Global Fund Nears Selection Of New Director For Transformed Organisation

The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria is in the final phases of selecting its next executive director. In the run-up to the decision, the international financing institution is multiplying signs of its good health as it looks to turn a corner after months of major reforms.

However, some members of civil society are raising concerns that the Fund may be straying from its core principle of demand-driven grant giving. While others caution that the changes lack transparency and are happening too quickly.

The Fund’s transformation began following fraud allegations in four recipient countries in 2010, which led to a high-level review of the Fund’s fiduciary controls and oversight mechanism. The Board appointed veteran banker Gabriel Jaramillo, who was part of the review process, as general manager responsible for overseeing organisational changes. Shortly after, former executive director Michel Kazatchkine announced his resignation (IPW, Public Health, 25 January 2012).

As general manager, Jaramillo has swiftly led the restructuring of the organisation, shrinking the bureaucratic side in Geneva by 40 per cent and focusing more on grant management. In what Jaramillo called a reflection of “increased confidence in our ongoing transformation” in his September report to the Board [pdf], the organisation’s financial forecast has improved. About one year since a new round of grants was cancelled, the Fund reports up to US$ 1.4 billion in new funding through the end of 2014.

Additionally, the Fund recently released its 2012 results report, which highlights landmark achievements met by national programmes supported by the organisation. Key numbers include the 8.7 million lives saved through HIV and tuberculosis treatment programmes and the distribution of 270 million insecticide-treated nets to protect people from contracting malaria.

As the Fund looks to name a new director, promising finances and strong health outcomes are being leveraged as signs of a successful transformation. “The new director will come in to lead an organisation that has already been reformed and is running well,” Seth Faison, the Global Fund’s director of communications, told Intellectual Property Watch.

The Fund’s New Face

The search for the new director was launched last May when the Board created an Ad-Hoc Nominations Committee chaired by Masaki Noke, a Board member who represents Japan, and vice-chaired by Karlo Boras, executive director of the Yugoslav Youth Association Against AIDS and a Board member.

The terms of reference for the nine-member committee are available here [pdf].

The committee has been charged with selecting a short-list of up to four candidates, which must be equal in gender, for the Board’s consideration and decision during its next full meeting from 13-14 November.

According to the committee’s third progress report [pdf] presented to the Board in September, 11 people, including five women and six men, from a range of regions and professional backgrounds, were identified in the first phase of the evaluation process.

A first round of interviews were scheduled to take place in London from 10-11 October and a second round on 25 October. The committee’s recommendations will be formalised in a comprehensive report, which will be submitted to the Board by 1 November.

Although the Global Fund has made the details of this highly involved process readily available, it is keeping candidate names confidential. However, some names said to have been identified during the first phase of nominations were circulated among civil society groups.

The names of the candidates have been closely held. However, according to sources, Helene Gayle, president and chief executive of CARE USA, part of the international organisation fighting global poverty, was approached, but has withdrawn from the process; Ngozi Okonjo-Iweala, finance minister of Nigeria and recent World Bank presidential candidate, was approached but declined; while Ambassador Mark Dybul, co-director of the Global Health Law Program at the O’Neill Institute for National and Global Health Law at Georgetown University and a former US Global AIDS Coordinator during the George W. Bush Administration, and Awa Marie Coll-Seck, executive director of the Roll Back Malaria (RBM) Partnership, were still on the nomination committee’s long-list.

When asked about the names, Faison said, “I can’t comment on any specific candidates. The committee would like to keep the names of the nominees confidential and will not make them public before the [November Board] meeting.”

New himself to the organisation, Faison took on his role as communications head on 1 May. A Pulitzer Prize-winning journalist for the New York Times, Faison specialises in crisis management consulting and media strategy, according to his bio on Sitrick And Company as of press time. Previously, he ran this strategic communications firm’s New York office.

The End of Rounds

New leadership is just one of the many changes underway at Global Fund. Historically, the Global Fund awarded grants through a rounds-based system, with a period of funding annually when countries could submit their proposals. Marking an end to this system, the leading international financier for the prevention and treatment of AIDS, tuberculosis, and malaria recently announced a new approach to grant giving, which was adopted during the September Board meeting.

The Board’s decision on the evolving funding model is available here [pdf] and a presentation by the Secretariat with additional explanation and remaining questions on the new funding model is here [pdf].

Upon implementation of the new funding model in 2014, countries will be able to apply for funding throughout the year by submitting a concept note, billed to be shorter than previous applications. The Global Fund says that it will be able to provide feedback to applicants faster than under the previous system.

Additionally, the new funding model changes how resources will be distributed. Countries will be grouped into “bands,” based mostly on disease burden and ability to pay, and affected to a lesser degree by other criteria, such as past funding history and most at risk populations.

