHO, Credit Suisse/Winterthur Group and the Swiss/Kenyan NGO Double Incentive Project (DIP) establishing and funding the Massive Effort Campaign, for the short term purposes of igniting, jump starting and building global support the fight against AIDS, TB and malaria.
For its initial year in WHO's parlance, the concept of a "massive effort" was a thunder clap that drew many important decision makers into the discussion. But as the creation of a well-resourced Global Fund grew more realistic, the phrase increasingly began to sound to some ears as foreshadowing of a WHO proprietary initiative, which was not the organization's intent. The phrase was gradually abandoned within WHO, and led to the Massive Effort being spun off as a new AIDS, TB & malaria advocacy NGO.
During the final months of 2000 and early 2001, political jockeying over who might host the Global Fund intensified. Many initially assumed hosting the Global Fund was WHO's end game. On August 19, 2000, The Washington Post reported that "Clinton Signs Bill Establishing Global Fund to Fight AIDS," effectively intending to locate it inside the World Bank.
According to The Washington Post, "President Clinton signed a bill today that sets up a global trust fund for AIDS patients that has been likened to a kind of Marshall Plan against the infectious disease." Soon thereafter, UNICEF's Carol Bellamy suggested that UNICEF was better equipped to know "How to Distribute AIDS Drugs" in her March 2001 The New York Times op-ed.
An article published in The Lancet by Harvard academics Amir Attaran and Jeffrey Sachs in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream of USD 7.5 billion or more to fund projects proposed and desired by the affected countries themselves, and that a panel of independent scientific experts validates as having epidemiological merit against the pandemic. 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.
In April 2001, GlaxoSmithKline CEO Jean-Pierre Garnier called for a "Marshall Plan" to fight AIDS in Africa.
In April 2001, an informal meeting of "stakeholders including some G8 and non-G8 members, representing different constituencies," was hosted by DFID and CIDA in London, to discuss the proposed "Global Fund for Health and AIDS." A number of potential options were on the table, including the "Ottawa Fund," a UNAIDS concept paper submitted on behalf of all UN agencies, and a proposal by Italy, which was about to host the upcoming G8 Summit. According to the minutes of the meeting, the aspirations of the group were to focus on HIV/AIDS, malaria and TB, with the potential to expand to other health conditions including children's illnesses and maternal health. This fund would be characterized by "highly visible operating systems, transparency of processes, the relentless pursuit of results, speedy disbursement, support for a diversity of service providers (including faith-based organizations) under common (usually national government) stewardship. Investors would be able to top predict the likely impact of their investments." It was noted the following week in a video conference with the UN Secretary General's office that, with the possible exception of France, "none of the bilaterals are keen to support an HIV/AIDS specific fund."
On April 26, 2001, in Abuja, Nigeria, at the urging of a wide range of parties--and particularly due to the emerging consensus among bilateral and UN agencies, the UN Secretary General Kofi Annan made the first explicit public call by a highly visible global leader for this new funding mechanism, proposing "the creation of a Global Fund, dedicated to the battle against HIV/AIDS and other infectious diseases." A month later, The Economist editorialized that "...the fund itself must not be devoured by a voracious UN bureaucracy. Mr Annan wants an independent board to administer the money... (and that) the amount of money needed, after all, is not huge: it is about half America's annual spending on pot-plants and flowers."
The first private contribution to the Global Fund was made by Kofi Annan. Having just been named the recipient of the 2001 Philadelphia Liberty Medal in May 2001 Annan announced he would donate his USD 100,000 award to the Global Fund "war chest" he had just proposed creating. On May 8, the International Olympic Committee made a USD 100,000 contribution.
In an address during WHO's World Health Assembly in May 2001, WHO Director-General Gro Harlem Brundtland described the challenges of going to scale smartly yet rapidly. "The timetable is necessarily a tight one. You might say that we are going to have to sail in the boat, while we are still building it. But the world is not going to wait while we get every detail in place." There was strong pressure that the Global Fund become operational by the year's end."
South Africa's Minister of Health gave notice that support from the Global Fund might not be welcomed in the single country home to the most HIV infections. "South African Health Minister Manto Tshabalala-Msimang told the conference a global fund being set up to fight AIDS, TB and malaria should not be used to force AIDS advisers on the region. 'We know what AIDS is and we know what is happening here. The region has its own experts on AIDS,' she said.
