Cheat-Seeking Missles

Tuesday, August 30, 2005

Global Fund Denies Bias

Rosie Vanek of the Global Fund promptly and not altogether satisfactorily responded to the nine questions I posed to her yesterday. I could excerpt portions like an MSM journalist do, but in the interest of fairness, I have copied in her entire response ... with my commentary in red.

Before getting to that, I want to make it clear that I am not against the Global Fund and its efforts to cure these horrible diseases. In fact, I'm a bit in awe of all they do, and the funding they are able to solicit and apply under sometimes extremely adverse conditions. God bless them and multiply their efforts.

What I am against is PC and anti-Christian attidues putting people's lives at risk. Those who relate abstinence with God and free-sex-and-rubbers with Reason have been extremely critical of the effort in Uganda, despite its success. They do not want to see that effort replicated elsewhere.

I am not convinced, despite Ms. Vanek's denial that the Condomites had anything to do with this decision, that Global Fund is above political pressure from the likes of George Soros and Bill Clinton (understandably a condom man).

There is good news in her response: That the Global Fund hopes to have the grants re-established within two months or less.

Now, to my questions and her responses:

1. In reviewing the 122 releases posted on your site, I have found no examples where multiple grants to a country were suspended in this manner. The only two relevant cases, Myanmar and Senegal, did not involve charges of corruption. Have no other grants been suspended for corruption?

In fact, the decision to suspend grants to Uganda was also not based on evidence of corruption but rather on clear evidence of mismanagement, such as inappropriate or poorly documented expenditures, and improper accounting. [That's a rather fine line, and it conflicts with Dr. Miller's statement that Uganda's controls are better than others.] Given these findings, the Global Fund was no longer comfortable with the Project Management Unit (PMU) as a conduit for program funds. The PMU is the organization in Uganda which has overseen grant implementation to date, but which will not play a role in the restructured management of grants after reinstatement of the grants (pending approval).

The Local Fund Agent (auditing body in Uganda; PricewaterhouseCoopers) did not pursued [sic] the review of the Round 1 HIV/AIDS grant to the level of a full audit (which would require that confidential documentation such as private bank records and other personal information be turned over to the LFA), and there is therefore no concrete evidence of corruption or fraud. [I could make a headline of that statement.]

In January of 2004, Grants to Ukraine were suspended because of concerns about the ability of the initial Principal Recipient to manage the grant. After a new Principal Recipient was chosen, the grants were able to go forward. I will include the press release issued by the Global Fund at the time the grants were relaunched for your reference. [The release was not on the Global Fund site. It is dated Feb. 2003 and is about a program set to expire in Jan. 2004, so this is apparently not a case of immediate cancellation. That in itself raises questions -- why the long notice in Ukraine and the immediate cancellation in Uganda. The release may just be dated wrong; if so, the fast fix of the problem is hopefully an example of what is to come in Uganda.]

The malaria grant to Senegal was not renewed for a second phase of funding, because it fell significantly short of the targets laid out in the grant agreement, as proposed by the grant recipient for the first two years. Each of the Global Fund’s more than three hundred grants is evaluated after 18 months for results achieved through support of Global Fund resources, and a second phase of funding is always contingent upon performance during the first phase.

The Global Fund operates as a funding mechanism to combat the three diseases on the basis that funds should be put to rapid, effective use, and where they are not demonstrably doing so, further resources should not be allocated. As the press release about Senegal points out, countries where grants are not renewed are encouraged to submit new proposals in future rounds, which demonstrate that obstacles to achieving results have been corrected.

For an illustration of how grants are evaluated, you may want to look at the grant scorecards for those grants which have already gone through this process, at the following link:

The decision to cancel the grant to Myanmar was based on new restrictions put in place by the government of Myanmar, which made grant implementation impossible. I will also attach the Myanmar fact sheet which gives thorough background information about this decision. [An entirely different example not pertinent to the discussion.]

2. If the problem was allegedly with the AIDS/HIV program, why did you also suspend tuberculosis and malaria programs, which appears to be an action that needlessly puts lives at risk?

While efforts are in progress to correct the management issues with the grants to Uganda, Global Fund Southern and Eastern Africa grant management team has traveled to the country to actively engage with the Principal Recipient to identify the elements of funded programs involving life-saving treatment and prevention activity not implicated in the findings of mismanagement, and to ensure that funding continues to reach those program areas. [Good!]

The Global Fund decided to suspend all five grants to Uganda because there was evidence of serious mismanagement by the Project Management Unit (PMU) for all Global Fund grants in Uganda. Although the review carried out by the LFA centered on only the Round 1 HIV/AIDS grant, the same PMU manages all five grants, and to minimize risk, all five have been suspended. [This was stated in the news release on the matter.]

