Return to December 2001 contents page
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
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.
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
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.
Return to December 2001 contents page