The decision to create the new funding mechanism was expected to be 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 WHO, Attaran and Sachs described. The United Nations system had been considered ill-conceived to implement a major increase in development funding. Multiple organizations were converging with small-scale projects on countries with limited institutional capacities, which exacerbated a series of problems, including poor coordination, duplication, high transaction costs, limited country ownership and lack of alignment with country systems.
Before the start of the Genoa G8, the United States, Britain and Japan had already contributed USD 200 million each, France had committed USD 127 million, and the Bill and Melinda Gates Foundation had committed USD 100 million. In July, Germany announced its contribution of USD 131 million. On July 18, Canada committed US$100 million and the European Commission agreed to a Euro 120 million contribution. On July 20, Russia contributed $20 million.
The G8 called for the creation of the Global Fund, although pledges were significantly lower than the USD 7 billion to USD 10 billion annually called for by Kofi Annan. According to the G8's final communique, "At Okinawa last year, we pledged to make a quantum leap in the fight against infectious diseases and to break the vicious cycle between disease and poverty. To meet that commitment and to respond to the appeal of the UN General Assembly, we have launched with the UN Secretary-General a new Global Fund to fight HIV/AIDS, malaria and tuberculosis. We are determined to make the Fund operational before the end of the year. We have committed $1.3 billion. The Fund will be a public-private partnership and we call on other countries, the private sector, foundations, and academic institutions to join with their own contributions - financially, in kind and through shared expertise."
In July 2001, Kofi Annan appointed Ugandan cabinet minister Crispus Kiyonga to chair the Transitional Working Group that would establish the Global Fund. The Transitional Working Group was composed of representatives from more than 40 countries, UN agencies, the World Bank, private groups and NGOs, and met for the first time in Brussels in October.
The September 11 attacks created serious challenges for the Global Fund. In the three months prior to 9/11, the New York Times had expressed its support for fully financing the Global Fund in four separate editorials; it wouldn't be until three months after 9/11 that it would again editorialize in support of the Global Fund. According to Timothy Wirth, former US Senator and head of the UN Foundation, "The attacks had a very damaging impact on funding, and we have to get everyone moving again to rebuild that momentum. The victims of Sept. 11, beyond the direct victims of the violence, have been the world's poorest people, particularly those with AIDS. The United States cannot say to the rest of the world, 'Help us' (in fighting terrorism) when we're not willing to help the rest of the world."
Officially operational in 2002, the Global Fund was intended to introduce a new aid paradigm based on partner country leadership, donor alignment with partner countries' development strategies, harmonization of donor actions, managing for results, and donor and partner being mutually accountable for results. This was subsequently conceptualized by the OECD in its 2004 Paris Declaration on 'aid effectiveness'.
The Global Fund's initial 18-member policy-setting board held its first meeting in January 2002, and issued its first call for proposals. The first Secretariat was established in January 2002 with Paul Ehmer serving as team leader, soon replaced by Anders Nordstrom of Sweden who became the organization's interim executive director. By the time the Global Fund Secretariat became operational, the organization had already received USD 1.9 billion in pledges. In the months to follow, the Bush Administration was sharply criticized in the media for promising to pledge only USD 200 million a year. However, within months, under the leadership of President George W. Bush, the President's Emergency Plan for AIDS Relief (PEPFAR) was created with bipartisan support from Congress, becoming the largest commitment by any nation to combat AIDS, tuberculosis and malaria. Fifteen billion dollars was given to a five-year plan running from 2003-2008.
In March 2002, a panel of international public health experts was named to begin reviewing project proposals that same month. In April 2002, the Global Fund awarded its first batch of grants - worth USD 378 million - to fight the three diseases in 31 countries.
Maps The Global Fund to Fight AIDS, Tuberculosis and Malaria
Fundraising
Since the Global Fund was created in 2002, public sector contributions have constituted 95 percent of all financing raised; the remaining 5 percent comes from the private sector or other financing initiatives such as Product Red. The Global Fund states that from 2002 to 2016, more than 51 donor governments pledged a total of USD 38.5 billion and paid USD 37.3 billion. From 2001 through 2016, the largest contributor by far has been the United States, followed by France, the United Kingdom, Germany, and Japan. The donor nations with the largest percent of gross national income contributed to the fund from 2008 through 2010 were Sweden, Norway, France, the United Kingdom the Netherlands, and Spain.
The Global Fund typically raises and spends funds during three-year "replenishment" fund-raising periods. Its first replenishment was launched in 2005, the second in 2007, the third in 2010, the fourth in 2013, and the fifth in 2016.
