Q&A: Shaping health finance at the Global Fund

Kalipso Chalkidou has spent the past two months shaping up the Global Fund to Fight AIDS, Tuberculosis and Malaria’s new health finance department. This has meant bringing together the different teams working on aspects of health financing across the secretariat. Putting these teams under one roof is supposed to help the fund streamline and bring more coherence to its work. “People working in the secretariat before were working together, but I think now it's an opportunity to offer a more coherent picture. … That's the hope, [and] we're now in the midst of shaping ourselves up to deliver on that,” she said. Chalkidou, who took on the role of head of health finance at the Global Fund in 2021, said it has been a challenging start, as everything is done in Zoom meetings. But she also underscored the importance of working on health financing in the current environment, in which countries are spending more on health because of COVID-19 but are also suffering economically from the pandemic. Chalkidou spoke to Devex about her vision for the Global Fund’s health financing, priorities for the year, and the role the fund can play in debt relief and blended finance. This conversation has been edited for length and clarity. Would you say COVID-19 influenced the decision to consolidate the health finance department and to bring in an expert such as yourself to lead this work? I think this has been in the works for a while and preceded COVID. Irrespective of what the initial intent was, it goes without saying that health financing in the current situation is hugely important. It's critical. And we need to think hard about what COVID means in terms of countries raising resources, committing their own resources to health, what it means in terms of commitments by other countries to fight the three diseases [AIDS, tuberculosis, and malaria], and also how we go about thinking about the future of health finance. “It's a very strong message that's being sent by the Global Fund that health financing matters — it's important and now more important than ever.” --— Kalipso Chalkidou, head of health finance, the Global Fund to Fight AIDS, Tuberculosis and Malaria For me ... being able to channel both debt relief and borrowing through institutions such as the Global Fund, in order to translate those investments into health for the poorest, is quite important. [It’s] even more important now because I think inequalities … probably very much increased during the [COVID-19] crisis and are probably likely to increase in the future. You mentioned debt relief and borrowing. Can you explain the role you see the Global Fund playing in that space? Over the years, the Global Fund has been working very closely with the World Bank. We’ve signed a co-financing agreement to streamline our partnership, and this work has preceded the crisis. But it's all the more important now that we work together. The World Bank is releasing resources for countries for health and social policy, [as well as other] regional development banks. ... It's an opportunity for the Global Fund to work together to blend grant and borrowing to get better results. What [do] I mean by that? We recently launched a loan buydown deal in India with the World Bank and the government of India, with a particular focus on TB notification. And this is so topical. It started way back. And it took us a long time to deliver. But I'm hoping now, with a new agreement in place, things will move faster. Debt2Health swaps — which traditionally, I think, have been underused — there's a lot of conversation now at the International Monetary Fund and others. This is obviously the latest initiative for debt relief … debt repayments, etc. But in general, there needs to be a step-change in the way the global health community — and more generally, G-7, G-20, and the private creditors — view debt relief and being able to channel debt relief to debt swaps, for example, onto measurable results in terms of health for poor people, who are by far the hardest hit by this crisis. There's lots of obstacles in achieving that, including whether countries feel confident to proceed with this kind of arrangement. But ultimately, I think we just need to rethink some of these ideas of debt relief and how exactly it works and could work for health [and] for social policy more broadly, and this is the time to do that. How much of a change is that within the Global Fund? It's a very strong message that's being sent by the Global Fund that health financing matters — it's important and now more important than ever. It is a shift, but we'll be building on the stuff that's happened before. It’s a change of gear, if you like, in terms of intensity and commitment, as opposed to a brand new thing that's being introduced. Coming to this new role, what vision do you have for health finance at the Global Fund? I'm going to sound banal, but I’m only sounding banal because I think this is something that has been reiterated but we haven't quite achieved it as a global health community, which is … more money for health, better results for the budget, and done in a way that's sustained and ultimately locally owned. That's a big ask. And as I said, it's been reiterated over and over again. It’s nothing new, but I think it is important. It doesn't have to be new to matter. And for me, that's the vision. What is your top priority for this year? A lot of it will be about constructing a team that can function, can serve the priorities I set out earlier [on]. How can we help countries mobilize more resources, prioritize those resources, spend those resources more effectively and efficiently, and do that in a way that's sustainable? But to do that, we're in the process of shaping the new department, and that will take us a few more weeks. In terms of priorities by the end of the year, we want to be able to deliver on some of the specifics of the vision. So we want to, for instance, support countries [to] boost their value for money and efficiency agenda at the local level, so they’re able to spend more efficiently. We want to work closely with our partners, WHO [the World Health Organization], the World Bank, [and] others to look through how we can help mobilize more resources at country level and globally. We want to try and put the co-financing framework with the World Bank in action and do what I described earlier, [which is] have one or two important impactful deals where we blend our grant money with loan money to target borrowing better and translate into verifiable health outcomes. It'd be wonderful to have a couple of those done by the end of the year, working again closely with partners.