Resources will be allocated to each band with a range of funding established for each country. Another stream of funds will also be available for “ambitious requests based on specific investment cases” that go beyond the core funding. Both the composition of the country bands and the proportion of grants provided through each funding stream should be decided during the November Board meeting.

While the public health community is largely welcoming the streamlined application process, concerns are being raised that the Fund’s new approach to grant giving, in particular the pre-set range of funding, could lead to countries limiting their full expression of demand.

“There are still pitfalls toward the final design of the funding architecture that will be presented by the Global Fund to its board at its November meeting,” Sharonann Lynch, HIV policy advisor for Médecins Sans Frontières (MSF, Doctors without Borders), told Intellectual Property Watch.

“If we’re going to cap a country’s response based on what we think is their ability to pay, and based on what we understand their disease burden to be, then we might be missing a huge opportunity for disease control,” Lynch explained.

“If the country bands are done in a way that strays too far away from the way the Global Fund has been operating the past ten years, which is demand-driven, country-driven, then we are going to have a real problem when it comes to making sure that improved interventions for marginalised populations are going to be served and are going to be applied for,” Lynch added.

In response, Faison insisted that “there are no caps” to the new funding model which encourages country ownership. “We want to reach all people, but we have to direct funds where they will have the most impact.”

“It is our experience that grants are more effective where there is a firm, consistent, health strategy, and stability in the ministry of health. Everything is more efficient. So part of the plan is to allocate more funds to countries with clear health strategies. In a small way, we hope that will be an incentive,” Faison said.

Pro-Industry Interests?

Beyond its approach to grant giving, the Fund is also reviewing its procurement policies. “We want to ensure that on an aggregate level the Global Fund is achieving the best value for money in large-scale purchases,” Faison said.

One civil society group has raised concerns about the influence of potentially pro-industry interests at the Fund. Last June, Knowledge Ecology International (KEI) called attention to the High-Level Independent Review Panel’s (HLP) assessment of the Fund’s procurement policies.

According to the HLP’s report [pdf], due to the large proportion of Fund spending that goes toward the purchase of medicines and other health products, “the procurement and management of pharmaceuticals and medical products poses larger risks to the Global Fund’s finances, operations and reputation than any other activity in its business model.”

The report recommends making the “VPP [Voluntary Procurement Pool] and other external purchasing channels the default for all grants, except if implementers can certify local institutions can meet and perform to international standards. One note of caution: no matter who does the buying, the Global Fund’s procurement policies should not prioritize purchasing on price alone, and should place more value on quality and the reliability of supply offered by vendors.”

KEI also indicated that the Fund had named William (Bill) Steiger, a former US public health officer, to manage this central programme. The Global Fund quickly refuted this claim, however confirmed that he works with the organisation as a consultant.

Currently a senior advisor for the consultancy firm Leavitt Partners, Steiger held key public health roles in the US including director of the Office of Global Health Affairs at the US Department of Health and Human Services. He has been called “pro-industry” by some members of civil society in his former roles. For example, as part of the US delegation during the 2001 World Health Assembly, Steiger was criticised by the Health GAP Coalition, a US-based advocacy organisation for people living with AIDS, for blocking efforts to promote developing countries’ access to affordable medicines through local generic drug production.

Even if Steiger is not slated to run the VPP programme, he has an important role within the organisation. According to Faison, “Bill Steiger has broad experience in government and in the private sector, and has extraordinarily deep knowledge of the Global Fund. He is also a brilliant writer. He is an invaluable consultant in several areas of Global Fund work.”

Swift Reforms

Some civil society groups say these changes are happening too quickly and without enough input from civil society. According to an article published by IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, two South African NGOs launched a campaign calling on the Fund to slow down the reform process and to improve communication about the new model.

Kate Macintyre, executive director of Aidspan, an official observer of the Global Fund, confirmed hearing these frustrations during the September Board meeting, but said the Secretariat is making efforts to do a better job at reaching out to civil society organisations.

“Since the September meeting, there has been quite a lot consultations going on with civil society organisations. The Fund is trying to make sure that information gets out through these consultations and also bring feedback back into the process,” Macintyre told Intellectual Property Watch.

Regarding concerns about the speed of the reforms, Faison said, “We have to move forward now. These things are complex. We could take years. However, we have told our donor countries that the Global Fund is reforming and when we go to ask for funding, we have to have a system that is working.”

After nearly a year of reforms, the Fund is steadfastly focused on the future, announcing new or expanded partnerships and other initiatives in recent weeks. For example, it will expand its partnership with Coca-Cola to improve the delivery of medicines to remote regions starting in Africa. It also launched a major communications campaign called, “The Big Push” along with public health partners and the Huffington Post, to raise awareness and funding to reach health-related Millennium Development Goals by 2015.

All that’s left now is to bring the transformation to where it’s needed most.

Related Article:

http://www.ip-watch.org/2012/03/23/global-fund-changes-continue-as-west-africa-team-leader-departs/