Alarms were raised prior to the third replenishment meeting in October 2010 about a looming deficit in funding, which would have led to people undergoing ARV treatment losing access, increasing the chance of them becoming resistant to treatment. UNAIDS Executive Director Michel Sidibé dubbed the scenario of a funding deficit an "HIV Nightmare". The Global Fund stated it needed at least USD 20 billion for the third replenishment (covering programs 2011-2013), and USD 13 billion just to "allow for the continuation of funding of existing programs." Ultimately, USD 11.8 billion was mobilized at the third replenishment meeting, with the United States being the largest contributor - followed by France, Germany, and Japan. The Global Fund stated the USD 1.2 billion lack in funding would "lead to difficult decisions in the next three years that could slow down the effort to beat the three diseases."
In November 2011, the organization's board cancelled all new grants for 2012, only having enough money to support existing grants. However, following the Global Fund's May 2012 board meeting, it announced that an additional USD 1.6 billion would be available in the 2012-2014 period for investment in programs.
In December 2013, the fourth replenishment meeting was held in Washington D.C. USD 12 billion was pledged in contributions from 25 countries, as well as the European Commission, private foundations, corporations, and faith-based organizations for the 2014-2016 period. It was the largest amount ever committed to fighting the three diseases.
The fifth replenishment meeting took place September 2016 in Montreal, Canada, and was hosted by Canadian Prime Minister Justin Trudeau. Donors pledged USD 12.9 billion for the 2017-2019 period.
France and French President Emmanuel Macron will host the sixth replenishment meeting in 2019 for the 2020-2022 period.
Leadership
Richard Feachem was named the Global Fund's first executive director in April 2002 and was about to get off to a rocky start days before the opening of the July 2002 International AIDS Conference in Barcelona. According to John Donnelly of The Boston Globe, "Richard G.A. Feachem...is already under fire from activists who want him to quit for saying the fund has "plenty" of money to start. At a critical time in the fight against the three killer infectious diseases, and on the eve of the 14th International AIDS Conference in Barcelona, Feachem is set to begin building an organization almost from scratch while fending off the activists."
Feachem served from July 2002 through March 2007. Dr. Michel Kazatchkine was then selected as executive director over the Global Fund's architect, David Nabarro, even though Nabarro was "considered the strongest of three shortlisted candidates to head the Global Fund ... A selection committee has evaluated the three nominees' qualifications and ranked 'Nabarro first, Kazatchkine second and (Alex) Cotinho third,' according to a Fund source."
In September 2011, the AIDS Healthcare Foundation called for Kazatchkine's resignation in the wake of isolated yet unprecedented reports of "waste, fraud, and corruption" in order that "reforms may begin in earnest." In January 2012, Kazatchkine ultimately declared his resignation, following the decision made by the Global Fund board in November 2011 to appoint a general manager, leaving Kazatchkine's role to that of chief fund-raiser and public advocate. Communications later disclosed by the United States government stated that Kazatchkine's performance was deemed unsatisfactory by the Global Fund board, notably in relation to the funding of activities related to the First Lady of France at the time, Carla Bruni-Sarkozy.
Following Kazatchkine's resignation, the Global Fund announced the appointment of Gabriel Jaramillo, the former Chairman and Chief Executive Officer of Sovereign Bank, to the newly created position of general manager. Jaramillo, who had retired one year earlier, had since served as a Special Advisor to the Office of the Special Envoy for Malaria of the Secretary General of the United Nations, and was a member of the high-level independent panel that looked at the Global Fund's fiduciary controls and oversight mechanisms. Jaramillo reorganized and reduced Global Fund staff in response to the previous year's critics of the Global Fund.
Dr. Mark R. Dybul was appointed executive director in November 2012. He previously served as the United States Global AIDS Coordinator, leading the implementation of the President's Emergency Plan for AIDS Relief (PEPFAR) from 2006 to 2009. Dybul ended his appointment in 2017.
A nominating process to find a successor to Dybul ran into trouble in 2017 because nominees had spoken out against Donald Trump as a candidate for president of the United States. The Global Fund board named Global Fund Chief of Staff Marijke Wijnroks of the Netherlands as interim executive director while the nominating process restarted.
The Global Fund board selected banker Peter Sands as executive director in 2017. He assumed the role in 2018.
Operations
The Global Fund was formed as an independent, non-profit foundation under Swiss law and hosted by the World Health Organization in January 2002. In January 2009, the organization became an administratively autonomous organization, terminating its administrative services agreement with the World Health Organization.
