Employee Mental Health at The Global Fund
Author:
Aidspan
Article Type:Article Number: 3
Mental health in the workplace has become more scrutinized over the last 10 years, particularly because of COVID. The Global Fund has global impact through its partnership model and investments, but what about its impact on the people within the organization and the workplace culture? This Aidspan article looks at the status of employee mental health at the Global Fund.
The Global Fund has had immense impact, as seen through the Results Report released in September 2024. To support its partnership in this achievement, The Global Fund has over 1,000 employees with full staff benefits and additionally uses consultants on a short- and long-term projects. Today we would like to focus on employee mental health at the organization, which has been a topic of Global Fund board and committee concern – but the Global Fund is hardly alone in experiencing huge shifts in ways of working over the last 5 years and this article is part of a global conversation on workplace mental health.
Much of this global conversation was instigated by COVID. COVID had a huge impact on the Global Fund as a workplace in many ways, including as a public health institution. The MOPAN Assessment of the Global Fund 2021-2022 lauded the Global Fund for not “revising downwards its targets for HIV, TB and malaria.” But it was staff who had to absorb the pressure: employees experienced changes in their immediate surroundings in Geneva, worried about family members abroad, were prevented from travel on mission, and became part of pandemic response and prevention – the COVID-19 Response Mechanism (C19RM). It cannot be ignored that the influx of C19RM funds, which nearly doubled the amount of money the Global Fund disburses in a normal 3-year period, dramatically altered expectations of the organization and its employees; This resulted in new staff being hired, but since C19RM funding is still being disbursed until the end of 2025 alongside normal HIV, TB, malaria and RSSH (Resilient and Sustainable Systems for Health) grants, the increase in COVID-linked expectations has not necessarily decreased for a typical Global Fund employee. As Staff Council told Aidspan: “The Global Fund secretariat is a high energy, high stress, high workload environment.”
The Global Fund leadership and administration are not blind to these issues and below there is information on their efforts and response, as well as information from the Global Fund Staff Council, OIG (Office of the Inspector General), and Ombudsperson.
Mental Health
Mental health is a difficult state to describe, varying greatly across workplace and global cultures with one person’s burnout workload as someone else’s ideal. Some people have been raised to complain loudly at the slightest change or inconvenience whilst others endure extreme suffering in silence. Our goal is not to judge anyone’s state of mental health but rather to explore how – and how well – this challenge is managed in a workplace as multicultural as the Global Fund. Far from a matter that can be neatly divided as East-West or North-South, mental health is a human issue; the importance of which is recognized by institutions globally, including through a program by the Africa Centre for Disease Control backed by the Wellcome Trust.
WHO says that “discrimination and inequality, excessive workloads, low job control and job insecurity pose a risk to mental health”. Repercussions can include loss of workdays to anxiety and depression. In the case of the Global Fund, this could mean a loss in the workplace itself, but also a ripple effect of sub-optimal service to the partnership, decreasing employee capacity to support live-saving programs.
Protecting and promoting mental health at work
Aidspan corresponded with the Global Fund HR (Human Resources) team, the Staff Council, and an anonymous source who enabled access to the Global Fund Ombudsperson Annual Report 2023. Both the Staff Council and HR have shared updates and concerns through regular presentations to and meetings with Global Fund committees and the board.
HR shared that during COVID a SRT (Situation Response Team) was appointed to “ensure crisis mitigation and wellbeing of the staff” and this SRT and the Head of HR at the time, Patrick Nicollier sent out COVID updates on a regular basis and launched initiatives to support employee wellbeing. As an example, one of Nicollier’s emails said, “Keep in mind that, even if you are restricted to home, it’s important to rest, take breaks and take scheduled annual leave. The current situation poses unique challenges for physical, mental and emotional health, and we all need to take care of ourselves.” Other emails reminded employees of the importance of taking screen breaks, encouraged parents to take annual leave during school breaks to avoid being overburdened, or promoted new suggested norms for email etiquette and, additionally, the Staff Counsellor was advertised as available to help staff.
HR initiatives during COVID included coffee catchups for individuals facing isolation, a neighbourhood care initiative where colleagues could assist each other with tasks, and efforts to engage staff and monitor their wellbeing through interactive team sessions using virtual tools. Towers Watson, a business management consulting firm, was hired to take out surveys as part of this monitoring. The Global Fund team did not provide statements from other leadership, the board, committees, or ombudsperson or survey results on this topic, so it is difficult to get an accurate picture of if and how this agenda was pushed more broadly, or how effective it was.
With C19RM resources, the Global Fund hired more staff but, nonetheless, HR shared that “sustaining the pace and intensity of our efforts over so many months – has inevitably taken its toll on individuals and teams, both in terms of workload and well-being” but the Staff Council pointed out that “the resources were already needed before COVID-19.”
