Ideas to Action:

Independent research for global prosperity

Prashant Yadav

Director of Healthcare Research at the William Davidson Institute, University of Michigan

Prashant Yadav is director of healthcare research at the William Davidson Institute at the University of Michigan. He serves on the faculty at the Ross School of Business and the School of Public Health at the University of Michigan. The views expressed are individual and not of the organizations the author is affiliated with, or with any of his advisory roles.

Started just over a decade ago the Global Fund has become the key instrument in the global fight against HIV/AIDS, TB and Malaria.  While it has achieved some remarkable successes, it has also been the object of criticism for lack of efficiency and effectiveness.  The first decade of the Global Fund has also transformed our understanding of the pragmatic and strategic approach required to achieve the ambitious goals set forth for the institution.  As the Fund undergoes a leadership transition, it is opportune to ask what would be priority areas for the new head of the Global Fund. Admittedly, he or she will have no shortage of priorities and issues vying for immediate attention. Below I highlight some that I consider important:

Stronger execution

The General Manager and his team have reorganized the Global Fund Secretariat to focus better on the core business of managing grants as investments. A more strategic investment model has also been put in place. The first priority for the incoming CEO will be to ensure that the newly reorganized internal team continues to deliver as planned and the momentum gained in the reform process is not lost. It will be even more important to ensure stronger, sharper, and timely execution of the investment strategies that have been developed. The well crafted strategies will not yield results until the Global Fund is geared to execute them well.

Narrower and deeper engagement in select areas

It will be important for the Global Fund to consider putting more of its resources in fewer areas; changing its role to be narrower but deeper. There will always be tradeoffs between ensuring equity amongst regions, countries, diseases, interventions and the ability to impact effectively and sustainably.  The new chief executive will need to decide a strategic path forward on this very early on.  

Driving change in other areas through non-traditional tools of engagement

While it will be imperative to have stronger focus, it is also important for the Global Fund to remain relevant in other areas and geographies where it is not the largest financier, for example in some of the lower-middle and middle income countries that in the past have been large recipients of Global Fund support.  This requires identifying and adding new non-traditional methods of program support to the Global Fund’s operating model. UNITAID and GAVI have to some extent used such non-traditional support tools that positively impact the provision of health services and health technologies even in regions that are not the direct recipients of their support. The Global Fund will have to add some such tools to its repertoire to foster stronger partnerships.

Talent acquisition, retention and development across the organization

The Global Fund has a very dedicated and professional team at levels in the Secretariat.  As it embarks on a more strategic investment approach and tries to use non-traditional models of program support it will require greater specialized expertise in areas such as investment impact assessment, strategy reformulation, health technology economic value assessment, procurement and supply chain management, and global market dynamics. Acquiring, retaining and developing talent in many such fields will require this to become a top priority for the new chief executive.

Better control over the supply chain

The Global Fund needs to have better control over the supply chain that helps it deliver products and services to the final recipients.  A single weak link in the Global Fund’s supply chain can significantly compromise effectiveness, efficiency and quality of its investment portfolio. Exercising control over the supply chain is not the same as owning the assets in the supply chain or controlling all decisions. It requires a model where there is greater accountability and performance tracking at each level and greater involvement of efficient private sector actors in portions of the supply chain that they are best suited to manage.

No shying away from asking for co-financing by recipient countries

Financial sustainability will remain to be a concern for many Global Fund programs in the future. While strong impact and results would hopefully lead to much larger replenishments in the future, shying away from co-financing because it is challenging is only postponing the problem to the future.  The new chief executive will have to create a strategic plan for how to achieve greater co-financing by the recipient countries. This will require working closely with the Global Fund’s main donors, recipient country governments, and civil society partners. Convincing recipient country governments that investment in health—and more specifically in the three diseases—is the best use of their monies should be a specific role within the Global Fund. Civil society organizations in recipient countries can be a strong partner of the Global Fund in moving this agenda forward.

Creating an agile Global Fund

Learning to manage well in uncertainty and ambiguity are an important trait of a successful organization. It is unrealistic to expect that the Global Fund can resolve all of the uncertainties in it business model anytime soon. Instead, it needs to create an organization structure and culture that is agile enough to reformulate strategy and execution plans quickly and continue to deliver well even when things change considerably.

Accepting that the Global Fund is different

In the pressing need for efficiency and value for money it will also be important to keep in mind that the Global Fund was created to be different, as a need driven financing institution. While it needs to learn from successes of other disease programs, it cannot be a replica of any other existing models.  A new best-of-breed hybrid model needs to emerge based on the learnings from the Global Fund, PEPFAR, GAVI and others.