The Global Fund: what, where, how much?

Graham McKerrow, HIV i-Base

The Global Fund to fight AIDS, TB and Malaria, is barely a year old, is recruiting 50 staff to work at offices based in Geneva, and has already promised $1.6 billion dollars over the next six years for prevention and treatment in the poorest countries in the world.

It has advertised seven senior posts on its website and in the 13 July issue of the Economist magazine, and promises a slim and efficient organisation.

Dr Richard Feachem, a British national, was appointed the first executive director of the Global Fund. He was founding director of the Institute for Global Health in San Francisco, and professor of international health at the University of California, San Francisco and Berkeley. He is also a visiting professor at London University. Previously, he was Dean of the London School of Hygiene and Tropical Medicine.

There have already been demands for Feacham to be sacked after he said in June: “We have got plenty [of money] to start with. The ball is in our court to demonstrate results.” He was criticised for suggesting the fund should “demonstrate results” before undertaking further fundraising.

The Fund’s board includes the heads of several international AIDS programmes, the managing director of McKinsey & Company, and four government ministers including British development secretary Clare Short and US health secretary Tommy Thompson.

Feacham has promised to announce a global plan of action for HIV/AIDS in October. He told the Barcelona conference that it would include the fund’s financial estimates of resources needed and rates of expenditure over the next several years.

Hopes are riding on the effectiveness of this independent public-private organisation to produce unprecedented results. Feacham has promised to be innovative. “We will take risks. We will fail. We will make mistakes. We will learn and we will move ahead,” he said in Washington recently.

The fund has so far committed $1.6 billion to 40 programmes in 31 countries, 60% of this going to HIV/AIDS programmes. $616 billion is committed for the first two years, with the remainder dependent on performance up to then. Feacham told delegates: “These commitments will double the current number of people receiving HAART in the developing world, and in Africa the number of HAART recipients will increase six-fold as a result of these commitments.” He added: “This is nothing like enough.”

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It is not difficult to wish the Global Fund well. It is good to see it move swiftly to fund projects and to see it make future funding dependent on results. It is also heartening to hear that it promises to be slim and efficient. We will take its word for now that a staff of 50 is really slim. We will also give them the benefit of the doubt that the director needs to receive the same pay as the director of the World Health Organisation and that staff need to get paid at the same levels as do UN employees – notoriously well! Perhaps it shows a commitment to hiring only the best.

But why does the Global Fund have offices in Geneva? Surely it would be cheaper to open offices in a developing country and make sense to spend money where it is needed. It would mean rents, salaries and fancy lunches could help a struggling economy rather than one of the richest in the world. It doesn’t make the Global Fund look like the ground breaking initiative it claims to be. It doesn’t make it look very global.

The critical thing now, though, is for people to pressure rich governments to give more money – every year – to the fund and for the fund to pass it on swiftly to projects in the field. So far the fund has been given $300 million and promised a further $1.8 billion.

Even 9.2 billion annually, as estimated by Professor Stefano Bertozzi (see separate story) will only slow the spread of the virus and treat just 3.2 million of the 40 million people with the virus.

It is estimated the England-Brazil clash in the football world cup cost the British economy $2 billion. So, as one speaker at Barcelona said, a $10 billion pot would be the price of five soccer games. Another speaker, Dr Amir Attaran from Harvard, said that in 2000 Britain spent $147 million, more than any other country, on international HIV/AIDS work — about half the production budget of the movie Titanic. We have to persuade governments, and their voters, to think on a different scale.

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