HIV/AIDS Global Trust Fund: A Proposed Organizational Structure

By Melvin Foote & Chinua Akukwe

The Perspective

July 24, 2001

In an earlier article in the Foreign Policy in Focus Journal (, we had argued for an efficient and equitable governance structure for the proposed HIV/AIDS Global Trust Fund. As the G-8 nations meet in Genoa, Italy to finalize or possibly launch the Trust Fund, we believe that it is crucial for the donor nations to develop a sustainable partnership with recipient nations based on mutual respect and understanding. The Trust Fund offers the rare opportunity to develop and nurture a global development agenda that eschews the failed master-servant relationships of the past.

The World Bank in its March 2001 report on foreign aid programs in 10 selected African countries concluded that donor -imposed conditions are doomed to fail without the active participation of the recipient nations in the design and implementation of such programs. The organizational structure of the proposed Trust Fund should reflect the perspectives of the key stakeholders in the global effort to stop AIDS in Africa and other parts of the world. It should also send reassuring signals to the taxpayers in the donor nations and the target populations in AIDS ravaged communities that the programs of the Trust Fund will reflect the identified priorities of proposed project areas. In addition, a balanced organizational structure would obviate the need for conditionalities and the subsequent remote control of the Trust Fund operations.


VISION STATEMENT: To aggressively prevent new HIV infections and to provide comprehensive clinical treatment and social support for persons living with HIV or AIDS and other chosen health conditions. The Trust Fund will implement grant-funded programs.

A) To reduce the incidence of HIV infection and other chosen health conditions such as TB and malaria.
B) To provide ethically acceptable clinical treatment to persons living with HIV/AIDS and other chosen health conditions.
C) To provide social support to individuals and communities ravaged by HIV/AIDS and other chosen health conditions.
D) To provide and distribute effective HIV vaccine to high-risk populations as soon as practicable.


We propose a 34-member board of trustees, the highest decision making body of the Trust Fund. The Board of Trustees should provide strategic leadership to the Trust Fund. The Board will approve requests for grant-funded programs after careful reviews and deliberations. In addition, the Board will appoint the staff of the Global Fund secretariat, and supervise their activities. The Board of Trustees will comprise proven men and women in various disciplines with experience in public, private, and civil society governance issues. We propose that they serve for an initial period of 3 years, renewable for another 3 years. We recommend that the Board should meet every 3 months or more frequently depending on the circumstances. The composition of the Board should be as follows:
1) One member from each of the G-8 nations (8 members), hereinafter referred to as the North.
2) One member from each of the following developing regions, hereinafter referred to as the South (North Africa, Southern Africa, Western Africa, Eastern Africa, Central Africa, Asia, Latin America, and the Caribbean) (8 members).
3) Representatives of the Civil Society, 2 from the North and 2 from the South (4 members).
4) Representatives of persons living with HIV or AIDS, 2 from the North and 2 from the South (4 members).
5) Representatives of the Foundations/Philanthropies, 2 from the North and 2 from the South (4 members)
6) Representatives of the Private Sector, 2 from the North and 2 from the South (4 members). The representatives from the South should not be affiliated with Western conglomerates.
7) The United Nations system (2 seats to be determined by the UN Secretary General, and possibly rotated regularly to avoid turf battles between the various UN agencies).

The Chair of the Board of Trustees should come from the G-8 nations and the Vice Chair from the recipient nations. We recommend the following committees for the Board of Trustees: Finance Committee to be headed by a representative of the South; The Technical Committee to deal with the professional issues of HIV/AIDS and other chosen health conditions; The Logistics committee to work on infrastructure and the movement of goods and services; and the Training committee to focus on clinical training programs, volunteer training, and community mobilization issues.


This Board will provide intellectual leadership to the Trust Fund. It will serve as a forum for sounding out complex issues confronting the Trust Fund. We propose a 20-member Board with a non-renewable term of 3 years. We feel that the Trust Fund should not become an avenue for the creation of an elitist class of "world class experts." Opportunities should be given to other professionals to participate in the activities of the Trust Fund. The Board should include experts in medicine, public health and development. The Board should comprise 8 members from the G-8 nations, 8 members from the recipient nations, and 4 members appointed on special merit. We propose that the Chair of the Board should come from the South and the Vice Chair from the North.


