1. Why is the The Fund to Fight AIDS being created?
2. Why a new Fund? Why not simply increase investments in current efforts?
3. What are the total current commitments to the Fund? How much more is needed?
4. Have the events of September 11 had an effect on donor commitments to the Fund?
5. What are the major outcomes of the 3rd TWG?
6. What has the process been in designing the Fund?
7. What are the next steps now in terms of setting up the Fund?
8. When will the Fund be able to disburse money?
9. How will the Board be structured?
10. How will the Board make its decisions?
11. Who will be eligible for Fund support?
12. Will NGOs be eligible for Fund support?
13. How will funding decisions be made?
14. How much of the Fund’s resources will go to AIDS, and how much to the other diseases?
15. How much of the Fund’s resources will be spent on prevention vs. care?
16. So what kinds of programs will the Fund support?
17. Will the Fund support the purchase of ARV treatment?
18. Will the fund be able to purchase generic drugs or will it be held to patent protections?
19. When were TB and malaria added to the Fund’s mandate?
20. How will the Fund ensure that it doesn’t duplicate – or compete with – the work of others in the field?
21. Will the Fund address the root causes of these diseases, including poverty, gender disparity, lack of education, and poor nutrition and sanitation?
22. What is the role of UN Secretary-General Kofi Annan in the Fund?
23. To whom will be Fund be accountable?
1. Why is the The Fund to Fight AIDS being created?
The case for more rapid, sustained and concerted action is overwhelming. AIDS has already killed 22 million people in a space of 20 years. In the year 2000, AIDS, TB and malaria together accounted for 10% of all deaths worldwide – nearly 6 million people. These diseases are deepening poverty in the impoverished developing countries. In addition, they have the potential to spread to other parts of the world and fuel conflicts and insecurity. Developing countries cannot reduce the negative social and economic impact of the diseases with current levels of spending. While many effective interventions exist, they are accessible to the few rather than the many. Achieving lasting reductions in the threat of these infections will require an intensive effort over many years, and additional funds over and above resources already pledged or obligated.
2. Why a new Fund? Why not simply increase investments in current efforts?
The idea behind the Fund is to build a global public-private partnership that brings together existing endeavors in a more coherent and accelerated way that will attract, manage and disburse additional resources. It is a novel approach to international health issues with an intense emphasis on public-private partnership, the achievement of results, independent technical validation of proposals, together with efficient processes for utilizing resources. The Fund is not meant to replace current efforts – in fact support for current efforts should also be increased.
The concept for an international funding mechanism to tackle HIV AIDS, TB and malaria began at the Okinawa G8 Summit in July of 2000, and was adopted at the G8 Summit this year in Genoa. It was championed by the UN Secretary-General Kofi Annan, together with many national leaders, at the first UN General Assembly Special Session to focus on AIDS, in June in New York.
3. What are the total current commitments to the Fund? How much more is needed?
Approximately $1.6 billion has been committed to the Fund thus far from industrialized and developing country governments, corporations, foundations, and private individual contributions. A number of these commitments are multiyear, giving the Fund approximately $700 million to disburse in 2002 at this point in time. While far more resources are needed to adequately address HIV AIDS, TB, and malaria, current pledges to the Fund will allow the Board to begin funding programs and demonstrate results. Once the Fund has shown that it is working as planned, it is hoped that current donors will continue and increase their commitments, and that new donors will come to the table. Looking to the future, no financial targets for the Fund have been set.
The figure of $7-10 billion quoted by the UN Secretary-General is an estimate of the total amount of resources required annually to address the HIV AIDS epidemic in low and middle income countries – from all sources including the new Fund, bilateral and other donors and the affected country governments themselves. Current estimates suggest that, similarly, the annual amount of total resources needed to effectively address TB and malaria is about $2 billion.
The Fund has never been envisioned to be the sole source of financial support but a new tool to attract, manage and disburse additional resources. It must be seen as an opportunity to leverage additional financing mechanisms – such as debt relief, governments’ own budgets, health insurance schemes, development loans, private sector contributions and other new financing strategies.
4. Have the events of September 11 had an effect on donor commitments to the Fund?
This appears not to be the case. In the past few months, world leaders have continued to express their commitment and reconfirmed their financial pledges to the Fund. Now that we have a fund structure, the World Bank – as the Fund’s fiduciary agent – will be actively following up with donors to turn the pledges into cash in the bank.
