The Global Fund to Fight AIDS, Tuberculosis and Malaria
Encyclopedia
The Global Fund to Fight AIDS, Tuberculosis and Malaria (often called The Global Fund or GFATM) is an international financing organization that aims to "[a]ttract and disburse additional resources to prevent and treat HIV
and AIDS
, tuberculosis
and malaria
." A public–private partnership, the organization has its secretariat
in Geneva
, Switzerland
. The organization began operations in January 2002. Microsoft
founder Bill Gates
was one of the first private foundations among many bilateral donors to provide seed money
for the project.
The Global Fund is the world's largest financier of anti-AIDS, TB and malaria programs and at the end of 2010 has approved funding of USD
21.7 billion that supports more than 600 programs in 150 countries. The organization states that it has financed the distribution of 160 million insecticide-treated nets
to combat malaria
, provided anti-tuberculosis treatment for 7.7 million people, and provided AIDS treatment for some three million people, saving 6.5 million lives. In 2009, the Fund accounted for 20 percent of around international public funding for HIV, 65 percent for tuberculosis, and 65 percent for malaria.
Currently the Global Fund is almost entirely funded by contributions from the governments of developed nations. Since the Fund was created in 2002, public sector pledges have totaled USD 28.3 billion (95 percent of all pledges). The remaining USD 1.6 billion (5 percent) has been pledged from the private sector
or other financing initiatives. The Fund states that from 2002 to 2015, 54 donor governments have pledged a total of USD 28.3 billion and paid USD 17.2 billion. From 2001 through 2010, the largest contributor by far has been the United States
, followed by France
, Japan
, Germany
, and the United Kingdom
. The donor nations with the largest percent of gross national income
contributed to the Fund from 2008 through 2010 are Sweden
, France, Norway
, the Netherlands
, and Spain
.
The global financial crisis has significantly impacted the fund. The Fund stated in May 2011 that it was short by USD 1.3 billion for 2011 through 2013, seeking at least USD 13 billion to cover minimum estimated needs but only holding pledges of USD 11.7 billion. The organization was also adversely affected by revelations of USD 25 million missing from community programs in four nations in Africa
, which caused Sweden and Germany
to suspend their donations until the completion of audit
in 2011. In 2011, the organization's internal investigation identified 13 countries, most in Africa, where several million dollars' worth of antimalarial drugs where stolen and presumably sold on the black market. A Global Fund spokesman confirmed that the organization suspected malaria drug valued at USD 2.5 million were stolen from Togo
, Tanzania
, Sierra Leone
, Swaziland
, and Cambodia
from 2009 to 2011, with some cases earlier. Investigations were continuing to determine the amount of theft in other countries.
And indeed, at the Okinawa Summit, G8 nations for the first time established measurable global targets for addressing AIDS, TB and malaria. Immediately following the Summit, WHO went on record stating that the G8’s commitment to fight AIDS, TB and malaria would cost at least $25 billion over the next five years, suggesting that 60 percent of this funding should be spent on HIV/AIDS, and the rest evenly split for campaigns against TB and malaria.
On September 28, 2000, the European Commission, WHO and UNAIDS announced that they were taking a common stand against the epidemics of HIV/AIDS, TB and malaria in the developing world.
In October 2000, WHO and the City of Winterthur, Switzerland convened a Massive Effort Advocacy Forum to engage over 200 public agencies, private sector and civil society organization in a process of building ownership and support to massively scale up donor funding to fight diseases of poverty. In eventually launching a massive global health resource drive, the City of Winterthur agreed to pay for the lodging of all of them Massive Effort guests. Speakers included Dr. Brundtland and Swiss President Ruth Driefus, in addition to Prof. Jeffrey Sachs via satellite. This subsequently led to WHO, Credit Suisse/Winterthur Insurance and the Swiss/Kenyan NGO Double Incentive Project (DIP) establishing and funding the Massive Effort Campaign, for the short term purposes of igniting, jump starting and building global support the fight against AIDS, TB and malaria.
During the final months of 2000 and early 2001, political jockeying over who might host the Global Fund intensified. Many initially assumed hosting the Global Fund was WHO's end game. On August 19, 2000, The Washington Post reported that "Clinton Signs Bill Establishing Global Fund to Fight AIDS," effectively intending to locate it inside the World Bank.
According to The Washington Post, "President Clinton signed a bill today that sets up a global trust fund for AIDS patients that has been likened to a kind of Marshall Plan against the infectious disease." Soon thereafter, UNICEF's Carol Bellamy suggested that UNICEF was better equipped to know "How to Distribute AIDS Drugs" in her March 2001 The New York Times op-ed.
An article published in the British medical journal The Lancet
by Harvard academics Amir Attaran
and Jeffrey Sachs
in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream of $7.5 billion or more to fund projects proposed and desired by the affected countries themselves, and that a panel of independent scientific experts validates as having epidemiological merit against the pandemic. Attaran and Sachs also recommended that the new funding stream "must be based on grants, not loans, for the poorest countries", unlike the World Bank
, which was the largest multilateral HIV/AIDS funder then existing.
On April 21, initiating a week of heightened, coordinated advocacy in support of establishing the Global Fund, GlaxoSmithKline CEO Jean-Pierre Garnier called for a "Marshall Plan" to fight AIDS in Africa. This followed on an announcement by 38 pharmaceutical companies that they would drop their challenge to prevent South Africa from providing cheaper generic ARVs.
On April 23, 2001, an informal meeting of “stakeholders including some G8 and non-G8 members, representing different constituencies,” was hosted by DFID and CIDA in London, to discuss the proposed “Global Fund for Health and AIDS.” A number of potential options were on the table, including the “Ottawa Fund,” a UNAIDS concept paper submitted on behalf of all UN agencies, and a proposal by Italy, which was about to host the upcoming G8 Summit. According to the minutes of the meeting, the aspirations of the group were to focus on HIV/AIDS, malaria and TB, with the potential to expand to other health conditions including children’s illnesses and maternal ill-health. This fund would be characterized by “highly visible operating systems, transparency of processes, the relentless pursuit of results, speedy disbursement, support for a diversity of service providers (including faith-based organizations) under common (usually national government) stewardship. Investors would be able to top predict the likely impact of their investments.” It was noted the following week in a video conference with the UN Secretary General's office that, with the possible exception of France, "none of the bilaterals are keen to support an HIV/AIDS specific fund." Canada, Japan The Netherlands, and the EC were most interested on focusing on the three diseases, with the UK, Italy and Sweden potentially wanting a broader mandate, and with Denmark, Norway and Germany being unclear about their positions.
