Reflections on the Global Fund

April 28, 2011

Posted by Alvaro Bermejo

Executive Director, International HIV/AIDS Alliance

Alvaro Bermejo, was recently selected as Board member for the Developed Country NGO Delegation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He reflects on the Fund, its governance and the different choices it has to make at the moment.

The Global Fund has allowed civil society responses to go to scale in unprecedented ways. Much of the current progress against HIV, TB and malaria is due to the energy and the resources the Global Fund has mobilised and the many changes it has catalised at country level.

The Global Fund has brought innovation in many ways. Most importantly, it has re-defined participation and ‘country ownership’ to include civil society and other stakeholders. By doing so it has dramatically changed the position of affected communities and civil society organisations. Affected communities have gone from patients and targets of ‘focused interventions’ to active agents involved in strategy, programming and resource allocation decisions. Civil society organisations have gone from being mere implementers of government services to active participants in the design, planning, implementation and supervision of national responses, in many cases directly channelling the resources from the Global Fund to community-based organisations.

Needless to say, it hasn’t always worked as well as it should. The Global Fund’s Board and the national level country coordinating mechanisms (CCMs) have all been new creations and all stakeholders have had to quickly learn new ways of doing things – that’s the (exciting) price for innovation. As Executive Director of the International HIV/AIDS Alliance I have regular contact with 36 linking organisations, most of which are recipients of Global Fund resources and/or sit on CCMs. This has provided a unique perspective on this increasingly complex Global Fund: the challenges of developing proposals, of implementing against tight performance targets, of ensuring appropriate oversight and of engaging with an expanded Secretariat in Geneva.

As I join the Board with the responsibility to mobilise and represent a broad constituency of developed country NGOs I think of how the Board can contribute to taking the Global Fund a step further. Strong ownershp in the ‘implementors bloc’, with countries fighting for a Global Fund that has enabled them to reduce the number of citizens with AIDS, TB and malaria, to stay alive. More consistency in the ‘donors block’, who must know they’ll pay a heavy price if they starve communities of the resources they need to continue making progress against these three diseases.

As a medical doctor that started his career in slums and rural villages of Latin America I know we must build on the Global Fund to achieve so much more in global health. Can this Board work with others at GAVI, at Gates, at WHO to develop a shared vision of the future global health architecture and of how the Global Fund fits in it? Will it happen in the next 2 years? I don’t know, but there can be little worse than knowing you were given a chance and didn’t try your best. The prize is too important. A Global Fund fully funded through a combination of overseas development aid and a tax on financial transactions. A Global Fund effectively supporting communities and countries on their way towards health and justice.

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