5. What are the major outcomes of the 3rd TWG?
Composition of the Board. Some of the constituencies have already selected their representatives: Currently known Board Members are the EC, France, Italy, Japan, Sweden, the United Kingdom, and the United States (representing donor countries); the Gates Foundation (representing foundations); Uganda (representing Eastern and Southern Africa); and Brazil (representing Latin America and the Caribbean). Other seats will be selected in time for the Board meeting in January.
Legal status. The Fund will be created as an independent legal entity to ensure autonomy and flexibility.
Fiduciary. The Fund finances will be entrusted to the World Bank, which will have primary responsibility for financial accountability, including collection, investment and management of funds, disbursement of funds to countries and programs, and financial reporting to stakeholders.
Location of the Secretariat. The Secretariat will be located in Geneva in order to benefit from the technical expertise of relevant UN agencies, such as WHO and UNAIDS. However, to ensure total independence, the Fund will have its own offices and not be housed within one of the UN organizations. The process to recruit an executive head is being initiated.
6. What has the process been in designing the Fund?
A Transitional Working Group (TWG), a group of nearly 40 representatives of developing countries, donor countries, NGOs, the private sector, and the UN system, was formed in order to transform the idea into reality. Over the past few months, the TWG has engaged in negotiations to design basic guidelines concerning the Fund’s operations, such as legal status, management structure, financial systems and general eligibility criteria. In January the Board will review the TWG’s recommendations, make refinements as needed, and adopt a framework document. The process has involved three meetings of the TWG, regional consultation meetings in Africa, Asia, Latin America and Eastern Europe, and thematic consultations among NGOs/civil society, the private sector and academia. The process has been facilitated by a technical support secretariat (TSS), located in Brussels.
7. What are the next steps now in terms of setting up the Fund?
A sub-group of the TWG will work with a few remaining TSS staff to prepare for the first Board meeting that will take place in Geneva on January 28 and 29. The Board will then set up an interim Secretariat, which will support the process until recruitment for the permanent Secretariat is finished. The process to recruit an executive head of the Secretariat has been initiated.
8. When will the Fund be able to disburse money?
It is hoped that the first call for proposals will be done by the Board after its meeting in January. Work on setting up the technical review panel and process is starting already, so the Fund may be able to make its first funding commitments by April.
9. How will the Board be structured?
The Board will include an equal number of donor and developing country governments, with seven seats each. And, in an exceptional move, the Board will also include two NGO and two private sector donor seats. The term of the Board members will be two years, with each constituency responsible for selecting its representatives; selections will be made in time for the first Board meeting next month. WHO and UNAIDS, representing the many UN agencies involved in the fight against these diseases, and the World Bank, as the Fund’s trustee, will have non-voting seats on the Board. In addition, the Board will include a person living with or affected by HIV AIDS, TB or malaria, in a non-voting seat.
10. How will the Board make its decisions?
The Board will seek in all cases to reach consensus. If after long deliberations, consensus cannot be reached, the Board will utilize a voting system based on a two-thirds majority from each of two major constituencies, with donors – including public and private sector – on the one hand, and developing countries and NGOs on the other.
11. Who will be eligible for Fund support?
The TWG will recommend that the Fund focus highest priority on proposals from countries and regions with the greatest need, based on high disease burden and lack of financial resources. These include sub-Saharan Africa, currently the region most affected, as well as some countries within the Carribean, Asia-Pacific, Latin America and Central and Eastern Europe. The TWG will also recommend that proposals from countries and regions with a high potential for risk be considered.
Proposals will be accepted from a Country Coordination Mechanism (CCM) that includes broad representation from government agencies, NGOs, community-based organisations, commercial sector organizations (where these exist), with the assistance of bilateral and UN agencies. Governments, NGOs and private sector organizations, with the assistance of bilateral and UN agencies involved in fighting the three diseases. It should preferably be based on an already existing body, but if no appropriate coordinating body exists, a new mechanism will need to be established.
The Fund will primarily target resources to country-level programs. However, the Fund could also support regional and global initiatives, as long as these initiatives apply to country programs and the Fund is not replacing existing sources of funding, and the proposals are consistent with the relevant CCMs.
12. Will NGOs be eligible for Fund support?
Tapping the energy, entrepreneurial spirit and innovation of NGOs and community-based organizations is critical to success. NGOs will in most cases work through the CCM to access Fund resources. NGOs would be eligible to submit proposals directly in special circumstances: the proposal must demonstrate clearly why it could not be considered under the CCM process at the country level, and the Board should require validation for these reasons. Criteria for the submitting NGO would include the quality, coverage, and credibility of their services and operations.
13. How will funding decisions be made?
Proposals will be reviewed by an independent technical review panel. This impartial team of experts will make recommendations to the Board, and guarantee the integrity and consistency of the proposal review process. Candidates for the panel are now being identified so that the Board can select and appoint members at its first meeting.
