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Leadership Interview: The successes that we see in malaria are a demonstration of feasibility

Interview with Prof. Michel Kazatchkine - Executive Director of the Global Fund (from February 2007 to March 2012)

[RBM leadership interview conducted by Katya Halil, Communications Officer, Roll Back Malaria Partnership Secretariat, March 2009]

Q: The Global Fund has affirmed itself as the main source of finance for malaria control programs since its creation in 2002. Funds for malaria control have quadrupled in the past 4 years, from $250 million annually in 2004 to more than $1 billion this year. Most of this funding comes from the Global Fund. What would you say are the critical success factors behind these results?

Prof. Kazatchkine: I would say that these results can be explained by some key general developments, as well as by developments that are specific to malaria and the RBM partnership.

For a long time health was considered to be an expenditure and not an investment. It was the AIDS crisis and its impact on human capital and the advocacy around AIDS that drove the world to realise that there will be no development, if health is not considered a priority. As a result, we have seen a change in paradigm since 2000, a change that unfortunately took too long to take place, but has clearly put health on the development agenda.

Secondly, there has been a progressive increase in advocacy around disease and development. Advocacy efforts have focused on building a world in which globalisation offers not only economic opportunities but also a voice to the poorest, to the voiceless. Some of that advocacy has of course been pioneered by the AIDS movement but very rapidly malaria has caught up. RBM has been the driver of that process. Although I don't see enough community and civil society advocacy for malaria, there is undoubtedly much more of it now than there was 3 years ago. And 3 years ago there was much more than, let's say, 6 or 7 years ago.

So the first factor is a new paradigm, that links heath and development; the second is an extraordinary advocacy effort; and the third is the very creation of the Global Fund. And I am not talking about the resources here. I am talking about the fact that the world came together in 2002 to create a specific instrument to fight major disease. It chose AIDS, TB and malaria when, as you know, there was a lot of discussion on whether this should not be a fund for AIDS only or, on the contrary, a global health fund.

And all of that has been followed by an unprecedented political mobilisation and commitment both from the Northern governments and leaders, including leaders such as President Bush, President Chirac in his time, Prime Minister Gordon Brown, and from Southern Heads of States, be it the president of Tanzania, or the Head of the African Union. Malaria was the focus of the Yaoundé Summit and Declaration, the Abuja meeting in 2000 and basically on all African Union Summits. It also made it to the agenda of the G8. So advocacy, the changes in paradigm and political mobilisation are the three factors that helped set the current landscape.

Then, of course, there has been a lot of mobilisation specifically around malaria. Not only in terms of advocacy but also in terms of technical support. Funding became available through the Global Fund, the World Bank Booster Programme and the PMI. As the provider of over two thirds of global funding for malaria, the Global Fund is clearly in the leading role here. Because we are country-driven and country-responsive, it is not us in Geneva who decide which countries should receive grants. We are responsive to country requests.

This has pushed different actors in countries to come together around their national malaria programmes. Governments, civil society groups, and to some extent the private sector have come together and are working hard on malaria plans. RBM helps structure all of that into what is currently country plans and, of course, channel that experience in the Global Action Plan.

More importantly, the RBM Partnership from its very early days has been progressively increasing its technical support to countries. RBM not only helps countries design their applications but also implement their programmes.

These are to me the major reasons why the Global Fund has been able to increase so much its funding for malaria in recent years.

Q: You mentioned the Global Malaria Action Plan which was recently launched in New York in parallel with the UN MDGs Summit. What would you say is the significance of having such a plan? What could be its added value for the malaria community?

Prof. Kazatchkine: Well, to me the value of the plan is to help the world understand that we know what is needed to eliminate malaria, at least as a major public health burden, if not eliminate malaria in a number of countries. To me the plan sends a strong message that our goal is feasible and shows what needs to be done to achieve it. When it comes to actually achieving it, the Global Action Plan will be implemented at country level or the regional and subregional levels. So it is absolutely essential that each country with its own forces and in its own context and specific epidemiological, financial, developmental and political environment comes up with a national plan.

To me the Global Action Plan is a roadmap that shows to the world that it can deal with malaria. This is extremely important. The successes that we see in malaria are a demonstration that major infectious diseases and epidemics can be dealt with. And helps people who work in the areas of AIDS and TB to gain confidence as well.

Q: So you are saying that the recent successes in malaria control can serve as an example for other infectious diseases.

Prof. Kazatchkine: Yes. It is a demonstration of feasibility and scale up, which are very important.

Q: At the launch of the Global Malaria Action Plan in New York, it was announced that the international community would put $3 billion in malaria control. Never before has there been that much funding available for malaria. The biggest single contribution is supposed to come from the Global Fund. Now that this funding has been pledged, what do you think needs to happen to see strong results in countries?

Prof. Kazatchkine: We need to be careful about saying that there has been a big meeting with pledges. There are some people who took it as a pledging meeting but the Global Fund did not make any pledges. The Global Fund simply announced the results of its Round 8 call for proposals. Even if the meeting in New York had not happened, I would have announced these same results. We have a yearly call for proposals, we are country-driven, we are not top-down in any way. Our Round 8 call for proposals resulted in a fantastic mobilisation in countries for malaria and, due to the support of the Harmonisation Working Group and partners and, primarily with the support of RBM, malaria proposals were extremely successful with a 68% success rate. So the Fund is in a position to actually finance 68% of the requests that were received for malaria. And that amounts to the $1.6 billion which were announced in New York. This funding corresponds to requests from countries that were cleared and accepted by our independent Technical Review Panel (TRP) and they correspond to implementable workplans by countries. What countries still need to do is sign the grants, which involves creating detailed plans of what they need to do on a day-to-day basis and then the money will be disbursed. But these are all countries that are ready to roll out their plans.

Q: So does that mean that the malaria community should now focus on helping countries sign their grants and implement their programs?

Prof. Kazatchkine: The malaria community can certainly help countries to accelerate the signing process and the signing process is all about translating a general workplan that is already fairly specific into a very detailed plan with indicators and milestones, so that we can implement our performance-based model of funding.

Q: As you said, Round 8 was very successful for malaria. An increasing number of ambitious country proposals will potentially be approved by the Global Fund at its Board meeting in November. Will the current financial crisis have an impact on the Global Fund's ability to fund the proposals approved in Round 8 and Round 9?

Prof. Kazatchkine: The current financial crisis may well have an impact. I cannot preempt in any way the decision that will be taken by the Board but this is not the first time that the Global Fund will be confronted with a disconnect between available resources and requests. If, in the worst case, we are short of resources, the Board could delay the actual final funding decisions for some of the proposals. So yes, the $1.6 billion figure for malaria for two years is the figure that the TRP will bring to the Board with the request for them to accept to fund it. But the final decision will be known after our Board meeting in November.