After COVID, the HR team said that “significant adjustments have been made to workload distribution to ensure the continued efficiency of our operations” including a review of staffing needs to rebalance workload across teams. HR emphasized in communications with Aidspan and, according to employees, posters around the office, a culture of “care and candour”. HR also provided a list of steps it has taken to make the Global Fund “a better place to work”, including flexible working arrangements, social wellbeing initiatives, and physical wellbeing opportunities. Social wellbeing activities focus on social cohesion and DEI (diversity, equity, and inclusion) topics through events that highlight the Global Fund’s cultural diversity, however, Staff Council, noted that even though awareness of this diversity is increasing “if the organization really wanted to dig down and unpack what they mean by DEI in terms of our culture, our structures and just how we do things, then we will start seeing those disparities… [we] haven’t seen an impact on that side as far as [we are]concerned. There’s awareness, but it’s still business as usual.” Examples of where disparities might appear are benefit caps (e.g. education grants), level of dependence on benefits of people from counties without national health insurance schemes, career progression or contract renewal of people from donor vs recipient countries, and even salary.
HR and Staff Council seem in alignment that mental health isn’t a “standalone issue” and is tied closely to workplace culture. HR’s initiatives paint a picture of a bottom-up approach through offerings to individual employees, whereas Staff Council sees the opportunity to take a more top-down approach that addresses “root causes in our operating procedures, the organizational culture, the tone of leadership and the mission… root causes are never, ever addressed year in, year out.” The Global Fund Ombudsperson Annual Report 2023 echoed the request for mental health support and awareness, training, and analysis of what lies at the root of burnout as part of the proactive preventive approach that is needed.
The Staff Council discussed its own role in protecting and promoting mental health and referred to its focus on equity and accountability of all Global Fund employees. In an interview with Aidspan, the Staff Council mentioned the Wellness Working Group, HR Office, Ombudsperson, Staff Counsellor, and therapy available via the health insurance scheme as important, but that additional resources were still needed. Staff Council shared that its objective is to “make sure that Staff are operating as productively as possible in an enabling environment… that enables them to work confidently to achieve their objectives.”
Staff Council helps employees with a range of issues and said that “People come to us with a range of problems, everything from burnout to issues involving evaluation of their performance to interpersonal conflicts, to concerns about contractual rates.” As an example a small team needs to get out a piece of work resulting in a decision on funding allocations or portfolio optimization and if a number of people are absent due to annual leave, trainings, illness, or personal obligations, the remaining team members are expected to “take up the slack and that has a direct impact on their mental health.”
Results
Despite efforts, not everyone feels positively about the Global Fund’s workplace culture and burnout is a regular occurrence. The Ombudsperson Report pointed out that work performance and psychological safety were affected by the behaviour of some of the Management Executive Committee or Extended Leadership Team, perhaps reflecting poor management on their part and a reference is made to an organizational environment beset by inimical practices of managing change and conflict. Concerningly, this Report stated that the number of people reporting symptoms associated with burnout or concerns about the workplace impact on their health rose sharply from 29 to 51, but overall constituted 4% of the workforce.
The Ombudsperson’s report noted a strong pattern of high-level risk associated with areas of Programmatic Monitoring and Risk, Supply Operations, Ethics, and Health Finance as illustrated in the graphic below.
Cases brought to the Ombudsperson in 2024 covered the following issues:
- Respect/treatment (19 cases)
- Perceived bullying/mobbing (13 cases)
- Consultation (13 cases)
- Work-related stress and work-life balance with reference to safety, health and the physical environment (51 cases)
- Organizational climate (13 cases)
- Leadership and management (10 cases)
- Restructuring and relocation (10 cases)
Cases were disproportionately brought by employees in higher grades, which the Ombudsperson believes signals that higher grade employees might feel more empowered or that employees at lower grades fear retaliation. This is not unique to the Global Fund. The United Nations Ombudsman Report 2023 made another valid observation that “the more that authority to determine contract renewals rests with one individual (a line manager or head of office), the greater the potential for real or perceived risk of retaliation when concerns are raised.” This makes even more important the function of the Internal Justice System.
The Ombudsperson, whilst appreciating the Global Fund HR initiatives described above, noted that a proactive approach is needed including addressing the root of burnout, training and building capacity at the managerial level and supervisory support for conflict resolution and people management processes with adherence to organizational values and the code of conduct. Staff Council shared that mental health issues such as burnout post-COVID “are very much linked to the regular cycle the organization is going through with grant making, replenishment etc. The addition on top of that ‘regular’ cycle of fighting against COVID has added some complexities… it’s extra work.”
