Our report on the 50th Global Fund Board Meeting, held from November 14th to 16th, provide and extensive summary of the discussion held at the Board. Some of our key takeaways from the discussions inside and outside of the Board Meeting room are below. To read the full report, click here.
Some thoughts about the Board Meeting
New Board Format
The Board Meeting agenda was built around a pre-day of updates on technical and governance issues, a first day dedicated to further updates from the Executive director and the Secretariat covering the three diseases and contributory objectives, with no decision points, and only then two days for the board to make decisions.
We liked this structure, which gave all in the room time to absorb context and helped clarify positions and build consensus across delegations before it came time to take decisions. It felt intentional and natural, and we hope to see it continue.
Informal mini board retreat
The Board Member and Alternates were scheduled for a day of informal board retreat immediately after the closure of the Board Meeting itself – GFAN was not invited to attend and though Board members were openly discussing their priorities for the retreat throughout the meeting, the exact agenda was not shared with us. The Members and Alternates seemed to want to focus discussions on governance (the proposal for a new voting seat on the Board for the African Union put forward by some delegations) and sustainability (see below).
Sustainability, Co-financing and Transition review
A proposal was put to the Board and the Secretariat for a review, opening the door to an eventual revision, of the Sustainability, Co-financing and Transition (STC) policy of the Global Fund. The proposal seemed motivated primarily by better tools to promote country ownership and providing donor with a clear “off-ramp” in the face of rising demand from the most vulnerable countries. The request was not only received positively, with a number of participants noting that the type of changes suggested to the STC policy could really be accommodated within its current iteration.
Linked to the STC discussions, “tradeoffs” really felt like the theme of the meeting. In the face of stagnating funding for GC7, limited prospects for improvements in GC8, and increased demand (see polycrisis below), the Secretariat, TRP, technical partners, and all delegations focused a lot of their interventions around resource allocation, what to prioritize and implicitly what to roll back.
Tradeoffs were discussed in particular with regard to innovation and coverage (buying new more expensive tools or cheaper, less effective ones), in terms of types of programs (prevention vs. diagnostics vs. treatment), and in terms of mandate (should certain thematic be relinquished in favor of other partners, and how should emerging issues be integrated without spreading the partnership thin?).
From our perspective, these discussions are essential to make sure there is transparency on what is prioritized and what is not, but the other side of that equation – how to increase the size if the pie so we do not have to trade one intervention for another or chase efficiencies all the way to US$2.3 more billions – was not featured enough throughout the meeting.
The Future of Global Health Initiative was mentioned repeatedly throughout the Board Meeting by different delegations both among donor and implementing constituencies. References to FGHI were made to support calls for greater country ownership, and for greater collaboration and coordination across GHIs; these same calls were also made under the slogan “One Plan, One Budget, One Report”.
Though some indicators were thankfully promising, the underlying tone for the meeting was one of concern if not gloom, encapsulated by the word “polycrisis” which creeped its way into a number of intervention (if the topic interests you this is a good newsletter and this is a good twitter account). The facets of the crisis of everything that were most discussed were climate change and its first, second and third order effects on health (i.e. respectively hotter temperatures, spread of vectors, and malnutrition, inequalities and poverty), the worsening of international tensions and ongoing conflicts (i.e. Ukraine and, though it was not mentioned directly as often, the ongoing Hamas/Israel conflict), the rise of resistance in Malaria to both insecticide and artemisinin, and a global anti-rights movement that made itself felt most starkly and most recently in Uganda.