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Global Fund Observer


Issue 202: 16 November 2012

GFO is an independent newsletter about the Global Fund.
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1. NEWS: Global Fund Board Selects Mark Dybul to Be the Fund’s Next Executive Director

The Global Fund Board has selected Dr Mark Dybul to serve as the Fund’s next Executive Director. He previously served as head of PEPFAR.

2. NEWS: Main Decisions Made at Board Meeting

This article provides a summary of the main decisions made by the Global Fund Board at its 28th meeting in Geneva on 14–15 November 2012.

3. NEWS: Global Fund Board Approves Design of New Funding Model

The Global Fund Board has approved a new funding model which will be rolled out over the next year, and fully operational by 2014. Retaining the principle of being demand-driven, the model is designed to be more flexible and simpler than the rounds system it replaces.

4. NEWS: Global Fund Board Approves Transition Phase for Implementing the New Funding Model

The Global Fund Board has approved the roll out of the new funding model with a transition year (2013) where a number of countries will be invited to test elements of the full implementation of the NFM, using a portion of uncommitted assets.

5. NEWS: Global Fund Board Approves Modification of AMFm

The Global Fund Board has unanimously approved a decision to modify the AMFm programme and integrate components of the programme into the Global Fund’s main funding mechanisms.

6. NEWS: Global Fund Board Fires Inspector General

The Global Fund Board has decided to fire John Parsons, its Inspector General. The Board said that the decision was made after a careful review of Mr Parsons’ performance, which it found to be “unsatisfactory.”

See section near the end of this newsletter listing additional articles available on GFO Live.

1. NEWS: Global Fund Board Selects Mark Dybul to Be the Fund’s Next Executive Director

Decision was close

Dr Dybul is expected to take office in early February

The Global Fund Board has selected Dr Mark Dybul to serve as the Fund’s next Executive Director. He previously served as head of the US President’s Emergency Program for AIDS Relief (PEPFAR). The decision was made by the Board on 15 November at its 28th meeting in Geneva, and the appointment will take effect in early February. (Gabriel Jaramillo will step down as General Manager on 31 January, as was always intended.)

The selection of Dr Dybul was the final step in a lengthy and carefully-planned recruitment process (see GFO article). The Board’s Ad-Hoc Nominating Committee – whose work was praised by many Board members – carried out the search and the shortlisting process, eventually delivering four names to the Board. Those names were Monique Barbut, the French outgoing chief of the UN’s Global Environment Facility; Mark Dybul; Robert Greenhill, the Canadian Managing Director of the World Economic Forum and former President of the Canadian International Development Agency (CIDA); and Barbara Stocking, the British outgoing head of Oxfam.

The four shortlisted candidates were all interviewed by the full Board on 14 November; observers were not present. GFO understands that prior to the interviews, the Board had agreed on a precise process whereby Board members would provide scores for each candidate. The outcome was that Dr Dybul and one other candidate received total scores very close to each other, with the other two far behind. After considerable discussion and some re-voting, it was clear that this situation would not change. The Board then abided by its agreed process and formally voted, with no votes against, to select Dr Dybul, the candidate with the highest score.

Dr Dybul helped create, and later led, PEPFAR, the bilateral US AIDS programme that is comparable in size to the Global Fund, and is the largest global health initiative ever undertaken to address a single disease. Trained as a medical doctor with a specialty in immunology, he became an expert on AIDS as a clinician, scientist and administrator. Dr Dybul, born in 1963, is openly gay.

“Mark Dybul is a true leader, who can take the Global Fund to the next level,” said Simon Bland, the Fund’s Board Chair. “He has a really impressive vision of how to achieve global health goals. He is passionate, energetic and focused.”

Dr Dybul currently co-directs the Global Health Law Program at the O’Neill Institute for National and Global Health Law at Georgetown University. 

Dr Dybul’s first position at PEPFAR was as Deputy Chief Medical Officer, in 2004. He was rapidly promoted, and in 2006 was appointed to head the organisation as US Global AIDS Coordinator. He served until 2009.

Dr Dybul has considerable understanding of programmes to treat and prevent AIDS, TB and malaria in developing countries, and has experience working with health administrators at many levels, especially in Africa. During his years with PEPFAR, he worked closely with the Global Fund, and in 2007–2008 served as Chair of the Fund’s Finance and Audit Committee.

The Global Fund’s press release announcing the appointment is available here.

