Reforming the Global Fund to Fight AIDS

AMBASSADOR-AT-LARGE AND U.S. GLOBAL AIDS COORDINATOR ERIC GOOSBY
Ambassador Goosby leads the U.S. delegation at the Global Fund to Fight AIDS, Tuberculosis and Malaria board retreat in Geneva, Switzerland, to review new General Manager Gabriel Jaramillo’s initial progress in reforming the Fund.

I'm wondering why the Global Fund to Fight AIDS, Tuberculosis and Malaria needs to be "reformed". Hasn't it been doing its job??

(And I see, when getting down to the last couple of paragraphs in the Wikipedia article below, that, why, yes, the Fund was discovered, in 2011, to be rife with corruption.)

From Wikipedia:
The Global Fund to Fight AIDS, Tuberculosis and Malaria (often called The Global Fund or GFATM) is an international financing organization that aims to "[a]ttract and disburse additional resources to prevent and treat HIV and AIDS, tuberculosis and malaria." A public–private partnership, the organization has its secretariat in Geneva, Switzerland. The organization began operations in January 2002. Microsoft founder Bill Gates was one of the first private foundations among many bilateral donors to provide seed money for the project.

The Global Fund is the world's largest financier of anti-AIDS, TB and malaria programs and at the end of 2010 has approved funding of USD 21.7 billion that supports more than 600 programs in 150 countries. According to the organization, it has financed the distribution of 160 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 7.7 million people, and provided AIDS treatment for some three million people, saving 6.5 million lives. In 2009, the Fund accounted for around 20 percent of international public funding for HIV, 65 percent for tuberculosis, and 65 percent for malaria.

The Global Fund is a financing mechanism rather than an implementing agency. This means that monitoring of programs is supported by a Secretariat of approximately 600 staff (as of 2011) in Geneva. [Rather an expensive place to live....]

Implementation is done by Country Coordinating Mechanisms, which are committees consisting of local stakeholder organizations in-country that include some or all of government, NGO, UN, faith-based and private sector actors. This has kept the organization smaller than other international bureaucracies, but also given rise to concern over its capacity to ensure appropriate use of its funds. It has also raised concerns about conflict of interest, as some of the bodies who sit on the CCMs also receive money from them.

Fundraising
Since the Fund was created in 2002, public sector pledges have totaled USD 28.3 billion (95 percent of all pledges). The remaining USD 1.6 billion (5 percent) has been pledged from the private sector or other financing initiatives. The Fund states that from 2002 to 2015, 54 donor governments have pledged a total of USD 28.3 billion and paid USD 17.2 billion. From 2001 through 2010, the largest contributor by far has been the United States, followed by France, Japan, Germany, and the United Kingdom. The donor nations with the largest percent of gross national income contributed to the Fund from 2008 through 2010 are Sweden, France, Norway, the Netherlands, and Spain.

The global financial crisis has significantly impacted the fund. The Fund stated in May 2011 that it was short by USD 1.3 billion for 2011 through 2013, seeking at least USD 13 billion to cover minimum estimated needs but only holding pledges of USD 11.7 billion. The organization was also adversely affected by revelations of USD 25 million missing from community programs in four nations in Africa, which caused Sweden and Germany to suspend their donations until the completion of audit in 2011.

Creation
The genesis of the Global Fund emerged during discussions between donor and multilateral agencies toward the end of 1999, leading up to the July 2000 G8 Summit in Okinawa, Japan.

During that time, under the leadership of World Health Organization (WHO) Director-General Gro Harlem Brundtland and WHO Deputy Director General David Nabarro, discussions were initiated with donors other UN agencies concerning the creation of a new global health fund to help achieve these targets. Just prior to the Summit, WHO publicly called for a "massive effort to tackle infectious diseases" and for creation of "a new mechanism to take proven interventions to scale. The mechanism would achieve internationally agreed targets to cut TB and malaria mortality by 50%, and HIV infection by 25%."

At the Okinawa Summit, G8 nations for the first time established measurable global targets for addressing AIDS, TB and malaria. Immediately following the Summit, WHO went on record stating that the G8’s commitment to fight AIDS, TB and malaria would cost at least $25 billion over the next five years, suggesting that 60 percent of this funding should be spent on HIV/AIDS, and the rest evenly split for campaigns against TB and malaria.

On September 28, 2000, the European Commission, WHO and UNAIDS announced that they were taking a common stand against the epidemics of HIV/AIDS, TB and malaria in the developing world.

