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Erin Hohlfelder is the ONE Campaign’s Policy Director for Global Health. In this role, she leads health research and policy analysis across ONE’s global markets, focusing primarily on infectious diseases, maternal and child health, and health financing mechanisms such as the Global Fund, the GAVI Alliance, and PEPFAR. Before joining ONE, she worked as the Policy Associate for the Global Network for Neglected Tropical Diseases at the Sabin Vaccine Institute, where she helped to develop and lead advocacy, social media, partnership development, and legislative efforts around NTDs. Previously, she also worked for Global Action for Children and the Duberstein Group, Incorporated.
Since the Global Fund was first created as a “war chest” to fight AIDS, TB, and malaria in 2002, it has leveraged billions from the international community to support impressive results on the ground. In the process, it has solidified its place as an indispensable health financing mechanism for donors, providing more than 81% of global financing for TB, 50% of financing for malaria, and 21% of financing for AIDS. Yet in the last two years, the Global Fund has faced a myriad of internal and external challenges, all set against the backdrop of an ongoing economic crisis.
At a point in time in which goals such as the virtual elimination of mother-to-child transmission of HIV and the end of malaria deaths glimmer on the horizon, it is critical that the Global Fund fully regain its momentum as the preeminent global actor driving progress against the three epidemics. To do this, the following actions should be considered:
A New Funding Model
Leadership must ensure that any new allocation model allows the Global Fund to be a more strategic investor, able to work with countries in a transparent, iterative process to better target grants to match localized epidemics and to align with national strategies. There will inevitably be pushback from those who say that this will undermine the Global Fund’s core tenet of country ownership, but the Global Fund should be stubbornly oriented toward saving the most lives and preventing the most infections with its resources in this economic environment. It is no longer acceptable, with so many public health goals on the line, that the Global Fund support outdated prevention modalities or fund grants that do not match a country’s epidemiological realities.
Any new allocation model should significantly weigh a country’s ability to pay, ensuring that resources first go to the countries with the highest disease burden and lowest income levels. But ideally, a new model would also incorporate criteria related to past performance, so as to incentivize innovation and exemplary performance and to mitigate instances in which countries write excellent proposals but cannot deliver sufficient outcomes. If performance is built into the model as one criterion, the Global Fund should consider the creation of a smaller “catch up fund” for countries with extreme burden and lower capacity to execute, so that they are not left to fall further behind.
Global Fund Leadership
Gabriel Jaramillo’s willingness to make difficult decisions from a private sector perspective at a time of transition for the Global Fund has often been challenging, but arguably quite necessary. However, if the Global Fund’s new allocation model moves away from being purely demand-driven, it is important that the new ED have meaningful first-hand experience working in development and with affected communities. This requirement will help ensure that what has made the Global Fund unique—a sustainable, community-led, ground-up orientation—will be valued under new leadership.
The Secretariat’s communications team must continue to build the Global Fund’s brand as the development mechanism leading the way in transparent operations while delivering results in some of the world’s most difficult places. Above all, in a time of fiscal restraint, the Global Fund must consistently focus its communications—with media, with donors, and with other global stakeholders—on the outcomes it will continue to achieve, not on the dollars it has disbursed.