THE GLOBAL FUND PARTNERSHIP FORUM MEETING
Report by Senator Mary Henry M.D.Member of the PNoWB Committe on HIV/AIDS, TB and Malaria
Bangkok - July 2004
The Global Fund Partnership Forum is an integral part of the Global Fund. It was an honour to represent both the Inter European Parliamentarian Forum on Reproductive Health and the Parliamentarian Network on the World Bank at the first meeting of the Forum in Bangkok on the 7th and 8th of July 2004. Ireland is a donor to the Global Fund so I felt I had my Irish Parliamentarian's hat on too. There were about 400 delegates at this well organised and useful meeting.
Helene Gayle of the Gates Foundation chaired the opening session and Tommy Thompson, Secretary of the U.S. Department of Health and Human Sciences and Chair of the Global Fund welcomed us by satellite link from Washington. With his usual warmth he encouraged us to remember these Forum meetings are important to the workings of the Fund and to speak our minds. In view of this I do note that he singled out \"faith based\" organisations for special mention. I do hope this does not only apply to Christian organisations only and and anxious that this approach, which appears to be the predominant one of the present American Administration, may leave many other usual vehicles for combating HIV/AIDs especially out.
The first session was of Perspectives from the field. Toni Mboya from Kenya urged the money from the Fund be used flexibly and there should be sensitivity to individual country led development processes. Donors, he said, should have a formal link with governments and setting up parallel or independent systems should be avoided.
Francisco Vidal and Marco Beccera from Chile asked for decentralisation and stressed the need to involve civil society. Chile, they said, was a very conservative country and it was difficult to market condoms. The Fund should also seek suggestions from people living with HIV/AIDs as to how money should be used.
Natalia Leonchuk of the Ukraine also asked that we should listen to those suffering from the diseases the Fund is trying treat. She told of instances of treatment being started under the auspices of the Fund and then the supply of drugs running out. This is a very serious issue and arose several times during the meeting.
Faraque Ahmed of Bangladesh brought the logistics of the situation there right before us explaining the health expenditure per capita was twelve dollars per year, that 300,000 of new cases of T.B. developed each year and 63,000 new cases of malaria in his country.
To be cheerful the Global Fund has purchased and distributed 108 million bed nets impregnated with long term insecticide. Those working for the Fund have also mobilised additional human resources especially from civil society by tapping into existing infrastructure, often at little cost. It is essential to ensure that the countries where help is given realise it is expected that they will continue to put money into these projects after the Global Fund has gone.
It would be quite wrong if health budgets were reduced because of the arrival of Global Fund money; it is supposed to be additional.
Delegates from recipient countries pointed out that the slogan \"making a difference\" must mean a difference for the better! It should not cause local competition and the Fund should be sure it is assisting the development of the health services of the country as a whole.
The dreadful development of HIV/AIDs has helped mobilise resources for TB and malaria in some countries, such as the DR Congo, we were told but in many places the money is being used as replacement and not additional funds. Civil society thanks to the Fund does feel more able to criticize relevant governments. It gives some power to them.
Flexibility regarding buying of drugs for malaria came up frequently because resistance varies from area to area. In Senegal the Global Fund has made a big difference in treating malaria by recognising this.
Lack of capacity to use the money came up over and over again too. Health services are very poorly developed in many countries with these diseases.
A representative from the corporate sector said he felt the Global Fund was too bureaucratic and had anti corporate sentiments! To be honest, I did not feel this was a valid criticism.
A delegate from Venezuela stressed the importance of A (abstinence) B (be faithful) and C (condoms) in the fight against HIV/AIDs and that development was useless without instilling values.
The problem of governments promoting non-government organisations (NGOs) which will be most likely to do their bidding was addressed. Governments may select people to be on Country Co-ordinating mechanisms(CCMs) who they can control.
Examination of projects by the CCM of a country is the main method of accessing the Global Fund so it has great power. The issue of the chair or vice chair of a CCM also being the Principle Recipient (PR) of funds was considered inadvisable seeing that it was the CCM which put forward cases for support.
Several times people working with TB or malaria claimed the Fund focused too much on HIV/AIDs and certainly nearly 60% of the money goes for this problem with only 13% being spent on malaria.
We must make a difference beyond treatment it was felt and make more of an effort to reach the most vulnerable and in need who were frequently in rural parts. Border areas can get left out, too and a delegate from Mongolia pointed to the problems of dealing with mobile populations. These are big challenges.
A doctor from the Congo felt countries should draw up their own action plans and he too, felt malaria was being neglected. Another doctor from Guinea felt more should be done about addressing the stigma associated with HIV/AIDs.
On Day 2 we got down to practicalities such as trying to see how CCM members could be best chosen. There are no clear guidelines for this at present.
Application guidelines for projects should be simpler and all UN languages used it was suggested.
At present continued funding is performance based and this can be very difficult to implement because recipients may have little secretarial assistance. The possibility of financing secretarial backup this was discussed, as was similar help for CCMs.
There were complaints that there were bottlenecks in distributing funds.
Sometimes a Minister for Health was not able to release funds without the agreement of the Prime Minister or Minister for Finance. If a co-ordinating mechanism exists already in a country it was felt this should be used and a new one not set up.
Specific problems in some countries arose, for example in Burma (Myamar) present legislation allows prosecution of a woman found carrying a condom!
The Burmese delegate also pointed out the need to co-operate with many government departments for example Forestry and Irrigation when dealing with malaria.
Donor countries, such as Germany, were very concerned about the sustainability of projects. We discussed drug prices, recognising that some small drug firms cannot be asked to drop prices if they are to survive. The need to be sure recipient as well as donor countries are clear what is meant by partnership was discussed but I regret to say this delegate was still unclear at the end of that discussion.
All in all it was an excellent meeting. One was well able to meet other delegates at the coffee and meal breaks. The venue was ideal, the UN convention centre in Bangkok. I do hope their new subway gives locals some relief from sitting in queues of cars every day. I feel I learned a great deal from the meeting and enjoyed it very much too.