BRIEFING - December 2001
The new global fund and GAVI: similar approaches or different?
Nine months after the first announcements of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Lisa Jacobs assesses progress and compares the experiences of GAVI and the new initiative
It works, and it's available now: the Global Fund is likely to focus on existing interventions of proven efficacy, such as this insecticide-impregnated bednet, which protects children from malaria.
THE progress of GAVI and The Vaccine Fund have been watched by many in the field of international public health. Some of the most keen observers are those involved in setting up the new Global Fund to Fight AIDS, Tuberculosis and Malaria.
The team that has been developing the framework for the new Global Fund is meeting for the third and last time this month and is expected to make some key decisions about how the fund will work. Meanwhile, discussions at previous meetings and negotiations have pointed to a basic outline for the fund's operations and priorities. A number of the strategies developed by the GAVI partners to provide money and new vaccines to countries' immunization systems are being analysed and modified to fit the needs of the new Global Fund.
Background to the initiative
The seeds for the new fund were planted at the G8 Summit in Okinawa in July 2000, when the idea for a global partnership to mobilize significant new resources to fight the three major infectious disease killers first emerged. In April 2001, UN Secretary General Kofi Annan issued a challenge to the world for an "AIDS war chest" at the OAU AIDS summit in Abuja. This challenge was accepted by world leaders in June 2001 at the first UN General Assembly to focus on AIDS, and one month later at the G8 Summit in Genoa.
Since then, a Transitional Working Group, a body of nearly 40 representatives of governments of developing and donor countries, nongovernmental organizations, the private sector and UN agencies, has been formed to build the foundations and working principles of the fund. Supported by a temporary secretariat in Brussels, by December 2001 the group will have organised six regional and thematic consultations with developing country health officials, NGOs, and academia, to develop strategy and options papers on how this fund should operate.
The GAVI "model" has been cited in a number of these discussions and documents that are helping to frame the development of the new disease fund. And as the fund moves closer to reality, a number of its elements will be familiar to those who have been involved with GAVI.
"No new bureaucracy", could be considered a rallying cry amongst those involved in setting up the fund. While basic decisions on the GAVI structure and its policy-making systems were made even before the Vaccine Fund was created, its aims of operating leanly and efficiently are considered equally appropriate for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The fine details are still being hammered out, but it has become clear that policies for the new fund will be decided by a small board with 18 members, the administrative functions will be carried out by a small secretariat, and options for policy and technical issues will be explored by task forces or working groups, for consideration by the Board. A larger partnership forum that meets every other year, such as those employed by GAVI, Roll Back Malaria, and the Stop TB Initiative, will provide the opportunity for a wide range of stakeholders to contribute to discussions on how the fund will work.
Independent review of proposals
For GAVI, the Independent Review Committee is considered to be an important component of the proposal process. It is intended to provide neutral, consistent advice to the GAVI Board about which country proposals are ready for approval and which countries need more technical assistance before funding and vaccines should be delivered. The new global fund will most likely develop similar arrangements, although it will need to closely monitor the review committee's workload, considering the potential number of proposals being submitted to address the three diseases.
Country level partnerships
Country inter-agency coordinating committees (ICCs) that were first developed to support polio eradication and then broadened to focus on improving routine immunization systems and prepare and implement proposals to GAVI and the Vaccine Fund, have proven to be a robust mechanism for increasing collaboration with national partners and ensuring that each country has full ownership of its immunization plans. The global fund will encourage similar partnerships, so that governments, NGOs, private sector organizations, bilateral and UN agencies involved in fighting the three diseases will work together to develop proposals, implement programmes and monitor results.
The GAVI "share" system investing in plans to increase immunization coverage and rewarding countries for results achieved is being closely examined as a method for disbursing funds from the new global fund. The details are still at the early stage of development, but options are being explored to fund programmes that measure indicators such as the percentage of children who sleep under bednets to protect them from malaria, the number of adults who have access to quality voluntary HIV testing and counselling programmes, and the proportion of people with TB infection that complete DOTS therapy. HIV incidence rates may also be used as an indicator.
The structure of the board will be somewhat different from that currently set up for GAVI. Country delegations will make up the majority of the board 14 seats, with 7 seats each from developing and industrialized countries. Civil society rounds out the Board with 2 seats for NGO representatives and 1 each for foundation and private sector donors. The global fund board will include UN agencies likely to be WHO, UNAIDS and The World Bank but as ex officio, non voting members. One ex officio seat would also be held by a person living with HIV/AIDS or from a community living with TB or malaria. Constituencies will develop their own processes for selecting board representatives from among their members, with the option to rotate or renew members.
In order to move fast to reduce the devastating impact and suffering caused by these diseases, the new disease fund will focus funding efforts on scaling up and increasing coverage of proven and effective interventions. The fund will seek especially in its earliest phase to maintain a focus on outcomes. However, past experience has shown that in order to promote sustainability, focused efforts must never lose sight of the broader context. The fund will therefore encourage programmes that build on, complement, and co-ordinate with existing regional and national programmes, policies, priorities and partnerships, including poverty reduction strategies and sector-wide approaches".
Many consider the start-up of GAVI and the Vaccine Fund to have been extremely fast. Political pressure on the Global Fund to Fight AIDS, Tuberculosis and Malaria is pushing it to move even faster. At its final meeting this month, the transitional working group will be exploring strategies for disbursing money quickly possibly by identifying programmes that are ready for implementation but lack resources, or providing seed money to projects that look promising and will deliver rapid, measurable results. With millions of people's health in the balance, the choices will be watched with intense interest.
GAVI Communications Officer Lisa Jacobs has been advising and assisting the temporary secretariat of the Global Fund to Fight AIDS, Tuberculosis and Malaria, working on a part-time basis.
Immunization Focus December 2001 - Contents