What’s Not Being Said about the U.S. Government’s Role in the Global Fund Replenishment

Since the Global Fund received $11.7 billion dollars in donor commitments for its next three years of programming, the media has focused on the over $1 billion dollar shortfall against the lowest resource scenario presented by the Fund in the lead up to its replenishment.  Understandably so. Of the three funding scenarios (ranging from $13-$20 billion), the lowest scenario was considered the bare minimum of what would be needed to continue to fund existing programs.  Under the lowest scenario—which is $1.3 billion more than the actual commitments—Michel Kazatchkine, Executive Director of the Global Fund, warned that new programs would be funded at significantly lower levels, if at all.  In the aftermath of this disappointing replenishment, most commenters dwell on specific commitment amounts (for example here and here) and perhaps overlook key messages that emerge from high-profile donor pledges.  Consider the Global Fund’s lead donor—the United States—and its Call to Action that accompanied  its pledge of $4 billion. I note two important takeaways:

1. The Global Fund needs dedicated partners and continuous replenishment to be an effective financing modelAccompanying their pledge, the U.S. government urged “fellow donors, implementing country partners and other stakeholders to develop and implement a comprehensive set of reforms to maximize the impact of the Global Fund.”  The Global Fund cannot succeed alone as a financing entity if it doesn’t have strong partners to develop and implement programs. This is not a new or trivial issue.  My colleagues and I have made these observations about the Global Fund  (here and here) for a few years now, but the U.S. government’s Call to Action makes this point explicit to the Global Fund Board and to all its partners—other donors, implementing country partners, technical partners and other stakeholders. Partners must play their role (whether it is implementation or technical assistance) for the Global Fund to succeed as an effective financing model and for donors to continue to commit resources to this financing mechanism.
2. U.S. calls for the Global Fund to work more “effectively and efficiently” raise questions about PEPFARThe U.S. has given the Global Fund a solid vote of confidence, but one which has an expiry date if a set of reforms around “efficient and strategic disbursement” of resources AND strengthening country capacity to use and “maximize the impact of Global Fund resources” is not developed and implemented against clear timelines with deliverables.  Although the Global Fund has already begun the process of making internal reforms, the U.S. is requesting a more comprehensive agenda—reforms at both the proposal level (development, review, and funding decisions, etc.) and the country level (grant implementation and review of effectiveness, etc.), with, “clear timelines and measures of progress so all parties can be held accountable for concrete steps in their respective areas of responsibility.”  It’s hard to take issue with any of the key focuses of the Call to Action for the Global Fund—efficient and strategic disbursement of resources and maximized impact are a must for the Global Fund—BUT will U.S. global health programs (PEFPAR and GHI) be held accountable to the same standards?  In taking the Global Fund to task, the U.S. is setting the bar higher for its own global health programs to be more efficient and effective.  While the U.S. touts principles of efficiency and effectiveness, it is almost impossible to find any information on how these principles are being applied and to what end. For example, where and how are efficiencies being created in the implementation of PEPFAR? How are resources being re-allocated from these processes?  Without any comparative data, how can we compare the Global Fund’s relative efficiency and effectiveness?  But, this is ultimately the question the U.S. will want answered if it is considering redistributing aid for AIDS, TB and Malaria from bilateral to multilateral channels in the near future.