The UK government has said that they intend to ‘up to double’ their contribution to the Global Fund to Fight AIDS, TB and Malaria, but will make the international health organisation wait for up to a year before confirming the increase. Speaking in front of a committee of MPs Secretary of State for International Development, Andrew Mitchell MP confirmed his support for the Fund but argued he needed more evidence that the institution was reforming before paying the increased amount activists said is needed to avert a funding crisis threatening millions of lives.
The Secretary of State was speaking as part of a hearing on the funding crisis at the Fund held by the International Development Select Committee on Tuesday 17th of April. Evidence was also given by Gabriel Jaramillo, the newly appointed General Manager of the Global Fund, Aaron Oxley of the UK Coalition to Stop TB and Mike Podmore, Chair of the UK AIDS Consortium. The committee heard evidence on the impact of the Fund, the on-going reform agenda and the consequences of a shortfall in donor funding for people living across the developing world.
The Global Fund: A Successful Enterprise
The Global Fund is a unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, TB and malaria. This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing with the Global Fund’s model being based on country ownership and performance-based funding.
Since its creation in 2002, the Global Fund has become the main financier of programmes to fight AIDS, TB and malaria, providing AIDS treatment for 3.3 million people, anti-tuberculosis treatment for 8.6 million people and 230 million insecticide-treated nets for the prevention of malaria. Although the Global Fund financially relies on voluntary contributions from all sectors of society – governments, private sector, social enterprises, philanthropic foundations and individuals – donor governments continue to provide the largest source of financing. The UK is a major supporter of the fund contributing almost £1bn since the Global Fund’s inception in 2002 (8% of total contributions). In addition, the UK is the current Chair of the Global Fund with DFID civil servant Simon Bland leading the current reform process.
The Crisis of Confidence
Early in 2011, some media stories misrepresented allegations of misuse of funds discovered in grants financed by the Global Fund in a number of countries. These incidents were in fact uncovered by the Global Fund’s own Office of the Inspector General, which has been undertaking a thorough review of the Global Fund portfolio to identify areas of the Global Fund’s grant oversight and risk management that need strengthening. Less than 5% of the Global Fund’s grant portfolio was misused but at the time of the media reports the Global Fund was already experiencing funding problems and donors who were already going back on funding commitments now had an excuse to delay payments.
In response to these articles some donors, despite having previously been informed of the problems, delayed their contributions. This cash-flow issue compounded the poor Global Fund Replenishment effort for the period 2011–2013 (held in October 2010), which raised only $11.7 billion in pledges, well below the target of $20 billion and even below the low ‘maintenance’ level of $13 billion.
As a consequence the Global Fund board cancelled Round 11 of new funding thereby putting on hold live-saving programmes. This cancellation was a devastating blow to country ambitions to scale up HIV prevention, treatment, care and support services. It also brought into question how basic services for those people already on HIV medication would be continued. To try and ensure essential services were not affected, the Board agreed to put in place a Transitional Funding Mechanism (TFM) that would be accessible only to current grantees.
The Global Fund’s Transformation
The General Manager of the Global Fund, Gabriel Jaramillo, a former chairman and CEO of Sovereign Bank, started his one year contract in February 2012 with the aim of leading reforms. At the IDC hearing Jaramillo explained that the Fund was implementing the “Consolidated Transformation Plan” to ensure that efficiency, risk management, transparency and anti-corruption practices are improved. He quoted these transformations as ‘game changing’ in order to restore donors’ confidence as quickly as possible. He said, “some say the Fund is changing too quickly, I say not quickly enough”.
The reforms include staff reorganisation, simplification of processes and disease-specific monthly meetings organised with grant committees and Partners to ‘stop and reflect’ on the work conducted.
Jaramillo ended his evidence to the Committee on a positive note stating: “We are going to do better what we do best which is to save lives”.
