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I nterview Michel Lavollay Senior consultant for UNAIDS Brussels January 2008 Michel Lavollay was practicing medicine in Paris when AIDS was discovered. He got involved with this disease in the 1980’s, and cooperated with French and international institutions to find responses to deal with the issue. This led him as far as the WHO in Geneva, the UNDP as well as at the UN Secretariat in New York, private foundations, and at the French Embassy in Washington. He then spent four years in the early creation of the Global Fund to fight AIDS, TB and Malaria, where he pushed for the establishment of a public/private strategy and funding mechanisms. Considering this heavy experience, he works now in Brussels as senior consultant for a variety of organisations and, more recently, UN- AIDS, where he aims at reinforcing the discussions on health, HIV, diseases linked to poverty and partnerships with the private sector. ■ Dialogues: How would you define UNAIDS’ priorities regarding the poverty situation in developing countries, since health problems are often linked to poverty and impede development? ML: UNAIDS’ experience is critical, because a lot of what is being discussed for the moment on health, partnerships, or mechanisms for delivery of services in the poorest countries, is very much related to what was achieved in responding to HIV. The participation of UNAIDS as well as other institutions - like the WHO or the Global Fund, the World Bank, and the UNDP, is essential to maintain a discussion on these health topics and the broader discussions on development objectives. UNAIDS’ role is also important in creating partnerships with the European institutions, governments, and the civil society. We aim to help the dialogue between civil society organisations and local institutions. Actually, just talking about the problems is not enough! Solutions and practical mechanisms to bring additional resources and capacities, in order to improve the efficiency of delivery of development aid must be found, and that is a real challenge. DG DEV (Directorate for Development of the European Commission) has an important and clear role in strengthening partnerships. ■ Dialogues: Big organisations created by the UN or the EU suffer criticism because of their complexity and delay before action is implemented. In your opinion, what could be done for these organisations to acquire a better knowledge on the matter and to improve the public/private partnerships? ML: There is an interesting parallel to draw between the transitions at the UN in the past twenty years, and what can happen with the EU, in the sense that the EU must go through transitions and transformations that take time in order to integrate fully civil society in its work. This is not about theory but reality and how partnerships can actually exist. The reality is that private corporations are developing programmes and partnerships on the ground with local authorities, NGOs, and are actually transforming the reality in these particular regions through these partnerships. It is this sort of action that needs to be valued and promoted. T he various institutions, the interested stakeholders and groups like <strong>EMRC</strong>, who have a critical role to play in bringing the people together like you did it in Lisbon, have to be supported in establishing a dialogue and to gradually bring the stakeholders to a common understanding that there is value and a benefit in these discussions, not just for the institutions, but also for the private sector. What is The problem is not the lack of resources, because governments are receiving large amounts of money. It is more a question of dialogue and understanding. striking in Brussels is that everyone, politically and in various parts of the EU process, is convinced that nothing can be done without public/private partnerships. This takes time and requires a confidence-building process. The potential partners must feel confident that what they bring to the various partnerships will not be modified or be deviated from their original purpose because companies get involved to do business! We have to stay away from substitution and philanthropy! I have participated with other institutions and bilateral entities in developing an approach that we call co-investment, a simple mechanism in which partners negotiate the terms of their partnerships in order for them to achieve common goals. These co-investments in areas such as HIV or malaria are being implemented in Africa. There are even projects now that benefit not only the partnerships, but also the eco-systems. For example, in some coastal areas in East-Africa, the regression of malaria allowed to promote tourism and other secondary benefits that are far beyond public health and have a direct impact on the local economies. Potentially, this is a constructive way to look at development. ■ Dialogues: A healthy environment creates and promotes development. In your opinion, what could be done to help governments focus on social issues, allowing therefore private companies to focus on business issues? ML: Today it is basically a question of necessity. If you analyse what public, private and local NGOs can achieve at a local level, the political variable is out of the equation. There is a lot less evaporation of funds nowadays and we can clearly see what these organisations can do together. The problem is not the lack of resources, because governments are receiving large amounts of money. It is more a question of dialogue, and understanding. Discussions are needed, because business objectives can be compatible with social objectives. Furthermore, there is a need to define and promote the kinds of mechanisms by which the objectives are not lost. The business community needs to be confident that its contributions are respected, that the lines of responsibility are well identified and that the monitoring is shared in order to reach common objectives. The analysis of what actually happens in practice shows us that common objectives can be found, that there are methodologies defined between the parties involved. But at the institutional level, there is always a tendency to interpret and mistrust. So the discussions should be focused on what is happening in concrete terms. All these elements from real - DIALOGUES - <strong>EMRC</strong>