In October 2000, WHO and the city of Winterthur, Switzerland convened a Massive Effort Advocacy Forum to engage over 200 public agencies, private sector and civil society organization in a process of building ownership and support to massively scale up donor funding to fight diseases of poverty. In eventually launching a massive global health resource drive, the city of Winterthur agreed to pay for the lodging of all of them Massive Effort guests. Speakers included Brundtland and Swiss President Ruth Dreifuss, in addition to Prof. Jeffrey Sachs via satellite.

This subsequently led to WHO, Credit Suisse/Winterthur Group and the Swiss/Kenyan NGO Double Incentive Project (DIP) establishing and funding the Massive Effort Campaign, for the short term purposes of igniting, jump starting and building global support the fight against AIDS, TB and malaria.

During the final months of 2000 and early 2001, political jockeying over who might host the Global Fund intensified. Many initially assumed hosting the Global Fund was WHO's end game. On August 19, 2000, The Washington Post reported that "Clinton Signs Bill Establishing Global Fund to Fight AIDS," effectively intending to locate it inside the World Bank. According to The Washington Post, "President Clinton signed a bill today that sets up a global trust fund for AIDS patients that has been likened to a kind of Marshall Plan against the infectious disease." Soon thereafter, UNICEF's Carol Bellamy suggested that UNICEF was better equipped to know "How to Distribute AIDS Drugs" in her March 2001 The New York Times op-ed.

An article published in the British medical journal The Lancet by Harvard academics Amir Attaran and Jeffrey Sachs in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream of $7.5 billion or more to fund projects proposed and desired by the affected countries themselves, and that a panel of independent scientific experts validates as having epidemiological merit against the pandemic.

Attaran and Sachs also recommended that the new funding stream "must be based on grants, not loans, for the poorest countries", unlike the World Bank, which was the largest multilateral HIV/AIDS funder then existing.

On April 21, initiating a week of heightened, coordinated advocacy in support of establishing the Global Fund, GlaxoSmithKline CEO Jean-Pierre Garnier called for a "Marshall Plan" to fight AIDS in Africa. This followed on an announcement by 38 pharmaceutical companies that they would drop their challenge to prevent South Africa from providing cheaper generic ARVs.

On April 23, 2001, an informal meeting of "stakeholders including some G8 and non-G8 members, representing different constituencies," was hosted by DFID and CIDA in London, to discuss the proposed “Global Fund for Health and AIDS.” A number of potential options were on the table, including the "Ottawa Fund," a UNAIDS concept paper submitted on behalf of all UN agencies, and a proposal by Italy, which was about to host the upcoming G8 Summit.

According to the minutes of the meeting, the aspirations of the group were to focus on HIV/AIDS, malaria and TB, with the potential to expand to other health conditions including children’s illnesses and maternal ill-health. This fund would be characterized by “highly visible operating systems, transparency of processes, the relentless pursuit of results, speedy disbursement, support for a diversity of service providers (including faith-based organizations) under common (usually national government) stewardship. Investors would be able to top predict the likely impact of their investments.”

It was noted the following week in a video conference with the UN Secretary General's office that, with the possible exception of France, "none of the bilaterals are keen to support an HIV/AIDS specific fund." Canada, Japan The Netherlands, and the EC were most interested on focusing on the three diseases, with the UK, Italy and Sweden potentially wanting a broader mandate, and with Denmark, Norway and Germany being unclear about their positions.

On April 26, 2001, in Abuja, Nigeria, at the urging of a wide range of parties—and particularly due to the emerging consensus among bilateral and UN agencies during the London meeting three days prior—UN Secretary General Kofi Annan made the first explicit public call by a highly visible global leader for this new funding mechanism, proposing "the creation of a Global Fund, dedicated to the battle against HIV/AIDS and other infectious diseases."

A month later, The Economist editorialized that "...the fund itself must not be devoured by a voracious UN bureaucracy. Mr Annan wants an independent board to administer the money... (and that) the amount of money needed, after all, is not huge: it is about half America's annual spending on pot-plants and flowers."[26]

The first private contribution to the Global Fund was made by Kofi Annan. Having just been named the recipient of the 2001 Philadelphia Liberty Medal on May 3, 2001 Annan announced that he would donate his US$ 100,000 award to the Global Fund "war chest" he had just proposed creating. On May 8, the International Olympic Committee also made a US$ 100,000 contribution to the Global Fund.