On April 26, 2001, in Abuja, Nigeria, at the urging of a wide range of parties—and particularly due to the emerging consensus among bilateral and UN agencies during the London meeting three days prior—UN Secretary General Kofi Annan made the first explicit public call by a highly visible global leader for this new funding mechanism, proposing "the creation of a Global Fund, dedicated to the battle against HIV/AIDS and other infectious diseases." A month later, The Economist editorialized that "...the fund itself must not be devoured by a voracious UN bureaucracy. Mr Annan wants an independent board to administer the money... (and that) the amount of money needed, after all, is not huge: it is about half America's annual spending on pot-plants and flowers."
The first private contribution to the Global Fund was made by Kofi Annan. Having just been named the recipient of the 2001 Philadelphia Liberty Medal on May 3, 2001 Annan announced that he would donate his US$ 100,000 award to the Global Fund “war chest” he had just proposed creating. On May 8, the International Olympic Committee also made a US$ 100,000 contribution to the Global Fund.
In an address during WHO's World Health Assembly on May 15, 2001, WHO Director-General Gro Harlem Brundtland described the challenges of going to scale smartly yet rapidly in operationalizing the Global Fund. "The timetable is necessarily a tight one. You might say that we are going to have to sail in the boat, while we are still building it. But the world is not going to wait while we get every detail in place." There was strong pressure that the Global Fund become operational by the year's end."
On May 31, France became the second bilateral donor after the US to announce a contribution to the Global Fund. This initial pledge wss for US$ 127 million.
Stephen Lewis of Canada was appointed as the United Nation's Special Envoy on AIDS on June 1, 2001. On the same day, Kofi Annan addressed the U.S. Chamber of Commerce and encouraged American business leaders to speak up loud and often about the AIDS epidemic as a way to fight the disease.
Fortellingly, South Africa's Minister of Health quickly gave notice that support from the Global Fund might not be welcomed in the single country home to the most HIV infections. "South African Health Minister Manto Tshabalala-Msimang told the conference a global fund being set up to fight AIDS, TB and malaria should not be used to force AIDS advisors on the region.
'We know what AIDS is and we know what is happening here. The region has its own experts on AIDS,' she said.
Early resistance to the promise of the Global Fund wasn't limited to Manto during the first week of June 2001. Andrew S. Natsios, head of the U.S. Agency for International Development, told The Boston Globe that Africans were incapable of following complicated, multi-drug AIDS treatment, which requires taking different pills at specified times of day, because many of them "don't know what Western time is." According to Natsios, "Many people in Africa have never seen a clock or a watch their entire lives, . . . they know morning, they know evening, they know the darkness at night."
Countering the week's spate of skepticism, the Massive Effort Campaign mobilized the first large corporate contribution to the Global Fund from Credit Suisse/Winterthur Insurance for US$ 1 million, signaling that while some health ministries and donor agencies might still have doubts about the viability of the Global Fund, one of the world's largest banks and health insurance companies did not.
On June 19, 2001, the multi-billion dollar Bill & Melinda Gates Foundation made a very timely and welcomed -- yet surprisingly modest -- initial commitment to the Global Fund for $100 million spread over a few years. Signaling that stopping the transmission of AIDS was the foundation's top global health priority, the Foundation announced that it would commit $100 million to the Global Fund over a multi-year period. The foundation also used the occasion to call on other organizations and governments around the world to support the new fund.
The decision to create the new funding stream was taken by heads of state at the 2001 G8 Summit in Genoa
(Italy), at the urging of United Nations Secretary General Kofi Annan
, and largely along the lines WHO, Attaran and Sachs described. Indeed, the United Nations system had been considered ill conceived to implement a major increase in development funding. Multiple organizations were converging with small-scale projects on countries with limited institutional capacities, which exacerbated a series of problems, including poor coordination, duplication, high transaction costs, limited country ownership and lack of alignment with country systems.
In July 2001, Kofi Annan appointed Ugandan cabinet minister Dr. Crispus Kiyonga to chair the group that would establish the Global Fund.
A key piece of evidence arguing for the importance of the Global Fund was delivered on December 20, 2001, when the Commission on Macroeconomics and Health made its findings public. Created by WHO’s Brundtland and chaired by Sachs, the report promised that “A drastic scaling up of investments in health for the world’s poor will not only save millions of lives but also produce enormous economic gains.” This report was particularly timely in reengaging journalists and refocusing the attention of policy makers on diseases of poverty and the emerging Global Fund, months following 9/11.
Officially operational in 2002, the Global Fund was intended to introduce a new aid paradigm based on partner country leadership, donor alignment with partner countries' development strategies, harmonization of donor actions, managing for results, and donor and partner being mutually accountable for results. This was subsequently conceptualized by the OECD in its 2004 Paris Declaration on 'aid effectiveness'.
The Global Fund's initial 18-member policy-setting board held its first meeting on January 28–29, 2002, and issued its first call for proposals. The first Secretariat was established in January 2002 with Paul Ehmer serving as team leader, soon replaced by Dr. Anders Nordstrom of Sweden who became the Fund's interim executive director. By the time the Global Fund Secretariat became operational, the Fund had already received $1.9 billion in pledges. In the months to follow, the Bush Administration was sharply criticized in the media for promising to pledge only $200 million a year.
At its inception, the Fund was adamant that it would not be about “business as usual,” but would be grounded in “tough love” as it wrote its checks. On February 14, 2002, The Wall Street Journal headlined that the “Disease Fund Plans Tough Standards.” In the article, a Bush administration official is quoted saying, “We envision a level of fiscal accountability . . . that’s unheard of in international development assistance.”
In March 2002, a panel of international public health experts was named to begin reviewing project proposals that same month. In April 2002, the Global Fund awarded its first batch of grants - worth $378 million – to fight the three diseases in 31 countries.
was named as its first Executive Director in April 2002 and was about to get off to a rocky start days before the opening of the July 2002 International AIDS Conference in Barcelona, a bi-annual meeting attendied by tens of thousands of the world's leading AIDS researchers, implementers, care givers and activists. According to John Donnelly of The Boston Globe, "Richard G.A. Feachem, about to become the first director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, is already under fire from activists who want him to quit for saying the fund has plenty of money to start. At a critical time in the fight against the three killer infectious diseases, and on the eve of the 14th International AIDS Conference in Barcelona, Feachem is set to begin building an organization almost from scratch while fending off the activists." During this defining moment, the Massive Effort Campaign, the activist NGO created, contracted and entrusted to ensure the Global Fund's successful launch throughout its first four years, was able to help prevent the Global Fund from being killed in its crib.