In line with Kofi Annan's call, we support a "small" secretariat of dedicated and dynamic men and women that will implement the programs of the Trust Fund, and develop sustainable partnerships with other players in international development. We recommend a five-year term for the executive officers of the Trust Fund, with a rare renewable second term. We believe that the leadership of the Trust Fund should be 'fresh,' energetic and responsive to new ideas and opportunities.

The Executive Officers of the Trust Fund

1). Director-General/CEO of the Global Trust Fund. This individual should be an expert on both HIV/AIDS and development. We recommend a representative of the South for this position, preferably from Africa, the epicenter of the pandemic. The Director General's office will likely include a small core support staff such as a Chief of Staff, a special assistant, a board liaison officer, a public relations officer, and an executive assistant.

2) Deputy Director General/Chief Operating Officer, to manage the day-to-day activities of the Fund. We recommend a representative of the North for this position. The Deputy Director-General staff will likely include a senior operations officer, a senior protocol officer, a senior human resources officer, and an executive assistant.

3) Executive Director, Finance to manage the fiduciary functions of the secretariat. We recommend a representative of the North for this position. This officer will likely be complemented by a senior financial officer dealing with financial policies and regulations; a senior financial officer to deal with disbursements, grants management, conferences, travel expenses, and training expenditures; and a senior financial officer for special duties and exigencies.

4) Executive Director, Logistics. This could be a Military or NGO veteran with extensive experience in forward logistics, supply side management, and infrastructure development. This officer will probably require a senior logistics officer, a senior infrastructure officer, and an appraisal officer.

5) Executive Director, Technical Services to provide leadership on HIV/AIDS and other chosen health conditions. We recommend a representative from the South for this position. This position will likely require a senior clinical officer, a senior preventive officer, and a senior grant management officer.

6) Executive Director, Training to provide support for the training programs undertaken by the Fund. The support staff will likely include experts in information, education, and communication (IEC), volunteer training, community mobilization, and clinical training.

7) Inspector General, to provide internal and external audit and ethics oversight. We recommend a person from the South for this position to provide a balance to the Executive Director, Finance from the North. Support staff will likely include a senior audit officer (internal operations), senior audit officer (external operations), and a senior inspector, ethics.

Operations at Country Level

We do not recommend the creation of new structures in the recipient nations. The Trust Fund leadership should work with the UN Country teams, host governments, the civil society and the private sector to implement delivery channels that meet the needs of the target population.

The TB infrastructure, primary care networks, and community-based development programs of developing should be the initial delivery mechanism for the Trust Fund.

Technical Relationships

We recommend that the Trust Fund should establish working technical relationships with various specialized UN agencies, think tanks, the organized private sector, and non government organizations. In Africa, the UN Economic Commission for Africa and the new and improved African Union (we hope) are crucial technical partners in the quest to marshal an effective continental response against HIV/AIDS and other chosen health conditions.

The Emperor Must Wear Clothes

To avoid the proverbial specter of the emperor without clothes, we strongly urge that the leadership of the Trust Fund must run an open, transparent, ethical, and accessible program. In the fight against AIDS, we cannot afford an organization that is answerable to a select few, accessible to a privileged group of "experts," and responsive to the whims and caprices of faceless pressure groups. In view of the urgency of the task at hand, the Trust Fund must operate with a sole focus - providing relief to the millions of men, women, and children living with HIV/AIDS or chosen health conditions or at the risk of contracting new infections.

For Related Article(s) Click The Link Below:
Battling Africa's HIV/AIDS Pandemic

Editor's Note:
Chinua Akukwe, Board Member, the Constituency for Africa and Adjunct Professor, George Washington University School of Public Health, Washington, DC.

Melvin Foote, President/CEO of the Constituency for Africa (CFA), a Washington, DC advocacy organization. CFA is promoting an AIDS Marshall Plan for Africa.

For Additional Information

The Constituency for Africa (CFA)
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Washington, DC 20037
Phone: 202 371-0588
Fax: 202 371-9017
Email: MF2420@aolcom,

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