In an address during WHO's World Health Assembly on May 15, 2001, WHO Director-General Gro Harlem Brundtland described the challenges of going to scale smartly yet rapidly. "The timetable is necessarily a tight one. You might say that we are going to have to sail in the boat, while we are still building it. But the world is not going to wait while we get every detail in place." There was strong pressure that the Global Fund become operational by the year's end."

On May 31, France became the second bilateral donor after the US to announce a contribution to the Global Fund. This initial pledge was for US$ 127 million.

Stephen Lewis of Canada was appointed as the United Nation's Special Envoy on AIDS on June 1, 2001. On the same day, Kofi Annan addressed the U.S. Chamber of Commerce and encouraged American business leaders to speak up loud and often about the AIDS epidemic as a way to fight the disease.

South Africa's Minister of Health quickly gave notice that support from the Global Fund might not be welcomed in the single country home to the most HIV infections. "South African Health Minister Manto Tshabalala-Msimang told the conference a global fund being set up to fight AIDS, TB and malaria should not be used to force AIDS advisers on the region. 'We know what AIDS is and we know what is happening here. The region has its own experts on AIDS,' she said.

Early resistance to the promise of the Global Fund wasn't limited to Manto during the first week of June 2001. Andrew Natsios, head of the U.S. Agency for International Development, told The Boston Globe that Africans were incapable of following complicated, multi-drug AIDS treatment, which requires taking different pills at specified times of day, because many of them "don't know what Western time is." According to Natsios, "Many people in Africa have never seen a clock or a watch their entire lives, . . . they know morning, they know evening, they know the darkness at night."

Countering the week's spate of skepticism, the Massive Effort Campaign mobilized the first large corporate contribution to the Global Fund from Credit Suisse/Winterthur Group for US$ 1 million, signaling that while some health ministries and donor agencies might still have doubts about the viability of the Global Fund, one of the world's largest banks and health insurance companies did not.

On June 19, 2001, the Bill & Melinda Gates Foundation committed $100 million, spread over a few years. Signaling that stopping the transmission of AIDS was the foundation's top global health priority, the Foundation announced that it would commit $100 million to the Global Fund over a multi-year period. The foundation also used the occasion to call on other organizations and governments around the world to support the new fund. Additionally, by the end of June, the UN Foundation set up a new mechanism for channeling private donations to the Global Fund.

The decision to create the new funding mechanism was expected to be taken by heads of state at the 2001 G8 Summit in Genoa (Italy), at the urging of United Nations Secretary General Kofi Annan, and largely along the lines WHO, Attaran and Sachs described. Indeed, the United Nations system had been considered ill conceived to implement a major increase in development funding. Multiple organizations were converging with small-scale projects on countries with limited institutional capacities, which exacerbated a series of problems, including poor coordination, duplication, high transaction costs, limited country ownership and lack of alignment with country systems.

Before the start of the Genoa G8, the United States, Britain and Japan had already contributed $200 million each, France had committed $127 million, and the Bill and Melinda Gates Foundation had committed $100 million. On July 13, Germany announced its contribution to the Global Fund amounting to US$ 131 million. On July 18, Canada committed US$ 100 million and the European Commission agreed to a Euro 120 million contribution. On July 20, Russia contributed $20 million.

The G8 didn't disappoint in calling for the creation of the Global Fund, although pledges were significantly lower than the $7 to $10 billion annually called for by Kofi Annan.

According to the G8’s final communique, “At Okinawa last year, we pledged to make a quantum leap in the fight against infectious diseases and to break the vicious cycle between disease and poverty. To meet that commitment and to respond to the appeal of the UN General Assembly, we have launched with the UN Secretary-General a new Global Fund to fight HIV/AIDS, malaria and tuberculosis. We are determined to make the Fund operational before the end of the year. We have committed $1.3 billion. The Fund will be a public-private partnership and we call on other countries, the private sector, foundations, and academic institutions to join with their own contributions - financially, in kind and through shared expertise.”

In July 2001, Kofi Annan appointed Ugandan cabinet minister Crispus Kiyonga to chair the Transitional Working Group that would establish the Global Fund. The Transitional Working Group was composed of representatives from more than 40 countries, UN agencies, the World Bank, private groups and NGOs.

