Switching gears from a typical executive director's report to the Board during the Global Fund's 33rd meeting on 31 March, Mark Dybul reflected on the six trips he had made in the first quarter of 2015 that demonstrated what he said were the breadth and flexibility inherent in the new funding model.
Echoing the Office of the Inspector General's assessment that the Global Fund was maturing, he said that it was right and appropriate for the Fund to begin embedding strategy in its design and development work, "to ensure management for impact".
While acknowledging that there have been delays in submission by country coordinating mechanisms of the concept notes to access the $14.82 billion in available funding for HIV, TB, malaria and health systems strengthening, Dybul sounded an overall positive note about progress towards ending the three diseases.
In meetings with CCM, PR and government representatives in Papua New Guinea, Honduras, Haiti, Swaziland, South Africa and Zambia, Dybul said he heard consistently that the new funding model was easier -- though still bureaucratic -- to navigate. In recounting a meeting with a nun who has been engaged in Global Fund-supported work in PNG since the outset, he noted that she said, "finally the Global Fund is a humane organization, clearly focused on human beings".
The formula, he said, is still a work in progress, but there are clear signs that it is moving in the right direction as in Haiti, where public hospitals are using health system strengthening funds to improve services available to TB patients. A hospital in Mirebalais, some 60km northeast of the capital Port-au-Prince, can claim a 100% cure rate for TB.
The "21st century partnership led by countries is moving beyond health towards sustainability," as in Honduras, where faith-based and community-based organizations are being tremendously effective in delivering services for malaria.
By integrating Global Fund investments into a full slate of activities, programs and behavior change campaigns, both Zambia and Swaziland are tackling the rising threat of HIV infection among women and girls: the populations most vulnerable to transmission.
"We are not just leveraging resources for disease [response] but for health," he said, also congratulating governments for committing some $3.9 billion in domestic financing to help support the full slate of envisioned activities across the Global Fund portfolio.
In painting a rosy picture globally, Dybul did also move to try and preempt some of the concerns that have been repeatedly raised by constituencies at the Board level, specifically related to the $1.1 billion anticipated gap due to shortened grant duration and the likelihood that the register of unfunded quality demand -- currently sitting at around $1.9 billion -- will not be fully funded.
He also acknowledged the challenges about the sustainability of programs that have traditionally been the purview of the Fund in countries preparing to graduate from Global Fund eligibility and agreed that the pace at which the Fund is moving towards transition has not been completely matched by countries themselves.
He called for efforts, worldwide, to continue "aggressive relationship-building" between civil society and government, in order to link communities to the health system at all levels.
Such linkages were imperative, many constituencies noted in their reactions to Dybul's presentation, evidenced by the current Ebola crisis still gripping three west African states -- which demonstrates the need for integration of disease-specific programs into basic primary health care, wider deployment of community-based initiatives and a mobilization of local resources that goes beyond the financial.