Presentation on Creation of The Global Fund To Fight AIDS, TB, and Malaria Paul Ehmer

1. Climate Finance From Cancun To DurbanInformal Meeting of Climate Finance NegotiatorsNew York City 2-3 February 2011 Presentation on Creation of The Global Fund To Fight AIDS, TB, and Malaria Paul Ehmer Team Leader, Technical Support Secretariat (TSS) August 2001-February 2002

2. Transitional Working Group (TWG)and the Technical Support Secretariat (TSS) August 2001 – February 2002 Brussels, Belgium; Geneva, Switzerland • TWG – “Proto-Board” composed of 45 official delegations • TWG Chaired by Dr. Crispus Kiunga, Minister of Health, Uganda – “vetted/endorsed” by UN Secretary General, Koffi Annan • TSS – Secretariat support • organize series of three meetings in Brussels of TWG (Oct/Nov/Dec 2001) • TSS led by Paul Ehmer, seconded from USAID, eventually with 19 staff seconded by other partners – also vetted/endorsed by UN Secretary General, Koffi Annan • Global Fund Created January 29, 2002, following incorporation in Switzerland and first Global Fund Board meeting in Geneva

3. Technical Support Secretariat (TSS) • Support provided by partners: • United States Agency for International Development (USAID) • Belgium • UK, France, Italy, Denmark, Ireland, Norway, Japan • WHO • World Bank • GAVI • UN Development Group • Global Health Council • Staff from: US, UK, France, Italy, Japan, Belgium, Thailand, Kenya, South Africa, Uganda, Nigeria, Brazil, Belgium, Germany, Ghana

4. Structure of Framework DocumentGF “Constitution” • Section I: The Title • Section II: Purpose • Section III: Principles • Section IV: Scope • Section V: Financing • Section VI: Country Processes • Section VII: Eligibility Criteria • Section VIII: Application Process • Section IX: Monitoring Program Progress • Section X: Fiduciary Responsibilities

5. Global Fund Purpose • The purpose of the Fund is to attract, manage and disburse additional resources through a new public-private partnership that will make a sustainable and significant contribution to the reduction of infections, illness and death, thereby mitigating the impact caused by HIV/AIDS, tuberculosis and malaria in countries in need, and contributing to poverty reduction as part of the Millennium Development Goals. • Agreement on this Purpose Statement essentially took two to two and one half days of the first three day TWG meeting • The rest was spent discussing language issues – would the GF do its business in English, French, Spanish, etc, or would English be the language?

6. Global Fund Framework Document Global Fund Founding Principles A. The Fund is a financial instrument, not an implementing entity. B. The Fund will make available and leverage additional financial resources to combat HIV/AIDS, tuberculosis and malaria. C. The Fund will base its work on programs that reflect national ownershipand respect country-led formulation and implementation processes. D. The Fund will seek to operate in a balanced manner in terms of different regions, diseases and interventions. E. The Fund will pursue an integrated and balanced approach covering prevention, treatment, and care and support in dealing with the three diseases. F. The Fund will evaluate proposals through independent review processes based on the most appropriate scientific and technical standards that take into account local realities and priorities. G. The Fund will seek to establish a simplified, rapid, innovative process with efficient and effective disbursement mechanisms, minimizing transaction costs and operating in a transparent and accountable manner based on clearly defined responsibilities. The Fund should make use of existing international mechanisms and health plans. H. Proposal Criteria – funding decisions to be based on best practices; political involvement and commitment; support substantial scale up; use existing regional and national programs; focus on performance; create government/private/NGO partnerships; participation of communities and people with diseases; follow international law and agreements; priority to the most affected countries; fight stigma and discrimination

7. Global Fund Comparative Advantage • Financial Mechanism, NOT Development Agency or Technical Assistance Provider – no country presence • Developed concept of Country Coordination Mechanism (CCM) – Develops proposals and Oversees Implementation • Proposal development field driven – no central or global strategy • Review and approval of proposals based on technical merit – Independent Technical Review Panel (TRP) of technical experts • Performance-based funding – emphasis on impact and results