The September 11 attacks created serious challenges for the Global Fund. In the three months prior to 9/11, the New York Times had expressed its support for fully financing the Global Fund in four separate editorials; it wouldn't be until three months after 9/11 that it would again editorialize in support of the Global Fund.

According to Timothy Wirth, former US Senator and head of the UN Foundation, "The attacks had a very damaging impact on funding, and we have to get everyone moving again to rebuild that momentum. The victims of Sept. 11, beyond the direct victims of the violence, have been the world's poorest people, particularly those with AIDS. The United States cannot say to the rest of the world, 'Help us' (in fighting terrorism) when we're not willing to help the rest of the world."

A key piece of evidence arguing for the importance of the Global Fund was delivered on December 20, 2001, when the Commission on Macroeconomics and Health made its findings public. Created by WHO's Brundtland and chaired by Sachs, the report promised that "A drastic scaling up of investments in health for the world’s poor will not only save millions of lives but also produce enormous economic gains." This report was particularly timely in reengaging journalists and refocusing the attention of policy makers on diseases of poverty and the emerging Global Fund, months following 9/11.

Officially operational in 2002, the Global Fund was intended to introduce a new aid paradigm based on partner country leadership, donor alignment with partner countries' development strategies, harmonization of donor actions, managing for results, and donor and partner being mutually accountable for results. This was subsequently conceptualized by the OECD in its 2004 Paris Declaration on 'aid effectiveness'.

The Global Fund's initial 18-member policy-setting board held its first meeting on January 28–29, 2002, and issued its first call for proposals. The first Secretariat was established in January 2002 with Paul Ehmer serving as team leader, soon replaced by Anders Nordstrom of Sweden who became the Fund's interim executive director. By the time the Global Fund Secretariat became operational, the Fund had already received $1.9 billion in pledges. In the months to follow, the Bush Administration was sharply criticized in the media for promising to pledge only $200 million a year.

At its inception, the Fund was adamant that it would not be about "business as usual," but would be grounded in "tough love" as it wrote its checks. On February 14, 2002, The Wall Street Journal headlined that the "Disease Fund Plans Tough Standards." In the article, a Bush administration official is quoted saying, "We envision a level of fiscal accountability . . . that’s unheard of in international development assistance."

In March 2002, a panel of international public health experts was named to begin reviewing project proposals that same month. In April 2002, the Global Fund awarded its first batch of grants - worth $378 million – to fight the three diseases in 31 countries.

Initial leadership
Richard Feachem was named as its first Executive Director in April 2002 and was about to get off to a rocky start days before the opening of the July 2002 International AIDS Conference in Barcelona, a bi-annual meeting attended by tens of thousands of the world's leading AIDS researchers, implementers, care givers and activists.

According to John Donnelly of The Boston Globe, "Richard G.A. Feachem, about to become the first director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, is already under fire from activists who want him to quit for saying the fund has plenty of money to start. At a critical time in the fight against the three killer infectious diseases, and on the eve of the 14th International AIDS Conference in Barcelona, Feachem is set to begin building an organization almost from scratch while fending off the activists."

During this defining moment, the Massive Effort Campaign, the activist NGO created, contracted and entrusted to ensure the Global Fund's successful launch throughout its first four years, was able to help prevent the Global Fund from being killed in its crib.

Feachem served from July 2002 until March 31, 2007. He announced he would not seek another term following a probe into the involvement of his wife in the Global Fund's business.

Michel Kazatchkine was then selected over the Global Fund’s architect, David Nabarro, even though Nabarro was “considered the strongest of three shortlisted candidates to head the Global Fund ... A selection committee has evaluated the three nominees' qualifications and ranked ‘Nabarro first, Kazatchkine second and (Alex) Cotinho third,’ according to a Fund source.”

Eventually, Michel Kazatchkine, a public health expert with over 20 years of experience in the field, was selected to be the Global Fund's second Executive Director. The September 2005 conference in London mobilized 3 billion euro, just over half the pledges at the Gleneagles G8 summit. On September 21, 2011, the AIDS Health Foundation called for Kazatchkine's resignation in the wake isolated yet unprecedented reports of "waste, fraud, and corruption" in order that "reforms may begin in earnest.” On January 24, 2012, Michel Kazatchkine ultimately declared his resignation.

Operations
The Global Fund has drawn much praise for the transparency of its organization. Information on the Global Fund's processes, including sensitive decision-making processes, is available from their official website.

