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Hurry up and stop: the global fund's bumpy inaugural year The Global Fund to Fight AIDS, Tuberculosis and Malaria was rushed into existence in 2002, a bold new initiative to fight three diseases crippling the developing world. United Nations Secretary General Kofi Annan called for the world's rich nations to donate $7 to $10 billion a year in new money to conquer the killer trio. And 6 months later, developed countries had met to pledge an initial $2.1 billion over 5 years, while 58 poor nations had received approval for their multi-sector programs to fight HIV/AIDS, tuberculosis and malaria, the world's three leading infectious killers. But almost as soon as the Fund was launched, it started to go sour. There was no problem with the proposals—which covered everything from DOT clinics for tuberculosis in Sierra Leone and condom distribution for Haitian prostitutes, to bed net vouchers for Tanzanian mothers and antiretrovirals in Peru. Excellent grant applications kept coming in, but the money didn't. One year after its inception, the Fund's supporters were already talking about it being bankrupt. It was already clear that, without a massive injection of cash, there would not be sufficient money to fund proposals past the first year. At the same time, Fund sceptics – led by the US delegation to the board of directors – were insisting on sophisticated monitoring measures that threatened to delay disbursement for months or even years. As quickly as it had captured imaginations, the Fund teetered on the brink of disaster. The first 6 months of 2003, though, brought the Global Fund new life. ‘‘The Fund is delivering,’’ said Jeffrey Sachs, the maverick Columbia University economist who helped Kofi Annan come up with the idea of a war chest for the three diseases, and who emerged in the Fund's first year as one of its strongest critics. ‘‘There has been an incredible outpouring of proposals, of programs, of thinking and energy in very poor countries, from people that for the first time see a chance to actually do something. The Fund is energizing high-quality partnerships in these countries. And money is getting disbursed.’' The first grants materialize At the Fund's headquarters in Geneva, staffers sense the change. ‘‘There's been a serious turnaround in the whole mood around the Fund,’’ said Jon Liden, vice president of external relations. ‘‘People on the board, people in [the UK's] Department for International Development or [Canada's] International Development Agency, the skeptics in the development environment, they have turned around and said: this is looking pretty good.’’ The Fund approved its first grants in April 2002 (worth $1.6 billion), but didn't actually disburse any money until February 2003. The delay was, in large part, due to the demands placed by donor governments for monitoring mechanisms. They simultaneously required that the Fund be a whole new entity – not a World Bank or United Nations off-shoot – but also that it have sophisticated systems in place to monitor the use of money and the effectiveness of projects in each of the countries which received grants. Of course, that took time—particularly when the countries most in need of grants, such as AIDS-ravaged Zambia or civil-war-torn Sierra Leone, had little capacity with which to establish those systems. In most cases, the Fund has contracted local firms – such as auditors PriceWaterhouseCoopers – to act as ‘local fund agents’ to handle the cash; monitoring the projects is more difficult. `‘We were able to wipe out the waiting lists for antiretrovirals in Honduras, the Ukraine and Rwanda— overnight. That's a couple of thousand people that wouldn't have had access to those drugs. That's progress.’' As a consequence of these requirements, the Fund was slow to start sending out checks—and this became the chief complaint of its critics, cited repeatedly by people such as then-UK Development Minister Clare Short, who said it would be ‘irresponsible’ for Britain to give the Fund more money when what it had was sitting in a bank account in Geneva. But by May 2003, enough of the groundwork was in place for the Fund to rapidly accelerate its pace of disbursement. By late June, $37 million had been shipped out, and Liden said he was confident it would be $100 million by October, $200 million by the end of 2003—most of it small, initial payments. `‘We approve projects for five years, we guarantee financing for three, but we only give money for a quarter or six months—whatever is the best to fit the project,’’ Liden explained, ‘‘So we're not risking too much money and we're not overloading the system with too much money at once—and we ask to see results, so we can pick up weaknesses along the way.’' And very quickly, the Fund started to see some tangible results. ‘‘We were able to wipe out the waiting lists for antiretrovirals in Honduras, the Ukraine and Rwanda—overnight,’’ Liden offered as an example. ‘‘That's a couple of thousand people that wouldn't have had access to those drugs. That's progress.’' And there with the of of is one of countries to a disbursement. 2002, Fund money has been in to a and five clinics with and in people were on in some new tuberculosis were And at to by a of programs in access to and and the United Nations Secretary for in the Fund's which governments to with the and of people with the three diseases, in their some not so but the governments to and to the a more of what the and be the Fund to in some as a it has not in any for a $100 million grant from the and The board and those who for the of people with the diseases in poor a for new but at the board he the US Secretary for and who the of of the Fund's board and who the And this the need to disburse and the need to the the ‘‘The US and Britain by the of the Fund,’’ Jeffrey a who in the developing on the board of the is a said in board and go over these to this and that and that, The people in of people with – we have to for – and in a months they not be has the and by the for ‘‘The demands for and and an monitoring countries Zambia and he delay the disbursement of and they and and in the countries. 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