28 Mar 2017

The Next Global Fund Executive Director: The Qualities We Will Look For

Recently, the Global Fund Board announced that the organization will restart its search for an Executive Director (ED), leaving those of us in the global health community to wonder what kind of leader the Global Fund needs for the next four to six years. This global institution has been influential on many levels and credited for its success in bringing big donor countries, implementers, civil society and communities together to sustain and save lives. This begs the question, what sort of leader can ensure the organization maintains these gains while also improving the Global Fund’s impact on the ground?

We are obviously entering troubling times, and it’s difficult to predict what sort of world we will be living in a decade from now. The rising conservatism and populism agendas in the West are no longer jokes we hear in activist gatherings; they are now difficult realities in many developed countries that have historically pioneered the global fight for public health. The same donor countries that used to be champions of human rights, defended key populations and provided the bulk of global health financing are poised to radically backtrack on their commitments.

On the other side of the world, countries receiving Global Fund grants have witnessed mixed progress in their work on the three diseases. Some countries have managed to improve their health responses, governments slowly recognizing the importance of human rights and community involvement. While those of us in the activist community often find this progress as slow as the speed of a turtle, at least some countries are heading in the right direction. However, other countries have taken an abrupt U-turn in their work and literally decided to wage wars against the poor, kill drug users, alienate sex workers, hunt MSM groups and further drive communities and key populations underground, cutting them off from health services.

While it is unfair to expect that a single person will resolve all these problems, many of which are manifestations of the planet’s growing inequality and the swell of xenophobic populism, we can still expect the new Global Fund ED to shape the organization into an organization that we, the communities, need. So, the question remains: what are the leadership qualities we are looking for, bearing in mind that the Global Fund’s upcoming leadership transition may involve not only the Executive Director, but also some of the senior staff as well?

First, the Global Fund’s ED should demonstrate an unshakeable commitment to human rights and key population issues. Nothing is more important in this changing global political landscape, where the organization’s biggest donor on human rights closed their borders to people fleeing conflict and violence. The work on human rights and key population issues in the Global Fund needs to focus on two levels. One is how to translate all the nice slogans and human rights principles into operations, where these lofty words often fail to become concrete grant components and programs. The Fund needs a leadership team that fully understands how to reflect “no one left behind” throughout its funding model, mainstreaming this into grant management, the broader M&E framework and all other operational components. The second level is the political and public sphere – where the ED works with the Global Fund Board to ensure human rights and key populations are reflected in the strategy, advocates with donors to make sure that the intersections between human rights and public health are captured in their priorities, and collaborates with technical partners and other global stakeholders to steer the global dialogue in the right direction –promoting and protecting the human rights of all for years ahead.

Second, the Global Fund needs to maintain its global relevance through improving its ability to go where the issues are and where communities need them to be. This speaks to the Global Fund’s present struggle. The current on-going replenishment has been largely celebrated as a success; however in reality it far from filling the funding gap towards ending AIDS, TB and malaria. A shrinking funding pool coupled with donors’ continued insistence for reduced investments in middle-income countries (and the Global Fund’s continued deference to these funders) makes it difficult to address the health issues of 70% of people living with HIV, all of whom reside in middle-income countries. While the Global Fund has made solid progress in creating responsible transitions away from its funding and working on sustainability, it needs a leadership team that fully acknowledges that donor disinvestment on middle-income countries is not just some technical issue around disease burden metrics and country economy classifications. It needs leaders that recognize that declining funding is primarily a matter of weakening political commitment; the mis-prioritization of resources and the failure of leaders to build and maintain global solidarities. It needs leaders that exercise bold and courageous leadership to fight for what is right; crafting their own resistance music and not just dancing to the tunes played by wealthy countries.

Third, we need a Global Fund that can make sure that available resources are focused to benefit and reach those who are directly affected by the three diseases. The Global Fund is often under pressure from its donors to make sure grants are not being misused or mismanaged, and these pressures created a risk-conscious organization. A risk-conscious organization is, in general, a good thing. However, the Global Fund’s risk management often only focuses on one dimension: financial risk. Anyone who has ever managed a Global Fund grant understands that mitigating financial risk consumes a significant amount of time, especially when you are handling country or regional grants. There are multiple layers of processes, protocols, and requirements. Each of these requires time, energy and of course, money: the same money that is intended to benefit affected communities. But this approach neglects the risks associated with poor program quality and the failure of some programs to benefit people’s health – putting the Global Fund at risk of not achieving its primary mission. It is not an “either or” situation: the Global Fund can change to still make sure grants are managed appropriately while also ensuring that its money is supporting high-quality programs.

On the other hand, misuse of funds or poor programs are not the only issues that prevent communities from fully benefiting from the Fund. Some countries cannot use the resources that have been allocated to them due to absorption capacity issues and bottlenecks. Both of these problems mean that communities cannot access most of their allotted resources because funds either have to go through middlemen that absorb a hefty chunk of the money through salaries and “grant management” fees; or funds are deposited in an account where they remain unused for significant periods of time because Principal Recipients and Sub Recipients don’t know what to do with the money. The Global Fund’s next leaders should focus on how to make sure that risk management focuses on the risks for the Fund’s primary beneficiaries and work upwards from there, instead of the current top-down approach to risk management.

The Global Fund’s current leadership team has made good progresses on all three areas mentioned above, and special thanks is due to the outgoing ED Mark Dybul for his commitment to human rights, communities and key population issues. We applaud that the Global Fund Board made a bold decision to restart the ED recruitment after acknowledging significant weakness in the previous process, and welcome Marijke Wijnroks as the Interim Executive Director, who we believe will support a smooth transition. In a time of global political turmoil, the Global Fund needs more bold decisions and actions in order for it to continue benefit communities around the world, wherever and however they live.


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