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Reflections On The Global Fund Replenishment: Montreal, Malawi And Doing Better

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Canada's Prime Minister Justin Trudeau makes closing remarks to the Fifth Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis, and Malaria in Montreal, Quebec, Canada September 17, 2016. Photo by REUTERS/Christinne Muschi.

By Charlie Baran

The following is adapted from an article that originally appeared in the Global Fund Observer on October 19, 2016.

I had the privilege of attending my first Global Fund Replenishment meeting last month in Montreal. The overall feel was of celebration and optimism. Canadian Prime Minister Justin Trudeau praised the Global Fund and its track record of saving lives and averting new infections, and backed up his talk with a US$720 million pledge to kick things off. The various other heads of state, health ministers, and private sector leaders all commended praised the Fund as well. The meeting closed with a heartwarming visual: Trudeau on stage, with a rainbow of people behind him, proclaiming, "We have reached our goal! Together, we have raised almost US$13 billion, and in doing so we have saved eight million lives."

Theatrics aside, this is fantastic. Over the next three years, the Global Fund is on track to save eight million lives because thirty-five some odd countries came together to do the right thing. It is a truly remarkable achievement. The countries that contributed should be commended.

But honestly, they could do better. Donor governments should be doing everything they can to end the epidemics of HIV, TB, and malaria. These epidemics, and the poverty that drives them, are part of the legacy of colonialism and the continued pillaging of African and other "developing" countries' wealth and resources by rich nations. The donor countries are doing something, but not enough. And no one country could be doing more than it is now than China.

China should be ashamed of its contribution. In a room where countries with significantly smaller economies were pledging hundreds of millions of dollars, the Chinese came "with empty hands." After the meeting China did announce an US$18 million pledge. Paltry is a generous description. For comparison, Italy contributes an amount, relative to its economy, 80 times larger than China does. But this isn't about numbers, it's about doing the right thing.

One cynical argument to be made -- and one that I would ordinarily entertain -- is that the European powers contribute to the Global Fund, among other aid programs, out of a sense of guilt over, or in rectification of, colonialism. It's a form of atonement for Europe's past sins, past sins that China simply didn't commit.

Past sins, maybe not. But the level of current Chinese economic activity in Africa is significant and visible. It too is deriving massive wealth from Africa, at Africa's expense. Where China's hands were empty in Montreal, they are certainly full in Africa.

About a week after the Replenishment meeting in Montreal, I visited Malawi (another great privilege). According to the World Bank, Malawi is the fourth poorest country on Earth, with a per capita GDP of around US$380 per year. That's about the cost of three nights at the Chinese hotel in Lilongwe. That's right, among the two or three large business hotels in Lilongwe one specifically targets a Chinese clientele. What this suggests to me is that there are significant Chinese economic interests in Malawi. So significant that they might account for half of all business visitors to the capital.

China needs to do better, in Malawi and everywhere. It should take every opportunity to give back to those countries, and those people, from whom it is extracting vast wealth. The Global Fund is as important and impactful of an opportunity that they will find. Moving the Chinese contribution towards numbers more like Italy's would be a great way to begin embracing that opportunity wholeheartedly.

The Global Fund, too, is present in Malawi in a big way. The Fund has disbursed nearly US$900 million in Malawi since 2003. Therefore the Malawian response to the three diseases is profoundly dependent on the Fund and other donors. Nonetheless, the leaders of the Fund often talk about country ownership and having "countries take the lead in determining where and how best to fight diseases." That approach is right and good. But coming out of Montreal, where there was lots of this talk, it was striking to find that there are very few local Malawian civil society organizations receiving Global Fund money to do programs. Rather, international NGOs are dominating the community space.

It's hard to reconcile the marginalization of Malawian civil society with the mantra of country ownership. It should be everyone's priority to empower local communities to take on the leadership and management of their response. But the current arrangement doesn't look like "country ownership;" It looks like foreign ownership, which is what colonialism looks like.

Which brings me back to Montreal. The process that unfolded there is essential to the Fund: it is how the money is raised to then be sent to the countries who need it. The Replenishment meeting was mostly about dollars. But it was also about replenishing the commitment of donors to the cause of ending HIV, TB, and malaria. But I wonder if all the praise and affirmation for donors wasn't a bit off the mark. As donors, they, quite literally, just sign the checks (however large or puny they may be). It is the people in recipient countries who are living the realities of these epidemics and doing everything they can to end them who should really be celebrated.

So just as we replenish the Fund and the resolve of its donors, we should also replenish the spirits and resolve of those who bear the biggest burden in all of this: the women, men, transgender people, children, advocates, outreach workers, and health-care providers without whom none of the great achievements of the Global Fund would be possible. They make the most valuable contributions of anyone. The money is simply the gas in their tank. And with the miles they're putting on, they can always use more of that. China, would you like to start the pump?

Charlie Baran has been an independent consultant since 2012, leading and supporting advocacy projects aimed at strengthening civil society and advancing key populations across the global AIDS response.

This blog is part of the blog series: AIDS, TB and Malaria: It's High Time for Us to End It. For Good by the Interagency Coalition on AIDS and Development (ICAD) in recognition of The Global Fund's Fifth Replenishment. The blog series runs from August 29 to October 3, 2016 and features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the work of The Global Fund and the opportunity that this moment presents us one year following the inauguration of the global Sustainable Development Goals (SDGs).

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

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