Steps taken to correct mismanagement issues are in fact meant to safeguard the delivery of lifesaving treatment to those who are either infected or vulnerable to HIV/AIDS malaria and TB, so that funds will be put to best use, precisely to protect as many lives at risk as possible. The Global Fund is hopeful that the Principal Recipient, in collaboration with Global Fund staff and the Country Coordinating mechanism will be able to devise new management structures rapidly so that pending disbursements of the grants will not be overly delayed. The outside window for completion of this process is less than two months, and the Principal Recipient of Uganda has indicated that it will make every effort to propose new management structures as quickly as possible. [The two-month window is good news. It will be interesting to see if forced restructuring of the program is a part of the new structure.]

3. Releases on your site indicate that for a period of at least two years, Global Fund has been working with South Africa regarding problems with its grants. Why did you immediately suspend the Uganda grant, when it is evident that you are willing to work long-term with a country that is having trouble meeting your expectations?

4. What is the nature of the problem you experienced, or are experiencing, with South Africa?

The Global Fund currently has five grants to South Africa. Could you clarify which grant or event you are referring to? [I will do this. There were only two releases on the site referring to the matter, so I thought it was pretty clear.]

To speak generally about problems with grants to a country would not be very meaningful, as typically grants each have their own weaknesses and successes which evolve and change over time. Whereas the Global Fund’s decision to suspend grants to Uganda, with a view to reinstating these grants pending correction of management issues, no similar grounds for concern about the management of South Africa’s grants apply.

5. Are you currently monitoring, or have you previously monitored, any other grant recipients as you monitored Uganda, i.e., with an outside firm like Pricewaterhousecooper?

Uganda is not at all unique in having an external monitoring body of this kind. Every country receiving Global Fund money has a Local Fund Agent (LFA), which provides an initial assessment of financial and management capacity of the Principal Recipient, and then provides ongoing verification of program results during the grant lifespan. The LFA is an in-country accountability mechanism providing appropriate oversight of grant performance. The LFA for each country is publicly listed on our website ( under the searchable country database of grants by country. You’ll find this information in the text box at the top of each country’s webpage. [If this is the case, it is astonishing to me that so few grants are suspended. Could the LFAs in Zimbabwe and Congo really find nothing wrong? The juxtaposition of a singled-out Uganda and criticism from the free-sex-and-rubbers crowd remains suspicious.]

6. Given the countries you lend to, it is evident that many governments with long histories of corruption receive funds. Why hasn’t the Global Fund seen it necessary to take similar actions against other countries? Is the Global Fund saying by its action against Uganda that problems encountered there were much greater than what you deal with regularly?

Firstly, the Global Fund does not lend funds, but rather approves grants to countries (without expectation of return), based on approval of technically sound work-plans and targets, laying out how the country will use grant resources to combat and prevent disease. [Mea culpa. Sometimes an editor would come in handy.]

The Fund strives to take a politics-neutral approach to funding efforts to combat the pandemics, and generally speaking Global Fund-financed programs can function in any country, as long as the government doesn’t actively try to obstruct them. In addition, the Country Coordinating Mechanism within each country is required by Global Fund guidelines to include a broad spectrum of sectors represented. Though government is often one participant, Civil Society, NGOs and the private sector in countries also take part in proposing and implementing grants, as these stakeholders collectively see it in the countries best interest. [This was a pivotal question, and it was completely dodged. She did not say whether Uganda was markedly more corrupt (or mismanaged).]

What part did Uganda’s emphasis on monogamy and abstinence have on your decision to suspend its grants?

No part at all.

What is Global Fund’s position on monogamy and abstinence programs?

As stated above, the Global Fund does not take a position on specific strategies used to combat the pandemics. Grants are country driven and implemented, and the Global Fund is flexible when it comes to strategies chosen by each country as that which best suits their needs. In short, if a country proposes a strategy which is found to be technically sound by the independent Technical Review Panel which the Global Fund relies upon for this evaluation, the Global Fund will approve funding. [One would hope this is not the policy. One would hope that policies that are not working well, like the free-sex-and-rubbers approach, would be discouraged and programs with an ABC (abstinence before condoms) approach would be encouraged since they are shown to work. I am requesting from Ms. Vanek the Technical Review Panel's findings on Uganda.]

What is Global Fund’s position on “safe sex” and condom programs without a monogamy and abstinence element?

See above.

As a public relations person, it is often my job to develop responses to tough questions received from the media. Ms. Vanek did a good job, all in all, by flooding me with information while remaining unresponsive in one key area (Is the Ugandan program that much worse than anyone elses?), and providing no support for the key statement that it has no position on ABC vs. safe sex programs.

See also:
I Get An E-Mail From Michael Moore!
Nine Questions For The Global Fund
Condomites In UN Attack Uganda
Finger-Pointing In Uganda
Ugandan AIDS Cut Unprecedented
Uganda AIDS Cut More Suspicious
Uganda Punished for Abstinence?