14. How much of the Fund’s resources will go to AIDS, and how much to the other diseases?
The intention is to target the Fund’s resources where the needs are greatest, based on country priorities. Current estimates of disease burden and economic indicators suggest that HIV AIDS will consume the greatest amount of Fund resources, followed by tuberculosis and malaria.
15. How much of the Fund’s resources will be spent on prevention vs. care?
One of the principles of the Fund is to pursue an integrated and balanced approach that covers prevention, treatment, and care and support in dealing with the three diseases. Taking a long-term perspective, preventing new infections is the most effective strategy for alleviating suffering and reducing the social and economic impact of these diseases. But care and prevention are clearly related – prevention efforts will never succeed if care and support services for the infected and directly affected are not provided.
16. So what kinds of programs will the Fund support?
Specific decisions about the kinds of programs the fund will support will be a Board decision. However, according to the Scope of the Fund, the types of activities that could be supported, for example, are: increased access to health services; provision of critical health products such as bednets, condoms, antiretrovirals, anti-TB and antimalarial drugs, STI treatments, and laboratory diagnostic kits; training of personnel and community health workers; behaviour change and outreach; and community-based programs, including care for the sick and orphans.
17. Will the Fund support the purchase of ARV treatment?
Provisions of antiretroviral treatment is currently included in the Fund’s scope as an example of the types of activities that could be supported. The Board of the Fund will need to balance the available resources against the priorities that countries themselves identify within the context of comprehensive health system strategies and plans.
18. Will the fund be able to purchase generic drugs or will it be held to patent protections?
The Fund will not act as a procurement agent; instead its resources may be used to support programs that include procurement of critical health products for the treatment and prevention of the three diseases. With its substantial resources, the Fund can play a role in ensuring the most affordable prices, strengthening existing global and local procurement and management systems, and contributing to long term commodity security. But as it will be an international fund, the use of its resources will need to be consistent with international law and agreements, such as the recent Doha declaration, while encouraging efforts to make quality drugs and products available at the lowest possible prices for those in need. It should be noted that many of the most critical drugs and products – such as antibiotics to prevent and treat tuberculosis and other AIDS-related opportunistic infections – are no longer protected by patents but are available from a variety of manufacturers.
19. When were TB and malaria added to the Fund’s mandate?
Tuberculosis and malaria have always been considered to be critical targets for the Fund. Still, the huge devastation caused by HIV AIDS often captures more headlines and attention.
20. How will the Fund ensure that it doesn’t duplicate – or compete with – the work of others in the field?
The Fund is not an implementing agency; it will rely on partners at national, regional and global levels to develop and implement the most appropriate strategies for addressing these diseases. It will seek to establish a simplified, rapid, innovative process with efficient and effective disbursement mechanisms, minimizing transaction costs and operating in a transparent and accountable manner based on clearly defined responsibilities. Wherever possible, it will work through existing mechanisms at the international and national level.
21. Will the Fund address the root causes of these diseases, including poverty, gender disparity, lack of education, and poor nutrition and sanitation?
The Fund will not be able to tackle all the root causes of infectious diseases – nor should it. Efforts to address these issues are ongoing and their missions should not be diluted by the existence of the Fund. Nonetheless, we will not succeed in achieving lasting impact against these diseases – particularly the HIV AIDS– if we fail to act from a broad developmental perspective. Reducing people’s overall vulnerability to infectious disease is as important as reducing the factors – such as unsafe sex – that put them at immediate risk. That is why the Fund will support programs that build on, complement, and co-ordinate with existing regional and national programs that support national policies, priorities and partnerships, including Poverty Reduction Strategies and sector-wide approaches.
22. What is the role of UN Secretary-General Kofi Annan in the Fund?
The leadership and vision of UN Secretary-General Kofi Annan, and his commitment to the Fund, has been and will continue to be an essential component of its success, especially in the areas of resource mobilization maintaining political commitment. However, this is not a ‘United Nations’ fund but a global partnership including governments, United Nations and other international organizations, industry, academic institutions, foundations and other relevant actors in civil society. The Secretary-General currently serves as the patron of the Fund’s Transitional Working Group; the Board of the Fund will determine his precise role in the final Fund structure, once it has been established.
23. To whom will be Fund be accountable?
First and foremost, the Fund will be accountable to the millions of people living with these diseases, their families, and those at risk of infection. Regarding the use of funds and the achievement of results, the Fund will be accountable to donors, technical partners and developing countries.
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