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Importance of Global Alliances/Funds to CORE Members

Nils Daulaire (Global Health Council)

In the past 100-150 years there has been an evolution in the way we think of our engagement with the health needs of the “south”, with basically three stages. First, there was missionary engagement, using a “moral” conceptual model, meaning we do it because it is the morally right thing to do.

Increasingly, we came into a period similar to “imperialism”, as nations looked to extend their influence and domination, using a conceptual model of “command”.

While we still see both models used in global health by governments and many health organizations, we are under a major transition, which really took off in the 1990s, of globalization. On a macro level, this conceptual model is partnership. It is not always viewed this way, but it is an inter-twining of elements of cultures and societies, opening up many options, if directed.

What has opened up globalization? We are not talking about affecting hundreds or thousands, but billions of human lives, on a tremendous scale. It is as if a giant banquet table has been laid, and the whole world is at the table. All the resources, the richness of those cultures, and their challenges, are out on the banquet table.

The first to come to this table was the business community, which recognized that globalization offers the opportunity to make not millions but billions of dollars-- an immense profit potential. Much of what we see today in the protesting of globalization is actually protesting private sector control over many aspects of globalization. This era is ending now and the next ten years should exhibit a more balanced control of globalization. There is still massive resource extraction going on now under the globalization rubric, though.

Here we as a civil society are the last at the table.

Globalization opens up vast opportunities for us. We have strength in numbers, in holding an important seat at the table.

Within globalization, new partnerships have emerged. To have a real effect in today’s world demands partnership. New institutions have been established, the global partnerships, also called global alliances. One of the first major ones, established in 1998, was GAVI, which was very different from previous efforts of UNICEF or WHO alone--it was a partnership going beyond government or multi-lateral agencies, with the Gates Foundation as the largest contributor to the fund. GAVI was also a conceptual model that recognized that private business had to join UNICEF and the familiar partners in making investments in new vaccine research and production; and that besides host governments, service delivery organizations needed a voice dealing with the delivery side of GAVI. These different sectors all have a role to play to get children immunized: with new discoveries which have to be made, in delivery of vaccines in a time-bound manner, etc.

Since then, we have seen the global alliance for tuberculosis drug development, which is more narrow, yet involves private industry, recognizing that the enormous cost of developing new drugs does not work well for populations without the money to buy the drugs (called “market failure”). In this kind of situation, without incentives being brought in, pharmaceutical companies would not be participating. The engagement of civil society here has been more limited: MSF has been somewhat involved delivering some drugs to populations, but this alliance has not been that of a whole partnership involving all needed partners.

The Global Fund to fight AIDS, tuberculosis, and malaria (Global ATM) is a major potential factor in the way we all will work. It was conceptualized about a year ago, having germinated for the previous two years at G-8 meetings, at WHO, and among people in the world AIDS community. It chrystalized in April 2001 with a speech by Kofi Anan in Africa in which he called for the creation of a new fund which would not be within a U.N. agency, but follow the new model of private/public partnership--an alliance--which would generate and employ up to $10 billion a year to fight these major killers. The fund was driven by growing attention and concern by the growing AIDS epidemic, and from there grew to encompass malaria and tuberculosis.

From a year ago when the fund was announced, we first had a statement from President Bush that $200 million would be made available out of the United State’s Foreign Aid budget; then additional governments made large commitments; then in July 2001 the G-7 meeting in Italy jointly contributed nearly $1.5 billion to the fund. In all, developing a Letter of Credit was a very short process.

Deploying this level of resources is a remarkable challenge. The next six months were devoted to setting up deployment processes, and a secretariat was set up in Brussels. Interestingly, while two elements were recognized (government, private sector), it has taken considerable effort for civil society (e.g. NGOs) to have and continue to have a seat at the table. The GHC sent a staffmember last fall to ensure that NGOs had a continual presence while the fund was being established, so that NGOs, civil society, international groups, indigenous groups, etc., are partners.

What we got out of that whole process was half a loaf (better than no loaf): two out of 17 board members came from civil society, one from the north and one from the south, out of a proposed 4-5 civil societymembers-- but this is an entry point.

The Board of the Global Fund is meeting right now in N.Y. to do its first allocation of resources. Initially this amount was $1.5 billion. By January 2002 there was a commitment of $2 billion (over the whole program—what happens each year is evolving). The plan is that $700 million will be programmed this year. Within the next few days there will be announcements of about $140 million in allocations. Some people think this process has been slow, while others think it is miraculous in its blinding speed.

For PVOs, for organizations working in the field right now, the principle window for funding is by means of a national proposal for funding from Country “x”. The preferred mechanism is that Country “x” will have worked with technical agencies, with outside agencies with expertise working with disease issues, with its own civil society, to have put together a funding plan. The reality is much short of this. Many proposals are being prepared by turn-key consultants, and with a month turn-around for a $50 million proposal there is not much room for engagement.

