PEPFAR vs. Global Fund: Continuing a Long Tradition

In an earlier post, I referenced the sometimes rivalry and contention between the President’s bilateral approach to AIDS (PEPFAR) and the multilateral Global Fund. Greg Behrman’s 2004 book The Invisible People suggests this bilateral vs. multilateral tension is not new. As Behrman writes on page 52:

Stark tension, and even at times animosity, between GPA [ the World Health Organization’s Global Program on AIDS] and USAID [the U.S.’s foreign assistance agency] thus ushered in a critical theme in the history of the U.S. response to the pandemic: should the United States respond bilaterally, that is through U.S. mechanisms directly, or multilaterally, that is by pooling U.S. resources and expertise with other nations and actors, and attacking the pandemic with an aggregated, global effort?

He goes on to talk about inter-institution rivalry, turf battles, jousting over funds, and the control issue, of the U.S being able to exercise more authority over how funds are spent. It would be a shame if the collective efforts globally continue to commit the sins of the past and lead to less effective action because of petty competition over who gets the kudos. Some of the issues, about being able to exercise control over the funds, are serious ones with good arguments on both sides about who should control the funds. Bilateral aid may be politicized (too much directed to abstinence) while there have been some control issues with the Global Fund with some high profile instances of corruption in some national contexts. Indeed, bilateral assistance may profit from stronger political backing than multilateral assistance, even if it proves less efficient. I’ve not seen enough to warrant hasty conclusions about the overall degree of coordination between the Global Fund and the U.S. government. I know the U.S. has been pretty involved in the Global Fund’s architecture since inception. I would love to hear more about what this has meant in practice.

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