Cape Town — In its short 10-year history, the Global Fund to Fight AIDS, Tuberculosis and Malaria has saved millions of lives, but as it marks its anniversary it finds itself the subject of questions and concern, rather than celebration.
Two recent announcements shocked and alarmed health workers, governments and activists in the developing world who rely on support from the Fund to provide treatment for millions of people living with Aids and tuberculosis, and to supply bed nets to prevent malaria.
In November 2011 the Global Fund cancelled "Round 11" of its funding cycle, stating that it would not accept any new applications for funding until 2014, and last week the executive director, Dr. Michel Kazatchkine, announced his resignation.
"Many people assumed that the Global Fund cancelled Round 11 because it was 'running out of money' and donors were drastically cutting back on their grants," says Bernard Rivers, executive director of Aidspan, an independent observer of the Global Fund. "The situation is serious, but it's much less serious than that."
From interviews by AllAfrica with Rivers and recipients of Fund grants, as well as an examination of fund documents, the following emerges:
** Far from running out of money, the Fund is boosting grants in the current funding cycle, but not by as much as it wanted to;
** The cancellation of Round 11 can be linked to the failure of donors to live up to their promises, which has forced the Fund to budget conservatively;
** Some recipients of grants are in financial difficulty as a result of the Global Fund's poor management, and unless the fund improves its internal systems it could see donor countries reducing their support;
** The fund recognizes that its systems are not working effectively and has appointed a new general manager to fix the problems; and
** There is enough money to honour grants within agreed timeframes, which pay for Aids and TB treatment for millions of people, and for bed nets to prevent malaria.
Explaining how Round 11 came to be cancelled, Rivers told AllAfrica that one of the reasons was the introduction of a more conservative forecasting methodology to anticipate what percentage of the amounts pledged by donors would actually materialise. These new calculations forced the fund to reduce its budget and curtail its grant-making.
A statement posted on the Global Fund website spells out what spending is likely to be in the next few years. In the statement, the chair of the Global Fund board, Simon Bland, says that the Fund will disburse "around $10 billion" between 2011 and 2013.
This is U.S.$2 billion more than in the previous funding period between 2008 and 2010, and, according to Bland, it will mean that in certain countries "more people, not less" will gain access to Aids and TB treatment in 2012 and 2013.
However, Bland admits that the current budget is $2 billion less than the $12 billion the Fund expected to have for new grants.
In his explanation of the decision to cancel Round 11, Bland said, "we are living in uncertain economic times and budgets are strapped. It would have been irresponsible to continue promising opportunities for additional funding when we are not sure we will have the money needed."
Bland's statement came in the wake of confusion and concern created by the way in which the Global Fund communicated its decision to cancel Round 11. The news that broke last November came just two months after the Global Fund had called for applications for Round 11 and many organisations had already started the painstaking process of applying for a Global Fund grant.
"The Fund did a terrible job in explaining that decision," says Rivers, who added that the fund has always been poor at explaining itself, whether it was to applicants to help them understand what the Fund wanted, or to those responsible for implementing grants. "But," he concluded, "you would think that for the writing of a basic press release which explains the news about what's happened with Round 11, that at least they would be able to write that clearly."
One organisation that has been frustrated by the Global Fund's reputation for poor and bureaucratic communication is the Treatment Action Campaign (TAC) in South Africa. TAC, one of the continent's strongest and most effective Aids advocacy groups, is facing bankruptcy due to Global Fund delays in releasing promised funds.
"The current payment [that we're expecting from the Global Fund] is seven months overdue," says Nathan Geffen, treasurer of TAC. "No other donor has ever defaulted in its payments to us. But with the Global Fund, hardly any of our tranches have been paid on time."
Soul City is another South African organisation that has won international acclaim for its edutainment model promoting health and development communication. It too has been exasperated by the Global Fund's bureaucratic processes and mercurial demands.
"They keep on shifting the goal posts as to what is required," says Sue Goldstein, programme director at Soul City. "It's impossible to know where you are and how to plan. Funding can be delayed by six months, then they ask you for a report, then you hear nothing. And you can't question them."
According to Rivers, who has permanent observer status at Global Fund board meetings, TAC's experiences are a very worrying indication of the internal management situation and the relationship between the Fund and its recipients, or "implementers" as the fund prefers to term them.
