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Africa: Global Fund Action Call

AfricaFocus Bulletin
Nov 11, 2004 (041111)
(Reposted from sources cited below)

Editor's Note

The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria is holding its first meeting to take place in Africa next week in Arusha, Tanzania. Ironically, one of its decisions may be to postpone announcement of a fifth round of funding, as donors led by the United States press to reduce expectations and pressure for future funding commitments. Activists in Africa and around the world are calling for mobilization to demand that the Fund stick to its original vision and continue to increase resources to fight the three diseases.

As of the beginning of November, the Global Fund had received $5.7 billion in pledges for 2001 through 2208, of which $3.2 billion had already been paid to the fund. $1.6 billion total is pledged for 2004, but only $905 million for 2005. (See While this falls far short of the levels estimated to be needed, both activists and the fund secretariat say that there are adequate funds pledged to open applications for a new round of grants, to be decided on in mid-2005. In any case, the need is urgent. The Fund needs to be raising more money and scaling up operations, not cutting back.

Activists are also arguing for other measures, such as more rapid disbursement of funds, increased involvement of people living with AIDS in country committees, and a change in the current restrictive policy that requires the Fund to have the total amount for a multiyear grant in the bank before it can make an initial commitment for the grant.

This AfricaFocus Bulletin contains a press release from activist groups in Kenya who are planning to demonstrate at the meeting in Arusha; a call for organizational sign-ons for a letter to members of the Global Fund board, and excerpts with background information from the most recent issue of the Global Fund Observer. For contact information, including where to send organizational endorsements of the sign-on letter, see below.

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

AIDS Activists to Donor Governments: Do not shut the Global Fund's Doors

Kenya PWA Groups Announce Mobilisation at Fund's First Board Meeting in Africa to Demand Launch of New Funding Round

Press Release

November 10, 2004

Dandlora Community AIDS Support Organization (DACASA) | Kenya Treatment Access Movement (KETAM) | Kenya Organisation of People Living with HIV/AIDS (KOPLWA) | The Movement of Men against AIDS in Kenya (MMAAK)

(Nairobi) AIDS activists today expressed outrage that the Global Fund to Fight AIDS, Tuberculosis and Malaria is in danger of not launching a new round of funding for poor countries at its upcoming Board Meeting in Arusha, Tanzania, 18-19 November.

The Global Fund's Executive Director Richard Feachem arrived today in Arusha for a meeting with a delegation of East African Heads of State on the role of the Global Fund in meeting the Millennium Development Goals.

Donor countries have broken their promises to fully fund the Global Fund, and will aggressively oppose the launch of a new funding round during the upcoming Board Meeting, according to activists.

"It will be impossible for the Global Fund to aid in the achievement of the Millennium Development Goals if the Global Fund is bankrupt and forced to close its doors due to donor country stinginess," said Siama Musine, Kenya Organisation of People Living with HIV/AIDS (KOPLWA).

The Global Fund needs at least $3.5 billion in 2005 in order to pay for the renewal of grants now reaching their 2 year anniversary, and to finance the launch of two new funding rounds.

Donor countries are preventing the growth of the Global Fund in 2005 and delaying the launch of a scheduled Round 5 call for proposals in November in order to relieve themselves of paying their fair share of money to the Global Fund next year, according to activists. "Next week in Arusha the board of the Global Fund must agree to a new round of AIDS, TB, and malaria proposals. The members of the board, including rich governments, must not turn their backs on the original promise of the Global Fund to be a "war chest" in fighting HIV/AIDS and on the millions of people who will die without treatment. Countries are relying upon the Global Fund to fill the funding gaps for AIDS medicines and more healthcare workers", said Patricia Asero Ochiemg, Dandlora Community AIDS Support Organization (DACASA), who is an adherence counselor in the ARV clinic at Mbagathi District Hospital. Money already earmarked for Kenya from an earlier round of funding is expected to provide antiretroviral therapy to 4,000 people in the first 2 years and fund the training of 1,800 health workers.

Some donor countries, particularly the U.S., have favoured their own bilateral programs over support for the Global Fund, an independent, evidence based, multilateral funding mechanism. The U.S. program, PEPFAR, has come under harsh criticism for its funding of unproven abstinence only prevention and the procurement of more expensive brand name medicines.

