Ideas to Action:

Independent research for global prosperity

Owen Ryan

Deputy Director, Public Policy for amfAR, The Foundation for AIDS Research

Owen Ryan is Deputy Director, Public Policy, amfAR, The Foundation for AIDS Research. Prior to amfAR, Owen spent four years working on HIV/AIDS policy and advocacy at the Bill & Melinda Gates Foundation. He has more than 15 years in global health policy and programming experience including work in Malawi, South Africa, and Zimbabwe. Owen earned his Masters of Public Health and of International Affairs from Columbia University.

Once the new Executive Director of the Global Fund is selected, he or she will enter a dramatically different organization than the one that was created just a decade ago. While the organization has matured, its work has become much more complicated. The new Executive Director will need to immediately establish clear priorities for Global Fund financing – the subject of much debate.

Currently, there are two competing approaches.

The first approach asserts that the Global Fund should focus its resources on countries in greatest need, i.e., the poorest countries with the most people living with or vulnerable to the three diseases. In the push to make hard, strategic choices for the greatest good, it suggests limiting investment to interventions with an established evidence base (e.g., male circumcision to prevent HIV infection). In this approach, having the greatest public health impact with limited resources is primary.

The second approach focuses on the unique role of the Global Fund. As a multilateral donor, the Fund has been able to support evidence-based programs that are too politically unpopular for bilateral donors and national governments. Such investments include syringe exchange to reduce HIV infection among drug users and civil society strengthening to promote accountability from national governments. This approach also recognizes the role the Fund has played in middle-income countries (e.g., reducing artemisinin resistance and malaria infections throughout Asia) where fewer bilateral donors exist. In this approach, ensuring an equitable global response to the three diseases is the hallmark of the Global Fund.

In balancing these approaches, there are several things the new Executive Director should keep in mind:

  • Middle-Income Countries – It is too simplistic to suggest that the Global Fund’s investments should be targeted only at the nexus of disease burden and economic status. Middle-income countries account for more than 70% of the world’s poor. However, the Global Fund cannot become an entitlement pool in which every middle-income country is guaranteed a minimum contribution.
  • Civil Society and Key Populations – Research has shown that countries divert funding away from politically unpopular groups such as men who have sex with men, even after a grant is approved. The future success of the Global Fund will be determined by its ability to finance programs that access the most hard-to-reach groups in all countries.
  • Evidence-Based Programs – The Global Fund needs to aggressively push country portfolios towards the most effective interventions. In cases where effectiveness data is lacking, the Fund and its technical partners should support country-led operations research and surveillance.
  • Performance and Data – Strong performance by national governments and civil society must be incentivized and rewarded. The Global Fund needs to build stronger data collection and reporting systems that can determine the strength of country programming and diagnose issues long before they become substantial problems.

When Global Fund financing begins to flow again early next year, it will need to accompany a clear indication to countries about where the Fund’s priorities lie and how it will support programs for years to come.

The future of the Global Fund depends on the decisions that are made in the next few months.