OIG Findings and ILO (International Labor Organization) Tribunal Cases
Source: OIG Advisory on Internal Justice Mechanism
Even if all HR, Staff Council, and Ombudsperson efforts were to solve issues for most employees, there would always be exceptions and the redress processes for cases where things have gone wrong are an important part of HR and employee wellbeing. For this the Global Fund has the IJM (Internal Justice Mechanism) as “an avenue for resolution of employment-related disputes.” The IJM for all case types is described in the image above.
In an OIG Advisory published in October 2024, the OIG found that “the design of the Global Fund’s IJM system is generally aligned to that of comparable international organizations.” and the Advisory also contained 2 recommendations for the Global Fund to improve the IJM:
- Encourage and enable greater use of informal dispute resolution approaches, including removal of HR as the recipient of requests for mediation and shifting this to the Ombudsperson.
- Amend key IJM system documents to improve clarity and align more closely to good practices of comparator organizations, including through an update of the employee handbook and amending the appeal board operating procedures.
Below is a breakdown of IJM case types between 1 June 2018 to 31 October 2022.
Comparator organizations like the United Nations (UN) have its Ombudsman’s Office involved in informal dispute resolution, but its 2023 report acknowledged that the Ombudsman’s Office tends to be involved at the end stage of formal conflict resolution rather than initially. This report observed “an increasing practice by some organizations to request written confirmation that someone engaging in informal conflict resolution is medically fit to do so. Such requests should be made in a sensitive manner, however.”
The OIG also audited HR Management Processes in 2019, at which point it found that “Although substantial progress has been made in certain areas… policies and procedures to support HR management processes, especially performance management, employee relations and the employee grievance process, need significant improvement. This is mainly due to continued issues in managing poor performance as a result of ineffective implementation of performance management processes by staff including people managers and the HR department.” A survey in this audit revealed that only 2% of respondents thought that the Global Fund took appropriate action when dealing with poor performance and that “The Global Fund lost eight cases at the ILOAT (International Labour Organisation Administrative Tribunal) between January 2016 and June 2018. These resulted in CHF1.9 million fines against the organization in addition to US$0.3 million in administrative costs. Management time in managing these processes, while difficult to quantify, is believed to be significant, representing poor value for money (particularly for senior staff).”
Prior to these, in a significant judgment in 2015 in Case No. 3506 on health insurance, the ILOAT agreed with the complainant that the Global Fund had failed in its “duty of care” to its staff member by not acting with “greater diligence and benevolence” to ensure that an outstanding amount of 8,647 Swiss francs was paid out by the insurance company knowing full well the complainant’s “critical state of health”. And this was in a case where the Global Fund admitted that the staff member’s ill-health was “service-incurred.”
Cases between the Global Fund administration and current/former employees have continued since.
Source: ILOAT Website
A case in 2024 that resulted in the Global Fund needing to amend its internal processes to allow employees to be provided “all material evidence likely to have a bearing on the outcome of his/her claims” and pay an award of €15,000 in moral damages to the employee.
Whilst ILO Tribunal cases are few, they are often the tip of the iceberg among employees who have workplace or workplace-induced issues with others likely unable or unwilling to come forward.
Conclusion
A key concern is: Who holds whom accountable, and what protections are in place for employees who raise complaints? Whilst employee handbooks might outline some basic rights, these are often insufficient to guarantee fair treatment or transparency throughout the process. The OIG Audit Report of Global Fund Human Resources in 2019 also underlined this noting that there are “no detailed guidelines on the stages of the investigation process in the Employee Handbook to explain complaint intake and assessment, investigation plans, evidence collection, and criteria on the use of external investigators; and no internal standard operating procedures governing the conduct of HR Business Partners or Employee Relation specialists to ensure consistency in the implementation of employee relations matters.” An Agreed Management Action from this report prompted an updated Employee Handbook issued since then with detailed information on how employees are to navigate an investigation.
The ILO serves as a critical independent recourse for employees, offering an external mechanism that complements internal procedures. However, concerns arise even by ILO when the organization fails to share investigation reports with all relevant parties including both the complainant and the individual against whom the complaint is made. This lack of disclosure can undermine trust, raise doubts about fairness, and hinder accountability.
The lack of transparency within the Global Fund has been a concern for a while now. An Aidspan article in 2022: Who Can Fix Four Fundamental Global Fund Problems? bemoaned that “It’s also no longer possible to find the names and contact details of Global Fund staffers who work in, or at least who lead, each secretariat department, or to find contact details for the Global Fund Board Constituency Focal Points.”
It’s par for the course then that the Global Fund Ombudsperson Annual Report 2023 meant to be a public document is also unavailable on the Global Fund website.
So, overall, it begs the question of the climate within the organization that will empower people to raise their concerns when the organization itself hesitates to make full disclosure on its own internal workings.
