[Ip-health] Guardian: The Global Fund - saved and wrapped in the US flag?

Thirukumaran Balasubramaniam thiru at keionline.org
Thu Jan 26 05:08:11 PST 2012


Sarah Boseley's Global Health Blog

The Global Fund - saved and wrapped in the US flag?

Bill Gates promises $750 million for the troubled Global Fund, its executive director Michel Kazatchkine quits and a new general manager is about to take over. The Fund could be revitalised, but may look a little different

Are we watching the rebirth of the troubled Global Fund to fight Aids, TB and Malaria, perhaps in a new, more US-flavoured guise?

The Fund has been in the mire now for some time after revelations that some of its grants fell into corrupt hands, short of money and unable to agree new grants to developing countries badly in need of disease-fighting programmes. There are real fears not only that countries like Zambia and Malawi will be unable to put more people on Aids drugs (which are now known also to prevent infections) but that they might even run short of cash to keep critical supplies going for those already on treatment.

But the dramatic events of the past few days suggest the Global Fund's fortunes might be on the turn as it hits its tenth anniversary.

Much of this is due to Bill Gates, as is so often the case. Today at Davos he announced a $750 million legally-binding "promissory note" for the Fund, complete with video, starring Bono, which is here. He has never wavered in his support for the Fund. In his annual letter, released on Wednesday, he devoted an entire section to the merits of the Fund, which has saved millions of lives, he said.

The Global Fund does a lot to make sure its money is spent efficiently. Given the places where the Global Fund works, it is not surprising that some of the money was diverted for corrupt purposes. However, the Global Fund found these problems itself and changed the way it handled training grants, where most of the problems were. Unfortunately, news of any corruption makes many citizens think the entire program is mismanaged and a huge portion of the money is being wasted. Some of the headlines that talked about two-thirds of specific grants being misdirected fueled this impression. In fact, less than 5 percent of Global Fund money was misused, and with the new procedures in place that percentage will be even lower. Our foundation is the biggest non-government supporter of the Global Fund, committing $650 million over the years because of the incredible impact its spending has. I am confident that this is one of the most effective ways we invest our money every year, and I always urge other funders to join us in getting so much bang for our buck.

In November, Hillary Clinton was singing from the same hymn sheet. Her landmark speech on HIV in November also endorsed the Fund.

We're calling on other donor nations to do their part, including by supporting and strengthening the Global Fund. Consider just one example of what the Global Fund has already done. In 2004, virtually none of the people in Malawi who were eligible to receive treatment actually received it. As of last year, with significant help from the Global Fund, nearly half did.

All of this is true. Nobody should under-estimate the achievements of the Fund, which, with the US President's Emergency Plan for Aids Relief (Pepfar) has enabled the roll-out and scale up of Aids drugs across Africa and Asia, as well as malaria and TB treatment and prevention tools.

The shock of the corruption revelations, which were pounced on by the US right, and subsequent loss of confidence in the Fund which led some donors to suspend payments was an alarm call. What would happen if the Fund failed? The Gleneagles promise of Aids drugs to all who needed them as well as the Clinton vision of an Aids-free generation (never mind hopes for eradicating malaria and reducing TB) would disappear over the far horizon.

What has happened now is a result of an ensuing determination that the Fund must not fail. An overhaul is underway, to ensure not just transparency but greater efficiency. On Monday, the Board approved a "Consolidated Transformation Plan for the organization to improve its risk management, fiduciary controls and governance". On Tuesday, executive director Michel Kazatchkine fell on his sword. The high-profile French clinical immunologist who had led the Fund's growth but also presided over its darkest hours said he would go in March. The Geneva Tribune claimed he did not jump, but was pushed, and pointed the finger at the Americans.

Kazatchkine, it is believed, felt there would be no room for him once a new general manager, Gabriel Jaramillo, a former chairman and CEO of Sovereign Bank, takes the business reins next week. The Columbian-born, Brazilian citizen was a member of the high-level independent panel that investigated the Fund's problems - under the chairmanship of former U.S. Health and Human Services Secretary Michael Leavitt, as well as former Botswana President Festus Mogae.

The Global Fund looks likely to carry on its important work under new management, but perhaps we should not be surprised if it has a bit less of a European flavour than it has done until now.


Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International (KEI)

thiru at keionline.org

Tel: +41 22 791 6727
Mobile: +41 76 508 0997

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