For the long-term, our attention needs to move here. All in this room have programs in eligible countries, and most if not all have insufficient funds for infrastructure, for drugs, or for other major required elements. This is a whole new window to expand your scope and activities, yet it is not just “going to happen”. The path of least resistance is for the governments to put the money into their own health services. You must ensure you have a seat at the table nationally, and that your organizations work at the international level to engage with CORE, with GHC, and with others to ensure that the voice of civil society is heard loud and clear on this. The first at the table do very well. The risk is that with these new global funds, lots of money will be sunk into ineffective health systems for salaries and per diems that do not translate into services.

We also have a role to report back on what is done with this money. This feedback route can be very helpful and more informative that the shorter feedback loop through the country.

We have a couple of seats set for us at this banquet table, and there will be a lot of resources--whether it is $1-2 billion or $10 billion a year it is still a lot of funding. Much of it will go into USAID. At GHC we work to ensure that Peter does not rob Paul by moving money into this from taking from somewhere equally important. The point is not to say that funds should go elsewhere besides the Global Fund, but to lobby actively that these funds are additive, and wisely spent.

There were concerns in the first year of the new administration as to whether civil society would have a seat. The representatives of the U.S. played fairly important roles as can be expected, and the feedback we have received from colleagues in other countries is that the U.S. has been pushing for larger roles for international PVOs and indigenous NGOs, which is in sharp contrast to many European countries who pushed for government-to-government funding. This is a very helpful sign, and we want to build on this.

Continuous pressure is needed, yet you all have programs to run. This is where working as an alliance is so important: what we can do as a group by pooling our resources far exceeds what any one individual organization can do. There are vested interests, and which organization receives funds affects individual organizations of course, but at the GHC we are pushing for civil society as a whole, and to increase the funding for global health. The government is now putting double the money into global health than occurred in 1998. GHC would like to raise this to$5.5 billion a year over the next few years.

Finally, in terms of advocacy, there is an important joint role for all of us to play. When speaking with Members of Congress, those with hands-on experience can be more persuasive than a macro-economist, talking about what happens at the community level, e.g.“reality testing”, which is a very strong advocacy tool that GHC is increasingly learning to use. CORE and others belong to the U.S. Coalition for Child Survival, and with all the attention on AIDS and infectious diseases, we do not want to forget children. Issues needs to be raised in concert. There was an op ed in last week’s “Washington Times” aimed at conservatives in Congress, building on Senator Jesse Helms’ call for $500 million to fight mother-to-child transmission of HIV/AIDS, and calling to broaden this to meet the needs of mothers and children more broadly. This all works together.

We can expect to see an explosion over the next five years on ways to really help people. This is no longer a back-burner issue. Top-level reporters are writing on these issues now. We really must seize on these issues and opportunities.

Nils Daulaire is president and CEO of the Global Health Council, the world’s largest membership alliance dedicated to advancing policies and programs that improve health around the world. The Council has built a global coalition that promotes improvement and equity in health for all the world’s citizens. “The Global Health Council,” says former President Jimmy Carter, “is helping people to secure their very freedom, for without health other freedoms cannot be enjoyed or cherished.”

Before assuming leadership of the Council, Dr. Daulaire served as the Clinton administration's Senior International Health Advisor. While in this position, Dr. Daulaire developed an integrated global strategy that encompassed programs totaling over $1 billion annually. His efforts, according to former USAID Administrator J. Brian Atwood, “have had an immeasurable impact on people’s lives around the world. Through his leadership global health is now understood to be a critical element of sustainable development.”

As the U.S. government's top international health expert, Dr. Daulaire developed close personal relationships with health and political leaders around the world. He was the lead U.S. negotiator on health at the Cairo International Conference on Population and Development in 1994, the Beijing World Conference on Women in 1995 and the Rome World Food Summit in 1996. He represented the U.S. at five World Health Organization (WHO) Annual Assemblies.

“For years Nils has been on the front lines in the effort to improve health conditions in the world’s poorest countries,” said Dr. Gro Harlem Brundtland, Director-General of the WHO. “Now, under his leadership, the Global Health Council has become a vital partner within the world health community.” A Phi Beta Kappa and summa cum laude graduate of Harvard College, Dr. Daulaire received his M.D. from Harvard Medical School in 1976 with residency training in family medicine at the University of Colorado. He received his Master’s in Public Health from Johns Hopkins University in 1978. He is board certified in preventive medicine and public health, and is a Fellow of the American College of Preventive Medicine. Dr. Daulaire's two decades of fieldwork in maternal and child health has included five years’ residence in Nepal, where he served as the senior health advisor to the Ministry of Health. He has also served in Mali as a technical advisor on primary health, and has worked extensively in Haiti, Bangladesh, and other low-income countries. He has provided technical assistance to more than 20 countries in all the regions of the world, and speaks seven languages. Dr. Daulaire’s research interests focus on child health and survival. He has directed multiple child health research projects in the field, including a pioneering study on community-based management of childhood pneumonia that proved the feasibility and mortality impact of this approach (Lancet, 1991). He has also carried out widely cited research on the child health and survival benefits of Vitamin A supplementation (BMJ, 1992).

Nils Daulaire has testified before Congress on numerous occasions and has appeared widely in the press and on television and radio.