Funded by the Global Fund through financial support from Product (RED), Tema Hospital cares for 2,200 people living with HIV. We recently visited their facility again –- their work never ceases to amaze me. The Global Fund make it possible for the hospital to provide ARV treatment and PMTCT (prevention of mother-to-child-transmission). Thanks to these interventions, only 4 percent of babies at Tema with HIV-positive mothers are born with the virus.

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When I was ten, I was busy doing important things like mastering long division, practicing softball and rocking the plastic glasses/bowl cut combo. While I’m proud of those accomplishments, I have to say I’m even more proud today to honor all the incredible things that the Global Fund to Fight AIDS, Tuberculosis and Malaria has achieved in its first ten years of existence. To understand the Global Fund’s impact, it’s important to remember just how bad things were before it existed: Fewer than 50,000 Africans had access to AIDS treatment. Malaria was killing nearly 1 million people annually. Treating TB was considered too expensive for most of the developing world.

In late January of 2002, leaders came together in Switzerland to launch the Global Fund. Built to be what Kofi Annan called a “war chest” to respond to these global health emergencies, it had the backing of donors, public health officials, developing country leaders and NGOs. Intentionally, it was designed to be different than other aid models; it was rooted in having local stakeholders (rather than donors) say what they wanted to do to fight AIDS, TB or malaria, and how much money it would take to get the job done.

Though no aid model is perfect, the Global Fund has clearly been doing something right, because it has delivered incredible results over the last decade:

In delivering these services — often in partnership with aid efforts including PEPFAR and with national health systems — the Global Fund has helped change the global health landscape. Though they each still claim far too many lives, all three diseases are all on the decline globally. Now, the mantra has shifted from a “stop the bleeding” approach to a more hopeful, long term approach characterized by phrases like “we can achieve the beginning of the end of AIDS” and “we know how to end malaria deaths by 2015.” And, just as my own personal style has thankfully evolved from those outdated plastic glasses to contact lenses, the Global Fund has gone through its own strategic reforms in the last 12 months to become an even more targeted, efficient mechanism in the years to come.

Funding — as always — remains a challenge. The Global Fund has said it is currently unable to fund new programs until 2014 due to a roughly $2 billion funding gap. Constricting global budgets, coupled with persistent whispers of corruption, are convenient excuses for donors to pull back on their contributions to these diseases. But the Global Fund has made the changes necessary to ensure that money invested in its programs will be monitored transparently, evaluated rigorously and directed toward specific outcomes. As a result, donors should feel confident that maintaining or increasing their contributions will go toward the achievement of bold new goals: saving 10 million lives and preventing 140 to 180 million new infections between 2012 and 2016.

Of all the aid projects I’ve been able to visit, the one individual who stands out most is a playful little girl named Madeline who I met at a Global Fund clinic in Ghana. She was born HIV-positive, but thanks to the Global Fund, her mother was able to access the antiretroviral treatment that will keep her alive and healthy. I get that 10 million lives saved through the Global Fund seems too overwhelming to conceptualize. So instead, I’d suggest we simply think of Madeline, and then think of all the other Madelines out there who, thanks to the Global Fund, will be able to grow up healthy and one day also master long division and practice softball like me. I just hope they all skip the bowl cuts!

On a plot of land about the size of a football field sit two yellow-and-white structures. The small building (pictured at top) is a tuberculosis “clinic” responsible for serving the 2 million people who live in Huaycán, a township of Lima that has the second-highest TB prevalence rate in Peru.

A new TB Excellence Center (pictured at bottom), financed in large part by the Global Fund to Fight AIDS, Tuberculosis and Malaria, sits just yards away. The center is already treating nearly 50 patients and is scheduled to open in full soon, providing treatment and care with modern equipment and proper ventilation.

Especially important are the center’s facilities for those infected with multidrug-resistant (MDR) and extremely drug-resistant (XDR) strains of TB. Without rooms available for quarantine, doctors and nurses in Huaycán have had no choice but to send the most highly contagious back into the community, where overcrowded housing increases the risk of patients’ passing TB along to their families and neighbors.

The recent 2011 report on TB control from the World Health Organization shows that, for the first time in two decades, the number of new cases of TB is dropping, with particular progress made in Latin America. These strides are thanks in large part to the many TB Excellence Centers supported by the Global Fund and others. But resistant strains in particular present a unique threat -– one that will only heighten if the world becomes complacent about anti-TB efforts.

The new building in Huaycán offers more than just increased capacity and adequate technology to guard against the transmission of MDR and XDR-TB -– it offers a dignified space where patients can be treated as individuals. “Norms say we should assign a number,” says nurse Victoria Zegarra. “We believe people aren’t numbers, so we keep their names on file. People don’t like to say that they are ‘Patient 18.’”

The dedicated nurses can enjoy their share of dignity, as well. “This is like a palace for us,” Victoria says of the new facility. “It makes us proud to come to work.”

