In general, the report of the High-Level Independent Review Panel (HLP) was well received by people and organisations that commented publicly. However, concerns were expressed about some of the Panel's recommendations. This article provides a summary of the reaction. Links have been provided to the full texts.
One of the first to react was Sarah Boseley of the newspaper The Guardian on 19 September. In her global health blog on the newspaper's website, Boseley said that the "devastating" verdict of the "very intelligent" HLP report was that that the Global Fund must "change or wither." She added that the HLP report could give donors the excuse they want to cut funding for the Global Fund. To avoid that happening, Boseley said, changes at the Global Fund have to happen "fast and convincingly."
Boseley said that funding for AIDS has dropped significantly. She called on the Government of the United Kingdom to take a more active role in convincing donor governments to reverse this trend. However, she said, "unless the Global Fund can come back fighting - stronger, more transparent, leaner and fitter than before - this is so unlikely to happen."
On 22 September, in his blog on global health policy, William Savedoff, a senior fellow at the Center for Global Development, said that the HLP did "an amazingly thorough job in only six months." Savedoff expressed satisfaction with what he called the report's "low-key style, which is a more appropriate response than the relative hysteria in the press earlier this year."
However, Savedoff expressed concern about the fact that the Global Fund, which was "expressly created to blaze an innovative approach to international aid," is now being counselled by the Panel "to back away from that vision." He said that the Panel's recommendations are aimed at making the Global Fund look more like other aid agencies.
Savedoff said that the HLP Report calls for the Global Fund to be less passive and more assertive in its dealings with countries. He said that, according to the Panel, its proposals for a new grant approval process, more scrutiny of CCMs, greater supervision of sub-recipients, and more time spent by staff engaged with grantees are compatible with "country ownership." But, Savedoff asked, "Are they really compatible?"
Savedoff said that even with the proposed changes, "the Global Fund will probably remain more nimble and flexible than other international agencies. It will certainly be able to produce more reliable accounts and it continues to be more open and transparent about its findings than other agencies."
Given the negative reaction of donors to last year's revelations of fraud by grant implementers, Savedoff said, "it is certainly safer for the Global Fund to mimic other agencies institutionally and procedurally. It is always riskier to stand out in the crowd. But it isn't necessarily the best way to effectively assist low- and middle-income countries to fight disease."
In a statement issued on 23 September, the Open Society Foundations (OSF) said that most of the Panel's recommendations would improve the work of the Global Fund and should be implemented. "However," the OSF said, "the Global Fund should be careful not to rush into making significant changes to its business model without evaluating the potential impacts of those changes on its ability to deliver on its mission."
The OSF expressed concern about the HLP's "focus on financial risk and oversight," saying that this left other, more difficult issues unaddressed, such as "how can the Global Fund strengthen civil society, evaluate the appropriateness and quality of the interventions it funds, ensure protections for human rights, and address the legal and policy context in which programs are implemented." The OSF said that these factors can undermine programmes just as easily as can misappropriation of funds, and that they warrant greater attention by the Global Fund Board and Secretariat.
The OSF expressed concern about what it termed "a culture of risk aversion at the Global Fund that is leading to paralysis in countries." The OSF referred to consistent reports that the Global Fund is micromanaging programmes in a way that hinders action, and that principal and sub-recipients are afraid to make decisions without sign-off from the Global Fund. According to the OSF, some of the key statistics by which the Fund tracks its performance confirm the extent of this risk aversion. For example, the OSF said, only 10 of the 111 grant agreements in Round 10 have been signed nine months after board approval; and disbursement rates during the first three-quarters of 2011 are less than half what they were in the same period in 2010. According to the OSF, the recommendations in the report do not offer any immediate solutions to these challenges. "This level of risk aversion is having a serious negative impact on programs and community-based organizations and should be addressed by the Executive Management Team urgently."
Separately, in a blog on the OSF website, Shannon Kowalski of the OSF said that "it would be unfortunate if the Global Fund emerges from this process with a focus only on strengthening its financial safeguards, without also committing to address some of the other factors that can just as easily undermine the effectiveness of its programs, such as a weak civil society or inadequate protections for human rights."
In a statement issued on 23 September, the Communities Living with HIV, Tuberculosis and Affected by Malaria Delegation (Communities Delegation) of the Global Fund Board said that the report's recommendations are consistent with the Global Fund's values of transparency and accountability. However, the Communities Delegation said that it was "deeply concerned" that some of the findings of the HLP might be misconstrued. Given the current economic climate, the delegation said, major Global Fund contributors could use the findings of the report as excuses not to meet funding commitments.
The Communities Delegation added that it does not support the Panel's suggestion that Round 11 be "re-evaluated" or its recommendation that current eligibility requirements be revamped.
On 3 October, the (Kenya) Daily Nation said in an editorial that the Panel "makes several forward-looking recommendations that will see the board improve its efficiency and reflect its maturity in health financing."
However, the paper expressed concern that one of the recommendations will make it difficult for the public to know when funds meant for their health care are being stolen. The paper was referring to the recommendation that separate versions of reports on investigations by the Office of the Inspector General (OIG) be prepared - "one for the board, another for law enforcers and a third, sanitised version for the public."
"This opacity makes it most difficult in the future for the public and the media to keep fund managers on their toes," the editorial said, "especially in a country like Kenya where theft of donor funds is common."
In a 3 October statement on its website, the International HIV/AIDS Alliance said that it welcomes the HLP Report and that it "praises the Fund for its proactive stance on stamping out corruption." As a member of the Developed Country NGO Delegation on the Board of the Global Fund, the Alliance said, "we will be fully supporting the implementation of many of the recommendations as swiftly as possible."
On 28 September, the United Nations Development Programme (UNDP) issued a statement welcoming the adoption by the Global Fund Board of the recommendations of the High-Level Panel. UNDP acts as principal recipient for about one-tenth of the Global Fund's overall portfolio, mainly in challenging environments such as in countries emerging from natural disasters, conflicts, or political crises.
"UNDP supports the Panel's constructive recommendations for further improvements in the collaboration between itself and The Global Fund," said Jeffrey O'Malley, UNDP's HIV/AIDS Group Director. "We will discuss these suggestions with the Global Fund's secretariat and its office of the inspector general over the coming weeks to ensure their timely implementation,"