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Global Fund Launches “Disease Committees”
In the strategy document adopted by the Board of the Global Fund late last year, several strategic goals are listed, as well as a couple of “strategic enablers” down at the bottom of the list. One of these enablers is “to enhance partnership to deliver results.” The new leadership of the Global Fund decided that a truly constructive way to engage with partners would be to set up three “disease committees” – one for HIV and AIDS, one for tuberculosis and one for malaria. After considerable planning, the Global Fund Committee on HIV and AIDS convened its first meeting on Monday, 18 June 2012. It was attended by a broad array of partners and by the entire Management Executive Committee of the Global Fund. Debrework Zewdie, Deputy Executive Director of the Global Fund, convened the meeting by citing an operating principle: If you are in a war, it’s a good idea to check with your allies once a month to compare progress. “This is not a technical committee,” said Dr. Zewdie. “This is a committee to advise the Global Fund on how the war is going.” A similar committee on tuberculosis met on 11 June.
Some committee members have objected to the military analogy. In answering them, Gabriel Jaramillo, General Manager of the Global Fund, pointed to the word “fight” in the name of the organization. Craig McClure, chief of the HIV/AIDS section at the United Nations Children’s Fund (UNICEF), commented, “I don’t like wars either, but I feel like I’ve been fighting one for the past 25 years. It could be coming to an end, if we really focus our efforts.” Eliminating mother-to-child transmission, reducing new infections by half, and securing universal access to treatment are three critical goals. Dr. Bernhard Schwartländer, Director for Evidence, Strategy and Results at UNAIDS, gave an authoritative overview of dramatic progress and serious challenges in AIDS prevention and treatment worldwide, prompting a spirited discussion about the numerous areas the committee can explore in coming months, such as cost of treatment, unit costs, drug optimization, inclusion of communities and a new investment framework.
Remembering Nadia Fuleihan
Nadia Fuleihan, Program Specialist at the United Nations Development Program, died Monday June 4th in a car accident in South Africa. Nadia, a long-time colleague and friend of many at the Global Fund, was instrumental most recently in mobilizing technical partners around the Global Fund’s strategy and work on human rights, which is what took her to South Africa. Nadia was a part of UNDP’s Global Fund Partnership Team from the creation of the Global Fund and her contribution to the cause was immeasurable. In addition to her role in shaping Global Fund policy through work on the Board and its committees, Nadia avidly supported those Global Fund grants managed by UNDP, which meant providing support in some of the toughest settings we work in. Nadia was vivacious, caring and warm and was greatly committed to the people served by Global Fund grants. The respect she earned from colleagues, as well as those who benefited from the Global Fund around the world, was the result of her commitment and her refusal to lose faith in the good that lives within us all. She will be remembered for her free spirit, enormous heart, and contagious smile.
A good head and a good heart are always a formidable combination – Nelson Mandela
Impressions of Madagascar, by Mireille Guigaz, Board Member
It is important for Global Fund Board Members to see what is happening on the ground. Geneva is a strategic location, but the field visits are important because they provide us with an opportunity to see the people who implement the programs and to observe the concrete results of the decisions we make. It's a bit like a ladder; we can go either up or down the rungs. In Madagascar, I got as close to the ground as I could in order to see for myself. I did not stay for very long. I was there for only a few days so I just caught a glimpse, but it was very important.
When I have to analyze what I see, I always say that there are positive and negative aspects. On the positive side, I was very impressed by the investment made by the people on the ground, in the communities, at the hospitals, by the Regional Health Directors and the doctors and nurses in charge of the programs. They are aware of the challenges and have a very high level of commitment; I got a very strong sense of that and it was very reassuring. However, I do have some questions, as I also got the feeling that these people deserve more support. The Global Fund projects are not a set of technical rules. The projects should be implemented with a holistic sense of what is happening on the ground. I would not want the reforms that we are undergoing to result in neglect of that reality in the field or a lack of flexibility just because we want the rules to be impeccable. I am all for impeccable rules; in my opinion, they are an ethical obligation. But context must also be taken into account. In the case of Madagascar, we are dealing with a very poor country where, as is often the case, the population feels the brunt of the events. Political instability does not penalize politicians; it does penalize real people who are often in a situation of extreme dependence on their own regime and on our funding. And so, it seems clear that impeccable rules are important, but at the same time, the ability to adapt, a vision and an even broader understanding are absolutely essential.
