The Global Fund has “missed the point” by jumping directly into the politically very sensitive issue of an allocation model (i.e. how to divide the money). This is the view of Anders Nordström, Ambassador for Global Health at the Swedish Ministry for Foreign Affairs, as expressed on a new online forum.
The Global Fund Forum was recently launched by the Centre for Global Development to present the views of prominent thinkers and practitioners on what reforms the Global Fund should prioritize and how it should best fulfil its mandate. The initial posts are from Mr Nordström; Erin Hohlfeder, Policy Director, Global Health at ONE; and Prashant Yadav, Director Healthcare Research at the William Davidson Institute, University of Michigan.
Mr Nordström says that the Global Fund should simplify its ways of working and at the same time allow for more robust and differentiated interactions with countries. “It is not reasonable to have the same operating model (with country coordinating mechanisms, local fund agents, principal recipients, etc.) in countries where the Global Fund provides a $10 million grant as in countries where the total resources amounts to hundreds of millions and constitute perhaps as much as 30–40% of the national budget," Mr Nordström said.
Mr Nordström argues that the discussion on the allocations model should have come “only after some more serious work based on the new strategy defining the Global Funds strategic role in different country contexts.”
In her post, Erin Hohlfeder says that while a new allocation model should give significant weight to a country’s disease burden and income level, it should also incorporate criteria related to past performance, “so as to incentivize innovation and exemplary performance and to mitigate instances in which countries write excellent proposals but cannot deliver sufficient outcomes.” If this is done, Ms Hohlfeder says, the Global Fund should then consider creating a smaller “catch up fund” for countries with extreme burden and lower capacity to execute, so they don’t fall further behind.
In his post, Prashant Yadav says that the Global Fund needs to have better control over the supply chain that helps it deliver products and services to the final recipients. “Exercising control over the supply chain is not the same as owning the assets in the supply chain or controlling all decisions,” Mr Yadav said. “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.”
The Global Fund Forum will add new perspectives in the coming weeks. In addition, readers are invited to join the discussion on the page that introduces the forum.