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



2. NEWS: Main Decisions Made at Board Meeting

On 14–15 November 2012, the Global Fund Board held its 28th meeting in Geneva, Switzerland. GFO was present, with observer status. The main decisions made at the meeting, in chronological order, were as follows. (For precise wording of what the Board agreed, see the decision points document that has been posted here. Background documentation will also, in time, be posted by the Global Fund at the same location.)

New Funding Model. The Board passed two key decisions on the Fund’s completely new approach to grant-making. [See Decision Points 4 and 5, and Articles 3 and 4 in this issue.]

AMFm future plans. The Board modified the AMFm funding mechanism and agreed to integrate it into the main Global Fund grants management system. [See Decision Point 6, and Article 5 in this issue.]

Selection of new Executive Director. The Board selected Dr Mark Dybul, the former head of PEPFAR, to serve as the Fund’s next Executive Director.  [See Decision Point 7, and Article 1 in this issue.]

Recognition of Debrework Zewdie. The Board noted that this will be the last Board meeting attended by Dr Debrework Zewdie, the Deputy General Manager and formerly the Deputy Executive Director. She will be returning to the World Bank. The Board acknowledged her numerous contributions to the Fund and praised her leadership in reforming the grant renewals process. [See Decision Point 8.]

Termination of Inspector General. The Board terminated with immediate effect the employment of John Parsons as Inspector General. [This decision is not recorded in the Fund’s decision points document, but it was announced by the Fund in a press release. See also Article 6 in this issue.]

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



3. NEWS: Global Fund Board Approves Design of New Funding Model

No significant changes from what was proposed by the SIIC

Model will not be fully implemented until 2014

The Global Fund Board has approved a design for the new funding model, though some elements of the design will require further work. The Board has also approved a transition phase for 2013 as a way of testing various elements of the new model. The full model will not likely be rolled out until 2014.

The approval of the New Funding Model was split into two decisions. This article describes the new funding model, as described in the first decision approved by the Board. (See separate article on the transition phase, which describes the second, but linked decision).

According to the Global Fund, under the new model the Fund will remain demand driven and will improve interactions between the Secretariat, applicants and implementers. The Fund adds that the new model will allow the Fund to more effectively leverage the funding and expertise of other organisations; create more flexible processes; provide strategic direction to the Fund’s portfolio more effectively; and increase the ability of the Fund to support national programmes.

The Global Fund also said that the new model will allow it to focus on countries with the highest needs and the least ability to pay, while remaining global.

Under the new model, applicants will be able to access two streams of funding through one application process: (1) an indicative funding stream, which the Fund describes as the “larger and more-predictable” stream; and (2) an incentive stream designed “to reward ambitious, high-quality expressions of full demand … “and to invest in well-performing programs with a potential for increased, quantifiable impact.”   

Allocation and implementation period of grants

Under the new model, the length of each allocation period will be three years, and this will be aligned with the Global Fund’s three year replenishment cycle. At the beginning of an allocation period, the Fund will determine how much funding is available for the entire period, and applicants may apply for this funding at any time during the period.

The standard length of a grant under the new model will be three years. If circumstances warrant, the Secretariat will have the flexibility to shorten or moderately extend the length of the grant, provided the applicant gives appropriate justification.  

Allocation of funding to country bands

A critical part of the process for allocating funding will be the creation of country bands – i.e. groups of countries that share certain characteristics. Countries will be assigned to one of four bands on the basis of ability to pay and disease burden. Ability to pay will be measured by gross national income per capita.

The four bands are as follows:

Band 1
Lower income
High burden
Band 3
Higher income
High burden
Band 2
Lower income
Low burden
Band 4
Higher income
Low burden

The Global Fund expects that proposals from most of the countries in Band 4 (higher income, low burden) will contain countries or regions that have higher income levels but contain concentrated epidemics of those most-at-risk populations (MARPs) for any of the diseases.  However, countries in Band 4 are not limited to those with MARPs, they may be countries with non-CCM proposals, multi-country or regional proposals, and proposals from small island states will be included in this group.

The composition of the bands will be reviewed at the start of each allocation period.

There will be a three-step procedure to allocate funding to the four bands: 

  • Step 1: Allocation by disease. Available resources will first be allocated among the three diseases. Initially, the Fund’s historical allocation data will be used (52% for HIV, 32% for malaria, and 16% for TB); by September 2013, a new measure to estimate disease burden and financial demand will be developed.
  • Step 2: Allocation to bands. Resources will then be allocated to the country bands, based on a formula and adjusted for certain qualitative factors. This allocation by disease split is only intended as a guide; countries will be free to determine their own disease split but will not be able to apply for more than the money allocated to them.
  • Step 3: Split. Within each band, a split will be made between indicative and incentive funding.

