A Powerful Partnership: PEPFAR and the Global Fund

This year marks the 10th anniversary of the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest bilateral program focused on a single disease in history. Launched by former President Bush in his 2003 State of the Union and built upon by President Obama, PEPFAR has enjoyed strong bipartisan support since its founding. It has also been an invaluable partner to the Global Fund in-country.

As part of Friends’ interview series, we spoke with Dr. Michael P. Johnson, the Global Fund Attaché to the Permanent Mission of the United States of America to the United Nations Office and Other International Organizations. From his office in Geneva, Dr. Johnson spoke to us about his role in improving collaboration between the two organizations and his experiences in global health.

Friends: On a personal note, why is global health important to you? How did you become involved with it?

Dr. Johnson: I started medical school with the intention of working in domestic, community-based primary care. My father was a civil rights and religious leader in Harlem and, as a result, the problem of health disparities and opportunity for service to others to combat disparities were very important to me.

Later, while in medical school, I went on an exchange trip for two months to West Africa, and saw the incredible need – but also the incredible opportunity – in global health. From there, I started to move towards a career in the field, was trained in infectious diseases, and began working when the AIDS epidemic hit. Ultimately, because HIV/AIDS finds the places of greatest disparity and exploits the most vulnerable, I’m still following my passion for tackling health-related inequalities.

What is your role as Global Fund Attaché?

It is a position that did not exist prior to my appointment, so I had the challenge and opportunity to define it. There are so many ways in which PEPFAR and the Global Fund can, and are, building relationships and achieving more effective and efficient programming. My role is to identify programmatic areas and opportunities for partnership between the two, and to enable and enhance the communication among the relevant people in the U.S., in the field, and at the Global Fund secretariat in Geneva.

What strength do you think each organization (PEPFAR and the Global Fund) brings to the fight?

The technical size and might of PEPFAR (especially in-country) is a unique strength. We have a robust and capable staff on the ground, including local partners who are technically strong, and also know the local situation.

On the Global Fund side, the first and obvious strength is the large financial commitment it brings to bear. Each country that contributes to the Global Fund leverages the funding of many others, so it’s a very effective mechanism to bring money to the table.

Another Global Fund strength is the Country Coordinating Mechanism (CCM) which facilitates important collaboration between the public sector and civil society to target resources in the best way possible in country. This is something that is not a natural structure in a lot of places. The model has challenges, but is important to bring about an inclusive and sustainable approach to community-based care, where the users of health services have a say in how and where resources are applied.

Can you point to an example or two where you think this collaboration has had particularly profound success in recent years?

Tanzania is certainly a place that comes to mind. Here, the Global Fund has transitioned largely to commodities purchasing, with PEPFAR resources wrapping around that support to provide technical strength and capacity to the interventions that are led by the government of Tanzania. We’re seeing this start to happen in other countries as well. In Nigeria, for example, PEPFAR and the Global Fund are examining our portfolio and identifying both geographic and programmatic “lanes” in which our work is harmonized and mutually reinforcing.

Another strong example that comes to mind is Haiti. The Fund Portfolio Manager at the Global Fund and the PEPFAR in-country team have mapped implementing grantees that we each support. In order to ensure there is no duplicative funding, the two organizations have aligned their reporting indicators and timelines. This led to a significant increase in efficiency and reduced the burden on the recipients by requiring one report instead of two.

How do you believe multilateral and bilateral organizations should work together? In terms of global health, can/should one exist without the other?

I think about it this way: What if there were no PEPFAR and everything had been done multilaterally from the beginning? Without PEPFAR, we would probably not have proven in such a short time that treatment in a complex environment can be scaled up and lives preserved. So, in this way, PEPFAR was incredibly important to show what is possible, and illuminates a pathway for the Global Fund.

Now, what if there were no Global Fund? If other countries had invented their own version of PEPFAR, there would have been chaos on the ground with multiple bilateral agencies operating in one space. So the multilateral mechanism, in the long run, is absolutely necessary.

The bottom line is that we can’t have one without the other. We need both in order to be successful.

This post was originally published in August 2013.