Mireille Guigaz is the Board Member of the Global Fund representing France
Profile: Rangarirai Chiteure
Rangarirai Chiteure is, more than anything, a dedicated health professional in Zimbabwe. He is not a doctor. He is a health administrator. But the role he plays in building access to health services - often for those who need it most - is critical to expanding disease prevention and treatment in his country. It is not just the what – Rangarirai is coordinator for the Country Coordinating Mechanism of the Global Fund – it is the how. Rangarirai is one of those people who thinks energetically about how to get things done, and puts in the time needed to make things happen. He always seems willing to go the extra mile, when it can make a difference in improved access to health services.
“We must not forget why we do our everyday work,” Rangarirai said recently when we visited him in Harare. “There are people that need our proactivity and engagement so we can ensure a healthy population.” Rangarirai, 43, has been working in the health and social development field for 20 years. He earned a degree in economics from the University of Zimbabwe as a young man. After working as a program analyst, program officer and Monitoring & Evaluation officer on health and population development issues for government of Zimbabwe, UNDP and for Care International, among other places, he also earned a master’s degree in population studies from the University of Zimbabwe. In his current position, he acts as liaison between Country Coordinating Mechanism members and stakeholders, among them the Global Fund headquarters, Principal Recipients, Local Fund Agents, the Zimbabwe Ministry of Health and Child Welfare, UN agencies and donor agencies. His main responsibilities are to ensure proper coordination of proposal development, grant negotiation and signing, and program oversight. Chiteure is also part of the East, Southern and Central Africa delegation of the Board of the Global Fund, which has been instrumental in planning and organizing the GF Africa Group meeting scheduled for RSA in July 2012. “The Global Fund is an important partner in Zimbabwe and we very much value it as financing mechanism,” he said. “I am also very expectant as to the new changes that are being implemented and I hope that these changes benefit us all and that we see the results on the ground very soon.”
The 55 Percent Solution
The Global Fund’s Strategy, Investment and Impact Committee will have a challenge when it meets in July to find ways of implementing a Board decision last November that 55 percent of all funding for grant renewals should go to low-income countries without, in the process, freezing out health programs in nations that are better off, but still have people in poverty.
The challenge finds it roots in November 2011, when the Board adopted a stand that has come to be known as the “55 percent rule.” The reasoning was logical. The Global Fund is committing close to US$ 6 billion to Phase 2 grant renewals in 2012. Many of the countries queuing up for an injection of Phase 2 grant money in 2012 have graduated into higher income brackets in the two years or more since they signed up for the first phase of their grants. Without any change in the ground rules, it looked highly likely that middle- and upper-middle-income countries would get the biggest slice of grant renewals, leaving less than half for low-income nations. That was an outcome the Board wanted to avoid. Enter the 55 percent rule, intended to fix the problem by giving poorer countries the bigger share.
To make sure that more resources really do get funneled to low-income countries, the Secretariat and the Board Chair in January adopted a follow-up measure. It gets a little complex. Grant renewals would continue to be pegged at 90 percent of the originally agreed funding amount for low-income and the lower of the lower-middle-income countries and a less-generous 75 percent would be introduced for all other countries. This prompted objections from the “upper” of the lower-middle-income countries - a category that includes Indonesia, Turkmenistan and Guyana - who feared that funding for some of their health programs would be restricted or reduced as a result.
At its meeting in May, the Board acknowledged that vital programs targeting the poorest people in “upper” lower-middle-income countries could be jeopardized. The Board therefore put its earlier decision on hold, with the result that the 90 percent ceiling will apply to all countries in the next wave of grant renewals.
The Strategy, Investment and Impact Committee has been asked to take a fresh look at the “55 percent rule” and come up with new recommendations to the Board. One option under consideration is to establish a kind of “quota system” with a ceiling for each individual country applying for additional funding. Another suggestion could be to earmark 75 percent of all grant renewal money for low-income and “low” lower-middle-income countries.
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