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Diplomacy in Action

The Obama Administration's Support for the Global Fund to Fight AIDS, Tuberculosis, and Malaria


Special Briefing
Eric Goosby, M.D.
U.S. Ambassador, Global AIDS Coordinator
Teleconference Briefing
Washington, DC
October 5, 2010

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OPERATOR: Welcome and thank you for standing by. At this time, all participants are in a listen-only mode. During the question-and-answer session, please press *1 on your touchtone phone. Today’s conference is being recorded. If you have any objections, you may disconnect at this time. And now, I’ll turn the meeting over to Mr. Mark Toner. You may begin, sir.

MR. TONER: Thank you, and good morning to everyone. We’ve very fortunate to have Ambassador Goosby, who is the U.S. Global AIDS Coordinator, today with us. He is participating in the Fund’s – the Global Fund to Fight AIDS Replenishment Conference that’s taking place yesterday and today, October 4 and 5, in New York.

Ambassador Goosby will discuss the U.S. commitment to the fund, including both financing as well as working with the Fund on reforms to save more lives efficiently and effectively. This briefing will be on the record, and when we get to the press Q&A, I ask that you identify yourself and your news affiliation. And also, just – the Ambassador can only take a short time to be with us, so his time is limited.

And with that, I’ll turn it over to Ambassador Goosby. Ambassador.

AMBASSADOR GOOSBY: Thank you, Mark. Thank you, everybody, for getting on the call. I just want to make a brief statement and then go into the questions.

At the replenishment meeting today, the Obama Administration is making an unprecedented 3-year pledge of $4 billion to the Global Fund to Fight AIDS, TB, and Malaria. The pledge is a 38 percent increase in the U.S. investment over the preceding three years and is, by far, the largest increase of any donor nation this year. It will save and improve lives of those devastated by those three diseases and increase expectancies. Moreover, this pledge is linked to a firm call to action that calls upon the Fund to make needed reforms and for other donor nations to share in the responsibility of saving more lives effectively and efficiently. Simply put, we have three goals with this historic pledge.

First, we need to drive needed reforms and ensure smart, effective investments are being made. We must build upon the successes of the Fund by ensuring that needed reforms are made that will result in smart investments that save more lives. The United States is calling upon the Global Fund Board to develop an action agenda that includes clear timelines and measures, progress so all parties can be held accountable for clear action steps.

Second, we make this pledge to leverage other donor nations’ contributions. This commitment serves as a challenge to other donors to do their share to save more lives, alleviate suffering, and increase life expectancies.

Finally, this pledge shows continued U.S. leadership to the ultimate measure of success, increasing the number of lives saved. The United States was the first and is, by far, the largest contributor to the Fund, providing more than 5.1 billion to date. This pledge is part of a comprehensive approach to combat AIDS, TB, and malaria through President Obama’s Global Health Initiative.

Ultimately, this pledge will allow the Global Fund to do its job and do it better with a call for needed reforms. We are proud of our relationship with and commitment to the Fund and the work it has done over the years. This unprecedented pledge is a signal to the world that even in these difficult times, the United States is firmly committed to fighting these devastating diseases and ultimately saving more lives.

So I will open it up to the questions.

MR. TONER: Thank you, Ambassador. Pat, we’re ready to take questions now.

OPERATOR: Certainly, thank you. At this time, if you would like to ask a question, please press *1 on your touchtone phone. To withdraw that request, press *2. Once again, please press *1 to ask a question. One moment, please. And our first question comes from Amy Lieberman. Please state your affiliation.

QUESTION: Hi, Mr. Ambassador. I’m with IRIN/PlusNews. Thank you very much for this briefing. I was hoping you could first touch a little bit on the decision to make a three-year pledge as opposed to the traditional one-year pledge that the U.S. has made. And also the accountability mechanism that you mentioned, what you’re hoping that will look like.

AMBASSADOR GOOSBY: Sure, Amy. It’s a good question. We have been aware this is the first time the United States Government has participated in a three-year pledge, and I believe it is a smart change in the way we support the Global Fund. It allows the Global Fund to expose its thinking and planning to a three-year trajectory instead of a one-year.

With the United States being close to a third of the Global Fund’s contribution, this planning tool really is enhanced because of the size of our award and the ability to look at and plan what will happen in two and year three. So it’s really a planning advantage.

I also think that it allows for planning (inaudible) bilateral programs and other foundation programs to look at how they can articulate with the resources that are coming into the Global Fund over that three-year trajectory in a more specific fashion. And that allows us to increase the number of lives that we’re going to save with this effort by a shared responsibility with who contributes to that effort and allows us to, as I say, be smart with the addition and integration of all those funding lines to have the biggest impact.

The second question was – what was it, Amy?

QUESTION: The accountability mechanism you mentioned.

