The Global Fund must "change or wither". That is the devastating verdict of a very intelligent report by the high-level independent review team brought in following a major crisis of confidence in the Fund, which channels money into developing country programmes for Aids, TB and malaria. Stories emerged at the end of last year of fraud and corruption among countries taking Global Fund money. In January, Germany suspended its payments and there was talk of other donor nations turning away.
The review, chaired by former US health secretary Michael Leavitt and former President of Botswana Festus Mogae, lays it on the line for the Fund. It gives it every credit for its emergency response to the disaster of Aids a decade ago, when it was set up specifically to raise money for much-needed drugs to keep people in Africa and Asia with HIV alive – although it suggests even then that pouring money into three diseases distorted health budgets in poor countries. But the halcyon days when rich governments competed to show their generosity to the poor are over, it says. The Fund, if it is to continue its great work, has to adapt to a very different and more difficult economic climate.
Austerity among the donors makes the Global Fund more vulnerable now than at any time in its history… Of necessity, the Global Fund is entering an era of consolidation, not expansion. During six months of work, the Panel has seen a high degree of vulnerability and accelerating deterioration in the Global Fund’s financial outlook for the next three years. As a result, based on current estimates from the Secretariat, the Global Fund’s Board will have substantially less to devote to new grants in round 11 than the estimate of $1.5 billion published in May 2011. The Panel finds this situation a cause for deep concern.
Good intentions and enthusiasm for saving lives has not been enough. The fiduciary controls put in ten years ago are not adequate to ensure the money goes where it is most needed and is not syphoned off by fraudsters. It is everybody’s fault, says the Panel – the Board but also the donors and recipients. In the scramble to save lives, governance and oversight were not as strong as they should have been in the early years.
The Global Fund has accepted and embraced the criticism in a very creditable way – as you would expect of this organisation. Simon Bland, chair of the Board, called it a "balanced and objective and pretty thorough analysis" of the past ten years. The reforms it recommended were already underway, he said. He talked of zero tolerance for corruption and learning lessons from the past "to strengthen the business model for the future".
Will it be enough? We will know before very long. Unfortunately, as the report spells out in very clear terms, donor governments are looking for opportunities to retrench, to spend less in these austere times. The changes in the Global Fund have to happen fast and convincingly.
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