Wed, Feb 08, 2012 - Page 9 News List

Bill Gates gives Global Fund a tonic, but it still needs surgery

Hefty financial support from Gates has rescued the birthday celebrations of the global health fund, but it needs to make changes to be able to continue combating disease

By Annie Kelly  /  The Guardian

At Davos last week, the Global Fund to Fight AIDS, Tuberculosis and Malaria received an unexpected birthday gift from Microsoft founder Bill Gates, in the form of a US$750 million “promissory note” to help shore up its faltering finances.

In pledging his hefty financial support, Gates effectively rescued the fund’s 10-year birthday celebrations. Despite its staggering successes — including helping to put 3.3 million people on HIV/AIDS treatment, 8.6 million on anti-tuberculosis treatment and providing 230 million insecticide-treated nets for the prevention of malaria — the fund’s recent troubles had threatened to overshadow its accomplishments as it prepared to mark a decade as the world’s main financier of programs to fight these three global epidemics.

In recent years, the fund has been mired in much-documented struggles with corruption, management breakdowns and a crippling US$2 billion funding shortfall, all compounded by the swiftness of the global economic downturn and donor fatigue.

There are fears that the knock-on decision to suspend the fund’s 11th round of funding and not disperse any more money until 2014 will have catastrophic consequences. There are predictions that without continued support, countries such as Zambia and Malawi will struggle to keep pace with infection rates and keep people on lifesaving medication, impacting millions of vulnerable patients.

Gate’s pledge was a show of faith that provided more than just a much-needed cash boost as he urged donors and the world to keep confidence in the fund’s ability to “[get] so much bang for our buck.”

The fund hopes that this, coupled with the departure of its executive director, Michel Kazatchkine, and the commissioning of an independent review that recommended an overhaul of its grant management and financial practices, will help re-establish its reputation as it steps into its second decade.

While all of this is clearly good news for the beleaguered fund, some frontline agencies are still reluctant to join in the celebrations.

Medecins Sans Frontieres’ HIV adviser Sharonann Lynch said Gates’ cash should be a wake-up call for the fund’s new board to “get back to work.”

“When addressing epidemics, the No. 1 factor is speed — and this isn’t the time to hit the snooze button,” she said. “Over the past few years the sense of urgency which once defined the work of the fund has become greatly diminished and the board basically gave themselves a holiday, instead of stepping up and doing their job, and ensuring that the funding shortfall was made up. On the one hand, they have a new ambitious strategy for change, and on the other, they have effectively closed for business. It is this lack of coherence that we find troubling — and patients will come to find deadly.”

On the back of the new injection of funding, Medecins Sans Frontieres is pushing for the fund to hold an emergency donor conference so that affected countries can apply for new grants and expand life-saving treatment this year. It is also urging the fund to become more creative in ensuring that it does not get caught on the back foot of funding cuts again.

“On top of voluntary funding, we also need predictable mechanisms — such as the financial transaction tax currently being debated in Europe — with part of funds generated to be dedicated to global health, including the Global Fund,” Lynch said.

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