AMBASSADOR GOOSBY: Oh. So we are clearly gratified by the response that we’ve gotten from the executive director, the secretariat, and the board in responding to this call for reform. The secretariat indeed had started on a path of self-reflection in looking at its mechanisms of dispersal and oversight, as well as its monitoring and evaluation capabilities and had already begun an internal revision of some of these systems to make them more responsive, more rapid, and again, increase their ability to have impact at the country level.

Our focus is with the secretariat, with the administrative systems and oversight mechanisms that come from the secretariat. But just as importantly, the second area of focus is the country level, country coordinating mechanism, the ability to put those resources to ground, translate, transform the resources into program, to monitor how well their programs interface or do not interface with the populations we’re trying to serve, and to allow for a self-correcting mechanism to be part of the way that CCMs do their business; as we move from year to year, that they get better and better at improving the interface of their programs on the populations we’re trying to impact.

To do that, I would just add that we are working with the secretariat and the executive director to set up a plan that has timelines and deliverables that will allow us to know that we indeed are moving linearly with this effort and that we all – and I include all with all the bilateral efforts that are present in the 140-plus countries that the Global Fund is engaged in – that we all use our bilateral resources to also support this effort. So it affords all of those opportunities.

QUESTION: Thank you.

OPERATOR: Thank you. Andrew Quinn, please state your affiliation.

QUESTION: Hi, it’s Andy Quinn from Reuters. Ambassador Goosby, in your calls to the Global Fund, in your donation here, you have this call for reform. And I’m wondering if there’s anything sort of implicit or explicit in this by way of warning that if they don’t enact these reforms, after three years the U.S. may reconsider its funding levels.

And secondly, the headline from the funding conference overall seems to be that despite the U.S. pledge, it looks like a lot of other countries are not going to be stepping up to the plate sufficiently. What do you feel this does to the fund’s effectiveness, and what can the U.S. do to twist some arms to get the money flowing?

AMBASSADOR GOOSBY: Well, those are good questions. I think that what we really have felt is needed, because we’re in 80 of the countries that the Global Fund is working in, we see the Global Fund’s role in bringing resources to a country coordinating mechanism, as a forum have country discussion that engages both government and civil society in the CCM process. That forum, when combined as a planning mechanism with our bilateral efforts, increases our ability to share responsibility, but most importantly Andy, be smart about how we allow our resources to collapse on one another to form an additive opportunity for resources, to be additive instead of parallel, or indeed miss that opportunity completely.

With this economic period that we’re in and with our desire to aggressively save more lives by moving toward the unmet needs that are present in virtually every country we both work in, we believe that converging our planning process, our implementation process, and our monitoring and evaluation process will better position us and other bilaterals to integrate our resources with the Global Fund’s, again, to bring more people into care.

We are convinced that this is the appropriate and smartest way to move because we can already see in smaller efforts and attempts to integrate our resources that we get a bigger impact very quickly. So we’re excited about this new repositioning of the way we’re doing it.

But in responding to the last part of your question, in terms of – we are holding the Global Fund accountable to engage in these reforms. We have been gratified with the response that we have gotten from executive director, secretariat, and the board chair, and we are looking forward to moving this commitment into a tangible plan that allows for specific outcomes to be identified so we, again, know that we are moving linearly to make this better and increase our impact, increase the number of people we serve.

QUESTION: Okay, thank you.

AMBASSADOR GOOSBY: Thanks.

OPERATOR: Thank you. Jennifer Cohn, please state your affiliation.

QUESTION: I’m with WVAI. Thank you for accepting my question. So, Ambassador Goosby, since this announcement of $4 billion over three years does not actually include enough funding to reach even the lowest Global Fund funding scenario, is the U.S. actually considering this to be kind of a floor number over which they may increase funding in the coming years, especially if the reform agenda which you just spoke about is addressed and met to your satisfaction?

AMBASSADOR GOOSBY: We really tried to carefully understand what the burden of commitment was to continue those programs from rounds one through nine that we had already at the Global Fund committed to supporting, and we also feel that those resources that we have put forward in the $4 billion over three years addresses that need. At the same time, the unmet need is extraordinary. Those who have not already been brought into care and treatment services, the prevention services that have not been established as well as treatment, and both prevention and treatment for tuberculosis and malaria – these needs still sit in front of us and we are committed to working with them over the next three years and beyond.

I think that our commitment to that baseline three-year commitment is informed by the response that we get in developing a plan and moving forward with timelines with our colleagues in the Global Fund. We’re encouraged by their embracing of this challenge, but further resources above that amount would be contingent on our ability to see that linear movement.

OPERATOR: Thank you. Edith Lederer, please state your affiliation.

QUESTION: The Associated Press. Mr. Ambassador, I’ve gotten several emails this morning from NGOs that are very interested in this issue really criticizing the U.S. for not putting up even more money, saying that the 4 million – the 4 billion, three-year pledge is not enough, and at least one of them saying that they had been hoping for 6 billion. And basically the health (inaudible) sitting there saying that, quote, “It is unfortunate this President, the winner of the Nobel Peace Prize, failed to respond to the call to support multilateralism.”

