Ending the epidemics is a greater challenge than achieving progress: Dybul
Executive Director Mark Dybul provided the Board with a report that celebrated the Global Fund’s achievements but also challenged the Fund to do better on a number of fronts.
Dybul said that the partnership the Global Fund has established has produced extraordinary results: more than 17 million lives saved through 2014. The Global Fund is recognized for innovation and for aligning well with country priorities and communicating frequently with governments, he said.
However, he added,
“We need to acknowledge that setting up a partnership model was in itself not enough. We have to continue to innovate, to work faster, better, and smarter. Achieving progress in the last decade was relatively easy because the need was so great and the impact was clear and visible. However, ending epidemics is a greater challenge, and for HIV and tuberculosis it requires dealing with deep-seated socio-cultural issues. The last mile is always the most difficult, and can be the most expensive. To end these epidemics by 2030, our investments have to be more focused, nuanced, and interwoven.”
Dybul said that a person-centered approach is at the heart of the Sustainable Development Goals. “A child fleeing Syria or Somalia needs food, education, shelter, health,” he said. “More important, that child and her family and community need investment in systems that provide elements of basic human dignity, and that help stabilize a society so that fewer people need to flee in the first place.” Dybul said that to serve the person, the Global Fund must make smart long-term investments in health and human rights.
“We are only beginning to fully acknowledge that fundamental inequality and discrimination against women and girls is the key driver of HIV infection in many parts of Africa,” Dybul said. “Rates among adolescent girls and young women are shockingly high, and stubbornly resistant to attempts to bring them down.”
Dybul cited a study published in The Lancet showing that cash incentives to keep girls in school can reduce the risk of acquiring HIV by as much as 12% a year. “Although such studies are imperfect, and could be difficult to replicate in some communities, they reflect the importance of a person-centered approach,” he said. “Combined with programs to end gender-based violence and other social protection and interventions, they point to an opportunity to reduce HIV while transforming society.”
Dybul said that although more than a third of the Global Fund’s investments go toward systems for health, “we must acknowledge that there is still much to be done within the ‘sectors’ of health to achieve the SDG vision of universal health coverage that delivers quality health for all. As we evolve, we are even more focused on the role of the Global Fund to support each country to build resilient and sustainable systems for health that link the clinical parts and the community parts of the system.”
Dybul said that efforts to link sectors, and to reach vulnerable and marginalized people, are essential. “The focus on financial sustainability is important,” he said, “but supporting countries in their efforts to advance the systems and programs to succeed is even more important. With some humility, we can admit that in development work, including global health, there have been a lot exits but not many successful transitions.” Programmatic and financial sustainability takes time and planning, Dybul added.
Dybul said that although the Global Fund is behind on some key performance indicators, he is encouraged by the fact that the KPIs are now being used for their intended purpose – “as the beginning of an analysis to understand fundamental issues that prevent achieving maximum impact and to develop a clear and accountable plan to fix them.”
Dybul said that we have to make sure we don’t lose the war by settling for minor gains. He added,
“Greater success is possible if we rise to the challenge to serving people, which is essentially coming back to our roots. Our whole wonderful journey began when people and communities affected by the three diseases stood up and demanded to be counted – counted as equals, with the dignity and the rights they deserve. Our cause is not just about the most significant epidemics of our time, it is a cause of social justice, moral progress and greater humanity.”
The Report from the Executive Director describes a number of approaches that the Global Fund is taking to address the challenges Dybul described above. GFO will report on some of these approaches in future issues.
The Report of the Executive Director, Board Document GF-B34-02, should be available shortly at www.theglobalfund.org/en/board/meetings/34.