“Health is Wealth” The Global Fund to fight AIDS, Tuberculosis and Malaria is headquartered in Geneva, Switzerland. It was set up in 2002 at the initiative of the then Secretary General of the United Nations, Kofi Annan, to mobilise, manage and disburse large sums of money, initially to combat the spread of HIV/AIDS in developing countries. Mr Annan put his money where his mouth was by time situations can be included in models that will be used to create partnerships and share experiences. ■ Dialogues: Considering that a company’s experience can stimulate other companies to follow its footsteps, could you give us an example that proves that the system works, where partnerships are actually taking place? ML : The Malawi project, is a very important project that was introduced four to five years ago, that I helped negotiate, where the Ministry of Health received one of the first rounds of grants from the Global Fund ($ 200 Million) on HIV treatment. The proposal was considered a very sound one but, not unexpectedly, within a year the government started to have some problems executing and implementing. The process at the Global Fund is results-based and if a recipient can’t deliver, then, either solutions are found, either the grant is lost. For the Malawi situation, we argued that there was a structured coalition of businesses involved in HIV. It included more than thirty companies, working together on the disease with clinics and trained personnel. After two years, the coalition negotiated the terms of delivery of a large part of the grant, which enabled the government to actually keep the grant. This shows that you can create large scale partnerships using the capacity, additional financial and technical resources. This example has become a very interesting and useful model for future projects. There are also very interesting initiatives regarding Malaria, like MOZAL, in South-Africa and Mozambique, developed for three years now. Joint programmes between local governments, the Global Fund and NGOs have been implemented to distribute medicine and treatments for malaria, which has brought very significant and rapid results, on the workforce, as well as on their families and the local communities. Also, the eco-system has benefited from these joint programmes and as a result, tourism has grown. ■ making a personal donation of USD100,000 to what he called the “war chest”. Today, five years later, the Fund’s assets total USD 21 billion, of which 10 billion have been committed to health programmes already approved by the fund in 136 countries on 5 continents. Moreover: today the Fund’s programmes target not only HIV/ AIDS, but also the two other major poverty-related pandemics: malaria and tuberculosis. At the present time, the Fund’s money accounts for 65% of available international resources in the fight against tuberculosis, 65% for malaria and 25% for HIV/AIDS. Within the Fund’s investment portfolio in developing countries, spending is almost evenly spread with 60% allocated to HIV/AIDS and 40% to malaria and tuberculosis combined. Contributors to the Fund include governments, institutions, foundations and private individuals. A donation from the Bill and Melinda Gates Foundation totalled USD650 million. ‘The three pandemics are closely related and often occur together, with the same devastating consequences, in particular for developing countries in Africa, Asia, Latin America and the Caribbean and also Eastern Europe. Of course these diseases exist globally. However: they are described as diseases of poverty because, compared to wealthy parts of the world, their impact in developing countries is devastating. Not only is there a lack of money for healthcare itself, but the extent of the diseases in poor countries poses a fundamental threat to development, claiming 6 million lives every year. Clearly, social and economic development is impossible where populations are decimated by disease. Health is wealth. Therefore, the situation needs to be met by what I consider to be a new approach to international health financing”, says Kinsley Moghalu, a former corporate lawyer who is Head of Global Partnerships of the Global Fund. This approach aims to address health treatment not merely by distributing medications, but on the multiple levels of prevention, treatment and care. Never prescriptive, the Global Fund is managed on a basis of a public partnership between so-called developed and developing countries. The policy is “bottom-up” to enable each country to take full ownership. Mechanisms for co-operation and co-ordination are in place for every individual project. Inputs are received from local governments, civil society, NGO’s, associations and so forth. The Economic development starts with the eradication of “diseases of poverty” needs are assessed locally, and before implementation, all programme proposals submitted for financing are carefully evaluated from technical, quality and potential impact points of view by an independent panel of technical experts retained by the Global Fund. The process of making funding decisions is a rigorous one: roughly half of all proposals are successful. Results are also evaluated, making it possible to confirm that almost 2 million lives were saved since the establishment of the Fund. Results have been especially encouraging in Ruanda, Tanzania and Sri Lanka, among others. “With regard to HIV/AIDS, one of the greatest challenges is to tackle issues of cultural stereotypes. An example often quoted is the belief in some countries that this disease can be cured by having sex with a virgin! But there are many other pre-conceived ideas and superstitions, based on traditional cultural and social systems, or simply due to lack of education. In short, education is key”, says Moghalu, “especially because, as yet, no cure has been found for this disease.” “As for malaria, it needs to be arrested at the source. A strategic, environmental approach should include a combination of general sanitation, draining of swamps where mosquitoes breed, use of long lasting insecticide treated bed nets and approved pesticides in rural and urban areas and, needless to add, and as with HIV/AIDS, universal access to medication and treatment.” Until recently, it seemed that tuberculosis had been all but eradicated in developed countries. Its recurrence in the form of dangerous new strains has become a global concern, requiring global strategies. Overall, having successfully mobilized USD21 billion over the past six years, another strategic challenge confronting the Global Fund is that developing countries need to scale up effective demand for the Fund’s money for more ambitious prevention, treatment and care programmes. “Yes, the Fund has made an impact, but we are not resting on our ears. Defeating these pandemics requires much more work on the part of developing countries and their international partners, such as the Global Fund”, says Moghalu. The Global Fund’s new approach to health financing proposes a multilevel philosophy and quality of partnership that offers hope for the future.■ Quarterly - Spring 2008 -
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