The Global Fund?’s growing pains

It?’s still too early to say whether the Global Fund to Fight AIDS, Tuberculosis and Malaria will succeed in raising and intelligently disbursing sufficient billions of dollars to have a significant impact. But it certainly got off to a hard-working high-speed start - albeit one which involved a couple of stumbles along the way.

Since January, the Fund has inspired the creation of ?“Country Coordination Mechanisms?” in dozens of countries. These CCMs are government-led but include representation (sometimes nominal, sometimes substantive) from civil society. The CCMs were required, in an astonishingly short time period, to create solid proposals for programs that would not otherwise be funded. Over 300 proposals were submitted for evaluation by the Fund?’s Technical Review Panel of independent experts. In April, some 60 of these proposals were approved for funding, involving some $1.6 billion in expenditure over five years (though funding will stop after two years in cases where effectiveness thus far is not proven).

At the same time, the Fund conducted a search for an Executive Director who will take office this month and will then hire a permanent staff to replace the severely under-strength seconded staff who have served thus far.

The new Executive Director, Richard Feachem, was quoted in a mid-June interview as saying that getting $200 million rather than the expected $500 million from the US Senate was not a blow - ?“We?’ve got plenty (of money) to start with. The ball is in our court to demonstrate results.?” This led to blasts by critics that Feachem should be ?“fired immediately?” if he meant that the Fund must ?“demonstrate results?” before undertaking significant further fundraising. And the Boston Globe revealed that Feachem?’s salary will be on a par with that of the head of the World Health Organization - though maybe that indicates that the Fund intends to hire the best and the brightest.

The Fund?’s Secretariat told AIDS 2002 Today that Dr. Feachem ?“intends to be a tireless fundraiser, seeking to raise billions of additional resources,?” and that some methods of documenting an impact can be achieved ?“within two years.?”

The greatest question about the Fund at this point relates to whether Feachem will be the charismatic yet flexible leader that strong supporters of the Fund are convinced is needed. Speaking in Washington last month, Feachem encouraged observers when he said '?”We will take risks. We will fail. We will make mistakes. We will learn, and we will move ahead.''

Said one high-level official, ?“He is a talented person, and seeing him more open to learning from others than I have seen in the past would increase my comfort level with him in his new role.?”

The Fund has some unique things going for it. It will be able to achieve economies of scale not available to smaller funding sources - particularly in purchasing generic drugs. It will be able to avoid - if it chooses - some of the complex politics that arise when recipients feel the need to meet the desires of bilateral donors. And, most important of all, it will be able to do desperately needed things in smart new ways, because it has no entrenched need to persist with less effective old ways.

The challenges the Fund faces are enormous. It must raise huge sums of money. It must make its ?“public-private partnership?” become much more of a reality than it is at present. It must put more effort into ensuring that CCMs genuinely represent all sectors of society. It must implement the transparency that it has promised but not yet delivered on, even though such a concept is probably somewhat alien to a number of its board members. And it must make significant progress on all these fronts by the time the next round of grants is approved in January 2003. Dr. Feachem will be a busy man.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team