UNAIDS: The First 10 Years

Chapter 6also a seat for a person affected by one of the three diseases. The Global Fund dependson teams of people (the Country Coordinating Mechanisms) in each country to review andsubmit proposals for funding and, once a proposal is accepted, to oversee the establishmentand running of the programme. Unlike the International Monetary Fund or the World Bank,the Global Fund does not lend money nor does it place economic conditionality on thefunds. Proposals must be ‘owned’ by the countries and therefore specific to their needs.159From when it was created, tension and competition between the Global Fund and UNagencies inevitably arose. These relationships have greatly improved today.“It’s veryclear that theprogrammes theGlobal Fundfinances couldnever get anywhereunless there arepartners likeWHO, UNAIDSand others on theground who helpcountries to besuccessful”.The process of developing the Global Fund, in such a short space of time and with a numberof difficult and tense meetings, was, stressed Andrew Cassels, who represented WHO in thenegotiations, an example of a good working relationship between WHO and the UNAIDSSecretariat. “There was an element of competition but on the whole it worked pretty well”.Bernard Schwartländer, formerly Chief Epidemiologist at UNAIDS, became Director ofWHO’s HIV/AIDS Programme in 2001 and in 2003 joined the Global Fund as its Directorfor Performance Evaluation and Policy. He has followed the interaction between the threepartner organizations and has seen a substantial evolution in the relationship.“There have always have been some tensions and difficult institutional issues challengingthe collaboration between the Global Fund, WHO and UNAIDS. I think these tensions wereamplified by initial uncertainty about roles and responsibilities and an initial perceptionthat there would be a competition for resources. … It also became clear that rather thancompeting for resources, the three institutions are interdependent and the Global Fundprogrammes are crucial to the realization of both UNAIDS and WHO policies and targets.Now the partners’ tremendous effort is being recognized by the Global Fund and its recipientsand I believe the three institutions mainly work together to solve their challenges”.After a year or more, the relationship between the Global Fund and UNAIDS improved.Schwartländer observed: “Now, I think what has come much to the forefront is the recognitionthat the Global Fund is nothing without its partners and also the Global Fund is a uniqueopportunity for all the partners because, for the first time, the partners have the money orthere is money in countries to do what UNAIDS and what WHO always wanted to do. Onthe other side, it’s very clear that the programmes the Global Fund fi nances could never getanywhere unless there are partners like WHO, UNAIDS and others on the ground who helpcountries to be successful. I think that was always the intention when the Global Fund wascreated”.The Global Fund’s form, function and overall effectiveness are still issues for discussion anddisagreement, for example, whether combining the three diseases was the right decision.The impetus behind the Global Fund clearly came from the AIDS world.