Delivery, but where's the cash? Update on the Global Fund

Even though I’m back from my blogbreak, a few guest posts continued to come in from Oxfam policy wonks over the Christmas break. Here’s one from Mohga Kamal-Yanni  (see pic) Oxfam’s senior health & HIV policy advisor

It has been a long journey for me from delivering babies on mud floors in a village in southern Egypt to the board Mohgameeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, where I represent international NGOs. Last month, the Global Fund held its 22nd Board meeting in beautiful Sofia (not that I saw anything except the road to the airport). Actually the Bulgarian government gave us a great welcome reception at the Natural History Museum with traditional music and dance in beautiful costumes. I even managed to see a few of the great specimens in the museums in between intense discussions with various delegates about the key issues for this board meeting: generating cash and spending it wisely.

The Global Fund was created by the G8 in 2001, and has an innovative governance structure with three board seats for civil society, who have equal votes to donors and developing countries. It is also a model for transparency.  Hard to imagine a civil society seat on the board of the IMF or World Bank any time soon.

The Fund recently announced that it is now paying for HIV/AIDS treatment for 3 million people, that it has distributed a staggering 160 million mosquito nets, and treated nearly 8 million people for TB.  This means the Global Fund has saved 6.5 million lives. It is something of which we should all be very proud – an effective and efficient modern multilateral institution working towards meeting the Millennium Development Goals.

You would think that this would make donors queue up to spend aid money to expand these achievements.   Yet the sad news is that the Global Fund is not raising enough money.  The Fund has ‘rounds’ of funding proposals. The current one is round 10, which fortunately has got enough funding.

However, failure to deliver enough future cash led to a decision to delay round 11.  What does this mean?  It means that people who have HIV/AIDS will be turned away because there is not enough money to give them medicines.  It means the huge progress made in tackling Malaria and TB could stall. Key endemic countries such as Malawi, Zimbabwe whose new proposals to round 10 failed on technical grounds, are left in the cold. Other countries that desperately need funding for health systems to deliver programmes for the 3 diseases such as Yemen have also failed to secure funding in Round 10. The board asked the secretariat to analyse the needs resulting from delaying the next round. An emergency fund may cover continuation of existing treatment for those currently on anti-HIV medicines but it is unclear if there will be enough money to rescue other programmes such as prevention. Whatever way you look at this is it is a very sad situation.

Donors are blaming their difficult budget problems at home, but this is not good enough.  In the same week as the Global Fund meeting, they managed to find an increase for the World Bank, which includes its health work. Yet the bank’s track record on health is very poor indeed.  The Global Fund is proof that aid works, and is something that all politicians in all rich nations should be proud to fund fully.   They complain that aid cannot show results – this is proof that it can.  They claim aid is unpopular with their publics – I wonder if that would change if the public actually knew that its taxes were being used to save this many lives?

Another important decision-though passed quietly given all the focus on the Round 11 delay- was the extension of the Affordable Medicine Facility for malaria (AMFm) pilot phase by 6 more months. This is to compensate for the countries that started late. The AMFm aims to use shopkeepers to deliver Artemisinin Combination Therapy (ACT), the most recent effective drug for fighting malaria. Oxfam has serious concerns about this pilot, in terms of creating resistance to the new medicines because shopkeepers are not qualified to diagnose and treat malaria. We favour an investment in expanding community health workers, who can be trained to diagnose and treat malaria and other children’s fevers like the 32,000 workers that the Global Fund has helped fund in Ethiopia

woman-at-gateThe AMFm pilot is being evaluated. The evaluation is supposed to provide data on 4 parameters: availability in private shops, market share compared to fake or inadequate medicines, affordability in terms of low price, and more importantly access and use by poor people in rural areas.  This final parameter is critical, as it is likely that their will be some success in substituting the new drugs for the old ineffective ones in urban shops and stalls, which although a good thing, will not automatically expand coverage to those most in need. 

However, so far the evaluation ignores measuring access and use in rural areas – the 4th parameter needed for a board decision. This is despite strong concerns expressed by the US, the drug companies themselves, and international NGOs. It is sad that the UK government, which prides itself on decades of caring for poor people, does not seem to be worried about this major omission. It seems that AMFm and its supporters are happy to measure the presence of the drug on the shelves in major towns/cities and ignore rural areas. In other words they are happy to stick to “tarmac road development”.

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3 Responses to “Delivery, but where's the cash? Update on the Global Fund”
  1. “he Fund recently announced that it is now paying for HIV/AIDS treatment for 3 million people, that it has distributed a staggering 160 million mosquito nets, and treated nearly 8 million people for TB.  This means the Global Fund has saved 6.5 million lives.”

    The number of lives said appears to be an estimate from a press release – not totally transparent, so I am assuming that the Fund is using assumptions about the impact of these three inputs on mortality, rather than actual evidence on the direct impact of GF programmes. We should be wary of such estimates.

  2. The role of GFATM in development is extremely important.

    It is one of the only funds working vertically and according to “evidence based” principles. Their main problem is their success.

    As AIDS was a very CNN-loved issue, the funding was initially generous, and the results were important too. Vertical approaches work and are necessary to resolve well-defined problems.

    When comparing this to more broadly aiming venues, like the Bank or UNDP, results could be good, but in fact we don’t know.

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