To arrive at the allocation for each band (Step 2), the Global Fund will use a formula based on    ability to pay and disease burden to calculate nominal country “shares.” The shares for each country in a given band will be added up to determine the total allocation for the band. This figure may then be adjusted, in the context of the country dialogue, by qualitative factors: (a) major sources of external funding, and (b) minimum required levels. (Note that a separate methodology will be used for aggregating shares to the fourth band – see below).

With respect to external funding, the Global Fund said that an adjustment may be required for bands that contain countries receiving substantial support from other major donors. Concerning minimum required levels, the Fund said that it may be necessary to adjust allocations to countries to ensure that their financial commitments do not fall below a minimum required level. What this level should be has not yet been decided.

Regarding Step 3, the split between indicative and incentive funding, the Global Fund said that it will determine what resources are required to meet applicants’ prioritised needs and then allocate resources to the indicative stream sufficient to cover these needs. The difference between needs identified and total available funding will be allocated to the incentive stream. The Fund said that additional resources mobilised during a replenishment period could be allocated to the incentive stream. Finally, the Fund said that additional criteria for determining the split, including a definition of “prioritised needs” will be approved by the Board at its 29th meeting, scheduled for May 2013.

Allocation of funding to individual countries

Once the allocations to country bands are determined, and the split is made between indicative and incentive funding, the Global Fund Secretariat will calculate an “indicative funding range” for each country. The amounts will be largely based on the formula (ability to pay and disease burden), but adjustments will be made for qualitative factors such as (a) major sources of external funding, (b) minimum required levels, (c) willingness to pay, (d) past performance and absorptive capacity, (e) risk and (f) increasing rates of new infections in lower prevalence countries. The SIIC emphasised that the qualitative factors may be used to increase or decrease the amounts that applicants within the Bands may apply for. The indicative funding range provided to a country will be for all three diseases combined; it will be up to the country to determine the disease split.

Countries’ initial funding ranges will be determined by the replenishment process (ie how much money the Global Fund raises during “replenishment”), but countries are still going to be encouraged to apply to fill the full quality demand for controlling the epidemics.

The Secretariat will develop the process and methodology for awarding incentive funding (subject to approval by the SIIC). 

Managing unfunded quality demand

“Unfunded quality demand” refers to programmes or parts of programmes that have been recommended for funding by the Technical Review Panel but which cannot be funded due to a lack of resources. The Secretariat will maintain a register of this unfunded quality demand and will prioritise the demand for future funding should additional resources become available. Donors may also be invited to fund such demand.

The Secretariat will develop the process and methodology for awarding money to unfunded quality demand (subject to approval by the SIIC).

The text of the Board decisions on the new funding model can be found in points 4 and 5 in the Board Decision Points document available at The paper submitted by the SIIC (Document GF/B28/02) should be posted shortly at the same site.

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



4. NEWS: Global Fund Board Approves Transition Phase for Implementing the New Funding Model

Secretariat will select participating countries

Implementation of the new funding model approved by the Global Fund Board (see article 4) will roll out in 2013 with a test of the full implementation in about five countries. The lessons from countries that participate in this phase will be absorbed into the NFM as it gains momentum for full implementation for all eligible countries in 2014.

Funds for this first phase will come either from existing grants being reprogrammed or from uncommitted assets that the Global Fund has on hand. The amount available from uncommitted funds will be set by the Finance and Operational Performance Committee (FOPC) of the Board. The Secretariat will decide which countries will participate, based on various criteria: (1) countries that are significantly under-funded in 2013–2014; (2) countries that face a severe risk of service interruptions; (3) the countries that are likely to achieve rapid impact; and (4) countries that come from diverse settings e.g., with different economies, sizes, geographies and varied capacities. Participants may also including countries with non-CCM and regional grant proposals. Countries may not necessarily have to meet all three criteria.

The Global Fund will consider that a country is “under-funded” if it is slated to receive less funding for 2013–2014 (from existing grants) than it would get from the application of the formula to be used under the new funding model.

Countries not invited to participate in this phase are encouraged to develop their strategic plans for the three diseases and begin the iterative country dialogue stage with the Global Fund’s Grant Management teams. This allows development of the concept notes in preparation for submission to the Fund in early 2014.

