As Pope Francis approached, coming up the stairs in St. Peter’s Square, Vatican City, Stefano Vella readied himself for the moment. He may have been waiting for two hours on a chilly morning, but as that handshake drew nearer, Dr. Vella knew it was going to be momentous, a milestone in his decades-long career in global health.
He had accompanied Mark Dybul, the Executive Director of the Global Fund, to thank the Pope for his work supporting the world’s poor, including those affected by HIV, TB and malaria.
Dr. Vella, a distinguished researcher in the HIV community, knows not to take such passing opportunities for granted. He recalls meeting Nelson Mandela during the July 2000 AIDS conference in Durban, South Africa. That conference became a turning point in the HIV epidemic, thanks to a speech by Mandela that galvanized the world into global action. Dr. Vella was the lead organizer for the conference.
Dr. Vella has had an incredible global health career. An extremely warm and generous man who punctuates conversation with the refrain “my friend,” he was appointed in March to be Vice-Chair of the Board of Friends of the Global Fund Europe, in charge of Italy, as part of the expansion process undertaken under the leadership of Chairman Laurent Vigier and Executive Director Sylvie Chantereau. Over the past year, two other Vice-Chairs have been appointed: Former Minister of Economic Cooperation and Development Heidemarie Wieczorek-Zeul, who became Vice-Chair for Germany; and Charles Goerens, Member of the European Parliament and former Minister for Development Cooperation in Luxembourg, who became Vice-Chair for European Institutions, Belgium and Luxembourg.
Dr. Vella sees his new responsibility as coming home. Clinicians and AIDS researchers like him working in the early years of HIV gradually realized that the disease called them to go beyond being scientists. They had to become advocates.
Dr. Vella was on the panel that wrote the 1996 guidelines for HIV treatment, launching a new way of fighting HIV that has saved many lives. It was an historic moment in HIV science, but it disturbed him that these advances were not reaching many poor people. “It was an injustice,” he said.
That called for action. “We needed to go to Africa,” he said. As President of the International AIDS Society at the time, he was instrumental in convening the AIDS conference of 2000 in South Africa. It was a controversial decision. Many objected, for political, logistical and security concerns with 12,000-14,000 attendees. Dr. Vella and his team knew it would be hard to pull off. But they also knew it was the right thing to do. “Too many people were dying in the global South,” he said.
Dr. Vella attributes his passion for pursuing justice to his parents. His father was a resistance fighter in World War II, battling the invasion of the Nazis and the Fascists in Rome, and maintained a lifelong commitment to fighting injustice.
In his new position at Friends Europe, Dr. Vella hopes to articulate the sense of injustice that is still present around the world, not just in HIV but across global health. He aims to engage policymakers and ordinary Europeans, impressing upon them that better health for the world is better health for Europe. He hopes to reach out to the people of Italy, inviting them to play a part in helping reduce inequalities in the world. A photo exhibition that opens in Rome this week is just one avenue to a larger cause. Dr. Vella believes that using the successful model developed by the AIDS community as a roadmap can point everyone toward reducing inequality. The world must pursue that path, he said: “It is a human rights issue.”
Education as a Multiplier
Linda Mafu and Feven Haddis know first-hand the importance of having strong woman mentors.
Feven Haddis never forgets that her mother’s education ended at the age of 11 when, out of necessity, she went to work. Feven’s mother was determined that her four children would have an education, a springboard out of poverty.
The transformative impact of learning was fresh in Feven’s mind during a Bank of America female mentoring program, Vital Voices, held in Johannesburg this month. “Sending us all to school was very tough, but she fought hard because she believed that if a girl has a chance through education, she can change the world,” Feven said as she attended the program.
It is working. Feven is multiplying the social benefit of her individual education. Her undergraduate and post graduate study helped her into a position as the global communications manager of Hamlin Fistula, an organisation based in Addis Ababa, Ethiopia, that is dedicated to treatment and prevention of childbirth injuries. She also published a book on the pivotal role women ought to play addressing political and economic problems in Africa.
Her mentor this week was Linda Mafu, who leads Political and Civil Society Advocacy at the Global Fund. Mafu says with more role models and mentoring, women like Feven will emerge to lead the effort in ending AIDS as an epidemic. “The girls are the first ones to lose out when it comes to education. We need to find a way as a community to keep our girls in school because it contributes to prevention of gender-based violence, prevention of HIV.
“When you sit down with them and say, ‘I grew up in a township like you, I was faced with some of these challenges, but I managed to move forward in my life,’ it gives them hope. That is what we are doing here.”
A Strong and Reliable Partnership
Cornelia Richter, GIZ Management Board member, with Mark Dybul, Executive Director of the Global Fund. Standing in second row are Immanuel Gebhardt, Director of the Department Contracts, Procurement & Logistics; Günther Taube, Director of the Division for Education, Health, Social Protection and Christoph Benn, Director of External Relations at the Global Fund.
A high-level delegation from the German international cooperation, GIZ, visited the Global Fund this month to explore ways to strengthen partnership. Led by Cornelia Richter, Executive Board member, the team talked about aligning strategies and collaborating to build resilient health systems. The Global Fund partnership recognizes the pivotal role of strong health systems in preventing and treating HIV, tuberculosis and malaria, with beneficial effects for the response to all diseases. Germany has been one of the leading donors of the Global Fund, contributing more than US$2.3 billion.
