Q: When do you officially start work as Executive Director of the Global Fund?

A: Monday July 15.

Q: How many professional staff will the Fund have, and by when?

A: Not more than 50, and as quickly as possible.

Q: How many of these staff will be involved in fundraising?

A: I don’t have an exact answer to that. We are appointing a senior person on the resource mobilization front. She or he will gather a small group around him or her – a few. We may also contract out some services related to fundraising.

Q: What will the Fund do, and when, to proactively seek contributions?

A: The Fund is already proactively seeking contributions. The business of raising large amounts of additional money for the Fund is extremely important business, and it’s business for right now. So we are putting out the message concerning our need for substantial amounts of additional funding. One of my purposes of being here in Barcelona is to make that call, and I’ll be making that call very clearly in my remarks at 12:30 tomorrow and in a press release that accompanies that. The other thing specifically that we will do, and that I will commit to in my speech tomorrow, is to construct between now and our October board meeting a detailed financial plan (which as of the moment we don’t have), which will be approved by our board in October, and which will specify out into the future in a lot more detail what our expectations are on the disbursement side and therefore what our requirements are on the revenue side.

Q: Does this mean the Fund will set fundraising goals?

A: It will.

Q: And will these be published?

A: They will, once they’ve been set and approved by our board. It’s extremely important that our board have ownership of our fundraising goals. If I go out and say it’s X billion and the board says “Well, we don’t agree”, then we don’t have a consolidated front.

Q: So conversely, when they have agreed, you can say “I’m instructed by my board to seek this level of funding”?

A: Exactly. We need a very strong consolidated front. And don’t forget that on my board are seven of our major donors.

Q: So, to be concrete: As of the end of the October board meeting, unless something has gone wrong, there will be fundraising goals, which will be made known.?

A: Absolutely. But between now and then, the pressure for substantially increased funding will be on, because whether our fundraising goal is $5 billion, $6 billion, or $7 billion, we know we haven’t got anything close to that right now, so we need a lot more money. So that message is already out there.

Q: Will the Fund’s proactive fundraising work only be directed at governments, or also at corporations, foundations, wealthy individuals, and members of the public – that’s four things?

A: Corporations – certainly yes. We do not have, today, significant contributions from the corporate sector. We were promised them, in the origins and the genesis of the Global Fund, and they haven’t been forthcoming. So we need to get them – that needs to turn into a reality.

Foundations – yes, with a caveat. We do have one major foundation strongly at the table, with $100 million. With other foundations, our message may be “Contribute to the Global Fund if you like, but if you would prefer, invest in things which are synergistic to what we do, in order to lever the value of our investments.” Now that’s a different message for foundations, one that they will find easier to respond to, and it assists us to get to where we want to get to.

Q: Can I put an example on the table, and you tell me if that is the sort of thing you were thinking about? Technical assistance…

A: Precisely

Q: …to entities that are wanting to put together proposals…

A: Precisely. And let me give you another example. Operational research, to better measure the effectiveness and pros and cons of the particular strategies that we’re investing in, and to improve the quality of the next round of applications – operational research that we may invest in, but it would probably be better if others invested in it parallel to us. And there are other examples. The manpower area is a crucial example. So this may be a way to go forward with foundations which will liberate substantial amounts of money for the same good end or cause, but be through routes other than direct contributions to the Global Fund.

Q: So there could be a synergy, with the Global Fund putting X amount into a country’s coordinated plan, and a foundation putting some other sum into some other activity in that country, as a result of which good things happen?

A: Precisely.

Q: And wealthy individuals, and the general public?

A: I don’t have an answer right now to either of those. The answer is Possibly. That’s a fundraising strategy that we have to give more thought to. Wealthy individuals are always of interest in any enterprise of this kind, and sometimes the dividing line between a wealthy individual and a foundation is a fine dividing line, with the new foundations. The general public is a whole other ballgame, as you’re well aware. Whether it’s a game that we would want to get into, or the board would want to get into, I just don’t know. I know there are some voices on the board saying Yes, others saying Not Sure, so we’ll see.

Q: Many donors do not want to give money to the Fund until it has proved that the donations will be used effectively, yet the Fund can’t prove effectiveness for between one and five years, depending on how you define “effectiveness”. How will you resolve this problem?

A: By defining “effectiveness” as something that really starts on Monday July 15. Effectiveness ranges from the obvious five year point of mortality decline robustly measured, right up to things that could happen on Tuesday July 16, in terms of demonstrating that we are putting in place an effective and businesslike organization, that management is in good shape, that systems are being created which build confidence and which are solid and robust against any kind of scrutiny. I think you could put all of that also in the category of performance. To put it another way, by the October board meeting, with the interim Secretariat developed very substantially, with a number of important policy issues either resolved or crystallized for resolution by the board, with the permanent Secretariat either recruited or substantially recruited, that’s all demonstration of results and good progress of exactly the kind that board members and donors are looking for. So mortality decline is where we’re heading, but it’s not by any means the only thing that donors are interested in. I’d go further, and say that some donors in some wealthy countries are as interested in new ways of conducting the business of Official Development Assistance as they are in making a difference to HIV/AIDS, TB and malaria – which brings me back to my managerial progress, my systems progress – that would be very confidence-building, if we do novel things, get them up and running, and people like them.

Q: I was informed by the Fund Secretariat that “45% of the funds approved in the first round are for products and commodities, including essential medicines such as antiretrovirals.” In a future round, would the Fund be willing, if asked, to purchase these on behalf of the grant recipients, in order to obtain economies of scale?

A: We have a Procurement Working Group looking at a whole range of issues, for a report to the October board meeting.

Q: You mean a range of possibilities?

