By Rachel Hammonds (ITM)
Two months ago a well-informed European Commission (EC) official told me that the ‘new’ Global Fund was everything the Commission had asked for. This comment has left me curious: was the remark merely political spin, or worse, was the new funding model signalling a move away from the more inclusive model involving multiple stakeholders in its decision-making, that the ‘old’ Global Fund had represented? With these questions in mind I was eager to attend a panel discussion organised by several MEPs, the Stop Aids Alliance and others at the European Parliament on 8 April. This debate preceded the EC hosted first meeting of the Global Fund’s 4th Voluntary Replenishment Process (2014-2016) on 9, 10 April in Brussels. The panellists included the new Executive Director of the Global Fund, Mark Dybul; the EC’s Deputy Director General for Development and Cooperation (DEVCO), Klaus Rudischhauser; Luxembourg MEP Charles Goeren; the former Minister of Health of the DRC and current Board Chair of Roll Back Malaria, Dr Victor Makwenge Kaput and two civil society representatives Oxana Rucsineanu of Moldova and Lucy Cheshire of Kenya; all debated the merits of the new funding structure.
The two hour session was tightly moderated by the Belgian EU affairs journalist Angelina Hermanns who asked the panellists probing questions and did not allow for waffle. Dybul’s remarks shed some light on how he and his team are positioning the new Global Fund. Three key take aways from his comments, and those of his panellists struck me as important.
First, Dybul emphasised that the Global Fund (new and old) is a 21st century partnership model. It aims to be country owned, embraces participation and acts as a catalyst for increased domestic financing. This partnership approach requires commitments from all involved. He argued that the co-financing rules that apply to middle income countries aim to push countries to take increased responsibility for funding their health sector. While acknowledging the importance of health systems strengthening Dybul noted the Global Fund has a role to play but health systems strengthening is not the role of the Global Fund. He did not suggest whose role it is then. Rudischhauser expanded on this, arguing that the Global Fund is a vehicle for helping countries assume responsibility for the health of their citizens. In discussing the co-financing rules he emphasised that the Global Fund is not the only instrument the EC has. He noted that for Eastern European countries there are other funds available and it is up to each country to set its priorities when applying for those funds. He argued that is the role of civil society to push governments to apply for funding to support things it has no budget for e.g. MDR TB treatment or needle exchange programmes.
Second, according to Dybul the Global Fund aims to be a learning organisation that drives change and then responds to that change. It could be argued that this is a nice-way of spinning the recent turmoil at the Global Fund and the resulting new approach. But, that is too cynical. Dybul noted this is how the private sector operates; firms have to adapt to survive. The consequences of the changes in the way the Global Fund operates are hard to predict but by moving towards a different funding model driven by countries not rounds, should help better align with national health discussions and better reflect country priorities. Dybul acknowledged that the transition to the new funding model beginning this year will be ‘messy’ as countries and the Fund learn its particular modalities on the go. It remains to be seen how messy.
Finally, a theme that ran through Rudischhauser and Dybul’s comments, human rights. Rudischhauser stressed how the Global Fund fits well with the EC’s Agenda for Change with its focus on human rights and good governance. Dybul, channelling his inner Jonathan Mann, emphasised how fundamental human rights are to the Global Fund approach which stresses the participation and support of marginalised communities and addresses stigma by engaging on issues that some countries deny and/or criminalise. Cheshire and Rucsineanu both noted how the Global Fund had managed to push their countries, Kenya and Moldova respectively to engage in issues they had chosen to ignore, the possibility of treating MDR TB and HIV/AIDS. Make no mistake, it is the money that interested (and interests) governments. To use it to help engage on human rights issues relating to the health of marginalised groups is a positive element of the Global Fund’s influence. So the new Global Fund aims to help national health ministers leverage global commitments to push for domestic funds to go to areas that are typically ignored or not visible. Not a horizontal approach but perhaps one that recognises the importance of empowering national health ministers to realise the rights of their people. Hopefully this new model can be a catalyst for change in approach. Otherwise we continue with the old vertical –horizontal debates and weak health ministers that can not deliver for their people.
Will the Global Fund receive the 15 billion it is asking for? Rudischhauser noted that this replenishment will focus on four pillars: the current donors, implementing countries, G-20 emerging countries and the private sector. At this meeting Dybul, the EC and many of those present appeared to be on the same page. EC DEVCO Commissioner Pielbags has reiterated that the EC’s financial commitment to the Global Fund for 2011-2013 will be honoured. The ongoing budget debates at the European Union make it hard to predict how much the EC will be able to commit for 2014-2020. The Obama Administration has signalled its continued support for the Fund with its FY 2014 request. This leaves open the role the other three pillars will play in shouldering the burden. If Dybul is as convincing a salesman for these other audiences hopefully this will translate into the funding the Global Fund needs to help fight three global killers.
Want to read more?
- The Stop Aids Alliance comment on 8-10 April – see http://www.aidsalliance.org/newsdetails.aspx?id=291523.
- The Global Fund Observer commented on the Obama Administration’s request http://www.theglobalfund.org/en/blog/31887/
- Euractiv also ran an informative story see http://www.euractiv.com/development-policy/global-fund-seeks-billions-eu-do-news-518954