"The Global Fund and its donors must not close the best chance we have to drastically increase the number of people on antiretrovirals", said James Kamau, Kenya Treatment Access Movement (KETAM).

East African HIV/AIDS treatment activists plan a public rally outside the Arusha hotel where Board Members will be meeting, in order to lobby the Global Fund Board to launch a new funding round immediately. "We will be in Arusha when the Global Fund meets next week in order to remind board members that their decisions have life and death consequences for people directly outside their doors. We cannot afford to have the Global Fund shut its doors to new grant requests that could save lives and give people hope, " said Nick Maisha, the Movement of Men against AIDS in Kenya (MMAAK).

"As people from the grassroots, we need these drugs. We are not ready to give up. The Global Fund and its board members must not give up on us," said Kassim Issa, a co-founder of Kenya Organisation of People Living with HIV/ AIDS (KOPLWA), based in the Kibera slum, the largest slum in Africa.


For more information, contact:

Patricia Asero Ochiemg, Dandlora Community AIDS Support Org (DACASA), Tel: +254 733-590-232

Nick Maisha, the Movement of Men against AIDS in Kenya (MMAAK), Tel +254 722-895-953

Siama Musine, Kenya Organisation of People Living with HIV/AIDS (KOPLWA), Tel: +254 722-554-510

James Kamau, Kenya Treatment Access Movement (KETAM), Tel: +254 722 886694

Global Fund Organizational Sign-on Letter

Health GAP

November 10, 2004

Please read below, and send your organizational endorsements to: Sorry, we are not accepting individual endorsements at this time. This letter will keep circulating until just before the Arusha Board Meeting starts, which means the organizations can sign on until COB Nov 15.


Asia Russell, Health GAP; tel +1 267 475 2645

--begin Global Fund sign on letter--

To: Board Members, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Richard Feachem, Executive Director, the Global Fund to Fight AIDS, Tuberculosis and Malaria

We, the undersigned, write to you as supporters of the Global Fund. The efforts of many of us were instrumental in creating the Global Fund; the health and stability of our communities depend on the strength and growth of the Global Fund.

As you know, when the Global Fund Board meets for its Ninth Board Meeting November 18-19 in Arusha, Tanzania, you will face critical policy decisions regarding Global Fund financing and governance.

Your decisions will determine whether the Global Fund's growth will keep pace with the pandemics of HIV, tuberculosis and malaria, or whether the Global Fund will shrink due to the broken promises of donors who are not funding their fair share of the global fight against AIDS, tuberculosis and malaria.

Your decisions will determine whether the Global Fund will endorse minimum, enforceable standards for the substantial participation of people living with HIV/AIDS in grant making and grant implementation, or whether these and other basic expectations of governance are rejected.

When the Global Fund was created, it also created a promise - an end to "business as usual." The world envisioned when the Global Fund was created would mobilize billions in additional resources, support locally-driven responses to the three pandemics, and would finally mount an emergency response to treatable, preventable infectious diseases killing 16,000 people daily.

But this promise, like so many before and after it, has been broken. UNAIDS estimates that $17 billion is needed by 2005, increasing to $20 billion annually by 2007, to fight AIDS alone. Yet donors are not paying their fair share. And despite successes around the world, bureaucracies at country level are preventing people in need in some countries from benefiting from approved Global Fund grants.

We, the undersigned organizations call on you, Board Members and the Secretariat to take the following urgent action at the 9th Board Meeting:

  • Support the immediate launch of Round 5, so that two Rounds of grants may be approved in 2005, in addition to grant renewals;
  • Fully finance the Global Fund, for 2005 and into the future, through a framework of equitable contributions, based on the demand of countries in need, not artificial calculations of what donors choose to supply;
  • Change the recommendations approved during the 8th Board Meeting for civil society participation in Country Coordinating Mechanisms (CCMs) to requirements; and
  • Address significant bottlenecks in grant disbursement as emergencies that must be addressed by relevant parties. We cannot tolerate avoidable delays in disbursement of life-saving resources.

The fate of millions around the world is in your hands. We look forward to your response to this urgent request; we will be monitoring the decisions of all Board Members closely.


<list in formation>

Global Fund Observer (GFO) Newsletter, a service of Aidspan.

