Interview with Lelio Mármora of the Global AIDS Fund

MEXICO CITY, Aug 8 2008 (IPS) – If the economic status of Latin America and the Caribbean continues to improve, the region s share of assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria is likely to drop to half the present level, under the current eligibility requirements, says Lelio Mármora, the Fund s portfolio manager for this region.

Credit: Daniela Estrada/IPS

The alternative is for the countries to improve their epidemiological statistics, design a regional agenda and present proposed modifications of the eligibility criteria to the Global Fund s Board of Directors, said the Argentine expert in an interview with IPS correspondent Daniela Estrada at the 17th International AIDS Conference, which ended Friday in Mexico City.

The Global Fund, which was created in 2002 at the initiative of the Group of Eight (G8) most powerful countries and a group of African nations, is a multilateral public-private partnership involving governments, civil society, the private sector and philanthropists that is managed by the World Bank as trustee.

In Latin America, 70 percent of the funds go towards anti-HIV/AIDS efforts and the remaining 30 percent are divided equally between efforts to fight malaria and tuberculosis. For the past year, Mármora has been the Global Fund s portfolio manager in the region.

At the start, the Fund only assisted the poorest countries. But it later opened up to lower middle income countries (between 936 and 3,705 dollars gross domestic product per capita), and a year ago it extended eligibility to upper middle income countries (3,706 to 11,455 dollars), although it set conditions in terms of prevalence rates and cost-sharing.

IPS: You mentioned that the Fund has innovative characteristics. Could you explain what you were referring to?
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LELIO MÁRMORA: There are three main characteristics of this innovative model. The first is that projects are designed through a multisectoral mechanism, the Country Coordination Mechanism (CCM), which includes representatives of the government, civil society, people living with the diseases, religious institutions, academia and other stakeholders.

The second aspect is that it is a results-based disbursement model. If a project performs well, it earns more funds, and vice versa.

And lastly, it is the countries themselves that define the objectives as well as the implementation of their plans.

We don t have administration manuals or purchasing or hiring rules. The country designs and implements its projects according to its own working style, and obviously assumes the risk that things will not go well.

IPS: How have countries in this region responded to that model?

LM: The response has been very successful. Today we have a portfolio of one billion dollars in the region, with annual disbursement of nearly 200 million dollars.

The number of proposals received has grown significantly. In 2006 we received 14 proposals and approved four, in 2007 we approved 10 out of 23 proposals, and this year we have received 35 a fast growth curve.

In general, the projects have performed well. We have an A through D grading system, and no projects have earned a C grade, which shows that implementation has been relatively successful.

IPS: For Latin America, the Fund s eligibility criteria will be a problem in the future .

LM: I wouldn t call it a problem, just a reality. The Fund is a mechanism designed for the poorest countries. It is necessary to keep this in mind in any analysis. It s truth that the steady growth that Latin America has experienced in the last six or seven years has pushed many countries into the upper middle income category, which makes them only partly eligible.

Until a year ago they were not eligible. But the Fund has become more flexible, and now it accepts upper middle income countries as eligible, with a few conditions: they have to have an overall prevalence rate of one percent, or a prevalence rate of five percent among vulnerable populations.

Although no one knows what each country s future growth curve will look like, if the current trends continue, many countries in the region will probably be in the upper middle income category in the next few years, which is a very good thing, but will reduce the number of countries that are fully eligible for the Fund. That is, if the current eligibility requirements are not modified.

IPS: At the conference s special session on Latin America and the Caribbean, you said the region s share of Global Funds resources could drop to five or even three percent. What does that mean?

LM: It is an estimate that lacks scientific rigour, because it depends on many variables. But if the current economic growth trends continue, we could say that in the worst case scenario we would be receiving half of the current nine percent that we currently represent in the total financing disbursed by the Fund.

However, that qualitative reduction could be accompanied by quantitative growth in the portfolio. In five years we will probably be disbursing more funds to the region than today, although that money will represent a smaller proportion of the total financing distributed by the Fund.

IPS: What could the countries of Latin America do to turn that situation around?

LM: There are two important elements, in my view. The first thing that we as a region need to do and this is not an option but an obligation is to significantly improve the quality of our epidemiological data and statistics, in terms of defining vulnerable populations and measuring poverty and social exclusion.

The countries have to work hard to have excellent data, to enable donors and funders to make decisions on a sound basis. There must be strong coordination and links between the health sector and the statistics agencies.

The second aspect, which not only applies to the question of eligibility but to the entire range of issues linked to the fight against these diseases, is the design of a regional agenda. Diseases don t respect borders. Although the response is country by country, the countries have to have a regional objective, a regional agenda.

The region has to know exactly what it wants to do, and through its institutions it has to bring those questions up to the Fund s Board of Directors, which is the logical place for decisions on eligibility, for example, to be discussed and adopted.

So, the countries of Latin America and the Caribbean have to have a concrete position with respect to what would be best for them in terms of eligibility for the Fund.

IPS: But is there a real possibility that the Fund may once again modify its eligibility criteria, in the short-term? In the conference, you spoke of the possibility of creating a different coefficient .

LM: What emerged in that panel (on Latin America) are views that are more personal than institutional. There are very interesting discussions going on about whether the eligibility requirements should be based on economic-financial criteria, epidemiological criteria, or a mixture of the two, by creating a coefficient, as you mentioned.

But until this question is brought up in the sphere in which it must be discussed, the debate will obviously not be generated, and decisions will not be reached. That is why, I insist, it would be good for the region to bring this up and study it.