A: A range of possibilities, of policy options. Anil [Soni] is the Secretariat member responsible for this line of work. In that policy document to the October board will be a discussion of exactly the question that you’ve just raised. I do not know what the answer will be, but clearly we have options there.

Q: If countries wanted to purchase additional products and commodities, using funds they had obtained from other sources, would the Fund permit its bulk procurement facility (if established) to be used for this?

A: If the Fund were to establish a bulk procurement facility – that’s a big If, clearly, bearing in mind particularly that there are other ways to go in bulk procurement. For example, to help a group of countries themselves to create a regional bulk procurement – as SADC are trying to do, wanting to do, but haven’t yet managed to find a way to do. If the Fund established – and again, Unicef has a bulk procurement facility, I mean, there are many reasons why …

Q: Then, if the Fund established one or established a relationship with an existing one?

A: Better put, right. Would we be happy to then operate on behalf of others in the procurement business? I wouldn’t close that door. No, it’s certainly not, to me, beyond the pale, no.

Q: If the Fund Secretariat were to privately conclude that the CCM in country X is little more than an extension of the government, with only nominal representation from other sectors – e.g. a couple of pet NGOs included, but a number of other clearly highly significant NGOs being very clearly excluded – what would the Fund do?

A: Well, let me give you my preference, and say that I hope that this would be a board consensus, but I don’t know that it would be a board consensus: If we came across a CCM that had the features that you’ve just described, my preference would be not to provide funds to that CCM. I think that to make the CCMs meaningful, we have to set some minimum standards. And if we’re going to set some minimum standards, we should stick to them, otherwise there’s no point in having them.

Now, my caveat on that is that countries are truly different. And we have to balance that with a respect, an appropriate respect, for country differences and country autonomy. So, I can imagine a wide spectrum, from a country where the strongest involvement by civil society is entirely consistent with how they conduct their affairs anyway, and it’s a natural way of doing business in that capital city, to a country where the whole idea of the CCM with any non-governmental organization sitting at the table is entirely strange, and even to get a couple of token NGOs around the table requires a major effort and is something really new. Now, I think we have to be attuned to the genuine differences among countries, and if we found – to construct a hypothetical case – a country which naturally would not be disposed to have anything like a CCM, [but] in order to be in a business relationship with the Global Fund, creates a CCM with some NGO representation – not ideal, not what we would hope for in the longer term, but a major step in the right direction. It might be appropriate for the Global Fund to say that that for now is OK, and we will fund good proposals coming through that CCM.

Q: I guess what it boils down to is this: Can you imagine a situation where proposals are rejected because the CCM just is not good enough?

A: I can imagine such a situation.

Q: Can you imagine a situation where the CCM looks pretty good, the proposal looks pretty good, but you have reason to suspect that your tens of millions would never end up actually doing those things specified in the proposal? Or to put it another way: If you were definitely privately nervous that the money would be channelled incorrectly, what would you do about such a situation?

A: Well, we have Local Fund Agents, as you know, so the details of our disbursement arrangements are not yet agreed, but the model that’s on the table includes the Local Fund Agent. If the Local Fund Agent wrote a very damning report on the principal recipient, and said in essence “We don’t think this principal recipient should be a recipient of Global Fund resources,” we would have to take that very seriously, otherwise, why would we have a Local Fund Agent?

Q: The Fund has a section at its web site that provides information regarding how to contact CCMs. However, sometimes the address is no more detailed than “Ministry of Health, Capital City X”, and sometimes the contact information is no more detailed than “John Smith, Prime Minister”. In such situations, it will be very hard for uninvited NGOs to ask to become part of the CCM, or to ask to have their programs be incorporated in the proposal. Will the Fund become more proactive in obtaining, and posting, two things: One is full contact data for someone other than the chair of the CCM, and the other is the entire membership list of the CCM?

A: Yes. I mentioned earlier minimum standards for CCMs, which we should stick to. It would be my assumption that minimum standards should include all information necessary to make the CCM transparent. That would include how do you contact it, and who is on it. We would absolutely intend to do that.

Q: Lastly, a personal perspective, rather than anything on behalf of the Fund: What excites you most about your new job?

A: What is most exciting about the Global Fund is that it is, unquestionably, the most important initiative in global health in my professional lifetime. It is an entirely new structure.

In my professional lifetime, we have seen lots of tinkering with existing structures, and those tinkerings have sometimes looked substantial to those involved in them, but if you stand back, they’ve been pretty minor. And some of them have made a small difference, and some have made no difference at all. And the overall record, as documented by this increasing aid-effectiveness literature coming from David Dollar and others, is not very good.

But here, we have a fundamentally different instrument being created, to transfer resources from those who have them to those who need them. Focussed on three diseases (which is a good idea, to have that focus initially), but is structured quite unlike anything which we’ve tried before. It’s very bold, it’s been very rapidly dreamt up and put in place, and a lot hinges on it success – far more than the future of HIV, TB and malaria. The future of investment in global health rides on its success. And I think to a considerable degree, future attitudes towards ODA, towards official development assistance, and towards ways of transferring resources from the North to the South, rest on its success. And I believe that the Fund’s achievements in innovating in the ways that we do business will be seen historically as being as important as our achievements in reducing the burden of these three diseases. And in fact they go hand in hand – success in one will generate success in the other. So I think it’s a matter of momentous importance, and I think that’s the big excitement.

Q: And what is the greatest challenge of your job?

A: I think the greatest challenge lies in the area of pioneering these new methods of getting money quickly to the front line in a way that is firstly accountable, so the mis-use of funds is clearly not taking place. And secondly, where the indicators of success are being measured and quickly feeding back to us evidence that the money is buying what it should have been buying and the world is becoming a slightly better place because of those investments. I think it’s seeing that, working rapidly, which is the biggest challenge. And if that does work rapidly and is seen to work rapidly, everything else will follow.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team