Feachem served from July 2002 until March 31, 2007. Dr. Feachem announced he would not seek another term following a probe into the involvement of his wife in the Global Fund's business. Once Feachem was out of the picture, Kazatchkine was then selected over the Global Fund’s brilliant architect, David Nabarro, even though Nabarro was “considered the strongest of three shortlisted candidates to head the Global Fund ... A selection committee has evaluated the three nominees' qualifications and ranked ‘Nabarro first, Kazatchkine second and (Alex) Cotinho third,’ according to a Fund source.”
Today, the Global Fund is headed by Michel Kazatchkine
, a public health expert with over 20 years of experience in the field. The September 2005 conference in London
mobilized 3 billion euro, just over half the pledges at the Gleneagles
G8 summit. On September 21, 2011, the AIDS Health Foundation called for Kazatchkine's resignation in the wake isolated yet unprecedented reports of "waste, fraud, and corruption" in order that "reforms may begin in earnest.”
Importantly, the Global Fund is a financing mechanism rather than an implementing agency. This means that monitoring of programs is supported by a Secretariat of approximately 600 staff (as of 2011) in Geneva. Implementation is done by Country Coordinating Mechanisms, which are committees consisting of local stakeholder organizations in-country that include some or all of government, NGO, UN, faith-based and private sector actors. This has kept the organization smaller than other international bureaucracies, but also given rise to concern over its capacity to ensure appropriate use of its funds. (See Corruption and Misuse of Funds section, below.) It has also raised concerns about conflict of interest, as some of the bodies who sit on the CCMs also receive money from them.
The Global Fund provides initial grant funding solely on the basis of the technical quality of applications, as evaluated by its independent Technical Review Panel. The Fund has no means of assessing the implementation capacity of the applicants. Grants are signed for an initial period of two years. It provides continued funding to programs based solely on the basis of performance, which is generally defined as disbursement and purchases. The Fund makes no attempt to confirm whether services were delivered or whether its grants had any effect on health status or outcomes.
The objective of the Global Fund — to provide funding to countries on the basis of performance — was supposed to make it different from other international agencies that concerned themselves primarily with recording what money has been spent on, rather than what targets have been achieved. These organizations have hundreds or thousands of staff that assist with implementation of grants. However, the Global Fund's five-year evaluation concluded that without a standing body of technical staff, the Global Fund is not able to ascertain the actual results of its projects. It has therefore tended to look at disbursements or the purchase of inputs as performance. It also became apparent shortly after the Global Fund opened that a pure funding mechanism could not work on its own, and it began relying on other agencies (notably WHO) to support countries in designing and drafting their proposals and in supporting implementation. UNDP, in particular, bears responsibility for supporting Global Fund-financed projects in dozens of countries. As a result, the Fund is most accurately described as a financial supplement to the existing global health architecture rather than as a separate approach.
Bilateral donors immediately pledged millions (in some cases billions) of US dollars in support of Global Fund programs. The innovative approach to its financing principles is obviously considered key to its success. Since its inception, the Global Fund has committed US $11.4 billion to more than 550 grants in 136 countries (as of December 2008).
In March 2010, Dow Jones Indexes
signed a memorandum with The Global Fund to explore the creation of co-branded indexes that could be licensed as the basis for investment products. The Global Fund aims to strengthen its engagement with the private sector, while the Dow seeks to add to its range of socially conscious indexes.
The Global Fund became the first organization of its kind, incorporated as a Foundation under Swiss law. It is a new kind of public-private partnership
but is often confused as being part of the United Nations family
. This may be because until January 1, 2009 Global Fund staff were officially World Health Organization
(WHO) staff members and besides this the World Health Organization
(WHO) provided many administrative services to the Global Fund secretariat and is also based in Geneva
, Switzerland
.
Effective January 1, 2009, the Global Fund became an administratively autonomous organization, terminating its administrative services agreement with the World Health Organization (WHO).
In March 2009, the head of the Fund criticized statements made by Pope Benedict XVI, according to whom AIDS "cannot be overcome through the distribution of condoms, which even aggravates the problems."
has dubbed the scenario of a funding deficit an "HIV Nightmare".
The Global Fund has stated that it needed at least 20 billion dollars in 2011-13, and 13 billion just to "allow for the continuation of funding of existing programs". Its 2001-2010 budget includes 19,4 billion dollars, with 600 interventions in 145 countries and 5.7 million lives saved.
Italy, founding member of the Fund seating in its administrative committee, announced at the Aquila 2009 G8 Summit
a una tantum contribution of 30 million €. Both the una tantum and the 2009 and 2010 contributions (130 million € each) have not been disbursed (in fall 2010), for a total debt of 290 million €.
At the October 2010 replenishing meeting $11.8 billion USD was mobilized, with the USA being the largest contributor - followed by France, Germany and Japan. The Global Fund has said that the $1.2 billion USD lack in funding will "lead to difficult decisions in the next three years that could slow down the effort to beat the three diseases".
reported vast corruption in programs financed by the Global Fund. The article cited findings of the GFATM OIG office that up to 2/3 of funds in some of the reviewed Global Fund’s grants were lost to fraud and the OIG report showed that systematic fraud patterns have been used across countries. GFATM responded to the AP story with a press release on January 24, 2011, stating that, "The Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds. It deploys some of the most rigorous procedures to detect fraud and fight corruption of any organization financing development."
In the days following the AP story, a number of op-eds, including one by Michael Gerson
which was published in the Washington Post on February 4, 2011, sought to put the controversy surrounding the misuse of Global Fund grants in perspective. In his op-ed, Gerson stated, "The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical."
These newly uncovered misuses of funds were investigated and made public by the Global Fund Inspector General's Office (OIG), an auditing unit independent from the Global Fund Secretariat that manages the disbursements of funds to the programs (the selection of new applications for grants is done by the Technical Review panel and the GFATM Board - both independent entities from the GFATM secretariat). This point was also highlighted by Gerson in his February 4, 2011, op-ed where he noted, "The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed." The GFATM Secretariat has posted a series of press releases on the GFATM website to publish their views on these dealings.
The Fund's Inspector General's office (OIG) which uncovered the corruption has been newly reinforced and was created during 2005, three years after the GFATM was founded.
During these investigation the U.N. Development Program (UNDP) that manages and supervises a large proportion (12%) of the fund's spending as Local Fund Agent (LFA) in-country (the Global Fund has no country offices) has claimed diplomatic immunity to block the GFATM inspector general from access to internal audits and books of investigated programs in the more than two dozen nations.
The OIG has only examined a small percentage of the grants so far. Previous reviews of grants and the organization have shown substantial misconduct in some programs, lack of adequate risk management and operational efficiency of the Global Fund.