The initial objective of the Global Fund -- to provide funding to countries on the basis of performance -- was supposed to make it different from other international agencies at the time of its inception. Other organizations may have staff that assist with the implementation of grants. However, the Global Fund's five-year evaluation in 2009 concluded that without a standing body of technical staff, the Global Fund is not able to ascertain the actual results of its projects. It has therefore tended to look at disbursements or the purchase of inputs as performance. It also became apparent shortly after the organization opened that a pure funding mechanism could not work on its own, and it began relying on other agencies - notably the World Health Organization - to support countries in designing and drafting their applications and in supporting implementation. The United Nations Development Programme, in particular, bears responsibility for supporting Global Fund-financed projects in a number of countries. As a result, the organization is most accurately described as a financial supplement to the existing global health architecture rather than as a separate approach.
The Global Fund Secretariat in Geneva, Switzerland, employs about 700 staff. There are neither offices nor staff based in other countries.
In 2013, the Global Fund adopted a new way of distributing its funds in countries to fight AIDS, tuberculosis and malaria. Under this funding model, eligible countries receive an allocation of money every three years for possible use during same the three-year period. The total amount of all allocations across all countries depends on the amount contributed by governments and other donors through the "replenishment" fundraising during the same three-year period. The countries, through their "country coordinating mechanism" committees, submit applications outlining how they'll use the allocation. The committees name entities, called "principal recipients," to carry about programs within their respective countries. An independent "technical review panel" reviews the applications. Once the applications are approved, the Global Fund provides funding to the principal recipients based on achievement toward agreed indicators and actual expenses. Performance and expenses are periodically reviewed by a "local fund agent," which in most countries is an international financial audit company.
In March 2010, Dow Jones Indexes signed a memorandum with the Global Fund to explore the creation of co-branded indexes that could be licensed as the basis for investment products. The Global Fund aimed to strengthen its engagement with the private sector, while the Dow sought to add to its range of socially conscious indexes.
Corruption and misuse of funds
In January 2011, the Associated Press reported vast corruption in some programs financed by the Global Fund, citing findings of the Global Fund Office of the Inspector General -- an auditing unit independent from the Global Fund Secretariat -- that up to two-thirds of funds in some of the reviewed grants were lost to fraud. The Office of the Inspector General report showed that systematic fraud patterns had been used across countries. The Global Fund responded to the story with a news release, stating, "The Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds. It deploys some of the most rigorous procedures to detect fraud and fight corruption of any organization financing development."
After the Associated Press story, a number of op-eds, including one by Michael Gerson published in the Washington Post in February 2011, sought to put the controversy surrounding the misuse of Global Fund grants in perspective. Gerson stated, "The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical."
Global Fund spokesman Jon Liden told the Associated Press, "The messenger is being shot to some extent. We would contend that we do not have any corruption problems that are significantly different in scale or nature to any other international financing institution." Subsequent Global Fund statements omitted any reference to other agencies.
Previous reviews of grants and the Global Fund had shown substantial misconduct in some programs, lack of adequate risk management, and operational inefficiency of the Global Fund. Cases of corruption had also been found in several African countries such as Mali, Mauritania, Djibouti, and Zambia.
Sweden, the Global Fund's 11th biggest contributor at the time (2011), suspended its USD 85 million annual donation until the corruption problems were resolved. Germany, the third biggest contributor at the time, also blocked any financing until a special investigation was complete. Funding was eventually restored.
Other cases of abuse of funds, corruption and mismanagement in a series of grants forced the Global Fund to suspend or terminate the grants after such dealings became publicly known in Uganda, Zimbabwe, Philippines, and Ukraine.
In February 2011, the Financial Times reported that the Global Fund board failed to act previously on concerns over accountability including on the conclusion of an external evaluation in 2009 that criticized the organization's weak procurement practices. Warnings of inadequate controls had also been reported periodically. The Financial Times also reported that its own review found that neither Global Fund staff nor "local fund agents" (the entities entrusted with audit-like tasks at the country level) had noticed the deficiencies reported by the inspector general.
In 2012, the Global Fund hired a chief risk officer, Cees Klumper. After pushing countries to reclaim stolen funds from the parties responsible and recovering only about half, the organization began in 2014 as a last resort reducing future grants by twice the amount of misappropriated funds. As of February 2016, this resulted in USD 14.8 million of reductions (collectively) for Bangladesh, Guatemala, Nigeria and Sri Lanka.
References
External links
- Official website
- Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
- Friends of the Global Fund, Japan
- Friends of the Global Fund Europe (Les Amis du Fonds mondial Europe)
- Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria
Source of article : Wikipedia
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