Examination of Witnesses (Questions 660
- 661)
MONDAY 21 APRIL 2008
Ms Diane Stewart and Dr Stefano Lazarri
Q660 Lord Howarth of Newport:
This is a slightly different question. You are a very important
grant-giver, you have been clear about what you will and will
not fund, and I imagine other people understand what your parameters
are. Among the things you will not fund is technical support to
people making bids to you and more broadly, I think, the development
of infrastructure in countries, building hospitals or the international
laboratories that Dr Lazarri mentioned. As you stand back and
review the overall pattern of the availability of funding for
the needs that there are, are there significant gaps? Where you
will not fund, are there always going to be others who in principle
are available to fund? There is a lot of money, all in all, being
channelled and disbursed through this hugely complex international
system of health organisations, intergovernmental and NGOs. But
are there needs that cannot in principle be met through this system?
Ms Stewart: Maybe just a few words, and then
I am sure Stefano will have more. One of the reasons that we have
been so successful in only six years has been because of our very
narrowly and clearly-defined mandate. There was also a reason
behind why the Global Fund was set up for those three diseases.
I think there are always going to be gaps, it is a question of
prioritisation and maybe process. What we have said all along
is that we want to be one of many, and what we are trying to do
is give an example of a model that might be a more effective development
model that could be used for other things. We have certainly been
talking about that a lot in relation to education, and we are
talking about much broader development issues. Even within the
health arena we are also saying that there may indeed be other
areas, neglected diseases et cetera, that could benefit from using
our model. What we are hoping for is to be able to say, "This
is a good way to go about it". It does not necessarily mean
that you expand our organisation to do all of those things, but
it may be you use that model to do that. There is also the question
of the MDGs and their priorities. One of the things we are already
seeing with our impact indicators—and I have some leaflets
that might be helpful—is our outcomes and impact can have
an effect that makes it possible for other things to be addressed.
Yes, there may be gaps right now today, but by dealing with some
of these things you make it possible for people to address other
things. The example I gave you about the health workers in Malawi
is a good one, where if you do not immediately deal with the fact
that those nurses are dying today of HIV/AIDS you cannot deal
with the fact that they need to be better carers for maternity
wings tomorrow. That is a Global Fund view of the world, but that
would be our immediate response to say that, yes, there are most
definitely gaps but it is a question of how you target your money
today most effectively.
Dr Lazarri: I would see at least three major
gaps. One is that we really have not achieved the coverage of
interventions nor sufficient funds for the three diseases; there
are still gaps in the three diseases. We would not wish to see
the Global Fund being the only funder, so there is definitely
room for others to come in. We have to be clear that we are not
there yet, we do not have all the resources required to properly
address the problems of HIV, TB and Malaria. The second one, and
we have touched on it, is the system problems, the weaknesses
that make achieving these objectives difficult, but also prevent
the achievement of better health as such. There again, the Fund
can play a role and we have described how we are trying to play
that role, but we cannot do that alone; we need major contributions
by many Partners, countries and governments. The third one is
on the research issue, coming up with new, appropriate and easier-to-use
tools. The TB people will tell you that they are using drugs which
are 40 years old and diagnostics which are 100 years old, and
we have technologies now to do better than that. So there is definitely
room to fill the gaps and come up with more appropriate tools.
This is an area where we need to make a greater effort.
Q661 Lord Avebury:
You mentioned earlier on the national strategies and said you
were funding these now, but could you give us an example? Not
now, but could you send us an example?
Ms Stewart: We will be funding them. We are
hoping to be able to fund them in Round 9. That is the short answer.
Dr Lazarri: We are already funding national
strategies but through a project proposal approach. We want to
use the strategy as the funding request, that is the difference.
So countries will develop the strategy, present it to the Global
Fund and we will fund it as it is; they will not have to come
every year with a grant proposal to be assessed every time. That
is the difference. What we are contributing in countries we expect
to be supporting the national strategies, that is the whole principle
of national ownership and being demand-driven.
Ms Stewart: We do have some if you want, for
example a national AIDS strategy, but there are disappointingly
few.
Dr Lazarri: A few countries have presented a
strategy as such for funding, so we could provide some examples.
Chairman: The fact that we have eaten
into our own time by ten minutes indicates that what you have
been saying has been very useful and helpful. Thank you very much.
If you do have any further thoughts or, indeed, want to give us
examples, as was indicated in the last question, do not hesitate
to send them to us. Once again, thank you very much for your attendance
and help today.
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