The Global Fund provides initial grant funding solely on the basis of the technical quality of applications, as evaluated by its independent Technical Review Panel. The Fund has no means of assessing the implementation capacity of the applicants. Grants are signed for an initial period of two years. It provides continued funding to programs based solely on the basis of performance, which is generally defined as disbursement and purchases. The Fund makes no attempt to confirm whether services were delivered or whether its grants had any effect on health status or outcomes.

The objective of the Global Fund — to provide funding to countries on the basis of performance — was supposed to make it different from other international agencies that concerned themselves primarily with recording what money has been spent on, rather than what targets have been achieved.

These organizations have hundreds or thousands of staff that assist with implementation of grants. However, the Global Fund's five-year evaluation concluded that without a standing body of technical staff, the Global Fund is not able to ascertain the actual results of its projects. It has therefore tended to look at disbursements or the purchase of inputs as performance.

It also became apparent shortly after the Global Fund opened that a pure funding mechanism could not work on its own, and it began relying on other agencies (notably WHO) to support countries in designing and drafting their proposals and in supporting implementation. UNDP, in particular, bears responsibility for supporting Global Fund-financed projects in dozens of countries. As a result, the Fund is most accurately described as a financial supplement to the existing global health architecture rather than as a separate approach.

Bilateral donors immediately pledged millions (in some cases billions) of US dollars in support of Global Fund programs. The innovative approach to its financing principles is obviously considered key to its success. Since its inception, the Global Fund has committed US $11.4 billion to more than 550 grants in 136 countries (as of December 2008).

In March 2010, Dow Jones Indexes signed a memorandum with The Global Fund to explore the creation of co-branded indexes that could be licensed as the basis for investment products. The Global Fund aims to strengthen its engagement with the private sector, while the Dow seeks to add to its range of socially conscious indexes.

The Global Fund became the first organization of its kind, incorporated as a Foundation under Swiss law. It is a new kind of public-private partnership but is often confused as being part of the United Nations family. This may be because until January 1, 2009 Global Fund staff were officially World Health Organization (WHO) staff members and besides this the World Health Organization (WHO) provided many administrative services to the Global Fund secretariat and is also based in Geneva, Switzerland.

Effective January 1, 2009, the Global Fund became an administratively autonomous organization, terminating its administrative services agreement with the World Health Organization (WHO).

In March 2009, the head of the Fund criticized statements made by Pope Benedict XVI, according to whom AIDS "cannot be overcome through the distribution of condoms, which even aggravates the problems."

Replenishment phase
As of 2010, the Global Fund has entered its 'replenishment phase', i.e. it needs funders to commit themselves to continued financing. Alarms have been raised prior to the 2010 October meeting about a looming deficit in funding, which would lead to people currently undergoing ARV treatment losing access to this - increasing the chance of them becoming resistant to treatment. UNAIDS Executive Director Michel Sidibé has dubbed the scenario of a funding deficit an "HIV Nightmare".

The Global Fund has stated that it needed at least 20 billion dollars in 2011-13, and 13 billion just to "allow for the continuation of funding of existing programs". Its 2001-2010 budget includes 19,4 billion dollars, with 600 interventions in 145 countries and 5.7 million lives saved.

Italy, founding member of the Fund seating in its administrative committee, announced at the Aquila 2009 G8 Summit a una tantum contribution of 30 million €. Both the una tantum and the 2009 and 2010 contributions (130 million € each) have not been disbursed (in fall 2010), for a total debt of 290 million €.

At the October 2010 replenishing meeting $11.8 billion USD was mobilized, with the USA being the largest contributor - followed by France, Germany and Japan. The Global Fund has said that the $1.2 billion USD lack in funding will "lead to difficult decisions in the next three years that could slow down the effort to beat the three diseases".

In 2011, the organization's internal investigation identified 13 countries, most in Africa, where several million dollars' worth of antimalarial drugs where stolen and presumably sold on the black market. A Global Fund spokesman confirmed that the organization suspected malaria drug valued at USD 2.5 million were stolen from Togo, Tanzania, Sierra Leone, Swaziland, and Cambodia from 2009 to 2011, with some cases earlier. Investigations were continuing to determine the amount of theft in other countries.

In November 2011, the Fund's board cancelled all new grants for 2012, only having enough money to support existing grants.

Corruption and misuse of funds
In January 2011, the Associated Press reported vast corruption in programs financed by the Global Fund.