I wonder if you could respond to this because I’m sure you’re going to see these responses from the NGO community as well.

AMBASSADOR GOOSBY: Well, thank you for that question. I guess I would say that there’s really no stronger supporter of the Global Fund than the United States; that’s a fact. We have put $5.1 billion into this effort over the course of our relationship. Our leadership role is shown in this new $4 billion pledge, a significant 38 percent increase over prior three-year commitments in a difficult economy. Our pledge will allow the Fund to continue making needed grants to save lives, and we looked at that on a very specific level when we came up with the amount. That percentage increase compares really favorably with all the other donors at the table.

Saving lives is our ultimate goal. That’s why we’ve also tried our – tied our pledge to what we talked about in the prior questions. And we have a shared responsibility still there to ensure that all of this – all of us involved in this struggle against this devastating disease make smart investments to continue to expand our ability to save the lives.

OPERATOR: Thank you. And once again, to ask a question, please press *1. Our next question comes from Jarrett Terrill. Please state your affiliation.

QUESTION: Hi, my name is Jarrett Terrill and I’m with South Florida Gay News in Fort Lauderdale, Florida. I just wanted to ask, in many of the nations served by U.S. funds for HIV and AIDS care, there have been problems with religious persecution and counterproductive legislation. Has there any – has there been any discussion with the Global Fund on reducing the counterintuitive involvement of religious organizations or faith-based initiatives in the process of prevention and treatment, where it is sometimes advocated that condoms are to be banned or people are sometimes jailed or killed for their personal relationships?

AMBASSADOR GOOSBY: Well, it’s a good question. It’s one that we all struggle with when we have a divergence of our norms and values with one of the partner countries.

We believe that our role there is to hold clear, hold true to what we believe in the way of access – issues of access, issues of availability of these services for all the populations that are impacted. We have been aggressive at creating strategies that often engage nongovernmental organizations to play the critical interface with the targeted population that we’re concerned about. MSMs, injection drug users, commercial sex workers tend to be left out of most medical delivery systems and all require a special sensitivity to barriers of access and to retention strategies over time.

I believe that the second component of our commitment to change those belief systems really is a diplomatic approach – engaging with our ambassadors, our senior leadership from the State Department, to regularly, when together with leadership in-country, to deal with the dissatisfaction and concern in continuing to target or marginalize these populations. We’ve been successful with this in most instances and will continue with this strategy. But I appreciate your question.

MR. TONER: Mark Toner here. I think we have just time for maybe two more questions. I know the Ambassador has to rejoin the meeting.

OPERATOR: Yes. Regina McEnery, please state your affiliation.

QUESTION: Hi. Regina McEnery from IAVI Report. Thanks for taking my question. I was wondering – I mean, you mentioned the timetable earlier in your address, and I was wondering if you could talk a bit more about the timetable that the U.S. is holding the Global Fund for in terms of – Global Fund to in terms of disbursement of funds and how this compares to how funds may have previously been spent in the past.

And then my follow-up question is: Are there any stipulations from the U.S. on how much of this $4 billion will be spent on HIV/AIDS versus malaria or TB?

AMBASSADOR GOOSBY: We are going to work together with the executive director, the chair of the board, and the secretariat to define the plan as we move forward that will include timelines and objective deliverables. That will be done jointly with them. They have embraced this reform effort and we want to work through their structural mechanisms to put the fix in place. We’re confident that this will be rapid, that it’s sincerely engaged with on part of the Global Fund leadership, and that we will have reforms that indeed address all of those issues, including disbursement time.

I would say that our ability to move resources to country and translate those resources into program is a difficult, complicated exercise, especially when you do not choose to use, as your instrument, a highly skilled and experienced NGO or university to be the conduit through which you deploy your program.

Moving to country ownership, using public sector clinics, hospitals and laboratory systems, using procurement distribution systems that are of the country afford specific challenges that we, the Global Fund, and PEPFAR are acutely aware of and have many years of engaging in and around. We all have seen the need to shorten time for allocation of resources to programs. We believe that the ability to streamline that process is already being discussed in the Global Fund. And we are adding our weight and encouragement to do it rapidly, to do it in an excellent fashion, and to make sure that we’re monitoring the outcomes to ensure that it stays corrected.

MR. TONER: I think we’ll make this the last question.

OPERATOR: And actually, I’m showing no further questions at this time.

MR. TONER: Terrific. Well, thank you so much for joining us, those journalists who could get on the call, and as well as Ambassador Goosby. I appreciate you taking time out of the conference to brief us on the details.

AMBASSADOR GOOSBY: Thanks, Mark. It’s a pleasure.

MR. TONER: Thank you, everyone. Have a good day.

OPERATOR: Thank you for participating on today’s conference call. You may disconnect at this time.



PRN: 2010/1413



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