Action: Fix the Global Fund! Sign-on letter
Asia Russell
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Dear all

Please read and endorse the following letter. The Global Fund's board is meeting April 21-22 in Geneva. Activists are demanding that the Global Fund do more to make sure that life threatening delays in disbursement of Global Fund money are corrected. We are also concerned that not enough Global Fund money is focused on treatment scale-up programs, despite the fact that addressing the crisis in lack of access to HIV treatment was the main reason the Global Fund was created.

Please send your organizational endorsements to Asia Russell (asia@healthgap.org) AS SOON AS POSSIBLE; the letter will be distributed at the board meeting to members of the Board as well as the Secretariat.

Thank you,

Asia

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Asia Russell
Health GAP
asia@healthgap.org
tel             +1 267 475 2645       
http://www.healthgap.org

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To: Board Members of the Global Fund the Fight AIDS, Tuberculosis and Malaria and Secretariat Leadership, the Global Fund the Fight AIDS, Tuberculosis and Malaria

We, the undersigned, represent organizations that are advocating urgently for HIV treatment scale up in developing countries around the world. We request that you use the 10th Board Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, April 21-22 in Geneva, to address an ongoing crisis that is undermining treatment scale-up efforts and that is undermining the legitimacy of the Global Fund.

Significant, avoidable delays in the implementation of Global Fund financed HIV treatment programs have meant that people are dying unnecessarily, while millions of dollars are not being spent saving lives--money that has been committed is sitting, unspent, either in the banks of Principal Recipients (PRs) or in the banks of the Global Fund trustee.

For example in India, a country with one of the largest HIV epidemics in the world, despite Global Fund 2-year commitments for HIV alone totalling $51,946,000 and approximately $5,543,000 already disbursed, no Global Fund money has been spent on antiretroviral treatment. This is unacceptable. In Guatemala, a Round 3 Global Fund grant including a treatment scale-up component still has not purchased a single antiretroviral, although $1,532,478 of the 2-year, $8,423,807 budget has already been disbursed. In Nicaragua as of December 2004 only $1,639,136 has been disbursed for that Round 2 HIV grant, approved in January 2003. Based on available estimates, that disbursed money has resulted in only 75 HIV positive people with access to treatment.

Other countries are experiencing similar situations. The Global Fund was created in large part because of global public outcry that millions were dying without access to HIV treatment. But in many countries the Global Fund has done little to fast-track and prioritize HIV treatment access.

There are various reasons for disbursement delays. In some cases, they are related to ineffective in-country bureaucracies and corruption, coupled with a lack of commitment to treatment scale up and a disregard for the lives of people with HIV. In other cases, policies of the Secretariat and/or the Global Fund Board have resulted in or contributed to these delays, in part by creating multiple entities with insufficient mechanisms for transparency, accountability, and coordination between them.

The Global Fund does not implement grants. But without a focus on solving problems that are blocking grant implementation by taking proactive steps in countries, delays will continue, people will die unnecessarily, and the Global Fund¹s results will suffer. Identifying and fixing the problems that have led to significant, life-threatening disbursement delays must become an immediate priority for the Global Fund Secretariat, its Board, and the technical experts and agencies that work with the Global Fund.

We recommend that the Global Fund and its supporters to take the following urgent next steps:

1. Immediately implement the overdue early-warning system and begin reporting publicly about disbursement problems. Richard Feachem, in his report to the 9th Board Meeting, stated that an early warning system, announced in June 2004, would be operational by early 2005. The Secretariat has failed to meet this deadline. A public, transparent early warning system meant to trigger increased attention from the Secretariat and others to grants before insurmountable problems develop is critical. It still is not in place, almost one year after the initial announcement. The Secretariat must prioritize implementation of this long overdue system, and address problem grants as emergencies, with the active engagement of grassroots networks of people living with HIV, technical partners and other allies.

The Secretariat should be reporting regularly about grants that are progressing slowly with a diagnosis of possible causes for lack of progress, information about what steps are being taken to address the problems, and who is taking those steps. This information is vital to civil society groups who are working in their countries for the appropriate and accountable disbursement of Global Fund money, and have limited or no access to this information. Furthermore, the Global Fund must act on its Board-mandated obligation to facilitate the provision of technical assistance and support in a ‘timely and coordinated fashion’ and should report in detail to the Board regarding these efforts.

2. Take early action in response to sub-standard Principal Recipients (PRs). Preliminary analysis shows that civil society PRs implement Global Fund grants faster than government PRs. When PRs are slow in disbursing funds for treatment scale-up, they should be immediately linked with technical experts that can help build and strengthen their capacity to disburse funds. They should be penalized if they continue to disburse funds slowly; non-disbursement of funds should trigger a change in PR. The Global Fund should develop requirements for a the addition of a civil society PR to be ‘twinned’ to non-civil society PRs that have been identified by the Global Fund to be at risk of poor performance.

3. Dedicate a proportion of qualified Global Fund operations staff for time-limited placements in key countries in their portfolios, to anticipate and facilitate the resolution of significant problems. This is particularly important in large countries, and in countries with major treatment scale-up challenges and a track record of poor performance in key indicators, such as community mobilization necessary for successful HIV treatment program implementation.

In cooperation with people with HIV, technical partners, and other experts, the Global Fund should also facilitate and support collaboration between grant recipients through in developing and sharing best practices for anticipating and overcoming common problems faced by Global Fund grantees that waste precious time, such as in the development of Global Fund Procurement Supply Management (PSM) plans.

4. Correct for the small amount of requests for funding for antiretroviral treatment through the Phase 2 renewal process. Many HIV grants awarded in rounds 1-3 do not contain substantive treatment scale-up components, as a result of lack of technical assistance during the time of grant request preparation, lack of government support for treatment scale up, pressure in CCMs not to prioritize treatment scale up, or other factors. Such Global Fund grants are not meeting evolving needs in country and should be evaluated during the Phase 2 renewal process for appropriate grant reprogramming to include fast-tracked treatment scale-up projects.

5. Commission a study to measure the quality of existing Global Fund financed treatment projects and report back to the 11th Board Meeting. Global Fund financed HIV treatment projects that require or appear to require ‘user fees’ are already dissuading the poorest and those most in need from gaining access to care. HIV treatment and care, including diagnostic and monitoring tests associated with treatment, should be the free at point of service as a matter of best practice. The Global Fund must see that these and other fundamental implementation issues are addressed, in order to ensure that clinical outcomes are as good as possible, and treatment reaches as many people as possible.

The Global Fund claims that, as a country-driven process and as a funding mechanism that is not an implementing agency, the Global Fund does not have the mandate to address these problems. This is untrue. The Global Fund must do more to ensure that avoidable problems are anticipated and addressed so money can be spent as quickly as possible, and lives saved.

According to the Secretariat’s own accounts, HIV/AIDS grants have been more difficult to implement than other grants. We are demanding action and leadership in response to our grave concern; our lives and the health of our communities is at stake--along with the life of the Global Fund. The Global Fund will fail if it continues to ignore the obstacles that are contributing to avoidable, and lethal, delays in treatment scale-up.

Sincerely,

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Agua Buena Human Rights Association, Costa Rica
Health GAP, USA
Global AIDS Alliance, USA