The article cited findings of the GFATM OIG office that up to 2/3 of funds in some of the reviewed Global Fund’s grants were lost to fraud and the OIG report showed that systematic fraud patterns have been used across countries.

GFATM responded to the AP story with a press release on January 24, 2011, stating that, "The Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds. It deploys some of the most rigorous procedures to detect fraud and fight corruption of any organization financing development."

In the days following the AP story, a number of op-eds, including one by Michael Gerson which was published in the Washington Post on February 4, 2011, sought to put the controversy surrounding the misuse of Global Fund grants in perspective. In his op-ed, Gerson stated, "The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical."

These newly uncovered misuses of funds were investigated and made public by the Global Fund Inspector General's Office (OIG), an auditing unit independent from the Global Fund Secretariat that manages the disbursements of funds to the programs (the selection of new applications for grants is done by the Technical Review panel and the GFATM Board - both independent entities from the GFATM secretariat).

This point was also highlighted by Gerson in his February 4, 2011, op-ed where he noted, "The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed." The GFATM Secretariat has posted a series of press releases on the GFATM website to publish their views on these dealings.

The OIG has been newly reinforced and was created during 2005, three years after the GFATM was founded.

During these investigation the U.N. Development Program (UNDP) that manages and supervises a large proportion (12%) of the fund's spending as Local Fund Agent (LFA) in-country (the Global Fund has no country offices) has claimed diplomatic immunity to block the GFATM inspector general from access to internal audits and books of investigated programs in the more than two dozen nations.

The OIG has only examined a small percentage of the grants so far. Previous reviews of grants and the organization have shown substantial misconduct in some programs, lack of adequate risk management and operational efficiency of the Global Fund.

Severe cases of corruption have been found in several African countries such as Mali, Mauritania, Djibouti and Zambia. Global Fund spokesman, Jon Liden, said; "The messenger is being shot to some extent. We would contend that we do not have any corruption problems that are significantly different in scale or nature to any other international financing institution." This statement triggered a wave of private protests from other agencies who felt the Fund was attempting to divert attention from itself. Subsequent Global Fund statements have omitted any reference to other agencies.

In response to the findings, Sweden, the fund's 11th-biggest contributor, has suspended its $85 million annual donation until the corruption problems are resolved. Together with Sweden, Germany, the 3rd biggest contributor to the fund has also blocked any financing until a special investigation has been completed.

These findings come on top of previously discovered massive abuse of funds, corruption and mismanagement in a series of grants that forced the GFATM to suspend or terminate these grants after such dealings became publicly known with Uganda, Zimbabwe, Philippines, Ukraine being the largest of these grants (more than US$ 100 million each).

The story widened in February 2011 when the Financial Times reported that the fund’s board of directors had failed to act previously on concerns over accountability, including the conclusion of an ex­ternal evaluation in 2009 which criticized the Fund's weak procurement practices. Warnings of inadequate controls had also been reported periodically.

In Feb. 2011 the FT also reported that its own review found that neither Global Fund staff nor the Local Fund Agents (the entities entrusted with ensuring accountability at country level) had noticed the deficiencies reported by the inspector-general.

Financing, major donations and administration
The GFATM is almost completely funded by contributions from the largest developed nations governments / tax payers. GFATM audited annual returns show that currently more than 96% of its yearly contributions are received from government organizations. Its largest private contributor by far is the Gates Foundation.

* In June 2001, Winterthur Group, the Swiss-based financial services group, a sponsor of the Massive Effort Campaign and at the time a subsidiary of Credit Suisse, became the first corporate contributor to the Global Fund with a gift of $1 million.

* In January 2006, Bono and Bobby Shriver announced the launching of the Product Red campaign, proceeds from which would go to the Global Fund. Questions have been raised by nonprofit watchdogs and marketing experts regarding the unusually high advertising budgets spent on Product Red that some (until 2007) estimated as high as $100 million. GFATM published data states that until February 2011 the Product Red campaign has contributed less than 1% ($163 million) of the almost $19 billion contributions received since establishing the GFATM 2001/02.

* In August 2006, the Gates Foundation contributed $500 million to the Global Fund, calling the fund "one of the most important health initiatives in the world".

* In March 2006, Executive Director Richard Feachem announced his intention to step down, as soon as his successor was determined by the Global Fund Board. In April 2007, Michel Kazatchkine became the Global Fund's new Executive Director.