Why Global Fund Reform Paves the Way for Robust Pledges

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Change is hard. It scares people, even those in uncomfortable situations. As I look at the New York skyline, preparing for President Obama's pledge to the Global Fund - a $6 billion pledge over 3 years is imperative - I think about the transformation of this city.

Not long ago, New York was crime-riddled and garbage-ridden. It's not anymore, and the changes have saved lives. Were the methods used to achieve this transformation proper? I'll save that topic for another day. But we do know that the city is cleaner, safer and more prosperous.

A similar transformation is going on at The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The Global Fund is an international financing institution that invests pledges from donor countries to fight disease. In the past, its application and funding process has been opaque, overly technical and unpredictable, in part due to lack of predictable funding from donors and in part due to the learning process. These inconsistencies have weakened the planning and budgeting process in recipient countries.

Last Spring, the Global Fund board announced a series of changes in its funding mechanism, revising prioritization and tweaking eligibility for countries that are not "poor enough" or "sick enough" to deserve significant investment. These reforms were designed to dampen demand so donors could shirk their commitments to fund all technically-sound requests from these countries. But the Global Fund board - seeing strong results from its contributions to maternal and child health - also launched discussions on evolving the organization into a Global Fund for Health MDGs, to match the Millennium Development Goals.

The MDG Summit is the reason I am in New York, representing the Global AIDS Alliance. It has been 10 years since the U.N. pledged eight, specific and targeted goals to end extreme poverty worldwide by 2015. The sixth goal addresses the HIV/AIDS pandemic, and this Summit is a way of taking stock on the U.N.'s progress. It also is where many nations, including the U.S., are expected to make their financial pledge to the Global Fund, which is a key multilateral funding mechanism to meet the MDGs.

My hope is that the more positive reforms embarked upon by the Global Fund - which includes coordination with other funders, such as the World Bank and the Global Alliance for Vaccines & Immunisation (GAVI), and a streamlining of grant processes to reduce transaction costs - will help influence donor countries to maximize their contributions. The reforms, while difficult, demonstrate a real commitment to improvement, and they have been transparent. It is particularly impressive how quickly reform is being implemented. This is saving lives.

Change is difficult, and the Global Fund is to be applauded for efforts. The U.S. pledge to it - which I pray will match its fair share of $6 billion over 3 years - must go to programs that work. These programs are already happening. The Global Fund awards grants to local- and national-level entities that propose specific programs tailored to their needs. That means the Fund can empower these entities to identify, address and solve their own problems.

As Jeffrey Sachs, former director of the U.N. Millennium Project noted in the New York Times on Friday, "When the donor nations have not just talked but have actually pooled their funds to support the national plans of poor countries, the speed of advance has been breathtaking. The Global Fund to Fight AIDS, TB and Malaria is the right model... On their 10th birthday, the Millennium Development Goals offer the world a realistic path to ending extreme poverty."

The global community should start moving more aggressively toward these sorts of solutions. This MDG Summit is a place to advance the discussion. It also is a place to applaud the work of institutions, such as the Global Fund, that understand that money alone is not enough. It must be spent wisely on proven, locally-driven solutions, by organizations that must continue to learn and evolve. That is the only way to meet the Millennium Development Goals in five years.

Dr. Paul Zeitz is executive director of the Global AIDS Alliance

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