How the Global Fund Spent Its Money
The two-year-old Global Fund, an ambitious private-public partnership to battle HIV, tuberculosis and malaria in developing countries, in its first round of grant-making, was met with applause and criticism at the International AIDS Conference. With nearly two billion dollars in pledges from Industrial and Third World nations and assistance from foundation support, the Fund awarded a total of $378 million over two years to 40 programs in 31 countries.
The Board also agreed to a fast-track process to approve an additional $238 million for 18 proposals in 12 countries, plus three multi-country proposals, provided certain conditions are met. This would bring the total funding over two years to $616 million.
The approved grants were selected from more than 300 proposals. In all, these proposals requested more than $5 billion from the Global Fund over five years. More than 60 percent of those dollars went to proposals addressing HIV/AIDS. More than 55 percent of the funding was targeted toward sub-Saharan Africa, an area hit hardest by HIV infections. A second wave of funding is scheduled for early 2003 and proposals must be submitted by late September.
Almost before the checks were written, the announcement of the approved grants was quickly caught up in a swirl of criticisms and politics. Many wondered if developed nations were over-represented in funding and whether enough funding was committed to nations battling TB or malaria.
The most noise came from activists who felt that not enough dollars went toward HIV treatment. Too much was handed out to prevention rather than treatment, they charged, and what treatment dollars there were went towards the promotion of patented medicines and generic brands.
Meanwhile, Richard Feachem, incoming executive director of the Global Fund, defended its grants. "We are committed to prevention and treatment funding," said Feachem, who was warmly received at an address in Barcelona. Grants will be balanced across the diseases and geographical regions, he pledged, saying, "HIV gets the lion's share and rightly so, but we will not turn our back on TB or malaria."
According to officials, Global Fund donations will make it possible over the next five years for 220,000 people living with HIV/AIDS to receive anti-retroviral treatments. It's a first step, but still more must be done, said Allison Dinsmore of Health GAP (Global Access Project), a U.S. group that monitors barriers to care for people living with HIV. After all, she said, that number represents only 10 percent of the people who have the virus in sub-Saharan Africa alone.
According to Milly Katana, a member of the Global Fund board representing non-governmental organizations, and who works with the group People Living with AIDS in Uganda, "it is just the beginning." More can be done, Katana argued, "to support people who have been fighting this plague with unlimited courage while lacking any other weapons. Billions more dollars are needed now for more prevention and treatment measures."
But activists remained skeptical. "We're not anti-Global Fund," explained Dinsmore, with Health GAP, "we're just concerned that the Fund, which is supposed to grow to $10 billion, isn't being taken seriously by the U.S. government." The Bush administration has pledged $500 million to the Fund. Dinsmore thinks it should commit more. "If we don't give, other countries won't be giving much either," she said. "Then the fund will be always bankrupt and will not accomplish much."
Members of ACT UP/Paris (AIDS Coalition to Unleash Power), a vocal advocate for HIV/AIDS issues known for its sometimes disruptive tactics, were wearing stickers in Barcelona questioning the Global Fund's bottom line. A goal of $10 billion was set when United Nations Secretary General Kofi Annan called for the creation of the fund. Annan suggested $7 to $10 billion was needed to address HIV, TB and malaria in the world's developing nations.
By mid-May, $1.9 billion had been pledged to the Global Fund -- less than 20 percent of the goal. The world's richest countries must contribute more to make a difference, said organizers with ACT UP/Paris. "To refuse to do so means the industrialized G-8 countries are responsible for the deaths of 10,000 persons every day," scolded Gaelle Krikorian, a member of ACT UP/Paris.
As officials with the Global Fund held meetings in Barcelona to explain its first round of funding, it asked participants to be patient with its growing pains. "We have to learn from our mistakes," said Christoph Brenn, an NGO representative with the Global Fund. "This is a new initiative, we have to make it work."
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