PHA-Exchange> global fund again

[Aviva]

Lancet   Editorial
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> Time to make the Global Fund global
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http://www.thelancet.com/journal/vol360/iss9328/full/llan.360.9328.editorial
_and_review.21861.1
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> Since the first International AIDS Conference in 1985, researchers have
> come to accept that there is no "magic bullet" to combat this modern
> plague. But as the fifteenth AIDS conference drew to a close in
> Barcelona, Spain, last week, it was clear that there is something akin
> to a magic bullet--money. How to finance the response to AIDS turned out
> to be one of the main themes at this meeting. The fiscal atmosphere in
> Barcelona was thus an appropriate backdrop to Richard Feachem's first
> speech as Executive Director of the Global Fund to Fight AIDS,
> Tuberculosis, and Malaria, since he used this opportunity to announce
> the development of the Fund's long-awaited financial plan. In October,
> the Fund's board will publish and widely disseminate the Fund's
> financial projection estimates and resources needed over the next
> several years. Pledges to the Fund--almost all of which are from the
> public sector--currently total just over US$2 billion. The US Government
> has given $500 million, and Japan, Italy, and the UK have pledged $200
> million each. The total amount is, of course, derisory in view of the
> task in hand. Jeffrey Sachs, chairman of WHO's Commission on
> Macroeconomics and Health, estimates that the Fund requires $5.5 billion
> in 2003, with $2.5 billion coming from the USA alone. Feachem promised
> that the Fund's financial projections will be open to public scrutiny.
> While this pledge towards transparency and openness in the Fund's
> activities is welcome, it seems odd that the topic chosen for public
> dissection is financial planning. To be sure, the resource requirements
> of the Fund are important issues, but surely they are of less immediate
> public interest than the way in which the resources are to be spent? The
> call for the second round of proposals is already well underway, but, as
> the Fund's guidelines make clear, only limited information on successful
> proposals will be disclosed, contrary to earlier statements from the
> Fund. The Fund states that proposal-specific deliberations will be
> confidential and information on the reasoning behind the different
> decisions taken on proposals will be shared only with the authors.
> Details of the review process may be shared with some other
> "stakeholders". It is unclear whether these stakeholders include the
> management consultancy firm who might eventually be charged with
> overseeing the Fund's disbursements, McKinsey & Company, whose Managing
> Director Rajat Gupta is the private-sector member of the Fund's board.
> It is clear, however, that the public, who have provided almost all the
> money so far, will not be able to see how it is to be spent. Is there a
> chance that the Fund will embody a genuinely new approach to health
> financing? It certainly seems likely that, with its focus on AIDS and
> the high profile of its supporters, the Fund exists within the right
> conditions to have some degree of success. Ironically, this may work
> against the wider range of Millennium Development Goals that the world
> has set itself to achieve by 2015. Although AIDS has pushed health up
> the international political agenda, it risks eclipsing the
> poverty-related health issues that needed to be tackled long before AIDS
> appeared. For example, the United Nation's Economic and Social Council
> was recently told of deep concern at the slow progress towards the
> Millennium Goals, notably in reducing child mortality. Maybe it is time
> to accept that AIDS is a special case and as such should have a single,
> separate fund. Many of the interventions likely to be successful in AIDS
> prevention--such as education--have little to do directly with medicine
> or public health. Sectioning off AIDS would allow another fund--a truly
> Global (and transparent) Fund--to finance all other health-related
> aspects of the Millennium Development Goals. There is a further issue.
> Whatever happened to the proposal from last year's Commission on
> Macroeconomics and Health to establish a Global Health Research Fund?
> Without supporting biomedical and health-sciences research on the
> problems facing the world's poor, the long-term value of these global
> funds will be severely compromised.
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> The Lancet
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