Stepping down after five years as Executive Director of the Global Fund to Fight AIDS, TB and Malaria, Michel Kazatchkine shares his parting views:  Full letter online here:

“As I leave the Global Fund, I wish in this open letter to share a number of reflections based on the unique perspective that is afforded the Executive Director. My hope is that these observations will contribute to ongoing discussions about the Fund’s future direction as it marks its tenth anniversary and undergoes a challenging process of transition under new leadership”.

His letter goes on to elaborate on five things he wishes to emphasise as he steps down:

1. The Global Fund has been highly effective in its primary role as a financing institution

2. Global Fund financing has allowed countries to achieve unprecedented results and impact in the fight against the three diseases

3. The Global Fund has shown that it is a highly effective mechanism for translating public health and human rights principles into action

4. Partnerships require a lot of attention and work but are the only way to ensure long-term success and sustainability

5. The leadership of the Global Fund needs to carefully assess and strike a balance between competing tensions that are inherent to the Fund’s model

Ireland and the Forum asks this question on behalf of the developing world, and the countries where health systems and their workers are under threat. The situation was best surmised by Dr Mphu Ramatlapeng, Minister of Health of Lesotho, who emphasized that the “‘production’ of healthcare officials is low, yet the demand for healthcare continues to grow due to increasing disease burden”.



These words were spoken in regard to the increasing ‘brain drain’ of skilled health workers from developing countries and sparked a discussion as to what can be done to address such a major human resources issue. In response or rather providing a potential answer, Dr Ramatlapeng pointed out that, if the quality of living was raised in countries such as hers and others, fewer highly qualified graduates would leave. Raising the ‘quality of life’ is a goal for all those involved in health and development, but when we will reach a standard that keeps doctors and nurses within their home countries is something we unfortunately cannot predict.



This ‘brain drain’ directly affects the work of groups such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Over croissants and coffee, Michael O’Connor (the Global Fund’s manager of civil society and private sector partnerships) and Louis Da Gama (representing the Global Fund but also the community delegation living with HIV and TB), openly answered questions from members of non profits and civil society on this issue.



Community involvement is seen as the ideal for many agencies, and those involved in health. Both individuals expressed that human rights and aiding groups that are difficult to reach form the foundations of such a large funding body as the Global Fund. Following breakfast, Mr O’Connor underlined this by presenting, via a lecture podium, examples of how countries have accessed the Global Fund alongside their responses and successes. These examples included training over 800 doctors in Rwanda during the Round 9 of funding, aiming to alleviate the ‘brain drain’ we see today.



This is amazing work, and must be continued. Communities must be engaged and partnerships must be made at all levels if health interventions and the human resources crisis facing health are to be solved.



As Mr Gama said, “the fund must be more visible, while setting an example”. This should be the case for all agencies and individuals if we are to change the way healthcare tackles the growing disease burden the world faces.



Dr Kunal Patel

Key Correspondent

Email: kunalthedreamer@gmail.com

Source: http://www.keycorrespondents.org/2012/02/03/ifgh-2012-the-global-fund-and-the-brain-drain/



This article was written as part of a series of articles written by the Key Correspondent Team (KC Team) who covered the IFGH 2012 International Conference. For more information on the KC Team click here: www.keycorrespondents.org


Author Affiliations: Dept. of Epidemiology and Public Health Medicine, Division of Population Health Sciences,Royal College of Surgeons in Ireland


Option 1 - Scientific / Empirical Research Findings

Presented as – Oral Presentation

Aims:

In the context of the Global Fund to Fight AIDS, Tuberculosis and Malaria, to

a)  examine how non-governmental and other civil society organisations (CSOs) have engaged in global level 
policy and decision-making processes that affect country and community responses, including health 
systems and workforce challenges

b)  highlight the impact CSOs have had on the Global Fund, and the impact on them of engaging in the Global 
Fund

Methods:

In-depth telephone interviews (2009-10) of purposively selected individuals (n=36) from: Global Health Initiatives (GHIs); developing country governments; bilateral donors; multilateral agencies; academic/research institutions; NGOs/CSOs; philanthropic foundations; and the private sector. Interviews were recorded, transcribed and thematically analysed.

Results:

Prior to establishment of the Fund, discussions on global HIV financing were shaped by donor priorities. Northern AIDS treatment CSOs became directly involved in 2001 through the Global Fund Transitional Working Group. Consultation was initially limited to Northern individuals and organisations connected to dominant Southern CSO networks. Over time, new technology enabled wider consultation with affected communities.

Early challenges included: perception of undemocratic and anti-participatory processes at global level; divisions and rivalries between CSOs; slow release of information; resource constraints. CSOs established mechanisms to enhance representativeness, communication and community engagement. Wider representation of CSOs ensued; however, tensions persisted around roles (advocacy versus service delivery); were divided along a Northern/Southern axis and shaped by competition for finances; and around fears of donor co-option.

Discussion/conclusions/ implications:

The Global Fund enabled CSOs and representatives of communities participate in global health policy processes. Contesting stakeholder views emerged on: i) who CSOs are accountable to; ii) meanings of country ownership; iii) and relationships between global and local level. Lessons learned from CSO engagement in Global Fund processes provide valuable examples to stakeholders on how to incorporate community perspectives, interests and needs into global HIV and health policy making.

Resources 

• The full report can be downloaded from here
• Global Fund press statement

As the report notes, the Global Fund has been a leader in advancing the way in which development assistance is delivered to countries, and health services delivered to those who need them. The authors note that its failure
would represent a 'global health catastrophe'. The report highlights several challenges inherent to the current Global Fund Model, as well as areas that need significant improvement across the entire structure of the Global Fund.

The authors suggest these issues can be addressed through significant reform, and provide six key recommendations:

1. Turn the Page from Emergency to Sustainable Response

1.1 No Amnesty for Fraud, but Focus Oversight on More-Recent Rounds of Grants

1.2 Strengthen the Relationship between the Secretariat and the Inspector General

2. Declare Doctrine of Risk and Manage to it

2.1 Adopt a New Risk-Management Framework

2.2 Redefine "Country Ownership"

2.3 Apply the Risk-Management Framework to the Existing Portfolio

3. Strengthen internal governance

3.1 Focus the Global Fund's Board on Management, Strategy and Risk-Management

3.2 Re-purpose the Committees

3.2.1 Investment Committee

3.2.2 Audit Committee

3.2.3 Finance Committee

3.3 Create an Executive Staff to Support the Global Fund's Board

4. Streamline Grant-Approval Process

4.1 Institute a Two-Stage Grant Process

4.2 Apply Risk-Differentiated Grant Processes and Requirements

5. Empower Middle-Management's Decision-Making

5.1 Establish a Chief Risk Officer

5.2 Align the Staffing Pattern to Bolster Grant-Management

5.3 Empower the Fund Portfolio Managers

5.4 Streamline and Expand the Country Teams

5.5 Reinforce the Executive Management Team

5.6 Leverage the Investment in the Local Fund Agents

5.7 Define and Clarify the Role and Responsibilities of External Auditors

6. Get Serious About Results

6.1 Measure Outcomes, Not Inputs

6.2 Focus on Quality and Value, Rather than Quantity

6.3 Consolidate the Reform Agenda

Carlos Bruen
Royal College of Surgeons in Ireland (RCSI)
Email: carlosbruen@rcsi.ie