Mark Dybul, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, on why now is a critical time to get infectious diseases under control.
Every era offers something special. I think the most special thing about our current time is the incredible opportunity that scientific advances have provided in the field of global health, giving us the ability to completely control highly dangerous infectious diseases such as AIDS, tuberculosis and malaria. The recent progress is breathtaking. If we can harness the funds needed, we can essentially take these diseases off the table as threats to greater development.
Timing is critical. If we do not start to act this year, we may miss that opportunity. As we have learned with other infectious diseases, when you have a window of time to control the spread of a disease, you must take action or else face the risk that the disease finds new forms that are far more complex and expensive to defeat. When that happens, all the investment made so far is effectively lost. We need to redouble our efforts this year to make sure we are raising the money we need to get this work done. We need to make a big push, to secure the funding we need.
Those of us who work in global health know that there is no greater investment in the world than in prevention and treatment of these terrible diseases. When health professionals working in cities, towns and rural areas in countries around the globe can take action to actively limit the spread of infectious disease, everyone benefits. Not just the patients, who maintain or regain their health, and not just their families that are immediately affected; it is also the larger communities and regions and countries whose economies and social fabric thrive on a healthy population.
It is a great privilege at this moment in history to be joining the Global Fund to Fight AIDS, Tuberculosis and Malaria as its new Executive Director. It’s exciting to have the chance to lead this remarkable institution at this time. I am determined to do all I can to help the Global Fund fulfil its mission of investing the world’s money in a way that enables health workers to save millions of lives.
Paradoxically, just at the time when we are making such broad scientific advances in fighting these diseases, we also face global financial constraints. That makes it challenging to take full advantage of the new science. But I am convinced that we can, and must, rise to the occasion. To do so, we must make several moves.
One, we must make our money count. “Value for money” is a term that investment advisers like to use when talking about traditional financial transactions. Investing in health is actually better value for money than almost any investment imaginable. When you can prevent the spread of malaria and save the lives of millions of young mothers and children with mosquito nets that cost a few dollars, that is an outstanding investment. When you can keep a man or woman with AIDS alive on drugs that cost US$ 125 a year, compared with US$ 10,000 a year just one decade ago, that is an outstanding investment. Great investments are effective, and efficient. To raise the money we need for global health, we need to demonstrate to everyone that this money is put to excellent use.
Two, we need to focus on impact. Building impact-measurement into the way that health interventions are designed helps health professionals ensure they are getting value for money. The highly effective grants in the Global Fund portfolio – such as those treating malaria in Ethiopia and HIV in South Africa – focus on impact from the start. Getting managers to consider impact helps programmes prioritize activities, identify risks and steer investments toward gaps in coverage. And then measuring impact once a programme is underway is important, too. It is good management to know about impact and to evaluate and integrate it into operations. Donors to global health efforts need to know what impact their investments are having, and need to assure taxpayers that their investments are effective.
Three, we have to combine every evidence-based approach that works to prevent the spread of disease. For HIV, for example, there are anti-retrovirals for prevention both for HIV-positive and for HIV-negative people; there is medical male circumcision; there are condoms; and there is behaviour change. No single effort will get the disease under control. And what works best in one country might not be best in another. So we have to use a combination approach, and we have to support countries as they design programmes that they know will be most effective.
Four, we must be accountable and transparent. There must be no question that money invested in global health projects is reaching its intended targets, and that the spending path is fully traceable. Any financial institution has to be concerned about the danger of the misuse of funds, and must chase down any misuse aggressively. At the Global Fund, we have an independent, well-resourced and strong Office of the Inspector General that conducts audits and investigations to provide assurance that grants are administered properly, and then publishes the results openly. No losses are acceptable, but the Global Fund openly reports its results and in 2012 found that 3.0% of its audited and investigated grants had been misspent, fraudulently misappropriated or inadequately accounted for. Only 0.5% was due to fraud.
Five, we have to work together. The Global Fund is an organization that from its founding has relied on technical partners, to make sure that programmes it supports are technically sound. We work closely with civil society organizations and with advocates of public health, who are essential to our success. We also work closely with bilateral organizations and with the private sector. It takes more than a village to raise healthy children around the world – it takes all of us, working together.
Six, we must always be learning. From its inception in 2002, the Global Fund has had an innovative approach to development, with a 21st century approach, constantly learning, constantly improving. The actions taken by the Global Fund in the last couple of years show that it is a learning organization. It learns, it reflects and it adapts. As a financing institution, the Global Fund will continue investing in programmes that support national health strategies, and will expect that implementers increasingly engage and focus on high value-for-money and high-impact programmes.
We have a historic opportunity to get these infectious diseases under control, which will change the fortunes of millions of lives and improve the development of many countries. With the right efforts, we can achieve truly great things. Ten years ago, almost no one thought we could make the advances against HIV and malaria that have been achieved. We need to be optimistic and open to new approaches. We also need to be aggressive while moving ahead with careful planning and skilful execution. We must not miss this chance by shying away from the challenge. We should not minimize the breadth of what lies ahead. But we know from experience that by working together, with shared responsibility, with clear mission focus, and with passion and compassion as global health citizens, these three diseases can be completely controlled and – with further scientific advancements – can actually be eliminated.
The Global Fund to Fight Aids, Tuberculosis and Malaria was launched at the Annual Meeting of the World Economic Forum in 2002.
Author: Mark Dybul is the Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria and is scheduled to participate at the World Economic Forum’s Annual Meeting 2013 in Davos.
Image: Candles are lit during World Aids Day in Jakarta REUTERS/Dadang Tri