Once the amount of allocation is known from the FOPC, the Secretariat will first split the available resources between the three diseases, based on the historical distribution of the Global Fund’s portfolio (52% for HIV, 32% for malaria, and 16% for TB). Then an indicative funding range for each country will be established. The ranges will be based on the degree to which each country is underfunded and the level of funding required to prevent programmatic service interruptions, as well as other qualitative factors (such as funding available from other sources).

Current Global Fund eligibility criteria will apply to this phase.

Applicants will be able to request funds for targeted interventions, including those that specifically support most-at-risk populations (MARPs). In fact, all upper-middle-income countries included in this phase would be required to focus on MARPs.

Only some of the countries selected for the transition phase will be invited to participate in two important elements of the new funding model: the submission of a concept note, and the opportunity to obtain incentive funding in addition to indicative funding. The Secretariat will establish the amount of incentive funding available to these countries.

The Secretariat and the Technical Review Panel (TRP) have identified points in the process where the TRP will review funding requests. This applies to all countries in the transition phase. It is expected that the TRP and its way of working and communicating will change from current practice. These changes are being worked out by the Secretariat and the Board.

During the transition phase, funding decisions will be taken by the Board through electronic voting. During this phase, the Secretariat will report quarterly to the SIIC on which countries are participating. The SIIC will be responsible for assessing the overall effectiveness of the NFM based on a monitoring and evaluation plan yet to be finalised by the Secretariat.

The text of the Board decision on the new funding model can be found in the Board Decision Points document available at The paper submitted by the SIIC (Document GF/B28/02) should be posted shortly at the same site.

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



5. NEWS: Global Fund Board Approves Modification of AMFm

The Global Fund Board has decided that the Affordable Medicines Facility-malaria (AMFm) programme will not continue as a stand-alone programme, but elements will be retained and integrated into the core funding system. The decision was made at the 28th Global Fund Board meeting held in Geneva on 14th and 15th of November.

The AMFm is an artemisinin combination therapy (ACT) subsidy programme with three main elements: price negotiations, a co-payment system to further reduce the price to first line buyers, and interventions to ensure effective scale up of ACT distribution. The programme is currently being implemented in eight pilots in seven countries. The pilot phase was to end in 2012, but was extended for a year (to end of 2013) to allow for a smooth transition and continuity of access to the affordable medicines.  

The Strategy, Investment and Impact Committee (SIIC), in its report to the Board (link), said that although the pilot had shown remarkable success in over half the countries, certain elements must be changed and the programme should be integrated within the Global Fund system to ensure sustainability. 

An external evaluation had shown that AMFm had significant impact in the private for profit sector in six out of eight pilots, but less impact in the public sectors of many of the pilots. It also appears that the longer the pilot was in place, the greater the effect of the programme. 

The AMFm has operated since mid-2010 as an independent funding line, with financing from UNITAID, the Bill and Melinda Gates Foundation, and the Canadian and UK Governments.

Under the proposed modified model, the Global Fund will still engage manufacturers in price negotiations and process co-payment on behalf of countries. However, countries will now be expected to mobilise resources for the co-payment, and place their proposals for controlling and treating malaria in their concept notes for funding through the new funding model.

The Board further asked countries to align the private sector co-payment with their national plans. That way, ACTs can be provided in conjunction with other interventions such as mass communication campaigns.  Following the decision, an orderly transition is expected in the pilot countries, with other interested countries gradually taking up the co-payment element.

The Board further recommended that given the changing malaria epidemiology in many countries, diagnostic testing should be scaled up in both private and public health sectors to ensure that over-treatment or treatment for non-malarial fevers with ACTs does not occur. 

This recommendation is consistent with guidance from the technical partners such as the World Health Organisation (WHO) and Roll Back Malaria (RBM). Increased diagnostic testing accompanying the ACT roll-out will also help minimise the spread of artimisinen-resistant malaria parasites.   

The importance of linking the use of ACT to malaria diagnosis was also highlighted in the Board decision. The Board asked for assessment of the feasibility of introducing a malaria rapid diagnostic test (RDT) co-payment system. Should such a system be adopted, countries will be expected to mobilise co-payment funds for both the ACTs and the RDTs. The decision on how to allocate resources between RDTs and ACTs will be left to individual countries.

Individual countries will be told the maximum amount of money that can be used for private sector co-payment. However, the SIIC report was not clear on how the amounts would be decided. Countries will be required to justify the co-payment amount requested for the private sector.

