Sometimes it takes a crisis to return an organization to its “original principles.”
Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, spoke with Devex about some of the challenges the organization faced — particularly around financial management — and about how they spurred a re-examination of the Global Fund’s approach.
“Everything we do, from our internal systems to how we work with countries, has been redone,” Dybul told Devex at the 2015 European Development Days in Brussels, Belgium.
Dybul assumed leadership of the Global Fund in 2012, after serving as U.S. global AIDS coordinator. His appointment came amid reports of mismanagement at the organization, which has disbursed nearly $27 billion since it was founded in 2002. Allegations of fraud in some of the fund’s partner countries led some major donor governments to suspend their contributions.
It also prompted the Global Fund to take a hard look at how it operates and works with countries, Dybul told Devex.
“We hadn’t really fulfilled the partnership approach to support countries to achieve objectives and move along that development continuum,” Dybul said.
The fund’s fifth replenishment — when donors commit resources to the organization to support three years of grant-making — will take place in 2016. Dybul spoke about how development funding models are changing, and what this means for a fund that bills itself as a “21st century organization.”
by Bianca Auping-Kamps –Senior Fund Portfolio Manager, the Global Fund
In remote parts of Papua New Guinea, focusing HIV prevention on those most at risk of the virus is not straightforward. I was confronted with this in Port Moresby recently as I discussed the condom use of sex workers with some of the Global Fund’s implementing partners.
What happens, for example, when someone is trading sex for transport? While they may not identify as a sex worker, they are nonetheless potentially exposed to HIV. Reaching people like this is an absolute necessity.
Challenges like this informed a new grant we formalised in Papua New Guinea today. While Papua New Guinea has made good progress in reducing its HIV epidemic, only a grassroots, community-led approach will make fresh inroads against the disease.
That’s why the new grant focusses on behaviour. It looks at how people at risk of HIV act in the real world, but also the attitudes of those who need to support them, such as medical and criminal justice workers. In Papua New Guinea, gender based violence and stigma against men who have sex with men and transgender people is still very real. So the solutions need to be grounded and realistic.
For example, peer leaders in the transgender community will be trained to distribute condoms among their friends and colleagues and point them towards medical services, when necessary. Since these peer leaders will work with specific clinics, trust will deepen. At the same time, health workers will be trained to be more sensitive and receptive to groups such as men who have sex with men. In a more trusting, open environment, people are more likely to discuss their behaviour and address risk.
Today’s grant agreement is a good encapsulation of the Global Fund Partnership. Partners such as the Australian and US Government have worked with people affected by HIV as well as Papua New Guinea churches, health officials and private sector partners such as Oil Search Health Foundation to create this program. No one has all the answers but by working together in partnership we can have a genuine impact.
Global Fund News Flash
Viral load testing is the best way to know if a child is HIV positive. It’s also a powerful tool to determine if HIV drugs are working. The problem is that until now, the tests were often prohibitively expensive and contract terms varied.
New agreements struck between the Global Fund and seven diagnostic manufacturers aim to change that. After a year of in-depth negotiation and intense study of the market, the Global Fund sourcing team believes it’s found a route to affordable and stable prices, better contracting, and hopefully, expanded testing.
The manufacturers have agreed to provide the test components at a stable and competitive all-inclusive price as low as US$15 per test, which includes the cost of testing equipment. Today, tests can cost as much as US$85.
A more competitive price is welcome, but Christopher Game, the Global Fund Procurement head, explained that it’s not the only benefit of the agreement.
“What we were really after was transparency and reliability,” Game said. “So yes, the price reduction is great, because it will free up money to do more testing. But just as importantly, we now have transparency around the various components of that price, such as transport and machine maintenance.”
The machines required for the tests don’t come cheap, selling for around US$150,000. By stabilizing the other elements required to test, Game and his team expect to see an expansion in the number of tests done.
The agreement should deliver net savings of at least US$30 million over three years to the Global Fund, and potentially much more. Seven manufacturers have been through a technical and commercial evaluation before being added to the panel of suppliers. The framework agreements last at least three years. Other public health funders and agencies will also be able to enter into agreements based on the benchmark prices and contracting negotiated.
Global Fund News Flash
The Stop TB Partnership launched an online consultation process today to engage a wide group of stakeholders in developing the Global Plan to Stop TB 2016-2020. The development of the Global Plan seeks to be as inclusive as possible, and the online consultation (http://stoptbplan2020.org/) aims to reflect a diverse range of input, including the voices of people, professional groups and TB constituencies who may not have been reached previously. The consultation process will run from 10 June to 10 August 2015. Participants are encouraged to provide comments based on top line questions.
Since its creation, the Stop TB Partnership has issued five and ten-year Global Plans for concerted global advocacy actions, and to provide an estimate for the resources needed to reach the WHO End TB Strategy goals by 2035. The current Global Plan provides a ‘business case’ for the period 2016-2020. It is meant as an instrument for those working with TB and those allocating funding.
The Stop TB Partnership said that to achieve WHO’s End TB Strategy goals, significant changes need to be made in the way most countries organize and run their TB interventions and programmes. An acceleration in research and development of new drugs, diagnostics tools and a vaccine is also imperative, it said.
In addition to the online consultation, the Global Plan to Stop TB 2016-2020 will be informed by the outcomes of four regional consultation meetings. The Global Plan will be launched at the end of the year in Cape Town, South Africa, during the 46th Union World Conference on Lung Health.
GENEVA, 18 May 2015—On HIV Vaccine Awareness Day, UNAIDS is calling for a renewed global commitment to finding an effective HIV vaccine.
“A vaccine would be a major step towards ending the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé. “There have been encouraging recent scientific advances that give us hope for the future development of an HIV vaccine.”
UNAIDS is committed to leaving nobody behind in the HIV response. A major advantage of vaccines is that they promote equity and can be used effectively in all communities and settings, including those where many other health services can be harder to deliver.
Studies show that an HIV vaccine is possible. The RV144 vaccine trial in 2009 lowered the rate of HIV infection by 31%. There is much hope that ongoing research will build on this trial and deliver results. Newer vaccine candidates, as well as neutralizing antibodies, are also being studied.
Vaccines have eradicated smallpox, and polio is close to eradication. Vaccines have also effectively controlled diphtheria, pertussis, tetanus, mumps, measles and rubella, among other infectious diseases.
However, in 2013, HIV vaccine research and development saw the largest decline in investment since 2008. In order to transform promising concepts into an effective and accessible vaccine increased and sustained funding will be critical.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.