Open Letter to new Executive Director of the Global Fund January 19, 2013
Dear Mark Dybol,
Congratulations. We are delighted to have you lead the Fund.
As you embark on a tough new assignment to lead the Global Fund, I write this letter with utmost frankness. Your job will not be easy, the global environment is not easy, and the Fund is in a transition period where demand for resources outstrip what you will be given by all donors. And we need to save millions of lives much sooner.
We want The Global Fund to succeed because that would mean millions of life saved. While putting people on treatment is a priority, a bigger priority is sustainable treatment and shifting the treatment liability to national budgets. When the Fund started, it had very few but highly focused goals. Time to get back to that focus. My consultation reveals few priorities: universal access to treatment, reaching out to key populations such as MSMs, CSWs, etc., human rights, capacity building of civil society, and public sector health systems strengthening.
The Fund created hope, thus generating additional demands for treatment and services which now faces the resource crunch. The idea of universal access to treatment and AIDS free generation has gained momentum without the drum beat of additional funds. But you have friends and partners who are willing and able to fight this battle together. They do not want to be friends without responsibility or partners of conveniences, rather want to be true partners for a battle that can be won easily. We are at the tipping point of winning the war against the three diseases. It can be won or lost based on what you do next. The Fund is a fine concept, the true test of success lies in saving lives.
Gates Foundation’s innovative financing provides hope for new vaccines and technology. They make additional resources available for innovative programs that have promise and are scalable. It is a Foundation that has shown tremendous resolve, stamina, and professionalism in the health sector, some of which are worth learning. It is a Fund that truly believes in using existing technologies to their full potential and doing it efficiently. We can learn from their experiences.
Michel Sidibe of UNAIDS espouses sustainable AIDS response in Africa and elsewhere. He has pushed his troops in the field to support countries make the difficult transition from donor dependency to national dependency, protect human rights of all those infected, and increase national level sustainability. He advocates for basic human rights so that each and every person has access to treatment and care, and we will see a day when each baby is born AIDS free.
Margaret Chan of WHO has strengthened her technical teams to be much more supportive in all three diseases and health systems. HTM, STOP TB, and RBM are working hard to implement their new strategies.
Jim Young Kim and David Wilson of World Bank will support health systems strengthening for sustainable health services. They will bring resources and expertise.
Denis Broun of UNITAID facilitates lowering of prices of drugs and diagnostics through market dynamics so that low income countries can afford them and can plan a transition strategy to fund their procurement with internal funds or interim international funds.
UNICEF, UNFPA, UNODC, UNDP, and international NGOs are ready to provide core expertise where it matters most.
Your friends at PEPFAR have some real good examples of private sector partnership, transition strategy (Botswana and South Africa), country partnerships, and integrated service delivery. US government focus on country ownership and AIDS free generation is what we espouse. None of these countries want to be in perpetual dependency but need technical and other help to fund their own programs.
GAVI provides good examples of co-investment, country ownership, and lean operation. We can learn a few things from them.
Then we have the countries, their experiences and expertise, and several local partners to implement programs more effectively and efficiently. But they want to be in the driving seat. CCM or no CCM, they want to make the decisions on investments and transition strategy. Health Ministers want to understand your transition strategy because it is not clear. Civil society want to know how they fit into the new strategy. The African Union, for example, has adopted a Roadmap on shared Responsibility and Global Solidarity for AIDS, TB and Malaria that outlines practical steps by which African countries, together with development partners, can deliver sustainable results. Shared responsibility and global solidarity move away from traditional donor– recipient relationships towards South–South and triangular cooperation.
Integrating HIV/AIDS, TB, and Malaria in existing health systems is efficient. The need for vertical programs are gone because sustainable health financing and service delivery demands integration. Without HIV/AIDS, maternal mortality will be 18% lower. Condom promotion and use reduces sexual transmission of HIV/AIDs, reduces unwanted pregnancies, and safer sex. More women are willing to accept testing and counseling if the HIV program is an integral part of ANC service delivery. Integrated platforms will reduce maternal and child mortality.
Many innovation exist, they are just under-utilized. Use of ICT can make monitoring efficient. Private sector partnership will promote co-investment with CSR funds. Co-investment examples of Neglected Tropical Disease program of USAID where private sector contribution resulted in reaching 250 million in six years. Such innovation is what we need to champion.
All these translate into need for highly focused investment strategy and serious roadmap for partnerships. The new funding model offers an opportunity provided it is managed by highly field experienced professionals. You need to take an uncompromising commitment to using comparative advantages of partners to make the best use of resources for greater impact.
You need to take full advantages of field presence of key partners. If needed, time to allocate some funds for this so that partners can also cover some of their costs. Money is not your problem, it is how you use the existing resources more efficiently to accelerate your work toward universal access to treatment. It is how you continue the public/private partnership and strategic engagement of civil society.
UN and other partners are key to your success. If a partner has procurement expertise, let Global Fund be open to using that to procure high quality drugs and diagnostics at the lowest possible prices. GAVI partnership with UNICEF is a good example. The power of pooling resources to influence the market is worth exploring. UNITAID partnership is a good example. And why not? We want sustainable financing through major reductions in prices for drugs, other health products, and diagnostics.
The technical assistance from US Government, French Government, and GTZ need to be used with strategic smartness. Utilizing key partners to fight the three diseases will require major change in mindset. It will require that the Fund become much more lean and reallocate certain amount of resources to buy the technical expertise and experiences that exists outside the Fund. You know how to do that. PEPFAR and USAID have been doing this for many years, that’s why US has so many strong partners among US international NGOs. Replicate such partnership. Be bold with outsourcing. Rethink efficiency and 'less is more'. Several hundred organizations have developed so much expertise and experiences that it would be a shame if we do not use them.
The time has come for the Fund to behave like a Venture Capitalist and be sharp with its investment strategy. The term I use is "venture social investment', investments for social good but with private sector rate of return concept and intense monitoring. VCs are highly trained in investment analysis and do not have too many people managing their business.
And the time has come for the Fund to showcase a new efficiency model that is innovative, sharp, and makes right investment decisions. It should not be a Fund that is still bogged down in processes to meet bureaucratic requirements, resulting in slow decision making. And you must set a new standard of transparency that is unmatched in the development assistance history. I firmly believe resources that donors pledged are sufficient provided innovative, cost efficient approaches and a focus on strategic partnership for collective actions are applied.
Simplicity has a sunny side, it gets the job done and it is efficient. Many countries already contribute a lot for the three diseases, we cannot ignore that nor can we ignore their plea for simplicity and much quicker investments to save million more lives. Country owned and sustainable health financing is what we should collectively aim for.
A final thought. It is time to mobilize Global Fund alumni to help you. They are a resource with experience which should not be overlooked. Let us also mobilise the Friends of the Funds with new strategy and a clear focus on universal access to treatment and human rights.
We wish you the very best of luck. We have much hope in your leadership. The world awaits the new Global Fund.
Founder, Center for Implementation