Through its BACKUP Initiative, commissioned by the German Federal Ministry for Economic Cooperation and Development, GIZ provides technical assistance to Country Coordinating Mechanisms and implementing partners, building capacity to access and implement grants. Since 2002, GIZ has supported over 560 projects in 90 countries with a total budget of €75.5 million. Interventions have focused on building capacity for good governance, financial and risk management, health systems strengthening, monitoring and evaluation, strategic assessments and facilitating the participation of key affected populations. Switzerland’s Agency for Development and Cooperation also finances BACKUP.
“We see great added value for our partner countries and their health systems if we combine and align the long standing in-country presence and capacity development expertise of GIZ with the resources of the Global Fund,” said Ms. Richter. “Together we can maximise the sustainability of our impact.”
Mark Dybul, the Executive Director of the Global Fund, added: “Our strong and reliable partnership with GIZ is allowing us to invest in the organizations, the people and the systems that promote, restore or maintain health. Working together we can end HIV, tuberculosis and malaria as epidemics.”
The visit was also an opportunity to discuss broader updates and areas of collaboration around the strategy development, the work of the Development Continuum working group, pooled procurement and E-market place, as well as sharing experience and best practices in terms of risk management. A Global Fund delegation will visit GIZ headquarters in the next months to review and agree on a set of priority countries and actions.
Evaluate and Learn
Before joining UNICEF as Chief of Health, Mickey Chopra worked as a rural doctor in the villages of southern and eastern Africa. That experience shaped his views on global health. “Focusing on women and girls has to be the benchmark for whether we are changing or succeeding,” he says. Dr. Chopra chairs the independent evaluation advisory group that is tasked with conducting the Strategic Review 2015 for the Global Fund.
For Dr. Chopra, who leads UNICEF’s work in maternal, new-born and child health, as well as immunization, pediatric HIV and health systems strengthening, the review is an opportunity to provide valuable guidance to the Global Fund’s Board as it considers how to best update its future strategy. Chopra, who has a PhD from Faculty of Medicine, University of Uppsala in Sweden, says the Ebola outbreak health crisis has put investing in health systems front and center. In this interview, he talks about the Strategic Review 2015.
What are the objectives of the Strategic Review 2015?
The Strategic Review has two main objectives. One is to review progress in implementing the Global Fund Strategy 2012-2016, which will be the first major review of the Global Fund’s transformative strategic framework. The second is to assess impact over the last decade, providing externally validated assessment of impact.
The Technical Evaluation Reference Group is responsible for ensuring independent evaluation of the Global Fund business model, investments and impact. We are trying to change the culture from an evaluation to a learning culture. We also want to build an evaluation system that is bottom-up and invest in the country’s analytical capacity. We encourage partners to conduct and improve on-going program reviews and evaluations at the country level.
How will it feed into the development of the next strategy and the next Replenishment?
We are very focused on producing a Strategic Review report with actionable findings and recommendations, which can be taken up by the Global Fund Board and the Secretariat during the development of the 2017-2021 Strategy or during preparation for Replenishment. We have focused the Strategic Review on areas of importance to the new Strategy: health systems strengthening, sustainability, human rights, gender and partnerships. The partnership model is central to the Global Fund and to work with partners is one of the central principles of the Strategic Review 2015.
How do you see the importance of investing in health systems?
The Ebola crisis in West Africa has put investing in health systems front and center. Our challenge is to use qualitative metrics that get a sense of how smart our investments are. You can argue that in Nigeria, for instance, we are investing in health system strengthening, because we invest in information systems.
But if you have only invested in a parallel information system of your NGO or your Principal Recipient, their reporting has been done better, but that may not necessarily be strengthening the integrated health information system.
The other problem with numbers is the type of investments that does not get captured. Maybe we have to focus on a few critical areas, such as supply chain, information systems and human resources, where the Global Fund has a direct impact, and measure those and give clear guidance. We need to simplify, reduce it to something people can understand, that is tangible and monitor it. It comes down to accountability and sustainability. At the end of the day if a country does not have an integrated supply chain with capacity sustainability is just pie in the sky.
Why should the response to the three diseases focus of women and girls?
When we talk about the future or sustainability it is about women and girls. They are going to be the acid test. If we can keep them educated, healthy and disease-free we have the foundation of a healthy and better society. We have to put ourselves in the shoes of women and girls in rural Africa.
Historically, they have been the last to benefit. In the past, you had a trickle-down approach: The government would introduce an intervention in the capital city and hopefully it would reach the girl in the rural village. What the Global Fund partnership can bring is starting with the rural girls and women. That is where cost-effective investments are.
How did the TERG select country case studies?
Sixteen country case studies will be conducted under main objective 1 of the Strategic Review. The 16 country case studies aim to provide a range of examples of how the Global Fund strategy is playing out across different categories of countries benefiting from Global Fund financing and will be used to collect more in-depth and qualitative information. While desk reviews will be conducted in the 16 countries, country visits will be conducted in four of these countries.
The case studies were selected to ensure a reasonable cross-section of countries, based on when they submitted their concept note, impact, risk, regional balance, joint HIV-TB concept notes and strategic interests such as health system strengthening and sustainability. The countries selected for case studies are Nigeria, DRC (country visit), Sudan, Ethiopia (country visit), Tanzania, Zimbabwe, Myanmar, Indonesia, Pakistan, Thailand (country visit), Burkina Faso, Rwanda, Kazakhstan, Moldova (country visit), Ukraine and Haiti. In addition, the Strategic Review will analyse existing documentation, such as program reviews done in countries and various data reported to the Secretariat by implementers.