As the Global Fund to Fight AIDS, Tuberculosis and Malaria gears up for its next replenishment meeting, the body’s leadership reflects some big changes. Among these are the axing of the Fund’s inspector general, John Parsons, and the appointment of Mark Dybul, previously of the US President's Emergency Plan for AIDS Relief (PEPFAR), as executive director.
IRIN/PlusNews offers a run-down of these latest changes:
1. Mark Dybul becomes executive director
After months of headhunting and interviews, the Fund has finally appointed its third executive director, Mark Dybul. Previous executive director Michel Kazachkine resigned in March 2012, after the Fund came under scrutiny following reports of grant misuse by recipient countries.
Dybul, a medical doctor specializing in immunology, became an expert on AIDS as a clinician, a scientist and an administrator of PEPFAR. Dybul currently co-directs the Global Health Law Program at Georgetown University, and sits on the advisory boards of Malaria No More, the Elizabeth Glaser Pediatric AIDS Foundation, the Children’s Investment Fund Foundation and the Global Business Coalition for Health, according to a Global Fund statement.
International humanitarian organization Médecins Sans Frontières (MSF) has already called on Dybul to make the approval of new grants his first order of business. Countries have not received new grants - aside from stopgap funding under the Fund’s Transitional Funding Mechanism - since the Fund was left cash-strapped in 2011, in part due to the grant-misuse scandal.
Dybul will serve a four-year term beginning in early February 2013.
2. The Fund will immediately transition to a new funding model
The Fund has announced it will transition to a new funding model, which it adopted in principle in September 2012, before the end of the year. Only countries with the highest needs or facing the biggest gaps in funding over the next year, risking service disruption, will initially be invited to apply for funding.
Under the new system, the Fund will moving away from its traditional "round" system, in which countries were periodically invited to apply for grants. Instead, they will have the flexibility to align Global Fund funding cycles with national planning. Grant applications will begin with a concept note, which the Fund will rework with countries to ensure proposals are sound. This should reduce delays in implementation further down the line, according to Fund officials.
The Fund has also released more details on a plan to divide recipients into country "bands" based on disease burden and ability to pay. The Fund has announced that ability to pay will be determined by gross national income per capita - a measurement also used by the GAVI Alliance to determine eligibility.
There will be four bands, including one devoted to higher-income countries with lower disease burdens, such as Russia. These countries will be able to apply for funding for the most-at-risk populations, including injecting drug users and men who have sex with men.
In about a year, the Fund’s Strategy, Investment and Impact Committee plans to release a formula for estimating disease burden and financial demand across all three disease.
|The Global Fund adopts new funding model|
|A timeline of Global Fund reforms|
|Global Fund shake-up signals new direction|
3. The Fund will integrate the Affordable Medicines Facility - malaria (AMFm) into core Global Fund grant management
The AMFm is a financing mechanism aimed at improving access to the gold standard of malaria treatment, artemisinin-based combination therapies (ACTs), through negotiated price reductions, subsidies and Global Fund support.
Independent evaluations have found that the initiative has increased availability and driven down costs of ACTs. Evaluations, however, did not determine whether the project reduced malaria incidence or related deaths.
AMFm will now be incorporated into the Fund’s grant management.
4. The Fund terminates embattled inspector general John Parsons for “unsatisfactory” performance
Parsons' Office of the Inspector General (OIG) was tasked with investigating fraud and misuse. The board’s decision to terminate Parsons comes after a performance review, an independent external peer review, and a report to the board by the Audit and Ethics Committee, according to the Fund.
The Fund will appoint an interim inspector general as it embarks on a six-month search for Parson’s permanent replacement.
In early 2011, news reports highlighted corruption among grant recipients after the OIG released audits detailing misuse. Though this kind of misuse frequently plagues major aid agencies, several donors nevertheless withheld funding. Parsons subsequently came under fire from Fund staff and board members.
The Fund’s high-level review in late 2011 expressed concern that the OIG’s “strongly worded” reports were becoming a liability. The review suggested that the OIG should report audit outcomes first to the executive director. It also recommended clearly outlining how and when reports should be communicated to the board, external parties and staff.