Issue 34 - Monday 8 November 2004.

[The GFO Newsletter is an independent source of news, analysis and commentary about the Global Fund to Fight AIDS, TB and Malaria ( Aidspan and the Global Fund have no formal connection, and Aidspan accepts no grants or fees from the Global Fund. The Global Fund bears no responsibility for the content of GFO or of any other Aidspan publication.

For formatted web, Word and PDF versions of this and other issues, see ]

1. NEWS: Global Fund Encounters Criticism in Washington, DC by Esther Kaplan, GFO Contributing Editor

The US Capitol Hill briefing in late September started out as a routine event - a discussion of what to do about the portion of the United States' 2004 allocation to the Global Fund that hadn't been matched, two-to-one, by other donors. But the briefing of Senate staffers by US administration officials quickly turned into an indictment of the Global Fund for everything from having poor financial management to supporting rogue states. The meeting nearly sparked one Senator to introduce legislation slashing the United States' 2005 contribution by $150 million, and it spurred Global Fund operations chief Brad Herbert to fly to the US Capitol for three days of damage control. The flurry of criticism may still have an impact on the United States' 2005 contribution to the Fund, likely to be finalized later this month.

The September 21 briefing for more than half a dozen Democratic and Republican Senate staffers was led by Bill Steiger (who directs the Office of Global Health Affairs in the department of Health and Human Services (HHS), is a senior advisor to HHS Secretary and GF Chair Tommy Thompson, and has long been a senior member of the US board delegation to the Fund), Pam Pearson (of the office of the Global AIDS Coordinator, which runs the President's Emergency Plan for AIDS Relief (PEPFAR)), and other administration officials. Steiger, whom the journal Science describes as "a political appointee with close ties to the Bush family," often comes across as skeptical of multilateral organizations; last spring, he instituted a policy that US government scientists must submit paperwork for foreign travel approval to meet with any UN organization - even if its office is just across town.

At the briefing, Steiger and the other administration officials raised significant concerns about the Global Fund's performance, including slow disbursements, inadequate staffing at the Secretariat, insufficient strength to manage a Round 5, and irresponsible disbursements to corrupt or repressive states. (Steiger and Pearson did not respond to GFO requests for comment.) What started out as an update on the Fund turned into a laundry list of complaints.


Facing this flurry of criticism, the Fund Secretariat responded decisively. Feachem sent a 10-page letter to Senate staffers responding to the issues raised at the September 21 briefing, and the Fund's Herbert flew to Washington on September 29 for meetings with Senators, Senate staffers, and administration officials.


Advocates close to these developments said that efforts by the Secretariat to smooth the feathers ruffled by the September briefing went well, and that people on Capitol Hill and in the administration were appreciative of Herbert's whirlwind of meetings.

Looking back on the meetings, Herbert told GFO, "I was expecting the worst, that it would all be political, but it wasn't. The meetings played out as frank exchanges and I really enjoyed them. I was talking with concerned staffers who had done their homework. Every question they asked was legitimate, and they were questions we should be answering on a more regular basis." As an illustration of the cooperative attitude, he pointed to the fact that his meetings with members of Congress were facilitated by Scott Evertz and other AIDS staffers in Secretary Thompson's office. "That demonstrates the confidence they have in us," he said.

But several Washington-based advocates for the Fund feel that the climate in Washington has deteriorated. "I saw that briefing as a shift in administration tactics," said Paul Zeitz of the Global AIDS Alliance, who attributes the shift in part to the beating that PEPFAR took at the Bangkok AIDS conference, and the perception that the Fund didn't adequately defend the US program. "For the first time, the administration was aggressively trying to undermine the Fund. And that has a ripple effect, because it sends a political signal." ...

The House and Senate will reconvene on November 15 to work out discrepancies between their numbers for the US contribution to the Fund in 2005 - $250 million on the Senate side and $400 million on the House side in the Foreign Operations bill, an additional $150 million on the Senate side and $100 million on the House side in Labor and Health appropriations, and a possible additional $150 million in emergency spending on the Senate side. It is difficult to predict the impact that the return to office of President Bush and the strengthened position of Republicans on Capitol Hill will have on US contributions to the Fund, given that the Fund has supporters on both side of the aisle. But it looks unlikely that the Fund will get more than the $547 million it was promised (subject to some matching requirements) for 2004, and it might get less.