Severe cases of corruption have been found in several African countries such as Mali, Mauritania, Djibouti and Zambia. Global Fund spokesman, Jon Liden, said; "The messenger is being shot to some extent. We would contend that we do not have any corruption problems that are significantly different in scale or nature to any other international financing institution." This statement triggered a wave of private protests from other agencies who felt the Fund was attempting to divert attention from itself. Subsequent Global Fund statements have omitted any reference to other agencies.
In response to the findings, Sweden, the fund's 11th-biggest contributor, has suspended its $85 million annual donation until the corruption problems are resolved. Together with Sweden, Germany, the 3rd biggest contributor to the fund has also blocked any financing until a special investigation has been completed.
These findings come on top of previously discovered massive abuse of funds, corruption and mismanagement in a series of grants that forced the GFATM to suspend or terminate these grants after such dealings became publicly known with Uganda, Zimbabwe, Philippines, Ukraine being the largest of these grants (more than US$ 100 million each).
The story widened in February 2011 when the Financial Times reported that the fund’s board of directors had failed to act previously on concerns over accountability, including the conclusion of an external evaluation in 2009 which criticized the Fund's weak procurement practices. Warnings of inadequate controls had also been reported periodically. In Feb. 2011 the FT also reported that its own review found that neither Global Fund staff nor the Local Fund Agents (the entities entrusted with ensuring accountability at country level) had noticed the deficiencies reported by the inspector-general.
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
and AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
and malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
." A public–private partnership, the organization has its secretariat
Secretariat
Secretariat may refer to:* Secretariat , racehorse that won the Triple Crown in 1973* Secretariat , 2010 film about the racehorse...
in Geneva
Geneva
Geneva In the national languages of Switzerland the city is known as Genf , Ginevra and Genevra is the second-most-populous city in Switzerland and is the most populous city of Romandie, the French-speaking part of Switzerland...
, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
. The organization began operations in January 2002. Microsoft
Microsoft
Microsoft Corporation is an American public multinational corporation headquartered in Redmond, Washington, USA that develops, manufactures, licenses, and supports a wide range of products and services predominantly related to computing through its various product divisions...
founder Bill Gates
Bill Gates
William Henry "Bill" Gates III is an American business magnate, investor, philanthropist, and author. Gates is the former CEO and current chairman of Microsoft, the software company he founded with Paul Allen...
was one of the first private foundations among many bilateral donors to provide seed money
Seed money
Seed money, sometimes known as seed funding, friends and family funding or angel funding , is a securities offering whereby one or more parties that have some connection to a new enterprise invest the funds necessary to start the business so that it has enough funds to sustain itself for a period...
for the project.
The Global Fund is the world's largest financier of anti-AIDS, TB and malaria programs and at the end of 2010 has approved funding of USD
United States dollar
The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....
21.7 billion that supports more than 600 programs in 150 countries. The organization states that it has financed the distribution of 160 million insecticide-treated nets
Mosquito net
A mosquito net offers protection against mosquitos, flies, and other insects, and thus against diseases such as malaria, dengue fever, yellow fever, and various forms of encephalitis, including the West Nile virus, if used properly and especially if treated with an insecticide, which can double...
to combat malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, provided anti-tuberculosis treatment for 7.7 million people, and provided AIDS treatment for some three million people, saving 6.5 million lives. In 2009, the Fund accounted for 20 percent of around international public funding for HIV, 65 percent for tuberculosis, and 65 percent for malaria.
Currently the Global Fund is almost entirely funded by contributions from the governments of developed nations. Since the Fund was created in 2002, public sector pledges have totaled USD 28.3 billion (95 percent of all pledges). The remaining USD 1.6 billion (5 percent) has been pledged from the private sector
Private sector
In economics, the private sector is that part of the economy, sometimes referred to as the citizen sector, which is run by private individuals or groups, usually as a means of enterprise for profit, and is not controlled by the state...
or other financing initiatives. The Fund states that from 2002 to 2015, 54 donor governments have pledged a total of USD 28.3 billion and paid USD 17.2 billion. From 2001 through 2010, the largest contributor by far has been the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, followed by France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
, and the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
. The donor nations with the largest percent of gross national income
Gross National Income
The GNI consists of: the personal consumption expenditures, the gross private investment, the government consumption expenditures, the net income from assets abroad , and the gross exports of goods and services, after deducting two components: the gross imports of goods and services, and the...
contributed to the Fund from 2008 through 2010 are Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
, France, Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
, the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, and Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
.
The global financial crisis has significantly impacted the fund. The Fund stated in May 2011 that it was short by USD 1.3 billion for 2011 through 2013, seeking at least USD 13 billion to cover minimum estimated needs but only holding pledges of USD 11.7 billion. The organization was also adversely affected by revelations of USD 25 million missing from community programs in four nations in Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
, which caused Sweden and Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
to suspend their donations until the completion of audit
Audit
The general definition of an audit is an evaluation of a person, organization, system, process, enterprise, project or product. The term most commonly refers to audits in accounting, but similar concepts also exist in project management, quality management, and energy conservation.- Accounting...
in 2011. In 2011, the organization's internal investigation identified 13 countries, most in Africa, where several million dollars' worth of antimalarial drugs where stolen and presumably sold on the black market. A Global Fund spokesman confirmed that the organization suspected malaria drug valued at USD 2.5 million were stolen from Togo
Togo
Togo, officially the Togolese Republic , is a country in West Africa bordered by Ghana to the west, Benin to the east and Burkina Faso to the north. It extends south to the Gulf of Guinea, on which the capital Lomé is located. Togo covers an area of approximately with a population of approximately...
, Tanzania
Tanzania
The United Republic of Tanzania is a country in East Africa bordered by Kenya and Uganda to the north, Rwanda, Burundi, and the Democratic Republic of the Congo to the west, and Zambia, Malawi, and Mozambique to the south. The country's eastern borders lie on the Indian Ocean.Tanzania is a state...
, Sierra Leone
Sierra Leone
Sierra Leone , officially the Republic of Sierra Leone, is a country in West Africa. It is bordered by Guinea to the north and east, Liberia to the southeast, and the Atlantic Ocean to the west and southwest. Sierra Leone covers a total area of and has an estimated population between 5.4 and 6.4...
, Swaziland
Swaziland
Swaziland, officially the Kingdom of Swaziland , and sometimes called Ngwane or Swatini, is a landlocked country in Southern Africa, bordered to the north, south and west by South Africa, and to the east by Mozambique...
