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Ambassador for Global Health at the Swedish Ministry for Foreign Affairs
Dr Anders Nordström holds the position as Ambassador for Global Health at the Swedish Ministry for Foreign Affairs in Stockholm. He also serves on the Boards of UNAIDS, GAVI, and is an alternate board member at the Global Fund to fight AIDS, Tuberculosis and Malaria. During 2002 Dr Nordström was the Interim Executive Director for the Global Fund to Fight AIDS, Tuberculosis and Malaria, after having being part of the Transitional Working Group during 2001. Dr Nordström has also served as Assistant Director-General at WHO for General Management, Acting Director-General of WHO, Assistant Director-General for Health Systems and Service, and as Director-General for the Swedish International Agency for Development Cooperation (Sida).
For the Global Fund it is now the time to “make it or break it”.
The fund has over the last 10 years evolved quicker and more substantively than any other global institution. Unfortunately the operating model has not matured in such a way that it supports effectively the operations of the Global Fund today.
Looking back to 2002 when it all started and we were a small team of some 25 people turning the first round of applications around for the board’s approval. Few of the operational processes and structures were defined at that time and we were driven by the political enthusiasm and the push from the activist on the ground.
Today the Global Fund is an institution that operates in 150 countries and with a yearly budget of approximately 3 billion USD. This is about a quarter of the budget of IDA! And this is for health only and 100% grant money. I am not arguing that the Global Fund and the World Bank are the same and should have the same ways of operating. But the differences are enormous in terms of the sophistication and robustness between the business models of the World Bank and the Global Fund.
The Global Fund needs today both to simplify its ways of working and at the same time allow for more robust and differentiated interactions with countries.
It is not reasonable to have the same operating model (with CCMs, LFAs, PRs etc) in countries where the Global Fund provides a 10 million grant as in countries where the total resources amounts hundreds of millions and constitute perhaps as much as 30-40% of the national budget.
The Global Fund’s new strategy provides an excellent starting point for a more differentiated and country by country approach. Unfortunately both the secretariat and the board have missed this “point” and instead jumped directly to the politically very sensitive issue of an allocation model (i.e. how to divide the money). For me this step should have come only after some more serious work based on the new strategy defining the Global Funds strategic role in different country contexts.
The operating model should be based on three dimensions 1) performance in the past and projected future results 2) risks and 3) relative size/role in the specific country.
The Global Fund should remain a financing entity, however a more strategic thinking is needed around the whole business model. A few examples;
The Global Fund with its substantive financial resources should e.g. not play the same role in low income countries as in middle income countries.
In countries where international resources are substantive, the Global Fund must be on-budget and be prepared to be part of national processes and not align the government and partners around the way the Global Fund operates.
We do not need the same kind of Country Coordinating Mechanisms in all countries.
Making sure that the technical partnerships with UNAIDS and WHO works in countries will weaker capacity is more important than in some other countries.
The LFA function must be differentiated in line with risk and volume of resources and aligned to national structures.
If business continues as today and only incremental change happens the Global Fund will be at even higher risk for failure in the future. We need a Global Fund 2.0.