2. ANALYSIS: Topics for Discussion at the Forthcoming Board Meeting


Round 5

Round 5 was the other issue on which the Partnership Forum [a 400- person informal advisory body to the Global Fund that met in July; see] had strong views. The Forum report says that "a large majority of delegates called for the Global Fund to launch Round 5 in November 2004 or early in 2005." And the Forum recommended that a board committee make a decision regarding Round 5, "soon enough to allow possible announcement at the November 2004 Board Meeting."

In June, the board asked the Secretariat to begin preparations for Round 5, in order to make it possible for a decision to be made at next week's board meeting regarding when Round 5 might take place.

[GFO adds: The US delegation has strong views on the timing of Round 5 that conflict with those of the Partnership Forum and the Global Fund Secretariat. The delegation has sent a memo to some board members as follows:

"The United States opposes a launching of Round Five at the Arusha board meeting. This is a position we hold with great regret; we support a strong and robust Global Fund, and would have wished to be in a position to support a strong new Round at this point in time. However, given its current level of performance, we do not believe the Fund currently has the capacity to support another round of grants. While a few grants have performed well or even exceeded expectations, far too many grants are in trouble

"We believe that in 2005 the Global Fund should focus on consolidating its work and [that it] will be in a better position to provide support for a new Round at the end of 2005. In addition the Fund regrettably does not have the financial means to launch a Fifth Round at this time

"We remain committed to finding additional sources of funding, particularly from the private sector and government donors that have never pledged to the Global Fund, that will allow us to move forward; but we believe that it would be an irresponsible move to raise the hopes of potential recipients by generating a round of grant writing that drains scarce resources, without any certainty that we will have the funds to approve a single grant at the July 2005 Board meeting."

Asia Russell of Health GAP, who will attend the board meeting as a member of the Developed Countries NGO delegation, responded, "The reason the US does not want a new funding round launched is because they know it would increase pressure on them to contribute their fair share to fully fund that round."

3. Commentary: It's Time to Soften the Comprehensive Funding Policy by Bernard Rivers

The Global Fund board looks all set for a difficult discussion about Round 5 next week. What are the factors?

First, precedent: Until the last board meeting, the Fund has always launched a new round of grants every second board meeting - that is, every eight months. According to that schedule, the board should have agreed in June to launch Round 5 two months ago. If, at next week's meeting, the board delays Round 5 until some unspecified future time, it will anger many, particularly the 52 countries that the board encouraged to improve and resubmit their Round 4 proposals in the next Round. (Those proposals alone had a 2-year value of $980 m.)

Second, capacity: As quoted in this issue of GFO, the US says "We do not believe the Fund currently has the capacity to support another round of grants", yet Brad Herbert, the Fund's Chief of Operations, says "It's a board decision when and how we initiate a Round 5. But the Secretariat will have no problem implementing it". And in July, Richard Feachem told GFO, "One of the strongest messages to emerge at the Partnership Forum was the urgent need to launch Round 5 immediately following the board meeting in Arusha in November. While recognizing the need for financial prudence, I fully support this call."

Third, money: The Fund calculates that if pledges for 2005 are approximately what they will be for 2004, there will be about $400 m. available for Round 5 grants next year (significantly less than the Round 4 cost of about $1,000 m.). That's true. But a continuation of those assumptions into 2006 shows that the Fund will then be $1,100 m. short of cash in 2006, because the cost of renewing Round 1-4 grants really escalates that year.


However, all this assumes that the Fund continues to follow its current financial rules, known as the Comprehensive Funding Policy. This policy says that before a 2-year (Phase 1) or a 3-year (Phase 2) grant agreement is signed, the Fund must put the entire cost in the bank, and that money cannot be used for any other purpose. The money then sits idle for up to 3.5 years.


The Comprehensive Funding Policy is a conservative approach that was perfectly appropriate when the Fund was new. But the Fund is now approaching its third birthday, and it's now both possible and appropriate to soften the policy. ...

[Bernard Rivers ( is Executive Director of Aidspan and Editor of its GFO. He will attend the Global Fund board meeting next week as an observer.]

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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