, and Cambodia
Cambodia
Cambodia , officially known as the Kingdom of Cambodia, is a country located in the southern portion of the Indochina Peninsula in Southeast Asia...
from 2009 to 2011, with some cases earlier. Investigations were continuing to determine the amount of theft in other countries.
Creation
The genesis of the Global Fund emerged during discussions between donor and multilateral agencies toward the end of 1999, leading up to the July 2000 G8 Summit in Okinawa, Japan. During that time, under the leadership of World Health Organization (WHO) Director-General Gro Harlem Brundtland and WHO Deputy Director General David Nabarro, discussions were initiated with donors other UN agencies concerning the creation of a new global health fund to help achieve these targets. Just prior to the Summit, WHO publicly called for a "massive effort to tackle infectious diseases" and for creation of "a new mechanism to take proven interventions to scale. The mechanism would achieve internationally agreed targets to cut TB and malaria mortality by 50%, and HIV infection by 25%."And indeed, at the Okinawa Summit, G8 nations for the first time established measurable global targets for addressing AIDS, TB and malaria. Immediately following the Summit, WHO went on record stating that the G8’s commitment to fight AIDS, TB and malaria would cost at least $25 billion over the next five years, suggesting that 60 percent of this funding should be spent on HIV/AIDS, and the rest evenly split for campaigns against TB and malaria.
On September 28, 2000, the European Commission, WHO and UNAIDS announced that they were taking a common stand against the epidemics of HIV/AIDS, TB and malaria in the developing world.
In October 2000, WHO and the City of Winterthur, Switzerland convened a Massive Effort Advocacy Forum to engage over 200 public agencies, private sector and civil society organization in a process of building ownership and support to massively scale up donor funding to fight diseases of poverty. In eventually launching a massive global health resource drive, the City of Winterthur agreed to pay for the lodging of all of them Massive Effort guests. Speakers included Dr. Brundtland and Swiss President Ruth Driefus, in addition to Prof. Jeffrey Sachs via satellite. This subsequently led to WHO, Credit Suisse/Winterthur Insurance and the Swiss/Kenyan NGO Double Incentive Project (DIP) establishing and funding the Massive Effort Campaign, for the short term purposes of igniting, jump starting and building global support the fight against AIDS, TB and malaria.
During the final months of 2000 and early 2001, political jockeying over who might host the Global Fund intensified. Many initially assumed hosting the Global Fund was WHO's end game. On August 19, 2000, The Washington Post reported that "Clinton Signs Bill Establishing Global Fund to Fight AIDS," effectively intending to locate it inside the World Bank.
According to The Washington Post, "President Clinton signed a bill today that sets up a global trust fund for AIDS patients that has been likened to a kind of Marshall Plan against the infectious disease." Soon thereafter, UNICEF's Carol Bellamy suggested that UNICEF was better equipped to know "How to Distribute AIDS Drugs" in her March 2001 The New York Times op-ed.
An article published in the British medical journal The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
by Harvard academics Amir Attaran
Amir Attaran
Amir Attaran is a Canadian lawyer, immunologist, and law professor.Currently, Attaran is Associate Professor of Law and Population Health and the holder of the Canada Research Chair in Law, Population Health and Global Development Policy at the University of Ottawa.-Early life and education:Attaran...
and Jeffrey Sachs
Jeffrey Sachs
Jeffrey David Sachs is an American economist and Director of The Earth Institute at Columbia University. One of the youngest economics professors in the history of Harvard University, Sachs became known for his role as an adviser to Eastern European and developing country governments in the...
in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream of $7.5 billion or more to fund projects proposed and desired by the affected countries themselves, and that a panel of independent scientific experts validates as having epidemiological merit against the pandemic. Attaran and Sachs also recommended that the new funding stream "must be based on grants, not loans, for the poorest countries", unlike the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
, which was the largest multilateral HIV/AIDS funder then existing.
On April 21, initiating a week of heightened, coordinated advocacy in support of establishing the Global Fund, GlaxoSmithKline CEO Jean-Pierre Garnier called for a "Marshall Plan" to fight AIDS in Africa. This followed on an announcement by 38 pharmaceutical companies that they would drop their challenge to prevent South Africa from providing cheaper generic ARVs.
On April 23, 2001, an informal meeting of “stakeholders including some G8 and non-G8 members, representing different constituencies,” was hosted by DFID and CIDA in London, to discuss the proposed “Global Fund for Health and AIDS.” A number of potential options were on the table, including the “Ottawa Fund,” a UNAIDS concept paper submitted on behalf of all UN agencies, and a proposal by Italy, which was about to host the upcoming G8 Summit. According to the minutes of the meeting, the aspirations of the group were to focus on HIV/AIDS, malaria and TB, with the potential to expand to other health conditions including children’s illnesses and maternal ill-health. This fund would be characterized by “highly visible operating systems, transparency of processes, the relentless pursuit of results, speedy disbursement, support for a diversity of service providers (including faith-based organizations) under common (usually national government) stewardship. Investors would be able to top predict the likely impact of their investments.” It was noted the following week in a video conference with the UN Secretary General's office that, with the possible exception of France, "none of the bilaterals are keen to support an HIV/AIDS specific fund." Canada, Japan The Netherlands, and the EC were most interested on focusing on the three diseases, with the UK, Italy and Sweden potentially wanting a broader mandate, and with Denmark, Norway and Germany being unclear about their positions.
On April 26, 2001, in Abuja, Nigeria, at the urging of a wide range of parties—and particularly due to the emerging consensus among bilateral and UN agencies during the London meeting three days prior—UN Secretary General Kofi Annan made the first explicit public call by a highly visible global leader for this new funding mechanism, proposing "the creation of a Global Fund, dedicated to the battle against HIV/AIDS and other infectious diseases." A month later, The Economist editorialized that "...the fund itself must not be devoured by a voracious UN bureaucracy. Mr Annan wants an independent board to administer the money... (and that) the amount of money needed, after all, is not huge: it is about half America's annual spending on pot-plants and flowers."
The first private contribution to the Global Fund was made by Kofi Annan. Having just been named the recipient of the 2001 Philadelphia Liberty Medal on May 3, 2001 Annan announced that he would donate his US$ 100,000 award to the Global Fund “war chest” he had just proposed creating. On May 8, the International Olympic Committee also made a US$ 100,000 contribution to the Global Fund.
In an address during WHO's World Health Assembly on May 15, 2001, WHO Director-General Gro Harlem Brundtland described the challenges of going to scale smartly yet rapidly in operationalizing the Global Fund. "The timetable is necessarily a tight one. You might say that we are going to have to sail in the boat, while we are still building it. But the world is not going to wait while we get every detail in place." There was strong pressure that the Global Fund become operational by the year's end."
