WHO IS THE NEW KID ON THE BLOCK IN THE GLOBAL HEALTH ECOLOGY ?
Article Number: 4
The World Bank’s PPR Fiduciary Intermediary Fund holds its first board meeting
ABSTRACT The Fiduciary Intermediary Fund for Pandemic Preparedness and Response had its first Board meeting on 8 and 9 September. As we conclude the Global Fund Replenishment Conference in New York, we ask if its creation has resulted in less overseas development assistance for the Global Fund.
Following the devasting global impact of COVID-19, pandemic preparedness and response (PPR) is a top global priority. Among international health donors, the Global Fund was the quickest to respond to the pandemic with its creation of a flexible new grant modality, the COVID-19 Response Mechanism (C19RM). With its track record in responding to global pandemics through 20 years of supporting national responses to HIV, TB and malaria, the Global Fund was well-placed and experienced in supporting developing countries’ priority communicable disease programs and was able to bring this to bear when responding to the new pandemic. It was even able to allow existing grants for the three diseases to be flexible in reprogramming existing allocations to address COVID-19.
WHO pushed for greater global response to pandemics
However, what if this pandemic were only the tip of the iceberg and presaged the advent of more and even worse pandemics? The world had been rocked by the havoc wreaked by COVID and the international community clearly felt that more was needed at the global level to prepare to address existing and potential new threats posed by hitherto unknown or emerging pandemics. In late 2020, therefore, the World Health Organization (WHO) established the Council on the Economics of Health for All to rethink how value in health and wellbeing is measured, produced, and distributed across the economy.
The Council’s stated aim is “to reframe health for all as a public policy objective and ensure that national and global economies and finance are structured in such a way to deliver on this ambitious goal.” The Council was aiming to create a body of work that sees investment in local and global health systems as an investment in the future, not as a short-term cost.
In response, the G20 set up a Joint Finance-Health Task Force on PPR
The G20 or Group of Twenty is an intergovernmental forum comprising 19 countries and the European Union (EU). Its mandate covers major issues related to the global economy, such as international financial stability, climate change mitigation, and sustainable development.
On 31 October 2021, a G20 communique noted the establishment of the Joint Finance-Health Task Force with the aim of “enhancing dialogue and global cooperation on issues relating to PPR, promoting the exchange of experiences and best practices, developing coordination arrangements between Finance and Health Ministries, promoting collective action, assessing and addressing health emergencies with cross-border impact, and encouraging effective stewardship of resources for PPR, while adopting a One Health approach”. Within this context, the Task Force was charged with investigating and reporting back, by early 2022, on modalities to establish a financial facility, to be designed inclusively with the WHO playing a central coordination role. It was to be G20-driven and from the outset engaging Low- and Middle-Income Countries (LMICs/MICs), additional non-G20 partners and Multilateral Development Banks, to ensure adequate and sustained financing for pandemic prevention, preparedness and response.
In April 2022, under the auspices of WHO, the Task Force produced a series of recommendations, Delivering on the G20 Leaders commitment to build an equitable and effective Financial Intermediary Fund (FIF) for Pandemic Preparedness and Response (PPR).
And, based on these, with broad support from members of the G20, the World Bank Board of Directors approved the establishment of a Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness, and Response (PPR) on 30 June 2022. The PPR FIF was officially established by its Governing Board at its inaugural meeting on 8-9 September 2022.
What’s a FIF?
For many of us, this was the first time we had ever heard of a FIF. However, they were around long before the one for PPR was set up.
Financial Intermediary Funds (FIFs) are a World Bank funding mechanism. They are financial arrangements that typically leverage a variety of public and private resources in support of international initiatives, enabling the international community to provide a direct and coordinated response to global priorities. Most FIFs have supported global programs often focused on the provision of global public goods, preventing communicable diseases, responses to climate change, and food security. According to the World Bank, FIFs often involve innovative financing and governance arrangements as well as flexible designs which enable funds to be raised from multiple sources, both sovereign and private. Funds can be channelled in a coordinated manner to a range of recipients in the public and private sectors through a variety of arrangements. FIF structures are customized, depending on the needs of the partnership and agreements with the World Bank.
What will this particular FIF do?