The Impact of the Crisis on Efforts to Save Lives
The IDC heard from members of civil society and the UN – all of whom recognised that the Global Fund can continue to improve its work, but highlighted that it is one of the most transparent, effective and innovative funding mechanisms in existence. They reinforced that the fraud concerned was less than 5% of the Fund’s grant portfolio and that over the last 10 years the Global Fund has done incredible work to help save more than 7 million lives in more than 150 countries.
What is clear from evidence being collected by communities, NGOs and UN organisations is that cuts to the Global Fund is having an impact now and that delays in the funding of new grants will further affect communities around the world.
The next opportunity for countries to apply for new grants will be during the next replenishment period 2014-2016. NGOs at the IDC hearing pointed out that new services would be cut and that the TFM was a mechanism for the status quo that did not include crucial aspects such as social protection, prevention, care and support. The TFM allows for continuation of treatment, but not for new treatment places meaning that those individuals newly diagnosed with HIV will be denied access to life-saving treatment. The TFM is not a mechanism to scale up services to reach Millennium Development Goal 6 (MDG 6) by 2015. The country impact studies in the International AIDS Alliance’s ‘Don’t Stop Now’ report documents the many ways in which the HIV response is now endangered lives including in the new Republic of South Sudan whose government was counting on a round 11 application to cover the 80% of the national AIDS plan that is currently unfunded.
DFIDs response to the Global Fund Crisis: Their Delay will Cost Lives
In 2011 DFID released a Multilateral Aid Review (MAR) within which the UK publicly acknowledged how critical the Global Fund is to the delivery of MDG 6. The MAR rated the Global Fund highly in terms of good value for money and delivering results but that it wanted to see reforms made to further strengthen its work.
The Fund has been shown to be an effective funding channel, the Fund is implementing the reforms that the UK wants to see, and there is a dire urgency to get the Fund fully funded and back to normal.
So why is the UK Government dragging its heels and not showing public confidence in the Global Fund by committing to fund its fair share? Why wait when lives are being lost?
Civil Society and UN partners at the IDC hearing called on DFID to support the call for a replenishment opportunity at the G20 Summit in Mexico in June- the perfect opportunity for the UK to play a central role in leveraging support from other donors.
The UK government’s Position
Andrew Mitchell told the IDC enquiry that DFID will continue its funding of the fund and in fact will commit to a £128 million in 2013, 2014 and 2015, working towards the previous Labour Government’s commitment of £1 billion to 2015. Beyond this he held out the possibility of a doubling in contribution from 2013 onwards. Great news. But the extra funding will be led by evidence that the Global Fund has made the necessary reforms. The Secretary of State was not opposed to a re-launch of pledges at the G20, but was concerned about the short amount of time between now and then.
The UK has traditionally demonstrated historic leadership on HIV. The UK should use its position to leverage others. Instead, it seems that the US and other non-European governments are taking the lead. On World AIDS Day, Barack Obama stated, “To the global community — we ask you to join us. Countries that have committed to the Global Fund need to give the money that they promised. Countries that haven’t made a pledge, they need to do so.” Germany, Japan ($340 million), Saudi Arabia ($25 million) and the Gates Foundation ($750 million) have all already pledged their support.
Like Walter Savage Landor famously stated: “Delay in justice is injustice”. What are we waiting for? Why wait? Delay is simply not acceptable because lives are at stake. Waiting will undermine the gains made so far in the HIV response and will lead to unnecessary illness and death.
It is time for the UK government to not delay and instead lead the way in the global rush to save lives.
Written by Marie-Ophelie Sarrade, Communications Volunteer, UK Consortium on AIDs and International Development
If you want to watch the video of the committee meeting go to: http://www.parliamentlive.tv/Main/Player.aspx?meetingId=10623
If you want to see more on what the Global Fund has achieved in 10 years, have a look at this video: http://www.youtube.com/watch?v=OA-31xD0log or go to http://www.theglobalfund.org/en/
Evidence of the impact of the Global Fund crisis can be found in their “Dont Stop Now” report: http://www.aidsalliance.org/publicationsdetails.aspx?id=90566