Rivers believes that part of the problem is a heavily bureaucratic system, and part of it is "risk aversion", resulting in a reluctance to make decisions. In May 2011, the Global Fund itself identified and exposed some cases of corruption in West Africa. These were picked up by the international media and led to concerns about the Fund's ability to avoid the mismanagement of funds.
"Nobody wants to be the manager on whose watch some piece of corruption took place," says Rivers. "Zero risk can only be achieved if they give zero grants, and if you give zero grants, you have zero impact. What you have to do is ascertain risk, manage it, and work out how best to deal with it."
The man who is now tasked with cleaning up the management problems at the Global Fund is Gabriel Jaramillo, a Latin American banker who was a member of a panel that evaluated the work of the Global Fund during 2011.
It was Jaramillo's appointment as general manager reporting directly to the Global Fund Board that prompted the resignation of the executive director Kazatchkine. He will leave the Fund in March this year.
Kazatchkine has been at the helm of the Global Fund for the past five years. "He's a brilliant and deeply motivated doctor who has done some remarkable medical research in the area of Aids," says Rivers, "but he's not a manager."
Shaun Mellors is a Global Fund board member, representing communities living with HIV, TB and affected by malaria. He too believes that a number of things about the Fund's management need to be fixed.
In the past it has taken too long from the point at which the Fund approves a grant, to when countries actually benefit from the resources, says Mellors. "So improving and strengthening some of the internal processes and information flow between the secretariat, office of the inspector-general and country level is crucial to a stronger partnership. This forms a big part of the comprehensive transformation plan that will be managed by the newly appointed general manager."
Some activist networks have been dismayed at the appointment of a banker to manage a fund that has cultivated radically distinctive characteristics from other international institutions. Rivers is less pessimistic. He points out that besides the billions of dollars that the Global Fund disburses, it has a staff of more than 600 with its own substantial administrative budget. This, he believes, requires "formidable" management.
Although Rivers does not know Jaramillo, he thinks the Global Fund has done the right thing. "It sounds like a good decision to bring in someone with significant management experience in dealing with money," he says.
So what are the challenges for the Global Fund as it enters its second decade?
According to Rivers, the Global Fund must put its house in order in 2012; otherwise it could see donors reducing their support. "If the Global Fund does not improve in some of its problem areas, or does not improve fast enough or visibly enough, donors, especially those that have their own economic problems, might well start cutting back," he said.
Mellors is also concerned. "We need to ensure that donors meet their pledges and turn them into actual contributions. A pledge, whilst sending an important political message, does not save someone's life."
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In its short history the Global Fund has forged a unique identity, which includes unparalleled levels of transparency.
"Tell me another donor which is as transparent as the Global Fund and as vigorous as the Global Fund in trying to find out whether the money has been spent as promised, or misspent. And then tell me another international donor, that having discovered to its horror that there had been some corruption will publish the details on its website," asks Rivers. "There is no other major donor like that."
For Rivers the Global Fund represents "philanthropy for the 21st century". It allows countries to identify their own needs and agendas, and it has created a governance structure that gives genuine voice and power to civil society and recipient governments, as well as to donor governments.
"There are very few global health institutions where civil society, especially communities living with and affected by the three diseases, have an equal say and vote, as countries such as the U.S., the UK or France," says Mellors.
The Global Fund may not be in crisis yet, but there is cause for concern. Aids treatment advocates are unanimous in their calls for the Global Fund not just to sustain the three million people who currently receive antiretroviral therapy courtesy of the Fund, but to expand access for others who need it.
According to Stephen Lewis, the former UN Special Envoy for HIV/Aids in Africa who is currently co-director of the advocacy organisation Aids-free World, the cancellation of Round 11 is a worrying step backwards.
In a speech at Yale University last November, Lewis expressed horror that the Global Fund would make no new grants in the next two years. "Quite simply, without adornment, people will die in large numbers. The fund will attempt to sustain the programs presently in place, but the opportunity to enroll others who need treatment-and that number is 7.6 million-will be lost."
Rivers says it's now time to gear up the Fund for its second decade. "I don't feel anyone, including donor governments, is saying let's scrap the Global Fund, or the key principles of the Fund. I think they're saying, let's get it right."
