World attention has been trained on the Occupy movement that has challenged the “one percent” of the global population that exercises disproportionate influence on economic and social policy from Lagos to New York. But many activists from the developing world — the biggest beneficiaries of the Global Fund — are more concerned with the future of the Global Fund as more and more donors desert it.
When the Global Fund was established in 2001 it was heralded as an innovative new institution — the creation of a movement that was coalescing around the idea that poor people need not die of preventable and treatable diseases simply because they happen to have been born on the wrong side of the planet or on the wrong side of town. Indeed, many thought that is was as close to an activist entity as was possible for an international body because it was created as a response to three devastating and somewhat interconnected epidemics, which had economic and social inequality as their common denominator.
The Global Fund promised the world that it would not become yet another bureaucracy staffed by grey men in grey suits. Instead, it pulled together a diverse staff of smart young management consultants; people living with HIV and Aids who had battle scars from years of activism; committed health workers with extensive public health experience; and economists and lawyers who had cut their teeth on drug company lawsuits that forced the prices of medicines down.
Together they represented a super-charged force, convinced that if they worked hard enough to demonstrate impact they would continue to raise resources for the hopelessly under-funded global response to Aids, TB and malaria.
And while the Global Fund was championed by activists, it was also embraced by the governments of poor nations. After years of structural adjustment programmes, the health systems of many developing countries — especially African countries — had been ravaged, with 30-50% vacancy rates, threadbare dispensaries and queues that seemed to never end.
Most importantly, the Global Fund represented a remarkable new system of funding, which encouraged collaboration between states and civil society organisations, and insisted that science rather than morality and politics should drive the agenda for resourcing national Aids programmes. So governments that had been reticent about extending Aids drugs to sex workers, gay men and refugees were forced to acknowledge that these populations have a right to services. And even if communities voted for the “wrong” political party, they would still receive insecticide-treated bed-nets to curb the deadly threat of malaria.
The governance structure of the Global Fund board is as innovative as its approach to funding. It comprises donors, communities of people affected by the diseases, civil society organisations from developed and developing countries, and governments. Each group has an equal vote, the right to table issues, and the power to hold the executive management of the Global Fund to account.
And yet today, despite the Global Fund’s track record of managing its funds well, demonstrating impact and acting swiftly to deal with corruption, donors have cited “bad governance” — as is the case with Zimbabwe — as an excuse for withholding further commitments. Others have blamed the global financial crisis.
The irony of this has not been lost on activists who deal with the drivers of Aids, TB and malaria on a daily basis. In the last two years, the Global Fund’s biggest donors — the US and the UK — have been able to bail out badly managed banks and other lending institutions, despite overwhelming evidence of unethical behaviour, abuse of power and “bad governance” by senior management. Furthermore, as the economist Jeffrey Sachs has pointed out, the US defence budget amounts to US$1,9 billion a day — just three days of that would plug the gap facing the Global Fund.
The reality is that the Global Fund — and I suspect, other development aid programmes — will bear the brunt of the rage of Western publics, incensed that good money has been thrown after bad to bail out large banks and then to save the eurozone, which irresponsible countries have brought to its knees.
If aid budgets are cut, and financing mechanisms as effective and innovative as the Global Fund are trimmed, the “one percent” will have much more to worry about than the Occupy movements. In the long run, if they insist on being penny wise and pound foolish, donor countries may contribute to outbreaks of more virulent strains of HIV and TB than they ever imagined possible. And like the economic contagion that has spread throughout Europe, these epidemics will have little respect for national borders.
In the end, rich or poor, we all lose if the Global Fund is not supported to live up to its full potential.
Sisonke Msimang is Executive Director of the Open Society Initiative for Southern Africa (Osisa).