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GFATM
How GFATM should be managed

Global Fund for AIDS, Tuberculosis and Malaria
One of Feachem's challenges
From 2002 ... Peter Burgess to listserve about GFATM

Peter Burgess COMMENTARY
The listserve exchange that follows took place in 2002 early in the life of the new Global Fund for AIDS, Tuberculosis and Malaria (GFATM). From the responses it suggests that my views are shared by others ... but sadly, not by most of those that control the process and make important decisions.

I learned engineering as a student, and in engineering there is no place for opinion, it is all about hard facts and calculations. Later I learned some economics and was appalled by the power of statistics to demonstrate correlation, but rarely to show causality. Later I became an accountant, which, like engineering starts off with some pretty hard data about economic activity, or at least the money dimension of economic activity.

When I wrote the message below, I had experienced the unbelievable sloppiness in money accounting that was the norm in the UN, the World Bank, USAID and throughout most of the official relief and development assistance (ORDA) industry. While most of these organizations had the ability to match petty cash vouchers with petty cash disbursements, when it came to the big fund lfows they seemed to lose track of everything extremely fast. My generation of accountants tended to learn how to 'connect the dots' and in so doing to learn where the funds were going in reality rather than where some superficial report said they were going. This explains how there are very rich people in very poor places. Money is a bit like water, when the pipe leaks the water disappears ... when the accounting process is poor, the money leaks in exactly the same way.

The subsequent performance of GFATM was decent to poor both in terms of its control over resources, and the actual effectiveness of its programmes. The process they have used is based on a UN model which was rarely particularly good. The only thing that can be said for it was that the insiders knew the process ... which actually enabled poor performance without any fear of accountability.

In the decade or so since this was written, there have been many examples of massive leakage of huge fund flows ... notably by the US authorities in Iraq and Afghanistan. It is almost impossible to visualize the scale of the money flow leakage and the almost total lack of accounting and accountability. I am disgusted ... and for obvious reasons sidelined when it comes to addressing the systemic issues that should be addressed.
Peter Burgess
http://www.afrifund.com/wiki/index.pcgi?page=DDIssueAccAccaae

GF: One of Feachem's challenges

To: 'BTS'
Subject: GF: One of Feachem's challenges
From: 'BTS'
Date: Mon, 29 Apr 2002 19:10:21 +0200
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Dear Colleagues

I would like to congratulate Dr. Richard Feachem on his appointment as the Executive Director of the GFATM. I wish him well as I am sure everyone else with concern over the Health and HIV-AIDS crisis must do.

The challenge facing Dr. Feachem is enormous. And it may be that the challenge is actually such that success is impossible.

Observers of the international official development assistance (ODA) community, of which GFATM is now a part, have a great concern that the resources available will be managed effectively. We know that the processes used in the ODA world to plan interventions and allocate funds and control expenditure and to monitor and control have been ineffective more often than they have worked well. And this has been going on for two or three or more decades. The changes have been frequent, but generally superficial.

The main systems and business processes used by the official development assistance (ODA) community have a focus on procedure and not too much on performance. Even though there has been massive resource mobilization for emergency and development over the past decades, the results are now measured more in the amount of accumulated debt rather than major improvement in the quality of life.

The resources that have already been made available to the medical and the international community to address health and HIV-AIDS issues have not yet produced anything like the results that should have been expected. Already many billions of dollars have flowed into work associated with the health and HIV-AIDS crisis, but not very much has been delivered to the people who are suffering and the affected communities.

It is absolutely apparent that performance in the use of scarce resources can be improved enormously, but requires much more focus on performance and much less on procedure. The Executive Director of the GFATM has the possibility to make a substantive change in the performance realized by the use of GFATM funds.

The ATCnet view is that funds need to go much more to programs that deliver benefits to those that are affected, and less to the overhead and oversite of programs, and to studies that confirm what is already known. Some work, however, needs to be done on what we do not know, and from our perspective, we know very little about what is happening in remote rural communities in Africa (and other developing areas). Conversely, these rural remote communities are also terribly unaware of the health and HIV-AIDS crisis that has engulfed the developing world, especially in Africa.

