Africa Makes its Priorities Known at the 49th Global Fund Board Meeting

Twenty-one delegates from East and Southern Africa (ESA) and West and Central Africa (WCA) led by the African Constituency Bureau board chair, Dr. Jean Jacques Mbungani, attended the 49th Global Fund Board Meeting in Hanoi, Vietnam. Several pre-board sessions and bilaterals were held before the 10-11 May 2023 Global Fund board meeting. The Global Fund has revived its tradition of gathering its constituencies in implementor countries, with Hanoi, Viet Nam being the chosen location for the meeting.

The delegation included members from Sierra Leone, Tanzania, Niger, Mauritania, Kenya, and South Africa, all supported by committee members. The rest of the board was represented by Dr. Magda Robalo, the WCA Alternate Board member, Mrs. Susan Mochache, and Dr. Charles Mwansambo, the respective ESA Board and Alternate Board members. The delegation was supported by its Secretariat, the African Constituencies Bureau. The meeting was an opportunity to reflect on progress made with the Global Fund partnership while presiding over intractable policy issues that impact ending the three diseases and reflecting on the collaboration as it implements its new 2023-2028 strategy.

Significant progress was noted toward achieving the 95-95-95 targets in Eastern and Southern Africa. Malaria remains a significant threat, particularly in West and Central Africa. In East and Southern Africa, resistance to drugs and insecticides has been noted. Other factors driving the malaria threat include the failure of rapid diagnostic tests to detect malaria parasites and the spread of new malaria vectors that negatively impact previous malaria programmatic gains. While there is positive progress on TB, it remains slow. This was highlighted during the Francophone lunch hosted by the Ambassador for Global Health, France, H.E Anne-Claire Amprou, whose theme focused on addressing challenges in the fight against Tuberculosis, that Childhood TB, currently on the rise, is lacking appropriate treatment. Finding missing cases, especially among key and vulnerable populations, treating people with TB, including those with drug-resistant TB, lack of intensive prevention, improved access to quality diagnosis, treatment, care, support, and an enduring funding gap.

In anticipation of the two-day packed Global Fund agenda, the African leadership engaged in several bilateral discussions with other constituencies to express their positions on critical issues such as grant implementation in fragile countries, also known as challenging operating environments (COEs), and additional safeguard measures (ASP), human rights, the pandemic fund, local manufacturing and procurement of health commodities, co-financing, resilient and sustainable systems for health, and risk management, among others. Bilaterals were held with France, the UK, the US, Canada- Switzerland- Australia, Germany, Point 7, and UNAIDS. The leadership also met with Global Fund Executive Director Peter Sands and the incoming Global Fund Board leadership – Lady Roslyn Morauta and Ms. Bience Gawana. During these meetings, Africa’s importance as a critical part of the Global Fund partnership was underscored. There was recognition of its growing influence at the Global Fund and driving the Global Health agenda.

The African delegation further participated in a day-long meeting with other representatives of the implementer constituencies. The implementer group released a joint statement highlighting essential topics with a particular emphasis on Gender and Human Rights. The statement highlighted ongoing and increased human rights violations, which, if not addressed, will hinder the successful implementation of this new Global Fund Strategy. The Implementer Group was firm that these violations would affect access to equitable and comprehensive health services for all, particularly key, vulnerable, and marginalized populations. It, therefore, called on all stakeholders to remain vigilant. The joint Implementer Group statement also spoke to issues such as the Pandemic Fund and Challenging Operating Environments which align with Africa’s position.

Africa remained resolute during the board meeting that investments in resilient and sustainable systems for health remain key in pandemic preparedness and response. It, therefore, called for increased investments in surveillance, human resources for health, reliable and timely data, and laboratory systems. Africa further urged a collaborative, coherent, and flexible approach in funding streams, particularly with the pandemic fund, to reduce the burden and transaction costs associated with applying for the much-required funds potentially to two organizations, i.e., the Global Fund and the World Bank.

The African board members were also unequivocal in supporting improved procurement and supply chain management capacities. COVID-19 exposed this weakness as Africa was on the back line when the much-needed therapeutics and vaccines arrived late. Further, while Africa gets its commodities through the global fund’s pooled mechanism, wambo.org, the anticipated economies of scale and lead times still need to be realized. Africa remains deeply concerned that it supplies less than 1% of the commodities to this wambo.org. Africa’s representatives, therefore, asserted that local manufacturing, in addition to increased supply chain capacities, would be critical in health system resilience and advance universal health coverage goals.

Our board leaders further highlighted the plight of fragile countries referred to as challenging environment countries. A total of 13 out of 29 countries come from our two constituencies. This year, the African delegation for the Board Meeting was marked by the high presence of COE and ASP countries facing many challenges due to the instability in their countries, which could cause significant disruption to efforts to tackle the three diseases. In his opening remarks, Dr. Mbungani highlighted the need to draw attention to these countries and their policies to ensure accountability of resources and save lives. Similarly, Mrs. Mochache emphasized the need for realistic expectations on co-financing.

The African board leadership called upon the Global Fund to do two things. First, review the Additional Safeguard policy applied in most countries under Challenging Operating Environments to ensure the policy is fit for purpose and, secondly, ensure coherence between this policy and all the other policies that apply in those countries. On the other hand, the African leaders reiterated their commitment to zero tolerance for corruption while focusing primarily on value for money to ensure impact across the three diseases. The African leadership further encouraged the global fund Secretariat to work with local accountability institutions – such as supreme audit institutions (SAIs) and anti-corruption commissions (ACCs) – to prevent fraud since they better understand the lay of the land and can better uphold fiduciary integrity.

On financing, while acknowledging the importance of domestic resources in advancing sustainability and transition goals, the African board members called on the Global Fund to have more realistic expectations on co-financing. This is specifically against the backdrop of increasingly constrained economic environments fueled by the Russia-Ukraine war, energy and food crises, inflationary pressures, debts, and conflicts that negatively impact country fiscal spaces. The leadership also acknowledges that the ongoing health financing dialogues happening in some countries are potentially increasing and potentially increasing domestic resources for health in countries.

Finally, the African representatives joined the rest of the board leadership to bid farewell to the outgoing board chair, Dr. Donald Kaberuka, and Lady Roselyn Morauta, who provided strong leadership during the COVID-19 pandemic, developing the 2023-2028 strategy and the 7th replenishment drive. They pledged to support the incoming board Chair Lady Roselyn Morauta and welcomed the incoming vice chair Ms. Bience Gawanas who will serve for three years.

Aaron Mulaki