Better Than Ever, Together

I love it when a plan comes together. My affection for synchronicity has been well fueled in recent months as a series of global health milestones have converged. Together, these landmarks paint a picture of remarkable alignment between the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

At the end of 2012, PEPFAR released its Blueprint for Creating an AIDS-free Generation. More recently, the Global Fund -- the world's largest public health financier -- rolled out its new funding model. Then, on February 20, the Institute of Medicine released its congressionally mandated evaluation of PEPFAR. And just this week, key opinion leaders came together in Washington, D.C. to discuss the IOM report in detail.

This flurry of events makes it clear; it is a time of transformation for global health. The recent announcements also show how complementary the two organizations are as they pursue the same mission: saving lives.

There are several consistent themes within the Blueprint, the new funding model and the IOM report that confirm the alignment between the organizations:

• Collaboration. One of the explicit action items called out in PEPFAR's Blueprint is strengthened support for the Global Fund. The document states quite clearly that the Global Fund is a critical multilateral vehicle in the fight against the HIV/AIDS pandemic. It also lays out the ways in which the two organizations can most effectively work together to achieve better health outcomes in recipient countries.

In places where the Global Fund and PEPFAR work together, funding models for both organizations are evolving. Resources provided by the bilateral program are focused on building on-the-ground capacity and technical support. As the IOM report indicates, "PEPFAR is gradually shifting funding away from providing services directly to providing technical assistance, building capacity and strengthening systems." The multilateral work, in turn, focuses primarily on providing commodities and other health products.

This approach is highly complementary. For example, both organizations are the primary funders of HIV programs in Tanzania. The Tanzanian government, historically, has used Global Fund financing to supply first-line antiretroviral drugs while PEPFAR's programs provided second-line ARV drugs. However, that is changing. By the end of 2013, Global Fund resources will finance all necessary ARV treatment while PEPFAR will transition to focus exclusively on technical assistance, capacity building, monitoring and evaluation, and voluntary counseling and testing. This new approach is intended to increase effectiveness.

Just as PEPFAR is helping to increase capacity and strengthen systems on the ground, the Global Fund is also taking the long view. Within the new funding model is a counterpart financing policy in which both a recipient country's ability to invest more of its own funds as well as demonstration of its willingness to do so are evaluated. The idea is to set countries up to, ultimately, be more self sufficient.

Through the new model, country and Global Fund representatives, along with civil society and local disease experts, come together from the outset to determine how best to address epidemics on the ground before proposals are sent to the Global Fund Board for consideration. Through these initial conversations, countries will receive feedback on their applications early on in an effort to better set them up for success.

For its part, PEPFAR, too, collaborates closely with recipient countries and other partners. It has done so throughout its history, resulting in an astonishing scale up of HIV services and programs. It has entered into an era of even closer cooperation with the Global Fund, which includes joint planning and implementation.

Perhaps the most powerful theme coming out of all of these recent events is "seize the moment." Mark Dybul, Global Fund Executive Director, has repeatedly referenced the unique window of opportunity in which we find ourselves. The scientific advances in global health that enable us to turn the tide on HIV/AIDS, tuberculosis and malaria already exist. But, as the IOM report rightly points out, "we will need to work... to ensure that these hard fought gains are not lost." In other words, we can invest now or we can pay forever.

The PEPFAR Blueprint; the Global Fund's new funding model; the IOM report: all are illustrations of the respective organizations' commitment to the constant evolution required to most effectively save lives. They are also examples of the remarkable alignment of these two organizations and a rationale for their continued support.