On May 31, France became the second bilateral donor after the US to announce a contribution to the Global Fund. This initial pledge wss for US$ 127 million.
Stephen Lewis of Canada was appointed as the United Nation's Special Envoy on AIDS on June 1, 2001. On the same day, Kofi Annan addressed the U.S. Chamber of Commerce and encouraged American business leaders to speak up loud and often about the AIDS epidemic as a way to fight the disease.
Fortellingly, South Africa's Minister of Health quickly gave notice that support from the Global Fund might not be welcomed in the single country home to the most HIV infections. "South African Health Minister Manto Tshabalala-Msimang told the conference a global fund being set up to fight AIDS, TB and malaria should not be used to force AIDS advisors on the region.
'We know what AIDS is and we know what is happening here. The region has its own experts on AIDS,' she said.
Early resistance to the promise of the Global Fund wasn't limited to Manto during the first week of June 2001. Andrew S. Natsios, head of the U.S. Agency for International Development, told The Boston Globe that Africans were incapable of following complicated, multi-drug AIDS treatment, which requires taking different pills at specified times of day, because many of them "don't know what Western time is." According to Natsios, "Many people in Africa have never seen a clock or a watch their entire lives, . . . they know morning, they know evening, they know the darkness at night."
Countering the week's spate of skepticism, the Massive Effort Campaign mobilized the first large corporate contribution to the Global Fund from Credit Suisse/Winterthur Insurance for US$ 1 million, signaling that while some health ministries and donor agencies might still have doubts about the viability of the Global Fund, one of the world's largest banks and health insurance companies did not.
On June 19, 2001, the multi-billion dollar Bill & Melinda Gates Foundation made a very timely and welcomed -- yet surprisingly modest -- initial commitment to the Global Fund for $100 million spread over a few years. Signaling that stopping the transmission of AIDS was the foundation's top global health priority, the Foundation announced that it would commit $100 million to the Global Fund over a multi-year period. The foundation also used the occasion to call on other organizations and governments around the world to support the new fund.
The decision to create the new funding stream was taken by heads of state at the 2001 G8 Summit in Genoa
Genoa
Genoa |Ligurian]] Zena ; Latin and, archaically, English Genua) is a city and an important seaport in northern Italy, the capital of the Province of Genoa and of the region of Liguria....
(Italy), at the urging of United Nations Secretary General Kofi Annan
Kofi Annan
Kofi Atta Annan is a Ghanaian diplomat who served as the seventh Secretary-General of the UN from 1 January 1997 to 31 December 2006...
, and largely along the lines WHO, Attaran and Sachs described. Indeed, the United Nations system had been considered ill conceived to implement a major increase in development funding. Multiple organizations were converging with small-scale projects on countries with limited institutional capacities, which exacerbated a series of problems, including poor coordination, duplication, high transaction costs, limited country ownership and lack of alignment with country systems.
In July 2001, Kofi Annan appointed Ugandan cabinet minister Dr. Crispus Kiyonga to chair the group that would establish the Global Fund.
A key piece of evidence arguing for the importance of the Global Fund was delivered on December 20, 2001, when the Commission on Macroeconomics and Health made its findings public. Created by WHO’s Brundtland and chaired by Sachs, the report promised that “A drastic scaling up of investments in health for the world’s poor will not only save millions of lives but also produce enormous economic gains.” This report was particularly timely in reengaging journalists and refocusing the attention of policy makers on diseases of poverty and the emerging Global Fund, months following 9/11.
Officially operational in 2002, the Global Fund was intended to introduce a new aid paradigm based on partner country leadership, donor alignment with partner countries' development strategies, harmonization of donor actions, managing for results, and donor and partner being mutually accountable for results. This was subsequently conceptualized by the OECD in its 2004 Paris Declaration on 'aid effectiveness'.
The Global Fund's initial 18-member policy-setting board held its first meeting on January 28–29, 2002, and issued its first call for proposals. The first Secretariat was established in January 2002 with Paul Ehmer serving as team leader, soon replaced by Dr. Anders Nordstrom of Sweden who became the Fund's interim executive director. By the time the Global Fund Secretariat became operational, the Fund had already received $1.9 billion in pledges. In the months to follow, the Bush Administration was sharply criticized in the media for promising to pledge only $200 million a year.
At its inception, the Fund was adamant that it would not be about “business as usual,” but would be grounded in “tough love” as it wrote its checks. On February 14, 2002, The Wall Street Journal headlined that the “Disease Fund Plans Tough Standards.” In the article, a Bush administration official is quoted saying, “We envision a level of fiscal accountability . . . that’s unheard of in international development assistance.”
In March 2002, a panel of international public health experts was named to begin reviewing project proposals that same month. In April 2002, the Global Fund awarded its first batch of grants - worth $378 million – to fight the three diseases in 31 countries.
Initial Leadership
Richard FeachemRichard Feachem
Sir Richard George Andrew Feachem, KBE, FREng is Professor of Global Health at both the University of California, San Francisco, and the University of California, Berkeley, and Director of the at UCSF Global Health Sciences...
was named as its first Executive Director in April 2002 and was about to get off to a rocky start days before the opening of the July 2002 International AIDS Conference in Barcelona, a bi-annual meeting attendied by tens of thousands of the world's leading AIDS researchers, implementers, care givers and activists. According to John Donnelly of The Boston Globe, "Richard G.A. Feachem, about to become the first director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, is already under fire from activists who want him to quit for saying the fund has plenty of money to start. At a critical time in the fight against the three killer infectious diseases, and on the eve of the 14th International AIDS Conference in Barcelona, Feachem is set to begin building an organization almost from scratch while fending off the activists." During this defining moment, the Massive Effort Campaign, the activist NGO created, contracted and entrusted to ensure the Global Fund's successful launch throughout its first four years, was able to help prevent the Global Fund from being killed in its crib.
Feachem served from July 2002 until March 31, 2007. Dr. Feachem announced he would not seek another term following a probe into the involvement of his wife in the Global Fund's business. Once Feachem was out of the picture, Kazatchkine was then selected over the Global Fund’s brilliant architect, David Nabarro, even though Nabarro was “considered the strongest of three shortlisted candidates to head the Global Fund ... A selection committee has evaluated the three nominees' qualifications and ranked ‘Nabarro first, Kazatchkine second and (Alex) Cotinho third,’ according to a Fund source.”
Today, the Global Fund is headed by Michel Kazatchkine
Michel Kazatchkine
Michel Kazatchkine is a French physician best known for his work in international AIDS treatment issues. Since February 2007 he has been director of the The Global Fund to Fight AIDS, Tuberculosis and Malaria.-Professional history:...