Having ceiling amounts per country is meant to ration the supply of ACTs. A recent analysis by the Clinton Health Access Initiative (CHAI) said that over 400 million antimalarials were used by individuals, buying those medicines through private sector outlets, who did not have malaria (CHAI Report).

 “The need to link treatment with diagnostic confirmation is vital, but the human resources to do this are scarce. We will need to work hard at solving this piece of the puzzle of malaria control,” said an implementer country delegate to the Board.

The SIIC estimates that between $114 and $154 million will be needed for co-payment for the pilot countries over the one-year transition period. In addition, an estimated $26 million will be required for supporting interventions. However, the Board expects existing grants to cover the costs for supporting interventions.

During the Board deliberations, the representative of the British/Australian delegation, who is from the UK Department for International Development (DFID), said that DFID was prepared to donate to the Global Fund an additional GBP36,000,000 (US$57,000,000) to help finance the transition year for these co-payments.

A few details remain unclear following the Board decision. While the AMFm unit will continue to exist during the upcoming year, it is not clear exactly how the system for collecting and processing co-payment funds will be implemented. In the past, some funders, most notably the US government, refused to fund the co-payment under the AMFm.

The Board was satisfied with the public-private cooperation that had developed as a result of the AMFm. To strengthen these further, countries were asked to develop policies that enable the use of grants to work with the private sector through co-payment mechanisms.

The decision to retain elements of the AMFm can be viewed as a compromise between two options that were being discussed: continuation (as is) and termination.

The text of the Board decision on the AMFm can be found in point 6 in the Board Decision Points document available at The paper submitted by the SIIC to the Board (Document GF/B28/04) should be posted shortly at the same site.

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



6. NEWS: Global Fund Board Fires Inspector General

An independent external peer review of the audit function was a factor

A permanent replacement will be found within six months

The Global Fund’s Inspector General, John Parsons, has been fired. The decision was made by the Fund’s Board on 15 November at its 28th meeting in Geneva. A press release from the Fund said that the Board made the decision after a careful review of his performance, “which was found to be unsatisfactory.” 

The Office of the Inspector General (OIG) is responsible for overseeing audits and investigations of the Global Fund and its grant implementers.

Despite firing Mr Parsons, the Board said that it supports an independent and strong OIG. “Robust audits and investigations are essential to the health of the Global Fund, to root out instances of financial impropriety and to assure donors and implementers that money is properly accounted for,” the Board said. 

The Board said that the decision to fire Parsons, which was effective immediately, was made after considering various factors, including: a performance review; an independent external peer review of the audit function; and a report to the Board from its Audit and Ethics Committee.

The Board said it will appoint an interim Inspector General to help maintain continuity in the audits and investigations currently underway. The Fund will then conduct a search for a new Inspector General, which is expected to take six months. 

The OIG was created in 2005 and Mr Parsons ran it from January 2008. Previously, he served as Director of the Internal Oversight Service at UNESCO (from 2001), Director of the Office of Internal Audit at UNICEF (from 1996), and Director of the UK National Audit Office (from 1989).

Mr Parsons was a controversial Inspector General. Relationships between him and the Global Fund Secretariat were usually strained. In addition, some of the OIG’s audits and investigations, particularly in Mr Parsons’ early years at the Fund, were criticised by the entities being audited and investigated.

[This article was first posted on GFO Live on 16 November 2012.]

To comment on this article, click here.



The following articles have been posted on GFO Live on the Aidspan website. Click on an article heading to view the article. These articles may or may not be reproduced in GFO Newsletter.

NEWS : Global Fund Resolves Stalemate over $102 Million HIV Grant to Zambia

The Global Fund has switched funds to Churches Health Association of Zambia after fraud concerns about Zambia National AIDS Network.

NEWS : OIG Releases Report on Diagnostic Review for Georgia Grants

The diagnostic review says that Georgia has made major achievements with Global Fund money such as attaining universal access to antiretroviral therapy and nearly eliminating malaria.

NEWS : Activists want Brazil government to drop proposed new AIDS funding rule

Activists in Brazil claim that the Ministry of Health is about to publish a decree that will allow states and municipalities to reallocate funding originally earmarked exclusively for HIV programmes.

NEWS : Too Many CCMs Remain Weak, but Progress is Possible, Report Says

Despite the challenges of developing strong country coordinating mechanisms and creating effective civil society engagement, resources and focused advocacy can make a difference, according to a report issued earlier this year by the International Treatment Preparedness Coalition and the International Council of AIDS Service Organizations.


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