Stepping off the roller coaster

August 1, 2013

Posted by Alvaro Bermejo

Executive Director, International HIV/AIDS Alliance

In 2010, Dr. Alvaro Bermejo, Executive Director of the Alliance, was appointed to the Board of the Global Fund to Fight AIDS, TB and Malaria. Last month, he ended his two year term.  In this short interview he reflects on the experience.

Why did you join the Board?

The Global Fund to Fight AIDS, TB and Malaria (the Global Fund) was and still is THE place where global health policy meets the real world and I was confident it would be a tremendous learning experience – if not the crash course it turned out to be!

When I joined (mid 2011), it was already clear the Fund was at a critical development stage. A High Level Panel had been appointed to chart the way forward and new leadership was coming on board. I also thought the experience I could bring was something that would complement what the Developed Country NGO delegation already had.

Finally, I wanted to be part of a team of hugely committed, passionate and knowledgeable NGO colleagues and be able to bring the Alliance experience of Global Fund implementation and links to many of the key players in both donor and implementer constituencies.
How has the Global Fund changed in the past two years, and how do you see it evolving in the next five years?

I would challenge anybody to name a multi-lateral organisation that has changed faster than the Global Fund has in the last two years. There are certainly none in global health. It has overhauled its governance system, introduced a New Funding Model (NFM), hired a new management team, and restructured its Secretariat so it is better focused on the fund’s core business (grant management). All of this while continuing to support grants that have turned around the epidemics in country after country. No wonder stakeholder confidence has soared from a low point in late 2011.
I won’t say it’s been simple, or that it hasn’t been painful. Of course it has, and I’m still convinced that some of that pain – the cancellation of Round 11 – could and should have been avoided. But the change was clearly necessary and it was done with courage.

While it was a huge effort that many of us contributed to, three people deserve, in my view, special credit: Simon Bland and Mphu Ramatlapeng, Chair and Vice Chair of the Board (up until June 2013), and Gabriel Jaramillo, member of the High Level Panel turned Global Fund General Manager (until January 2013) for much of the transition.
Looking forward, Mark Dybul, the Global Fund’s new Executive Director, couldn’t have made a better start. He’s working tirelessly and strategically to turn the emerging scientific developments into high impact interventions and translating the recovered donor confidence into actual pledges.
So you’re optimistic?

Without doubt it is exciting that people are talking about the potential to end AIDS – and we know we can only achieve this with a Global Fund that channels the world’s shared responsibility towards this objective in an effective way.
In my day to day work I get to see, to feel, the Global Fund from the ground up. Alliance Linking Organisations are Principal Recipients for seven grants and sub recipients for many more. The initial feedback from the transition phase of the NFM has been encouraging and grant management has improved, particularly for the 20 high impact countries, but we’ve got more work to do. The application process needs to become simpler and easier for the country stakeholders that in the end ‘own’ the programmes and determine their success or failure.
As a Board member I also looked at it from the top down. We have a critical replenishment conference coming up at the end of 2013 – where the Global Fund will present to donors its funding needs for the next three years. If the world comes forward with the $15 billion required we shall achieve something historic for global health and for human development.

So I’m excited and I’m determined to make every effort, but am I optimistic? That I’m not sure.  At least, not yet.
How big a challenge will it be to raise new funds this year?
We do not underestimate the challenges ahead. Whilst millions of people are still not getting the life-saving treatment they need and key populations remain stigmatised, discriminated against and criminalised, health is important to countries, even as they tighten their belts in everything and try to look for high impact investments.

So while we are in an economic downturn, I believe that institutions like the Global Fund that are focused on value for money, partnership, and high impact, will still do well. The Global Fund is uniquely positioned to help address these issues and it is essential we all work together to secure the necessary investment.

What can you say about the New Funding Model (NFM)?
The NFM aims to expand country dialogue, and support country-owned approaches. But this has to be done in partnership, and in full recognition of the vital role of that civil society plays in delivering successful programmes, particularly those that need to reach marginalised populations. Ultimately it is the communities themselves who know what needs to be done and how to solve the problems.

That’s why the Alliance is concerned about the downsizing of the civil society team within the Global Fund secretariat (see these comments by the Alliance’s US Director Jason Wright in the Global Fund Observer) and is investing in tools and resources to support our Linking Organisations, as well as wider civil society groups, to play an active and informed role in Global Fund grant implementation (in concept note development, in grant implementation, and as members of Country Coordinating Mechanisms).
How would you sum up your experience as a Board member?

It’s been a roller coaster, with many tense moments.  The Board meeting in Ghana in November 2011 – just after the cancellation of Round 11 – was probably an all time low.  A time when it looked like the world had changed so much that the spirit of solidarity, activism and social justice that had created the Global Fund had all but disappeared in the face of the crisis created by our financial systems. Fortunately, it has not.

I am proud to have been able to represent civil society advocates and implementers; proud to be part of a movement that refused to accept the predictions about the demise of the Fund two years ago.  It’s been an exhilarating couple of years full of intense work and learning.  I extend my appreciation to the many colleagues who provided support and friendship along the way.

Read our call to donors to recommit to the Global Fund at the 2013 replenishment conference.

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