We have been disappointed that the initial procedures for use of fund resources are predicated on a GFATM-to-Government arrangement. This is understandable, but the use of funds effectively under this procedure needs to be studied with care. There needs to be a strong system of performance assessment and total accountability. Under the GFATM-Government arrangement it is difficult to ensure that funds are allocated to programs that are working, not to programs with great objectives that are failing.

The flows of funds into the pipeline for health and HIV-AIDS, and the other killer diseases ...... should actually come out doing excellent work in the area. This is something that certainly cannot be said to have happened with a lot of the HIV-AIDS funding that was mobilized in the US for these purposes. The GFATM should get engaged in the issues surrounding the massive publicly funded investment in research and the immensely costly therapies that were the corporate response to available funding.

I know from my corporate experience over a period of almost 20 years that major performance improvement is possible based on systems and process changes and a concentration on strengthening what is essential and what works. The results are immediate and also serve to satisfy strategic goals. I hope this will be on the agenda of the GFATM.

My development and emergency consultancy experience also for about 20 years has shown that amazing results are possible when people are motivated to perform, and the priorities are based on the needs of families and communities that are the intended beneficiaries. Many years of exposure to development and emergency shows how often we (the NORTH and the ODA community) implement value destroying activities, and then we are concerned about debt repayment having a higher priority than funding health and education and human services. I hope this concept will be understood by the GFATM.

But few are as disappointed as I am at the terrible performance of development and emergency interventions over the past twenty or thirty years. This is not about bad lazy people ...... the problem is great people working very hard in institutions and organizations that have become slaves to ineffective systems and processes and procedures. It is time we broke out of this vicious situation, and created a virtuous loop of positive feedback based on accountability and performance criteria.

ATCnet is working in the information dimension for development .... and the effective use of ICT and database technology to enable much more informed decision making in development. This is especially critical at any time when resources are limited and the work to be done is huge.

Thank you. Good luck

Peter Burgess

T. Peter Burgess
VP and CFO ATCnet
New York USA
Tel 212 772 6918 Fax 707 371 7805
website: www.atcnet.org
email: profitinafrica@aol.com / hivaidsstories@aol.com

[This piece has been cross-posted from ID21’s current time-limited discussion on: Delivering HIV treatment in developing countries – an online discussion. For information: hiv@lyris.ids.ac.uk]

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GF: Re: One of Feachem's challenges

To: 'BTS'
Subject: GF: Re: One of Feachem's challenges
From: 'BTS'
Date: Tue, 30 Apr 2002 19:33:24 +0200
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Two responses to Peter Burgess’ message of yesterday...

1. Richard Mahoney
2. Ishrat Husain

Richard Mahoney
***************

Colleagues,

Peter Burgess' comments are very important and thoughtfully presented.

I believe there is a sound basis for optimism with the GFATM especially under the new leadership of Richard Feachem. There have been some marvelous successes in the last few decades in public health. Of greatest note are the successes in family planning and immunization. Use of fertility control technologies and delivery of safe and effective vaccines have helped billions of couples to have the number of healthy children they want. Both of these successes, which certainly face continuing challenges, were achieved with beginnings in the early 1970s. While there is no room for complacency and every need for urgent action, I think enough lessons have been learned from the population and immunization fields to serve us well for achieving success with the GFATM.

There are few people who know these lessons as well as Richard Feachem.

Richard Mahoney
International Vaccine Institute
Seoul, Korea
Email: rmahoney@yahoo.com
Ishrat Husain
*************
I totally agree with Mr. Burgess that proper and effective use of funds is an enormous challenge. I have been in development field for over three decades. Much of the failure of development assistance can be attributed to management problems and yet very little is done by the development community in a concerted manner. The best that has been done is the visit of a few management consultant or a few management studies. We all have learnt that good management of resources require a change in culture and the acceptance of changes in the way business is done. Thus changes have to be generated from within the system.

A number of examples of sound management of resources by dedicated Africans exist. Yet these have not been replicated or recognized. Similarly, there is a model that is being developed and successfully implemented by the University of Natal in the education sector. It helps the Ministries improve the use of existing and new resources by addressing the systemic issues themselves.

A concerted effort to help countries improve and strengthen the use of resources is the single most important program the donor communities can help countries undertake.

Ishrat Husain
Email: ihusain@afr-sd.org

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