The Global Fund had not begun, a little more than a decade ago, when Bernard Rivers, who had worked as a freelance journalist and a software entrepreneur, found himself with enough time and money to spend a couple of years learning a new field. As a teenager he had lived in Africa, and wanted to learn about something he could do there.
“The biggest issue was AIDS and the fact that ARVs did exist, and that not everyone could have them,” he says now. “Just to call it a health problem understates it significantly.”
It was, he says, a financial problem, and while he was considering what he could do, United Nations General Secretary Kofi Annan announced the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. At first he thought he wanted to go work for it, he says now, but his wife reminded him, he “doesn’t take kindly to bosses.”
Instead, he decided to work on it, “in a way that, if I upset the Global Fund, they could not fire me.”
That was the beginning of Aidspan, the organization that puts out the Global Fund Observer . The organization serves as a watchdog of the Global Fund, and as a guide through its complexities. Tomorrow, Friday, Rivers will step down as its executive director, turning the organization he founded a decade ago on his own, and that now has a staff of about 10, over to new hands.
His goal was never to upset, or to criticize, but to serve, rather, as a “loving watchdog,” he says.
“We want nothing more than for the Global Fund to succeed and be effective,” he told Science Speaks. “Would it be possible for it to be 1 percent more effective?”
Estimates say the Global Fund has saved 8.7 million lives, he explains. “And 1 percent of 8.7 million lives is 87,000 lives,” he goes on. “That’s a challenge worth taking on.”
The biggest challenge the Global Fund would face, he thought early on, would be raising the money.
“I wanted to tell the Global Fund story, so donors could see the value of it,” he says.
That wasn’t the biggest challenge, though. The biggest challenge turned out to be how the Global Fund could distribute the money so that it could be used with maximum effectiveness. Nobody, including himself, he said, foresaw how much of a challenge that would be. It is why, he says, the Fund, which projected it would need a staff of no more than 50, grew to encompass a staff of 600 employees.
Along with the disbursal of billions of dollars, the Fund necessarily developed complicated application and paperwork procedures which were unavoidable, Rivers says.
“So the people who were actually involved in filling out the application forms were overwhelmed by the complexity.”
While saying he understood why the Global Fund needed a complicated application procedure, he adds, “The Global Fund could do much better than it’s done in explaining its bureaucratic requirements.”
In response to that shortcoming, one of Aidspan’s first publications was a document called “The Beginners Guide to the Global Fund,” he says. “That is another area there was a role for us.”
Based in New York, Rivers travelled to Africa to see Global Fund grants in action. Then, when Open Society Foundations began to fund the group, Rivers moved the organization to Kenya, where its staff grew. “Nearly all our staff is from East Africa, and I think that’s right, that’s good,” he says.
In 2011, news reports of missing and misallocated money challenged the fund, and donors, particularly as how much money had gone unaccounted for was unclear. Rivers now points to the Global Fund’s estimate of about three percent, and says that represents a combination of money applied to programs not authorized by grants, money spent as allowed, but not documented, as well as corruption.
“Yes, there were problems, as anyone could have predicted if they had been looking at billions of dollars being given to very poor countries,” Rivers says.
The Global Fund’s vigorous auditing and transparency with the results threw some donors, Rivers says, adding that some might have preferred not to know.
But, he adds, “I’m actually now quite hopeful.”
The money is coming back, the staff has been reduced and reorganized, “They’re getting up to speed,” Rivers says.
“I think this year is going to be significantly better than last year,” he says, “but last year was very bad.” While allowing that another year like it would have been “very serious,” his view of the Global Fund’s future is “cautiously optimistic.”
He does not speculate on what the Global Fund’s new funding model, to be decided in September will bring.
“The classic debate is between bottom up, and top down,” he says.
A pure bottom up model is impossible, because the money that donors will produce will always be limited, he says. A pure top down approach, in which “mean and stingy” donors dictate the response runs so counter to the Global Fund’s model, he says, “that’s absolutely never going to happen.”
He will not be running Aidspan anymore, but plans to continue to research and write about Global Fund issues. What he does for the Global Fund Observer will be up to the new boss, he says.
He sees hope in scientific advances against the AIDS epidemic, too, but they are qualified hopes.
“I see some encouraging signs,” he said. Still, he adds, “If you had a baby born with HIV tomorrow, and that baby lives his or her full life, unless there is a massive and amazing medical breakthrough, that person will need ARVs for the next 70 or 80 years.”
New medicines likely will continue to simplify treatment and make it more effective over the years, he says, but a realistic view of the future, he says, includes this: “There’s going to be decades upon decades of more of the need for treatment, and more of the need for prevention.”
His dream, he says, is a vaccine and a cure, but with those years away, “There will continue to be for decades the need for money.”
So he has another dream.
“I live in Kenya, and I hope for the day when Kenya says ‘we can afford our own medicine, and we don’t need to go anymore, cap in hand to the donor,’” Rivers said.
“The most important thing of all is economic growth. If you have economic growth and good governance, then the Global Fund won’t be needed.”