The following guest blog post is by David Bryden, the Stop TB Advocacy Officer at RESULTS.
The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria approved an action plan Monday in response to recommendations made recently by the High-Level Independent Review Panel on Fiduciary Controls and Oversight Mechanism (HLP). The board stated that it accepts the underlying analysis made by the panel and that it “presents a compelling case for a rapid and urgent transformation of the Global Fund.”
Former U.S. Health and Human Services Secretary Michael Leavitt, who co-chaired the high level panel, welcomed the board’s decision. “The board’s acceptance of the panel’s recommendations is a catalytic event in the history of the Global Fund. Prompt implementation will provide donors with confidence their contributions will fuel a more efficient and sustainable response to HIV and AIDS, tuberculosis and malaria,” said Leavitt, former Governor of Utah.
In addition, the board extended the application deadline for Round 11 from December until at least March 1, 2012, given the board’s intention to take into account recommendations of the HLP regarding the application process and uncertainties over contributions from donors.
The HLP was formed in March in response to misappropriation of funds revealed among some Global Fund grant recipients. But, the HLP’s report, published last week, went beyond the issue of eliminating such problems to cover broader issues, including an examination of the effort to ensure “country ownership,” which has implications for how this goal could be realized within the U.S. Global Health Initiative. Aidspan provided a helpful summary, calling the report full of “strong, clear and blunt opinions.”
The HLP carried out an exhaustive assessment over six months, reviewing a representative sample of grants in 40 countries and visiting 12 countries. They stated, “We see key areas that need significant improvement, but nothing that cannot be fixed by appropriate reform.” The report noted that in some cases the required changes have already begun, as with local Fund agents, who are now more actively looking for potential problems in a grant, including among sub-recipients.
The report included high praise for the broad impact of the Fund, stating that, “The Global Fund is a vital part of what makes health care function in many countries—its failure would bring tragic, cataclysmic consequences.” It noted its impressive record in terms of lives saved and stated that:
“The influence of the Global Fund’s investments and its innovative model for doing business has extended well beyond the battle against the three diseases….Ministries of Health are moving away from an exclusive, physician-centric approach, to now building partnerships with civil society and at the community level.”
The HLP also noted that, “The Panel has seen for itself that many people at the Secretariat work extremely hard over long hours under a great deal of pressure and external scrutiny, with passion, determination and commitment.”
However, the Report said the Fund is more vulnerable than has been acknowledged by its leaders, and the Fund must “reform itself to remain relevant.” The panel found that the Fund tended to favor a “light touch” with countries, out of a desire to foster “country ownership,” and that this took precedence over good governance. The panel said that a “culture of passivity” developed in grant management, with Fund portfolio managers showing reluctance to engage proactively to solve problems for fear of engaging in “micromanagement.”
The report said the Fund must adapt to fundamental shifts in technology and scientific understanding, for instance adoption of new diagnostic tools for malaria and tuberculosis could eliminate waste of resources. It said that medical male circumcision, the “tremendous preventative effect in treating all HIV-positive people with antiretroviral therapies early in the course of their disease,” and the widespread availability of mobile phones are all developments in the fight against AIDS, TB and malaria that the Fund must take into account.
The activity posing the biggest vulnerability for the Fund, according to the panel, is the procurement and management of pharmaceuticals and medical products. For example, the Fund covers 40 to 50 percent of the orders placed through the Global Drug Facility for medicine to treat multidrug-resistant tuberculosis. The panel recommended the Fund insist on pooled procurement and the outsourcing of drug storage and delivery.
In addition to procurement, the Panel’s recommendations covered a wide range of areas:
- The board should specify the maximum available funding for each type of country, according to risk, capacity, burden, and funding available from other sources.
- A simplified, two-stage application process should be set up, with more active cooperation between the Fund’s secretariat and the Country Coordinating Mechanism (CCM), which submits the application.
- The Office of the Inspector General should speed up its investigations, focus on grants made from 2007 to the present, and improve its methods.
- The Executive Management Team should be reinforced and empowered.
- The Fund should focus more on outcomes, not inputs.
The Communities Delegation issued a response, making clear its support for the Fund’s Executive Director Michel Kazatchkine and for the Fund itself as a crucial supply of life-saving resources:
“We bring to the Global Fund Board the voices and needs of millions of people living with and affected by the three diseases… We call for the responsible use of the public information released in the HLP report by media and governments and other partners, with a reminder that the challenges related to the three diseases is an on-going emergency in many parts of the world. We need to ensure that the recommendations of the Board, and its responses to these recommendations, constantly place the lives of people at the centre of our discussions.”