, a public health expert with over 20 years of experience in the field. The September 2005 conference in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
mobilized 3 billion euro, just over half the pledges at the Gleneagles
Gleneagles, Scotland
Gleneagles is a glen which connects with Glen Devon to form a pass through the Ochil Hills of Perth and Kinross in Scotland...
G8 summit. On September 21, 2011, the AIDS Health Foundation called for Kazatchkine's resignation in the wake isolated yet unprecedented reports of "waste, fraud, and corruption" in order that "reforms may begin in earnest.”
Operations
A characteristic of the Global Fund that has drawn much praise is the transparency of the organization. Information on the Global Fund's processes, including quite sensitive decision making processes, is available from their official website.Importantly, the Global Fund is a financing mechanism rather than an implementing agency. This means that monitoring of programs is supported by a Secretariat of approximately 600 staff (as of 2011) in Geneva. Implementation is done by Country Coordinating Mechanisms, which are committees consisting of local stakeholder organizations in-country that include some or all of government, NGO, UN, faith-based and private sector actors. This has kept the organization smaller than other international bureaucracies, but also given rise to concern over its capacity to ensure appropriate use of its funds. (See Corruption and Misuse of Funds section, below.) It has also raised concerns about conflict of interest, as some of the bodies who sit on the CCMs also receive money from them.
The Global Fund provides initial grant funding solely on the basis of the technical quality of applications, as evaluated by its independent Technical Review Panel. The Fund has no means of assessing the implementation capacity of the applicants. Grants are signed for an initial period of two years. It provides continued funding to programs based solely on the basis of performance, which is generally defined as disbursement and purchases. The Fund makes no attempt to confirm whether services were delivered or whether its grants had any effect on health status or outcomes.
The objective of the Global Fund — to provide funding to countries on the basis of performance — was supposed to make it different from other international agencies that concerned themselves primarily with recording what money has been spent on, rather than what targets have been achieved. These organizations have hundreds or thousands of staff that assist with implementation of grants. However, the Global Fund's five-year evaluation concluded that without a standing body of technical staff, the Global Fund is not able to ascertain the actual results of its projects. It has therefore tended to look at disbursements or the purchase of inputs as performance. It also became apparent shortly after the Global Fund opened that a pure funding mechanism could not work on its own, and it began relying on other agencies (notably WHO) to support countries in designing and drafting their proposals and in supporting implementation. UNDP, in particular, bears responsibility for supporting Global Fund-financed projects in dozens of countries. As a result, the Fund is most accurately described as a financial supplement to the existing global health architecture rather than as a separate approach.
Bilateral donors immediately pledged millions (in some cases billions) of US dollars in support of Global Fund programs. The innovative approach to its financing principles is obviously considered key to its success. Since its inception, the Global Fund has committed US $11.4 billion to more than 550 grants in 136 countries (as of December 2008).
In March 2010, Dow Jones Indexes
Dow Jones Indexes
Dow Jones Indexes was formed in 1997 as an entity within Dow Jones & Co. It is now owned by the CME Group. It serves as the marketing name of CME Group Indexes, LLC. It produces, maintains, licenses and markets indexes as benchmarks and as the basis of investible products such as exchange traded...
signed a memorandum with The Global Fund to explore the creation of co-branded indexes that could be licensed as the basis for investment products. The Global Fund aims to strengthen its engagement with the private sector, while the Dow seeks to add to its range of socially conscious indexes.
The Global Fund became the first organization of its kind, incorporated as a Foundation under Swiss law. It is a new kind of public-private partnership
Public-private partnership
Public–private partnership describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies...
but is often confused as being part of the United Nations family
United Nations System
The United Nations system consists of the United Nations, its subsidiary organs , the specialized agencies, and affiliated organizations...
. This may be because until January 1, 2009 Global Fund staff were officially World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) staff members and besides this the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) provided many administrative services to the Global Fund secretariat and is also based in Geneva
Geneva
Geneva In the national languages of Switzerland the city is known as Genf , Ginevra and Genevra is the second-most-populous city in Switzerland and is the most populous city of Romandie, the French-speaking part of Switzerland...
, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
.
Effective January 1, 2009, the Global Fund became an administratively autonomous organization, terminating its administrative services agreement with the World Health Organization (WHO).
In March 2009, the head of the Fund criticized statements made by Pope Benedict XVI, according to whom AIDS "cannot be overcome through the distribution of condoms, which even aggravates the problems."
Replenishment phase
As of 2010, the Global Fund has entered its 'replenishment phase', i.e. it needs funders to commit themselves to continued financing. Alarms have been raised prior to the 2010 October meeting about a looming deficit in funding, which would lead to people currently undergoing ARV treatment losing access to this - increasing the chance of them becoming resistant to treatment. UNAIDS Executive Director Michel SidibéMichel Sidibé
Mr Michel Sidibé has been the Executive Director of UNAIDS, the Joint United Nations Programme on HIV/AIDS, and Under-Secretary-General of the United Nations since 1 January 2009....
has dubbed the scenario of a funding deficit an "HIV Nightmare".
The Global Fund has stated that it needed at least 20 billion dollars in 2011-13, and 13 billion just to "allow for the continuation of funding of existing programs". Its 2001-2010 budget includes 19,4 billion dollars, with 600 interventions in 145 countries and 5.7 million lives saved.
Italy, founding member of the Fund seating in its administrative committee, announced at the Aquila 2009 G8 Summit
35th G8 summit
The 35th G8 summit took place in the city of L'Aquila, Abruzzo, on July 8–10, 2009. It was moved from the Sardinian seaside city of La Maddalena as part of an attempt to redistribute disaster funds after the 2009 L'Aquila earthquake.....
a una tantum contribution of 30 million €. Both the una tantum and the 2009 and 2010 contributions (130 million € each) have not been disbursed (in fall 2010), for a total debt of 290 million €.
At the October 2010 replenishing meeting $11.8 billion USD was mobilized, with the USA being the largest contributor - followed by France, Germany and Japan. The Global Fund has said that the $1.2 billion USD lack in funding will "lead to difficult decisions in the next three years that could slow down the effort to beat the three diseases".
Corruption and Misuse of Funds
In January 2011, the Associated PressAssociated Press
The Associated Press is an American news agency. The AP is a cooperative owned by its contributing newspapers, radio and television stations in the United States, which both contribute stories to the AP and use material written by its staff journalists...
reported vast corruption in programs financed by the Global Fund. The article cited findings of the GFATM OIG office that up to 2/3 of funds in some of the reviewed Global Fund’s grants were lost to fraud and the OIG report showed that systematic fraud patterns have been used across countries. GFATM responded to the AP story with a press release on January 24, 2011, stating that, "The Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds. It deploys some of the most rigorous procedures to detect fraud and fight corruption of any organization financing development."
