Speakers:

Professor Richard Feachem, Executive Director - Global Fund to Fight AIDS, Tuberculosis and Malaria
Chair:

Neil Gerrard, MP

1) This meeting on The Global Fund to Fight AIDS, Tuberculosis and Malaria was chaired by Neil Gerrard MP, Chair of the All-Party Parliamentary Group on HIV/AIDS. The speaker was Richard Feachem, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria.

2) Richard Feachem explained that the Fund had been created in response to a strong perception that the battle was being lost against three main infectious diseases. Incidence rates for TB had been worsening, especially for multiple drug-resistant strains. Malaria was also getting worse, accounting for one quarter of under-5 deaths, and spreading to new areas. And, of course, the situation with respect to HIV/AIDS was catastrophic in southern Africa, and extremely serious in other areas. Prevalence rates in southern Africa especially were in excess of 20% and in extreme cases like Zambia, life expectancy was heading in the wrong direction back towards only 30. In that country, the number of teachers dying of HIV/AIDS was twice that the country was able to train. In Asia, the problem was spreading rapidly: India now had the most cases.

3) The key decisions had been taken at the Okinawa G8 Summit in 2000 and the Genoa Summit in 2001. The Fund had become operational in January 2002. It now had 300 programmes in 130 countries. Against committed income of US$5.7 billion, it had potential programmes to the value of US$8 billion. In terms of geography, 60% of expenditure was in Africa; 50% was being spent through governments and 50% through civil society. And in terms of items of expenditure, 50% was being spent on drugs and other commodities, and 50% on building health infrastructure. It was interesting that the Fund itself had no policy on these outcomes. Rather, projects were proposed by recipients, passed by a Technical Advisory Board and recommended to the Board of the Fund.

4) 2005 was a very significant year for the Fund. Richard Feachem expected the HIV spread to be picked up by the Africa Commission, but also malaria to be identified as a quick win. The key issue, however, was financing. The Fund would be asking for new financing in 2005 (Round 5). This issue needed to be picked up by the Gleneagles Summit, and examined in the context of the International Financing Facility. The most important task facing the G8 was to establish the Global Fund at an appropriate 'cruising altitude'.

5) A first issue for discussion was what this cruising altitude might be. Richard Feachem said that a realistic figure without the international financing facility was about US$3 billion. However, if the Facility came into operation, then he expected that a sustainable figure of US$7-8 billion should be reached. His Board would meet in Arusha in about 3 week's time, and would have to decide whether to launch Round 5.

6) A number of points were then made about the impact of the Global Fund on other aid flows. It was clear that there were some additionality, certainly for donors, though perhaps not so much for countries. Richard Feachem was clear that the figure of US$5-7 billion was not achievable in the current aid climate, which is why the MDG exercise and the IFF were important. Of course, the same argument could be made for other sectors, like water.

7) This then led to a number of questions about how the Global Fund could be integrated into donor mechanisms for funding nationally owned poverty reduction strategies and medium-term expenditure plans. Did a 'vertical fund' like the Global Fund, make it more difficult alignment with donor objectives. Richard Feachem emphasised that the Fund was committed to harmonisation. It was not always straightforward, however. Of the 130 countries in which the Fund worked, perhaps only 12 had health sector plans. Furthermore, there were some countries where the infectious disease issues, particularly HIV/AIDS, did not receive the political priority they needed. India was cited as an example, where domestic funding for HIV/AIDS was close to invisibility.

8) This led to a debate about the desirability of a Global Fund rather than managing spending on the diseases through 'normal channels'. Richard Feachem's unequivocal answer was that there was no other way to tackle potentially catastrophic global problems. The three diseases had been running out of control. It had been absolutely necessary to have a dedicated war chest.

9) It was also important that the Fund had been able to fund civil society projects. Richard Feachem pointed out that in Africa 50% of all health expenditure was in the private sector, with figures of 80% for India, and 90% for Cambodia. The Fund had pioneered support to NGOs, church groups and the like, who were able to reach important target groups.

10) There was a discussion about prevention vs. cure. Richard Feachem estimated that over 50% of the Fund's expenditure had been spent on prevention. This might fall because of the availability of new treatment options, such as new malaria drugs, and the greater availability of generic anti-retroviral treatments. He also referred approvingly to new technologies for impregnating bed-nets with insecticide.

11) In this connection, an important role was played by the Fund in creating markets that would not otherwise exist, and thereby incentivising the private sector. It was also able to work closely with research foundations (Gates, Welcome, etc).

12) In conclusion, Neil Gerrard emphasised the importance of the fight against HIV/AIDS and the other diseases. He urged participants to support the Round 5 funding initiative, including politically.

Simon Maxwell

21 October 2004