At the recent UN High Level Meeting on AIDS, world leaders made a critical step in the right direction with the launch of a global plan to eliminate new HIV infections among children by 2015 and to keep their mothers alive. Last fall, ONE members tirelessly advocated for the Global Fund during our “No Child Born with HIV” campaign, and we’re pleased that this plan will help us work towards turning that goal into reality.

Tremendous gains have been made in recent years in reducing HIV infections among children and scaling up the prevention of mother-to-child transmission (PMTCT) of HIV, yet much work remains. In 2009, an estimated 370,000 new infections occurred among children, primarily in sub-Saharan Africa. The global strategy identifies two top goals: to reduce the number of new infections among children by 90 percent and reduce the number of AIDS-related maternal deaths by 50 percent. Under the plan, resources will be channeled to 22 priority countries, where nearly all HIV-positive pregnant women live.

The global plan identifies a four-prong framework for achieving these goals: preventing HIV among women of reproductive age through services related to reproductive health such as postpartum care; providing appropriate counseling and support to women living with HIV; ensuring HIV testing, counseling and access to treatment for pregnant women living with HIV; and HIV care, treatment and support for women and children living with HIV and their families.

We’re pleased to see that the global plan puts accountability at the helm and recognizes the critical importance of an integrated approach that connects an array of maternal and child health services across the health system. Additionally, the plan identifies the need for countries to be at the lead by providing political leadership, funding, effective strategies and strong monitoring and evaluation. While we applaud the effort to create this strategy, a plan is only so strong in so far as it has concerted political support and funding. Moving forward, if we hope to ensure no child is born with HIV by 2015, we need to see the following:

In answering the call to action at the launch of the plan, the United States President’s Emergency Plan for AIDS Relief announced an additional $75 million to prevention of mother-to-child transmission of HIV efforts. Additionally, private donors — including the Bill & Melinda Gates Foundation — pledged $40 million, Chevron pledged $20 million and Johnson & Johnson pledged $15 million.

During the high-level meeting, Ambassador Eric Goosby, the United States Global AIDS coordinator, summed up the need for this critically important plan: “Nearly every minute a child is born with HIV. Working together, we can reverse this tide as we have done in the United States and they are very close to doing in Botswana. Preventing new HIV infections among children across the globe is truly a smart investment that saves lives and helps to give children a healthy start in life.”

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Last week, the Global Fund board of directors met to review a range of issues, the most pressing of which was answering concerns about reports by its Office of Inspector General (OIG) of the theft of money or drugs from Global Fund grants.

It’s an important discussion, but it can also be deflating. Donors are demanding action and threatening reduced funding. So, ONE and other advocacy groups do our best to provide facts and context, knowing that the scale of the problem is much smaller than the political response. At the same time, we’re all appalled. Stealing from the Global Fund is robbing innocent people of the medicines they need to stay alive; put bluntly, here theft is murder.. We also applaud the Global Fund’s work to discover misuse of funding, prosecute the thieves and recover the money.

This back and forth occupied a lot of last week’s board meeting, along with a delicate discussion on how to support the Office of the Inspector General to find this corruption while at the same time set up more clear expectations that information provided is accurate and appropriately contextualized.

This last bit –- supporting the work and independence of the OIG while also ensuring accountability and oversight – is the toughest part for the board. Donor representatives struggle to deal with it — who wants to be seen as soft on corruption or restraining the Inspector General? Implementing country representatives are also noticeably quiet, all too aware that their grants could be next on the audit list.

So, it’s left to a few from civil society and the private sector to ask the tougher questions, and here are a few:

1. How much should the Global Fund spend to find corruption? Is it worth it to spend $10 million to find $2 million that’s misspent?

2. What’s the hidden cost of all this hysteria? Are the Global Fund’s grant management staff going to shy away from being flexible with countries, as is often needed to increase grant impact? Are countries going to follow their original grant agreements robotically, even when they see a better way that might require changes and negotiations?

3. How does zero tolerance for corruption not become zero tolerance for risk? If the Global Fund can’t take risks, how can it ever hope to succeed in fighting three raging epidemics in some of the poorest countries in the world?

To help provide guidance, the Board agreed to conscript a high-level panel, led by former US Health Secretary Mike Leavitt and former Botswana President Festus Mogae. Its budget? More than $2 million. That’s likely to be money well spent, if only to assuage donor concerns that the Global Fund is awash in corruption and to elicit some smart recommendations for improving oversight. But $2 million could also be spent in other ways. It’s AIDS treatment for 4,000 for a year. It’s 130,000 bed nets to protect children and mothers from malaria. It’s tuberculosis treatment for 10,000 people.

Let’s remember that responding to all the news and concern about the Global Fund, and providing reassurance to those who decide on its funding (often with surprisingly little accurate information) come at a real cost, both financial and human. The Global Fund was established a decade ago to help raise and speed funding to the poorest countries to help save the lives of millions who would otherwise perish. That mission is as important today as it was 10 years ago, and so failure of the Global Fund is not an option. Our best path forward is to look for opportunities to improve grant oversight without immobilizing progress, to extinguish misinformation with facts, and most importantly, to carry on the most difficult work of the Global Fund: saving lives.

