Ideas to Action:

Independent research for global prosperity

Todd Summers

Senior adviser to the CSIS Global Health Policy Center

Todd Summers is a senior adviser to the CSIS Global Health Policy Center, which he joined in September 2012. His primary focus is on international financing for global health, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Prior to joining CSIS, he worked as an independent consultant focused on addressing urgent global health challenges. Most recently, he has been working on behalf of the Global Fund Board of Directors as chair of its Strategy, Investment, and Impact Committee.

It’s an exciting time for those fighting AIDS, tuberculosis, and malaria: new knowledge and interventions give us unprecedented opportunity to change dramatically the course of all three epidemics, saving both lives and money. This builds on tremendous progress already made on reducing global morbidity and mortality rates: annual AIDS-related deaths dropped 40% since 2005; TB deaths dropped 40% since 1990; and malaria deaths are down by more than 25% globally since 2000.

Yet at the same time, the organization established to help finance this fight – the Global Fund – has been struggling to adapt to an increasingly austere funding environment and to transform itself from a passive funder into a more proactive investor. It has also had to deal with significant management and governance challenges, poor performance and occasionally fraud in some beneficiary countries, and a rapidly challenging relationship with key funding and technical partners.

Much of this came to a head last fall, when the Global Fund’s board of directors met in Accra, Ghana. At this tumultuous meeting, the board unanimously agreed on a bold new five-year strategy (“Investing for Impact”), canceled the current funding round due to lack of funds, implemented an overhaul of its governance processes, and forced out the executive director by agreeing to hire an interim general manager to assume all management responsibilities. The process itself left deep wounds between and among board constituencies, management, implementing countries, and advocates.

Over the past year, work has been underway to heal these wounds and get back to the business of saving lives. The general manager has led a transformation of the Global Fund’s Geneva-based secretariat, the board has delegated more responsibility to new committees and set in place a search for a new executive director, and advocates have resumed work to make a case for increased contributions from donors. Implementing countries are perhaps still coming to grips with all of the changes, wondering whether they can still rely on the Global Fund to finance major expansion of their efforts to fight the three diseases.

This November, nearly a year after Accra, the board will take important steps in getting the Global Fund back up to full speed. A new funding model that fits its updated strategy is set for approval, a new executive director will be chosen to lead the team, and the next three-year replenishment process will start among donors.  Next spring, the Board will choose a new chair and vice chair, who will have to support the new executive director and continue the work to improve governance.  Three priorities for the Global Fund are clear:

  • Implement the Strategy: Putting the new funding model in place is an important part, but other critical aspects remain, especially work to address human rights barriers that continue to prevent many people from accessing lifesaving prevention and treatment services.
  • Increase Sustainability: Many countries receiving Global Fund support struggle to demonstrate the scale of political and financial commitment needed to ensure long-term program sustainability.  The Global Fund, hand in hand with the US and other big-muscled donors, is going to have to engage political leaders (Ministers of Finance and Heads of State) to get them to take increasing responsibility for addressing the three diseases and other health needs.  Focus should be on the 20 or so countries that account for most of the burden for AIDS, TB, and malaria.
  • Make the Case: Every day, funds provided by the Global Fund save lives across the world, yet few people know of its impact.  For political leaders to sustain and increase support, the Global Fund will need to do more to demonstrate that it is an effective, efficient, and focused institution.  It will also have to harness the incredible capacity of advocacy groups like the ONE Campaign to help it tell its great story to the public, and to motivate them to communicate support to their political leaders.

The Global Fund is indeed at a pivotal moment. Hopefully, wounds have largely healed, and a newly revitalized Global Fund will emerge better able to support countries in seizing the very real opportunity to bring an end to three of the most deadly epidemics in history. While it may take another generation, every day counts when the metric for success is life or death for millions.