Editor's Note: In the session on "The Global Fund: The Next 5 Years" at the International AIDS Conference in Washington, D.C. on 26 July, Mireille Guigaz, Ambassador of France for the Fight Against HIV and Communicable Diseases, and representative of France on the Global Fund Board, described what she saw as the opportunities, challenges and risks for the Fund. This text is based on a transcript of her remarks and the slides she presented. For the most part, we have paraphrased what Ms Guigaz said. However, some direct quotes have been included.
In discussing what the next five years will be like for the Global Fund, we need to examine three fundamental questions:
- What could have a positive or negative impact for the Global Fund as a whole?
- What could potentially strengthen or impede the performance and legitimacy of the Secretariat?
- What might be the consequences of the new grant model for the end users (the patients)?
Below, I set out what I think are the main opportunities and issues. Along the way, I identify some of the risks we face.
Money. Official development assistance (ODA) by itself will not be enough to alleviate all poverty gaps. We need to think very hard about new and innovative ways to raise money.
Intellectual property. We have to take action to alleviate the barriers of intellectual property. Of course, research must be remunerated, but it is equally important to ensure that knowledge is shared and that everyone can benefit from the findings of the research.
Commitment. We need to maintain a high level of political commitment to the Global Fund.
Risk: There is a risk that global health will become deprioritized. "We know that we are not going to fulfil the millennium goals." There is a rush to try to meet the goals in agriculture, nutrition, food, education, etc. - but we have to ensure that global health remains a priority.
Risk: There is a risk that the response to AIDS, TB and malaria will suffer because of competition with other diseases, especially non-communicable diseases. Of course, these other diseases are important, but now is not the time to stop our commitment to AIDS, TB and malaria.
Risk: There is a risk that the current financial and economic crisis will limit the ability of the Global Fund to raise money.
Risk: There is a risk of more negative communication about the Global Fund, of the type we saw when some money was misappropriated in a small number of countries.
Treatment and services. We need new treatments and other technologies, and we need a large scale-up of services.
Governance. "The Board of the Global Fund is weak. You know that." We need courageous governance reform that will produce an effective and balanced dialogue between implementers and donors, and much more ownership of the Fund among Board members. I am not just expressing negative criticism here; I think this is a real opportunity to do something positive.
Risk: "There is also a risk of harsh power struggles among donors to dominate the Fund. This may be going on [already]." We don't need one super power, or a second or third super power, trying to dominate the Fund. "The Fund belongs to all of us."
Risk: There is a risk that we will make the wrong choice when we select a new executive director for the Global Fund. ("France was prepared to continue with the previous one, but [he] decided to leave.") We need not only a bright manager, not only a bright communicator, but also a visionary - someone with a strong vision of where she wants to take the Fund and the ability to understand the signals coming from stakeholders the world over. I say "she" because the next ED should preferably be a woman, and preferably a woman from the South.
Risk: There is a risk of "reform fatigue at all levels. So let's develop the [five-year] strategy, let's have the new [funding] model and then let's work and let's not change every five minutes with the board wanting to micromanage."
Front runner status. We want a Fund that will continue to be a leader and an innovator, much as the Fund has been in its first decade. "We don't want a Fund whose only role is to fill a gap."
Responsiveness: We want a Fund that is nimble and flexible, able to react quickly, able to adjust its approach according to the circumstances, and able to get disbursements out quickly.
Risk: There is a risk that we will end up with a Global Fund that has "a big head full of brain, full of grey matter - but poor hands and broken legs."