bjohnson - Feb 28, 2006

I agree with Chike's statement that we need to balance funds in relation to the human impact of diseases, but the GF must not only guage this on purely quantitative data.

Type of data to consider during decision-making:
In regards to HIV and AIDS (and my apologies if this statement is primarily focused on the response to HIV and AIDS--but that is also my primary area of focus), it is not acceptable to distribute funds based merely on a country's estimated prevalence. The GF should also take into consideration a country's GDP, access to health care for its citizens and overall health indicators such as infant and maternal mortality, life expectancy, current access to prevention and treatment options for the target diseases, current mortality rates for the target diseases, and the economic, social and multisectoral impact of the target diseases on the broader society. The GF should also look at the resources already available in countries to respond to the target diseases and especially work to strengthen capacity in countries and regions with little resources.

More regions to consider: Please don't forget to provide adequate funding to regions with emerging HIV and AIDS epidemics such Eastern Europe and southeast Asia and also don't forget the impact of the target diseases in the Americas.

Interventions and actions: The Global Fund should also work to build capacity at the grassroots level by organising workshops to train community-based organisations in how to apply and manage funds from the GF. Also, the GF should work with a broad range of people at the grassroots level including local leaders, representatives from faith-based organisations, traditional healers and recognise the important role that community-based health care workers and caregivers play in providing education, care, counselling and treatment monitoring.

Maximising access to treatment by supporting variety of treatment types: Lastly, greater access to treatment options for people affected by the target diseases should also include treatment literacy and greater options. I have lost too many clients and friends to AIDS-related illnesses because they would rather die than face the possible side effects of ART. Access to treatment also includes access to proper nutrition to improve the immune system functioning, prevent opportunistic infections and help individuals to better metabolize drugs. Additionally, as the majority of the world's population does not access allopathic medical treatment as a first line treatment, it is imperative to work with practitioners of natural and traditional healing instead of side-lining these individuals and their contributions. Focus should be placed on how to work towards greater plurality in the response to health and giving individuals options.

In short, the Global Fund's response should be HOLISTIC both in the way it decides to distribute funds and the criteria it uses to decide who the beneficiaries of the funds will be.

--Becky A. Johnson, M.A.

Feb 28, 2006

Message from Dr. Isao Arita, Japan.

I Propose as follows:

1. Constitute an independent assessment team to measure the cost-effectiveness of GFATM (grants).

2. Discussions should include why current measures cannot stop HIV transmission in selected regions, for instance Southern Africa, India or China.

I could add more on our practical proposals for improvement if you are interested.

(Dr. Arita has been requested to elaborate on practical proposals, which will be published here once available)

All the best,
--------------
Isao Arita, M.D.
Chairman
Agency for Cooperation in International Health (ACIH), Japan.

Feb 28, 2006

Message from Nurul Dulu, DCPUK, Bangladesh.

What actions should the Global Fund take to ensure that its overall portfolio of grants is balanced – particularly, that it is proportionally disbursed according to the needs across the three diseases, different types of interventions, different kinds of recipients, and regions?

DCPUK thoughts on this are:

Interventions :

- Capacity Building of the members .
- Capacity building of Civil Society members.
- Advocacy and awareness activities to prevent the spread of disease.

Recipients:
- (Increased funding to?) NGO and partners.

Region:

(Increase funding to?) South Asia, Vulnerable Areas

Nurul Dulu, DPCUK, Bangladesh.

Chike - Feb 28, 2006

Balancing funds across regions should be considered only in relation to the human impact of the diseases. At the moment the mortality rate of malaria remains high in sub-Saharan Africa. However the per capita mortality rate of HIV/Aids appears higher in the South-east of Africa.

While malaria and Tuberculosis funding should not be undercut, the mode of transmission of HIV and its disproportionate devastation of the productive population merits a higher level funding focus. The experience of Europe and America in slowing down the infection rate and the long-term promise of intergrated intervention with emphasis on education and prevention can be replicated in these areas.

Therefore human toll in sheer numbers should remain the criteria of fund allocation while intervention must always emphasize grassroot capacity building with programatic / technical support sourced from more experienced agencies and institutions. In addition, agencies should be held accountable to provide evidence based outcomes. There should be less tolerance for excuses to failure. Rating of qualities of the performance of service providers should form part of the agencies' profile.

Ben Karenzi - Feb 27, 2006

Firstly, I still would like the GFATM to stick to the business model where performance is pivotal. Secondly, the technical aspects of proposals as reviewed by the TRP should be maintained.

Having said the above, the GFATM Secretariat should consider capacity building measures to assist regions or countries that are not benefiting /performing. In the final analysis, it is the patients that we all would like to help that are missing out.

As far as distribution with regard to the three diseases is concerned, I would also want to maintain the principles of performance and sound technical project proposals. If the GFTAM loses these important tenets, it will be like all these other mechanisms that want to disburse funds without impact assessment.

Dr. Ben Karenzi,
Permanent Secretary, Ministry of Health, Rwanda.

Feb 26, 2006

What actions, if any, do you think the Global Fund should take to ensure that its overall portfolio of grants is balanced – particularly, across:
- The three diseases;
- Different types of interventions;
- Different kinds of recipients;
- Different regions?