Fighting corruption, at a cost

Ashaiman Health Clinic site visit in Ghana

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.