The World Bank will serve as the FIF’s trustee and host the Secretariat, which will include technical staff seconded from WHO. The Governing Board will appoint a Technical Advisory Panel, chaired by WHO, and comprising leading experts to assess and make recommendations to the Governing Board on the technical merits of proposals for funding, ensuring linkages to the International Health Regulations, as part of the broader global PPR architecture.
Following its inaugural meeting, according to the World Bank’s press release, the PPR FIF will provide a dedicated stream of additional, long-term financing to strengthen PPR capabilities in low- and middle-income countries and address critical gaps through investments and technical support at the national, regional, and global levels. The FIF will draw on the strengths and comparative advantages of key institutions engaged in PPR, provide complementary support, improve coordination among partners, incentivize increased country investments, serve as a platform for advocacy, and help focus and sustain much-needed, high-level attention on strengthening health systems.
The first calls for proposals for investments to be funded by the FIF will open in November 2022.
How will this complement or duplicate the Global Fund’s PPR response?
In June GFO published an article speculating on whether the new PPR FIF would replicate the Global Fund, highlighting the similarities and differences and asking if the existence of a new global funding mechanism will adversely impact the Seventh Replenishment efforts (The Financial Intermediary Fund: A new model that duplicates the Global Fund).
In terms of overlap of activities, FIF financing can be requested to help strengthen and sustain PPR capacity in areas such as zoonotic disease surveillance; laboratories; emergency communication, coordination and management; critical health workforce capacities; and community engagement. FIF-financed projects can also help strengthen PPR at the regional and global levels, for example, by building capacity for medical countermeasures. The FIF can support peer-to-peer learning, provide targeted technical assistance, and help with the systematic monitoring of PPR capacities. Some potential for overlap, therefore, and already we can see that there will be a need to identify synergies between the different funding streams at the country level to ensure complementarity and avoid duplication of activities.
To date over $1.4 billion in financial commitments to the FIF have already been announced and more are expected in the coming months. So far, commitments have been made by Australia, Canada, China, the European Commission, France, Germany, India, Indonesia, Italy, Japan, Republic of Korea, New Zealand, Norway, Singapore, South Africa, Spain, the United Arab Emirates, the United Kingdom, the United States, the Bill & Melinda Gates Foundation, the Rockefeller Foundation, and Wellcome Trust. Most of these are also Global Fund donors. Of course, we don’t know how much more the Replenishment might have received without the existence of the PPR FIF and may never know. But with diminishing overseas development assistance (ODA) due to the global economic downturn it is reasonable to assume that there has been some negative impact in terms of funding available for other priorities.
What about the FIF governance?
The new PPR FIF is overseen by a Governing Board, which will set the overall work program and make funding decisions. The FIF’s Governing Board includes equal representation of sovereign donors and potential implementing country governments (co-investors), as well as representatives from foundations and civil society organizations (CSOs). The World Bank says that together with WHO it will intensify its work with the Governing Board in consultation with CSOs and other stakeholders, to help operationalize the fund and develop the FIF results framework and priorities in the run up to the first call for proposals.
The Governance Structure is described on the website and from this we can see that, unlike the Global Fund, implementing partners (known as implementing entities or IEs) have already been pre-selected. These are the African Development Bank, Asian Development Bank, Asian Infrastructure Investment Bank, European Investment Bank, Food and Agriculture Organization, Inter-American Development Bank, International Finance Corporation, UNICEF, World Bank, and WHO. Gavi, the Vaccine Alliance; the Global Fund; and the Coalition for Epidemic Preparedness Innovations (CEPI) are also being considered for inclusion as IEs. This implies that the Global Fund itself might then be eligible to receive a grant which could then be passed on to countries’ PPR activities as appropriate, presumably using the Global Fund’s existing funding mechanisms.
Where large amounts of money and influence are concerned, the balance of power becomes a significant factor. The Global Fund already has a number of checks and balances to its work through the various Delegations’ inputs and rotating presence on the Committees and Board, as well as the African Constituency Bureau and the Global Fund Advocates Network. This is without including Aidspan’s role as the only global independent, objective watchdog and observer at Global Fund Board meetings which enables us to publish autonomous and impartial views on the work of the Global Fund. We hope transparency will be among the top priorities for the PPR FIF……