8. Global Fund Board Governance • Principle of equal representation • Donor/recipient; Developed/Developing) • Voting Members (20) • Donors (10) • US; Japan; Italy; France/Spain; UK/Australia; Canada/Germany/Switzerland; Point Seven (Norway, Denmark, Ireland, Luxemburg, Netherlands, Sweden); EC (Belgium, Finland, Portugal); Private Foundations; Private Sector • Recipients (10) • Eastern Europe/Central Asia; Eastern Mediterranean; East and Southern Africa; West/Central Africa; Latin America/Caribbean; Western Pacific; Southeast Asia; Communities with Diseases; Developed Country NGOs; Developing Country NGOs • Ex-Oficio (non-voting) Members • UNAIDS; WHO; World Bank (Trustee); Swiss Representative; Secretariat • Developed Country Delegations (10) • Developing Country Delegations (10)

9. Issues (1) • GOVERNANCE (1): Commitment to balanced and equal partnership between donors and recipients • Reflected in Board structure • Donors don’t call the shots • PARTNERSHIP: Government versus civil society at country level (Country Coordination Mechanism - CCM) • Partnerships emphasized and not government control • PRIVATE SECTOR: --involvement vs traditional mistrust between public and private sectors – private sector still not large donor as expected • LANGUAGE: --English best workable alternative to multiple UN-type approach • SECRETARIAT: Structure, Location, and Support • Tradeoffs between quick action and more independent approach • WHO administrative support in Geneva vs more independent approach that might take longer and require more organization for administration and management

10. Issues (2) • TRUSTEE: Who holds the money – World Bank chosen for ease of administration and other similar experience • ACCOUNTABILITY: • how to assure at country level with no country presence; • development of the “Local Fund Agent” (LFA) – programmatic issues remain • GOVERNANCE (2): • Board still weak in terms of NGO representation, but better than other mechanisms (3/20) • Private Sector participation still weak (1/20) • COUNTRY-LEVEL PARTICIPATION AND DECISIONMAKING: • Government insistence of control vs NGO, Private, and Other Partner p • Country Coordination Mechanism (CCM) designed to deal with this • FINANCING MECHANISM • No need to replicate existing technical/development partners • Remaining issues then of how to provide technical assistance to ensure quality proposals

11. THANKS MEMBERS OF THE TECHNICAL SUPPORT SECRETARIAT (TSS) • Moses Aiken Economic Analyst; (Ghana); funded by WHO • Ann Duncan Fiduciary Liaison; (US); funded by World Bank • Shyla De Klyppele Assistant; (Belgium); funded by TSS • Paul Ehmer Team Leader; (US); funded by USAID • Lisa Jacobs Public Relations Coordinator; (US); funded by GAVI • Macharia Kamau Strategy and Policy, (Kenya); funded by UNDG • Churnrurtai Kanchanachitra Southeast Asia Liaison; (Thailand); funded by TSS • Ginevra Letizia NGO liaison; (Italy); funded by Italy • Ray Mabope Africa liaison (East and Southern Africa); (South Africa); funded by TSS • Arnaud Marty-Lavauzelle NGO liaison; (France); funded by France • Sophia Mukasa Monico NGO/Community Liaison; (Uganda); funded by TSS • Abdul Nasidi Africa liaison (West and Central Africa); (Nigeria); funded by TSS • Mary Partlow NGO relations; (US); funded by Global Health Council and TSS • Willis Ritter Legal Advisor; (US); funded by the TSS • Yoshiko Saito East Asia liaison; (Japan); funded by Japan • Martin Taylor Strategy and Policy; (UK); funded by DFID • Guido Torelli Finance and Operations; (Italy); funded by WHO • Nemora Tregnago Latin America liaison, (Brazil); funded by TSS • Laurence Vercammen Administrative Assistant; (Belgium); funded by the TSS • Melanie Zipperer Communications and Public Relations; (Germany); funded by WHO • Note: support (cash funding, and in-kind) for the TSS provided by the United States, UK, Italy, Belgium, Ireland, Denmark, Norway, France, Japan, GAVI, Global Health Council, UNDG, the World Bank, and WHO.