In the days following the AP story, a number of op-eds, including one by Michael Gerson
Michael Gerson
Michael John Gerson is an op-ed columnist for The Washington Post, a Policy Fellow with the ONE Campaign, and a former senior fellow at the Council on Foreign Relations. He served as President George W...
which was published in the Washington Post on February 4, 2011, sought to put the controversy surrounding the misuse of Global Fund grants in perspective. In his op-ed, Gerson stated, "The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical."
These newly uncovered misuses of funds were investigated and made public by the Global Fund Inspector General's Office (OIG), an auditing unit independent from the Global Fund Secretariat that manages the disbursements of funds to the programs (the selection of new applications for grants is done by the Technical Review panel and the GFATM Board - both independent entities from the GFATM secretariat). This point was also highlighted by Gerson in his February 4, 2011, op-ed where he noted, "The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed." The GFATM Secretariat has posted a series of press releases on the GFATM website to publish their views on these dealings.
The Fund's Inspector General's office (OIG) which uncovered the corruption has been newly reinforced and was created during 2005, three years after the GFATM was founded.
During these investigation the U.N. Development Program (UNDP) that manages and supervises a large proportion (12%) of the fund's spending as Local Fund Agent (LFA) in-country (the Global Fund has no country offices) has claimed diplomatic immunity to block the GFATM inspector general from access to internal audits and books of investigated programs in the more than two dozen nations.
The OIG has only examined a small percentage of the grants so far. Previous reviews of grants and the organization have shown substantial misconduct in some programs, lack of adequate risk management and operational efficiency of the Global Fund.
Severe cases of corruption have been found in several African countries such as Mali, Mauritania, Djibouti and Zambia. Global Fund spokesman, Jon Liden, said; "The messenger is being shot to some extent. We would contend that we do not have any corruption problems that are significantly different in scale or nature to any other international financing institution." This statement triggered a wave of private protests from other agencies who felt the Fund was attempting to divert attention from itself. Subsequent Global Fund statements have omitted any reference to other agencies.
In response to the findings, Sweden, the fund's 11th-biggest contributor, has suspended its $85 million annual donation until the corruption problems are resolved. Together with Sweden, Germany, the 3rd biggest contributor to the fund has also blocked any financing until a special investigation has been completed.
These findings come on top of previously discovered massive abuse of funds, corruption and mismanagement in a series of grants that forced the GFATM to suspend or terminate these grants after such dealings became publicly known with Uganda, Zimbabwe, Philippines, Ukraine being the largest of these grants (more than US$ 100 million each).
The story widened in February 2011 when the Financial Times reported that the fund’s board of directors had failed to act previously on concerns over accountability, including the conclusion of an external evaluation in 2009 which criticized the Fund's weak procurement practices. Warnings of inadequate controls had also been reported periodically. In Feb. 2011 the FT also reported that its own review found that neither Global Fund staff nor the Local Fund Agents (the entities entrusted with ensuring accountability at country level) had noticed the deficiencies reported by the inspector-general.
Financing, major donations and administration
The GFATM is almost completely funded by contributions from the largest developed nations governments / tax payers. GFATM audited annual returns show that currently more than 96% of its yearly contributions are received from government organizations. Its largest private contributor by far is the Gates Foundation- In June 2001, Winterthur Insurance, the Swiss-based subsidiary of the Credit Suisse financial services group and sponsor of the Massive Effort Campaign, became the first corporate contributor to the Global Fund with a gift of $1 million.
- In January 2006, BonoBonoPaul David Hewson , most commonly known by his stage name Bono , is an Irish singer, musician, and humanitarian best known for being the main vocalist of the Dublin-based rock band U2. Bono was born and raised in Dublin, Ireland, and attended Mount Temple Comprehensive School where he met his...
and Bobby Shriver announced the launching of the Product RedProduct RedProduct Red, styled as RED, is a brand licensed to partner companies such as Nike, American Express , Apple Inc., Starbucks, Converse, Bugaboo, Penguin Classics , Gap, Emporio Armani, Hallmark and Dell...
campaign, proceeds from which would go to the Global Fund. Questions have been raised by nonprofit watchdogs and marketing experts regarding the unusually high advertising budgets spent on Product RedProduct RedProduct Red, styled as RED, is a brand licensed to partner companies such as Nike, American Express , Apple Inc., Starbucks, Converse, Bugaboo, Penguin Classics , Gap, Emporio Armani, Hallmark and Dell...
that some (until 2007) estimated as high as $100 million. GFATM published data states that until February 2011 the Product RedProduct RedProduct Red, styled as RED, is a brand licensed to partner companies such as Nike, American Express , Apple Inc., Starbucks, Converse, Bugaboo, Penguin Classics , Gap, Emporio Armani, Hallmark and Dell...
campaign has contributed less than 1% ($163 million) of the almost $19 billion contributions received since establishing the GFATM 2001/02. - In August 2006, the Gates Foundation contributed $500 million to the Global Fund, calling the fund "one of the most important health initiatives in the world".
- In March 2006, Executive Director Richard FeachemRichard FeachemSir Richard George Andrew Feachem, KBE, FREng is Professor of Global Health at both the University of California, San Francisco, and the University of California, Berkeley, and Director of the at UCSF Global Health Sciences...
announced his intention to step down, as soon as his successor was determined by the Global Fund Board. In April 2007, Dr. Michel KazatchkineMichel KazatchkineMichel Kazatchkine is a French physician best known for his work in international AIDS treatment issues. Since February 2007 he has been director of the The Global Fund to Fight AIDS, Tuberculosis and Malaria.-Professional history:...
became the Global Fund's new Executive Director.
See also
- Student Global AIDS CampaignStudent Global AIDS CampaignThe Student Global AIDS Campaign is an advocacy group with more than 85 chapters at high schools, colleges, and universities across the United States. The group is committed to bringing an end to HIV and AIDS in the U.S...
- Friends of the Global Fight Against AIDS, Tuberculosis, and MalariaFriends of the Global Fight Against AIDS, Tuberculosis, and MalariaFriends of the Global Fight Against AIDS, Tuberculosis and Malaria is an advocacy organization dedicated to sustaining and expanding United States support for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Founded in 2004 by Edward W. Scott, Adam Waldman and the late Jack Valenti, Friends...