News
Global Fund for AIDS, TB and malaria opens shop
We have the money, we have the commitment now what do we do? This is the unusual question that will be facing AIDS, TB and malaria programme managers over the next few months.
The reason? The Global Fund to Fight AIDS, Tuberculosis and Malaria is ready to spend its first moneys. The fund is a new international financing mechanism championed by Kofi Annan, Secretary-General of the UN, to tackle these diseases in low- and middle- income countries.
In February of this year the interim secretariat, now based in Geneva, issued a worldwide appeal for proposals for interventions against the three diseases. Formal proposals, agreed by all partners in the countries concerned, must be in by 10 March 2002. On 23 and 24 April the Board of the fund will meet to make the first allocations from the US$ 800 million to be spent in the first year of operation. Donors have so far pledged US$ 2000 million over the next five years.
Although this spending will be nothing like the US$ 13 000 million a year WHO estimates is needed in total from all sources combined to deal with the three diseases, it represents a large and sudden injection of funds into the control, treatment and prevention of HIV/AIDS, TB and malaria.
If the whole US$ 800 million now made available by the fund can be allocated to effective programmes (probably in two or three separate rounds during 2002), it will increase the scale of existing spending on the three diseases by roughly half, according to Anders Nordstrom, the acting director of the fund. As he put it: "WHO and UNAIDS projections we got just before the fund's first board meeting [2829 January] were that without the fund, US$ 200 million would be spent in 2002 on malaria, US$ 200 million on TB, and US$ 1200 million on AIDS. That makes US$ 1600 million. Now, in addition, the fund has the possibility of disbursing between US$ 700 million and US$ 1000 million for the same year. So if we can disburse US$ 800 million, for example, that's a 50% increase quite substantial."
Nordstrom, who has been seconded until May from his post as director of the health department of the Swedish International Development Agency, told the Bulletin "The increased political, economic, and financial interest in investing in health has been dramatic in the last two or three years. I think that's partly related to the work of the Director-General of WHO, Gro Harlem Brundtland, and the way she's been able to put health on the agenda."
"But now the critical question is what to do with this money and political momentum," said Nordstrom.
He believes the fund could be a very important financial mechanism for the next 1030 years, but that the key to that will be results. Donors are waiting to see how the fund performs before they top it up, even for one more year.
"That's why we are moving as quickly as we can," said Nordstrom. "We will be judged on whether we are able to disburse money, get it out to effective programmes, and report back clearly both on how the money was spent and on the results. This might mean, for example, going from a 10% to a 20% geographical coverage with a particular programme, or ensuring that medicines now reaching 50% of patients start reaching 80%."
Given the speed with which they have become available, it seems likely that, to begin with, the new funds will primarily generate an expansion of existing programmes. "But at the same time I hope the new resources will stimulate new thinking, new partnerships at country level; we're definitely not just looking at gap filling or continuing business as usual; there's a strong emphasis on results but also on new partners" said Nordstrom.
The fund's call for proposals and guidelines was sent to ministers of foreign affairs and ministers of health, "but with a very clear message that they should reach out to NGOs, the private sector, and all partners in the country" said Nordstrom. The letters went to every country in the world, to ensure transparency, but the priority will be to given to countries most in need.
But with the very short time available will the countries most in need have the capacity to come up with competitive projects?
"Yes, the structures are weak, there is lack of capacity" said Nordstrom, "but still, in all African countries there are national AIDS programmes, in all countries affected by malaria there are malaria programmes, and the same for TB. I think the fund comes in at just the right moment for the work that's been done by Roll Back Malaria and StopTB in making situation analyses and preparing national strategies and programmes. There's been a big discussion about how quickly to move, but in the countries they say, 'Don't wait. People are dying! People are waiting for the fund to be operationalized, to be disbursing money!' So we've decided it's very important to move quickly, at least for the first round." Part of the challenge for the fund is to start by striking the right balance between prevention, treatment and care.
Until May at least, Anders Nordstrom will be having an exciting time. 
Robert Walgate, Bulletin