Here’s an excerpt of his piece:

“Opponents of foreign aid like to paint it as wasted money that does nothing good for America. The fact is, foreign aid is working. Look at the countries of Africa, for instance; they have some of the fastest growing economies in the world. One reason is because of the work of groups like the Global Fund, because good health is a foundation of economic development.

Denying the Global Fund support because of its efforts to uncover and end corruption would be throwing the baby out with the bathwater, though in this case it would literally mean denying millions of babies around the world the lifesaving medicines and care they need to reach their human potential.”

For the full story, go to the Huffington Post’s website.

We’re big supporters of the Global Fund to Fight AIDS, TB, and Malaria here at ONE, with so many of our members helping raise awareness about the great work it’s doing to save lives. Despite fantastic results — providing AIDS treatment for 3 million people, anti-TB treatment for 7.7 million people, and 160 million insecticide-treated bed nets for prevention of malaria – the Global Fund is under attack.

Columnist Mike Gerson has just written an excellent column on this issue that’s published in today’s Washington Post. We encourage you to read it, and share it widely!

We at ONE have been working hard to respond to this wave of negative coverage of the Fund, which is based almost entirely on one initial press report that took incidents in a few countries where funding was misappropriated – incidents caught and identified by the Fund itself! – and twisted them to imply that fraud was widespread. We blogged here on this, joining other allies in trying to get out the facts. It’s been tough, with so many being all too willing to believe the worst.

We’re also pleased to hear that the Global Fund announced today that it is taking some extra measures to increase its vigilance, including an external review of all of its financial safety systems. Those already in place are robust, but this might help assuage the donors. The Global Fund needs to deal with this problem to be sure, but its most important work is to speed resources to countries fighting three raging epidemics and the sooner it can get back to that the better.

Over the weekend, the Associated Press filed a story about corruption involving a small number of grants made by the Global Fund, an international partnership that channels funds to fight AIDS, TB and malaria from donors, like the United States, to some of the poorest countries in the world. It’s always interesting to me when stories create news with misused facts and salacious headlines. So I thought it might be useful to have a little background and perspective from someone who’s spent a lot of time with the Global Fund.

The AP report was correct in saying that the Global Fund’s Inspector General has taken an aggressive approach to rooting out and publicizing incidents of fraud and abuse, but the story erred by extrapolating the findings in a few countries to tarnish the entire grant portfolio. Let’s put this to rest: there is absolutely no evidence that there is widespread fraud or corruption of Fund grants. On the contrary, of the $13 billion disbursed by the Global Fund to date, only a portion has been audited by the Global Fund’s inspector general, and of that only a relatively small amount — US $43 million — has been rescinded.

Now just because the percentage of grants found to be misused is relatively small doesn’t mean it’s okay — just the opposite. That’s still a lot of money, and it should piss off anyone who cares about the world’s poorest. We should not rest until all taxpayer supported programs can report no misuse of funds — including those administered right here at home.

While I was thinking about this over my morning coffee, I spied a New York Times front-page article that started, “Since the government took over Fannie Mae and Freddie Mac, taxpayers have spent more than $160 million defending the mortgage finance companies and their former top executives in civil lawsuits accusing them of fraud.” Now I’m willing to bet that all those gloating over the Global Fund stories won’t get nearly so exercised about this kind of pervasive corruption.

I also don’t want to fall into the trap of denying there are problems. We will undoubtedly hear about other instances of abuse. So I’m thankful that the Global Fund and its partners, especially the countries that desperately need the money, take this all very seriously.

There’s already lots of work underway to continue to make improvements. The Fund is pursuing suspected corruption aggressively, usually in close cooperation with local authorities: corrupt officials are going to jail, funds are being returned, new safeguards are being put in place. At the same time, the Global Fund is working hard to strike a balance, continuing its policy of zero tolerance for corruption while not becoming so risk adverse that it can’t get its job done.

So in the end what’s the conclusion? We should celebrate the openness of the Global Fund, even if the information it provides can be abused. We should fight hard to support programs that improve global health AND governance and transparency — fighting for funds needed to save lives and at the same time to build robust systems and checks and balances needed to guaranty their effective use. And we should feel proud that we’ve helped the Global Fund weather this storm and continue its amazing work to save lives.

Here’s some really cool news — we just caught wind that Rwanda is donating $1 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

According to a press release, Rwanda is the fourth African country to contribute to this year’s replenishment, which has received $11.7 billion in commitments from both the private and public sector for the next three years.

“Even a modest additional investment can save millions of lives, improve overall health of the population, strengthen health systems and provide economic gains through increased productivity of the workforce,” said Paul Kagame, president of Rwanda.

Rwanda has been very active in engaging with the Global Fund and is set to reach its UN Millennium Development Goals targets by 2015. Read more about their Global Fund donation on the Africa News website.